Affektive Interaktion zwischen Patienten und Therapeuten

Zusammenfassung Eine positive therapeutische Beziehung wird therapieschulenübergreifend als wichtige Voraussetzung für den Therapieerfolg angesehen. Meist wird jedoch in Studien lediglich die schriftliche Patienteneinschätzung erfasst. Nonverbale Aspekte der Interaktion zwischen Patienten und Therapeuten werden kaum untersucht. Aus einer Studie zur Vorhersage des Erfolgs stationärer Fokaltherapie werden affektive Interaktionsprozesse im Erstinterview exemplarisch zwischen einer erfolgreichen und einer nicht erfolgreichen Behandlung mit mikroanalytischen Verfahren (facial action coding system, FACS) verglichen. In der nicht erfolgreichen Therapie waren die mimischen Affektäußerungen reziprok; Therapeutin und Patientin zeigten ähnliche vorherrschende (sog. Leit-)Affekte. Erfolgreicher waren die Behandlungen, wenn die Therapeuten komplementäre Affektmuster zeigten. Implikationen für Behandlungstechnik, Supervision und Weiterbildung werden diskutiert.     

Doctor's Expertise and Managing Discrepant Information from Other Sources in Genetic Counseling: A Conversation Analytic Perspective

The study examines a recurrent interactional pattern in genetic counseling. It describes clinical geneticists' responses in situations in which clients have presented information from other sources that is potentially discrepant with information given by the doctor. The data consists of 12 video-recorded sessions of genetic counseling in Finland, and the method is conversation analysis. There are two primary ways the doctors respond: either they accept the client's information as such, but show that it is not discrepant with the doctor's information, or they reject the client's information. In the latter case they mitigate the ‘wrongness’ of the client's information. The clinical geneticists seem to be working with a dilemma: they need to find a balance between ensuring correct understanding of the information and showing respect for the expertise of others. A particularly complex case is also analyzed and reflected on.     

Care of the Self and Patient Participation in Genetic Discourse: A Foucauldian Reading of the Surgeon General's “My Family Health Portrait” Program

Critics of genetic discourse are concerned that deterministic and discriminatory views of genetics are increasingly becoming adopted. These views argue that current genetic discourse becomes a source of power whereby powerful institutions harm people with so-called “bad” genes. This essay argues that current analyses of the power of genetics discourse are grounded in an improper reading that disempowers patients. Deploying Michel Foucault's concept “care of the self,” this essay claims that genetics discourse is better understood as a way that patients take on power through rhetoric rather than a force that has power over patients. Through a close reading of the “My Family Health Portrait” program, this paper argues that patients experience a process of “subjection” wherein they become agents of and objects of genetics discourse both. This alternative mode of analyzing the power of genetics discourse has implications for our collective understanding of the operations of the care of the self and the uses of genetic information that we propose.     

Differences in Individual Approaches: Communication in the Familial Breast Cancer Consultation and the Effect on Patient Outcomes

This multicenter study aimed to assess (i) whether individual clinical geneticists and genetic counselors vary in their communication skills and (ii) whether this variation in communication impacts on patient outcomes, such as anxiety, depression, genetics knowledge, and satisfaction. One hundred and fifty women from high-risk breast cancer families attending their first genetic counseling consultation completed pre and post-consultation self-report questionnaires. The consultations were audiotaped and transcribed verbatim. Univariate analyses showed highly significant differences between individual clinical geneticists and genetic counselors in: facilitating understanding (p 0.001); facilitating active involvement (p 0.001); facilitating partnership building (p = 0.003); addressing emotional concerns (p 0.001); and discussing prophylactic mastectomy (p = 0.017). Multivariate linear regressions showed that this variation in communication resulted in a greater change in patients depression 4 weeks after the counseling session (p = 0.017). These findings suggest clinical geneticists and genetic counselors have achieved some standardization in communicating information, but showed diversity in their facilitation skills. Communication skills may be a useful area to explore further in this field.     

