Psychiatry: The Importance of Understanding Persons While Treating Diagnoses

Modern psychiatry emphasizes chemical, genetic, psychosocial, and similar theoretical biological sciences. While these sciences can explain mental disorders they fail to generate a full understanding of the patient as a person. I argue that psychiatry, to not stereotype persons, must integrate both the important advances in molecular and social sciences needed to diagnose and treat mental illnesses and provide an encounter with the person who is the patient. Standardized forms of diagnostic interviewing now dominate in the psychiatrist–patient relationship. Individualizing forms of inquiry, by contrast, elicit a personal understanding of the patient and her problems and the information necessary to diagnose and treat the patient's mental disorders.

This understanding attitude towards individuals is essential so that psychiatrists avoid falling into over-simplified stereotyping explanations of the persons who are their patients. If psychiatry allows its diagnoses of disordered processes that occur within persons to function as labels for persons, then psychiatry appears scientifically to condone the uses of stereotypes. With an understanding attitude towards patients, psychiatry can better treat mental disorders, while also respecting human diversity.     

Women’s preference of therapist based on sex of therapist and presenting problem: An analog study

An analog study was conducted to examine differences in women’s preference for and anticipated comfort self-disclosing to hypothetical therapists of different sexes based on the type of hypothetical presenting problem. The impact of general level of self-disclosure was also examined. Participants included female college students (n?=?187). Anticipated comfort self-disclosing to male or female therapist was rated by subjects when presented with therapists of each sex with the same qualifications. Women preferred and reported higher levels of anticipated comfort self-disclosing to a female therapist. The type of hypothetical presenting problem and general level of self-disclosure also impacted anticipated comfort self-disclosing. There was an interaction between general level self-disclosure and the sex of therapist on anticipated comfort self-disclosing. General level of self-disclosure only impacted anticipated comfort self-disclosing when the therapist was male. This information is relevant for therapists or organizations that provide psychosocial services to women. Organizations may want to inquire about a client’s preferences about sex of therapist beforehand and, if possible, cater to the client’s preference.     

Puzzles of Discourse in Being and Time: Minding Gaps in Understanding

Abstract

This paper takes issue with Heidegger’s claim that discourse and understanding are equally basic in the constitution of our making sense of the world. I argue that Heidegger cannot consistently establish this claim, and that discourse can be thought of as being more basic than understanding. The proposed line of thinking has the advantage of shedding light on both the finitude and the normativity of our making sense of the world. Thus, by setting up an exchange with the later Wittgenstein’s discussion of rule‐following makes it possible to develop an approach to the normativity of meaning which was not readily available on Heidegger’s account. Further, the paper offers an inquiry into a certain aspect of our finite sense of the world which, in spite of Heidegger’s marked attention to finitude, was obscured by his approach to discourse. The implications of the argument might be far‐reaching. The view of a basic role of discourse can put into question Heidegger’s guiding vision according to which time alone is ultimately the fundamental constituent of our sense of what there is. The engagement with Wittgenstein indicates, in conjunction with other themes of the paper, that there are certain perspectives and issues in phenomenology which are much closer to aspects of the analytic tradition than is usually granted.     

Cognition of Being in the Peak Experiences

Two samples, one gifted, the other “normal,” of 30 children each (11 to 13 years of age) were matched on age, sex, race, and father's occupation. A parent of each child completed the Children's Behavioral Classification Project instrument, and a profile of 30 scaled scores was obtained for each protocol. A discriminant analysis on the basis of the profiles classified 50 of the 60 Ss correctly into their respective sample category, either gifted or normal. Though the results of a multivariate analysis of variance showed no significant differences between the groups when the 30 profile factors were viewed as a whole, univariate analyses on the separate factors yielded significant group differences on several related factors. These were interpreted with caution. Additional factors displayed significant sex differences and one demonstrated a group-by-sex interaction effect.

Coefficients of pattern similarity (the r_p ) were computed among all pairs of the 60 Ss. An unweighted average linkage cluster analysis grouped 34 of the 60 Ss into six clusters which accounted for 26 of 30 possible gifted children.

