网络环境下医患关系的新变化及其改善对策

从正反两方面详细剖析了网络环境的发展给医患关系带来的影响,并分析了医患关系产生的新变化,针对这些影响和变化,提出培养适应网络时代的医务工作者、利用好网络环境双刃剑、不断完善网络医疗信息环境建设、借助网络媒体促进和谐医患关系等改善网络环境下医患关系的策略.     

Book reviews

Abstract

Eldercare by James Kenny&;Stephen Spicer. Buffalo, NY: Prometheus Books, 1988, 152 pages, $11.95 paper

Lonely All the Time: Recognizing, Understanding and Overcoming Sex Addiction, for Addicts and Co-dependents by Ralph Earle&;Gregory Crow with Kevin Osborn. New York: Pocket Books, 1989, 337 pages, $19.95

The Imperfect Therapist: Learning from Failure in Therapeutic Practice by Jeffrey A. Kotter&;Diane S. Blau. San Francisco: Jossey-Bass, 1989, 188 pages, $19.95

Families with a Difference: Varieties of Surrogate Parenthood by Michael Humphreys&;Heather Humphreys. New York: Routledge, 1988, 177 pages, $45.00

Between Husbands and Wives: Communication in Marriage by Mary Anne Fitzpatrick. Newbury Park, CA: Sage Publications, 1988, 283 pages, $35.00 hardbound, $16.50 paperback     

Importance of Therapist Use of Social Reinforcement with Parents as a Model for Parent-Child Relationships: An Example with Parent-Child Interaction Therapy

ABSTRACT

This paper focuses attention on the therapeutic relationship in parent-child therapy by using social reinforcement with parents and children as it relates to Parent-Child Interaction Therapy (PCIT). As in other therapy contexts, it is argued that having the therapist serve as a mediator of social reinforcement facilitates client change, After discussing different aspects of PCIT, we discuss the therapeutic relationship as viewed through other theoretical frameworks. This is followed by a discussion of the role of social reinforcement in the parent-child relationship. We then discuss at methodological and applied levels, the importance of therapist accuracy and consistency in the delivery of reinforcement as a means of changing the parent-child relationship. Next, this is followed by a discussion of the therapist-to-parent-to-child sequential chain of behaviors involved in PCIT. Finally, suggestions for future empirical studies are considered.     

Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

Reciprocal effects of student-teacher and student-peer relatedness: Effects on academic self efficacy

This study investigated the reciprocal effects between teacher-student relationship quality (TSRQ) and two dimensions of classroom peer relatedness, peer liking and peer academic reputation (PAR), across three years in elementary school and the effect of both TSRQ and the peer relatedness dimensions on academic self efficacy. Participants were 695 relatively low achieving, ethnically diverse students recruited into the longitudinal study when they were in the first grade. Measures of TSRQ and peer relatedness were assessed in years/grades 2-4. Peer liking and PAR were moderately correlated with each other at each time period. As expected, peer liking and TSRQ exhibited bidirectional effects across the three years. Year 3 TSRQ had an effect on Year 4 PAR, but PAR did not have an effect on TSRQ at either time interval. In an additional analysis, Year 4 PAR mediated the effect of Year 3 TSRQ on Year 5 academic self efficacy. Implications for teacher professional development are discussed.     

责任关系视角下的儿童责任行为发展研究

为了解社会转型期儿童责任行为的发展特点,本研究以“责任关系”的视角,通过问卷调查的方式考察了儿童的责任行为发展特点及其与学校、家庭表现之间的关系。结果显示：（1）不同性别儿童责任行为存在显著差异,女生的责任行为水平无论在总体或各因子得分上,均显著高于男生;（2）不同年级儿童责任行为存在显著差异,小学生的总体责任行为水平高于初中生;（3）独生子女的自我责任行为显著低于非独生子女,核心家庭儿童在自我责任行为上显著低于扩展家庭中的儿童;（4）责任行为水平高的儿童具有更高的社会能力,家长问卷中参与家务的行为也更多。总之,儿童的责任行为水平与年龄、性别、家务劳动和社会能力均有显著的关联。     

Integrity and identity: Moral identity differences and preferred interpersonal reactions

Moral identity affects interpersonal relationships by guiding how people perceive and respond to feedback, evaluate others and select task partners and friends. Self‐described principled participants (high scorers on the Integrity Scale) more strongly preferred principled‐prototypic others over expedient ones and believed it possible to be more principled in one's beliefs (Study 1), preferred evaluators who regarded them as principled over expedient (Study 2), had friends who saw them as principled and paired up with friends who were themselves principled (Study 3). In contrast, expedient individuals did not display mirror‐image reactions but saw merit in being both expedient and principled; they were accepting of any relevant feedback and partner preferences. Moral identity is a key link between ethical beliefs and behaviours. Copyright © 2010 John Wiley & Sons, Ltd.     

A thematic dialogue: towards a conclusion and a follow-up

Following the themed debate that took place after the panel, we reconsidered and explored further our hypotheses in light of the comments made by our colleagues. Clearly, it is the structural approach that underlies both the Freudian primal phantasies and the Jungian archetypes, while taking account at the same time that their approaches are informed by contemporary emergentist theories. Our discussion centred on the divergences in the cases of psychosis and neurosis, on the roles, in turn, of a return to childhood and the play of archaic representations, on the transference and countertransference functions and finally on the need to pay attention to what are deemed synchronous moments in the event.     

Attributions for spousal behavior in relation to criticism and perceived criticism

This study examined relations between spousal attributions and criticism in a sample of 118 married couples. Spouses rated general perceived criticism (PC) and their own expressed criticism as well as interaction-specific PC from a videotaped discussion. Independent judges also coded criticism from the discussion. Spouses’ self-reported causal and responsibility attributions for hypothetical spousal negative behavior were related to all types of criticism. Attributions were also associated with unique variance in spouses’ reports of general PC and criticism, even after controlling either for judges’ or partners’ ratings of criticism and marital adjustment. General PC and expressed criticism appear to reflect more than either the amount of criticism present or feelings about the marriage; rather, general PC and expressed criticism are uniquely associated with the cause and responsibility ascribed to partners’ behavior.     

Intimate boundaries: Therapists’ perception and experience of erotic transference within the therapeutic relationship

Aim: This study explored therapists’ understanding and experiences of erotic transference within therapeutic relationships. Method: A small‐scale qualitative research project was undertaken with six therapists working within different counselling contexts. Data was collected through semi‐structured face‐to‐face interviews, and an Interpretative Phenomenological Analysis used for analysis of individual perception and experience. Findings: All participants had experienced what they understood to be erotic transference and/or sexual and loving feelings within therapy. There was little differentiation between the two phenomena, and both were often referred to interchangeably. There were contradictory views as to whether using the phenomena would be beneficial to client work, but there was a strong motivation to learn more about it. Therapists who encountered sexual attraction within therapy experienced feelings including shame and embarrassment. Supervisory support was seen to be beneficial. Implications/conclusion: The importance for therapists to acknowledge a lack of clarity that exists around the understanding of erotic transference and its relationship to sexual attraction within therapy is noted. Also, a recognition that better access to training regarding erotic transference and sexual responsibility within client relationships might be helpful to therapists in their work.