A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

Internet pornography and paedophilia

Various indices of use of Internet pornography have drawn attention to the extent of adult sexual interest in children; clinical experience and now research evidence are accumulating to suggest that the Internet is not simply drawing attention to those with existing paedophilic interests, but is contributing to the crystallisation of those interests in people with no explicit prior sexual interest in children. Drawing on clinical experience in a specialist NHS outpatient psychotherapy service, the author argues that a dichotomous notion of paedophilia is no longer tenable, and any model of paedophilia needs to take account of eruptions of a sexual interest in children in those who appear not to be consistently paedophilic and who have had adult-to-adult sexual relationships. This phenomenon is analysed in two ways: first, by considering how it is that the adult sexual adaptation might ‘unravel’ under the influence of Internet sex to reveal underlying paedophilic currents and second, by revisiting general and psychoanalytic theories of paedophilia and by considering how predisposing factors to paedophilia might be amplified through access to Internet pornography.     

Motivational and cognitive determinants of control during conflict processing

Previous studies suggest that both reward anticipation and expected or experienced conflicts activate cognitive control. The present study investigated how these factors interact during conflict processing. In two experiments, participants performed a variant of the Stroop task, receiving performance-dependent monetary rewards in some blocks. In addition, we manipulated the level of conflict-triggered reactive and expectancy-driven proactive control: In Experiment 1, we compared the Stroop effect after previously congruent and incongruent trials to examine the conflict adaptation effect (reactive control). We found that the level of motivation did not interact with conflict adaptation. In Experiment 2, we varied the proportion of congruent and incongruent trials to manipulate conflict expectancy (proactive control). The data suggest the effects of motivation to be less pronounced under conditions of high conflict expectancy. We conclude that the interaction of motivation with cognitive determinants of control depends on whether these activate proactive or reactive control processes.     

The effects of team strategic orientation on team process and information search

We tested the effects of team strategic orientation on team member perceptions, work strategy and information search. In Experiment 1, 80 teams worked on a hidden profile decision-making task. A defensive team strategic orientation increased members’ perceptions of the problem’s scope, leading to a more process-focused work strategy and broader information search compared to an offensive team strategic orientation. When teams needed critical information from the environment, defensive teams outperformed offensive teams; offensive teams performed better when critical information resided within the team. In Experiment 2, these findings were replicated with 92 teams performing a different decision task. When making a second decision, half of the teams were led to change their strategic orientation; teams shifting from offense to defense altered their information search behavior more readily than did teams shifting in the opposite direction, suggesting an asymmetric adaptation effect.     

Adapting School-Based Substance Use Prevention Curriculum Through Cultural Grounding: A Review and Exemplar of Adaptation Processes for Rural Schools

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin’ it REAL substance use prevention curriculum for a rural adolescent population. We argue that adaptation processes like those presented should be incorporated into the design and dissemination of prevention interventions.     

Physical,Psychological and Social Adaptation of African American Nuns to Their Religious Communities as They Age: Implications for Aging in Place

ABSTRACT

This study examined the association between health status, stress, depression, satisfaction with the relationship with the religious community, alienation from significant persons, racial/cultural identity and “aging in place,” as measured by length of time in the same religious community, for a purposive sample of 72 African American nuns. Aging in place was significantly associated with perceptions of better health status, less stress and depression and greater satisfaction with relationships with the religious community. However, the study also found that the longer the nuns lived in their respective communities, the less racially/culturally identified they became. These findings underscore the need for finding ways to keep nuns in their religious communities as they age and to provide avenues of racial/cultural expression for African American nuns.     

A Controlled Pilot-Outcome Study of Sensory Integration (SI) in the Treatment of Complex Adaptation to Traumatic Stress

This study tested whether sensory integration (SI) treatment combined with psychotherapy would improve symptom outcome over psychotherapy alone in the treatment of complex posttraumatic stress, as measured by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) clinical construct in a group of 10 adult patients with histories of childhood abuse. DESNOS symptoms were assessed at three time periods (T1, baseline; T2, after experimental group SI treatment; and T3, after wait-list control group SI treatment) using the Structured Interview for Disorders of Extreme Stress (SIDES). The Sensory Learning Program? (SLP), developed by the Sensory Learning Institute of Boulder, Colorado, was used as the SI treatment modality. Results indicated significant differential improvement for the group treated with SLP in SIDES Total Score (T1/T2 and T2/T3), Self Perception (T1/T2 and T2/T3), Affect Regulation (T2/T3), and Alterations in Meaning (T1/T2).     

In- and out-of-school peer groups of immigrant youths

Multiethnic societies typically aim to have immigrant and native youths mix and be friends, preferably in all contexts in which they spend time. Schools and neighbourhoods are the two settings where youths spend the most time with peers during adolescence. The present study explored the in- and out-of-school peer groups of 174 immigrant junior high school pupils (Mean age = 14.39) who attended an integrated school but lived in a segregated neighbourhood. A person-oriented approach was used and cluster analyses were conducted both within and across the two settings. The results show that youths mostly have the same kind of friendship formations in both settings, regardless of the ethnic composition of each setting. In terms of adaptation, the results consistently show that for boys, having only immigrant friends is related to problematic adaptation in both settings. No relationship between peer formations and adaptation was found for girls. The study highlights the importance of considering gender and viewing youths as embedded in systems of multiple settings, in order to achieve true integration.     

Drivers’ illusions––no more risk

In this invited address to the International Congress of Applied Psychology, it is argued that traffic psychology has not had a major impact on accident prevention. The factors that have determined this are discussed. A review of the theories and models pertinent to drivers’ risk taking and road user behaviour in general is presented. It is argued that both risk-homeostasis theories and task capability model are not sufficiently precise to be used as a basis for preventive measures. Attitude–behaviour models derived from social psychology have proved to be powerful in identifying motivational factors influencing road user behaviour, but the majority of empirical evidence is based on self-reported rather than observed behaviour. It is argued that individual differences can provide a basis for accident prevention, in particular driver training.