Complexity science: A framework for psychotherapy integration

The paradigm of complexity science provides a new way to address the problem of psychotherapy integration and allows us to bypass the various shortcomings of the linear-interventionist perspective. Nine criteria are outlined, which should be satisfied by any integrative approach to psychotherapy: (a) the use of complexity science to provide a meta-theoretical and generic understanding of change processes (from neuronal to social system levels); (b) a comprehensive and formalised modelling of change processes and personality development; (c) an integrative method of case formulation; (d) the ability to understand a variety of techniques in terms of basic change principles; (e) criteria to guide microdecisions; (f) the application of data-driven feedback and real-time monitoring of change dynamics; (g) standardised assessment of outcomes in naturalistic settings; (h) guidelines for training; and (i) strategies that are well-suited to science–practice integration. Using these criteria as a framework for evaluation, one may grasp the potential of complexity science to drive innovation in the pursuit of psychotherapy integration.     

Fictional Stories With Ethical Content: Guidelines for Using Stories to Improve Ethical Behavior

Fictional literature has been used as a pedagogical tool to elevate student awareness and moral reasoning, ultimately helping them to develop sound decision-making skills when they are confronted with ethical situations. However, the use of fiction for teaching ethics is still uncommon, leaving considerable potential for advancement. This particular study develops theoretical guidelines for using fictional stories with ethical content (FSECs) as a suitable method for teaching ethics. The FSEC guidelines include a working definition and 5 supporting principles that collectively differentiate FSECs from other forms of fiction that can be used for teaching ethics.     

Dementia and Suffering in Nursing Homes

SUMMARY

This paper uses case studies of challenging behaviour associated with dementia to demonstrate, firstly, that disturbed behaviour is often a manifestation of suffering caused by multiple phenomena such as medical problems or the care environment. Addressing these causes instead of simplistically ‘treating the behaviour’ usually reduces the behaviour. Secondly, staff distress with a particular difficult resident is often caused by more general fundamental problems such as a lack of support or knowledge. Addressing these problems reduces staff distress. Finally, results from a Swedish intervention study are presented. They show that suffering for both staff and residents can be reduced, and quality of life improved, by providing increased autonomy for hands-on staff, systematic emotional support, and collaboratively developing care plans based on each resident's emotional and physical needs, rather than the problems they present.     

On Using a Cancer Center Cancer Registry to Identify Newly Affected Women Eligible for Hereditary Breast Cancer Syndrome Testing: Practical Considerations

The goals of this research were to describe the process of identifying and recruiting individuals registered with a cancer center's cancer registry who were eligible to participate in cancer genetic research. This study specifically focused on younger women with personal and family cancer histories strongly suggestive of hereditary breast cancer syndromes, as determined by genetic counselor review. Of special interest was to determine the proportion of women from minority backgrounds who were (a) identifiable in this manner and (b) interested in genetic testing for hereditary breast cancer through a family cancer clinical research program. An initial query of the 292 cases of women newly affected with breast cancer and contained within the registry indicated that 124 met demographic eligibility criteria. The personal and family cancer histories of each of these women were then reviewed by a genetic counselor and the remaining, eligible patients (n = 31) were subsequently contacted by mail and telephone: approximately three-fifths (18/31) of these patients were White and two-fifths (13/31) were Black or of another racial background. Of the women who were sent one or more study-related mailings, 10% (3/31) were unreachable by telephone due to incorrect contact information, 32% (10/31) were reachable by telephone but unresponsive to messages left, 26% (8/31) had already participated in the family cancer program (i.e., were positive controls), 6% (2/31) were interested in participating in the program, 23% (7/31) were uninterested in participating in the program, and 3% (1/31) were later determined to be ineligible. Comparing the racial backgrounds of women who were either positive controls or interested in participating (i.e., “tester” category) to women who were either unreachable, nonresponsive, uninterested, or ineligible (i.e., “nontester” category), there was a nonsignificant trend for more non-White women to fall into the nontester than tester category, Fisher's Exact Test = .09. This work underscores practical steps in planning and carrying-out cancer genetic testing research among women newly affected with breast cancer and members of special populations. It also underscores the role that genetic counseling professionals play in this process.     

