\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining (...) and multi-level models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

This paper develops and defends a new account of therapeutic trust, its nature and its constitutive norms. Central to the view advanced is a distinction between two kinds of therapeutic trust – default therapeutic trust and overriding therapeutic trust – each which derives from a distinct kind of trusting competence. The new view is shown to have advantages over extant accounts of therapeutic trust, and its relation to standard (non-therapeutic) trust, as defended by Hieronymi, (...) Frost-Arnold, and Jones. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be defended are (...) then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

Clinical trials play a crucial role in generating evidence about healthcare interventions and improving outcomes for current and future patients. For individual trial participants, however, there are inevitably trade‐offs involved in clinical trial participation, given that trials have traditionally been designed to benefit future patient populations rather than to offer personalised care. Failure to understand the distinction between research and clinical care and the likelihood of benefit from participation in clinical trials has been termed the ‘therapeutic misconception’. The evolution (...) of the clinical trials landscape, including greater integration of clinical trials into healthcare and development of novel trial methodologies, may reinforce the significance of the therapeutic misconception and other forms of misunderstanding while at the same time (paradoxically) challenging its salience. Using cancer clinical trials as an exemplar, we describe how methodological changes in early‐ and late‐phase clinical trial designs, as well as changes in the design and delivery of healthcare, impact upon the therapeutic misconception. We suggest that this provides an impetus to re‐examine the ethics of clinical research, particularly in relation to trial access, participant selection, communication and consent, and role delineation. (shrink)

Although the therapeutic misconception (TM) has been well described over a period of approximately 20 years, there has been disagreement about its implications for informed consent to research. In this paper we review some of the history and debate over the ethical implications of TM but also bring a new perspective to those debates. Drawing upon our experience of working in the context of translational research for rare childhood diseases such as Duchenne muscular dystrophy, we consider the ethical and (...) legal implications of the TM for parental consent to research. In this situation, it is potentially the parent who is vulnerable to TM. In our analysis we not only consider the context of informed consent for research but also the wider environment in which the value of research is promoted, more broadly through the media but also more specifically through the communication strategies of patient organizations. All dissemination about developments in research for health runs the risk of portraying an overly optimistic view of the promise of biotechnological solutions and has the potential to encourage a ‘collective’ TM. In this paper we consider the challenge that TM presents to parents as well as explore the ethical and legal responsibilities of researchers to ensure an appropriately informed consent: compatible with a hopeful disposition of parents who consent for the their children whilst avoiding a blind and misleading optimism. (shrink)

The therapeutic and integrative significance of faith in the African quest for healing and wholeness has attracted a considerable level of interest amongst scholars in recent times. Despite the increasing interest in places of healing, faith communities have not paid much attention to studying the intersection of these practices for appropriate community hermeneutics. By means of qualitative methods, this research explored the therapeutic implication of the role of faith in the quest and appropriation of health and wholeness in (...) modern Africa. Exploring perspectives from Ghana and Nigeria, the study engaged, through focus groups and individual interviews, the proper place of therapeutic significance of faith in the quest for healing and wholeness. Findings revealed that the African quest for health and wellness is anchored in the belief of a deity whose presence, love and benevolence transcend the ecclesiastical boundaries of one’s faith tradition. The study further describes the therapeutic and integrative significance of these prevailing faiths in God within the appropriation of health and wholeness in modern Africa, with the possibility of fostering a partnership amongst the three key players in the triangulation process.Contribution: The study falls within the field of practical theology and its major contribution falls within the quest of wellness and healing in Africa. (shrink)

Psychotherapists and counsellors confront several ethical dilemmas as they tend to provide effective services. There has been much debate among psychotherapists and counsellors alike around the utility of therapeutic contracts. Some view contracts as being restrictive to the therapeutic process and often hindering the work done in sessions. In contrast, many counsellors and psychotherapists use those agreements to revisit specific therapeutic topics and establish the guidelines necessary for this professional arrangement. No matter the opinion or preference of (...) contracts, the development of written and/or verbal consent of specific topics in psychotherapy remains essential. This remains one of the formal features of the arrangement and starting relationship in current counselling and psychotherapy practice. This paper aims to discuss the necessity and ethical demand of therapeutic contract in counselling and psychotherapy practice. (shrink)

