医生主动放弃治疗的法律问题

医生对身患绝症,没有治疗效果的病人主动放弃治疗给法律带来了三方面的冲击。法律在放弃治疗问题上的革命否定了对该类病人的“治疗”是真正意义上的治疗,否定了延长此类病人的存活期限一定符合病人利益的主张,甚至否定了此类病人的生命权益。在我国有关放弃治疗立法中,应注意对放弃治疗的定义、对象、决定的作出者以及放弃治疗的例外作出界定,设立放弃治疗宣查委员会,在法律上规定其职能,。     

The Influence of Trauma Symptoms on the Therapeutic Alliance Across Treatment

The authors examined the influence of early phase dissociation, interpersonal problems, and retraumatization on the therapeutic alliance at early, middle, and later treatment phases. Participants were 84 female survivors of child abuse (ages 18 to 60 years, 53.6% Caucasian) who were receiving counseling at a university training clinic. Master’s- and doctoral-level students provided counseling using integrated relationship and trauma-based cognitive behavior therapy. Treatment followed a 3-phase model. The authors used structural equation models to test the hypothesis. In the early and later phases, fewer interpersonal problems significantly predicted a stronger alliance. In the middle phase, fewer interpersonal problems, less dissociation, and more revictimization significantly predicted a stronger alliance. Tasks, goals, and bond contributed significantly to the alliance in each of the 3 phases. Interpersonal problems were consistently the strongest predictor across the 3 phases, whereas tasks consistently made the greatest contribution to the therapeutic alliance across all 3 phases.     

Therapeutic Encouragement as Conceptualized by South Korean Youth Counselors

This study explored counselors’ conceptualization and use of encouragement as a therapeutic tool. Responses to two questions from 100 South Korean youth counselors were analyzed using consensual qualitative research–modified. As a result, six categories emerged under each domain. Implications for counseling and future studies are discussed. Este estudio exploró la conceptualización y el uso del apoyo como herramienta terapéutica por parte los consejeros. Usando el método modificado de investigación cualitativa consensual, se analizaron las respuestas proporcionadas a dos preguntas por 100 consejeros surcoreanos que trabajan con jóvenes. Como resultado, surgieron seis categorías bajo cada dominio. Se discuten las implicaciones para la consejería e investigaciones futuras.     

Incarnational Christian psychology and psychotherapy: What do we believe and what do we do?

The following paper proposes a viewpoint regarding the working assumptions, theology and practice for an “incarnational” psychology or “Christian psychology,” particularly with regard to psychotherapy. This essay is primarily meant to be an affirmation and guide for those Christian psychologists and others working in the allied professions. However, both veteran theorists and newcomers to such inquiry will benefit from this essay. Discussion begins with the dynamic of surrendering and receiving a personal relationship with Jesus Christ. The understanding of the unique person as soul: in mind, body, life and spirit is discussed. In addition, the working of the incarnate Holy Spirit is elaborated for both therapist and patient in the regenerative and therapeutic process. Psychopathology is reframed in reference to the Judeo-Christian revelation of sin and evil. In addition, truth, falsity and psychopathology are considered in light of the essentially regenerated man/woman or “new creation” in Christ. Some practical examples for psychotherapeutic intervention are offered, including the unique role of the Christian psychologist and his or her relationship with both patient and Christ. Seven major assumptions of “incarnational” or Christian psychology, which diverge from purely secular (psychological) theory and practice, are presented. Lastly, Christian psychology is distinguished from both “integrated” psychology and theology; and Biblical counseling.

Relationships,not boundaries

The authors find it more useful to payattention to relationships than to boundaries.By focusing attention on bounded, individualpsychological issues, the metaphor ofboundaries can distract helping professionalsfrom thinking about inequities of power. Itoversimplifies a complex issue, inviting us toignore discourses around gender, race, class,culture, and the like that support injustice,abuse, and exploitation. Making boundaries acentral metaphor for ethical practice can keepus from critically examining the effects ofdistance, withdrawal, and non-participation.The authors describe how it is possible toexamine the practical, moral, and ethicaleffects of our participation in relationshipsby focusing on just relationships rather thanon boundaries. They give illustrations andclinical examples of relationally-focusedethical practices that derive from a narrativeapproach to therapy.     

Linking work: from violence to subjectivization

For certain adolescents, the eruption of puberty sometimes carries the risk of a break in their psychic life: a break in their impression of continuity in existence, in the investment of their inner world, and in their relation to external objects. When these adolescents are unable to tolerate the discontinuity that accompanies the experience of adolescence, this can lead to pathologies of compulsive breaking away, depression, violence, or psychosis. Linking work, on the contrary, enables adolescence to become a transforming process on the psychic level and contributes to the dynamic character of the therapeutic process.     

Islamophobia and the therapeutic dialogue: Some reflections

In the atmosphere of fear and controversy that surrounds Muslims at this moment in time it is hardly surprising that they feel unable to voice their fears and concerns openly. Added to this is the fact that Muslims already underutilize mental health services (Patel et al., 2000 Patel, N, Bennett, E, Dennis, M, Dosanjh, N, Matitani, A, Miller, A and Nadirshaw, Z. 2000. Clinical Psychology: ‘Race’ and ‘Culture’: A training manual, Leicester: The British Psychological Society.  [Google Scholar]). In the counselling arena four distinct aspects of the counselling relationship are affected. First, the therapeutic alliance, second, the socio-political context in which counselling occurs, third, the awareness of personal characteristics and competencies that facilitate multicultural counselling and, finally, the training requirements of multicultural counsellors. This paper seeks to consider each of these aspects of the therapeutic encounter with regard to Muslim clients.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken

Metcalf and Dimidjian (this issue) have provided an important review of the current evidence base for mindfulness‐based cognitive therapy (MBCT) and presented a helpful summary of the proposed mechanisms of change. It is necessary to engage in a continuous dialogue regarding the evidence base for change mechanisms, and the article by Metcalf and Dimidjian highlights an important barrier of concern to the field of treatment outcome research. The present commentary aims to expand the discussion regarding the definition, measurement, and evaluation of “mechanisms of change.” Using MBCT as an example, this commentary addresses the ambiguity surrounding the definition and operationalisation of these mechanisms in research on psychological therapies and how the method of measurement may impact the results obtained in clinical trials. It is argued that a potentially fruitful avenue of future research would involve investigation of techniques, important client‐therapeutic processes, and mechanisms in a single study in order to comprehensively evaluate how change occurs.