Clients talk about their experience of the process of counselling

The purpose of this study was to ascertain clients’ experiences of their counselling. This was done through use of a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in agency located in a mid-sized city in New Zealand. Several themes were identified and discussed in relation to the literature on clients’ perceptions of their own counselling. Specifically, clients were asked to comment on whether their counselling was effective, how much of their improvement was due to counselling versus other factors, the quality of the relationship with their counsellor, specific in-counselling events that were helpful or unhelpful, and how their counselling was terminated. Implications for practice were suggested.     

误诊误治病例所致医疗纠纷分析——附3例报告

当前医疗科技发展的相对性、疾病规律本身的复杂多变性、医生医疗知识的局限性等,导致了临床误诊误治的不可避免性,而医院发生的医疗纠纷事件中,大多是由于误诊误治所致。通过对3例误诊病例及所致医疗纠纷的分析,指出临床误诊误治的客观性、主观性及不可避免性。同时提示临床医师在疾病诊治过程中,随时更新医疗知识,注意疾病的鉴别诊断,及时完善相关的辅助检查,积极治疗,减少对疾病的延误诊治,减轻病人痛苦,改善医患关系,从而减少医疗纠纷。     

"仁"——医德的元德

医德是医学道德的简称,具言之,它是指医务人员在医疗卫生服务的职业活动中应该具备的仁爱、救死扶伤等的品德,是道德德目在医务人员身上的内化,也是对医务人员必须具备的最起码的要求.我们评价一个医生,首先是直面他的医德,医德是医生形象的体现,没有医德的医生即使技艺再高超,也算不上一个完整意义上的医生,"无德不成医".事实上一个医德低下的医生,他的技艺也不会高超的.     

未成年患者的同意能力研究

众所周知,医疗机构必须在取得成年患者的有效同意后才能实施医疗行为。而当患者是未成年人时,这种对医疗行为的同意是否有效呢?对此,国内外法学均未形成统一的定论。通过比较国外医事法学领域相对成熟的同意能力理论,初步建立我国未成年患者的同意能力理论体系,其中评估方法是关键。     

Sectioned offenders presenting with enduring mental illness: a study exploring behaviors indicative of bullying

Logit and logistic regression analyses were employed to explore the nature, extent and predictors of behaviors indicative of "being bullied" and of "bullying others" in a sample of 125 adult male offender-patients sectioned for enduring mental illness and detained within a high-secure psychiatric hospital. The study addresses the lack of research into this specialized population to date, with a subsidiary aim of comparing the results directly with a previous study conducted with a population of adult male personality-disordered offender-patients (n = 53). Participants were required to complete a self-report behavioral checklist (Direct and Indirect Patient behavior Checklist-Hospital version Revised). The prediction that indirect (subtle) aggression would be reported more frequently than direct aggression was supported in relation to perpetration estimates, with evidence such aggression was also more prevalent among personality-disordered than mentally ill offender-patients. As predicted verbal aggression was the most commonly reported direct behavior. Although it was predicted that those perpetrating aggression would present with increased experience with secure settings this was only supported with regard to bully-victims. Contrary to the prediction made, those victimized did not present with less experience of secure settings. Consistent with the hypothesis, bully/victims were predicted by increased negative behavior toward staff and hospital rules. The results are discussed in relation to the environment in which the aggression is taking place with the implications for practice and future research outlined.     

Desire and the female analyst

The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, counter-transference, incest taboo - mothers and sons and sexual themes in the transference.     

DISCRIMINATIVE CONTROL OF THERAPISTS' PERFORMANCE1

In order to examine therapists' discriminative responding to normal and idiosyncratic patient responses, naive subjects were presented with a simulated “patient” for treatment. The subjects were made to believe they were reinforcing normal verbalizations emitted by this patient In fact, they were listening to a tape on which normal and idiosyncratic verbalizations had been recorded. Different probabilities of normal and idiosyncratic “patient” verbalizations could be presented to the subjects by means of a digital programming unit. In one of a number of conditions, the subjects' accurate reinforcing responses were followed by an increased probability of the patient's normal verbalizations. Accurate reinforcing responses emitted by the subjects were brought under the control of normal and idiosyncratic patient responses, by use of contingent feedback, change in patient responding, and monetary reinforcers. When the patient's normal verbalizations increased in probability, so did the subjects' accurate reinforcing responses following the patient's normal verbalizations, and to a lesser degree, the subjects' inaccurate reinforcing responses following the patient's idiosyncratic verbalizations. When the patient's idiosyncratic verbalizations increased in probability, the subjects' accurate and inaccurate reinforcing responses decreased in probability. The clinical implications of these tendencies are discussed.     

Evaluation of self-contained training procedures for the Time-Sample Behavioral Checklist

The comparative effectiveness of two time-limited modes of training observers to code the behavior of clients in residential treatment programs on the Time-Sample Behavioral Checklist (TSBC) was evaluated. The susceptibility of training procedures to consensual observer drift and the predictability of TSBC mastery from trainee characteristics were also examined. Two equated groups of undergraduate students (N=15 each) participated in full-time training on the TSBC and another instrument for 27 days, followed by criterion testingin vivo and on videotapes. One group was trained by experienced personnel using procedures known to be effective but potentially subject to consensual observer drift. The other group was trained using a previously untested set of written and videotape procedures that do not rely on experienced personnel. Comparative effectiveness and observer drift were evaluated by multivariate and univariate ANOVAs on mastery scores reflecting both pattern agreement and level differences between each trainee and criterion codings. The new, more efficient training procedures were found to be as effective as the original training procedures in the degree of mastery achieved by trainees. Original training procedures were found to be resistant to consensual observer drift, with such a phenomenon appearing in only 1 instance of 156 opportunities. The high degree of mastery achieved by trainees during the time-limited training period was comparable to that previously achieved with the original training procedures. No meaningful predictions of coding mastery were found, with only one trainee characteristic being significantly related to one of six mastery criteria. The results document procedures that are both efficient and resistant to invalidity for training observers in the use of multidimensional observational systems, as well as providing guidelines for the development of standardized procedures.This article is based on a thesis submitted to the Graduate College of the University of Illinois at Urbana-Champaign in partial fulfillment of the requirements for the Ph.D. degree in psychology by the first author and under direction of the second author. The third and fourth authors also participated as supervisors. Appreciation is extended to other members of the thesis committee, Fred Kanfer, Ross Parke, and Julian Rappaport, and to John Gottman and W. Robert Nay for their comments and recommendations. This study was partially supported by Public Health Service Grants MH-25464 and MH-14257 from the National Institute of Mental Health and by grants from the Joyce Foundation, the MacArthur Foundation, and the Illinois Department of Mental Health and Developmental Disabilities.