Creative consensus on interpretations of qualitative data: The Ward method

Designing explainable AI to improve human-AI team performance: A medical stakeholder-driven scoping review

The rise of complex AI systems in healthcare and other sectors has led to a growing area of research called Explainable AI (XAI) designed to increase transparency. In this area, quantitative and qualitative studies focus on improving user trust and task performance by providing system- and prediction-level XAI features. We analyze stakeholder engagement events (interviews and workshops) on the use of AI for kidney transplantation. From this we identify themes which we use to frame a scoping literature review on current XAI features. The stakeholder engagement process lasted over nine months covering three stakeholder group's workflows, determining where AI could intervene and assessing a mock XAI decision support system. Based on the stakeholder engagement, we identify four major themes relevant to designing XAI systems - 1) use of AI predictions, 2) information included in AI predictions, 3) personalization of AI predictions for individual differences, and 4) customizing AI predictions for specific cases. Using these themes, our scoping literature review finds that providing AI predictions before, during, or after decision-making could be beneficial depending on the complexity of the stakeholder's task. Additionally, expert stakeholders like surgeons prefer minimal to no XAI features, AI prediction, and uncertainty estimates for easy use cases. However, almost all stakeholders prefer to have optional XAI features to review when needed, especially in hard-to-predict cases. The literature also suggests that providing both system- and prediction-level information is necessary to build the user's mental model of the system appropriately. Although XAI features improve users' trust in the system, human-AI team performance is not always enhanced. Overall, stakeholders prefer to have agency over the XAI interface to control the level of information based on their needs and task complexity. We conclude with suggestions for future research, especially on customizing XAI features based on preferences and tasks.

Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care

Achieving high value, biopsychosocial pain care can be complex, involving multiple stakeholders working synergistically to support the implementation of quality care. In order to empower healthcare professionals to assess, identify and analyse biopsychosocial factors contributing to musculoskeletal pain, and describe what changes are needed in the whole-of-system to navigate this complexity, we aimed to: (1) map established barriers and enablers influencing healthcare professionals' adoption of a biopsychosocial approach to musculoskeletal pain against behaviour change frameworks; and (2) identify behaviour change techniques to facilitate and support the adoption and improve pain education. A five-step process informed by the Behaviour Change Wheel (BCW) was undertaken: (i) from a recently published qualitative evidence synthesis, barriers and enablers were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF) using "best fit" framework synthesis; (ii) relevant stakeholder groups involved in the whole-of-health were identified as audiences for potential interventions; (iii) possible intervention functions were considered based on the Affordability, Practicability, Effectiveness and Cost-effectiveness, Acceptability, Side-effects/safety, Equity criteria; (iv) a conceptual model was synthesised to understand the behavioural determinants underpinning biopsychosocial pain care; (v) behaviour change techniques (BCTs) to improve adoption were identified. Barriers and enablers mapped onto 5/6 components of the COM-B model and 12/15 domains on the TDF. Multi-stakeholder groups including healthcare professionals, educators, workplace managers, guideline developers and policymakers were identified as target audiences for behavioural interventions, specifically education, training, environmental restructuring, modelling and enablement. A framework was derived with six BCTs identified from the Behaviour Change Technique Taxonomy (version 1). Adoption of a biopsychosocial approach to musculoskeletal pain involves a complex set of behavioural determinants, relevant across multiple audiences, reflecting the importance of a whole-of-system approach to musculoskeletal health. We proposed a worked example on how to operationalise the framework and apply the BCTs. Evidence-informed strategies are recommended to empower healthcare professionals to assess, identify and analyse biopsychosocial factors, as well as targeted interventions relevant to various stakeholders. These strategies can help to strengthen a whole-of-system adoption of a biopsychosocial approach to pain care.

Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups

The literatures examining psychoeducational groups and telehealth services have demonstrated positive results but less is known about the efficacy of psychoeducational telehealth groups. This study examines the perspectives of 105 Latinx college students who participated in an 8-session psychoeducational group via a telehealth platform during the COVID-19 pandemic. The research questions included (a) What was the experience of these Latinx college students participating in telehealth psychoeducational groups? and (b) What were the potential perceived advantages and disadvantages of implementing telehealth psychoeducational groups? Postintervention, a total of 16 focus groups were convened with a total of 105 Latinx college students (average number of participants per group = 6). Interviews were coded using conventional qualitative analysis and yielded four main themes: (1) group cohesion, which involved group members feeling that they were connected and that the group was a safe space; (2) group leaders, which involved leaders' preparation and knowledge and their ability to foster a safe environment); (3) cultural issues, which involved cultural values and acculturative and first-generation stress.; and (4) telehealth implementation, wherein participants described advantages and disadvantages of the telehealth approach. We discuss study limitations and directions for future research.

Care for the Cancer Caregiver: a Qualitative Study of Facilitators and Barriers to Caregiver Integration and Support

Informal family caregivers are critically important for patient care throughout the cancer care trajectory. Family-centered care, which seeks to integrate family members as experts, is a framework that values partnerships with family members and can benefit both the physical and psychosocial health of patients. However, little standardization or system-level implementation of family-centered care models to integrate and support family caregivers have emerged in adult oncology care settings in the USA. To better understand potential barriers and facilitators to the integration and support of family caregivers in cancer care settings, we conducted semi-structured interviews with informal family caregivers (n = 12) and members of the cancer center leadership team and health care providers (n = 11) at an NCI-designated Comprehensive Cancer Center. We frame our results using the social ecological model and identified facilitators and barriers at the individual, interpersonal, and system level. While caregivers and team members were able to identify facilitators and barriers at the individual (i.e., caregivers are motivated to learn, but overwhelmed and focused only on the patient) and interpersonal levels (i.e., relationships are a valuable resource, but communication is sometimes challenging), team members were more likely to identify system-level barriers (i.e., constraints within the larger healthcare structure). To implement family-centered care in cancer settings, it is incumbent on the healthcare system to pursue standardization of communication, programs that facilitate family integration and support, and advocate for policy change. Barriers must be addressed at multiple levels to provide inclusive and supportive environments for all patients and their families.

Socioeconomic diversity and typology of Bedouin communities in the hot dry Coastal Zone of Western Desert, Egypt

The study was carried out to assess the diversity of the farming system and the associated development needs of Bedouin communities in the rural area of the hot dry Coastal Zone of Western Desert (CZWD), Egypt with the objective of improving surveillance of the Bedouin communities to the harsh desert conditions. The area has low irritated rainfall (60–140 mm/yr.) and frequent incidences of drought. Specially designed questionnaires were adopted on 151 householders and 51 women groups in 4 locations. More than 50% of the householders are fully engaged in agriculture activities, whereas 31% of them are partially engaged in other businesses. The householders are extended families of 12.2 members on average. Gender differences in education are recognizable; 20% of boys ≥15 years of age are illiterate vs. 60% of girls. Dominant agricultural activities of the householders are sheep raising (98.7%), goat raising (89.4%), olive and figs cultivation (84%), and rain-fed barley (78%). Land tenure averages 31.3 acres/ household. Crop cultivation relies on rainfall, 29% of the householders apply supplement irrigation for fruit trees and vegetables. Natural pasture is an important asset for livestock, where small householders do not hold pastureland. Females do not contribute to field cropping, while 53% of them participate in animal husbandry, especially at the house. The typology of the studied stakeholders showed clear diversification in farming systems. They are clustered into four groups; depending mainly on the livestock assets, followed by the land/crop and human assets. Number of species and flock size are the most important variables for the diversity of stakeholders. The cultivated area is the main variable within land/crop assets, family members in livestock and family size are the main variables from human assets. Most of the householders (95%) give their top need for water cisterns, water reservoirs ranked second (78.6%), followed by raising and improving goats. Pasture development got the lowest priority. Goat and poultry rearing, followed by dairy processing got the top needs of women.

Student assistantship programme: an evaluation of impact on readiness to transit from medical student to junior doctor

BACKGROUND

Studies report that medical graduates are not prepared for practice as expected, and interventions have been developed to prepare them for practice. One such intervention is the assistantship, which provides hands-on opportunities to hone clinical skills and undertake responsibilities under supervision. The Lee Kong Chian School of Medicine (LKCMed) is Singapore's newest medical school, and students undergo a Student Assistantship Programme (SAP) to prepare for practice as junior doctors (PGY1). This study evaluated the SAP from the students' and clinical supervisors' perspectives.

