Chapter 9 Clinical Risk and Brief Psychodynamic Therapy

Abstract

This article explores the risk environment confronting practitioners of brief psychodynamic treatment, and describes strategies that can help clinicians practice effective risk management. I argue that clinicians can reap only limited benefits from a focus on profiles of high-risk clients and litigation “hot spots.” The optimal approach is attention to the contextual dynamics shaping clinical practice. Among the most important are the relational processes driving the clinician-client dyad, the clinician-client-third party payer triangle, and the interface between the mental health and legal systems. I close with a discussion of the ambiguity and uncertainty that characterize clinical decision making and risk management.     

The Criminal Liability of Child Soldiers: In Search of a Standard

Despite the recent focus on the problem of the recruitment and use of child soldiers, there is still no clarity on the criminal liability of child soldiers who participate in conflict. In this article, we analyze the criminal liability of child soldiers against the historical background child soldiers. This aritle reports on its prevalence, and discusses the international legal framework liability. We pose the question whether the dual status of child soldiers as victims and perpetrators negatively impacts their criminal liability and whether it may in fact hamper the attainment of justice.     

Mother–Infant Joint Attention and Sharing: Relations to Disorganized Attachment and Maternal Disrupted Communication

The normative development of infant shared attention has been studied extensively, but few studies have examined the impact of disorganized attachment and disturbed maternal caregiving on mother–infant shared attention. The authors examined both maternal initiations of joint attention and infants’ responses to those initiations during the reunion episodes of the Strange Situation Procedure at 12 and 18 months of infant age. The mothers' initiations of joint attention and three forms of infant response, including shunning, simple joint attention, and sharing attention, were examined in relation to infant disorganized attachment and maternal disrupted communication. Mothers who were disrupted in communication with their infants at 18 months initiated fewer bids for joint attention at 12 months, and, at 18 months, mothers of infants classified disorganized initiated fewer bids. However, the infant' responses were unrelated to either the infant' or the mother' disturbed attachment. At both ages, disorganized infants and infants of disrupted mothers were as likely to respond to maternal bids as were their lower risk counterparts. Our results suggest that a disposition to share experiences with others is robust in infancy, even among infants with adverse attachment experiences, but this infant disposition may depend on adult initiation of bids to be realized.     

Higher Processes in Motor Learning

A linear displacement task was used to study the effects of post-KR verbal activity and the time of its introduction in the learning process on the acquisition of a simple discrete motor task. The temporal occurrence of the interpolated act was systematically varied (3 and 10 sec. immediately following KR). Reading polysyllables during the post-KR delay interval interfered with the learning process. Interference occurred whether the post-KR delay interval lasted 3 or 10 sec.     

Poly Implant Prothèse : en l’absence de responsabilité de l’État,quelle indemnisation possible ?

With two decisions dated November 16th 2020, the French administrative Highest court (“Conseil d’État”) has compromised the possibility for PIP's victims to demonstrate the deficiency of the National medicines agency (ANSM) in its duty of health control. Those decisions transpose to medical devices already well-established principles, used for other healthcare products. There are of interested because they give the Highest court the opportunity to precisely detail the qualification of the facts. Although the consequences for the victims seem to be only of symbolic value, the scope of the solution is not limited to the liability of the State. By reducing the number of potential liable persons, those decisions also seem to jeopardize the compensation of the victims by the national solidarity funds.     

L’anormalité du dommage : une notion juridique stabilisée ?

Medical liability, in accordance with liability law, is traditionally based on the triad of operative event, causal link and damage. The emergence of systems of no-fault liability gave rise to the concept of abnormal damage, which is a necessary condition for liability. In terms of medical liability, in 1958 the administrative courts ruled that this criterion was necessary in order to compensate medical damage in situations of liability for alleged misconduct, then from 1990 in situations of no-fault liability. This condition was extended to compensate medical hazard from 1993. The Court of Cassation refused to adopt a no-fault liability system, leading to unequal treatment. Thus, the law of March 4, 2002 created a system which, in situations of no-fault liability, allowed national solidarity to be engaged in the event of abnormal damage. However, the legislation did not clearly set out the character of this abnormality, and jurisprudential hesitation over this criterion has made compensation uncertain. In 2014, the administrative and judicial courts clarified their jurisprudence by adopting a more specific definition of this criterion of abnormality. However, a very restrictive view taken of this criterion means that many victims now risk being excluded from the scope of compensation. As such, this jurisprudential stability is perhaps but temporary.     

关节周围骨折手术入路探索的哲学思考

关节周围骨折多属于高能量损伤,临床处理相当困难,术后疗效差,现运用科学认识的规律,以康复理念为指导探索新的手术入路,并阐述新的手术入路与功能康复的辩证关系。     

走向双赢:动机倾向和信息分享质量在整合性谈判过程中的作用

研究的主要目的是考察谈判组的动机倾向、信息分享数量和质量、对优先考虑事项和利益一致事项的判断准确性和联合收益之间的关系,以及信息分享质量在谈判过程中的重要性。采用一对一的买卖式谈判任务,由226名被试组成113个谈判组进行面对面的谈判。结果表明,动机倾向、信息分享数量和质量以及谈判双方对优先考虑事项的判断准确性都对联合收益有显著影响,而且信息分享质量比信息分享数量更有预测力。中介作用分析结果显示,信息分享质量在动机倾向和联合收益之间起完全中介作用,对优先考虑事项的判断准确性在信息分享质量和联合收益之间起部分中介作用。研究揭示了整合性谈判的整个过程,验证了信息分享质量在谈判过程中的重要作用。     

The role of negative features in joint and separate evaluation

Separate and joint evaluations differ in the manner in which attribute information is processed. We propose that negative attributes weigh more in separate compared to joint ratings. To assess the relative weights of positive and negative attributes, stimuli were employed containing mixed attribute valence, with good and poor attributes. In three experiments it was demonstrated empirically that, using such mixed valence options, the negative attributes indeed weighed more than the positive ones in separate compared to joint ratings. Direct evidence for the increased weight of negative attributes in separate ratings was provided by showing preference shifts between joint and separate ratings for options with mixed attribute valence. Copyright © 2004 John Wiley & Sons, Ltd.     

医疗风险、责任与对策

医疗风险是医疗实践中客观存在的一种具有不确定性、损害性事件,对患者、医院和医学的发展有着不利的影响。医疗风险的存在有着复杂的原因,因此,对医疗风险管理与防范也应该采取包括提高医疗技术水平、加强风险教育、实行医疗责任保险等多种手段。