Therapist Positioning and Power in Discursive Therapies: A Comparative Analysis

The “discursive turn” in therapy gave the therapeutic relationship its deserved significance, which was implied but never fully recognized in traditional therapy literature. The exception would be the writing of Rogers, Satir, and Whitaker. Therapists’ actions in relation to clients became the topic of critical analysis and reflection rather than a resource for addressing some underlying inter- or intra-psychic forces and processes. This paper focuses on the issue of the therapist’s relational engagement with families, particularly the notion of therapist power, as conceived within three discursive approaches to family therapy: narrative, solution-focused, and collaborative.

产前筛查的几点思考

在临床工作中,患者因某些原因不能得到有效或常规的治疗,而最终选择停止继续治疗、即放弃治疗,及时、合理、正确地处理放弃治疗对患者、医务人员、家庭、社会等是极其重要的。对临床上常见的放弃治疗原因进行了全面分析,包括患方、医生、功利、无奈、道德等方面的原因,并提出了解决放弃治疗的临床决策,该研究为临床治疗过程中提供了重要的理论参考。     

Assessment of Psychosocial Outcomes in Genetic Counseling Research: An Overview of Available Measurement Scales

The aim of the present paper was to describe and evaluate many of the measurement scales currently used in genetic counseling outcomes research. A team of three researchers reviewed the available literature and selected a variety of validated instruments suitable for measurement of genetic counseling outcomes. There are numerous scales to assess each of the following outcomes among counselees: satisfaction with genetic counseling; knowledge; decision-making; psychological adjustment; coping; perceived personal control; perceptions of disease risk; and family communication about genetic risk. However, the strengths and limitations inherent to each instrument warrant careful consideration prior to implementation. In the genetic counseling context, scale selection should be undertaken with thought directed towards the characteristics of the research sample (e.g. levels of literacy, culture, medical condition), the practicalities of the research setting (e.g. available funding and resources, time restrictions, researcher expertise), the purpose of the research (i.e. the specific aspect of the genetic counseling experience to be studied), and the science underlying the scale (e.g. theoretical framework, psychometric properties).     

Applying a Theory of Change Approach to Interagency Planning in Child Mental Health

One of the challenges facing nonprofit organizations today is the demand for measurable results. Increasingly, these organizations are focusing less on program outputs and program outcomes in favor of community outcomes or changes demonstrated in the larger community. Success by 6(R) is a popular United Way initiative that emphasizes defining and measuring community outcomes. In this paper, we describe our work with 24 Success by 6(R) initiatives around the country. It is clear that not all of these initiatives are measuring community outcomes. Of those initiatives that are experiencing some success measuring community outcomes, similar measurement strategies are reported. Additionally, our experience suggests several United Way employees express dissatisfaction with the logic model as a framework for defining and measuring community outcomes although no preferred alternative model is identified. Evaluators working with community-wide initiatives must find ways to communicate the differences between program and community outcomes to key stakeholders and funders.     

Adherence to Wraparound Principles and Association with Outcomes

Maintaining fidelity to the principles of the Wraparound process in serving children with emotional and behavioral disorders is a high priority. However, the assumption that greater adherence to the model will yield superior outcomes has not been tested. The current study investigated associations between adherence to Wraparound principles, as assessed by the Wraparound Fidelity Index, second version (WFI), and child and family outcomes in one federally funded system-of-care site. Results demonstrated that higher fidelity was associated with better behavioral, functioning, restrictiveness of living, and satisfaction outcomes. No associations were found for several additional outcomes making interpretation difficult. Our study provides initial support for the hypothesis that maintaining fidelity to the philosophical principles of Wraparound is important to achieving outcomes. The study also provides support for the construct validity of the WFI as a service process measure.     

Rhythms of dialogue in infancy: comments on Jaffe,Beebe, Feldstein,Crown, and Jasnow (2001)

Analysis of coordinated interpersonal timing has become an important tool for the study of infant-adult, peer, and marital interactions. Past research suggests that social coordination is informative about the quality of the caregiver-child social relationship. Does infant experience of certain types of coordination and pattern in early social interactions with caregivers predict better cognitive and social developmental outcomes? The recent monograph "Rhythms of dialogue in infancy" (Jaffe, Beebe, Feldstein, Crown, & Jasnow, 2001) provides the strongest evidence to date that it does. Moderately coordinated social interactions in early infancy predicted the most favorable developmental outcomes, and degree of coordination was influenced by contextual factors such as setting and nature of the relationship between the infant and its social interaction partner. This study provides a model for future research in this area and points toward important questions for future research on infant-caregiver social interactions.     

Sorrow,shame, and self-esteem: Perception of self and others in groups for women survivors of child sexual abuse

Despite evidence that exists about the severity of impact of child sexual abuse (CSA), less has been published about treatment options. Much CSA is enshrouded in secrecy in the context of dysfunctional family dynamics, therefore group work is often recommended as a method of treatment. Although long- and short-term groups are seen as being equally effective, there are few published studies of long-term analytic groups for survivors of CSA. This study was designed to analyse the process of one long-term group. A case is made for using Core Conflictual Relationship Theme (CCRT), a method designed to analyse individual therapy, with reference to group theory. Shifts in self-perception and in relation to others are analysed from the beginning to the end of therapy.     

Behavior Problems in Toddlers With and Without Developmental Delays: Comparison of Treatment Outcomes

The purpose of this study is to examine the effectiveness of an in-home parent management program for toddlers with behavior problems and developmental delays by comparing outcomes for a group of toddlers with developmental delays (n = 27) and a group of toddlers without developmental delays (n = 27). The majority of children lived in single parent, low-income homes. Results suggest that the parent management program is equally effective for children with and without developmental delays. Parents from both groups reported clinically significant improvement in their children's behavior and parenting practices. Clinical implications regarding the importance of these findings for improving outcomes for toddlers with behavior problems and developmental delays living in poverty were discussed.     

Principles of coparticipant inquiry: An introductory outline and implications for therapeutic action

Abstract

Historically, two paradigms have been dominant in clinical psychoanalysis: the classical paradigm, which views the impersonal analyst as objective mirror, and the interpersonal/relational model, which views the analyst as intersubjective participant-observer. An evolutionary shift in psychoanalytic consciousness has, however, been quietly taking place, giving rise to coparticipant inquiry, a third paradigm that integrates the individualistic emphasis of classical theory and the social focus of participant-observation, avoiding the reductionism of each. This new perspective, which is rooted in the radical teachings and clinical experiments of Sandor Ferenczi, represents a significant shift in analytic theory and has major clinical implications. This essay articulates the seven guiding principles of coparticipant inquiry and reviews its contribution to the psychoanalytic theory of therapeutic action. The curative process of reconstructive new experience in the analytic situation, referred to as the “living through” process, is seen to subtend curative change, for both patient and analyst. The inherent mutuality and bi-directionality of this beneficial “living through” process is examined in both its direct and its dialectic coparticipatory aspects.