METHODS

Students completed online questionnaires to assess readiness for practice before and after SAP, and a subsample were interviewed about their experiences of SAP and its impact on their preparedness for PGY1. In addition, after our graduates had begun work as PGY1 doctors, their clinical supervisors completed an online questionnaire and were interviewed about the perceived benefits of SAP and the attributes of our graduates as junior doctors.

RESULTS

Fifty (96%) students completed the pre-SAP questionnaire and 46 (92%) completed the post-SAP questionnaire. Levels of preparedness increased post-SAP (mean scores range pre-SAP: 2.38 to 4.32 vs post-SAP: 3.08 to 4.48); so did opportunities to undertake PGY1 duties (pre-SAP: 56% vs post-SAP: 96%), and hands-on experience in medical emergencies (pre-SAP: 76% vs post-SAP: 89%).Experience of acute care situations increased except "paracetamol overdose". Readiness to be first respondents in ten acute situations improved (statistically significant for asthma, chronic obstructive pulmonary disease exacerbation, gastrointestinal bleed, sepsis, and adverse drug reactions). Three themes emerged from twenty-five student interviews: learning about the work environment, opportunities to learn in a safe environment, and enhancing SAP for future students. Thirty-three supervisors completed the questionnaire, and 70% rated SAP positively in preparing students for PGY1. Eight supervisors interviewed shared positively about the content, timing, and duration of SAP; and suggested future SAPs help students to develop coping and reflective skills.

CONCLUSIONS

The SAP improved students' preparedness and experience across clinical areas, and students felt the SAP helped bridge undergraduate curriculum and work, provided opportunities to hone their skills and learn from junior doctors. Most clinical supervisors rated the SAP effective in preparing students for PGY1. This is the first formal evaluation of an assistantship in Singapore, and the findings are encouraging from the perspective of students and PGY1 supervisors.

Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England

PURPOSE

Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned.

METHODS

The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT.

RESULTS

Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources.

CONCLUSION

Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.

"I'm Like A Chameleon": An Exploration of the Experiences of Mexican American Women Who Are Group Psychotherapists-in-Training

The purpose of this study was to explore the tasks, challenges, and perspectives of group-therapy leadership among Mexican American women who are psychotherapists-in-training. The literature regarding counselor and psychotherapist development suggests that culture and gender interact and shape group leadership, along with the group leader's effectiveness, behavior, and style. This study sought to answer the following research questions: (1) What are the experiences of group leadership of Mexican American women who are psychotherapists-in-training (PITs)? (2) What tasks and challenges do Mexican American women PITs encounter as group psychotherapy leaders? Results suggest that Mexican American women group PITs encounter obstacles to group leadership associated with their cultural and professional identities. However, consistent with Anzaldúa's borderlands theory, the Mexican American women group PITs in this study straddle two cultures and competing demands while also turning obstacles into sources of empowerment and strength. Implications for training and supervision of Mexican American women group PITs are discussed.

STPA methodology in a socio-technical system of monitoring and tracking diabetes mellitus

In this paper, an adaptation of the system-theoretic process analysis (STPA) approach to a sociotechnical system of monitoring and tracking diabetes mellitus (DM) is proposed. Several human controllers such as the patient, physicians, other healthcare providers, and people in the social environment were considered in the hierarchical safety control structure. During the identification of the causal factors (causal scenarios) for the unsafe control actions of the human controllers, the three-phase approach proposed by France (2017) as well as the interaction problems between the subsystems in the hierarchical safety control structure were considered, and the implementation of the basic safety design procedure was included in the methodology for the improvement of system. A dynamic STPA methodology is also proposed as an extension to the basic methodology.

The challenge of pain identification, assessment, and management in people with dementia: a qualitative study

BACKGROUND

Painful conditions are common in older adults, including people with dementia. The symptoms associated with dementia (for example, diminished language capacity, memory impairment, and behavioural changes), however, may lead to the suboptimal identification, assessment, and management of pain. Research has yet to qualitatively explore pain management for community-dwelling people with dementia.

AIM

To explore pain identification, assessment, and management for community-dwelling people with dementia.

