A discourse analysis of health provider interactions with parents who are reluctant to vaccinate

ObjectiveVaccine hesitancy is a persistent barrier to vaccination uptake, and health professionals report interactions with such parents to be difficult. Using discourse analytic techniques, we examine the foundation of a therapeutic relationship: the display of empathy and attempts to build rapport, in consultations between immunisation specialists and vaccine reluctant parents.MethodsConsultations between consenting clinicians and parents in two Specialist Immunisation Clinics in Australia were recorded. Twelve conversations between the clinicians and parents were analysed using interactional sociolinguistic (IS) discourse analytic methods.ResultsThis paper takes a case study approach by citing two interactions that exemplify the interactional work of the consultants as they strive to engender mutual understanding and goodwill, noting examples of discursive choices that demonstrate empathy and the building of rapport.ConclusionAwareness of discourse strategies that interweave relational and clinical goals enable a more nuanced understanding of communication skills that support a guiding partnership in vaccine related decisions with parents.Practical implicationsThrough highlighting the strategic interactional work that displays empathy and builds rapport, we can inform educational approaches and build a repertoire of communication choices that strengthen the communication skills of health professionals.     

Perdita and Oedipus: A Tale of Two Adoptions

The paper proposes Shakespeare's The Winter's Tale (WT) as foundation narrative for attachment‐informed psychotherapy, and a counterpart to Oedipus Rex (OR), covering similar psychological territory but in a strikingly different way. Both start with a father's rejection of a baby and its rescue and adoption by distant shepherds. Both revolve around murderousness and desire in a mother–father–child triangle, but in WT the prime mover is filicide rather than parricide. WT points to the positive aspects of the care‐giving dynamic. The main characters of WT, in contrast to OR's phallocentrism, are the rejected Queen Hermione, her handmaiden Paulina and Perdita herself. Their relationships are characterized by attachment security: this gives Paulina the courage to confront and instigate mentalizing in Leontes, the psychotic king, and for Perdita to find her sexuality through her transgressive love for Florizel. The environmental benefits of adoption are highlighted as WT's tragi‐comic dynamic moves from chaos to renewal and rebirth: Hermione survives the ‘attack on the good object’; Leontes recovers from his jealous hatred and subsequent depression; ruptures are repaired. WT depicts secure attachments as bulwarks against loss, and the key to resilience in the face of trauma.     

Mindfulness to regulate emotions: The Mindfulness and Emotional Intelligence Program (PINEP) and its adaptation to a virtual learning platform

The present study examines the effect of the Mindfulness and Emotional Intelligence Program (PINEP), adapted to the virtual learning platform Moodle where participants receive Mindfulness training in 12 sessions lasting an hour and a half. The sample consists of 89 people, assigned randomly to a control group on the waiting list and to an experimental group that undertakes the training. The results indicate that the participants who completed PINEP showed improvement in the variables of health, empathy and mindfulness, in comparison with the participants of the group on the waiting list.     

La passion du soin et du travail psychiques,un paradoxe ?