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of ‘misunderstandings’ that research participants may have. In this paper, we describe a new concept—therapeutic appropriation. Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an (...) opportunity to enhance patients' clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them. (shrink)

Background and Purpose: Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. Participants and methods: A single-centre opinion survey (...) of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Results: Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor’s family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient’s care. But more than 75% of respondents think that the advance patient’s consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. Conclusion: The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families’ support. But they ask to require previously expressed patient’s consent and family’s approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy. (shrink)

ABSTRACTBased on the case of Rosa, a nine‐year‐old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an (...) ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity. (shrink)

My essay argues that neoliberal forms of government emerged through the shifting political trajectory of the therapeutic ethos in the postwar period in Anglo-American societies. In the postwar era, the therapeutic ethos attracted the attention of conservative cultural critics who described it as a destructive force on communal obligation. Initially, the therapeutic ethos appeared to align naturally with New Left ideas of democratization in the workplace and private sphere. However, I argue that the New Right was subsequently (...) able to sever the therapeutic ethos from its alignment with social democratization by imbuing it with an alternative set of meanings centered on the ideas of market freedom and the entrepreneur. The result was the construction of the new, neoliberal forms of power, which, I argue, take the form of the management of subjectivity. Finally, I outline the two major social pathologies of the neoliberal era, namely, the consequences of its contractualized notion of citizenship and the explosion of social inequality, both of which are traceable to the influence of therapeutic notions of the self. (shrink)

Since its inception in the 1900s, the concept of countertransference has been mired in controversy. Psychoanalytic literature is divided on its utility, significance and its clinical value in psychotherapy. While some psychotherapists have advocated for the importance of therapists’ expertise in the comprehension and processing of countertransference dynamics in the treatment of sexually abused children, others see no value in competency in countertransference in trauma treatment of sexually abused children. The purpose of this article is to explore whether countertransference is (...) a useful therapeutic tool, or a hindrance in the treatment of sexually abused children. A qualitative paradigm, particularly interpretative phenomenology, was employed in this research to make meaning of the therapists’ experiences. The analysis of the results revealed the following five main themes that were supported by 18 superordinate themes. These themes reveal that therapists treating sexually abused children experience a myriad of feelings, including a) feeling emotionally overwhelmed, b) anger toward perpetrators and the need to protect and rescue their patients, c) the importance of social support and self-healing, d) feelings of empathy and identification with the client, and e) erotic countertransference. These findings reveal two contradictory findings. Firstly, they tell of variable utilisation of countertransference among participants and, secondly, they highlight a lack of application of countertransference in the treatment of sexually abused children. The implications of the current study are that there is a need to both highlight the importance of countertransference as a therapeutic tool and to incorporate it in the treatment of sexually abused children. (shrink)

The aim of this paper is to discuss monastic paideia in the context of providing shelter for ASD individuals in the High Middle Ages. Firstly, we will canvas the historical and conceptual shift from Ancient Greek paideitic ideas to their Christian counterparts. Then, by drawing on the recent literature in the history of medicine that traces the signs and symptoms of autism spectrum disorder (ASD) in Hildegard of Bingen, a German abbess in the 12th century, we will turn to her (...) invented language Lingua Ignota as a source of both her diagnosis and a manner of dealing with her disability. This, in turn, could be further advanced by identifying monasteries as therapeutic loci for neuroatypical individuals who had trouble finding their place within the arid and somewhat monochromatic medieval society. (shrink)

