The Cogency of Risk Assessments

Preventive detention schemes rely on assessments of risk carried out by forensic practitioners. Corrective services departments and other organs of the state inevitably present the approaches they adopt and the tools they employ in this endeavour as being “best practice” and “evidence based”. Typically these assessments are conducted according to a bureaucratic template and are based on a selected suite of tests that are heavily biased towards actuarial assessment. The validity of this approach is gravely suspect as is the failure of many forensic professionals to properly identify the diagnostic accuracy/inaccuracy of the tests and methods they rely upon in conducting risk assessments. This article iterates the methodological and evidentiary problems with risk assessment of sexual offenders. It is concluded that common extant approaches lack scientific objectivity and fail to provide the courts with cogent evidence. As a result of these errors in investigatory processes miscarriages of justice are inevitable.     

Psychotherapy expertise in Singapore: A qualitative investigation

Abstract

Personal characteristics, developmental influences, and therapy practices of nine peer-nominated expert psychotherapists practicing in the diverse country of Singapore were identified using qualitative methods. Sixteen themes were organized within four categories: (a) personal characteristics (empathic, nonjudgmental, respectful); (b) developmental influences (experience, self-awareness, humility, self-doubt); (c) approach to practice (balance between support and challenge, flexible therapeutic stance, empowerment/strength-based approach, primacy of the therapeutic alliance, comfortable addressing spirituality, embraces working within a multicultural context); and (d) ongoing professional growth (professional development practices, benefits of teaching/training others, challenges to professional development in Singapore). Cross-cultural comparisons between this study and Jennings and Skovholt's (1999) study of Minnesota expert psychotherapists found considerable overlap of themes. Implications for research and practice of psychotherapy are offered.     

Alliance ruptures and rupture resolution in cognitive–behavior therapy: A preliminary task analysis

Abstract

An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive–behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures and what they actually do and suggested that the rational model should be expanded to emphasize client validation and empowerment. Therapists’ ability to attend to ruptures emerged as an important clinical skill.     

Predoctoral interns’ nondisclosure in supervision

Abstract

In interviews with 14 counseling center predoctoral interns regarding a significant nondisclosure in supervision, eight interns reported good supervisory relationships and six indicated that they experienced problematic supervisory relationships. Nondisclosures for the interns in good supervisory relationships related to personal reactions to clients, whereas nondisclosures for interns in problematic supervisory relationships related to global dissatisfaction with the supervisory relationship. In both groups, interns mentioned concerns about evaluation and negative feelings as typical reasons for nondisclosure. Additional reasons for nondisclosure for interns in problematic supervision were power dynamics, inhibiting demographic or cultural variables, and the supervisor's theoretical orientation. Both groups described negative effects of nondisclosure on themselves and their relationships with clients. Interns in problematic supervision also reported that nondisclosures had negative effects on the supervisory relationship.     

A mathematical model of psychotherapy: An investigation using dynamic non-linear equations to model the therapeutic relationship

Abstract

Mathematical models, such as the one developed by Gottman et al. (1998, 2000, 2002) to understand the interaction between husbands and wives, can provide novel insights into the dynamics of the therapeutic relationship. A set of nonlinear equations were used to model the changing emotional state of a therapist and client. The results suggest: (1) The person that is most responsive to the other achieves the most positive state, (2) the emotional state of the client oscillates before reaching its final state, (3) therapy is least successful when the therapist starts from a negative state, and (4) there is an inverse relationship between models that change only the influence parameter and models that change only the inertia parameter, creating a series of four basic models to work with. These theoretical models require further, empirical investigation to test the derived parameters. If validated, or revised based on observations of therapist-client relationships in development, they could provide specific direction in creating successful therapeutic relationships for training clinicians and those already in practice.     

Patient change processes in psychotherapy: Development of a new scale

Abstract

There is considerable interest in understanding and augmenting the process of change in psychotherapy. In this study qualitative and quantitative analyses were used to examine patient processes associated with change in recorded psychotherapy sessions from the Christchurch Psychotherapy for Depression Study. The sample consisted of 177 outpatients with a primary diagnosis of major depressive disorder randomized to receive weekly therapy sessions of Cognitive Behavior Therapy or Interpersonal Psychotherapy. Qualitative analyses identified four main themes associated with patient change. From these themes a 10-item rating scale, the Patient Psychotherapy Process Scale (PPPS), was developed. Analyses indicated the PPPS is a reliable and valid measure of important patient change processes, with higher scores associated with a better response to psychotherapy.     

Somatic underpinnings of perceived empathy: The importance of psychotherapy training

Abstract

This study investigated the somatic underpinning of empathy using an interpersonal physiology approach. Thirty-nine dyads were formed by a “pseudo-patient” and a “listener” (a therapist, a psychologist, or a non-therapist). Dyadic physiological concordance in electrodermal responses and listeners' empathy were evaluated during simulations of clinical sessions. A significant positive correlation between empathy as perceived by pseudo-patients and physiological concordance was found, providing empirical evidence of a somatic underpinning of empathy. Moreover, therapists showed higher levels of physiological concordance and empathy, confirming the importance of psychotherapy training in managing clinical interactions.     

The roles of age, gender, inhibitory control, and parental supervision in children's pedestrian safety

OBJECTIVE: Thousands of American children are injured or killed each year as pedestrians, but behavioral factors in pedestrian injury etiology remain poorly understood. We examined the roles of children's individual differences (age, gender, and inhibitory control) and parental supervision in children's pedestrian behaviors. METHODS: Using the pretend road method, a sample of 85 children and 26 adults crossed a pretend crosswalk set adjacent to a real road. Safety of crossing the pretend road was determined based on actual traffic on the real road. Adults also crossed the real road. RESULTS: Adults' behavior on the real road paralleled that on the pretend road, supporting validity of the method. On the pretend road, younger children, boys, and children with less behavioral control engaged in riskier pedestrian behaviors. Children with less behavioral control responded more noticeably to increases in parental supervision. CONCLUSION: Results are discussed in relation to children's development and injury prevention.     

从药品质量标准的视角探讨药品的监督与管理

目的：从药品质量标准的视角探讨如何进一步加强药品的监督与管理,促进医药产业发展、保障公众用药安全。方法：通过对监督抽检发现的药品质量标准存在的问题进行分析研究,提出相应的解决措施和意见建议。结果与结论：部分药品质量标准在标准制定、审批发布、标准管理、标准执行以及质量标准的可及性等方面存在不足,影响了质量标准的执行和药品生产及安全监管,应从建立药品审评审批与药品质量标准管理的联动机制、完善监督抽检机制、加强对药品质量标准执行的监管等方面加以解决。