Exercise Stage of Change and Self-Efficacy in Primary Care: Implications for Intervention

Multiple chronic diseases are caused or complicated by a sedentary lifestyle. Thus, an important and challenging application of psychology in clinical settings is changing the behavior of sedentary primary care patients. This study focused on exercise stage of change and self-efficacy in a sample of adult family practice patients recruited while waiting for their scheduled physician appointment. Regarding exercise stage of change, 15% of respondents were in the Precontemplation stage, 26% in the Contemplation stage, 50% in the Preparation stage, 7% in the Action stage, and 13% in the Maintenance stage. Mean self-efficacy scores for exercise were significantly higher among respondents in the Action and Maintenance stages of change. These cross-sectional data are consistent with the hypothesis that movement through the exercise stages of change could be encouraged by clinical interventions that increase exercise self-efficacy. The identification of multiple personal opportunities for increasing exercise self-efficacy may be clinically useful in this context. Recommendations for psychologists in primary care settings in their work with physicians are offered.     

A Qualitative Investigation of Student and Supervisor Perceptions of Live Supervision in Genetic Counseling

Live supervision of genetic counseling students is critical for ensuring quality client care and student clinical skill development. However, no research has investigated students' and supervisors' experience of this primary supervision method. In this study, separate focus groups of students and supervisors discussed their perceptions of the nature and impact of live supervision. A modified Consensual Qualitative Research method (Hill et al. (1997) Couns Psychol 25:517–572) was used to analyze the data. Results suggest that live supervision is an essential and effective method that promotes student skill development and professional development for both students and supervisors. There is a lack of formal training regarding supervision; most learning is trial and error. Students worry about being evaluated, and supervisors wonder if they are providing supervision effectively. Both samples emphasized that client care should not be compromised. Participant recommendations for improving live supervision are described, and suggestions are made for future research.     

The Güttingen study of psychoanalytic therapy: First results

Results of a naturalistic study of the effectiveness of psychoanalytic therapy are reported. Outcome data are presented for a sample of N = 36 patients who were treated with psychoanalytic therapy. For a sample of n = 23 of these patients, data for 1-year follow-up are available at present. According to the results, psychoanalytic therapy yielded signifi cant improvements in symptoms (Symptom Checklist 90-R, SCL-90-R and rating of psychoanalysts), in interpersonal problems (Inventory of Interpersonal Problems, IIP), in quality of life (Questionnaire of Quality of Life, FLZ), in well-being (Questionnaire of Changes in Experience and Behaviour, VEV) and in target problems defi ned by the patients (Goal Attainment Scaling, GAS). Large effect sizes between 1.28 and 2.48 were found in symptoms (GSI of the SCL-90-R), interpersonal problems (IIP-total), quality of life (FLZ-total), well-being (VEV) and target problems (GAS). At 1-year follow-up, all improvements proved to be stable or even increased. The self-reported improvements in symptoms were corroborated by the ratings of the psychoanalysts. At the end of therapy, 77% of the patients showed clinically signifi cant improvements. In the 1-year follow-up group, this was true for 80%. Further results are presented and discussed.     

医学院校教学医院临床实践教学的现状与对策

国家赋予医学院校教学医院救死扶伤和教书育人的两个职能,它在现行医疗体制改革的情况下与病人的维权发生了激烈的碰撞,临床实践教学出现了滑坡现象.在分析了医学院校教学医院临床实践教学现状的基础上,作者试从制定相应法规,保障临床实践教学;践行行医准则,尊重病人权利等几个方面进行了阐述,以期保证医学院校教学医院临床实践教学的质量.     

关于证候定义的三点商榷

对证候定义研究中存在的问题进行剖析,提出三点商榷意见.首先,"证"是病理学概念,不是诊断学概念.其次,"证"发生在病人身上,并非由诊断"概括"出来.第三,应当把内在的病理改变与外在疾病征象区别开来.     

通过医患沟通引导病人就医行为:美国的做法

病人对病情的理解和对医疗信息的记忆能力是医生影响病人就医的基础。耐心的积极教育是病人自愿同意推荐诊疗计划的必须。在协商时尊重病人和知晓病人的期盼对医生如何影响病人的就医行为是很有帮助的。     

Validation of psychoanalytic theories: Towards a conceptualization of references

The authors discuss criteria for the validation of psychoanalytic theories and develop a heuristic and normative model of the references needed for this. Their core question in this paper is: can psychoanalytic theories be validated exclusively from within psychoanalytic theory (internal validation), or are references to sources of knowledge other than psychoanalysis also necessary (external validation)? They discuss aspects of the classic truth criteria correspondence and coherence, both from the point of view of contemporary psychoanalysis and of contemporary philosophy of science. The authors present arguments for both external and internal validation. Internal validation has to deal with the problems of subjectivity of observations and circularity of reasoning, external validation with the problem of relevance. They recommend a critical attitude towards psychoanalytic theories, which, by carefully scrutinizing weak points and invalidating observations in the theories, reduces the risk of wishful thinking. The authors conclude by sketching a heuristic model of validation. This model combines correspondence and coherence with internal and external validation into a four‐leaf model for references for the process of validating psychoanalytic theories.     

临床决策与卫生政策

从讨论趋利性临床决策与泛企业化卫生政策的共同作用是造成我国医改失败的根本原因入手,在对3个典型案例进行深入剖析的基础上,论证了临床决策和卫生政策相互依存、相互作用的基本关系;研究了临床决策与卫生政策的决策主体、影响因素、决策过程、信息反馈、关系调整的循环路径;认为完善决策机制是保证临床决策和卫生政策正确有效的必要条件,提出了进一步完善临床决策和卫生政策的决策机制的具体意见和建议。     

自我提升的利与弊：理论、实证及应用

自我提升的适应价值问题目前备受心理学家关注。进化与认知神经科学研究者认为自我提升在演化史中具有潜在的适应价值, 它具有生物遗传性; 而社会心理学家发现, 自我提升在现实中的表现是利弊参半的, 主要存在三种理论解释：调节因素论、生态比拟论、多维多功能模型; 临床咨询心理学家在实践中提出的发展适应性自我提升的建议, 有助于趋利避害地将自我提升加以应用。未来的研究将聚焦于测量的改进、文化、发展及内隐研究等领域。     

Value of interviews for admission to clinical training programs: Perspective of program directors

Abstract: The interview has a long history of being used to select individuals for positions in industry, professional occupations, and for a variety of specialised educational programs. Despite its widespread popularity, the selection interview is often criticised for its potential bias and unreliability, which in turn has led to its decreasing use in some settings. The purpose of the present study was to explore the views of the directors of 21 Australian clinical training programs as to the value of interviews as part of the admission process for their clinical psychology postgraduate training candidates. Three programs reported not conducting interviews at all, expressing reservations concerning their validity. Most other directors saw interviews as having at least some value, with the opportunity to evaluate interpersonal skills being one of the most commonly mentioned advantages. A variety of methods was used for the final admission decisions, with substantial variation in acceptance rates by candidates who survived the interview process. Implications for selection processes in the future are discussed.