An evaluation of support groups for patients with long-term chronic pain and complex psychosocial difficulties

There is a significant group of chronic pain patients with complex psychosocial needs who are frequent users of hospital outpatient departments and who do not participate in or benefit from traditional pain management treatments and are convinced there is a medical solution to their problems. They are a particularly challenging group of patients to help, often shunned by medical and psychological professionals. A new type of ten-session psycho-social group for these patients that is less demanding than traditional pain management group programmes is investigated. It is designed to foster the development into community-based self-help groups and reduce the need for professional support and unnecessary medical intervention. Accounts of four groups of patients who participated in support groups and successfully established their own groups is presented. To assess changes in motivation, mood and pain disability standardized questionnaire measures were given before and after group attendance. Findings suggest that patients benefited and took increased responsibility for their pain management but did not demonstrate positive changes on measures of mood or level of pain disability. Patients experienced satisfaction with the groups and established their own self-help community groups. The positive experience of participants and staff suggests further work with support groups would be productive for this group of patients.     

The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

L’auto efficacité créative,la flexibilité cognitive et le soutien à l’innovation comme antécédents du comportement innovant

The necessity to innovate is a concern for many practitioners and researchers. This research aims to demonstrate the role of cognitive flexibility and of the climate of support for innovation in developing innovative behavior at work. The mediating role of creative self-efficacy is tested. The results confirm that cognitive flexibility and the climate for work group innovation are antecedents of the innovative behavior.     

Refuser sans dire non : étude d’un jeu de langage dans une transaction entre un patron et un employé

The aim of this paper is to go on with the articulation between the notions of form of life and language game started by Agnoletti (2006). In this way, we want to show the links between language game and activity through the study of pieces of verbal interaction coming from a professional transaction between a chief and his employee. By using the hierarchical and functional analysis (Roulet et al., 1985), we show regularities, both at the level of the structure of the interaction and in that of the sentences and vocabulary. We make then a relationship between the linguistic forms and the context in which they appear and we consider that we have to deal with a language game which has two modalities: appeal to the rule and the charge. These forms are related to power and authority.     

Concerning a Moral Duty to Cheat in Games

Stimulated by Hugh Upton's recent article in this journal, in which he argues that there can be a moral duty to cheat in games, I attempt to examine his claims. Much of what he writes revolves around examples from two sports, cricket and rugby, and with differing connections to those games' rules. While the example from cricket is said to involve a breach of the spirit of that game, it is contravention of the written rules of rugby on which the latter part of Upton's case focuses. Given limited space I concentrate on the cricketing example, but several of the points I make about that apply also to when rule-breaking itself is involved. My conclusions express doubts about whether a case for a moral duty to cheat in games has been established.     

群体独特性对群际偏差的影响

群体独特性影响群体认同,较高或较低的群体独特性都可能引发群际偏差,分别称为“反射式独特性假说”与“反应式独特性假说”.调节作用研究揭示,在较低群体认同或上位群体分类凸显时,群体独特性越高越易引发群际偏差;而在较高群体认同时,独特性越低越易引发群际偏差.动机作用的研究表明,在具有群际竞争目标时,这两种过程分别受工具性动机与认同性动机的驱动.情绪与认知的中介作用研究显示,在低独特性条件下,社会身份复杂性与焦虑情绪可起中介作用引发群际偏差.     

Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy

According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in ICT and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.     

Mindful Parenting: a group approach to enhancing reflective capacity in parents and infants

In this paper, the process of ending therapy is likened to the ordinary developmental task of ‘letting go’ that parents have to undertake, to help their child to grow up. ‘Letting go’ is contrasted with the process of ‘holding’ the child in mind that is so central to the therapeutic and parental task Following thoughts about some of the external issues that play a part in the decision to end a child's treatment, this developmental perspective of psychoanalytic psychotherapy is discussed through a clinical illustration of the ending of a 5-year-old boy's treatment. Different strands of the therapeutic relationship as highlighted during the ending phase of therapy are distinguished and attention is drawn to the role of the ‘new relationship’ between therapist and child and how this differs from the transference relationship. Countertransference issues in their broadest form are also considered.     

Clinical concepts

In this section authors have written about the Winnicottian concept that they value most in their everyday working lives. This provides a valuable insight into the ways in which Winnicott's work is being used as a springboard for new ideas, as well as enlightening familiar ground. It is striking to see how the original Winnicottian idea takes on new form as it is taken up by new generations of clinicians. Despite the absence of a Winnicottian training school, his pervasive impact continues to influence current theory and practice.