The doctrines of therapeutic nihilism and administrative nihilism are both based on the belief that the norms of activity are intrinsically linked to the structure of the body. Just as there is a vis medicatrix naturae in the individual organism, which renders any intervention of the therapist vain, there would be a vis medicatrix rei publicae in the social body, which makes the intervention of the legislator in economic life pointless and even dangerous. However, such a symmetry is not (...) quite as clear as it appears at first. It has also been upheld that the real parallel is not between therapeutic and administrative nihilism, but between therapeutic nihilism and statism. In this view, government is less comparable to a therapist than to the nervous system, and just as a well regulated organism is a one with an extensive nervous system, a well regulated society is one with a strong State.We intend to retrace the historical origin of these two schemas of correspondence, which has his roots in the celebrated controversy in the 1870’s between Herbert Spencer and Thomas Henry Huxley. We examine the causes of this apparent paradox, which sometimes views the doctrine of administrative nihilism, and sometimes the opposing doctrine of statism, as being the equivalent in politics of therapeutic nihilism in medicine. In our opinion, an important part of the explanation must be sought in the variations of the field of extension, which is implicitly given to the concept of vis medicatrix, or –as we now usually call this notion– that of Self-regulation. (shrink)

The unexpected roles of the microbiota in cancer challenge explanations of carcinogenesis that focus on tumor-intrinsic properties. Most tumors contain bacteria and viruses, and the host’s proximal and distal microbiota influence both cancer incidence and therapeutic responsiveness. Continuing the history of cancer–microbe research, these findings raise a key question: to what extent is the microbiota relevant for clinical oncology? We approach this by critically evaluating three issues: how the microbiota provides a predictive biomarker of cancer growth and therapeutic (...) responsiveness, the microbiota’s causal role(s) in cancer development, and how therapeutic manipulations of the microbiota improve patient outcomes in cancer. Clarifying the conceptual and empirical aspects of the cancer-associated microbiota can orient future research and guide its implementation in clinical oncology. (shrink)

Therapeutic reactivity among psychology trainees was ascertained by their response to 10 clinical vignettes depicting clients with HIV who are sexually active with uninformed partners. This construct accounts for the relative change in decisions to maintain the confidentiality of clients who acknowledge safe versus unsafe sexual behavior. As anticipated, an analysis of variance revealed a significant main effect for safety and a significant 3-way interaction. Subsequent analyses revealed that trainees exhibit the highest level of therapeutic reactivity toward heterosexual (...) male clients, and the lowest reactive stance toward heterosexual female clients. Although the decisional pattern evidenced toward heterosexuals seems congruent with epidemiological estimates of risk, the decisions toward lesbians and gay males appear more likely a function of bias. The ethical implications of these findings are discussed. (shrink)

Therapeutic touch, a healing technique based upon the laying‐on of hands, has found wide acceptance in the nursing profession despite its lack of scientific plausibility. Its acceptance is indicative of a broad antiscientific trend in nursing. Adherents of this movement use the jargon of postmodern philosophy to justify their enthusiasm for a variety of mystically based techniques, citing such postmodern critics of science as Derrida and Michel Foucault as well as philosophical forerunners Heidegger and Husserl. Between 1997 and 1999, (...) 94 articles in nursing journals referred to postmodernism, according to a database search. This paper criticizes the postmodern movement for abandoning the biological underpinnings of nursing and for misreading philosophy in the service of an antiscientific world‐view. It is also suggested that nursing can retain its tradition of ‘caring’ without abandoning the scientific method. (shrink)

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in (...) which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

