青少年来访者服务工作的困境和思考

作为一名心理治疗师,我的工作对象一般是来医院就诊的已确诊焦虑症、抑郁症、强迫症等疾患的成人来访者.但有时也会在心理治疗室中见到由父母带来就诊的青少年来访者. 相比成人来访者,青少年来访者服务工作有两个特殊的地方. 心理治疗费用由来访者的父母支付 成人心理治疗是由成人付费的,心理治疗关系相对简单.而青少年来访者的心理治疗...     

不同职业背景心理咨询和治疗从业者的伦理行为

目的:了解不同职业背景心理咨询和治疗从业者的伦理行为,加强心理咨询和治疗职业伦理教育。方法:以前期编制的心理咨询或治疗伦理问题调查问卷(咨询师版),对全国西北、华北、华东、中南、东北、西南每个行政区的3～4个城市共690名心理咨询和治疗从业者进行调查,并分析精神科医师、临床心理治疗师、学校心理咨询师三种职业背景从业者的伦理行为状况。结果:三种职业背景的从业人员中,以精神科医师的从业年限最长(10年的占16.7%),对于每一个来访者平均的治疗次数最多(10占20.1%),平均每次咨询时长最短(≤30分钟的占3.4%)。伦理行为调查中,在胜任力方面,三组人员各有70%都"感到力不从心、难以胜任";67.7%的精神科医师和62.5%的学校心理咨询师害怕自己不能够满足患者的需要;在知情同意和保密方面,17.4%的精神科医师"在走廊、电梯等公共场所与同事讨论来访者治疗方案";84.5%的临床心理治疗师"在治疗前向来访者讲明收费标准和规定";双重关系条目中,超过30%的精神科医师、临床心理治疗师和学校心理咨询师"特别喜欢某些来访者";14.1%的精神科医师对某些来访者产生性幻想;在咨询设置方面,有31.4%的精神科医师、25.0%的临床心理治疗师和20.1%的学校心理咨询师在咨询期间接听电话。不同性别、从业年限的心理咨询和治疗从业者"害怕不能满足患者需要"等部分条目差异有统计学意义。结论:本研究显示,不同职业背景心理咨询和治疗从业者都存在一定比例的违背伦理要求的行为,精神科医师出现违背伦理行为的比例较高。提示需要根据不同职业不同特点有针对性的进行伦理教育。     

行为疗法治疗精神分裂症个案的过程分析:语言反应模式角度

目的:关注行为疗法治疗精神分裂症患者过程中治疗师和来访者的言语行为,来探讨(1)行为治疗过程中,参与者双方语言反应模式的类别及其变化;(2)治疗师何种语言反应模式能引起来访者的认知-情感探索,初步从言语行为层面来探索来访者如何形成并维持新的行为模式。方法:本研究为观察性研究。采用立意抽样法获取一例精神分裂症来访者的行为治疗过程的视频音频资料,将其整理为会谈脚本,使用定性分析与定量分析结合的方法来研究该案例行为治疗的过程。结果:本案例行为治疗过程中,治疗师运用较多的解释、反映、建议和确认等语言反应模式,而来访者则运用较多的揭露、承认等语言反应模式。治疗师探索式反映的语言反应模式,能够较多地引起来访者的认知-行为探索和情感探索。结论:在本案例行为治疗的不同时期,治疗师和来访者语言反应模式的主要类别不同,在言语行为层面,治疗师探索式反映的语言反应模式能较多地引起来访者的认知-情感探索,提高其治疗参与度,有利于来访者形成并维持新的行为模式。但来访者的治疗性改变究竟是如何产生的,尚需进一步的研究。     

来访者对心理咨询或治疗师的伦理行为评价

目的:了解来访者对心理咨询/治疗师伦理行为的评价状况。方法:采用问卷调查法,以自编心理咨询和治疗伦理问题调查问卷(来访者版)为评价工具,在全国范围内选取12个城市的1100名来访者进行调查,回收有效问卷807份。结果:84.5%的来访者对正在进行的治疗有信心,89.2%的来访者认为自己的心理咨询/治疗师能够胜任工作。15.9%的来访者评价,心理咨询/治疗师有时会表现出不耐烦的情绪或向来访者倾诉自己的压力。59.1%的来访者了解心理咨询或治疗的性质、作用和局限性,53.4%的来访者知道心理咨询/治疗师的专业背景。91.3%的来访者认为自己的隐私和治疗内容能够得到保密。来访者与心理咨询/治疗师发生亲密关系的占7%,发生性关系的占1.5%,在生活中是朋友关系的占18.3%。79%的来访者所接受的心理咨询或治疗能够按时开始和结束。结论:从来访者评价的角度,绝大多数的心理咨询/治疗师在工作胜任能力、保密、遵守时间设置方面做得较好,但在知情同意、双重关系方面存在问题,需要引起重视并改进。     

熟人社会下来访者对专业关系的态度

目的：研究中国熟人社会文化下,来访者对待专业关系的态度和行为倾向。方法：采用质性研究方法,选取16位有心理咨询意愿的访谈对象进行半结构化访谈,并采用解释现象学方法对资料进行分析。结果：来访者认为咨询师的角色类似于医生或指导者,心理咨询中的专业关系可以不拥有明确的界限,并有打破专业关系边界的行为倾向。结论：熟人社会这一文化背景会影响来访者对专业关系的理解和期待,这使得我国心理咨询或心理治疗行业中的伦理议题变得更为复杂。咨询师或治疗师需兼顾文化和实际情况做出适宜的伦理决策。     

