Taking control of violence against doctors

Violence against healthcare professionals is a serious but understudied global problem and one that lacks evidence-based solutions. The current research offers a novel explanation and intervention for addressing this issue: We propose that low feelings of control among patients and their family members play an important role in shaping doctor-patient relationships. To regain a sense of control, we suggest that patients attribute responsibility to doctors for their suffering, which may in turn lead to aggressive behavioural intentions against one's doctors. We conducted three studies to understand whether individuals with low perceived control blame doctors more, and whether threats to their sense of control cause participants to attribute more responsibility to doctors. Study 1 found that feelings of lack of control were an important predictor of attributing responsibility for negative illness-related incidents to doctors in a manner consistent with blame. Study 2 specified that the chaotic and unpredictable nature of illness, and not just its negative valence, is what drives attributions of increased responsibility to doctors. Study 3, which utilized a field setting in hospitals, found that an experimental intervention to increase feelings of control decreased frustration against (Study 3a/3b) and intention to harm doctors (Study 3b). These findings suggest that increasing feelings of control among patients can improve patient-doctor relationships. We also discuss the role of control and scapegoating during the COVID-19 pandemic.     

Therapists facing masks: A qualitative study of the nature of relationships between masks and relational depth

Background

Central to this research was exploring characteristics facilitating and disinhibiting meetings at relational depth to explore underlying driving factors of change. The overall aim was to explore relationships between masks and relational depth. Viewing masks as a characteristic sought to understand further the socio-cultural impacts of masks on client/patient care and decision-making to meet at depth. This research demonstrates immediate social and international context due to COVID-19.

Methods

A phenomenological methodology was utilised. The primary research vehicle was an examination of primary data from semi-structured interviews. Four therapists who had used masks within sessions (where both therapist and clients wore masks) provided data on meetings at relational depth.

Findings

Interpretative phenomenological analysis revealed four themes: ‘epicentre of aetiology’, ‘loss’, ‘masked-disinhibition’ and ‘disconnection paradox: depth through disconnection’. Findings suggest masks are a characteristic that can facilitate and inhibit meetings at depth—acknowledging common factors, including how therapists related to masks as an extended part of the client, and mutuality within disconnection to masks, not one another, was significant.

Conclusions

Findings suggest the exigent presence of masks could facilitate or inhibit meetings at depth, regulated by what masks represented to therapists/clients at moments of contact. Yet, when both therapist and client appeared mutually disconnected (to masks, not each other), they found moments of relational depth within the disconnection. Masks are suggested as a characteristic that can influence meetings at depth. Opportunities for depth seemed reliant on individual capabilities to offer depth, emphasising therapists' experiential awareness of their interoceptive process.     

Patient-targeted googling by psychological therapists: A narrative review of the literature and ethical implications

Background

“Patient-Targeted Googling” (PTG) refers to a healthcare professional using the Internet to discover information about a patient. The present review explores PTG by psychological therapists. The review focused on the prevalence of PTG, how often consent is sought from the patient, and the motivations for and consequences of PTG.

Method

A narrative literature review of published PTG studies was undertaken. Potentially eligible studies were identified by searching PsycINFO, PsycARTICLES, Psychology and Behavioural Sciences Collection, and MEDLINE. Results were screened for suitability for inclusion in the sample (n = 9). All studies were appraised for quality using a structured tool developed for this review.

Results

PTG prevalence rates ranged from 20% to 98%, with rates of non-consent ranging from 60% to 84%. Motivations for PTG included curiosity, to gather new information and to verify existing information. Consequences of PTG included enhancing the therapist's sense of safety and causing harm to the therapeutic relationship.

Discussion

Current literature on PTG is limited and focussed largely in the United States. This review revealed no published PTG studies including UK-based psychological therapists, as well as issues in defining and operationalising PTG. Further research is needed to understand the prevalence of PTG by UK-based psychological therapists, as well as the motivations behind, and consequences of, PTG. This evidence base will inform the development of PTG professional guidelines and training, neither of which currently exist for therapists practising in the UK. Both would be timely given the increasing move of the therapeutic frame to the online environment due to the COVID-19 pandemic.     

