Viewing cognitive conflicts as dilemmas, implications for mental healthGuillem Feixas
The idea that internal conflicts play a significant role in mental health has
been extensively addressed in various psychological traditions, including personal
construct theory. In the context of the latter, several measures of conflict
have been operationalized using the Repertory Grid Technique (RGT). All of
them capture the notion that change, although desirable from the viewpoint of
a given set of constructs, becomes undesirable from the perspective of other constructs.
The goal of this study is to explore the presence of cognitive conflicts in
a clinical sample (n = 284) and compare it to a control sample (n = 322).
It is also meant to clarify which among the different types of conflict studied
provides a greater clinical value and to investigate its relationship to symptom
severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas
were the only ones to discriminate between clinical and nonclinical samples.
These dilemmas were found in 34% of the nonclinical sample and in 53% of
the clinical sample. Participants with implicative dilemmas showed higher symptom
severity, and those from the clinical sample displayed a higher frequency of
dilemmas than those from the nonclinical sample.
This study examined cognitive conflicts known as implicative dilemmas (IDs) in people with unipolar depression compared to a non-clinical sample. The repertory grid technique was used to identify IDs in 113 patients diagnosed with major depressive disorder and 90 non-clinical participants. IDs were found to be more prevalent and frequent in depressive patients, with 70.1% having at least one ID compared to 33.3% of controls. Depressive patients also had more IDs on average than controls. The presence of these cognitive conflicts may help explain the difficulty depressive patients have overcoming dysphoric mood and progressing in treatment. The identification of IDs provides additional treatment targets beyond traditional cognitive behavioral therapy for depression.
Sepi 2013 workshop_guillem feixas_working with internal conflictsGuillem Feixas
A FLEXIBLE THERAPY MANUAL FOR WORKING WITH INTERNAL CONFLICTS
Guillem Feixas, Universitat de Barcelona
Internal conflicts have been a common focus for psychotherapies of a variety of orientations. All of them share the idea that internal conflicts (or personal dilemmas) are at the heart of human functioning. However, their almost opaque nature makes it difficult to identify and gauge. The notion of internal conflict can be formulated within the context of a broader psychological theory capable of contributing in more specific terms, as well as instruments for measuring it. Based on Personal Construct Theory, a constructivist theory that regards the significance attributed to events as being the basis of human functioning, research has been conducted on several clinical problems. Results suggests that internal conflicts can become a target for interventions promoting change. These personal dilemmas are identified in people who associate self-identity characteristics in which change is desirable (e.g., “timid”) to other, more central core identity constructs (e.g., “modest”). By implication, achieving change (e.g., becoming “social”) is linked in the subject’s cognitive system to characteristics which are unacceptable for the person’s sense of identity (e.g., “arrogant”).
This workshop is designed to: (1) provide the clinician methods to identify internal conflicts, (2) use them for case formulation, and (3) offer the clinician specific guidelines for a dilemma-focused intervention. The presenter will describe and illustrate a protocol for working with internal conflicts, a mechanism that may be blockading change in a variety of clinical problems.
Feixas, G. (2015, Marzo). Conflict in Meaning Systems: Perspectives and Implications for Mental Health and Psychotherapy. Symposium Chair en el International Convention of Psychological Science, de la APS (Association for Psychological Science), Amsterdam, Holanda.
Variables and concepts are important tools in theoretical research. A concept is an abstract idea that combines related observations, while a variable is an empirical measure that can take different values. There are different types of variables, including independent, dependent, and intervening variables that indicate causal relationships. Numerical variables can be discrete or continuous, while categorical variables involve mutually exclusive and exhaustive categories. Researchers define concepts and variables conceptually by relating them to other concepts, and operationally by specifying how to measure them. Propositions state relationships between concepts or variables but are not tested directly like hypotheses.
Personal construct theory wikipedia, the free encyclopediaPriyadarshi Bhaskar
George Kelly developed personal construct theory which proposes that people develop internal constructs to anticipate and predict events based on their interpretations of experiences. These constructs are bipolar and people develop a system of constructs to understand themselves and the world. Kelly derived a psychotherapy approach and repertory grid technique where a patient's constructs are uncovered through minimal interpretation. The repertory grid involves identifying elements and constructs through a series of questions to build a matrix that reveals a person's perspective. Personal construct theory has applications in clinical psychology, education, and organizational development through the use of repertory grids.
