Persons who identity as LGBTQ+ should be treated with respect, compassion, and sensitivity. Under the guise of helping such persons, legislation is surreptitiously appearing in several countries seeking to ban so-called conversion therapy. While the definition of the term remains concerningly vague, the terms of enforcement for alleged offences tend to be precisely delineated, often including provisions that curtail Christian catechesis, teaching, and preaching in the areas of human dignity and sexuality. These problematic and repressive initiatives can prevent (...) access to any psychotherapy that is not strictly gender-affirming. This article reviews and assesses conversion therapy in support of a judicious approach to the practice, accurately understood. It reviews past abuses and misunderstandings while considering the merits of conversion therapy and related therapeutic and pastoral approaches. Concerns about gender-affirming interventions are considered, especially for youth and teenagers, and efficacy claims around conversion therapies and related psychotherapies are also discussed. (shrink)

Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, (...) although it is mistakenly conflated with conversion therapies. Psychotherapy does not impose restrictive gender stereotypes, as is sometimes claimed, but critically examines them. It empowers young people to develop creative solutions to their difficulties and promotes agency and autonomy. Importantly, an exploratory psychotherapeutic process can help to clarify whether gender dysphoria is a carrier for other psychological or social problems that may not be immediately apparent. Psychotherapy can therefore make a significant contribution to the optimal, ethical care of gender-dysphoric young people by ensuring that patients make appropriate, informed decisions about medical interventions which carry risks of harm and have a contested evidence base. (shrink)

The ‘born this way’ movement for sexual orientation minority rights is premised on the view that sexual orientation is something that can neither be chosen nor changed. Indeed, current sexual orientation change efforts appear to be both harmful and ineffective. But what if ‘high-tech conversion therapies’ are invented in the future that are effective at changing sexual orientation? The conceptual basis for the movement would collapse. In this chapter, we argue that the threat of HCT should be taken seriously, (...) motivating a change in tactics for proponents of sexual orientation minority rights. We also discuss some of the practical-ethical and public-policy issues surrounding HCT, in case the technology is one day developed. (shrink)

The American Psychological Association's (APA's) as well as other professional organizations' (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about exual orientation. Since then, APA (2000) disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, the (...) limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed. (shrink)

In the last few years, many countries have introduced (or are proposing to introduce) legislation on ‘conversion therapy’, prohibiting attempts to change or suppress sexual orientation and/or gender identity. This legislation covers ‘aversion therapy’, a form of torture that has already been criminalized in most progressive countries, and also ‘talk therapy’, involving things like counselling, psychoanalysis, and prayer. Focusing on this latter category of practices, I explain what is at stake in the fact that sexual orientation (...) and gender identity have been paired for the purposes of this legislation. I use a particular law reform institute’s approach to this legislation as a case study, and review their literature review in mind to discovering whether they provided sufficient empirical justification for including gender identity in their conversion therapy legislation. I conclude that they did not, and suggest that the pairing of sexual orientation and gender identity may be purely political. (shrink)

Conversion therapy refers to a range of unscientific, discredited and harmful heterosexist practices that attempt to re-align an individual’s sexual orientation, usually from non-heterosexual to heterosexual. In Australia, the state of Victoria recently joined Queensland and the Australian Capital Territory in criminalising conversion therapy. Although many other jurisdictions have also introduced legislation banning conversion therapy, it persists in over 60 countries. Children are particularly vulnerable to the harmful effects of conversion therapy, which (...) can include coercion, rejection, isolation and blame. However, if new biotechnologies create safe and effective conversion therapies, the question posed here is whether it would ever be morally permissible to use them. In addressing this question, we need to closely examine the individual’s circumstances and the prevailing social context in which conversion therapy is employed. I argue that, even in a sexually unjust world, conversion therapy may be morally permissible if it were the only safe and effective means of relieving intense anguish and dysphoria for the individual. The person providing the conversion therapy must be qualified, sufficiently independent from any religious organisation and must provide conversion therapy in a way that is positively affirming of the individual and their existing sexuality. (shrink)