The impact of dialectical behaviour therapy training on therapists in Singapore: A mixed-methods study

Background

While dialectical behaviour therapy (DBT) has much empirical support for treating borderline personality disorder (BPD) and other conditions, little research has examined the dissemination of DBT in Southeast Asia.

Aims

This study evaluated training outcomes following a 5-day intensive DBT training programme in a group of psychologists in Singapore, who were in the process of implementing DBT as part of the training's objectives.

Methodology

A mixed-methods design was employed. Fourteen psychologists from a public psychiatric hospital in Singapore were recruited. Seven self-selected into DBT training, and the remaining were matched controls who were not attending the training programme. The latter served as a nonrandomised control group. Prior to and 3 months after training, all participants completed measures of stigma towards BPD patients, burnout and therapeutic alliance. DBT training participants additionally attended a focus group discussion assessing their experiences and challenges implementing DBT in Singapore's context.

Findings

Quantitative analyses using mixed ANOVA showed that, compared with controls, DBT-trained participants demonstrated significantly greater increases in acceptance towards BPD patients. No between-group differences were found on changes in burnout or therapy alliance with patients. Analyses of qualitative data using thematic analysis revealed that DBT training impacted the way participants conceptualised and delivered therapy for BPD patients, and highlighted several challenges in implementing DBT in the local hospital context.

Conclusion

The findings demonstrate the potential of DBT training in improving clinicians' attitudes towards BPD patients and support a need for policymakers to prepare organisations for DBT implementation to ensure programme sustainability.     

Facilitating the client's experience of relational depth in counselling and psychotherapy: A thematic review

Aim

There is increasing interest in relational depth and its relevance and benefits for clients receiving therapy in a number of different therapeutic orientations. This research set out to draw together the available evidence from a wide range of therapies about clients' experiences of relational depth. The aim was to identify approaches that create the conditions where relational depth is more likely to be facilitated. The research focused on clients' views, given the increasing emphasis on their experiences in therapy.

Methodology

A systematic search of papers published in English between January 1996 and September 2022 was conducted using EBSCO Host, Google Scholar and citation chaining. Twenty-seven papers met the inclusion criteria, and a thematic analysis was conducted on these papers.

Findings

Six themes were identified: (1) establishing dialogue with the client's inner world, (2) working with attachment in therapy, (3) responding sensitively to the client's beliefs and values, (4) deepening the client's understanding of the therapist, (5) addressing ruptures in therapy and (6) the client's role in meeting at relational depth.

Conclusion

Facilitating the client's experience of relational depth can support and enhance many aspects of therapeutic practice and in itself may contribute to healing. Therapists who offer warmth and genuine engagement are more able to build confidence and trust, as long as these conditions are received by their clients. It is the clients who ultimately decide whether or not to share their deepest feelings.     

组织情境下的不道德行为现象:来自道德推脱理论的解释

为什么企业中的不道德行为会屡屡发生?这是一直以来困扰组织管理实践者和学者们的难题,不道德行为的发生与发展机制已经成为心理学研究的一个重要领域。其中,心理学视角下的道德推脱理论为这一难题提供了解释思路。在企业的现实情况中,可以从员工个体和组织领导两方面维度研究各自对应的组织情境因素通过道德推脱机制对不道德行为产生的影响。未来研究的关键在于探讨和实证检验组织情境下道德推脱机制的选择偏好对不道德行为的影响作用,不断丰富和加强道德推脱对员工个体以及领导不道德行为影响机理的研究。     