DESIGN & SETTING

A qualitative study was undertaken, set in England.

METHOD

Semi-structured interviews took place with people with dementia, family caregivers, GPs, and old-age psychiatrists. Data were analysed thematically.

RESULTS

Interviews were conducted with eight people with dementia, nine family caregivers, nine GPs, and five old-age psychiatrists. Three themes were identified that related to pain identification and assessment: gathering information to identify pain; the importance of knowing the person; and the use of pain assessment tools. A further three themes were identified that related to pain management: non-drug strategies; concerns related to analgesic medications; and responsibility of the caregiver to manage pain.

CONCLUSION

Identifying and assessing the pain experienced by people with dementia was challenging. Most people with dementia, family caregivers, and healthcare professionals supported non-drug strategies to manage pain. The minimal concerns associated with non-drug strategies contrasted the multifactorial concerns associated with analgesic treatment for people with dementia. Given the complexity of pain identification, assessment, and management, primary care should work together with family caregivers and community services, with case finding for pain being considered in all assessment and management plans.

Values in persons with borderline personality disorder: their relevance for the therapeutic interview

This is an explorative study on values of 25 patients affected by borderline personality disorder interviewed in a clinical setting (phenomenological-dynamic psychotherapy) and re-classified following Consensual Qualitative Research. We identified three main categories of values: recognition (the importance for attention, acknowledgment, commendation and acceptance by the other), authenticity (the importance of absolute emotional fusion with the other), and immediacy (the importance of instantaneous, hic et nunc satisfaction of one's needs/desires). Each of these values expresses a kind of 'logic', namely the logic of intimacy (the other's closeness as indispensable for defining oneself and establish/reinforce one's selfhood and identity), spontaneity (over-reliance on feelings unrestricted by social norms undermining their intensity), and instantaneity (glorification of 'now-moments'/execration of procrastination draining the vitality of feelings). The borderline person lives an emotional normativity constituted by the intensity of feelings under the spell of a frustrated normativity since they enter into a collision with the hypocrisy of common-sense ethical norms and social rules and conventions, as well as by potential conflicts with the feelings of the other. Acknowledging the values affirmed by borderline persons may help to better understand their condition - that is, to grasp 'what it is like' and make sense of the phenomena that affect them - and particularly to find a logic in their otherwise irrational and incomprehensible self-defeating behavior.

Co-designing a Mobile Gamified Attention Bias Modification Intervention for Substance Use Disorders: Participatory Research Study

Background

Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals.

Objective

The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders.

Methods

The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype.

Results

Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation.

Conclusions

The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm.  

Researchers' perspectives on public involvement in health research in Singapore: The argument for a community-based approach

Background

Singapore is becoming a world‐class research hub, promoting the advancement of patient care through translational clinical research. Despite growing evidence internationally of the positive impact of public involvement (PPI), in Singapore PPI remains unusual beyond patient participation as subjects in studies.

Objective

To explore health researchers' understandings of the principles, role and scope of PPI, and to identify barriers and opportunities for implementation in Singapore.

Design

Semi‐structured qualitative interviews between April and July 2018. Data were analysed using thematic framework analysis.

Results

Whilst most participants (n = 20) expressed a lack of experience of PPI, the interview process provided an opportunity for reflection through which it emerged as a beneficial strategy. Interviewees highlighted both utilitarian and ethical reasons for implementing PPI, particularly around increasing the relevance and efficiency of research. In addition to those challenges to PPI documented in the existing literature, participants highlighted others specific to the Singaporean context that make PPI at an individual level unlikely to be successful, including the socio‐political environment and prevailing social and professional hierarchies. They also identified asset‐based strategies to overcome these, in particular, a more community‐oriented approach.

Conclusion

The cultural reluctance of individuals to question perceived authority figures such as researchers may be overcome by adopting an approach to PPI that is closer to family and local community values, and which facilitates patients and the public collectively engaging in research. Further work is needed to explore the views of patients and the public in Singapore, and the implications for other Asian communities.