Chapter 6 Theories and Application of Contextualism and Chaos TheoWilheminaRossi174
Chapter 6 Theories and Application of Contextualism and Chaos Theory to Careers
Things to Remember
The importance of context in the development of self
Differences between modern and postmodern theories
The language of contextualist and chaos theory theories
The process of postmodern career counseling, particularly assessment tools
Four theories of career development and counseling will be discussed in this chapter. The discussion begins with the contextualist theory developed by Young, Valach, and Collin (2002) and expanded by Young, Marshall, and Collin (2007). It continues with the most recent elegantly rendered theory developed by Savickas (1995, 1997, 2013). Savickas’ contextualist model is well created, but his theory is a bit more complex. It may be hard to grasp at first reading and could easily be dismissed for that reason. If you are considering a postmodern underpinning for your practice, dismissing Savickas would be a mistake. Importantly, Savickas builds bridges between traditional, modern approaches and his constructivist ideas that may help the reader develop a better understanding of both views.
In Chapter 1, I began a discussion of the differences between modern and postmodern thinking. I continued that discussion into Chapter 3 by laying out the assumptions of modernism. At this point, the basic tenets of postmodern thinking will be reviewed.
Postmodern theories, often referred to as constructivist theories, are a relatively new addition to the theories of career choice and development. These theories depart radically from the assumptions of the theories based on positivist philosophy. The following assumptions underpin these theories:
Human behavior is nonlinear and thus cannot be studied objectively.
Cause-and-effect relationships cannot be determined.
Individuals cannot be studied outside of the context in which they function.
Research data cannot be generalized to other people or groups.
Research is not a value-free process. The researcher’s values should in fact guide the research process.
The stories (narratives) that students tell are legitimate sources of data.
Research is goal free: It is a search for actual effects based on demonstrated needs. Random samples are replaced with purposeful sampling—that is, studying individuals who can respond to the research in a meaningful manner. For example, to understand sex-role stereotyping of occupational choice, a researcher might select subjects who knowingly chose careers because of stereotypes rather than selecting a random sample that included people who made decisions based on other variables.
Career counselors focus on the stories (narratives) of their clients, use qualitative assessment procedures, and help clients construct career goals based on their perceptions of the context in which they function.
The self develops in continuous interaction between the individual and her or his contexts.
Some postmodern theorists accept the idea of an objective sel ...
John Kelly developed the theory of personal constructs which proposes that individuals perceive and interpret phenomena through constructs which are concepts or ideas used to understand experiences. Personal constructs are bipolar and dichotomous, having two opposite poles. Constructs have properties like range of applicability, focus of applicability, and permeability. There are different types of constructs including pre-emptive, constellatory, and assumptive constructs. Constructs can also be classified as comprehensive or private, main or peripheral, and hard or loose.
Viewing cognitive conflicts as dilemmas, implications for mental healthGuillem Feixas
The idea that internal conflicts play a significant role in mental health has
been extensively addressed in various psychological traditions, including personal
construct theory. In the context of the latter, several measures of conflict
have been operationalized using the Repertory Grid Technique (RGT). All of
them capture the notion that change, although desirable from the viewpoint of
a given set of constructs, becomes undesirable from the perspective of other constructs.
The goal of this study is to explore the presence of cognitive conflicts in
a clinical sample (n = 284) and compare it to a control sample (n = 322).
It is also meant to clarify which among the different types of conflict studied
provides a greater clinical value and to investigate its relationship to symptom
severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas
were the only ones to discriminate between clinical and nonclinical samples.
These dilemmas were found in 34% of the nonclinical sample and in 53% of
the clinical sample. Participants with implicative dilemmas showed higher symptom
severity, and those from the clinical sample displayed a higher frequency of
dilemmas than those from the nonclinical sample.
This study examined cognitive conflicts known as implicative dilemmas (IDs) in people with unipolar depression compared to a non-clinical sample. The repertory grid technique was used to identify IDs in 113 patients diagnosed with major depressive disorder and 90 non-clinical participants. IDs were found to be more prevalent and frequent in depressive patients, with 70.1% having at least one ID compared to 33.3% of controls. Depressive patients also had more IDs on average than controls. The presence of these cognitive conflicts may help explain the difficulty depressive patients have overcoming dysphoric mood and progressing in treatment. The identification of IDs provides additional treatment targets beyond traditional cognitive behavioral therapy for depression.