谁是最大的受害群体:群际受害者竞争

长期冲突的群体双方都致力于建构自己的最大受害者角色,他们认为自己比对方遭受了更多、更不公平、更不合理的伤害,这种现象称之为群际受害者竞争。群体通过强调冲突给自身造成的伤害后果的严重性与不公平性、伤害的处理方式等,努力声称内群体比对方遭受了更多的伤害。集体受害感、冲突责任归因、记忆的选择性、消除威胁的内在需要以及其他心理特点是群际受害者竞争的心理基础。通过构建"共同的受害者-侵犯者"认同以及增加群际接触等可以降低群际受害者竞争的水平,促进群际关系的和谐。今后的研究需要进一步完善群际受害者竞争的机制,深入探讨群际受害者竞争的其他影响因素,争取在干预策略上有所突破,关注非暴力冲突的群体情境中群际受害者竞争的特点,了解第三方群体对谁是最大受害者群体的认知和评价机制。     

The day the earth stood still: The presence of trauma in time experience

The experience of time is commonly perceived as developing within the context of the early relationship between mother and infant. The beginning of life occurs in an adapted environment, aimed to protect the child from internal and external disruptions. Through healthy development, the mind acquires a feeling of continuity that gradually becomes a cohesive sense of personal identity. However, in cases of traumatic interruptions to the primary environment, the defensive shield of the self is penetrated and the individual becomes prematurely aware and adapted to the external reality. This forced acknowledgement of time and reality could be manifested in various types of time disturbances, such as disorientation about time or difficulties in following a schedule. In therapeutic relationships, this drama would be enacted in a struggle against the psychoanalytic setting, which disrupts the continuity of being with the therapist. Importantly, these patients express a deep conscious or unconscious fantasy to live in a timeless world, in which they would not be forced to adapt themselves to others’ expectations or needs. Clinical examples are used to illustrate how traumatic history is evident in the patient’s time experience and in the psychoanalytic dialogue.     

Enhancing social relationships through positive psychology activities: a randomised controlled trial

Despite the robust relationship between well-being and social relationships, the latter has received little examination within positive psychology activities (PPAs). This study aimed to test whether kindness- and gratitude-based PPAs, through positive social interaction with peers, enhanced relationship satisfaction. Using a longitudinal randomised controlled design, 225 participants were assigned to one of three conditions (relationship-focused, self-focused or control) and completed measures of relationship satisfaction, social support and happiness on three occasions (baseline, post-intervention and six weeks). The experimental PPAs were relationship-focused (involving social interaction) or self-focused (no social interaction). Those who completed relationship-focused PPAs had greater increases in relationship satisfaction than the self-focused and active control activities at six-week follow-up. Additionally, only those in the relationship-focused condition felt their existing friendships had improved at intervention cessation. Regardless of participants’ initial levels of social support, the intervention effects remained. In conclusion, PPAs fostering social kindness and gratitude significantly strengthened relationship satisfaction.     

Relationship Characteristics Associated with Teen Dating Violence Perpetration

Teen dating violence (TDV) is unstable across dating relationships, suggesting that characteristics of the relationship could be related to TDV. Few empirical studies have examined these links. This study examined associations between relationship characteristics and TDV perpetration among teens and sex differences in those associations. Relationship characteristics examined include tactics used to manipulate partners, ways of responding to relationship problems, relationship duration, exclusivity of the relationship, age difference between partners, and history of sexual intercourse with partner. Data were drawn from 667 teens in a current relationship (62.5% female and 81.4% White) enrolled in the 11th or 12th grade in 14 public schools in a rural U.S. state. Bivariate and multivariable regression analyses examined proposed associations. A total of 30.1% and 8.2% of teens reported controlling and physical TDV perpetration, respectively. In multivariable models, frequent use of manipulation tactics increased risk for controlling or physical TDV perpetration. Teens dating a partner 2 or more years younger were at significantly increased risk for both controlling and physical perpetration. A significant interaction emerged between sex and exit or neglect accommodation for physical TDV. Characteristics of a current dating relationship play an important role in determining risk for controlling and physical TDV perpetration.