The first fruits of the literary career of St. Augustine, the great theologian and Christian philosopher par excellence, are the dialogues he wrote at Cassiciacum in Italy following his famous conversion in Milan in 386 AD. These four little books, largely neglected by scholars, investigate knowledge, ethics, metaphysics, the problem of evil, and the intriguing relationship of God and the soul. They also take up the ancient philosophical project of identifying the principles and practices that heal human desires in (...) order to attain happiness, renewing this philosophical endeavor with insights from Christian theology. Augustine's later books, such as the Confessions, would continue this project of healing desire, as would the writings of others including Boethius, Anselm, and Aquinas. -/- Mark Boone's The Conversion and Therapy of Desire investigates the roots of this project at Cassiciacum, where Augustine is developing a Christian theology of desire, informed by Neoplatonism but transformed by Christian teaching and practices. (shrink)

Definition of the problem: Doctor-patient-conversation is still a great challenge for doctors and patients despite intense discussion, legal normation, and multiple efforts. It seems to be particularly difficult in cases of telling the truth about diagnosis or prognosis which can be threatening to the patient.Method: It is shown by two case studies that the patient directs a specific need to the doctor which has been neglected in both the ethics discourse and in practical medicine: the need to evaluate the patient's (...) options for action at an argumentative-critical level. Derived from a general theory of language functions a model of doctor-patient-conversation is developed which allows for both ideal case typology as well as for problem analysis. Referring to a Three-Stages-Model of Doctor-Patient-Dialogue, an integrative model “Language and Relationship Between Doctor and Patient” is formulated which permits a better understanding of the processes and difficulties between doctor and patient.Conclusion: The integrative model presented may help to realize a more comprehensive doctor-patient-conversation. It may help as well to decide which of the components of this conversation may be selectively sufficient. Consequences for the conceptualization of the physician's role as well as the scope of the model in practice are discussed. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and (...) receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

BackgroundPsychotherapy interventions increasingly utilize digital technologies to improve access to therapy and its acceptability. Opportunities that digital technology potentially creates for art therapy reach beyond increased access to include new possibilities of adaptation and extension of therapy tool box. Given growing interest in practice and research in this area, it is important to investigate how art therapists engage with digital technology or how practice might be safely adapted to include new potential modes of delivery and new arts (...) media.MethodsAn integrative review of peer-reviewed literature on the use of digital technology in art therapy was conducted. The methodology used is particularly well suited for early stage exploratory inquiries, allowing for close examination of papers from a variety of methodological paradigms. Only studies that presented empirical outcomes were included in the formal analysis.FindingsOver 400 records were screened and 12 studies were included in the synthesis, pertaining to both the use of digital technology for remote delivery and as a medium for art making. Included studies, adopting predominantly qualitative and mixed methods, are grouped according to their focus on: art therapists’ views and experiences, online/distance art therapy, and the use of digital arts media. Recurring themes are discussed, including potential benefits and risks of incorporating digital technology in sessions with clients, concerns relating to ethics, resistance toward digital arts media, technological limitations and implications for therapeutic relationship and therapy process. Propositions for best practice and technological innovations that could make some of the challenges redundant are also reviewed. Future directions in research are indicated and cautious openness is recommended in both research and practice.ConclusionThe review documents growing research illustrating increased use of digital technology by art therapists for both online delivery and digital art making. Potentially immense opportunities that technology brings for art therapy should be considered alongside limitations and challenges of clinical, pragmatic and ethical nature. The review aims to invite conversations and further research to explore ways in which technology could increase relevance and reach of art therapy without compromising clients’ safety and key principles of the profession. (shrink)

This study is part of a larger exploration of ‘talk and cure’ that combines the examination of talk-in-interaction, with nonverbal displays, and measurements of the client’s and therapist’s autonomic arousal during therapy sessions. A key assumption of the study is that psychotherapy entails processes of intersubjective meaning-making that occur across different modalities and take place in both verbal/explicit and nonverbal/implicit domains. A single session of a psychodynamic psychotherapy is analysed with a focus on the expression and management of affect, (...) with an aim to describe key interactive events that promote change in both semantic and procedural domains. The clinical dialogue is analysed discursively, with a focus on the conversational processes through which new meanings are jointly constructed and affective states shared; detailed attention is paid to nonverbal displays of affiliation and affect. Furthermore, we explore whether the interactional patterns implicated in joint meaning-making, as revealed by analysing the therapeutic conversation, have correlates in the autonomic arousal of the two protagonists, as reflected in their heart rates. Conversation analysis has still untapped potential to illuminate interactional patterns that underlie the practice of psychotherapy. In this exploratory study we suggest that discursive analyses of talk-in-interaction can be enriched through detailed focus on nonverbal displays as well as measures of physiological arousal. Drawing upon the analysis, we suggest that bringing the methodological strengths of language-based analysis into fertile dialogue with embodied quantitative data can help our explorations of what’s really going on in psychotherapy. (shrink)

