Creativity and dialectical phenomena From dialectical edge to dialectical space1

The seeds of creativity have the potential to germinate and flourish within the rich, ambiguous and unsettling tapestry of the core dialectical tensions related to the central organizing dialectic, life and death, generated in the patient‐analyst relating. The author introduces the concept of the ‘dialectical edge’ and describes it as the pivotal point in the dialectical struggle within these core dialectical dilemmas. This is a fluid, emotionally evocative threshold, where there is maximum potential for change, as well as for homeostatic stagnation. Drawing on Winnicott, the author illustrates how the presence of an edge within these dialectical dilemmas has the potential to open up into a creative, reflective space. He suggests that this, however, will depend on the therapist's capacity to contain/hold at this edge the arousing and intense affects‐such as anxiety, dread, excitement and passion‐that are inevitably generated at these pivotal relational moments. This will determine whether the patient will move forwards into the light of a creative, reflective, dialectical space, or backwards into collapsed, non‐reflective darkness, where fluid oscillation is transformed into rigid ossification. The author uses a clinical example to illustrate these dialectical phenomena, with a special focus on two clinically relevant dialectics, i.e. ‘ritual versus spontaneity’ and ‘closeness versus separateness’.     

个体化角膜屈光手术的探讨

对个体化角膜屈光手术这一屈光矫正领域的新理念和新方法进行探讨,提出医务工作者要勇于思想创新;以辩证思维看问题;关注社会需求,正确处理以人为本与追求经济利益的关系;加强多学科交叉合作和复合型人才的培养,才能推动个体化角膜屈光手术不断向更高层次迈进.     

内部动机与外部动机的关系

内部动机与外部动机的关系问题在20世纪90年代重新成为动机研究的热点。该文综述了内部动机与外部动机关系的实验研究与理论研究状况。认为实验研究经历了外部动机削弱内部动机、外部动机与内部动机共存、外部动机能够对内部动机产生促进作用三个阶段,研究者的心理学立场是造成分歧结果出现的重要原因;不同的理论模式各有所长,尤其是自我决定理论的新进展“有机辨证元理论”中关于需要的阐述是近期动机研究的亮点,在更高层次上实现了对内部动机与外部动机关系的整合。并提出探讨内部动机与外部动机具体成分之间的关系,检验特质状态与情境状态中二者的相互作用,及心理需要对情境与动机的中介机制应当成为未来研究的方向     

A developmental perspective on psychotherapy process, psychotherapists' expertise, and “Meaning-Making Conflict” within therapeutic relationships: A two-part series

Part I (in this issue)—A Dialectical-Constructivist View of Human Development, Psychotherapy, and the Dynamics of Meaning-Making Conflict Within Therapeutic Relationships— reviews a dialectical-constructivist model of human development and articulates, in the language of that model, how psychotherapy, in general, works. It describes and illustrates three generic processes, which contribute to the frequent successes of an extremely diverse range of psychotherapy theories and practices. This view of psychotherapy focuses on both the client's meaning-making processes and the therapist's meaning-making processes and how they contribute together to effective psychotherapy. Part I also offers a way of understanding what is going on when therapeutic progress is blocked by conflict between the client's and the therapist's meaning-making processes. Part II—Dialectical Thinking and Psychotherapeutic Expertise: Implications for Training Psychotherapists and Protecting Clients from Theoretical Abuse—explores those experiences in which the therapist's own exercise of his or her meaning-making structures, and maintenance of the integrity of his or her theories, has a limiting or destructive impact on the value of therapy to the client. It considers the concept of “theoretical abuse” by psychotherapists as a way of characterizing the most destructive of these experiences. This serves as a rhetorical device for introducing comparisons between these phenomena and the phenomena of sexual abuse by psychotherapists, in terms of dynamics, prevalence, and appropriate strategies for prevention. Part II uses work on the development of dialectical thinking in adulthood to conceptualize how different understandings of the nature of psychotherapists' expertise increase or decrease the likelihood and severity of “theoretical abuse”. Finally, it derives implications for training psychologists and other psychotherapy professionals.     

Speaking truth to power: Empowerment ideology as social intervention and policy

The popularity, and subsequent ambiguity, in the use of the term “empowerment” has created an even greater need for reassessment in the applied context than in the theory and research literatures. This paper outlines some of the areas of community, organizational, and societal level social intervention and policy ostensibly based on the concept of empowerment. These include neighborhood voluntary associations (for environmental protection, community crime prevention, etc.), self-help groups, competence-building primary prevention, organizational management, health care and educational reforms, and national and international community service and community development policies. Issues in applying social research to community organizations and to legislative and administrative policy making are reviewed. Ten recommendations are offered, including the value of a dialectical analysis, for helping researchers and policy makers/administrators make more effective use of empowerment theory and research. Humpty Dumpty: “When I use a word, it means just what I choose it to mean neither more nor less.” King of Hearts: “If there's no meaning in it, that saves a world of trouble, you know, as we needn't try to find any.”—Lewis Carroll Portions of this paper were first presented in the program “Empowerment Theory, Research and policy” at the Biennial Conference on Community Research and Action, Williamsburg, Virginia, June 18, 1993. The author thanks Barbara B. Brown, Jo Ann Lippe, Ken Maton and his students, David V. Perkins, Marc A. Zimmerman, and the anonymous reviewers for their very helpful comments on earlier drafts.     

住院医师规范化培训中辩证思维能力的培养

精湛的临床思维能力和良好的辩证思维能力是住院医师岗位胜任能力的根本要求。如何切实提升住院医师的辩证思维意识和思维习惯是现阶段住院医师规范化培训中一个亟待解决的现实难题。阐述了培养住院医师辩证思维能力的必要性和重要性,重点分析了住院医师规范化培训中应着力掌握的几种思维素养和能力。在规范化培训阶段,应以提升住院医师的辩证思维素养、强化辩证思维意识和思维习惯的养成教育、注重临床诊治实践能力的培养等为着力点培养住院医师辩证思维能力。     

Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical Illness (DBT-CMI)

Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence.DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.