Identification of fatal outcome in a childhood nasopharyngeal carcinoma patient by protein expression profiling

Nasopharyngeal carcinoma (NPC) is a rare disease in children with good prognosis and high cure rate. Nevertheless, certain patients have an unfavorable prognosis due to development of refractory NPC that is unresponsive to any therapeutic strategies. The current study studies a case of a 17 years-old female with non-keratinizing NPC type IIb (T2N0M0), who passed away as a consequence of resistance to chemo-, radio- and β-interferon therapy, and to an allogenic stem cell transplantation. In order to identify factors that lead to treatment failure and fatal outcome, immunohistochemical analyses of different tumor biomarkers and hierarchical cluster analysis were performed and compared with those of eight other patients with NPC who experienced complete remission following conventional therapy. Hierarchical cluster analysis of the immunohistochemical results clearly demonstrated that staining for immunological factors (CD4, CD8 and CD56) distinguished this patient from the others. To further investigate a potential role of the immune system, lymphocytic infiltration was assessed in tumor tissue by evaluation of hematoxylin and eosin-stained tumor sections. Indeed, no tumor infiltrating lymphocytes (TILs) were observed in this NPC case, while 7 out of 8 of the other NPC samples contained variable TIL amounts. The view that immunodeficiency of the patient may be a factor in the fatal outcome of treatment is supported by the fact that this patient with NPC was not positive for Epstein-Barr virus markers and also infected by several other viruses and fungi (herpes simplex virus, human herpes virus 6, Varicella zoster virus, and Candida). In conclusion, the investigation of rare NPC cases with poor prognosis may provide an improved understanding of the molecular mechanisms involved in refractory tumors and identification of novel potential therapeutic targets for NPC in the future.

Interactions between Obsessional Symptoms and Interpersonal Ambivalences in Psychodynamic Therapy: An Empirical Case Study

The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2) documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009). Similar to the first empirical case study (Chapter 1), Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed.

Narrative change in Gloria Films: Comparing various processes of therapeutic innovation

AIMS

The present study focuses on the analysis of novelty emergence in classic Gloria Films with Rogers, Perls, and Ellis to understand how the same client formulated her own problem and if and how change occurred in those three sessions.

METHOD

The Innovative Moments Coding System was applied to track innovative moments (IMs) and their themes.

RESULTS

The session with Rogers showed more diversity in disclosed problems and themes of IMs, as well as a higher proportion of reflection IMs. The session with Perls demonstrated a high proportion of protest IMs. The session with Ellis showed less innovation than other sessions. The changes found were based mostly on reflection and protest IMs in three sessions.

CONCLUSION

Narrative innovations occurred in the three single sessions. The type of dominant innovation is consistent with the therapeutic model and the IMs model. The exploration of the IMs' themes allowed a more precise identification of Gloria's new narrative positions and their development throughout those sessions.

The bodily self: a qualitative study of abnormal bodily phenomena in persons with schizophrenia

Subtle anomalies of bodily experience have for long been described as relevant features of schizophrenia spectrum disorders, however such disturbing and alienating experiences are usually neglected in routine clinical examination. The overarching aim of this qualitative study is to offer an experience-close mapping of abnormal bodily phenomena (ABP) in patients with schizophrenia that might assist clinical examination and inform the development of dedicated assessment tools. We followed a stepwise methodology: first, data from n=550 clinical interviews were analyzed adopting consensual qualitative research (CQR) inductive method in order to identify relevant clusters of ABP. Then, ABP profiled in schizophrenia patients (n=301) were contrasted with ABP identified in patients affected by major depression (n=56). 70% of the interviewees in the schizophrenia sample reported anomalies of lived corporeality, that could be condensed in the following categories: Dynamization, Morbid objectivation, Dysmorphic-like phenomena and Pain-like phenomena. Those appeared to be reducible to two core features that were not paralleled in the affective disorder sample: dynamization (e.g. ongoing bodily feelings of disintegration/violation) and thingness/mechanization (e.g. one's body experienced as a object-like mechanism). We suggest that dynamization and thingness/mechanization might be considered schizophrenia-specific experiential phenotypes that can contribute to early differential diagnosis of somatic complaints in mental health help-seekers.

