医患交际的“复调”研究

近几十年来，医患交际日益受到社会学家和语言学家的关注，成为医患关系研究的热点。医患交际是人类对话的一种形式，充满了与疾病有关的各种声音。拟运用巴赫金的复调理论对医患交际中的各种“声音”进行研究，揭示医患交际中，医生的医生声音、教育者声音、同伴声音和患者的叙述病情声音、能力声音、社会交际者声音、发话者声音等在对位对话中并存共生，既各自独立又彼此相关。     

Coping strategies used by middle-aged males with noise-induced hearing loss,with and without tinnitus

Abstract

The aim of this study was to examine the relationship between general coping strategies and specific communication strategies, adopted by males with noise-induced hearing loss (NIHL) in order to deal with stressful events and demanding auditory situations. The sample included 72 males with NIHL; 22 without tinnitus, 26 with mild tinnitus, and 24 with severe tinnitus. The following variables were measured: “active coping” “escape coping” and “passive acceptance” (general coping strategies), and “maladaptive behaviours”, “verbal strategies” and “nonverbal strategies” (specific communication strategies). The results showed that males without tinnitus or with mild tinnitus combined “active coping” and “passive acceptance”, whereas males with severe tinnitus supplemented these strategies with “escape coping”. The relationship between general coping and specific communication strategies was weak, although giving a significant correlation between “escape coping” and “maladaptive behaviours”. The results indicate that the hypothesis that a person's general pattern of coping has influence on his/her ability to cope effectively with a hearing impairment can not be supported. Further research should concentrate on the contribution of personality factors as well as environmental factors to the variance in coping with NIHL and tinnitus.     

The use of early recollections as a narrative aid in psychotherapy

A narrative framework is put forward for using early recollections as a narrative aid in psychotherapy. According to this framework, early recollections are beginning episodes in the current version of an autobiography or self-narrative which is continuously updated to make sense of current concerns. Inclusion of these episodes in psychotherapy can provide therapists who share an interest in narrative and their clients with a quick way to recognize central themes that are restricting clients’ lives and detect openings to revise them. Revisions regard the form and content of early recollections. Three case examples propose ways of incorporating early recollections in empathic dialogs, including the process of detecting restricting themes and encouraging persons to tell stories in more compassionate voices. Group therapy is proposed as one of the contexts where early recollections can be discussed, but readers are encouraged to extend these ideas to work with individuals and families.     

听力障碍初中生自我决定能力的基本特点及社会支持的作用

以125名聋校听力障碍初中生为被试,采用问卷法探讨该群体自我决定能力的基本特点及社会支持对其自我决定能力的作用。结果发现：（1）听力障碍初中生的自我决定能力整体水平不高;（2）不同性别、障碍程度的听力障碍初中生的自我决定能力间差异不显著,而不同年龄段、年级、父母受教育水平的听力障碍初中生的自我决定能力间存在显著差异;（3）年级、教师工具性支持、母亲价值增进支持是听力障碍初中生自我决定能力的显著正向预测指标。     

Prevalence of auditory verbal hallucinations in a general population: A group comparison study

The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio‐demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay‐Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life‐time prevalence of AVH. Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH.     

心理咨询中当事人的改变过程：同化模型的视角

摘 要 目的：选用心理咨询中获得成功改变的中国当事人,验证美国学者William B. Stiles等提出的同化模型。方法：采用同化分析这一用来追踪心理治疗中当事人问题经验发展进程的研究方法,对案例的会谈逐字稿资料进行分析。结果：三位研究者追踪到了两个主题（两对声音）,摘录了68个段落。其对两个主题摘录段落的同化评分与三位独立评定者的评分具有较高的相关（0.90和0.85）,同化的评分随着会谈的进程而提高（相关分别为0.89和0.91）。当事人在心理咨询中的改变过程遵循同化模型有关治疗改变的发展序列。结论：中国当事人的心理咨询改变过程支持同化模型的理论构想。     

心理咨询中好坏效果案例的同化水平对比:基于同化模型的视角

目的:通过对比心理咨询中4例好效果案例和4例坏效果案例同化水平的差异,对同化模型有关成功治疗改变过程的理论构想进行检验,并寻找区分好坏案例的关键点。方法:选用7位经过培训的评定者组成三个研究小组,采用同化分析这一用来追踪当事人问题经验发展进程的研究方法,对8个当事人完整的咨询逐字稿资料进行分析,并对涉及当事人问题经验的段落进行摘录。依据同化问题经验量表和同化标识手册对摘录的段落进行同化评定。结果:8个案例的核心问题得到一致确定,三组评定者评分的组内相关系数ICC(1,1)在.64~.86之间,ICC(1,K)在.84~.96之间。好效果案例结束时的同化水平均分(M=5.50)和同化进展均分(M=4.25)高于坏效果案例(2.13和-.13)。好坏效果案例的同化进程均出现前进中倒退的情形,但好效果案例能够在倒退中保持上升,而坏效果案例未能完成上升。好效果案例最终的同化水平均达到了4(理解/领悟)及以上,坏效果案例最终的同化水平均未达到4。结论:研究结果基本支持同化模型的理论设想,即症状强度的减少同更高的同化水平相联系;并初步确定区分好坏效果的关键点是同化水平4;但从同化进程来看,可考虑对模型的发展序列进行修改完善。     

Programming generalization of social skills in preschool children with hearing impairments.

The efficacy of a social skills training package in producing stimulus generalization, both with and without the systematic application of generalization programming techniques, was evaluated with 5 preschool children with hearing impairments. The evaluation was conducted within a multiple baseline design. Generalization probes were conducted daily. The social skills training package was implemented in a training setting and produced high, stable rates of social interaction in that setting. However, generalization of the social skills to new teachers, peers, and play activities did not occur until generalization programming strategies were applied in the original training setting. Using sufficient stimulus exemplars and contacting natural consequences appeared to be the key strategies for promoting generalization of social interaction. In addition, the use of supplementary procedures (e.g., a fluency criterion and treatment integrity checks) may have contributed to stimulus generalization.     

Grey Matter: Ambiguities and Complexities of Ethics in Research

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research.     

Demonstrating “Reasonable Fear” at Trial: Is it Science or Junk Science?

This paper explores how scientific knowledge is used in a criminal case. I examine materials from an admissibility hearing in a murder trial and discuss the dynamics of contesting expert scientific opinion and evidence. The research finds that a purported form of “science” in the relevant scientific community is filtered through, tested by, and subjected to legal standards, conceptions, and procedures for determining admissibility. The paper details how the opposing lawyers, the expert witness, and the judge vie to contingently work out what will count in court as appropriate scientific authority, methods and evidence, and as a scientifically valid and legally admissible account of “reasonable fear.” When science becomes enmeshed in legal controversies, science does not trump law. Rather, it is the court’s canons of proper procedure and measures of substantive adequacy that take precedence.