This paper is divided into two parts: in part one I give some examples from a study of how patient or client perspectives on treatment and life with cancer are “discovered”, addressed, included and shaped within cancer research and treatment after World War 2. In this first part I draw on analyses from my Ph.D. thesis about the concept of quality of life and psycho-social research on cancer, in which I focused on the development and interrelationships between (1) welfare (...) state forms of governance, (2) the practice of cancer treatment and its relation to research, and (3) client’s relations to treatment regimes and a life with cancer. I argue that the client’s perspective is represented in medical practice in many different, and often problematic, ways. A core problem is that this perspective is often represented from a third-person point of view, not from a direct first-person point of view. I find a number of reasons for this. The lack of first-person involvement is not isolated to medical practice but is also obvious in psycho-social practice that evolves in the relation to medical treatment and research in the last part of this century. The conflict around this is reflected in psychological theories about illness and disease that are formulated in this period. In the second part of the article I discuss the directions in which psychological theory has to develop in order to contribute to the recognition and involvement of first-person perspectives in medical treatment and research. The aim of this discussion is not limited to understanding how we as subjects handle everyday life with biological changes of bodily function. (shrink)

‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home‐care services. The aim of this article is to analyse ‘client involvement’ in practise seen from the positions of healthcare professionals, an elderly person and his relative in a home‐care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The study (...) has a focus on the relational aspects of home care and the structural, political and administrative frames that rule home‐ care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receiving home care’; ‘Client involvement inside the home: performing a professional task and living an everyday life’; ‘Client involvement outside the home: liberal business and mutual goal setting’; and ‘Converting a home to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in public home‐care practice remains limited. (shrink)

Hawley introduced the idea of the client's perspective on knowledge, which she used to illuminate knowing-how and cases of epistemic injustice involving knowing-how. In this paper, I explore how Hawley's idea might be used to illuminate not only knowing-how, but other forms of knowledge that, like knowing-how, are often claimed to be distinct from mere knowing-that, focusing on the case studies of moral understanding and ‘what it is like’-knowledge.

At times the personal beliefs or values of graduate students in training programs for professional psychology can create complications in their providing therapy for certain patient populations. This issue has been brought to national attention recently through several prominent legal cases in which students have contested their expulsion from graduate programs due to their assertions that they were unable to treat clients in same-sex relationships because of their own religious beliefs. The goals of the current article are to review the (...) literature on values conflicts, provide an analysis of how portions of our professional Ethics Code directly relate to this issue, describe a developmentally sensitive theoretical framework that is designed to foster the growth of ethical reasoning over time, and provide a forum for trainee perspectives on this issue based on trainees’ responses to an ethical vignette describing an intern struggling with a values conflict. The trainee quotations are used to structure a discussion of practical recommendations for how to handle values conflicts within the context of training and clinical supervision in professional psychology. (shrink)

An explicit linking of the minutiae of everyday parenting practices and the good of society as a whole has been a feature of government policy. The state has taken responsibility for instilling the right parenting skills to deal with what is said to be the societal fall-out of contemporary and family change. ?Knowledge? about parenting is seen as a resource that parents must access in order to fulfil their moral duty as good parents. In this policy portrait, caring for children (...) is posed as a classless and gender-neutral activity. A key theme of this article is that parents from different social class groups are positioned and understand themselves in quite distinct ways in relation to parenting skills advice and expert intervention into their family and home lives. We take a ?relational? perspective to show how mothers and fathers from different social class groups see themselves, and are located by policy and practice, as clients or consumers, and as commonplace or pioneers, in relation to parenting support for themselves and the education system for their children. We identify the lived gendered and classed disparities of power, and associated moral worth, attached to particular parenting practices. (shrink)

The purpose of this paper is to examine what heals and harms the client in the psychotherapeutic encounter, from the client's perspective. The experience of eight clients was explicated using a model based on Giorgi and Schweitzer. The counselling experienced as healing by clients has at its core a vibrantly warm and honest relationship where the client feels held in the safety of the good heart space of the counsellor. The counsellor is experienced as providing an (...) intense beingness for the client that embraces the client's suffering and provides solid ground created out of the crucible of the counsellor's own encounter with his or her shadow. The counsellor is emptied out of his/her own agenda and provides space for the client's experience. The counsellor can evoke the higher resources of the client. The counselling is experienced as renewing and reconnecting the clients to his/her sense of self, of other and the lifeworld. The counselling relationship experienced as harming is described as being drained of human presence and transforming power. There is no alive human connection. The counsellor is experienced as insubstantial, and has no ability to hold traumatic experience. The counsellor's cold reception to the client's vulnerabilities has the power to shatter, fragment and splinter the client. The counsellor is full of self. This fullness may be ego that manifests as dry intellectualising or playing manipulative games as a substitute for human presence. This may lead the client to terror, sickness and anxiety. The counsellor may be full of their own fears and are experienced by the client as chaotic, avoidant and overwhelmed. Their unavailability leads clients to experience emotional depletion, exhaustion and frustration. The counsellor's self-righteousness, judgement and critical disengagement are experienced by clients as being belittled, condemned and diminished. The therapeutic encounter results in a weakening of the human potential for recovery. Both client and counsellor emerge as lesser human beings, with weakened relationships to self, others and the world. Indo-Pacific Journal of Phenomenology , Volume 1, Edition 2 September 2001. (shrink)

