Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

The Story of Alex—An Improvisational Drama

This paper describes the intensive, long-term psychotherapy of a woman, severely abused in childhood, who remembered her abusive experiences although devoid of any affect. Alex was agoraphobic and unable to sustain intimate relationships. This paper describes how, during the course of this long-term therapy, she used improvisational acting techniques to access and integrate those repressed affects.This paper was presented at the Conference of the National Membership Committee for Psychoanalysis in Chicago in March, 2002.     

The Third Time Was the Charm

Abstract

A therapist's three experiences as a recipient of psychotherapy have led her to appreciate the ways in which one therapy informs another. She examines what may be learned from a less than successful therapy. She reflects on several lessons she has learned from her own therapieslessons that have shaped her as a clinician. In particular, she notes that when the therapist and patient are remarkably similar in their values and strengths, the therapist needs to take great care that key issues are not glossed over or mishandled.     

The Charisma and Deception of Reparative Therapies: When Medical Science Beds Religion

ABSTRACT

In this article, I examine the history and resurgence of interest in sexual reorientation or reparative therapies. I begin with a critique of the contemporary “ex-gay” movement, interrogating Exodus as the prototype of a politico-religious transformational ministry that works to “cure” homosexuals, and examine how Exodus utilizes ex-gay testimony to deceive harried homosexuals looking for escape from the effects of internalized and cultural homophobia. Next, I investigate how reparative therapies function as orthodox treatments that charismatically meld conservative religious perspectives with medical science to produce a pseudoscience promising to treat homosexuality effectively. In this regard, I assess the ongoing debate regarding gay-affirming versus reparative therapies by first looking at the history of medicalizing homosexuality and then surveying the debate spurred by Robert L. Spitzer's research. I conclude with a consideration of research needed to measure whether efficacious change in sexual orientation is possible.     

Nonpharmacological Pain Management by Ethnically Diverse Older Adults With Chronic Pain: Barriers and Facilitators

As key players in multidisciplinary health care systems, geriatric social workers must understand the dynamics of pain management among older adults with chronic pain. This study identified perceived barriers to, and facilitators for, utilizing nonpharmacological pain management through face-to-face interviews with 44 ethnically diverse community-dwelling older adults. Constant comparative analysis identified barriers not recognized in prior studies: (a) embarrassment/self-consciousness, (b) unavailability of certain treatments, and (c) lack of faith in effectiveness of nonpharmacological treatments. Most frequently reported facilitators were (a) social support, (b) positive attitude, and (c) available resources. Social workers can provide counseling to motivate older adults to exercise to manage chronic pain and refer them to exercise programs tailored for older adults. To resolve the most frequently reported barrier—transportation—social workers can link older adults with transportation services offered by senior centers or other nonprofit agencies.     

Tuning and Practicing the Therapeutic Instrument: The Therapist's Life Experience

This article views the therapeutic use of self broadly as if through a wide-angle lens focusing on the therapist within his or her surroundings. These contextual features can be seen as projections of the therapist's self and therefore useable in treatment. Through an interest in alternative brain functions due to her own struggles with a neurological illness, the author arrived at the idea of utilizing her personal interests which naturally come into the milieu as therapeutic vehicles. Personal interests that are compatible with the patient's character offer alternative modes for experiencing, expressing and regulating affect states. These interests in the expressive arts together with the person of the therapist constitute a medium for rotating attention around unfamiliar parts of the mental landscape. Disavowed or dissociated affects can be unearthed, made conscious, put into language, and treated. This idea in practice nests neatly within recent thinking in psychoanalysis, neuroscience, and the philosophy of science. When language alone is not enough to move the therapeutic process forward, other working knowledge in the therapist's life can be brought to bear as a powerful evocative force for therapeutic change.     

Being,Belonging, and Becoming

Abstract

We conducted a study at the rehabilitation unit of a childrens hospital to explore the perspectives of children with disabilities and their guardians on quality-of-life issues. Both quantitative (The Canadian Occupational Performance Measure; N = 1,559) and qualitative (focus groups) methods were employed to elicit this information. The results revealed that socialization is the most important quality-of-life issue for children with disabilities. The study also indicated a need for social workers to create a support system for the guardians of those children with disabilities receiving rehabilitation therapies.     

Treating Problem Gamblers: Working towards Empirically Supported Treatment

There is an urgent need for mental health professionals to develop effective treatments for pathological gambling. A scientific meeting was held in Quebec City in June 2002 where 13 specialists in the treatment of gamblers pursued the objectives of making the State of the art statement concerning the procedures and the methodology to be used in future treatment outcome studies. This paper introduces this special issue of the Journal of Gambling Studies and identifies some of the key issues that confront clinicians and researchers interested in evidence based treatment for gambling related disorders.     

Working with women: Semi-structured interviews with Australian complementary medicine maternity care practitioners

ProblemDespite the known prevalence of complementary medicine use by women during pregnancy and childbirth and the evolution of preferred models of maternity care, very little is known about the nature and characteristics of the care provided to women by complementary medicine practitioners during this important life stage.BackgroundWoman-centred care is a speciation of person-centred care which has achieved prominence in maternity care policy in recent years. There is also evidence that the core principles of some complementary medicine systems of medicine emphasise patient-centredness and that these principles are core drivers toward complementary medicine use in multiple populations.AimThis study aims to explore the approach to care delivered by complementary medicine practitioners to women during pregnancy and birth.MethodsSemi-structured individual interviews were conducted with 23 complementary medicine practitioners who identified as specialising in maternity care. Data from the interviews were analysed using a framework approach.FindingsThe analysis of the perspective of complementary medicine practitioner’s experiences providing care to pregnant and birthing women identified three main themes: Responding to women’s expectations of care; providing woman-centred care; and the therapeutic relationship at the heart of woman-centred care.DiscussionThe approach to maternity care reported by complementary medicine practitioners aligns with the principles of woman-centred care, possibly due to the similarities between woman-centred care and the core features of many systems of medicine within complementary medicine.ConclusionComplementary medicine practitioners may contribute to an overall experience of woman-centred maternity care for pregnant and birthing women.