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121.
患者门诊话语中确认性问句的信息索取功能   总被引:2,自引:0,他引:2  
确认性问句是门诊患者使用最多的向医生索取核心医学信息的间接方法。经考察这种兼有信息索取功能的确认性问句的功能、语言形式、内容、医生的答句各方面的特征,得出结论:这种确认性问句是病人综合考虑其目的和利益及其在医患角色关系中所处的地位、医生心理、语用原则、当前医惠关系现状各因素后所选择的语言策略,医生应该认真对待。  相似文献   
122.
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.  相似文献   
123.
    
Aims: The therapeutic alliance is a concept that has received a great deal of attention within face‐to‐face counselling. Furthermore, links have been made between the creation of strong alliances and successful therapeutic outcomes. This study examines the therapeutic alliance when counselling services are offered online to young people. Method: Fifteen young people took part in online interviews (utilising synchronous and asynchronous methods), and Grounded Theory techniques were utilised to analyse the data. Findings: A core category of ‘Client‐Service Match’ and three subcategories pertinent to the individuals’ experiences of creating good quality relationships with the counsellors were identified: (1) initial engagement, (2) developing rapport, and (3) establishing control. Discussion: The themes elicited are all relevant to the matching process and viewed as a chronological process similar to face‐to‐face counselling. However, unlike face‐to‐face work, specific nuances related to the online work arise that counsellors should be mindful of, including the rationale behind each individual's choice to approach services online, their own computer‐mediated communication skills, technical hurdles, and the perceived ‘power’ of the counsellor.  相似文献   
124.
    
This one-year study explored the impact of an occupational therapy consultation model on housing status and goal attainment among 57 people with severe mental illness who were homeless or at risk of homelessness. A repeated-measure experimental design was used. Although results were mixed, the significant improvement in housing stability and goal attainment six months into the study supports the value of continued research on the effects of both direct and consultative occupational therapy intervention on client goal attainment.  相似文献   
125.
    
Adolescents in serious emotional difficulty are often unwilling to accept help from formal and statutory services. However, they remain a great worry to their parents, families and society as a whole. In this paper, I present the development of a model where the parents of adolescents are seen without the adolescent being referred. The adolescents themselves are occasionally present to help in the thinking about what they need from their parents and what they find unhelpful. They are not there to be engaged in therapy. Parents are encouraged to restore their authority and develop their role as parents appropriate to the new demands and needs of adolescents, who are held in mind by the therapist and are engaged indirectly through the work with their parents.  相似文献   
126.
    
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.  相似文献   
127.
    
This paper will illustrate the utilization of systemic family therapy services inside a hospital in a war-affected region of the Central African Republic. Through an international non-governmental organization (NGO), the author, a family therapist, provided counselling supervision and services to hospital staff and patients in an area of open conflict in the northern region of the country. In circumstances of chronic insecurity fuelled by both government and rebel forces, families displaced in this region are vulnerable to numerous health conditions and social problems. Family therapy techniques and ideas were used to work with individuals, couples and families presenting with health and social problems resulting from HIV-TB, infections, chronic malnutrition, acute poisoning and beliefs about sorcery. Case examples illustrate the systems consultation model used with the mental health team in order to expand and promote the sustainability of patient mental healthcare in this underserved region.  相似文献   
128.
    
This article examines the conceptual and practice relationship between medical family therapy (MedFT) and its parent field, family therapy, with MedFT viewed as the extension of relational sense‐making and understanding into a specific venue; that of medicine. The extension of this relational meaning system into medicine is typified by the ability of the therapist to negotiate and connect three main areas of conceptual difference that often account for conflictual relationships between mental and biomedical healthcare providers: (i) patient and provider conceptualizations of issues and goals, (ii) linear and circular understanding of issues and goals and (iii) consultative and expert positions on issues and goals. Two case examples are offered to describe how these three areas of tension are reconciled in practice.  相似文献   
129.
    
Just as there are many roads to Rome, the trial period may be considered one of many opening moves in psychotherapy or psychoanalysis. The responsive – and responsible – therapist must be many things to many patients, some of whom know nothing about the psychotherapeutic/analytic process. Freud advocated the trial period to help him take a “sounding” when he knew little about the patient and when the patient knew little about psychoanalysis. R.I.P.? This brief communication laments the apparent demise of this promising procedure and makes an effort at resurrection by describing the hitherto unmapped latent structure of the trial period. Even if there are fewer patients in psychoanalysis today, there may be a number of reasons to recommend a trial period, no matter what we name this period of optimistic uncertainty at the beginning of every treatment. Even if “consultation” is the term de jour, the psychoanalytic psychotherapist cannot escape certain role responsibilities at the beginning of every treatment, which has been made clear in the ethical principles of the American Psychoanalytic Association. What we will learn about the trial period should serve our understanding of what must also occur in the beginning of every psychotherapy or psychoanalysis. Conceptually, I propose that a trial analysis (1) will serve as a discriminative stimulus, signaling, to the patient, the unique nature of the analytic conversation; (2) will permit an in vivo assessment of the patient's suitability for psychoanalysis, and, more importantly, the fit between analyst and patient; (3) will provide anticipatory socialization for the unfamiliar and difficult roles of patient and therapist within the analytic process; (4) will offer true informed consent about the task facing therapist and patient; and (5) will facilitate an opportunity for therapeutic assessment, all of which will help the naive patient acquire the skills and lived experience to become an analytic patient. The trial period is the perfect host for all that must happen – and what we can do– to help naive patients become analytic patients.  相似文献   
130.

基于话语分析理论,通过分析“春雨医生”网站上的会话语料,区分了在线医患交际中患者情绪表达和医生回应的不同类型。研究发现,患者倾向于先直接表达消极情绪,后间接表达;而医生则优先专注于完成医疗任务,情感回应滞后。同时,患者在获取医疗信息时存在认知偏差,造成情绪波动,导致医生无法直接予以情感响应,需先纠正患者误解。此外,医患情感互动的主题多元化,不仅包括与疾病相关的负面情绪,还涉及回复滞后致歉、经济和医疗资源等现实问题。随着在线医疗咨询的发展,医患情感交互的重要性愈加突出,对医患双方均有重要意义。

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