Recognizing the importance of health‐promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client–provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client–provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic‐level and broader social (...) and health policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in‐depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as ‘good’ or ‘bad’. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers’ and clients’ negotiated relationships are explored, but this is couched within both local and system‐level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. (shrink)

Intermediaries are social agents who can be found in all types of different environments, cultures, and organizations. More often than enough, intermediaries are middlepersons between two power centers, yet their agency is precarious due to their position as brokers who gain from bridging otherwise unconnected parties, or marginalized vulnerable individuals who suffer from the invasion of the neighboring power holders. How can these two different perspectives of the intermediaries be reconciled? Under what conditions do they shift from one type of (...) agency to another? Previous scholarship attributes the agency of intermediaries to static positionality. This paper treats the position of the intermediary as an opportunity structure, which is shaped by multi-level relational dynamics. We show the changing agency of three intermediary tribal groups (i.e. the Tibetans in northwestern China, Uriyangqad Mongols, and Jurchens) who were situated between the sedentary Chinese and nomadic Mongols during the Ming dynasty (1368–1644) through a systematic study with horse trade data. The group-based and officially-regulated horse trade constituted the most important linkage between the intermediaries and these two power centers. We study the changes in the dynamics of their contact during trade, and explain why these intermediaries became client, client to two patrons, and broker in their trade with the Chinese and Mongols in different eras. We argue that the position of the intermediaries did not provide definite advantages for their exploitation, nor did it paralyze them with any concrete disadvantages. Rather, their position offered them unpredictable opportunities that arose from their relational dynamics with the power centers. Moreover, the self-serving and local interests of the intermediaries, and the strategies and tactics that they used, determined their capacity to respond to emerging and unpredictable opportunities and capitalize on them. (shrink)

This paper develops a model of persuasive demand inducement in the expert–client relationship. The expert frames the decision on whether or not to buy expert services faced by a client with prospect-theoretic preferences, by making the client see this decision from the perspective of a particular reference point. When inducing a client to buy risky curative services, the expert should set a high reference point, and frame all outcomes as losses. When instead inducing a (...) class='Hi'>client to buy safe preventive services, as long as the client’s loss aversion is sufficiently high, the expert should set an intermediate reference point, framing high outcomes as gains and low outcomes as losses. (shrink)

The present study is a cross-sectional survey that investigates ethical practices among Chinese psychotherapists from the perspective of a large representative sample of Chinese clients (N?=?1,100). In reports from clients, we found that psychotherapists did poorly in providing informed consent and had other ethical difficulties in the therapeutic setting and with dual relationships. We conclude that Chinese culture, especially Confucianism, had significant impact on the attitudes toward the psychotherapists' ethical practices, which complicated ethical dilemmas. It is important for cross-cultural (...) psychotherapists to become sensitive to the influences of traditional Chinese culture when counseling Chinese clients. (shrink)

Two decades of literature and discussion on the topic of therapist-client sexual relationships have revealed much about the nature and consequences of these relationships and have produced an explicit prohibition against such relationships in American Psychological Association (APA) Ethical Principle 6a. This article reviews the literature as it relates to the ethically gray area of sex with former clients. The relative lack of an empirical basis for extending the prohibition of Principle 6a to posttermination relationships is noted. This article (...) describes concepts from three theoretical perspectives about psychotherapy that support an extension of the prohibition to sexual relationships with ex-clients. (shrink)

Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mental health professionals, particularly psychiatric nurses. This article examines the traditional ‘beneficence-autonomy’ approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major changes in compulsory psychiatric (...) care - community orders and care for patients with untreatable severe personality disorders - further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-health professional relationship no longer provides an adequate framework for mental health professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mental health professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives. (shrink)

Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention and return-to-work. However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional (...) contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility, social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences. (shrink)

This paper is based on a study of therapists’ experiences of working with suicidal clients. Using a hermeneutic-phenomenological methodology informed by Heidegger, the study provides an understanding of the meaning of therapists’ experiences from their perspective as mental health professionals in New Zealand. In this regard, the findings of the study identified three themes: Therapists’ reaction of shock upon learning of the suicide of their client; Therapists’ experience of assessing suicidal clients as a burden; and finally, Therapists’ professional (...) and personal crises as a result of their experiences and struggling to come to terms with events.The study sheds light on how the experiences of therapists whose clients have committed suicide can be understood. The findings show how mainstream prevention and intervention strategies result from the misrepresentation and misinterpretation of our traditional way of knowing what it means to be human. When therapists discover that phenomena are not necessarily what they appear to be, they feel unsettled and confused about their responsibilities and what it means to live and die as a human being. The study reveals that therapists experience a profound legacy of guilt, doubt and fear when a client commits suicide. Finally, the study proposes that the time has come for the profession to care for its own in order to allow therapist, in turn to care for (and about) the vulnerable other. (shrink)