En la actualidad, aún se desconoce el verdadero alcance de la vasta cultura de Lope de Vega, pues, aunque se sabe que fue un gran lector, que legó más de 1500 libros, sus títulos se han perdido a lo largo de la historia. No obstante, en sus obras trasciende una serie de textos que contribuyeron a su formación. En el presente trabajo se analiza La Arcadia, considerada la novela pastoril más erudita del Siglo de Oro, desde la perspectiva de los (...) agentes terapéuticos. En esta obra se mencionan remedios de procedencia herbal, de procedencia mineral y también de procedencia animal. Los resultados confirman que Lope de Vega pudo utilizar una serie de textos científicos en sus citas sobre la materia terapéutica. Entre ellos cabe destacar a Andrés Laguna y su Dioscórides y Plinio el Viejo, cuya Historia Natural pudo haber consultado como fuente primaria, a través de alguna traducción comentada, como la de Gerónimo de Huerta o a través de alguna otra obra basada en ella, como el opúsculo de Constantino Castriota, pues, en este último caso, se encuentran párrafos muy similares y, en algunos casos, casi literales. Nowadays, the true extent of the vast culture of Lope de Vega is still largely unknown. Although it is known that he was a great reader, who bequeathed more than 1500 books, his titles have been lost throughout history. However, a series of texts that contributed to his education become known in his works. In the present paper, La Arcadia, considered the most erudite pastoral romance of Spanish Golden Age, is analyzed from the therapeutic perspective. Remedies of herbal origin, of mineral origin and also of animal origin are mentioned in this novel. The results achieved confirm that Lope de Vega was able to use a series of scientific texts in his quotations on the therapeutic subject. Among them, it is worth mentioning Andres Laguna, and Pliny the Elder, whose Natural History could have been consulted as a primary source, through some commented translation, such as that of Geronimo de Huerta, or through some other work based on it, like Constantino Castriota's opuscule. In the latter case, there are very similar and, in some cases, almost literal paragraphs. (shrink)

: "Therapeutic misconception" has been misconstrued, and some of the newer, mistaken interpretations are troublesome. They exaggerate the distinction between research and treatment, revealing problems in the foundations of research ethics and possibly weakening informed consent.

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a (...) disturbed body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)

This paper reviews some of the evidence indicating that hallucinogens or psychedelic substances have therapeutic effects. The general character hallucinogen use in non- Western societies is briefly reviewed to present data about the characteristic beliefs and uses associated with these substances. Evidence for therapeutic effectiveness is addressed from several perspectives: the findings from clinical medicine on effects of LSD; a general model of altered states of consciousness, their physiological characteristics, and therapeutic effects; and laboratory studies of physiological, (...) sensory, emotional, behavioral, and cognitive effects of hallucinogens. These findings illuminate the general psychophysiological effects of hallucinogens and their consciousness altering and therapeutic mechanisms. (shrink)

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

_Therapeutic Approaches in Psychology_ is a simple introduction to the many psychological therapies in use today, including cognitive-behavioural, humanistic and psychodynamic approaches.

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a (...) conversation with a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

In order to answer the question raised in the title of my paper, I first put forward a general ethical theory, which is based on the traditional maxim neminem laedere. Second, I show how this principle in conjunction with certain assumptions concerning the value of life entails certain fundamental bioethical principles. Thus killing a living being Y is morally wrong whenever the intrinsic value of the life that Y would otherwise live is positive. But procreating a living being Y is (...) prima facie morally neutral, i.e. neither bad nor good. Third I will argue that the question of moral rights should always be reduced to the question of the morality of certain corresponding actions. In particular, granting Y a right to life should be taken to mean that it would be morally wrong if someone else were to set an end to Y’s life. In a similar vein, I suggest answers to some other questions of the reproductive rights issue. Fourth, with respect to the controversial issue of therapeutic and genuine cloning, I do not see any compelling moral reasons against this utopian way of procreating full-grown individuals.Nevertheless, I think there are a lot of other good reasons not to try to produce a human Dolly. Finally, as regards the use or abuse of human embryos as potential suppliers of stem-cells for the cure of other people’s diseases, it seems morally safe to perform experiments at least with those embryos which, like spare embryos that remained from measures of in vitro fertilization, would not have a life anyway. It’s more difficult to decide, however, whether it would be morally safe to produce embryos only for the sake of using them in the aforementioned way. (shrink)