Yoga and the battlefield of ethics: Highlighting an infusion model for ethics education

This paper articulates an infusion model of ethics education for engineering students by illuminating the value of a religious studies course on yoga. This model is distinguished from four other possible approaches that have traditionally been used to prepare engineering students to face the challenges of the work place. The article is not claiming that this approach should be used to the exclusion of the other approaches, but rather that it adds strength to the other approaches. Specifically, the article claims that the infusion model provides an opportunity for students to reflect upon the foundational ethical positions emanating from the world's religions and thereby provides them with a vista from which they can not only ask what professional ethical code applies in a given situation, but also ponder the nature of character needed to follow that ethical code.     

An Analyst’s Experience Working In A Skilled Nursing Facility: A Case Study

With the closing of long-term psychiatric facilities, no alternative social institution has arisen to treat those persons whose chronic mental illness makes self-care impossible. This paper explores the typical paths to placement in a skilled nursing facility or nursing home and the author’s experience in working with this population using the principles and techniques of interpersonal psychoanalysis. She presents several case examples and explicates both the analyst’s and the patient’s transference. The author discusses the difficulties inherent in creating an analytic space in such a setting and working outside of the usual psychoanalytic frame.     

The Logic of Analogy in the Law

This paper deals with two issues in the field of reasoning by analogy in the law. The one issue is whether there exists such a thing as analogous rule application, or whether there is only the ‘normal’ application of a broadened rule. It is argued that if rules, as the entities made by a legislator, are distinguished from generalised solutions for cases, the idea of analogous application of rules makes sense. It is also shown how the so-called ‘reason-based model of rule application’, in contrast to the traditional modus ponens or subsumption model, makes it easy to give a logical account of analogous rule application. The other issue is how to argue logically about whether two cases are sufficiently similar to adopt the outcome of the one case for the other case. Section 3 provides a general logical model to establish this. The model is based on the comparison of the reasons for and against a particular solution in the two cases.     

Ayahuasca in Western society and the metacognitive counselling approach

Ayahuasca is a hallucinogenic plant used throughout South America for religious, cultural and healing ceremonies. Previous studies have analysed it as a therapy method from either the microperspective, such as physiological and psychological effects of substance use, or the macroperspective, such as legal issues or cultural appropriation of ayahuasca by Westerners. There is a need to combine those two aspects to fully understand the effects of ayahuasca for therapists and clients in Western communities. By utilising an autoethnographic instrumental case study, we discuss the possible risk of ayahuasca gaining popularity in Western societies without an understanding of how the social context plays a tremendous part in healing using this method. We also discuss the risk of intrapsychic experiences brought about by ayahuasca that may deter individuals from seeking appropriate treatment. It is not our intention to present ayahuasca as an illegitimate or invalid method of healing; rather, we emphasise the importance of integrating micro- and macroperspectives in psychotherapy practice. We suggest that the metacognitive counselling approach be taken by both clients and therapists when adopting indigenous methods of therapy which may add a significantly positive effect. Although we hope this study offers realistic and lived experiences to generate pragmatic solutions for therapists and clients, we recognise that it is necessary to collect data from a larger number of both clients and therapists to better support our suggestion of the metacognitive counselling approach.     

Getting started: Charles Darwin's early steps toward a creative life in science

Charles Darwin's original and important contributions to science resulted from commitment, persistence, and hard work throughout his adult life. How, when, and where Darwin developed these prerequisites for creative thinking is the focus of this paper. Using a cognitive case study approach to examine the rich record of Darwin's life and work indicates that the 1 &frac; years he spent in Edinburgh as a medical student when he was 16–18 years old was the major turning point in his transformation from a hobbyist into a scientist. Darwin first found hisvoice in science in Edinburgh during late adolescence.     

Philip Roth'sPatrimony: Narrative and ethics in a case study

I assess the ethical content of Philip Roth's account of his father's final years with, and death from, a tumor. I apply this to criticisms of the nature and content of case reports in medicine. I also draw some implications about modernism, postmodernism and narrative understandings.A version of the first two sections of this paper was presented at the annual meeting of the Society for Health and Human Values November 6, 1993, Washington, D.C.