This study focuses on family members of clients with Chronic Renal Insufficiency (CRI) in hemodialytic treatment, signaling the importance of their participation in care aiming toward an adaptation of a new reality in one’s life. The objective of this study is as follows: to understand the meaning attributed by significant family members to their participation in caring for the client with CRI in hemodialytic treatment. This investigation was developed using a qualitative research modeled after Alfred Schutz’s phenomenological approach, namely (...) to increase understanding in interaction with the other as a process of facilitating an understanding of one’s experience that constitutes the newly constructed reality. The subjects of the research were ten family members noted significantly for their care by the clients of a hemodialytic center from the state of Espírito Santo (Br). The results allowed to identify the care activities developed by the family members. The phenomenological interview consisted of a central question: what do you have in mind when caring for a family member with CRI? The analysis of the responses pointed principally toward two categories: the well-being of the client and the well-being of the family member, or caretaker. Generally, this demonstrates that the care given to the client by the family member is intended to enhance the health care needs of both the client and the family member, or caretaker. These perspectives support the quality of care through the nurse’s action in planning health and nursing care for the client as well as for the client’s family member, allowing recognition of each as a subject of his or her professional action.RESUMO: Este estudo focaliza os familiares dos clientes com insuficiência renal crônica (IRC) em tratamento hemodialítico, sinalizando a importância de sua participação nos cuidados tendo em vista a adaptação a uma nova realidade de vida. Tem como objetivo: compreender o significado atribuído pelo familiar significativo à sua participação no cuidado ao cliente com IRC em tratamento hemodialítico. Constitui uma pesquisa qualitativa, utilizando a abordagem fenomenológica de Alfred Schutz como método, entendendo a interação com o outro um processo facilitador de compreender as experiências e vivências que constituem uma realidade construída. Os sujeitos da pesquisa foram dez familiares apontados pelos clientes de um centro de hemodiálise no Estado do Espírito Santo como significativos no cuidado. Os resultados permitiram identificar as atividades desenvolvidas pelos familiares como cuidado. A entrevista fenomenológica consistiu da questão central: o que você tem em vista ao cuidar do seu familiar com IRC? A análise dos depoimentos apontou para duas categorias Bem Estar do cliente e Bem Estar do familiar ou cuidador.. O típico da ação demonstra que os cuidados dispensados ao cliente pelo familiar visam a atender tanto as necessidades do cliente quanto daquele que cuida. Estas perspectivas subsidiam a ação do enfermeiro para buscar a qualidade da assistência, planejando ações direcionadas ao cuidado da clientela, inclusive seus familiares, reconhecendo a ambos como sujeitos de sua ação profissional. (shrink)

In this article, we introduce important others, accounting firms, in the ethical decision making system. The rational economic person assumption does not always provide the best choice for accounting firms in the influence mode selection on the clients' immoral behaviors. It still leaves many arguments. From the perspective of virtue ethics, we take a step forward for the literature and propose the ethical obligations and active influence of accounting firms on clients' immoral behaviors. We then empirically investigate the influence (...) of accounting firms on the immoral informational disclosure of China's listed companies. Our research goes beyond some of the traditional perceptions on accounting firms such as irrelevant excuse, capability discrimination, forced auditor rotation, and maximum audit tenure. From the perspective of business ethics, we use theory of virtue ethics to further explain the results. Conclusions and implications are presented at the end of this article. (shrink)

Workplaces are often described as places in which individuals are motivated by their self-interests and in which negative events like time pressure, anxiety, conflict with co-workers, miscomprehensions, difficulties in solving problems, not-transmitted or not-exchanged information that lead to mistakes, and in some cases to injuries, stress or control, are part of everyday life. Such situations are often the result of the limited comprehension of needs, skills, or information available to colleagues, supervisors, subordinates, clients or providers. However, workplaces are also places (...) in which employees take care of clients, support colleagues and subordinates, are enthusiastic about their job, are motivated by leaders that encourage employees to transcend their own self-interests for the good of the group or the organization and provide them with the confidence to perform beyond expectations. Thus positive relationships at work are becoming a new interdisciplinary domain of inquiry. Within this positive relationships framework, in this paper we focus on a positive component of workplaces, and particularly on an individual cognitive and emotional process that has an important role in the workplace because it facilitates interpersonal relations and communications: it is the perspective taking process. In order to describe perspective taking, we will refer to some empirical studies and particularly to the review published by Parker, Atkins and Axtell in 2008 on the International Review of Industrial and Organizational Psychology. Perspective taking is a well established psychological construct, investigated both in the field of human development, as an important component of reasoning and moral development, and also in social and clinical psychology, where it is considered a component of social behaviors and of the therapeutic process. It has also been conceptualized in different ways. Duan and Hill describe three approaches to explain reasons for perspective taking behavior: a dispositional approach, that considers empathy as a relatively stable trait or a general ability; a cognitive-affective experience influenced by situational conditions; and finally as a multiphased experiential process. However, although in modern organizations working cooperatively and taking into account customers’ needs and experiences are becoming even more important, very few studies have considered perspective taking process within organizations. This is interesting because taking into account the perspective of others may contribute to more collaborative workplaces, where it is pleasant to work, as also enlighted in the title of the Parker, Atkins and Axtell’s paper: “Building better workplaces” is one of the possible outcomes of perspective taking. This paper aims to make available to a large audience such studies and, in relation to the topic of the conference organized by “Psychology and Communion”, consider connections between this concept and ideas and writings by Chiara Lubich. (shrink)