This article describes the pilot projectShadows&Light Within: Untold Stories—a two-phase, multi-partner community-based project that explores the hypothesis that Autobiographical Therapeutic Performance can help traumatized individuals to improve executive functioning. A group of 10 individuals ranging in age from 32 to 69, with lived experiences at the intersection of trauma, mental health, and the court system, were paired with theater mentor-coaches for a 10-month creative group process, in which they shaped their stories into autobiographical performance pieces, through movement, improvisation, story-telling, (...) and self-discovery. In the second phase of the project, their stories were merged into a theater production, weaving movement, song, and voice, and performed by an ensemble of experienced actors from the community. Pre- and post-interviews and self-report standardized measures of executive functioning were used to assist in establishing criteria and direction for future research. The results suggest that the individuals involved in this pilot may have improved executive functioning and acquired more ability to engage in human service programs designed to increase job readiness and enhance adaptive living skills. (shrink)

The Therapeutic Process attempts to present an informative, sequential, well-defined, and clinically rich guide to the process of psychodynamic psychotherapy. The book was specifically designed to have broad appeal and value, for the beginning clinician to more experienced clinician, or the clinician who also teaches students of psychoanalytic psychotherapy. For the beginning clinician, the book has many illustrative examples, and terms are well defined. For the long-time clinician, the book attempts to put clearly into words, what many of us (...) have thought all along. This book arose from a series of lectures that were part of a course for the psychiatric residents at UCLA Neuropsychiatric Institute and Hospital, as well as from the instruction of many therapists from other mental health disciplines. The challenge in the initial instruction of psychoanalytic psychotherapy is always to be able to introduce fundamental concepts and convey the importance of a solid theoretical background, while concurrently addressing the clinician's pressing desire and often immediate requirement to understand the clinical process. Novel heuristic models are described and illustrated in clinical vignettes, in order to quickly bring together clinical and theoretical terms with the practice and process of psychotherapy. (shrink)

This article utilizes recent Western approaches to the ethical inquiry into human activities of forgetting, especially the approach represented by Ricoeur’s work on memory and forgetting and their ethical functioning. The three areas of Ricoeur’s investigation includes the therapeutic/pathological area; pragmatic area, which deals with the issue of individual and group’s self-identity in relation to time and otherness; and the more explicitly ethical area. These three divisions are useful to start with, but Ricoeur’s work shows some narrowness in neglect (...) of positive, productive and healthy forgetting, which has been deemed significant by the Zhuangzi. This paper is the first of the author’s serial writings to apply Ricoeur’s three areas of forgetting to investigate the forgetfulness of the Zhuangzi, and examines therapeutic forgetting and its ethical dimension only. (shrink)

Abstract:Therapeutic misconception (TM)—when clinical research participants fail to adequately grasp the difference between participating in a clinical trial and receiving ordinary clinical care—has long been recognized as a significant problem in consent to clinical trials. We suggest that TM does not primarily reflect inadequate disclosure or participants’ incompetence. Instead, TM arises from divergent primary cognitive frames. The researchers’ frame places the clinical trial in the context of scientific designs for assessing intervention efficacy. In contrast, most participants have a cognitive (...) frame that is personal and focused primarily on their medical problems. To illustrate this, we draw on interview material from both clinical researchers and participants in clinical trials. We suggest that reducing TM requires encouraging subjects to adjust their frame, not just add information to their existing frame. What is necessary is ascientific reframingof participation in a clinical trial. (shrink)

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of (...) class='Hi'>therapeutic benefits for patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

Specific inhibition of gene expression by antisense agents provides the basis for rational drug discovery based on molecular targets. Due to the specificity of Watson‐Crick base‐pair hybridization, antisense oligodeoxynucleotides have been used extensively in attempts to inhibit gene expression in both in vitro and in vivo models. Analogues modified from normal phosphodiester oligodeoxynucleotides have entered clinical trials against diseases including AIDS and cancer. Although the precise mechanism of action of these drugs has not been clarified, these oligodeoxynucleotides offer considerable promise (...) as novel molecular therapeutics. We review the recent attempts to harness the therapeutic potential of these oligodeoxynucleotides and appraise the near‐term prospects for antisense technology. (shrink)

