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.     

In Defence of Kripkenstein: On Lewis’ Proposed Solution to the Sceptical Argument

Abstract

In Wittgenstein: On Rules and Private Language, Saul Kripke argues for an extreme form of meaning scepticism. One influential reply to Kripke’s arguments was developed by David Lewis. The reply developed by Lewis makes use of the notion of mind-independent relations of similarity and difference. The aim of the paper is to argue that Lewis’ reply is not satisfactory: the challenge to find a refutation of Kripke’s sceptical arguments remains unmet.     

A Primer on Psychological Theory

This paper addresses some of the principal constituent elements in the formation of theories in the science of psychology. To that end, means of theory construction, concomitant theory functions and types, and norms of acceptance are presented. Where appropriate, efforts were made to cite particular historic or contemporary theories of human behavior as cogent exemplars.     

What are the positive consequences of illness?

Abstract

Fifty five people, either currently sick or having recovered from their illness, were recruited if they reported positive consequences of illness. They were questioned about their experiences of illness, 41 by semi-structured interview and 14 by open-ended questionnaire and responses were classified into 17 categories. The categories were similar but slightly more extensive than previous accounts of positive consequences reported in the literature. The content of the interviews and questionnaires was used to construct a 66 item questionnaire about positive consequences of illness which was then completed by 97 patients. A principal components analysis indicated a large first factor accounting for 27% of the variance. Endorsement of items varied between 87% and zero for chronic lung disease patients attending pulmonary rehabilitation. However, all patients endorsed at least one item and the median number of items endorsed was 31. Positive consequences of illness are highly varied and more common than often realised, and this has implications for the concept and measurement of quality of life.     

Against Magnetism

Magnetism in meta-semantics is the view that the meaning of our words is determined in part by their use and in part by the objective naturalness of candidate meanings. This hypothesis is commonly attributed to David Lewis, and has been put to philosophical work by Brian Weatherson, Ted Sider and others. I argue that there is no evidence that Lewis ever endorsed the view, and that his actual account of language reveals good reasons against it.