After an item analysis was performed on the original data, a 42 item subscale of the CBCP questionnaire was constructed which correctly classified 31 of 40 individuals in a cross-validation sample.     

The relationship between emotional-state language and emotion understanding: A study with school-age children

We carried out an investigation with primary-school children on the relationship between both use and comprehension of emotional-state language and emotion understanding. Participants were 100 students between 7 and 10 years old (mean age=8 years and 10 months; SD=15.3 months), equally divided by gender. They completed four tests evaluating their language ability, use of emotional-state language, comprehension of emotional-state language and emotion understanding (EU) respectively. Significant correlations were found between both use and comprehension of emotional-state talk and children's EU. In addition, regression analyses showed that comprehension of emotional-state language, rather than its use, plays a significant role in explaining children's emotion understanding.     

Counter-Closure

The focus of this paper is the prima facie plausible view, expressed by the principle of Counter-Closure, that knowledge-yielding competent deductive inference must issue from known premises. I construct a case that arguably falsifies this principle and consider five available lines of response that might help retain Counter-Closure. I argue that three are problematic. Of the two remaining lines of response, the first relies on non-universal intuitions and forces one to view the case I construct as exhibiting a justified, true belief to which none of the usual diagnoses of knowledge failure in Gettier cases apply. The second line involves claiming that Fake Barns and its ilk are misdiagnosed by epistemological orthodoxy as Gettier cases. We are thus confronted by a trilemma: either the case I discuss undermines the first-blush plausible principle of Counter-Closure; or the case I discuss instantiates a novel kind of Gettier case; or a popular conception of a key range of alleged Gettier cases must be rejected. No matter which horn we choose, the case points to a philosophically curious conclusion.     

A comparison of two online cognitive‐behavioural interventions for symptoms of depression in a student population: The role of therapist responsiveness

Objectives: The study aimed to compare the efficacy of eight weekly sessions of a self‐administered online CBT treatment (cCBT; n=51) to a therapist‐assisted email CBT treatment (eCBT; n=50) in University students. Design: The design was a randomised parallel group trial. The study randomised participants with symptoms of depression to one of two available treatments. Method: Participants were offered eight weekly sessions of either cCBT or eCBT. Participants completed the Beck Depression Inventory‐II (BDI‐II) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) at pre‐and post‐treatment, at weeks 16 and 32 follow‐up. The Working Alliance Inventory‐Short Form (WAI‐SR) was completed at weeks 2, 4, and 6. Results: For both groups, pre‐post within group effect sizes reported were large for the BDI‐II and the CORE‐OM and these were maintained at follow‐up. Perceptions of working alliance were similar in each group, but Bond was significantly stronger for the eCBT condition. WAI scores correlated more positively with the outcome on BDI‐II for those in the eCBT condition than the cCBT condition, but not significantly. Conclusion: There were no significant differences between the two online treatments, both reduced depressive symptoms and improved general functioning. Similarly, at post‐treatment and follow‐up, clinical improvement and recovery was demonstrated for both groups equally. The study demonstrates the possibility for cCBT in a university setting that may contribute to addressing the shortcomings in meeting increasing demands that mental health services presently face.     

Extended problem solving treatment for depression

Introduction: Effective brief psychological approaches for depression that can be delivered by a variety of health professionals with minimal training increase access to treatment by patients. Problem Solving Treatment (PST) was developed for primary care and was modified for this study (EPST) to better meet the needs of mental health patients. Method: A total of 92 therapists from different professional backgrounds completed EPST workshops and treated 92 patients with major depression with interval clinical and treatment process assessments. Results: EPST achieved a significant reduction in depressive symptom scores, life problem scores, and there were few treatment non‐completers. Treatment outcome was predicted by process and therapist variables. Discussion: EPST is an effective and easy to teach treatment that can be delivered by a variety of practitioners and suitable for busy primary mental health care settings.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.