In ‘A politics of reminding: Khoisan resurgence and environmental justice in South Africa’s Sarah Baartman district’, Burnett et al. scrutinize the memory activism of the Gamtkwa Khoisan Council, which is part of the wider ‘Khoisan resurgence’ sweeping across post-apartheid South Africa. Although the authors missed important nuances, they also pointed out flaws in the way I used Niezen’s ‘therapeutic history’ [Niezen, R. (2009). The rediscovered self: Indigenous identity and cultural justice. McGill-Queen’s Press] in my work to account for why (...) Khoisan activists turn to the past. I therefore not only respond to their criticism, but also revise aspects of my theoretical framework. Therapeutic history is not divorced from material concerns. Nor is it representative of all engagements with the past by indigenous people or simply the opposite of academic history. Instead, by drawing on my ethnographic fieldwork and theorizing alongside the Khoisan, I show how it captures emic discourses on the past that entangle notions of indigenous identity, healing, and history in order to resist settler colonialism and its oppressive etic histories. While the concept of therapeutic history has its limitations, it effectively highlights indigenous people’s agency in the face of settler colonialism in South Africa and elsewhere. (shrink)

Introduction: Despite being considered as a contravention under some countries’ legislation, the therapeutic use of Cannabis sativa has been growing in Brazil, due to the promising results observed in many pathologies. Such a scenario has fostered the need to deepen discussions on the subject and possibly revise legislation governing the substance use and access. Objectives: Identify the types of stigma related to the therapeutic use of Cannabis and describe the strategies people use to overcome stigma. Methods: This integrative (...) review was carried out in the databases PubMed, Scopus, CINAHL, MEDLINE, PsycINFO, Web of Science, and Cochrane Library, with 565 articles being retrieved. Triads’ cross-check were done, first maintaining the “cannabis” and “therapeutic use” pair, added by “stigma,” “bioethics,” “ethics,” “social consequences,” and “legal consequences.” The final selection resulted in six articles. Ethical Consideration: However, the ethical issues that pervade and regulate decisions on this subject must be considered. Results: Different dimensions and types of stigma related to the therapeutic use of Cannabis have been identified. The bioethical principle of autonomy was an expression of citizenship and human rights, mitigating internal conflicts related to self-stigma and the effects of external stigma on the person’s life. Conclusion: It was possible to identify the types of stigma related to the therapeutic use of Cannabis is an internal dimension represented (self-stigma) and an external dimension, represented (social and structural stigmas) and to identify strategies adopted to face this stigma: skills training group for users, elaboration of laws and specific programs to clarify the therapeutic use of Cannabis with a greater social scope, and support for family members. Thus, contributing to the building of people’s autonomy in a broader context of decision-making autonomy and executive autonomy will provide the development of people’s capacity to perform complex tasks of self-management and, consequently, to continue promoting and preserving their decision-making process and their capacity to plan and perform tasks associated with managing their lives and their treatments. (shrink)

ObjectiveDropout rates are a prominent problem in youth psychotherapy. An important determinant of dropouts is the quality of the therapeutic relationship. This study aimed to evaluate the association between the therapeutic relationship and dropouts in an intensive mentalization-based treatment for adolescents with personality disorders.MethodsPatients included were either dropouts or completers of an intensive MBT. The therapeutic relationship was measured with the child version of the Session Rating Scale, which was completed by the patient after each group therapy (...) session. For each patient, the treatment termination status was indicated by the treatment staff. The reliable change index was calculated for the C-SRS to determine significant changes in the therapeutic relationship.ResultsWhile both groups started with similar scores on the C-SRS, the scores between dropouts and completers differed significantly at the end of the treatment period. On average, during therapy, an increase was seen in the scores of completers, and a decrease was seen in the scores of dropouts. While dropouts could not be predicted based on the C-SRS scores, a significant decrease in C-SRS scores during the last two sessions occurred more often for dropouts than for completers.ConclusionOur findings show that to prevent dropouts, the patient’s judgment of the quality of the therapeutic relationship should be monitored continuously, and decreases discussed with the patient and the group. (shrink)