[Assimilation of problematic experiences: a case study on short-term dynamic psychotherapy]

The assimilation model is a qualitative and integrative approach that enables to study change processes that occur in psychotherapy. According to Stiles, this model conceives the individual's personality as constituent of different voices; the concept of voice is used to describe traces left by past experiences. During the psychotherapy, we can observe the progressive integration of the problematic voices into the patient's personality. We applied the assimilation model to a 34-session-long case of an effective short-term dynamic psychotherapy. We've chosen eight sessions we transcribed and analyzed by establishing points of contact between the case and the theory. The results are presented and discussed in terms of the evolution of the main voices in the patient.

Relationship between mental states in depression: the assimilation model perspective

Metacognitive theories describe relationships between mental-affective self-states, including the capacity of one self-state to reflect upon another self-state. The assimilation model is a metacognitive approach that understands self-states as made of traces of experiences at different levels of integration. Psychological problems are understood as impaired accessibility of certain self-states to the person's normal awareness. These states are distressing or otherwise subjectively problematic when they emerge. This exploratory study used the assimilation framework to describe mental states in 17 clients who participated in a clinical trial of cognitive-behavioral therapy for depression. Three clinically sophisticated raters examined transcripts of 1h-long psychotherapy session per client to construct qualitative descriptions of self-states and their relationship patterns in these depressed individuals. We then systematically compared and integrated these raters' descriptions of the clients' self-states. In each case, we found a conflict between two internally incompatible states: an interpersonally submissive state and an interpersonally dominant one, a pattern consistent with the model's theoretical description of depression.

Numbers in assimilation research

We describe the assimilation model, a developmental theory of psychological change that focuses on interpretive study of people’s experience in therapy. Assimilation research relies on methods that are simultaneously interpretive and quantitative, and uses them in mutually complementary ways. We explain how quantitative techniques have been useful in research on the model. We give examples of numeric techniques and their uses in specific studies that included helping establish reliability of interpretive accounts of clients’ change, investigating substantive issues of theoretical interest, testing hypotheses about the model, and formulating clinical implications of assimilation concepts. These procedures quantify our understanding of people’s subjective experience of change in therapy and rely on contextual interpretation of meanings. These examples illustrate and advocate the use of numeric properties for the purposes of contextual interpretive inquiry.

Das Berufsfeld Sportpsychologie im Leistungssport aus der Sicht der in der Praxis Tätigen

Zusammenfassung. Der Bologna-Prozess bietet die Chance zur Entwicklung berufsfeldspezifischer Studiengänge, etwa der Sportpsychologie im Leistungssport. Für die notwendige Kenntnis über die Anforderungen des Feldes, mögliche Tätigkeitsfelder sowie Beschäftigungschancen zukünftiger Absolventen existieren jedoch nur wenig belastbare Daten einer Studie von Allmer, Schlicht und Singer, (2000) . Daher wurden im Berufsfeld Tätige zu den Bereichen Qualifikationen, Kompetenzen, Tätigkeitsfelder und Perspektiven online befragt. Die Daten weisen auf die Bedeutung der Psychologie für das Berufsfeld, auch wenn der Zugang breiter möglich ist. Bei den Fachkompetenzen werden sowohl psychologische als auch sportpsychologische Kenntnisse betont. Die Befragten sind meist in mehreren Berufsfeldern tätig, in der Sportpsychologie überwiegend in der Einzelbetreuung. Sie sehen insgesamt gute Perspektiven für sich selbst und für zukünftige Sportpsychologen, wenngleich sie mit den finanziellen Bedingungen nicht ganz zufrieden sind. Einschlägige sportpsychologische Studiengänge erscheinen angemessen, die Fachdisziplin muss aber die Verbindung zur Psychologie erhalten und einheitliche Qualitätsstandards definieren.

[Methods of psychotherapy case studies: current perspectives]

There is a renewal of interest among psychotherapy researchers and psychotherapists towards psychotherapy case studies. This article presents two paradigms that have greatly influenced this increasing interest in psychotherapy case studies : the pragmatic case study and the theory-building case study paradigm. The origins, developments and key-concepts of both paradigms are presented, as well as their methodological and ethical specificities. Examples of case studies, along with models developed, are cited. The differential influence of the post-modern schools on both paradigms are presented, as well as their contribution to the field of methods of psychotherapy case studies discussed and assessed in terms of relevance for the researcher and the psychotherapist.