This article is the result of a theoretical analysis of a consultation family therapy interview conducted by the well-known family therapist, Dr. S. Minuchin. In the interview, Minuchin effectively challenges the family's structure and the individual members' presenting identities and social roles. Through his successful use of metaphor and techniques like confrontation, enactment and confirmation, he leads the family members out of their confinement toward interaction. Based on a phenomenologically oriented analysis, the authors propose a theoretical formulation to account for (...) the interpersonal space created during the therapeutic process. The directing question they address is: if every member of the family is confined to and legitimates his own conception of himself and his circumstances, how can mutually influencing relations be evoked? A main hypothesis is posed: the therapist faced with conflictual relationships effects consecutive synthesis which allow movement toward desired and alternative behaviors and toward the integration of each member into the family. Initially, the presenting behaviors are of a repetitive and unidimensional nature. The therapist proceeds to unlock these states mainly by using metaphors which point towards actual behaviors and desired alternatives. He thus opens a second dimension by presenting means which make reflection possible and heightens differentiation of self. Subsequently, the family members are led toward the formation of a positive and shared identity confirmed and affectively supported by the therapist. This process results in a third dimension where family members manifest personal reflective awareness of different ways of relating to each other. Integration of the individuals into a new family matrix becomes possible. (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

BackgroundA patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suffering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ. Organ donation after euthanasia is a so-called donation after circulatory death (DCD), (...) Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no-touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital. Case presentationThis article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.ConclusionsOrgan donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital. (shrink)

In this study, we investigate, both theoretically and empirically, the impact of language gender marking on gender wage inequality and country income inequality. We find that nations with a higher level of gender marking in their dominant language have a higher wage gap between genders. Using an instrumental variable approach, we also find that gender marking has an indirect impact on country income inequality via gender wage inequality. Furthermore, we find evidence that the income inequality of a society as a (...) whole is affected by gender wage inequality. Finally, we document that linguistic gender marking outperforms survey-based cultural gender dimensions as a predictor of both gender wage inequality and country income inequality. (shrink)

In recent years, there has been a marked increase in the use of imaginative play in child psychotherapy, yet the theoretical conceptualization of the meaning of play is lacking behind its application in practice. In search of a deeper understanding of the phenomenon of imaginative play, the author turns to Merleau-Ponty's ontology and to his phenomenology of structure, of the lived body, of perception, and of expression. In light of his work, play is an embodied mode of being in the (...) world and a body-world phenomenon. Imaginative play in particular exemplifies the human order in that it enables the child to create and re-create his own meanings within his play world. In a therapeutic context, the evocation of play imagery and the expressive shaping and reshaping of play meanings lead to surprising insights and new discoveries relevant to the child's life-world. A central therapeutic value of imaginative play lies in its promise for facilitating change and healing. A clinical case illustration of a young boy is provided, and the meaning of his imaginative play is exemplified in light of Merleau-Ponty's thought. Some implications are drawn for the theory of play in child psychotherapy. (shrink)

In his original metabletic research on the nature of neurosis. Van den Berg revealed how, towards the 19th century, the increasingly complex and dividing nature of Western society led to the emergence of neurosis as a form of divided existence. By the mid 20th century, the manifestations of neurosis itself changed from a crystalized disorder to vague neurotic disturbances which Van den Berg related to the societal disorder, incoherence and instability which followed the second world war. He identified a series (...) of neuroticizing factors at the time including the ambivalence of society, the increased mobility, a changed sense of time, the disappearance of small groups, the weakening of family ties and the fear of death. In our postmodern world today, the nature of neurosis has changed once again and awaits a new metabletic investigation to reveal its nature and its particular manifestations. (shrink)

In the process of individual psychotherapy, the client and the therapist work together towards clarifying the client's problems, unlocking vicious circles, opening new perspectives and creating a new narrative congruent with the client's experiencing. The real and undeniable situation in individual psychotherapy across different therapeutic systems is that therapists enter the therapeutic encounter equipped with their own vision of humanity and their own particular theory and methods of psychotherapy. Through the differences in power between therapists and clients and the powerful (...) role of language, clients in their dependent position are apt to assimilate the percepts and the ideas of their therapists. Consequently therapists tend to exert a dominant and influential force in their client's lives. This raises a main ethical concern: to what extent do therapists from different therapeutic systems really help clients to recover their freedom to live their lives congruent to their own authentic perceptions and experiences? (shrink)

We investigate the effect of Lesbian, Gay, Bisexual, and Transgender -supportive corporate policies on credit ratings. To the extent that LGBT-friendly policies are beneficial to the firm and therefore improve its expected cash flows, credit rating agencies should assign more favorable credit ratings to the firm. To alleviate endogeneity concerns, we exploit the variations in the LGBT populations across the states in the U.S. as our instrument. Our instrumental-variable analysis reveals that firms that adopt LGBT-supportive corporate policies enjoy better credit (...) ratings, supporting the stakeholder and good management hypothesis. Further analysis using propensity score matching also yields consistent results. (shrink)

We would like to respond to the comment we received from our colleagues on our case report about organ donation after euthanasia starting at home. We reply to their statements on medical and legal aspects, and provide more information on our view of informed consent.