This article applies Russon's principles of reading Plato's dialogues to solve a problem arising from both the dramatic and philosophical aspects of Plato's Republic: persuasive speech seems effective only when its audience is already willing to listen and be convinced. Yet if so, then either persuasive speech is powerless to persuade anybody truly, or it is unclear how it differs from simple manipulation or brainwashing. This article resolves this dilemma by using Russon’s insights about the kind of rationality Plato invites (...) us to assume, namely a “concrete rationality,” and by analyzing the ????irst three interlocutors of Socrates in the Republic: Polemarchus, Cephalus, and, of course, Thrasymachus. This approach enables us to differentiate these three interlocutors, explain Thrasymachus’s persistence in listening to the conversation until the end despite his unwillingness to listen, as well as the therapeutic function of theōria for providing him some momentary relief from his “hatred of speech” (misologia). (shrink)

By analyzing session exchanges and questionnaires administered to family therapy clients, this article examines questioning as conversational practice grounded in institutional goals that are therapist-directed and therapist-conceived. In their manifestation in talk and text, therapeutic questions function to replace client accounts with the nosological accounts of institutional psychiatry. The analysis illuminates three ways in which questioning works in the session and then locates these in therapy's professional and institutional logic. A critical reflection on psychotherapy's questioning practices in a (...) social context concludes the article. (shrink)

We contend that the talk of therapy, like everyday talk, is where and how people construct their understandings and ways of living. This is the fundamental insight of the social constructionist, or discursive, therapies. ‘Meaning’ is not some pre-given ‘thing’ that is communicated more or less successfully from one individual to another. Rather, ‘meanings’ are negotiated or constructed in the process of communication until each party is clear that they have a grasp of what they are ‘talking about’. Similarly, (...) ‘meanings’ are not universal, nor necessarily arranged in a given ethical hierarchy, with some absolutely superior to others: ‘meanings’ are local and accountable in their locality. Yet, meanings, and actions following from them, are central to the conversations of therapy. In our view, the social constructionist or discursive therapies point to enhanced possibilities for collaborative and relevant conversations with clients. In this article we summarize themes common to contemporary discursive approaches to therapy. (shrink)

Transgender conversion practices involve attempts to alter, discourage, or suppress a person’s gender identity and/or desired gender presentation, including by delaying or preventing gender transition. Proponents of the practices have argued that they should be allowed until proven to be harmful. Drawing on the notion of expressive equality, I argue that conversion practices are prima facie unethical because they do not fulfill a legitimate clinical purpose and conflict with the self-understanding of trans communities.

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by (...) reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (shrink)

Using therapeutic conversations from a televised talk show as the source data, this article investigates how people solve emotional problems in an institutional setting within a specific social cultural context. In light of the genre framework and the Systemic Functional Linguistics, the investigation considers the TV talk show therapy under examination a distinct genre. The claim is based on the linguistic evidence drawn from the analytical work. As a valid genre the talk show therapy has been characterized with (...) the communicative intentionality to resolve emotional problems and to promote mental health to the public. These components in turn have shaped the generic structures, which become the crucial criteria that constitute a text as a genre. The article proposes that a broader conception of genre framework is an effective research method to describe the textual typologies and interpret the semantic structures of the social interaction in postmodern society. (shrink)