In this article, the nursing health history is revisited with a hermeneutic lens to uncover means by which this tool can better serve nursing practice. It is argued that further distanciation from the developmental and medical model is necessary to accurately uncover health and history in the nurse–client encounter. Based on the works of prominent hermeneutic philosophers, such as Heidegger, Gadamer, Merleau‐Ponty, Ricoeur, and Taylor, four orientations to health history and nursing are explored: orientation to caring, orientation to narrative, (...) orientation to time, and orientation to the body. The nursing health history is used as a vehicle for illuminating the usefulness of a hermeneutic perspective in everyday nursing practice. This article reveals views of health, history, and health history that are already known to nurses and the nursing milieu but are concealed by more dominant outlooks. The hermeneutical perspective presented in this article can help to reveal the important dimensions of everyday nursing practice and foster a richer attunement with the complex health experiences of individuals. (shrink)

This paper aims to evoke an alternative viewpoint on surrogacy, moving beyond popular Western feminist beliefs on the practice, by introducing the history and current context of East Asian surrogacy. To elaborate a different cultural perspective on surrogacy, this paper first introduces the East Asian history of contract pregnancy systems, prior to the emergence of the American invention of ‘modern’ surrogacy practice. Then, it examines Japanese mass media portrayals of cross‐border surrogacy in which white women have become ‘convenient’ entities. (...) The results of the analysis show how Japanese culture has adopted a rhetoric about the use of white women as convenient surrogate mothers in the global commercial surrogacy market. An essential aspect of surrogacy is the premise that a woman’s reproductive function should be accessible to others. Past discussions among feminists have neglected this important point. Moreover, they share the assumption that white surrogacy clients are exploiters, who take advantage of women of colour as surrogate mothers. The current situation in Asia flips this perspective—with white women regarded as easier targets for exploitation by wealthy people of colour. For Asian clients, Westerners can be easily regarded as ‘others’ whom they can use for their reproductive needs. In today's globalized era, the surrogacy industry is no longer for affluent Westerners only. Considering this change, it is crucial to discuss surrogacy issues by reconstructing feminist perspectives with a globalized view, to help protect women’s bodies, regardless of nationality, ethnicity, skin colour, or religion. (shrink)

Open Dialogue is an approach to working with mental health problems that emphasises promoting dialogue between multiple perspectives within an individual person and between all the people present, including the therapists. Therapists’ own perspectives are often introduced during conversations called reflections, which present a potential source of different perspectives. Using conversation analysis we analysed 14 hours of video-recorded Open Dialogue sessions with a focus on therapists’ reflections. We noticed that therapists did not display explicit agreement with each other’s reflections. This (...) absence of explicit agreement was displayed through a variety of verbal and non-verbal forms. Eliding agreement facilitated deference to the epistemic authority of the client, assertion of epistemic rights from second position, emphasis of a positive perspective or to voice multiple perspectives. Therapists avoided consensus and thus presented multiple perspectives to the family while also attending to issues of contingency. The implications of epistemic primacy and asymmetry connected to sequential structures in talk pose a challenge to the generation of collaborative reflective dialogues. (shrink)

Summary Giancarlo Trombini presents the continuation of his research on the question of which criteria can be used to assess the progress of therapy in an objectively verifiable way and to make the decision on the completion of therapy. In the first phase of his research, the phenomenological criterion of a qualitative change in the patient’s relations toward the positive and higher complexity was proposed for this purpose. In terms of the working method in analytic therapy, this meant concretely: attention (...) should be paid to what development is shown in the comparison of the relationships that occur in the dream narrative and in the subsequent associations. This criterion was therefore given the name manifest dream/association comparison (MDAC)—comparison between the manifest dream and the subsequent associations. The idea can easily be transferred to those therapy methods, which do not primarily work with reports of dream memories and subsequent associations—also, in other ways of working, it is possible to pay attention, in the way suggested by Trombini, to the qualitative development of the relationships which are thematized by the clients in the course of an hour. To this first criterion, another phenomenological criterion is now added in the present article: that of the “concluding therapeutic turn” (CTT). If the patient’s development reaches this turn in the course of the therapy in one session, this indicates, according to Trombini, that the therapy can soon be concluded. The fulfillment of this criterion can be recognized by the fact that in the sequence of dream narration and subsequent associations in a session, a relational dynamic toward the positive and higher complexity becomes recognizable and that is, at the same time, connected with a reconciliation of the three temporal reference systems (past, present, and future). The achievement of this CTT indicates that the patient is aware of the changes made in therapy and makes it evident to the therapist that the therapy is nearing completion. (shrink)

The globalized nature of modern organizations presents new and intimidating challenges for effective relationship building. Organizations and their employees are increasingly being asked to manage unfamiliar relationships with unfamiliar parties. These relationships not only involve working across different national cultures, but also dealing with different organizational cultures, different professional cultures and even different internal constituencies. Managing such differences demands trust. This book brings together research findings on organizational trust-building across cultures. Established trust scholars from around the world consider the development (...) and maintenance of trust between, for example, management consultants and their clients, senior international managers from different nationalities, different internal organizational groupings during times of change, international joint ventures, and service suppliers and the local communities they serve. These studies, set in a wide variety of national settings, are an important resource for academics, students and practitioners who wish to know more about the nature of cross-cultural trust-building in organizations"--Provided by publisher. (shrink)

