Shifting from Treatment Plans to Action Plans: Solidifying the Therapeutic Alliance

This article summarizes the evolution of my theoretical orientation and treatment intervention style over the past thirty-something years. It discusses the pathways taken, influences felt, and experiences that have contributed to my expanding mindset and current therapeutic modus operandi, progressing from past to present. As to what will be in the future, that is difficult to predict as the metamorphosis keeps happening, although some components remain essential ingredients and provide grounding and balance. Que será, será sums up the future succinctly.     

Teacher acquisition of functional analysis methodology

The current study examined methods for training teachers to use functional analysis methods. Teachers first received written and verbal instructions detailing attention and demand conditions. They then received training that included modeling, rehearsal, and performance feedback. Finally, probes were taken during ongoing class instruction. Results indicate that teachers acquired the skills and used them in classroom settings.     

What Kind of Doing is Clinical Ethics?

This paper discusses the importance of Richard M. Zaner’s work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics – applied ethics, casuistry, principlism, and conflict resolution – cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is bound up with the normative commitments of medicine as a therapeutic enterprise.     

A Study of Pastoral Care,Referral, and Consultation Practices Among Clergy in Four Settings in the New York City Area

Clergy (N = 179) in the catchment areas of four hospitals in New York and Connecticut were surveyed about their pastoral care activities. Factor analysis revealed two separate sets of problems presented in pastoral counseling, with respect to clergys ratings of their competence to address them. The first factor included grief, death and dying, anxiety, and marital problems, in descending order of frequency. The second factor consisted of depression, alcohol/drugs, domestic violence, severe mental illness, HIV/AIDS, and suicide. Clergy were significantly less confident of their ability to deal with Factor 2 problems, yet clergy rarely consulted with mental-health professionals about either type of problem. Less than half of the clergy had training in Clinical Pastoral Education, but those who did tended to feel they were more competent to deal with both types of problems. On average, clergy devoted 3.7 hours per week to visiting patients and nearly 55% said they were definitely more likely to refer a patient to a hospital with a pastoral care department.     

COMPETENCE IN ASPECTS OF BEHAVIORAL TREATMENT AND CONSULTATION: IMPLICATIONS FOR SERVICE DELIVERY AND GRADUATE TRAINING

This study examined the extent to which competence in applying behavioral procedures (timeout from positive reinforcement) was sufficient to establish competence in teaching others to apply the same procedures. During baseline, graduate students attempted to instruct parents with a history of child abuse and neglect in the use of time-out. Students were then instructed in the use of time-out until they achieved proficiency in a role-play context. They then reattempted to instruct the parents. Finally, the students were instructed in certain consultation skills (i.e., teaching others to apply behavioral procedures) and again attempted to instruct parents in the application of time-out. Observations of students' consultation skills, parents' proficiency at administering time-out, and children's compliance to parental instructions revealed that explicit training in behavioral consulting skills was necessary to produce improvements in these behaviors. Students' proficiency at administering time-out was insufficient to enable them to instruct others in its application. These results were corroborated by surveys of both students and staff. The implications for graduate training and service delivery are discussed.     

When is enough enough? We are only beginning

Sheridan (1995) presents the problem of the psychologist consulting to a medical residency program as an example of the difficulty one experiences in attempting to challenge, even from a data-based perspective, the calcification inherent in health systems and medical education in particular. This paper responds to her challenging questions, “How much should we get involved in changing health care and medical education, and at what level (local, national) should psychology intervene (if at all)?” It is suggested that psychologists pick up the challenge to bring about change, whenever possible, with the admonition—we are only beginning.     

ONGOING CONSULTATION AS A METHOD OF IMPROVING PERFORMANCE OF STAFF MEMBERS IN A GROUP HOME

A model of ongoing consultation was implemented in a community group home for 8 adults with severe and profound mental retardation. Two consultants, highly experienced in working with people with mental retardation and in the procedures used in group homes, taught staff members to use a token reinforcement system, to engage the adults in a variety of activities, and to improve the content and style of the staff members' interactions with the adults. The consultants taught skills to 9 staff members through brief mini-workshops, direct observation of the staff members' use of the skills during regular activities in the group home, and individual verbal feedback regarding a staff member's performance of the skills. Evaluation of the ongoing consultation process by the 2 consultants showed it to be effective in improving the performance of the staff members and in changing the behaviors of the adults who lived in the home. Continued implementation of the process, however, appeared to be necessary for the behavior changes of staff members to be maintained at high levels.     

Why philosophers should offer ethics consultations

Considerable debate has occurred about the proper role of philosophers when offering ethics consultations. Some argue that only physicians or clinical experienced personnel should offer ethics consultations in the clinical setting. Others argue still further that philosophers are ill-equipped to offer such advice, since to do so rests on no social warrant, and violates the abstract and neutral nature of the discipline itself.I argue that philosophers not only can offer such consultations but ought to. To be a bystander when one's discipline does offer insights and methods of value discernment is pusillanimous. But this position requires a view of clinical medical ethics as one that arises out of the clinical practice of medicine, and not just from an application of general ethical principles to the practice of medicine. I conclude with some skills that trained philosophers can bring to the consultation service, and note that all consultations are in the form of recommendations that the patient, family, and physician are still free to accept or reject. Philosophers in the clinical setting do not make decisions.     

一个大学生的心理困惑——心理咨询案例

青少年心理健康教育是素质教育的重要组成部分,心理问题是阻碍青少年健康成长的重要因素之一。本文从帮助一个大学生摆脱心理痛苦的案例出发,介绍了心理咨询的一些方法、过程和技巧。特别强调了心理咨询要透过现象看本质,既要分析来访者所遭遇的负性事件,又要把握来访者的个性特征、成长经历以及父母教养方式等诸多因素。在治疗方面,既强调发挥来访者自我潜力的重要性,又要重视来访者家庭支持的辅助作用。