Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians’ recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians’ attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.     

Jungian Constructivism and the Value of Uncertainty

Introducing the basic assumptions of constructivism as a philosophical position, this paper illustrates how Jung's psychology - especially complex, archetype and transcendent function - is consonant with constructivism. Further, the paper explores some clinical implications of constructivism by reviewing the problems of chronic projective-identification in a stalemated analytic case, drawing on the contributions of Winnicott, Ogden and Modell in expanding our understanding of, and facility with, the transcendent function.     

From dialectic to organization: Bogdanov’s contribution to social theory

This paper situates Bogdanov in the context of social theory generally and socialist theory in particular. It outlines briefly the principal characteristics of his mature system, and assesses the strengths and weaknesses of his approach to the fundamental problems of social thought. The paper devotes particular attention to the problem of just how systems develop from less complex to more complex forms of organization, and evaluates Bogdanov’s solution to this problem against the background of populist, social democratic, and Leninist alternatives.     

Consider the source: One step in assessing premise acceptability

Premise acceptability is conceptually connected to presumption. To say that a premise is acceptable just when there is a presumption in its favor is to give a first approximation to this connection. A number of popular principles of presumption suggest that whether there is a presumption for a premise, belief, or claim depends on the sources which vouch for it. Sources consist of internal belief-generating mechanisms and external testimony. Alvin Plantinga's notion of warrant lays down four conditions upon a source for the belief which it generates to be warranted. We argue that there is a presumption for a premise, belief, or claim if and only if there is a presumption of warrant for that premise,belief or claim. This amounts to the thesis that there is a presumption for a belief from a challenger's point of view if and only if there is a presumption from that person's point of view that her cognitive faculties which have generated the belief have been functioning properly, in an appropriate cognitive environment, in accord with a segment of her design plan aimed at the truth, and that these faculties are reliable. In light of our argument for this thesis, we may legitimately claim that one way to determine that there is a presumption for a belief is to determine that there is a presumption of warrant for that belief, and thus that in determining whether there is a presumption for a belief or premise, we may consider the source.     

辩证行为疗法：理论背景、治疗效果及作用机制

辨证行为疗法（Dialectical Behavior Therapy, DBT）于20世纪90年代初由美国治疗师Linehan创立。作为第三代行为治疗之一,该疗法以行为主义理论、辩证哲学、生物社会理论及禅宗为哲学基础,通过增加患者的技能使用,提高其情绪调节能力,以达到治疗目的。临床研究已证明其在边缘人格障碍,自杀及自伤行为中具有良好的治疗效果,除此之外也广泛适用于其他心理障碍及群体。DBT的临床效果、改变机制及拓展应用都需进一步研究。     

Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

An Exploration of Johnson's Sense of ‘Argument’

This essay attempts to give definitions and identity conditions for the two predominant senses of Argument currently in use, the one involving reasons for a conclusion and the other denoting an expressed disagreement with ensuing verbal behaviour by two parties. I see Johnson's new concept of Argument, as developed in his book Manifest Rationality, as a hybrid of the two common senses of Argument, and, accordingly, I try to define and give the identity conditions of Johnson-arguments. Finally, I disagree with Johnson on the nature of the definition he thinks he has proposed, and I conclude with observations suggesting that his logical perspective has dialectical and rhetorical components.     

Developmental Differences in Metacognition and their Connections with Cognitive Development in Adulthood

This study investigated developmental differences in some metacognitive variables in ill-defined problem solving and their possible connections with cognitive development in adulthood. Participants were 57 individuals of different ages (adolescents, young adults, mature adults and older adults). They solved one well-defined and six ill-defined problems while their thinking-aloud was taped. They then answered a metacognitive statements questionnaire. Differences in performance were statistically significant in all problems: the best results in interpolation and divergent production problems were achieved by the younger adult group and the best performance on most dialectical everyday problems was found in the mature adults' group. We found no significant differences between age groups in the on-line monitoring of the solving process. Accuracy in metacognitive statements was however significantly better in the mature adult and the younger adult groups. Awareness of and reflection on one's own mental processes showed a similar developmental pattern to relativistic/dialectical thought: low expression in adolescence, an increase in early adulthood, a peak in mature adulthood and a minor decline in later years.