Borderline personality disorder in an intermediate psychological therapies service

The intermediate psychological therapies service is provided for individuals referred with common mental health problems within the primary care psychological therapies service, but whose difficulties are longstanding and/or complex. The prevalence of borderline personality disorder (BPD) in intermediate psychological therapy services has not been researched to-date. The current study aimed to measure the prevalence of BPD amongst patients attending intermediate psychological therapies (n?=?63). The prevalence of BPD was established by identifying the number of patients who met DSM-IV criteria. BPD prevalence amongst patients attending an intermediate psychological therapy service was 37%. The high proportion of patients presenting with BPD indicates the potential need for staff training and supervision in how to manage such high levels of need at this service level. This is the first study to report prevalence rates of BPD specifically in an intermediate care psychological therapy service.     

Measuring social influence of a senior midwife on decision‐making in maternity care: an experimental study

The document Changing Childbirth produced by the Department of Health (1993) requests provision of more choice, continuity and control for women during pregnancy and childbirth. In this context this study considers whether midwives'decisions are influenced by a senior midwife. A simple, valid and reliable scale—the Social Influence Scale for Midwifery (SIS‐M)—was devised to measure and score midwives' private anonymous responses to 10 clinical decisions. The SIS‐M was initially administered as a self‐completed postal survey by 209 midwives. Following a 9‐month time gap, a stratified sample of 60 (20 E, F, G grade midwives) were invited for interview in which a senior midwife attempted to influence SIS‐M responses in a conformist direction. Overall, a 3 × 2 (E, F, G grade midwives x private and interview SIS‐M scores) analysis of variance (ANOVA) revealed midwives were significantly more conformist when influenced by a senior midwife, in comparison to private anonymous responses. No significant interaction between groups was found. These findings indicate that there is influence of a senior midwife on clinical decisions that should be woman‐centred, according to Changing Childbirth (1993). The implication is that this influence may remove choice from women. Copyright © 2005 John Wiley & Sons, Ltd.     

Dementia care‐giving in black and Asian populations: reviewing and refining the research agenda

Despite the increased prevalence of dementia little work has been done to explore the extent and nature of care‐giving in black or Asian‐UK populations. Evidence that does exist suggests that the consequences of care‐giving are significant but different from those experienced by white carers and are mediated by a number of culture‐related factors. These include: ethnically specific conceptualisations of dementia; expectations of family duty; religiosity; the adoption of positive re‐appraisal strategies, and beneficial outcomes. Present approaches to research are narrow, do not take account of cultural dimensions and employ terminology and care‐giving frameworks which are of limited relevance. That the evidence base is characterised by small‐scale studies, and weak methodology further undermines its validity. Research deficits are systemic and fundamental and are both conceptual and methodological. A key contribution would be the development of a multi‐dimensional theoretical model that takes account of the role played by culture, ethnicity and structural inequality in shaping care‐giving experiences and profiles. Incorporating the perspectives of black and Asian carers, and the influence of the life course of individuals and communities and employing qualitative methods would also influence the direction of research, improve its quality and generate knowledge in this underdeveloped field. Copyright © 2005 John Wiley & Sons, Ltd.     

开放医疗市场 强化政府责任 解决看病难

当前对医疗改革的批评较多,不少人认为是过度市场化的结果。但是,“过度市场化”的问题不能一概而论,可以从两个方面来分析,从医疗服务方面来说,有过度市场化的倾向;但是从医疗资源的配置或投入来说,市场又没有充分放开。所以不能简单的或笼统的把医改的问题归咎于市场化。该开放的医疗市场未开放,政府责任不到位,才是当前中国医疗改革的问题所在。     

Widows, women, and the bioethics of care.

Widows, women, and the bioethics of care must be understood within an authentic Christian ontology of gender. Men are men and women are women, and their being is ontologically marked in difference. There is an ontology of gender with important implications for the role of women in the family and the Church. The Christian Church has traditionally recognized a role for widows, deaconesses, and female monastics, which is not that of the liturgical priesthood, but one with a special relationship to care and therefore with particular implications for health care and a Christian bioethics of care in the twenty-first century. In the shadow of early male mortality, women as wives should turn to support their husbands and as widows to support those in need. Widows, in becoming authentic Christian monastics, can bring into the world an icon of rightly ordered women providing rightly ordered Christian care for those in need. They can enter the moral vacuum created by misunderstandings of the place of women and the service vacuum created by a disappearance of religious nuns in Western health care facilities with a presence that is at one with the Church of the Fathers.     