Conversation analysis (CA) of children-adult—interaction in various contexts has become an established field of research. However,child therapyhas received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley,2006). Psychotherapy process researchers in (...) adult therapy (Stiles et al.,2015) have found that therapists “invent” a new therapy for each patient (Norcross and Wampold,2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of “unexplainable rage.” The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe “doing contrariness,” as a conversational practice producing epistemic and affiliative disruptions, while “avoiding doing contrariness” and “remedying contrariness” are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bernard Mandeville and the Therapy of “The Clever Politician”Harold J. CookAs the institutional authority of the learned physicians of Augustan London waned, new threats to the classical foundations of medical practice appeared. 1 Patients had more freedom to chose from a variety of practitioners and practices, giving both consumer demand and the advertising skills of suppliers an even more powerful hand in medical affairs. While the burgeoning medical (...) marketplace developed mostly because of the profound socio-economic and political changes of the late Stuart period, intellectual transformations were at play, too. The new science appeared to encourage empiricism and the development of new remedies based on experimentation, devaluing university education in medical classics, but conversely the new science could strengthen physicians’ claims to superiority over mere patients and practitioners. Medical materialists, for instance, could turn the classical advisor/client relationship into that of an expert contolling a passive recipient (patient) for his or her own good.One contemporary debate that shows the implications of materialism for medical relationships is the theory of the passions. The passions linked mind and body. According to most classical accounts, one could (or should) control the passions by applying reason, resulting in both a virtuous and a healthy life. But according to a strong version of materialism, the mind could not hope to control the passions. A doctor therefore could no longer appeal to patients’ reason; rather, he had to manipulate the patient’s passions for his or her own good. Hence for a materialist, the doctor was not an adviser to the patient but an expert therapist, not a teacher of health and virtue but a “clever politician” who ordered bodily passions. Some versions of the new science, then, favored [End Page 101] the expertise of physicians while undermining older views about learned authority. Such an outlook is clear in the work of Dr. Bernard Mandeville, whose famous Fable of the Bees shows how the “clever politician” played on passions to make the body politic run smoothly. Mandeville held coherent views on politics, economics, moral philosophy, and medicine. Like many doctors of his time, he fought to establish his expertise in the new science. His views are expressed most clearly in the theory of the passions. By examining his discussion of the passions in both his social commentary and his medical dialogues, we can note similarities among his various writings and glimpse one of his fundamental positions on medicine and humanity.The Fable and its CriticsTo many English minds of the early eighteenth century, no one exemplified materialism’s threat better than Dr. Bernard Mandeville. Mandeville’s famous slogan, the subtitle of his Fable of the Bees—“private vices, public benefits”—seemed to epitomize materialism’s inherent immorality. The book seemed to argue that what most people recognized as human vices were the main engines of the collective good. Mandeville’s famous book pictured human nature as animalistic, in which the passions held sway over reason. In Mandeville’s world, it appeared, reason became little more than the ability to rationalize, the instrument of hypocrisy, merely letting people cover their true motives (grounded as they were in the passions) with empty words pretending to more exalted ends.His Fable had begun as a little, anonymous, satirical poem in 1705, titled “The Grumbling Hive: or, Knaves Turn’d Honest.” It began by speaking of “A Spacious Hive well stockt with Bees, / That liv’d in Luxury and Ease.” Many of the bees were knaves, with no calling free of deceit, but while “every Part was full of Vice, / Yet [was] the whole Mass a Paradise; /... Such were the Blessings of that State; / Their Crimes conspir’d to make them Great.” Avarice, prodigality, luxury, pride, envy, vanity, folly, fickleness, and inconstancy employed millions, encouraging ingenuity and industry and creating pleasures and comforts “To such a Height, the very Poor / Liv’d better than the Rich before.” But many of the thriving bees complained, shouting for honesty and virtue. When Jove “rid / The bawling Hive of Fraud,” economic collapse followed, with the consequent end of arts and sciences as well; population declined; the hive’s territory decreased; and the remaining bees toiled long and... (shrink)

This paper is about a particular kind of relating between people engaged in processes of change, such as in therapy, primary medical care practice or participatory action research. My thesis is that if a therapist, practitioner or facilitator of research engages with individuals or groups on a basis of relational equality the outcomes can be unanticipated new knowledge which leads to new actions. This 'new' knowledge can be thought of as 'knowing of the third kind' and its expression is (...) a greater sense of connectedness to diverse entities. (shrink)

Subject-scientific and solution-focused approaches share several critical concerns with regard to mainstream psychological concepts and therapeutic practices. Also, the alternatives presented have certain obvious similarities, such as 1) respecting subjective experience and everyday practices, 2) accentuating cooperation and 3) articulating possibilities. The articulation of the societal mediatedness of human experience and action has not, however, been an important theme in solution-focused therapy. Whereas it is justifiable to leave the societal mediation unarticulated in conversations with some clients, it is clear (...) from a subject-scientific perspective that it is necessary for a therapist to seek to comprehend the societal both in her own action and experiences as well as in those of the client. In this article I describe a way of getting a subject-scientific hold of the societal in the everyday living of clients through typical solution-focused practices. I begin by outlining a subject-scientific approach to personality and psychological research. Subject-scientific research is articulated in a way that accentuates the concept of fabric of grounds as a central figure in the architecture of research into subjective experience. This articulation is then conjoined – as a guiding principle – with a description of solution-focused practice. Finally, I will indicate ways of utilizing the knowledge that is being created in solution-focused subject-scientific case study research. (shrink)

