医疗社会工作：现实意义和发展趋向

医疗社会工作是社会工作专业的重要实务领域之一,在西方发达国家的医疗事业中扮演着不可替代的角色,具有解决患者及其家属问题、处理医患关系,并促进公共卫生政策的改善等多种功能。从我国目前的发展来看,尚处于起步阶段,还有诸多需要努力的方面,包括完善相关政策、提高服务质量、修正教育模式、突出中国特色等。     

日本新的社区保健医疗教育对我们的启示

从2004年开始,日本一改36年来的医师法,对大学本科毕业并获得医师资格的青年医生实行2年的临床必修制度,其中重要内容之一是:加强初级卫生保健的继续教育。在我国已开展十年的临床医生早期规范化培训以来,对初级卫生保健方面的培训尚处于薄弱状态。有必要借鉴日本的新作法,结合中国的实际情况,切实有效地开展此方面的培训工作。     

包医合同法律效力分析

虽然医疗行为存在多种风险与不确定性,但也不是所有的医疗行为都是不确定的。生活中经常有医方向患者承诺保证治疗效果的情形,从法律的角度来说,这时在医方与患者之间就形成了包医合同关系。论述了包医合同的性质及其法律效力。     

Mentalization, insightfulness, and therapeutic action The importance of mental organization

Continuing debates over the relative importance of the role of interpretation leading to insight versus the relationship with the analyst as contributing to structural change are based on traditional defi nitions of insight as gaining knowledge of unconscious content. This defi nition inevitably privileges verbal interpretation as self‐knowledge becomes equated with understanding the contents of the mind. It is suggested that a way out of this debate is to redefi ne insight as a process, one that is called insightfulness. This term builds on concepts such as mentalization, or theory of mind, and suggests that patients present with diffi culties being able to fully mentalize. Awareness of repudiated content will usually accompany the attainment of insightfulness. But the point of insightfulness is to regain access to inhibited or repudiated mentalization, not to specifi c content, per se. Emphasizing the process of insightfulness integrates the importance of the relationship with the analyst with the facilitation of insightfulness. A variety of interventions help patients gain the capacity to refl ect upon and become aware of the intricate workings of their minds, of which verbal interpretation is only one. For example, often it seems less important to focus on a particular confl ict than to show interest in our patients’ minds. Furthermore, analysands develop insightfulness by becoming interested in and observing our minds in action. Because the mind originates in bodily experience, mental functioning will always fl uctuate between action modes of experiencing and expressing and verbal, symbolic modes. The analyst's role becomes making the patient aware of regressions to action modes, understanding the reasons for doing so, and subordinating this tendency to the verbal, symbolic mode. All mental functions work better and facilitate greater self‐regulation when they work in abstract, symbolic ways. Psychopathology can be understood as failing to develop or losing the symbolic level of organization, either in circumscribed areas or more ubiquitously. And mutative action occurs through helping our patients attain or regain the symbolic level in regard to all mental functions. Such work is best accomplished in the transference. The concept of transference of defense is expanded to all mental structure, so that transference is seen as the interpersonalization of mental structure. That is, patients transfer their mental structure, including their various levels of mentalizing, into the analytic interaction. The analyst observes all levels of the patient's mental functioning and intervenes to raise them to a symbolic one. At times, this will require action interpretations, allowing oneself to be pulled into an enactment with the patient that is then reprocessed at a verbal, symbolic level. Such actions are not corrective emotional experiences but are interpretations and confrontations of the patient's transferred mental organization at a level affectively and cognitively consistent with the level of communication. Nonetheless, the goal becomes raising the communication to a symbolic level as being able to refl ect symbolically on all aspects of one's mind with a minimum of restriction is the greatest guarantee of mental health.     

The profession of ferryman: Considerations on the analyst's internal attitude in consultation and in referral1

Psychoanalytic consultation is an interview with a patient who will not be taken in treatment by the consultant analyst, but who will be sent to another, perhaps specifi cally chosen, colleague after one or more assessment sessions. This practice is becoming increasingly important since, besides traditional private relationships between consultant and patient, it is now common in many specialized centres affi liated to offi cial psychoanalytical institutions. The author explores some fundamental aspects of the analyst's internal attitude in consultation: motivation to know; a ‘concave’ attitude to listening; responsibility in proposing suitable technical choices and referral to a further specialist; empathy and partial identifi cation; the balance between authentic experience in the consultation and risks of seduction; internal links within the community of colleagues; the technique for sending patients on. He presents a clinical example, specifi cally aimed at reproducing the internal attitude of the analyst, together with the necessary work that allows a diffi cult patient to initiate psychoanalytic treatment.     

Beyond transference,countertransference, the silences and the opinion1

The author examines several works of an intersubjectivist trend, as well as writings by Hanly, Cavell and Bion, defending many of the named psychoanalysts' viewpoints. These viewpoints are expressed in the search and the struggle for truth, recognizing, like Popper, that truth exists but that we cannot know with certainty whether and when we touch upon it, only that this endless effort merits a lifetime's work because it is the attempt at an encounter with ourselves‐the true encounter. The author explains the criticisms by Green of Jacobs, and defends the maintenance of ‘a certain possible neutrality’ (Eizirik). He poses some questions with regard to Ogden's ‘third subject’, considering it, among other aspects, from the supervisory point of view, which may demonstrate the existence of ‘a certain possible objectivity’ of the emotional confl ict. He develops some criticisms concerning silence as an interpretative action by Ogden, and summarizes two case histories. Both were unconsciously attempting to manipulate the analyst intensely‐one of them to get the analyst to intervene in his love life, and the other to interrupt acting out.     

‘Mutual Obligation’ and ‘New Deal’: Illegitimate and Unjustified?

It is now commonplace for governments in Western countries to require the unemployed to work in exchange for their unemployment benefits. In this article I raise some serious doubts about the most promising and philosophically interesting defence of this argument, which relies on the ‘principle of reciprocity’. I argue that it is seriously unclear whether the obligations imposed on welfare claimants by ‘workfare’ schemes are legitimate and justified according to the principle of reciprocity. I do this by reconstructing the arguments for the obligations of the unemployed put forward in both the United Kingdom and Australia.     

国有企业与民营企业员工工作价值观的比较研究

采用修订后的工作价值观调查表对我国大陆6省市的257名国有企业员工和219名民营企业员工进行了调查。结果表明,国有企业员工的工作价值观在舒适与安全维度上显著高于民营企业员工;在能力与成长维度上显著低于民营企业员工;在地位与独立维度上二者差异不显著。     

New job market entrants' future work self,career adaptability and job search outcomes: Examining mediating and moderating models

Based on career construction theory and the model of proactive motivation, the current research examined the mediating and moderating models for the relations among future work self, career adaptability, job search self-efficacy and employment status. A survey study was conducted among Chinese university graduates (N = 270). The results showed that future work self (measured at wave 1) had positive effect on employment status (measured at wave 3), with this relationship partially mediated by career adaptability (measured at wave 1) and job search self-efficacy (measured at wave 2). In addition, the results further revealed that the positive effect of future work self on job search self-efficacy was stronger among the graduates who had a higher level of career adaptability. In support of the hypothesized moderated mediation model, for individuals with a higher level of career adaptability, the indirect effect of future work self on employment status through job search self-efficacy was stronger. These findings carry implications for research on job search behavior, career education and career counseling.