Report of the Working Group on Research

Prepared by the Working Group on Research from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper focuses upon the challenges for psychologists who wish to maintain active research programs in academic medical settings. Six specific strategies are offered that, if followed, would increase opportunities and visibility of psychological research programs both within academic medical settings and within society at large.     

Too individualistic for safety culture? Non-traffic related work safety among heavy goods vehicle drivers

IntroductionThis article reports on a study of non-traffic related work safety among drivers of heavy goods vehicles in Denmark. In the heavy goods vehicle transport (HGV) sector only 6.4% of workplace accidents involving drivers are traffic related. HGV work is characterised by solitary work, as drivers tend to work at a physical distance from their own company and their working environment is also influenced by the working environment of other companies e.g. the places where they deliver goods. This study focuses on an analysis of HGV drivers’ and managers’ differentiated understandings of risk and safety and its management within an organisational context. The situational focus involves viewing HGV drivers’ working environment as a part of the organisational structure as well as of other social relationships. An understanding of safety culture as practice is applied with the view of identifying values and attitudes as well as organisational and technical aspects in relation to how individualist or collectivist understandings of risk and safety influence the working environment in HGVs.MethodThe study applied a mixed methods approach and in this article the qualitative interviews conducted with drivers and managers is the primary data source.ResultsThis study suggests a widespread understanding of drivers as being individually oriented in their work, from drivers and management alike. However, the study also demonstrates that, in conducting their work, the drivers are actually interdependent, and share knowledge frequently, albeit informally. The organisational structure of the company shapes their individual attitudes towards safety but they also report being dependent on relationships with, and information from, their fellow colleagues, former colleagues and friends who shape their understandings and attitudes towards hazards and safety practices. The analysis points to risk-taking and unsafe practices as prevalent among HGV drivers, who often refer to risk as trivial and the management of such risks as one’s own responsibility. Knowledge of how to manage risks in everyday practice is shown to be principally related to personal experiences but also to the good advice and examples of fellow drivers.ConclusionsThe analysis points to interdependent and collectivist practices among HGV drivers even though they are perceived as being individualistically oriented when it comes to safety. Therefore, non-traffic related safety practices, in this case the loading and unloading of vehicles, occur in the grey zone of organisational safety management. Despite the fact that organisational safety initiatives are initiated, the management sees limited possibilities for enforcing them and hence safety practice is often left to the individual driver.Practical applicationsA safety culture perspective might enhance work safety among HGV drivers if we are able to understand workplace culture in a pluralistic way. Collectivist practice among the drivers can be utilised in order to improve knowledge sharing and situational safety practices. The informal communication identified among the drivers might offer a new model for safety initiatives based on more collectivist, albeit informal, safety culture practices on behalf of HGV companies.     

Building therapeutic relationship in schizophrenic and alcohol-related disorder cases

Current literature on the dual diagnosis in cases of schizophrenia and alcohol dependence has reported how pharmacological treatment has positive effects on the reduction of both disorders. Nevertheless, patients have considerable difficulties in following the prescribed medication. This work aims to build an engagement stage and therapeutic relationship in seven patients with schizophrenic and alcohol-related disorder cases. This result was achieved through the use of the vignette technique and narrative psychodynamic approach during group counselling sessions. Positive and Negative Symptoms Scale (PANSS) and Munich Alcoholism Test (MALT) were applied before and after treatment. A follow-up session was organized. The PANSS and MALT scores indicated there was no reduction of the psychiatric symptoms after treatment. The follow-up session showed positive outcomes in terms of increasing the level of socialisation as well as awareness of their own condition; at the same, an adherence to pharmacological treatment and psychotherapy for all the subjects.     

Dynamic interpersonal therapy in an NHS tertiary level specialist psychotherapy service

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service.     

A fertile matrix: the birth of the Forensic Psychotherapy Society

This paper traces some aspects of the fertile matrix within which, over many years, the application of a psychoanalytic perspective to clinical work with the most severely mentally ill, difficult and at times frightening patients in secure and community settings has evolved and now led to the recent inauguration of the Forensic Psychotherapy Society (FPS), a new Member Institution of the British Psychoanalytic Council. The Society provides both a framework for a national, multidisciplinary professional training in psychodynamic forensic psychotherapy and the potential launching pad for an active post-qualification organisation supporting CPD and all other forms of professional development. The particular contributions to the birth of the FPS of the Forensic Psychotherapy Department at West London Mental Health NHS Trust, partly because we know it best but also because it is part of the largest forensic psychiatric service in the United Kingdom, are described.     

Psychology Internships in the Treatment of Severe Mental Illness: Implications for Training in Academic Medical Centers

Despite an increasing focus over the past 2 decades by federal and state governments on the care of persons with severe mental illness, psychologists remain underrepresented among behavioral health professionals working with this population. Within the discipline there is growing concern about the need to adequately train, recruit, and retain psychologists in this specialty. This is a particular concern in academic medical settings where the overall severity of illness among those receiving psychiatric services continues to increase. The purpose of this qualitative research study was to intensively examine the experience of predoctoral interns engaged in treating individuals with severe mental illness in an academic medical center in order to identify the professional developmental experiences and training needs of those learning to care for this population. This analysis, conducted with semistructured interviews at four points during the internship year, yielded a series of recommendations for improving internship training and recruiting psychologists to this specialty.     

论医学哲学的特征

医学哲学也称为医学辩证法,是在总结医学科学成就的基础上,通过对医学理论和实践中一般、普遍、共性问题的研究,揭示医学认识主体思维活动普遍规律的科学：是人们认识和处理健康和疾病问题的一般方法论。无论是与医学还是与哲学相比。医学哲学都有着显著的区别,运用对比分析的方法。对医学哲学的研究对象、理论体系特别是思维方式等不同方面的特征,进行理论探讨。     

当代中国医德建设与相对主义医学伦理学

当代西方相对主义医学伦理学有许多建树,但也有其致命性的缺陷,这就是否定医学道德的客观绝对性和普遍性医学伦理准则。在引进、介绍了这种学说之后,需要下功夫同它进行对话,即以医德绝对性与相对性辩证统一的原理,对这种学说进行追问,从中借鉴有益的经验和教训,以顺利全面地推进我国当代的医学道德建设。