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.     

One size doesn't fit all: Full inclusion and individual differences

Recent studies have documented the increasing trend among school districts toward adopting full inclusion as the predominant model for serving students who qualify for special education services. Although these data may suggest that a paradigm shift has already taken place and that a consensus of opinion has been achieved, several organizations representing students with specific disabilities continue to support a continuum of placement options. This paper challenges a one size fits all approach to special education, and highlights the importance of considering the individual characteristics of students. The relevance of research on full inclusion, as well as methodological issues that limit generalizability of findings related to student outcomes, are discussed. The radical perspective of full inclusion is rejected in favor of an approach that emphasizes the complexities of placement decisions.     

Teacher efficacy: A model for teacher development and inclusion

Students with special needs must have the opportunity to learn in inclusive classrooms. However, this requires that classroom teachers believe that (a) students can learn in spite of any negative environmental influences in their lives, and (b) they personally have the ability to reach any student. Securing this teaching efficacy for teachers in inclusive classroom settings requires paradigm shifts in preservice and inservice teacher development programs with the precept that all students can learn and that we can assist them. The authors, one a regular and the other a special education teacher educator, collaborate to explore the issue of how best to provide and maintain a positive personal teaching efficacy among regular teacher education candidates who are faced with the challenges of having students with varying levels of ability and behavioral responses in their classrooms.     

An investigation of peak shift and behavioral contrast for autoshaped and operant behavior.

Instrumental treadle press and nonreinforced key peck responses were monitored during discrimination training and generalization testing in pigeons on positive and negative reinforcement schedules. In Experiment 1, six pigeons pressed a treadle for food on a multiple variable-interval extinction schedule. In Experiment 2, three pigeons pressed a treadle to avoid shock on a multiple free-operant avoidance extinction schedule. Different color keylights signaled S+ and S- components. Some positive behavioral contrast occurred during discrimination training, but the effect was small. Pecking occurred to the S+ keylight in Experiment 1 but not in Experiment 2. On stimulus generalization tests, all subjects displayed a positive peak shift when pressing the treadle for food or to avoid shock. However, peak shift was not found for nonreinforced "autopecks" on the stimulus key, although an area shift was observed in Experiment 1. This is the first demonstration of peak shift for pigeons pressing treadles and the only reliable demonstration of peak shift when negative reinforcement maintained responding. These results, in combination with previous demonstrations of peak shift for rats pressing levers and pigeons pecking keys, indicate that peak shift is a general by-product of operant discrimination learning, since it occurs across a variety of the organisms, responses, and reinforcers.     

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。