The future health of children depends on clinical research which is an important part of medical progress. The principles of the child’s best interests standards and how it is applied in the context of research are explored. This review will show that there is a need for research involving children but there are gaps in the current legal and ethical framework which are not readily applicable to non-therapeutic research involving children. There are significant challenges in trying to achieve a (...) balance between what is socially good and the obligation to protect children who participate in research. (shrink)

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same (...) population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses’ perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions. (shrink)

Summary Gestalt Theoretical Psychotherapy, in the broader sense of the term, has developed in various forms on both sides of the Atlantic since the 1920s. Gestalt Theoretical Psychotherapy, in the narrower sense of the term, came into being in the second half of the 1970s in German-speaking countries. In Austria, it is a state-approved, independent scientific psychotherapy method since 1995, and an integrative psychotherapeutic approach based on the Gestalt theory of the Berlin School. With reference to this comprehensive, consistent, scientific (...) theory, this article presents the basic concepts of therapeutic practice in the field of Gestalt psychotherapy. Starting from the overarching whole to the parts, the paper first examines the concept of therapeutic relationship and therapeutic attitude, and then describes the basic principles of the practical design of the therapeutic process. (shrink)

This article explores the spatial dimensions of selfhood and the pathic felt-bodily resonance, emphasizing their role in understanding the connection between health and the environment. Adopting a phenomenological perspective, it provides an overview of the relationship between embodiment, spatiality, and affectivity and their alterations in mental conditions. It highlights the significance of alterations in affective permeability and embodiment, particularly in conditions such as schizophrenia, depression, and addiction, which lead to distortions in lived space and constrictions in the field of available (...) affordances. It suggests the concept of ‘therapeutic atmospheres’ as those that open the corporal and emotional space of the patient and flexibilize the field of affective intensities navigated by them. It highlights the relevance of the therapists’ atmospheric competence and body availability to sustain the therapeutic space. (shrink)

The mapping of therapeutic collaboration throughout counseling deepens our understanding of how the helping relationship fosters client change. To better understand the process of career construction counseling, we analyzed the therapeutic collaboration on six successful face-to-face cases. The participants were six Portuguese adults, five women and one man, real clients of a career counseling service, and four psychologists, three female and one male trained in the career intervention model. The participants completed demographic questions and measures of career certainty, (...) vocational identity, career indecision, and psychological functioning. The Therapeutic Collaboration Coding System was used to track collaboration throughout all interactive episodes. The clinical significance of the intervention was calculated by analyzing pre-post-test statistical differences for each case, with the Reliable Change Index and Z score. The findings evidenced a pattern of therapeutic collaboration evolution for good outcome cases. Based on this pattern, we propose a model of process-outcome evolution for the three phases of CCC. (shrink)

Dissecting Bioethics, edited by Tuija Takala and Matti Hayry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The department is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people’s actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are particularly appreciated. To submit a paper or to discuss (...) a suitable topic, contact Tuija Takala [email protected].:This article examines some of the assumptions and implications associated with the Belmont era context in which the concept of therapeutic misconception was forged. We argue that the justification of therapeutic misconception should be reconsidered based on less paternalistic and more participatory models of research. Finally, we identify conceptual and practical approaches that might better reflect contemporary research practice. (shrink)

Psychodrama is an effective psychotherapeutic model but interventions with adolescents require age-tailored techniques that maximize engagement and facilitate communication processes. This study describes a novel adaptation of a therapeutic mask technique to psychodrama with adolescents. Over the course of eight group sessions of psychodrama, five adolescents created their own mask and explored its therapeutic use. Their experiences were captured at the end of each session with the Helpful Aspects of Therapy form, and at the end of the study (...) with the Clinical Change Interview. Awareness/insight/self-understanding, empowerment and relief were the most significant aspects experienced by the adolescents, along with perceived increase of calmness and world connection, satisfaction in interpersonal communication and better emotional expression and regulation. The mask technique was experienced as a playful and engaging task that facilitated insight and interpersonal communication. Findings provide preliminary evidence on the clinical utility of mask-based psychodrama with adolescents. (shrink)

