Desires in Palliative Medicine. Five Models of the Physician‐Patient Interaction on Palliative Treatment Related to Hellenistic Therapies of Desire

In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches to desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has.     

Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians

There has been growing concern about the effects on the patient–physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called double agency. Various authors have proposed ways to restore patient centeredness to the patient–physician interaction. We have previously discussed the need to establish a patient–physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug doctor; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient–physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.     

Re-Evaluating Professional Autonomy in Health Care

Professional autonomy, as the symbol of the traditional freedom ofdecision-making of medical professionals is criticized. This essayexamines the critique. It analyses the underlying assumption that theautonomy of health professionals is incompatible with the need fororganisation and management in order to control rising health carecosts. It is argued that the concept of professional autonomy should beredefined, not through restricting the decision-making freedom ofindividual health professionals, but through expanding the concept intothe sphere of management, so that managers will take responsibility forpatient care.     

Impact evaluation of the family expectations program and moderation by sociodemographic disadvantage

The federal government, through the Administration for Children and Families (ACF), has funded community-based relationship education programs for couples, individuals, and families, with a strong focus on serving economically disadvantaged and racially diverse families. This study evaluated the impact of a 36-hour, workshop-based couple relationship education program that was funded by ACF using a randomized controlled trial (RCT) design and intent-to-treat (ITT) analyses. Participants were 1320 couples who were either expecting a baby or had a baby within the past 3 months, at the time of enrollment. Follow-up surveys were administered 12 months later. Analyses evaluated program impacts on relationship stability, constructive communication, and destructive conflict compared to a no-treatment control group. Analyses showed a statistically significant impact of the program on destructive conflict (d = 0.10) but not on constructive communication (d = 0.06) or stability (d_Cox = 0.10). Based on findings from previous evaluations, we also examined whether participants’ levels of sociodemographic disadvantage moderated these effects. There was significant moderation by sociodemographic disadvantage on constructive communication and destructive conflict, but not on stability. Effects were observed for those at higher levels of sociodemographic disadvantage.     

Evaluation of the 14-h together relationship and financial education program for couples

A 14-h version of TOGETHER, a relationship and financial education program for couples (Author, 2015), was evaluated by comparing pre- and post-intervention changes in psychological distress, relationship functioning, and financial management in couples that participated in this shorter 14-h workshop (14HW) version, in the original 20-h workshop (20HW) version, or in a control group that received no intervention. The total sample included 649 community couples (14HW group: 320; 20HW group:182; control group: 147) recruited from the Washington, DC, metropolitan area. Self-report data were analyzed through dyadic multilevel models to test mean differences within each group (control, 14HW, and 20HW) and across groups from pre-intervention to post-intervention controlling for demographic differences and baseline measurement of variables. Compared to the 20HW version, the 14HW format had lower attrition and greater participation. In addition, improvements in positive conflict management, relationship quality and satisfaction, and commitment, and reductions in negative conflict management and difficulties paying bills were not significantly different from the 20HW group, but they were significantly different from the control group. Participants reported high levels of program satisfaction. Limitations and programmatic implications, as well as the need for further evaluations of the 14HW version, are discussed.     

Similar minds in the family: COVID-19 centrality and relationship quality

We examined whether perceived similarity in COVID-19 centrality (i.e., the extent to which one thinks of the pandemic as shaping current and future life) is associated with family relationship quality during the pandemic. Thinking that other family members are similar to oneself regarding the pandemic's centrality may improve the quality of family relationships. We collected data from Turkish family triads (i.e., mother, father, 18–25 years old child) and had 481 participants from 180 families. Participants rated their similarity in COVID-19 centrality with the other two family members and reported the general and daily quality of their relationship with them (relationship satisfaction, closeness, conflict). We analyzed the data using the Social Relations Model. We found that family members who, on average, perceived more similarity in COVID-19 centrality reported higher levels in positive attributes of general relationship quality (i.e., satisfaction and closeness). The effects on conflict and daily relationship quality were less conclusive. This research confirms that family members' reactions during the COVID-19 pandemic are interdependent. Perceiving that other family members are of similar minds about the centrality of the pandemic relates positively to some aspects of relationship quality.     

Challenges and stressors in intimate intercultural relationships: A systematic research synthesis

Globalization has facilitated increasing cross-cultural interactions and the formation of intimate intercultural relationships. This study systemically screened and reviewed fifteen quantitative studies that included participants in a current intimate intercultural relationship, synthesizing their research methods and findings with a focus on investigating stressors and challenges. The results revealed that intercultural couples could face various external challenges like marginalization and family disapproval and internal challenges such as conflicting cultural values. When these challenges and stressors are present, couples are more likely to experience lower relationship satisfaction and more negative relational interactions. This study provides an overview of the state of quantitative research on intercultural relationships, highlighting its limitations and future directions. The findings of this critical analysis can also inform clinical practices with distressed intercultural couples.     

Editorial synthesis for counseling psychology and relationship science: Making connections and expanding disciplinary diversity

The field of relationship science began with understanding the role of attraction and has expanded to examine factors associated with relationship initiation, development, and maintenance. Despite the growth of the field, recent reviews of topics present in relationship science have revealed a dearth of literature examining sociocultural contexts that may impact relational processing, especially for traditionally underrepresented groups in science. Notably, given the theories, frameworks, and methods applied in these disciplines, counseling psychology and relationship science are at the forefront of examining such contexts. To this end, the goal of the special issue was to bring together scholars whose work is either an application of or showcases how the contemporary foci of counseling psychology, including but not limited to intersectionality, social justice, cultural competence/humility, identity, strengths-based approaches, and social power hierarchies are applicable to the study of relationships broadly defined. This editorial synthesis provides a brief summary of the four articles that are included in this special issue and ends with recommendations for future research that intersects counseling psychology and relationship science.     

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.