Is passion, a concept difficult to define, disturbing affect by its double emotional and representative dimension, “a normal pathological state”? It concerns any relation to an “object” that wants to occupy a considerable place in existence. Can a therapist be passionate or be crossed by passion? Whether it is cultural, artistic, sporting, passion can provoke, we know it well, a passionate outburst. How can one accept its necessity while being wary of its destructive side (mystical passion, delusional passion) where the subject ends up getting lost? Etymology may provide a partial response to the polysemy of the word that has created confusion. Passion comes from the Latin “passio” which refers to the fact of suffering, experiencing. The Greek root “pathos” gave pathology whose original meaning is the study of passions and then that of diseases, and also non-medical terms (pathetic…). The semantic confusion has been based on this for centuries. Passion remains difficult to pin down. What maintains my desire, my passion in this solitary work? I need to remain in the unceasing research, in the questioning. Here are the basics inscribed in me: reading, working meetings that bring pleasure to think while maintaining openness to the unconscious by better grasping the counter-transference, belonging to a society to share the same passion of human knowledge and the same desire to heal. Passions remain pervasive and some take up more space than the object of passion. This is one of the many paradoxes. An other: the passion, this “dark complacency to vertigo” (Paul Ricoeur), allows to alienate oneself in the bond to better find oneself, to recreate oneself. We cannot, escape knowledge about ourselves. Beyond its excess, constitutes a real psychic work of elaboration and symbolization. Let us keep alive this passion for psychic care and work. To do this, let us remain confident in our theoretic-clinical commitments as well as in the changes we deem necessary to help those who come to tell us about their suffering. Who are they? Interest in their own mental health is initially acquired for neurotic patients; it is legitimate and useful. With patients working on a psychotic register, this is not the case and we are faced with an obstacle cited by Marcel Sassolas, which is “the distrust developed by these people towards their own psychic activity”. The only real objective of psychiatric care remains the safeguarding and restoration of their psychic activity, knowing full well that being present is a source of danger. What maintains our desire for care and psychic work with the attention we pay to it? The way we work with the richness of the commitments it unders understands – psychoanalysis for me – allows us to understand the human in an exceptional and exciting way. Here are two of my tools. First empathy. It is a dialectic between understanding and feeling that manifests, occurs, in an unseeded manner at the level of the preconscious of one (therapist) or the other (patient). My other tool is this therapeutic device that is co-work (shared associative movement). Daniel Widlöcher's co-thought… The latter has taken up the Freudian concept of “induction of thought”. This allows him to link empathy, through “the transfer of thought”, to the associative and representational co-thinking of the therapist and the patient. What is this co-work? In psychoanalytic relaxation, for example, we know that a particular word, a phrase, a phoneme can have, for the relaxer, an emotional impact that is inscribed in his thought (reverie) and in his body (sensation). Passion allows creative psychic care by producing from living. It strengthens our need for new projects that boost our motivation and confidence. It maintains our desire to be at the heart of psychic work and that of transmitting that strength. Creativity is not the ability to create a work, it is the ability to creatively live a meaningful life (Winnicott). It is vitality in the service of self-building. Stay alive and passionate, even late in practice, not because of knowledge, experience, but because of the uninterrupted work in self-discovery. To conclude? I consider that a living therapeutic process, that is, subjective appropriation, implies a passionate character in the therapist who offers a place for what is to be deposited there. We are often in paradoxical situations. To better understand its scope, I rely on the Oxford Dictionary's definition: a paradox is an assertion that seems absurd, though maybe truly well-founded. It's all in the maybe. Isn’t the psyche that heals the psyche the passion of dialogue with our unconscious?     

Paracetamol alters empathy scores in healthy and headache subjects: Functional MRI correlates

IntroductionAlthough previous evidence suggest that paracetamol decreases psychological reactivity in healthy subjects, there is still no confirmed correlation between the empathy scores and brain activity in healthy and headache patients after paracetamol treatment.Material and methodsThe study group included 16 patients with tension-type headache, and 12 healthy age-and sex-matched controls. After a detailed neurological examination Positive and Negative Affect Schedule (PANAS) and Empathy for Pain Scale (EPS) were applied to all subjects. Next, 1000 mg paracetamol tablet was administered orally, after administration of paracetamol, EPS were repeated, and fMRI was performed to all subjects.ResultsWe have revealed increased empathy scores in the headache group after the paracetamol treatment which were associated with significant alterations in brain regions which play a critical role in the processing of empathy.DiscussionThe observed neuroimaging and clinical difference between healthy and headache subjects could be related to the fact that pain perception in healthy subjects might differ in some aspects from the mechanisms of empathy in headache-experienced patients.ConclusionTo the best of our knowledge, this is the first study that evaluated the paracetamol treatment and neural networks' correlation with pain empathy in healthy and headache individuals.     

Adaptation of the Youth Connectedness to Provider scale to assess the relationship between health professionals and adolescent and young adult patients

ObjectiveThe aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale).MethodThe questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10–24 years old and Cronbach's alpha coefficient was calculated.ResultsA content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach’s alpha = 0.76). The questions showed a good correlation, except for the question about judgment (Spearman’s rho = 0.03–0.19).ConclusionsThe scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.     

Physician experience is associated with greater underestimation of patient pain

ObjectiveProcedural pain is unique in that physicians simultaneously cause and assess it. Experienced male physicians are known to underestimate their female patients’ pain more than other physicians. However, it is unknown whether this also occurs in obstetrics/gynecology, where all patients are females. This study addresses the gap in literature on procedural pain assessment accuracy.MethodsThe present research compares paired pain evaluations from 20 obstetricians/gynecologists and their 92 female patients.ResultsOur data demonstrate that patients’ reported pain levels (M = 5.53, SD = 2.7) were significantly higher than their physicians’ pain estimates (M = 4.89, SD = 2.19), t = 2.64, p < 0.005. The gap between patients’ and physicians’ pain estimates was greatest among physicians with the greatest procedural experience (M = 1.49, SD = 2.24), f = 5.72, p < 0.005. Male physicians underestimated their patients’ pain significantly more than female physicians do, t = 2.27, p < 0.05.ConclusionOur results shed light on systematic underestimation of procedural pain and highlight the significance of experience and sex differences in pain evaluation.Practice implicationsPhysicians’ experience influences their perception of patient pain while performing procedures. Experienced male physicians, even those who exclusively treat female patients, need to be aware of this ubiquitous bias in assessing their female patients’ procedural pain.