In this article, we want to reply to the recent article by Buturovic, to be able to correct some statements and allegations about this combined procedure. Organ donation after euthanasia is an extremely difficult procedure from an ethical point of view. On the one hand, we see a suffering patient who wants to die but who also wants to make an altruistic effort to donate his organs. On the other hand, we visualise a patient in need of an organ but (...) who is wary of the fact that someone else needs to die in order to potentially receive a transplant organ. Healthcare professionals seem to walk a tightrope when balancing between the interests of the patients at these two extremes: while facilitating the dying patient’s last wish on the one hand and abiding by all regulations regarding donation and transplantation on the other. Yet, these physicians, nurses and transplant coordinators do their utmost best to keep a strict line between euthanasia and organ donation, to avoid any external pressure on the patient, and to respect his autonomy. They really make an utmost attempt to make the process bearable for the donating patient. However, undeniably the patient who is about to undergo organ donation after euthanasia is nevertheless confronted with dozens of feelings and thoughts. However, this does not imply that procedural safeguards are failing to disentangle organ donation from euthanasia. (shrink)

O Bem-Estar Psicológico (BEP) de estudantes universitários da gradução tem sido objeto de crescente interesse na pesquisa científica por ser reconhecido como uma dimensão multifacetada e central da saúde mental. Nesse sentido, este trabalho propôs-se a apresentar os fatores de risco e os fatores de proteção que influenciam nos índices do BEP, de modo a evidenciar as estratégias eficazes de cuidado em saúde mental para o referido segmento populacional. Metodologicamente, trata-se de uma pesquisa com abordagem qualitativa, a partir de uma (...) revisão integrativa de artigos publicados em português e inglês, disponíveis na íntegra nas bases BVS-Psi e PubMed. Foram utilizados os descritores “bem-estar psicológico”, “universidades” e “saúde mental” ou “bem-estar psicológico”, “fatores de risco” e “fatores de proteção” para BVS-Psi e para PubMed, respectivamente, sendo selecionados e analisados 19 estudos. Os resultados ressaltaram que a sobrecarga de trabalho acadêmico, as expectativas elevadas, a competição intensa e a incerteza em relação ao futuro profissional são fatores de risco. Evidencia-se, ainda, que a criação de relações sociais fortes e de estratégias de gerenciamento do tempo aliadas à orientação profissional eficaz são fatores de proteção que auxiliam na promoção da saúde mental nesta população. (shrink)

With contributions from medicine, psychology and philosophy, Pathways into the Jungian World looks at the central issues of commonality and difference in phenomenology and analytical psychology. The essays investigate how existential phenomenology and analytical psychology have been involved in the same fundamental cultural and therapeutic project. They both legitimize the subtlety, complexity, and depth of experience in an age when the meaning of experience has been abandoned to the dictates of pharmaceutical technology, economics and medical psychiatry. The contributors reveal how (...) Jung's relationship to the phenomenological tradition is being developed and rigorously show that the psychological resonance of the world is immediately available for phenomenological description. Contributors: Lionel Corbett, Veronica Goodchild, John Haule, David Michael Levin, Stanton Marlan, Bertha Mook, Robert Romanyshyn, Ronald Schenk, Charles E. Scott, Eva Marie Simms, Michael P. Sipiora, Mary Watkins, Mark Welman. (shrink)

Starting from the acceptance of the Egalitarian Principle I exhibited a version which I considered too lax (BEP) and one I considered too strict (NEP), arriving at a version (MEP) which allows that there can be tolerance-limiting reasons for adhering to traditions but only if they are based on unreasoned knowledge claims. In fact, I hold that the situation most of us find ourselves in restricts such claims on religious topics to very general ones. Hence the choice between NEP and (...) MEP is not significant.It follows that we should take up one of two positions concerning religious traditions: either we argue from the shared assumptions of a variety of traditions without genuine participation in any of them; or we justify participation in one of them by noting various marks of reliability, such as serendipitous understanding. (shrink)