Throughout their history, symbolic interactionism and critical perspective have been viewed as divergent theoretical perspectives with different philosophical underpinnings. A review of their historical and philosophical origins reveals both points of divergence and areas of convergence. Their underlying philosophies of science and views of human freedom are different as is their level of focus with symbolic interactionism having a micro perspective and critical perspective using a macro perspective. This micro/macro difference is reflected in the divergence of (...) their major concepts, goals and basic tenets. While their underlying philosophies are different, however, they are not necessarily contradictory and areas of convergence may include the concepts of reference groups and looking glass self within symbolic interactionism and ideological hegemony within critical perspective. By using a pragmatic approach and combining symbolic interactionism and critical perspectives, both micro and macro levels come into focus and strategies for change across individual and societal levels can be developed and applied. Application of both symbolic interactionism and critical perspective to nursing research and scholarship offers exciting new opportunities for theory development and research methodologies. In nursing education, these two perspectives can give students added insight into patients' and families' problems at the micro level while, at the same time, giving them a lens to see and tools to apply to problems at the macro level in health care. In nursing practice, a combined symbolic interactionism/critical perspective approach assists nurses to give high-quality care at the individual level while also working at the macro level to address the manufacturers of illness. New research questions emerge from this combination of perspectives with new possibilities for theory development, a transformation in nursing education, and the potential for new practice strategies that can address individual client and larger system problems through empowerment of clients and nurses. (shrink)

Based on anthropological fieldwork conducted in the Eastern Cape, the paper explores the interconnections between dreams (amathongo, amaphupha) and medicines (amayeza, imithi, amachiza) as aspects of the Xhosa diviner’s culture, knowledge and experience. Background information is provided in the introduction, inter alia, on the Xhosa patrilineal clan (isiduko), divination (imvumisa, evumiso) and religious and cultural change. The ability to dream, inter alia of the ancestors and medicines, is central to the diviner’s intuition and professional stock-in-trade, which are part and parcel (...) of a religious healing tradition. Examples of dreams involving the ancestors (iminyanya), diviners, clients and medicinal plants are presented and analysed in relation to relevant case material. The ritual significance of dreams is explored in some detail. The distinctions between diviner (igqirha lokuvumisa) and herbalist (ixhwele), and between medicines and charms (amakhubalo), receive attention in the section on medicines. The underlying purpose of traditional Xhosa religious ideology is discussed in the conclusion. (shrink)

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress. Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that (...) although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident. (shrink)

Ethnomedicine is the field that analyzes medical traditions comparatively. An ethnomedical approach is used in the essay to analyze the topic of medical ethics. General properties of medical ethics as realized in different societies are outlined. These pertain to the healer's relations with clients, with other healers, and with the group or society. The conditions of medical practice and the influence of social and political factors that affect them are discussed in relation to medical ethical questions. Unique developments of contemporary (...) medical science that affect and condition practice and raise new ethical questions are examined in light of ethnomedical generalizations. The essay aims to clarify the cultural bases of medicine generally and ethical aspects of medical practice and care more specifically. (shrink)

Professional ethics, in general, deals with justified moral values that govern the work of professionals. Profession is an expertise who is committed to promote a distinctive public good, such as learning or education. Professionals are committed to special duties to make services available, maintain confidentiality, secure informed consent for services, and be loyal to clients, employers, and others with whom one has fiduciary relationship. Professional ethics deals with theoretical issues which seek to understand how the justified moral values governing professionals (...) are linked to wider values. It also deals with practical issues as to how to apply duties in particular contexts. Professional values include principles of obligation and rights, virtues, personal moral ideals as manifested in the great lives. Given such a Western idea of professional ethics, it is indeed fascinating to trace professional ethics in the Upaniṣads. The Upaniṣadic sages since time immemorial have shown the path to peace and progress for all humanity, not only by laying down theoretical ideals or speculation, but by actually applying truths in their practical life. They have demonstrated the practical application of the ethical ideals or moral values in the personal and professional life and proved that self-realization alone can not only save man from misery but promote to the state of highest bliss. The standards laid down by them have been followed practically by people even today. Gītoponiṣad states that whatever action is performed by the great is imitated by the common people; whatever standard is set by him is followed by them. The Kaṭha Upaniṣad prescribes professional values to the extent that not he who has not ceased from evil conduct can obtain Him by knowledge. Good conduct as a value is thus emphasized here. In Taittirīya Upaniṣad, for instance, the teacher prescribes certain values in the form of commandments: speak the truth and practice virtue. Thus, it is evident that the Upaniṣadic teacher is not only concerned about the intellectual progress of the student but also its personal and professional life as well. The paper is a humble attempt to explore the roots of professional ethics in the Upaniṣadic ethics. (shrink)

Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores (...) that indicate no reliable change in depression symptoms with a qualitative inquiry of patients’ perspectives. Methods: The study took place in the context of a Randomized Controlled Trial evaluating time-limited psychodynamic and cognitive behavioural therapy for major depression. A mixed methods study was conducted including patients’ pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients’ interviews. Findings: From the patients’ perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients’ resistance and impossibility and the context as a source of distress. “No change” in outcome scores therefore seems to involve a “partial change” when considering the patients’ perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed. (shrink)