New interpretative styles: Progress or contamination? Psychoanalysis and phenomenological psychopathology1

Psychoanalysis has started to recoup, often quite implicitly, a more phenomenological stance, ever since psychoanalysts have started working with borderline and psychotic patients. As many of these patients have commonly been through traumatic experiences, psychoanalysts have been using an approach that questions the role of traditional psychoanalytical interpretation and pays more attention to the patient's inner conscious experiences; this approach is characteristic of a specifi c form of contemporary psychiatry: phenomenological psychopathology, founded by Karl Jaspers in 1913 and developed into a form of psychotherapy by Ludwig Binswanger, with his Daseinsanalyse. If what we could call a phenomenological ‘temptation’ has been spreading over psychoanalysis, so too has a psychoanalytical ‘temptation’ always been present in phenomenological psychopathology. In fact, even though this branch of psychiatry has led us towards a deeper understanding of the characteristics of psychotic being‐in‐the‐world, its therapeutic applications have never been adequately formalised, much less have they evolved into a specifi c technique or a structured psychotherapeutic approach. Likewise, phenomenological psychotherapy has always held an anaclitic attitude towards psychoanalysis, accepting its procedures but refusing its theoretical basis because it is too close to that of the objectifying natural sciences. Psychoanalytic ‘temptation’ and phenomenological ‘temptation’ can thus be considered as two sides of the same coin and outline a trend in psychoanalytic and phenomenological literature which points out the fundamental role of the patient's inner conscious experiences in the treatment of borderline and psychotic patients.     

终末期癌症病人诊治中的心理特征与人文关怀

在诊治终末期癌症病人过程中不仅要关心他们的躯体方面,更要关心他们的心理方面,在诊治过程中要根据他们的独特的心理特征来进行人文心理关怀,维持生命质量和保证他们应有的人格尊严.     

A Standard of Care for the Assessment of Suicide Risk and Associated Treatment: The Florida State University Psychology Clinic as an Example

The Florida State University has established a set of guidelines to be used as a standard of care for suicide. This standard of care guides therapists through a suicide risk assessment that focuses on key variables related to suicidal behavior that are among the best predictors of completed suicide. This standard of care includes necessary components of suicide risk assessment, critical steps to follow to ensure the safety of suicidal patients, treatment recommendations, and guidelines for minimizing the legal risk of the therapist. Though this standard of care was developed in a research and training clinic, these principles may be applied to all clinicians offering psychological services to patients, regardless of the nature of the clinic or setting.     

“One Size Fits All”: An Existential-Constructivist Perspective on the Crisis Intervention Approach with Suicidal Individuals

The empirical data on the relationship between suicide and suicide attempts are interpreted as suggesting that the contemporary assessment and intervention approaches to suicidal individuals are, by and large, ineffective. In support of our argument, we focus on the crisis intervention model as one example and suggest that the crisis intervention approach to responding to suicidal individuals is at best, ineffective and, at worst, can be viewed as exacerbating suicidal risk through its distancing, marginalizing, and stigmatizing effects. Additionally, we hypothesize that the mechanics of the crisis intervention model contribute to the societal message that a meaning and contextual-based discussion of suicidality is taboo and that this message tends to continue into more long-term psychotherapeutic approaches. Along these lines, we present an alternative to the crisis intervention model grounded in an existential-constructivist theory of suicidal behavior and the principles of therapeutic and feminist assessment philosophies as an heuristic intended to stimulate the development of new and innovative approaches to working with suicidal individuals.     

Dynamic Psychotherapy and the Problem of Time

This paper examines the dilemmas psychodynamic clinicians face in dealing with the challenges of the current clinical climate. We look to our theories, to the evolution of psychodynamic technique and to the collaborative nature of the therapeutic endeavor as they relate to the goals of psychotherapy. A case illustration is provided, and guidelines are offered for current professional practice.