Sepi 2013 workshop_guillem feixas_working with internal conflictsGuillem Feixas
A FLEXIBLE THERAPY MANUAL FOR WORKING WITH INTERNAL CONFLICTS
Guillem Feixas, Universitat de Barcelona
Internal conflicts have been a common focus for psychotherapies of a variety of orientations. All of them share the idea that internal conflicts (or personal dilemmas) are at the heart of human functioning. However, their almost opaque nature makes it difficult to identify and gauge. The notion of internal conflict can be formulated within the context of a broader psychological theory capable of contributing in more specific terms, as well as instruments for measuring it. Based on Personal Construct Theory, a constructivist theory that regards the significance attributed to events as being the basis of human functioning, research has been conducted on several clinical problems. Results suggests that internal conflicts can become a target for interventions promoting change. These personal dilemmas are identified in people who associate self-identity characteristics in which change is desirable (e.g., “timid”) to other, more central core identity constructs (e.g., “modest”). By implication, achieving change (e.g., becoming “social”) is linked in the subject’s cognitive system to characteristics which are unacceptable for the person’s sense of identity (e.g., “arrogant”).
This workshop is designed to: (1) provide the clinician methods to identify internal conflicts, (2) use them for case formulation, and (3) offer the clinician specific guidelines for a dilemma-focused intervention. The presenter will describe and illustrate a protocol for working with internal conflicts, a mechanism that may be blockading change in a variety of clinical problems.
Feixas, G. (2015, Marzo). Conflict in Meaning Systems: Perspectives and Implications for Mental Health and Psychotherapy. Symposium Chair en el International Convention of Psychological Science, de la APS (Association for Psychological Science), Amsterdam, Holanda.
Variables and concepts are important tools in theoretical research. A concept is an abstract idea that combines related observations, while a variable is an empirical measure that can take different values. There are different types of variables, including independent, dependent, and intervening variables that indicate causal relationships. Numerical variables can be discrete or continuous, while categorical variables involve mutually exclusive and exhaustive categories. Researchers define concepts and variables conceptually by relating them to other concepts, and operationally by specifying how to measure them. Propositions state relationships between concepts or variables but are not tested directly like hypotheses.
Personal construct theory wikipedia, the free encyclopediaPriyadarshi Bhaskar
George Kelly developed personal construct theory which proposes that people develop internal constructs to anticipate and predict events based on their interpretations of experiences. These constructs are bipolar and people develop a system of constructs to understand themselves and the world. Kelly derived a psychotherapy approach and repertory grid technique where a patient's constructs are uncovered through minimal interpretation. The repertory grid involves identifying elements and constructs through a series of questions to build a matrix that reveals a person's perspective. Personal construct theory has applications in clinical psychology, education, and organizational development through the use of repertory grids.
Chapter 6 Theories and Application of Contextualism and Chaos TheoWilheminaRossi174
Chapter 6 Theories and Application of Contextualism and Chaos Theory to Careers
Things to Remember
The importance of context in the development of self
Differences between modern and postmodern theories
The language of contextualist and chaos theory theories
The process of postmodern career counseling, particularly assessment tools
Four theories of career development and counseling will be discussed in this chapter. The discussion begins with the contextualist theory developed by Young, Valach, and Collin (2002) and expanded by Young, Marshall, and Collin (2007). It continues with the most recent elegantly rendered theory developed by Savickas (1995, 1997, 2013). Savickas’ contextualist model is well created, but his theory is a bit more complex. It may be hard to grasp at first reading and could easily be dismissed for that reason. If you are considering a postmodern underpinning for your practice, dismissing Savickas would be a mistake. Importantly, Savickas builds bridges between traditional, modern approaches and his constructivist ideas that may help the reader develop a better understanding of both views.
In Chapter 1, I began a discussion of the differences between modern and postmodern thinking. I continued that discussion into Chapter 3 by laying out the assumptions of modernism. At this point, the basic tenets of postmodern thinking will be reviewed.
Postmodern theories, often referred to as constructivist theories, are a relatively new addition to the theories of career choice and development. These theories depart radically from the assumptions of the theories based on positivist philosophy. The following assumptions underpin these theories:
Human behavior is nonlinear and thus cannot be studied objectively.
Cause-and-effect relationships cannot be determined.
Individuals cannot be studied outside of the context in which they function.
Research data cannot be generalized to other people or groups.
Research is not a value-free process. The researcher’s values should in fact guide the research process.
The stories (narratives) that students tell are legitimate sources of data.
Research is goal free: It is a search for actual effects based on demonstrated needs. Random samples are replaced with purposeful sampling—that is, studying individuals who can respond to the research in a meaningful manner. For example, to understand sex-role stereotyping of occupational choice, a researcher might select subjects who knowingly chose careers because of stereotypes rather than selecting a random sample that included people who made decisions based on other variables.
Career counselors focus on the stories (narratives) of their clients, use qualitative assessment procedures, and help clients construct career goals based on their perceptions of the context in which they function.
The self develops in continuous interaction between the individual and her or his contexts.
Some postmodern theorists accept the idea of an objective sel ...
