Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Affektive Interaktion zwischen Patienten und Therapeuten

Zusammenfassung Eine positive therapeutische Beziehung wird therapieschulenübergreifend als wichtige Voraussetzung für den Therapieerfolg angesehen. Meist wird jedoch in Studien lediglich die schriftliche Patienteneinschätzung erfasst. Nonverbale Aspekte der Interaktion zwischen Patienten und Therapeuten werden kaum untersucht. Aus einer Studie zur Vorhersage des Erfolgs stationärer Fokaltherapie werden affektive Interaktionsprozesse im Erstinterview exemplarisch zwischen einer erfolgreichen und einer nicht erfolgreichen Behandlung mit mikroanalytischen Verfahren (facial action coding system, FACS) verglichen. In der nicht erfolgreichen Therapie waren die mimischen Affektäußerungen reziprok; Therapeutin und Patientin zeigten ähnliche vorherrschende (sog. Leit-)Affekte. Erfolgreicher waren die Behandlungen, wenn die Therapeuten komplementäre Affektmuster zeigten. Implikationen für Behandlungstechnik, Supervision und Weiterbildung werden diskutiert.     

Changes in the structure of children's isometric force variability with practice

This study examined the effect of age and practice on the structure of children's force variability to test the information processing hypothesis that a reduction of sensorimotor system noise accounts in large part for age-related reductions in perceptual-motor performance variability. In the study, 6-year-olds, 10-year-olds, and young adults practiced on 5 consecutive days (15 trials/day), maintaining for 15-s trials a constant level of force (5 or 25% of maximum voluntary contraction) against an object using a pinch grip (thumb and index finger). With increasing age, the amount of force error and variability decreased, but the sequential structure of variability increased in irregularity. With practice, children reduced the amount of variability by changing the structure of the force output so as to be more similar to that of their older counterparts. The findings provide further evidence that practice-driven changes in the structure of force output, rather than a decline in the amount of white noise, largely account for age-related reductions in the amount of force variability.     

The import of infancy for individual, family, and societal development: commentary on the special section: does infancy matter?

Across their life spans humans actualize a rich potential for cognitive and behavioral plasticity, a set of developmental changes that require regulation of organism-context relations on the part of both the individual and society. An individual’s action on the context must be started in infancy and maintained in subsequent periods of life for adaptive functioning to occur across ontogeny. The process of the individual acting as an agent of his or her own development is continuous, although the particular ways in which such control is manifested will change in developmentally appropriate ways. As demonstrated by the papers in this special issue, the significance of infancy for the rest of the life-span rests on an integration of this continuity and discontinuity within the person-context developmental system.     

中国考试文化的古今嬗变与镜鉴

中国考试文化生态因社会环境、经济土壤、社会结构和国际环境影响而形成从保守封闭性向包容开放性转变的特征。本文从三个层面考察中国考试文化的当代嬗变： 考试观念文化从单一的政治情结向综合人文素质嬗变, 考试制度文化从僵化到创新嬗变, 考试行为文化则从场所、教学行为、主体、应试行为和实践行为考察。通过合理挖掘中国传统考试文化中的道德诉求与和谐理念, 力求凝练出一种具有深厚文化内涵和现代竞争意识的考试文化。     

伊斯兰复兴思潮下的伊斯兰经济思想

20世纪上半叶,伊斯兰教复兴思潮迭起,穆斯林比以往更加明确,伊斯兰教依然是他们解决精神、政治、经济问题的行之有效的途径。20世纪中后期,伊斯兰复兴的浪潮在经济思想领域产生了两方面影响:其一,带动了伊斯兰经济思想的研究。其二,促成了伊斯兰金融体系的建立。     

Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field

Abstract: This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of ‘Rachael’, initial dreams gave rise to what Hobson (1984) called ‘moving metaphors of self’ in the analytic field. Dream imagery, projective and introjective processes in the transference‐countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.