Stem cell research has entered the public consciousness through the media. Proponents and opponents of all such research, or of human embryonic stem cell research specifically, engage in heated exchanges in the modern public forum where stakeholders negotiate, the agora. One common claim that emerges from the fray is that a particular type of stem cell research should be pursued as the most promising path toward the reduction of suffering and untimely death for all of humanity. Upon evaluation, experimental data (...) regarding the potential role of stem cells in regenerative therapies for three conditions—spinal cord injury, type 1 diabetes, and cardiovascular disease—tell distinct, complex, and inconclusive stories. Further analyses in this article incorporate realistic considerations of a broad range of relevant factors--limited funding for biomedical research, media motives, the discordance hypothesis of evolutionary medicine, the relationship between religion and science, medical care in developing nations, and culture wars over abortion. Holistic investigation inspired by the current agora conversation supports the need to drastically change interactions regarding stem cell research so that its potential to benefit humanity may be more fully realized. (shrink)

Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman’s micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a therapist’s question, block or dominate the development of the conversation’s topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were prompted by (...) threats that the first couple therapy consultation imposes upon the clients’ self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices. (shrink)

I am grateful to Anastasia Scrutton for opening up a very important area for thought, reflection, and practice. Her paper presents a fascinating argument for an understanding of depression that is framed as a potentially spiritually transformative experience with positive therapeutic implications. In doing so, she offers a way for theologians, philosophers, and practitioners to effectively perceive, understand, and engage with the spiritual dimensions of the experience of depression. As such, she has made an important contribution to the ongoing and (...) often fraught conversations around the role of spirituality in understanding mental health issues. The models she outlines neatly encapsulates a broad range of... (shrink)

Sedlakova and Trachsel (2023) discuss the ethical concerns associated with employing what they term conversational artificial intelligence as therapist substitutes. Given their apprehensions, they...

Cell therapy means treating diseases with the body's own cells. One of the cell types most in demand for therapeutic purposes is the pancreatic β‐cell. This is because diabetes is one of the major healthcare problems in the world. Diabetes can be treated by islet transplantation but the major limitation is the shortage of organ donors. To overcome the shortfall in donors, alternative sources of pancreatic β‐cells must be found. Potential sources include embryonic or adult stem cells or, from (...) existing β‐cells. There is now a startling new addition to this list of therapies: the pancreatic α‐cell. Thorel and colleagues recently showed that under circumstances of extreme pancreatic β‐cell loss, α‐cells may serve to replenish the insulin‐producing compartment. This conversion of α‐cells to β‐cells represents an example of transdifferentiation. Understanding the molecular basis for transdifferentiation may help to enhance the generation of β‐cells for the treatment of diabetes. (shrink)

As mental health nursing roles expand, is education expanding mental health nurses? an emotionally intelligent view towards preparation for psychological therapies and relatedness Mental health nurses (MHN) in the UK currently occupy a challenging position. This positioning is one that offers a view of expanding roles and responsibilities in both mental health act legislation and the delivery of psychological therapies, while simultaneously generic pre‐registration training is being considered. Clearly, the view from this position, although not without challenge and internal discipline (...) dispute, can also offer growing professional prestige, influence and respect from other health disciplines, as well as the wider public. Conversely, if the training, education and strategic enactment for new MHN roles is formulated and delivered from predominantly non‐MHN axiomatic and epistemological stances, MHN identity can be seriously and potentially permanently diminished. This paper offers the construct of emotional intelligence as a framework to respond to these future challenges through making individual MHN enablement a primacy. This enablement of MHNs through enhanced emotional intelligence competencies is argued as requiring priority over the standard approach of enhancing strategies alone. (shrink)

In this article we illustrate how trainers and trainees negotiate epistemic and deontic authority within systemic family therapy training. Adult education principles and postmodern imperatives have challenged trainers’ and trainees’ asymmetries regarding knowledge and power, normatively implicated by the institutional training setting. Up-to-date, we lack insight into how trainers and trainees negotiate epistemic and deontic rights in naturally occurring dialog within training. Drawing from discursive psychology and conversation analysis, we present an analysis of eight transcribed, videotaped training seminars from (...) a systemic family therapy training program, featuring three trainers and eleven trainees. Our analysis highlights the dilemmatic ways in which participants resist and affirm the normatively implicated trainers’ deontic and epistemic authority. Trainers are shown as mitigating directives and trainees as resisting them, with both displaying knowing, while attending to concerns about symmetry. We discuss our findings’ implications for systemic family therapy training. (shrink)