BackgroundSexual boundary violations in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.MethodsWe carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to (...) explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.ResultsWe found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: setting rules and regulations, engaging in dialogue about sexuality, and addressing systemic and organizational dimensions.ConclusionOur findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations. (shrink)

This article is presented as a defence of voluntary active euthanasia from a virtue perspective and it is written with the objective of generating debate and challenging the assumption that killing is necessarily vicious in all circumstances. Practitioners are often torn between acting from virtue and acting from duty. In the case presented the physician was governed by compassion and this illustrates how good people may have the courage to sacrifice their own security in the interests of virtue. The (...) doctor's action created huge tensions for the nurse, who was governed by the code of conduct and relevant laws. Appraising active euthanasia from a virtue perspective can offer a more compassionate approach to the predicament of practitioners and clients. The tensions arising from the virtue versus rules debate generates irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and support the call for a change in the law. The controversial nature of this position is acknowledged. The argument is put forward on the understanding that many practitioners will not agree with the conclusions reached. (shrink)

BackgroundHealth service delivery should ensure ethical principles are observed at all levels of healthcare. Working towards this goal requires understanding the ethics-related priorities and concerns in the day-to-day activities among different health practitioners. These practitioners include community health workers (CHWs) who are involved in healthcare delivery in communities in many low-and middle-income countries such as Uganda. In this study, we used photovoice, an innovative community based participatory research method that uses photography, to examine CHWs' perspectives on ethical concerns in their (...) work.MethodsWe explored perspectives of 10 CHWs (5 females and 5 males) on ethical dimensions of their work for 5 months using photovoice in a rural community in Wakiso district, Uganda. As part of the study, we: 1. Oriented CHWs on photovoice research and ethics; 2. Asked CHWs to take photographs of key ethical dimensions of their work; 3. Held monthly meetings to discuss and reflect on the photos; and 4. Disseminated the findings. The discussions from the monthly meetings were audio recorded, transcribed, and emerging data analysed using conventional content analysis with the help of Atlas ti version 6.0.15.ResultsCHWs were aware of and highly concerned about the need to observe ethical principles while carrying out their roles. The ethical principles CHWs were aware of and endeavoured to observe during their work were: maintaining professional integrity and abiding by ethical principles of practice; ethical responsibility in patient care; maintaining confidentiality while handling clients; respect for persons and communities; and enhancing their knowledge and skills for better practice. However, CHWs also identified challenges concerning their observance of ethical principles including: low commitment to their work due to other obligations; availability of some reference materials and guidelines in English yet majority could only read in the local language; and minimal avenues for knowledge enhancement such as trainings.ConclusionsCHWs were aware of and keen to discuss ethical issues in their work. However, there is need to address the challenges they face so as to facilitate observing ethical principles during the course of their work in communities. (shrink)

This paper offers insights into corporate social responsibility (CSR) consulting in Greece. It sheds light on perspectives of how socially responsible business conduct is shaped by consultancies in a national business environment where such an essential aspect of organizational commitment and behavior exhibits comparatively little resonance among companies and is primarily induced by supranational and international policy schemes as well as foreign competitors. Drawing from long interviews with consulting professionals, we explore key topics: the domestic CSR (consulting) industry's characteristics, issues (...) pertaining to the engagement with clients, the endorsement of CSR standards and initiatives, along with the consultants' perspective on institutional dynamics and their prospects with respect to the future of CSR in Greece. In this context, we aim to indicate trends on CSR implementation, pressures exerted on consultants, and managerial attitudes towards corporate responsibility. Our findings illustrate an oligopolistically structured market that encourages consultancies to compete intensely, the consultants' limited capacity to influence the business behavior of their clients, with the latter to adopt a promotional communicative approach to CSR, as well as a lack of institutional coordination and mechanisms that will materially embed social responsibility in the strategic management of business. (shrink)

In this article, there is a suggestion that the application of certain key concepts or procedures of Husserlian phenomenology can be helpful in the practice of therapy. It is well known that how a therapist is present to a client and his or her story is critical for the success of therapy. What is less clear, however, is how to address this "way of being" in therapy and what kinds of interventions are helpful to clients. In addressing some of (...) these difficult issues, the Husserlian concepts found to be helpful are Husserl's chief directive to go "back to the matters themselves," the distinction among real and irreal objects, presence to the order of phenomena, the phenomenal realm, the intentional-fulfilling-identifying nature of conscious acts, the phenomenological-psychological reduction, and the discovery and description of eidetic structures of experience. These fundamental philosophical distinctions are taken up within a psychological perspective and elaborated and used within a phenomenological psychological perspective. (shrink)

Background Healthy aging is one of the essential aspects of a health promotion program in the elderly. Aim Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context. Research Design This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data. Ethical considerations The ethics (...) committee of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation. Findings The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers. Discussion The findings showed that due to nurses’ unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients. Conclusion Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly. (shrink)