心理治疗中治疗师与来访者的性关系

在早期的伦理学法典中关于健康保护方面即有规定 :从业者不能与来访者发生性关系[1] 。但是 ,现在临床伦理学法典却忽视了这方面的问题。直到1970年代 ,研究发现在心理治疗中有不少的治疗师违反了这一规定时 ,才明确提出 :治疗师与病人之间的性关系是违反规定的行为。随后这一规定便被法庭认识并接受。早期对心理治疗中治疗师与来访者的性关系的理解主要是基于理论、一般感受及个案研究的结论 ,在最近 2 5年来这种情况大为改善 ,许多系统的调查研究提供了客观真实的数据统计资料。本文将概述这方面的情况。1　文献回顾从Ｍａｓｔｅｒ及Ｊｏ…     

心理治疗师理论取向选择的相关因素(述评)

心理治疗师的理论取向对治疗过程、结果、治疗师的职业满意度和培训都有重要意义。本文介绍了影响理论取向选择及其改变的相关因素,包括"外部"因素(例如培训、督导等)和"内部"因素(例如人格特点、认识论等),并阐述了其研究意义。     

治疗中,你们能顺利地结为联盟吗?

在心理治疗中,来访者和咨询者之间需要配合,专业术语将其称之为治疗联盟。实际上,治疗联盟说的就是一种关系,一种在心理治疗过程中,病人与治疗师建立的特殊的人际关系。为了保证心理治疗工作的顺利进行,     

心理咨询师/治疗师与来访者对职业伦理的态度比较

目的:考察我国当前心理咨询或治疗师与来访者在心理咨询与治疗领域职业伦理上的态度和意识,以帮助专业人员更好地理解和解决职业伦理困境,并为制定我国在该领域的职业伦理规范提供参考。方法:采用自编心理咨询与治疗职业伦理意识和态度问卷对48名专业人员(咨询师/治疗师)和48名来访者进行调查,比较两组人群在职业伦理意识和态度上的差异,以及一些重要人口学变量的可能影响。结果:两组人群在自编问卷的12个条目评判上有显著差异,其中涉及咨询关系原则4条(如47.9%的来访者认为专业人员可以和来访者发展私人关系,专业人员持同样看法的为4.2%,P<0.01);保密性原则1条;职业责任原则2条;评估、测量和解释原则2条;督导、培训和教学原则2条,另有一条为询问被调查者是否听闻过有违伦理的行为,发现来访者知晓的违反伦理行为(35.4%)显著少于专业人员(97.9%)(P<0.001);专业人员群体在17个条目上评判一致,仅在涉及咨询关系原则的1条目有争议,即48.3%的专业人员认为在来访者和咨询师价值观冲突时应转介来访者,51.7%的专业人员认为不应转介;来访者群体则在11个条目上评判一致,有4个争议条目,其中涉及咨询关系原则的条目3条(即在咨询师可否和来访者发生私人关系,咨询可否给来访者带来伤害,咨询师可否接受来访者的礼物问题上持肯定或否定意见的来访者都在40%以上);职业责任原则的条目1条,即56.3%的来访者认为咨询师可以按照自己的喜好选择病人,46.7%的来访者则持反对意见。结论:专业人员总体上表现出较强的伦理意识和较为一致的伦理态度,而来访者的伦理态度更不一致,两组人群在保密原则和咨询关系方面的态度差异尤其明显。     

心理治疗师在不同流派中的角色

心理治疗者要能帮助来访者，探明并解决他们提出的各种问题和困难。就要有理论的支持。理论思想决定着治疗师在治疗遏程中的一系列的反应。如何看待治疗师在治疗过程中的角色和功能，各个流派都有自己的定位。     

Secular change in menarche in women in Madrid

The age at menarche was estimated by recollection in 1617 women between the ages of 18 and 60 in Madrid and a nearby suburb, Pinto. The population of Pinto is working-class and the Madrid group, taken from residential neighbourhoods , belongs to the upper middle class. In both groups we found a diminution in average age at menarche, from 14.04 to 13.02 years in Madrid and from 14.55 to 13.16 years from about 1935 to about 1965 in Pinto. These changes have been more intense in the group which is less well-off economically, where living conditions have varied much more drastically.     

Intestinal helminthiasis in school children in Haiti in 2002

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.     

Experience in adult population in dengue outbreak in Delhi

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.     

Changes in the hypothalamic nuclei in in experimental allergy

Summary In rabbits subjected to prolonged sensitization and in which the Arthus phenomenon was induced there was a marked reaction of the hypothalamic nuclei. Staining by Gomori's method indicated a cellular swelling, loss of granules, and protoplasmic vacuolization in the supraoptic nucleus. There was a considerable increase in the size of the cross-sectional area of the cells. The same effects were much less well shown in the paraventricular nucleus. These results show that marked signs of increased neurosecretion developed in the animals at the height of the Arthus phenomenon.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten Éksperimental'noi biologii i Meditsiny, Vol. 55, No. 4, pp. 110–113, April, 1963.     

Development in in vitro toxicology

There are three principal pressures driving the development of in vitro toxicology: (1) the need for more efficient testing systems to cope with the large number of xenobiotics currently being developed; (2) public pressure to reduce animal experimentation; and (3) a need for a better understanding of the mechanisms of toxicity. Within this, in vitro toxicology is focused on local, systemic, and target-organ toxicity. It is becoming increasingly apparent that a step or decision-tree approach using input of a variety of experimental data (physicochemical properties, biokinetics, cytotoxicity) provides the most efficient system for predicting toxicity. Examples of the use of in vitro toxicity systems for prediction of systemic toxicity and target-organ (liver) toxicity are presented.Originally presented at ECCP 93.