This study reports an analysis using the conversation analytical approach of the use of laughter within a corpus of cognitive therapy sessions. The results relating to eight first encounter sessions reveal that a client’s laughter may accompany disagreement as well as agreement with the therapist. In both cases, the therapist does not reciprocate the client’s laughter and replies by investigating the client in question’s condition, and this approach to the client’s laughter produces significant results in therapeutic work. This article (...) focuses on the asymmetry that characterizes the roles of the psychotherapist and the client in psychotherapy sessions and, in particular, on the part that laughter plays in this type of scenario. (shrink)

The experience of loss of agency is one of the reasons for clients to go for psychotherapy. Enhancing clients’ agency has been considered a fundamental factor for successful treatment in psychiatry and psychotherapy, yet few studies have investigated the interactional realization of how therapists do this in authentic psychotherapeutic encounters. Drawing on audio-recorded talk-in-interaction between clients and psychotherapists in cognitive behavioral therapy encounters at a mental health center in China, this paper uses the method of conversation analysis to demonstrate (...) how therapists ascribe agency positions to clients by issuing formulations of what the clients have just said. Two types of formulation were identified: affirmative formulations and challenging formulations. In the first type, the therapists highlight the positive aspect of the clients’ description of their experiences and ascribe an agentic position to the clients. In the second, the therapists challenge the clients’ implausible views and their non-agentic positioning of themselves. This study shows that the therapists’ formulation could be employed to manage the epistemic difficulties associated with claiming knowledge about the clients’ inner states and assessing their feelings. In this sense, the formulation is a robust interactional device in negotiating epistemic problems in addressing the clients’ experiences and promoting their agency in therapy. However, it is noteworthy that in the challenging formulation, therapists claim privileged access to the clients’ knowledge domain and challenge their prior epistemic status, which might run the risk of engendering clients’ resistance. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Family therapists face a number of challenges in their work. When children are present in family therapy they can and do make fleeting contributions. We draw upon naturally occurring family therapy sessions to explore the ‘pseudo-presence’ and ‘pseudo-absence’ of children and the institutional ‘gossiping’ quality these interactions have. Our findings illustrate that a core characteristic of gossiping is its functional role in building alignments’ which in this institutional context is utilized as a way of managing accountability. Our findings (...) have a number of implications for clinical professionals and highlight the value of discourse and conversation analysis techniques for exploring therapeutic interactions. (shrink)

Duchenne's muscular dystrophy (DMD), which affects 1/3500 live male births, involves a progressive degeneration of skeletal and cardiac muscle, leading to early death. The protein dystrophin is lacking in DMD and present, but defective, in the allelic, less severe, Becker muscular dystrophy and is also missing in the mdx mouse. Experiments on the mdx mouse have suggested two possible therapies for these myopathies. Implantation of normal muscle precursor cells (mpc) into mdx skeletal muscle leads to the conversion of dystrophin‐negative (...) fibres to ‐positive, with consequent improvement in muscle histology. Direct injectidn of dystrophin cDNA into skeletal or cardiac muscle also gives rise to dystrophin‐positive fibres. Although both appear promising, there are a number of questions to be answered and refinements to be made before either technique could be considered possible as treatments for myopathies in man. (shrink)

Medical ethics, principles, persons, and perspectives is discussed under three headings: History, Theory, and Practice. Under Theory, the author will say something about some different approaches to the study and discussion of ethical issues in medicine—especially those based on principles, persons, or perspectives. Under Practice, the author will discuss how one perspectives based approach, hermeneutics, might help in relation first to everyday ethical issues and then to public controversies. In that context some possible advantages of moving from controversy to conversation (...) will be explored; and that will then be illustrated with reference to a current controversy about the use of human embryos in stem cell therapy research. The paper begins with history, and it begins in the author’s home city of Edinburgh. (shrink)