The philosophy of empowerment, which is based on the premises that clients must be active, equal and collaborative participants, who are aware and commited to change, has guided research in empowerment interventions. This article reports on a small part of a research study that sought to understand Chinese cancer patients’ conceptualization of empowerment. Qualitative delineation of the concept of empowerment by means of in-depth interviews was carried out with 12 Chinese patients with cancer. The findings showed that empowerment is a (...) process whereby patients develop a sense of inner strength through connection with others, including families, friends and health care professionals. It is also a process of transformation through which they actively develop new perspectives by reframing and reinterpreting their illness. Acceptance of illness was shown to result from a realization of a lack of control in the situation, which is then enhanced by the beliefs of Confucianism and Taoism. In the cancer context, personal control comprises both primary and secondary processes. Active involvement, awareness of the situation, partnership, self-determination and self-reliance are important values in empowerment. The concept and therapeutic foundations of empowerment provide ample legitimacy for its vigorous pursuit in nursing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 87-94 [Access article in PDF] Talk and the Nature of Delusions:Defending Sociocultural Perspectives on Mental Illness Eugenie Georgaca Keywords discourse, social constructionism, delusions, psychosis, mental illness, context It is very pleasing to see writers from philosophy, psychiatry and psychology, the three disciplines represented by this journal, debating the issue of delusions. The majority of the papers in this volume set out to determine (...) the underlying mechanisms responsible for delusions. As such, they offer themselves as discussions of the etiological factors of the formation and maintenance of delusions. My paper analyzes the interactional presentation and negotiation of statements that would be considered as delusional. This led some commentators (Ghaemi 2004; Sass 2004) to argue that the analysis of talk about delusions is useful, but cannot be extended to claims about the nature of delusions. In the following section, I discuss the ways in which analyzing interactions can be useful in clinical research and practice. Subsequently, I identify and critically discuss the assumptions about the nature of delusions that underlie these criticisms and the majority of the papers in this volume. The Usefulness of the Study of Interaction My paper can be seen as part of a growing body of studies that attempt to elucidate the role of interactional and discursive processes in the identification and management of disorders (Barrett 1988; Coulter 1975; Hak 1989; Pollner 1975; Smith 1978; Soyland 1994). Microsociological and ethnographic studies look at the properties of client-professional interaction with the aim of clarifying the tacit skills and knowledges used in such encounters. Palmer (2000), for example, argues that the recognition of disorder is a social and interactional issue both in the sense that the judgment of disorder is based on social criteria and in the sense that diagnosis is an interpersonal process with its own inherent social order. The aim, therefore, of analyzing professional-client interactions would be to articulate the properties of this implicit social order. Other researchers argue that diagnosis is not a process of identification or recognition of disorder, but rather a process of active construction of disorder and of transforming the person to a mental patient. Barrett's (1988) analysis of the transformation of a [End Page 87] person to a "person suffering from schizophrenia" and subsequently a "schizophrenic" through interviewing and report writing is an excellent example of this kind of work.The application of this approach to the field of delusions would attempt to address the issue of how delusions are diagnosed and managed through the interactions between the delusional patient and the clinician. In this paper and in previous work (Georgaca 1996, 2000) I showed that statements that have been diagnosed as delusional are presented and argued through using appropriate conversational strategies, drawing on socially meaningful systems of knowledge and applying appropriate rules of evidence. Moreover, I argued that there was no way in which these disagreements over competing versions of reality could be definitely settled conversationally, and that instances of breakdown in communication were due not to the delusional version being proven wrong, but to lack of explanatory frameworks within which the competing versions could be negotiated. At least in the exchanges analyzed, the criteria of implausibility, conviction, and incorrigibility were shown not to apply.Clinicians do not customarily investigate the truth of patient claims against empirical data (Maher 1992), which means that they have to judge claims on the basis of the patient's presentation in the diagnostic interview. Because there are no technical guidelines for the assessment of truth and falsity, plausibility and implausibility, rationality and irrationality, clinicians have to rely on personal judgment. The question then is on what grounds the clinician's personal judgment is granted the status of determining the truth of someone else's claim and in what capacity clinicians are called to make such decisions. I will not pursue this argument any further here. The point I want to make is that the analysis of professional-client interactions foregrounds the active role of professionals in clinical decisions and questions the criteria upon which decisions are... (shrink)

In this article, it is argued that multinational companies (MNCs) that operate in South Africa should include a macroethical perspective in their ethical reflection. MNCs in South Africa are subjected to significant societal changes. At the same time, they are in a position to exert their influence in a way that affects more people than simply their shareholders, clients and employees. It is argued that a macroethical perspective can assist MNCs in coming to terms with these changes by (...) expanding their understanding of their responsibility towards South African society and future generations. (shrink)

Phenomenology has remained a sheltering place for those who would seek to understand not only their own “first person” experiences but also the first person experiences of others. Recent publications by renowned scholars within the field have clarified and extended our possibilities of access to “first person” experience by means of perception (Lingis, 2007) and reflection (Zahavi, 2005). Teaching phenomenology remains a challenge, however, because one must find ways of communicating to the student how to embody it as a process (...) rather than simply to learn about it as a content area. Another challenge issues from the fact that most writings on applied phenomenology emphasize individual subjectivity as the central focus, while offering only indirect access to the subjectivity of others (for example, by way of analyzing written descriptions provided by the individual under study). While one finds in the literature of psychotherapy plentiful elucidations of the “we-experience” within which therapists form impressions of their clients’ experience, there is still need for a more thoughtful clarification of our rather special personal modes of access to the experience of others in everyday life. This paper will present “second person perspectivity” as a mode of resonating with the expressions of others and will describe class activities that can bring students closer to a lived understanding of what it means to be doing phenomenology in the face of the other. (shrink)

