Toward a Reconstruction of Medical Morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

A Grammar of Love

Abstract

Recently researchers in the family therapy field have encouraged a focus on aspects of therapy common across all models that are important to therapeutic change. The purpose of this study was to build on the “common factors” literature by exploring clients' perspectives of what was useful to their therapeutic experience. Quantitative and qualitative measures were used to collect data from 41 clients who participated in therapy at a university-based family therapy clinic. Quantitative results indicated that therapeutic relationship, client motivation, extratherapeutic factors, and hope and expectancy accounted for 49% of the variance of clients' perception of change and 73% of the variance of clients' perceptions of therapy helpfulness. Qualitative results indicated the therapeutic relationship to be the most helpful aspect of clients' therapeutic experience.     

Multicultural Issues in Evidence-Based Interventions

SUMMARY

School psychologists involved in the delivery of psychological and educational interventions face the challenge of identifying interventions that will work within their schools. The evidence-based intervention (EBI) approach has received attention as a promising way to identify effective interventions. The national Task Force on Evidence Based Interventions in School Psychology (sponsored by the American Psychological Association Division 16 and the Society for the Study of School Psychology, and endorsed by the National Association of School Psychologists) has developed coding criteria to review, evaluate, and identify efficacious interventions. This paper expands the work of the Multicultural and Diversity Committee of the EBI Task Force and offers direction for school psychologists in selecting and implementing interventions appropriate for their settings. We explore the meaning of EBIs in the context of a diverse world and discuss the cultural considerations that are necessary to responsibly adopt an EBI perspective. The paper is organized into three sections where we (a) examine EBIs from a multicultural perspective, (b) describe recent advances in infusing a multicultural perspective into EBI work and the Procedural and Coding Manual for Review of EBIs, and (c) offer a set of guidelines for making decisions about implementing an EBI in a new setting.     

Organizational Identification and Perceived Intra-School Conflict Among Secondary Special Education and General Education Teachers

The relationships between the organizational variables-teacher assignment (general education or special education) and primary organizational identification (teachers' individual schools or respective district-level departments) and perceived organizational conflict were investigated. Four-hundred and fifty-four high school teachers—382 general education and 72 special education—responded to a three-part questionnaire. Both general education and special education teachers identified with both the school and the district-level departments to a greater than neutral level; the general education teachers identified more with their local schools than their district-level departments and the special education teachers identified equally with both their local school and the district-level department. Significant correlations between teacher organizational identification and perceived conflict were found for both groups of teachers—as the identification increased, the perception of conflict decreased. No significant differences were found in comparisons of general education and special education teachers on the identification or perceived conflict variables. Conclusions, with alternative causative factors, and recommendations for enhancing relationships between general educators and special educators are provided.     

Inclusion

Summary

In a growing number of schools in the United States, it now is possible to walk into elementary, middle, and secondary classrooms and observe students who could be identified as having moderate and severe cognitive, physical, and emotional disabilities successfully receiving their education together with similar-aged classmates who have no identified special education needs (Falvey, 1995; Lipsky & Gartner, 1997; Schrag, 1998; Villa & Thousand, 1995). This practice of welcoming, valuing, and supporting the diverse learning needs of all students in shared general education environments is referred to as inclusive education, inclusive schooling, or inclusion. This article examines inclusive education along a number of dimensions. First, the evolution of the inclusion moment is briefly examined. After the construct of “severe disability” is considered in the context of inclusive education, various rationale for inclusion are examined along with outcome data, legislation, and legal and U.S. Department of Education decisions which forward inclusive policy. Next, eight factors most frequently associated with successful inclusive education are described and discussed. In describing the factors, examples are provided of specific assessment, planning, and communication processes that support the inclusion of students with intensive cognitive, physical, and emotional disabilities. The article ends with a discussion of the implications of inclusive education for a 21st Century democracy.     

Dynamics of Peer Victimization in Early Adolescence

ABSTRACT

This study addressed the stability of victimization across four consecutive years from Grades 4 to 7, and the concurrent correlates, short-term consequences, and predictors of victimization in early adolescence. Participants were 600 students (49% girls) enrolled in 10 elementary schools in Grades 4-5 and 2 middle schools in Grades 6-7 in an ethnically diverse school system. Data collection included peer nominations, self-reports, and teacher reports in each year. Victimization was highly stable across all years, including the transition from elementary to middle school. Both concurrent and short-term consequences showed that victimized 6th graders, especially girls, experienced significantly greater maladaptive outcomes than their nonvictim counterparts. For both genders, risk factors for adolescent victimization included externalizing and internalizing behaviors, while protective factors included academic and peer sociability elements. Implications for prevention and intervention are discussed.     

A Quantitative Estimate of Schema Abnormality in Socially Anxious and Non‐Anxious Individuals

Although cognitive theories of anxiety suggest that anxious individuals are characterized by abnormal threat‐relevant schemas, few empirical studies have estimated the nature of these cognitive structures using quantitative methods that lend themselves to inferential statistical analysis. In the present study, socially anxious (n = 55) and non‐anxious (n = 62) participants completed 3 Q‐Sort tasks to assess their knowledge of events that commonly occur in social or evaluative scenarios. Participants either sorted events according to how commonly they personally believe the events occur (i.e. “self” condition), or to how commonly they estimate that most people believe they occur (i.e. “other” condition). Participants' individual Q‐Sorts were correlated with mean sorts obtained from a normative sample to obtain an estimate of schema abnormality, with lower correlations representing greater levels of abnormality. Relative to non‐anxious participants, socially anxious participants' sorts were less strongly associated with sorts of the normative sample, particularly in the “self” condition, although secondary analyses suggest that some significant results might be explained, in part, by depression and experience with the scenarios. These results provide empirical support for the theoretical notion that threat‐relevant self‐schemas of anxious individuals are characterized by some degree of abnormality.     

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.