Cosmetic surgery and techno-medical manufacturing of the body are booming. The transformative potential of cosmetic surgery is used to shape and enhance physical appearance, gender identity and sexuality. Among the cosmetic procedures that have become popular is intimate surgery for women, which is oriented towards an ideal shape of the vulva. Almost in parallel with this trend, vulva-positive websites highlighting the diversity of the vulva are becoming ever more widespread in order to enlighten women and contribute to women’s health. This (...) Art-Science Interaction consists of two parts that are in conversation with one another. Artist Merve Şahinol presents in her part “VULVA STUDY. hidden but not undiscovered” photographs of clay vulvas she modeled during therapy sessions to use in talks with women who are challenged by their own perception of their body image. She shares her thoughts and experience of the modeling and learning process in form of prose. In “Manufacturing the Vulva”, sociologist Melike Şahinol explores the rhizomatic dilemma between self/body awareness and empowerment, and the normalization and beauty constraints of manufacturing the vulva. This contribution emphasizes the awareness of the vulva as well as the lack of specific analyses of post-surgery embodiment experiences that include the “new” corporeal experience of sexuality and the fact that these experiences in general have been addressed but not sufficiently analyzed. (shrink)

Psychedelics such as psilocybin reliably produce significantly altered states of consciousness with a variety of subjectively experienced effects. These include certain changes to perception, cognition, and affect,1 which we refer to here as the acute subjective effects of psychedelics. In recent years, psychedelics such as psilocybin have also shown considerable promise as therapeutic agents when combined with talk therapy, for example, in the treatment of major depression or substance use disorder.2 However, it is currently unclear whether the aforementioned acute (...) subjective effects are necessary to bring about the observed therapeutic effects of psilocybin and other psychedelics. This uncertainty has sparked a lively—though still largely hypothetical—debate on whether psychedelics without subjective effects (“nonsubjective psychedelics” or “non-hallucinogenic psychedelics”) could still have the same therapeutic impact, or whether the acute subjective effects are in fact necessary for this impact to be fully realized.3,4,5. (shrink)

The following paper argues that Husserl’s description of the natural attitude can be used as an alternative to Beck’s cognitive therapy’s understanding of the change process and the perpetuation of an emotional disorder. Conversely this also provides further insight into the natural attitude. Specifically the works of Sebastian Luft and Alfred Schutz are referred to as a means of developing what is termed by the paper as the universalising attitude. The paper extrapolates the incidental, yet significant, phenomenological structures within (...) CBT’s process of guided discovery to support its hypothesis that the change process can be understood as the patient undertaking at various times in therapy, a series of differing epoché. It is argued that CBT ultimately ‘works’ by the patient learning to achieve a rudimentary phenomenological attitude. The patient acquires insight by ‘standing back’ from their factual understanding of self, others and the world. (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised (...) to treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

Aphasia is a language disorder that occurs after a stroke and impairs listening, speaking, reading, writing, and calculation skills. Patients with post-stroke aphasia in Japan are increasing due to population aging and the advancement of medical treatment. Opportunities for adequate speech therapy in chronic stroke are limited due to time constraints. Recent studies have reported that intensive speech therapy for a short period of time or continuous speech therapy using high-tech equipment, including speech applications (apps, can improve (...) aphasia even in the chronic stage. However, its underlying mechanism for improving language function and its effect on other cognitive functions remains unclear. In the present study, we investigated whether intensive speech therapy using a newly developed speech support app could improve aphasia and other cognitive functions in patients with chronic stroke. Furthermore, we examined whether it can alter the brain network related to language and other cortical areas. Thus, we conducted a prospective, single-comparison study to examine the effects of a new speech support app on language and cognitive functions and used resting state functional MRI (rs-fMRI) regions of interest (ROI) to ROI analysis to determine changes in the related brain network. Two patients with chronic stroke participated in this study. They used the independent speech therapy system to perform eight sets of 20 randomly presented words/time (taking approximately 20 min), for 8 consecutive weeks. Their language, higher cognitive functions including attention function, and rs-fMRI, were evaluated before and after the rehabilitation intervention using the speech support app. Both patients had improved pronunciation, daily conversational situations, and attention. The rs-fMRI analysis showed increased functional connectivity of brain regions associated with language and attention related areas. Our results show that intensive speech therapy using this speech support app can improve language and attention functions even in the chronic stage of stroke, and may be a useful tool for patients with aphasia. In the future, we will conduct longitudinal studies with larger numbers of patients, which we hope will continue the trends seen in the current study, and provide even stronger evidence for the usefulness of this new speech support app. (shrink)