A personal and professional issue that confronts all nurses is that of attempting to understand the experiences of our patients or clients. The position taken here is that understanding another person as a human being is much more than being able to explain their experience according to a particular model of ill‐health. Rather, it is an issue of human dignity and respectfulness. Gadamerian hermeneutics has been used in nursing research to articulate the process of understanding and to develop interpretations of (...) particular experiences. Gadamer's exposition of understanding shows that we need to be aware that our understanding of other people is developed through a fusion of our own history, language and culture with that of the other person. This occurs through a hermeneutic question–answer dialogue in which we put our ideas at risk of being modified or rejected in the process. Understanding then, is a perceptual and conceptual process in which we fully participate. In this way, the experience of understanding those we nurse increases our understanding of ourselves as well as enhancing our ability to further understand others. (shrink)

The objective of this paper is to investigate, through a qualitative study based on 38 semi-structured interviews with agents who provide assurance of sustainability reports, how they perceive and manage ethical issues underlying the verification of sustainability reports. Most of the ethical issues observed involve four interconnected aspects: the commercialism underlying sustainability assurance, the symbolic nature of the verification process, interdependency between auditing and consulting activities, and familiarity with the audited companies. The findings shed light on the reflexivity of assurance (...) providers on these issues and the legitimation strategies used to explain how they reconcile the independence and impartiality required for auditing activities with commercial aspects related to client–provider relationships. The study also shows the role of contextual variables in the ethics of assurance services. The paper contributes to the literature on the legitimacy of sustainability assurance and commercialism of the audit function. Practical implications and avenues for future research are also developed. (shrink)

Drawing on east central European, mainly Hungarian, experience, this paper views—from a different angle—some of the issues raised in international literature in connection with the ethics of applied human geography, and raises new ones. Citing a few examples of various personal, institutional and political economic ‘terrains’ within geography, it intends to underscore the importance of the issue of ‘what kind of geography and what kind of geographers’ in studying the ethics of geographical research. The paper also offers an east central (...) European critical perspective on well‐known issues like relevance, usefulness, values and the relationship between the researcher and research subject and that between the researcher and the client. (shrink)

‘Vulnerable mission’ as a technical term was devised by a small team in 2007. There has been considerable Internet and conference debate on this issue since 2007. The issue for which vulnerable mission was formed is to create a way through dependency syndromes. For those working in areas of patron–client cultures where it is too easy to allow a dependency syndrome to develop, how can a vulnerable approach by the one sent be realistically engaged? This paper is an attempt (...) to consider the definition and biblical warrant for the concept of missional vulnerability. Surveying various biblical scenes even in so brief a paper brings a prophetic challenge. (shrink)

Therapist’s and client’s experience in the session are emerging from the field forc-es in play; these forces are the intrinsic tensions of the emerging field. We propose an understanding of the therapeutic process as a field phenomenon: the process of change is made by the forces already active in the field and the therapist has just to let them move on without interfering, or sometimes to support them. Psy-chopathology is then the emerging absence, and therapy becomes the art of (...) presence. (shrink)

Over the last decade, successive New Zealand governments have instituted social, political and economic changes that have fundamentally challenged nurses’ sense of themselves and their position in society. Major upheavals in the health service have occurred as a result of reforms promoting competition and contestability. This paper deals with the impact of one aspect of the reforms, that of the deregulation of the labour market through the Employment Contracts Act 1991. More specifically, the way in which discussions and decisions regarding (...) the withdrawal of nursing labour are shaped by the language available to those involved are considered. The intersection of ethics and union discourses may exacerbate feelings of ambiguity and confusion in nurses facing strike action. The result can be unnecessary and unproductive division and conflict: among nurses, between employers and employees, between unions, between nurses and the public, and between nursing organizations and the Government. An examination of some of the discourses of strike action may serve as a tool to elucidate the way nurses see themselves and their clients in the context of social change and social action. (shrink)

The integrated model of mental health recommends nowadays the collaboration between psychiatrists, psychotherapists and clinical psychologists. It is currently the agreed model in the managed health care system in the West and research has shown that mixing the medical model with the psychological model both in theory and practice elicits the best outcomes and guides the client towards recovery. In this paper I will challenge this view on a particular area of psychopathology, mild and moderate depression and anxiety, showing (...) that in these particular situations, 15-20 sessions of psychotherapy are sufficient and efficient for recovery and there is no further need for medicating the client, unless the client himself desires this particular type of psychiatric approach. I will also focus on a target group, pregnant women who fear toxic reactions for the fetus and don’t consider taking antidepressant and anxiolytic medication out of fear of adverse reactions. I will also explore the ethical implications of prescribing these target groups medication against their will. CBT, REBT and Existential Psychotherapy are effective options to treat both the symptoms and causes of mild and moderate anxiety and depression, whilst exercise, nutrition and mindfulness meditation can also be effective treatments. Since medications such as antidepressants have recently become the treatment of choice in United States with a 147.5% increase in antidepressant prescription rates between 1990 and 1998 and with a 10.9% decrease in the utilization of psychotherapy, my paper aims to balance this approach in the favour of psychotherapy as a first choice option. (shrink)