This article sets forth the argument that Christian ministry in Africa must become socially and culturally informed and constructed or else it will not touch the African soul and thus remain superficial. Black African people aspire above everything else to experience fullness of life and wellbeing here and now, as demonstrated by their greetings that are actually an enquiry into each other's health and an expression of the wish for the other's good health and wellbeing. The mainline churches that operate (...) in Africa should embrace the scripturally sound Christian healing ministry in obedience to Christ's commission to preach the gospel and heal the sick, if they are to prosper. Hence, this article discusses the following eight points, namely, good health and healing as Africans' important aspiration, healing as the work of God and thus of the church, the imperative of serious consideration of and respect for the African worldview, membership decline and mainline churches' loss of influence, rethinking church in African Christianity, the need for the black African church to adopt a therapeutic or healing community ecclesial model in order to position itself strategically to cater for the holistic needs of African church members and surrounding communities, the rationale of the healing ministry in today's Reformed Church in Africa and the recommended healing ministry. The article closes with a few concluding statements and advice. (shrink)

Background: The therapeutic itinerary is not limited to the identification and availability of health services offered, but relates to the different individual searches and sociocultural and economic possibilities of each patient. In this study, we discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user’s perspective. Objective: The aim of this study was to discuss the therapeutic itinerary of transsexual people seeking healthcare, from the user’s perspective. Design and participants: Individual interviews were performed with 10 (...) transsexuals at the Trans Space of a University Hospital of Pernambuco, using the Universal Declaration of Human Rights as the theoretical reference and the Bardin’s thematic content analysis as the reference methodological framework. Ethical considerations: This study was approved by the Human Research Ethics Committee at the Federal University of Pernambuco under protocol no. 91284218.5.0000.5208. Findings: The comprehensive care for transsexual people was evidenced through four categories analyzed: low demand of transsexuals in health services; use of social name in health services; care permeated by prejudiced and discriminatory attitudes; and health system and professionals who are not able to meet transgender health issues. Discussion: Transsexual people are stigmatized and experience prejudice in their daily health, in a way they do not enjoy fundamental rights, as if they had fewer rights, or infringe the principle of universality of access to health. Thus, for effective and comprehensive care, the health team must keep up to date on the public policies existing in the healthcare of transsexual people and reconstruct what they understand by gender. Conclusion: Knowledge about the therapeutic itinerary of transgender people may support evaluation processes of health service networks to ensure the access to and reorganization of these services. Understanding this dynamic allows fostering discussions about the structure of health services at all care levels for the care of this population. (shrink)

Universities are generally understood as organizations that extend knowledge based on codified bodies of work developed from systematic research and scholarship. This article examines the emergence of an organizational form that increasingly competes in contemporary higher education: the therapeutic university. A recent phenomenon, the therapeutic university is predicated on emotion in which the goal is to make the experience as a student as comfortable as possible. The article discusses organizational morphology of the therapeutic university by identifying practices (...) within it. The practices establish a contest between a rational-universalistic orientation of the university on the one hand and an emotion-particularistic orientation on the other. The article provides an explanation for why this organizational form arose and what it purports to accomplish. Its operations are ensnared by major paradox: as its identity implies, the therapeutic university postures to do good, but its practices, it is argued, debilitate students and higher learning. The mandate that the broader society gives to higher education is thereby susceptible to lost confidence. The article concludes by discussing a way in which universities may be inoculated from the conditions that support their present-day therapeutic proclivities. (shrink)

The long history of theorizing about perception divides into two quite distinct and irreconcilable camps, one that takes sensory experience to show us external reality just as it is, and one that takes such experience to reveal our own mind. I argue that we should reject both sides of this debate, and admit that the phenomenal character of experience, as such, reveals little about the nature of the external world and even less about the mind.