In our country, mildly mentally disabled students are being educated in general education classes by means of integration. An individualized education program (IEP) is being prepared for these students when needed. However, the impact of BEP on students with intellectual disabilities in religious education has not yet been sufficiently discussed. The purpose of this research is to examine the impact of the IEP on the achievement of religious education of mentally disabled students and the level of religious learning of these (...) students. For this purpose, in addition to the education given in the general education class for the 6 mildly mentally disabled integration students studying in the 4th grade of primary school, 2 hours of education were carried out in the support education room per week during the education and training year. Semi-experimental study was designed according to the single-tasked multiple-start model. Education process was evaluated by Achievement Test, the Teacher Observation Form, the pre-test based on the Self-Assessment Form, post-test and retention tests. As a result, it has been seen that BEP has a positive effect on the achievement of religious education of mentally disabled students (ZEKÖ). In this framework, it has been found that students are influenced by the society, especially by their peers, when they are given time they constitute religious knowledge, they understand normal individuals religious behaviours, they are more emotional, they forget religious information that is not used in everyday life and when they accomplish they increase self-confidence and self-esteem and internalize values.SummaryPeople differ in their creation. This difference is greater in people disabled. In terms of individual traits and educational qualifications, individuals with disabilities who are severely different from their peers and who have difficulty in playing the roles they should play are evaluated in several groups. One of these groups is mentally disabled. Mentally handicapped people have various rights as normal individuals. One of these rights is the right to education. National and international laws guarantee the educational rights of individuals with intellectual disabilities. Similarly, Islam and his best practitioner, the prophet Muhammad, did not consent to the transformation of the mentally disabled into begging masses or to their isolation, but rather to integrate them into society. According to Islam, individuals with intellectual disabilities have the “capacity to acquire rights“, even if they do not have "capacity to act". This right requires them to receive an education that takes into account their differences, just like normal individuals. Because of their learning characteristics, mentally retarded students differ from their peers, therefore they cannot benefit from the educational activities organized for normal students. So, these students need a special education to ensure that the mentally disabled are successful and live in society without being dependent.Inrecent years, in our country as well as in the world, the principle of "least restricted education environment" is taken into consideration for mentally handicapped people who need special education, which approaches to co-education with their peers. This approach is tried to-be applied at all educational levels. Due to the diagnosis and evaluation in the Guidance and Research Center, a large number of mentally retarded students are placed in normal schools. These students, like other courses, take the Religious Culture and Moral Knowledge Course together with the normal students. However, depending on their learning, they have the right to receive separate training as 1-3 people at-the support training room. The instructional adaptations necessary for the education of these students made by the Guidance and Research Centers are carried out by the teacher who plays the basic role in the education of the students. One of the important elements in the education of these mentally retarded students who need special education is the individualized education program. This program is prepared by the cooperation and joint decision of all stakeholders who may contribute to student’s education. The status of the student to participate in the learning and teaching activities, the amount and the quality of the education to be received in the support education room are made within the framework of this program.One of the most important courses in the education of mentally retarded students who are educated by inclusion is the Religion Culture and Moral Knowledge course. Because this course has the potential to make serious contributions to the socialization of students and to maintain their lives independently. However, there are a limited number of studies investigating the quality of religious education at-the scientific level. Furthermore, it has not been observed that these studies have been quasi-experimental. This study aims to reveal the quality of education for the mentally handicapped students. For this purpose, it aims to determine the contribution of religious education in the support education room to the success of the student depending on the individualized education program. It also makes it possible to make conclusions about how mentally handicapped people use their mental skills to learn religion. Depending on the aim of the study, during the 2015-2016 academic year, primary school 4th grade students and 6 mentally disabled inclusion students were educated. The quasi-experimental study was designed according to the single-subject multiple-start model. The process of the education, in other words, the development of mentally retarded students towards religious learning; were evaluated by Success Test, Teacher Observation Form and Self-Assessment Form based on pre-test, post-test and retention tests.Findings of the study; Faith, worship, the prophet Muhammad, Qur’an and its commentary, are classified according to the fields of morality, religion, and culture. The post-test achievement scores of the students in all learning areas were higher than the pre-test achievement scores. This shows that religious education in the support training room based on individualized education plan contributes positively to the success of the student. The results of the retention test are close to the results of the final test. In addition, it was determined that the students were affected by the society, especially by their peers, structured the religious knowledge when given time, they understood the religious behaviors of the normal individuals, became more emotional, forgot the religious information that is not used in daily life, increased their self-confidence and self-esteem as they succeeded and internalized the values. Based on these results, the following recommendations have been developed.Support Education Rooms should be functionalized and special attention should be given to individual or group-based religious education based on the nature and objectives of the subject in these rooms.In religious education, by taking into account the performances of mentally retarded inclusion students (MHIS), the relevant dimension of religion should be given importance according to their contribution to their normal lives and they should be consistent and patient in this process.Since MHIS has different levels of learning and perception and different developmental characteristics at every stage of life, it should prioritize their proper use of their existing capacities based on their religious education, interests and curiosities.Since MHIS is influenced by the emotion dimension rather than the information dimension of religion, religious education for them should be oriented towards life, which is not academic, literal or doctrinal, but rather their life and feelings.Similar studies with different study group students must be done and the results of the study should be interpreted comparatively. 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