“Hands up Who Wants to Die?”: Primoratz on Responsibility and Civilian Immunity in Wartime

The question of the morality of war is something of an embarrassment to liberal political thinkers. A philosophical tradition which aspires to found its preferred institutions in respect for individual autonomy, contract, and voluntary association, is naturally confronted by a phenomenon that is almost exclusively explained and justified in the language of States, force and territory. But the apparent difficulties involved in providing a convincing account of nature and ethics of war in terms of relations between individuals has not prevented liberal theorists from attempting this task. This paper examines a recent attempt by Igor Primoratz to sketch out the implications of a consistent liberalism for just war doctrine and, in particular, as regards the question of who may be a legitimate target of attack in wartime. Primoratz’s paper itself is a critique of Michael Waltzer’s authoritative exposition of just war theory for failing to be sufficiently and consistently liberal. The debate between these two authors is a productive site for investigating the potential and limitations of liberal theories of just war.     

2003年诺贝尔医学奖给科学界的多重启示(上)

2003年诺贝尔医学奖授予了两位美英物理学家,劳特布尔和曼斯菲尔德,表彰他们在磁共振成像方面的发现.这些发现导致现代磁共振技术的开发,这一技术标志着医学诊断学和科学研究中的一项突破.该项发现建筑在核磁和核磁共振现象被发现的基础之上.核磁现象的发现及其应用导致了1943、1944和1952年诺贝尔物理学奖的获得.核磁共振现象的发现及其应用导致了1991年和2002年诺贝尔化学奖的获得.这意味着,2003年诺贝尔医学奖是该系列发现中第六个诺贝尔科学奖.     

Something from nothing: exploring dimensions of children's knowing through the repeated reading of favourite books

Witte‐Townsend and DiGiulio explore some of the dimensions of knowing that children, teachers and parents may engage together during story‐time. They reflect on some of their own long‐term relationships with children and children's books, especially Phoebe Gilman's Gilman P 1992 Something from nothing (New York, NY, Scholastic Inc)  [Google Scholar] Something from nothing (published in 1992) and Simms Taback's Taback S 1999 Joseph had a little overcoat (New York, NY, Viking‐Penguin)  [Google Scholar] Joseph had a little overcoat, published in 1999. The authors probe issues such as why children ask to hear a favourite story over and over and why they suddenly abandon all interest and move on to a new book. They explore the meaning of the silences that sometimes arise during story‐time, pooling around the young listeners as the last words of the book are read. Witte‐Townsend and DiGiulio remind us of the value of literature in the lives of children and they affirm that the reading and re‐reading of favourite stories enables the understanding of complex human issues and contributes significantly to social, emotional and spiritual growth.     

Changes in values cognition after rating values-associated feelings

This study investigated values change as an outcome of assessing feelings elicited by contemplating the actualization of the same values. The subjects were divided into an experimental and a control group. They completed three tests in a single session. In the pretest, all subjects were asked to rate the importance of 20 values items on a 4-point scale. Subjects in the experimental group were then asked to rate the degree of pleasure they would feel in actualizing each of the values, while those in the control group rated the degree of inequality they considered women suffer in the actualization of each of the values. The post-test consisted of the same items as the pretest. The subjects in the experimental group completed a second post-test 3 months later. It was found that the experimental procedure produced significant change in the ratings of 15 values at the post-test, whereas the control procedure produced change in only five. The results suggest that rating one's emotional response to a value-related situation can change one's cognition of that value. At the post-test 3 months later, only 3-value ratings remained changed.     

Use of newsletters to promote environmental political action: an experimental analysis

The managers of beach businesses were randomly assigned to receive no intervention or two newsletters per week for 6 weeks that presented economic consequences of damage to coastal water quality and how to contact politicians. The percentage of proenvironmental political contacts was significantly greater in the experimental (newsletter) group than in the control group. Logistical regression showed that contacts in the newsletter group were more than five times that of controls after adjusting for history of contacts and predisposition to take such action. Results suggest that the intervention can promote political action that could influence environmental policies and human health.     

Government Subsidized Academic Research: Economic and Ethical Conflicts

Justification for public funding of academic research is based on the linear model of technological advance first proposed by Francis Bacon. The model hypothesizes that government subsidized science generates new technology which creates new wealth. Mainstream economics supports Bacons model by arguing that academic research is a public good. The Bayh–Dole Act allows universities to privatize federally funded research and development (R&D) which is in direct conflict with the public good argument. Diminishing returns to university R&D, challenges to Bacons linear model and the labor exploitation of young scientists by research universities suggest that policy makers may want to reconsider the system for allocating federal R&D to universities and colleges.