John Kelly developed the theory of personal constructs which proposes that individuals perceive and interpret phenomena through constructs which are concepts or ideas used to understand experiences. Personal constructs are bipolar and dichotomous, having two opposite poles. Constructs have properties like range of applicability, focus of applicability, and permeability. There are different types of constructs including pre-emptive, constellatory, and assumptive constructs. Constructs can also be classified as comprehensive or private, main or peripheral, and hard or loose.
This document discusses a model of response to loss proposed by Kübler-Ross. The model suggests individuals pass through 5 stages in response to loss: denial, anger, bargaining, depression, and acceptance. While criticized in academia, the model has proven useful for clinicians. The document proposes the model also applies to organizations responding to major changes that disrupt their identity. It suggests maintaining congruence between structural and cognitive identity drives response to loss across different social levels.
Madness and the sociology of disablement: tensions and possibilities by Helen Spandler - a presentation from the symposium on social movements and their contributions to sociological knowledge on mental health at the University of Wolverhampton. Held on 13 June 2014.
Mario TamaGetty Images NewsGetty ImagesLearning Objectiv.docxendawalling
Mario Tama/Getty Images News/Getty Images
Learning Objectives
After reading this chapter, you should be
able to:
• Explain how Tolman’s concept of latent learn-
ing sparked a need for theoretical accounts
that went beyond basic classical and operant
conditioning models.
• Describe the beginning of the cognitive revo-
lution and the importance of George Miller’s
memory studies.
• Explain how the computer has been used as
a metaphor for the way the mind processes
information.
• Describe how the cognitive counterrevolution
was different from the behavioral revolution
before it.
• List and define some of the foundational
concepts of cognitive approaches.
• Characterize George Kelly’s personal construct
theory and his view of humans as scientists.
Cognitive and Cognitive-Behavioral
Approaches to Personality 6
Chapter Outline
Introduction
6.1 Metacognition: Thinking About Your
Thinking
6.2 Major Historical Figures and Theories
• Edward Tolman and Latent Learning
• Chomsky and the Role of Language in
Cognition
• George Miller: The Cognitive Revolution
• Von Neumann and McCulloch: A Conceptual
Leap From Computers to the Mind
• Describe the contributions of the social learning theorists Julian Rotter, Albert Bandura, and Walter Mischel and
their contributions to such concepts as reward value, behavioral expectancies, self-efficacy, self-regulation, self-verification,
and motivated reasoning.
• Describe the process of modeling in both human and animal models.
• Compare and contrast the cognitive theories of Albert Ellis, Aaron Beck, and Marsha Linehan.
• Name and briefly describe some of the more commonly employed assessment tools used in the cognitive perspective.
Lec81110_06_c06_163-194.indd 163 5/21/15 12:39 PM
CHAPTER 6
Introduction
“There are no facts, only interpretations.” F. Nietzche
It’s December 14, 2012, at approximately 9:30 a.m. It’s an otherwise normal day
at Sandy Hook Elementary School in the small town of Newtown, Connecticut.
Then, 20-year-old Adam Lanza arrives on the scene carrying an arsenal of high-
capacity weapons, and he proceeds to gun down 20 helpless children and 6 adults
and terrorize many more. Authorities would later discover that Lanza had also
shot and killed his mother prior to coming to the school. Unfortunately, the mas-
sacre was not an isolated incident in American history, but it was the second dead-
liest school shooting in American history. Some claim that this incident points to
the disturbed nature of some individuals. Others point to the need for stricter gun
control to limit access to high-capacity weapons. Still others suggest that violence
in the media or video games were to blame. What was your take on these events?
If the goal were to predict your behavioral response to this event, could we do
so simply by understanding the environment in which you were brought up in
and currently live, or would we also need to understand how you cognitively pro-.
Mario TamaGetty Images NewsGetty ImagesLearning Objectiv.docxalfredacavx97
Mario Tama/Getty Images News/Getty Images
Learning Objectives
After reading this chapter, you should be
able to:
• Explain how Tolman’s concept of latent learn-
ing sparked a need for theoretical accounts
that went beyond basic classical and operant
conditioning models.
• Describe the beginning of the cognitive revo-
lution and the importance of George Miller’s
memory studies.
• Explain how the computer has been used as
a metaphor for the way the mind processes
information.
• Describe how the cognitive counterrevolution
was different from the behavioral revolution
before it.
• List and define some of the foundational
concepts of cognitive approaches.
• Characterize George Kelly’s personal construct
theory and his view of humans as scientists.
Cognitive and Cognitive-Behavioral
Approaches to Personality 6
Chapter Outline
Introduction
6.1 Metacognition: Thinking About Your
Thinking
6.2 Major Historical Figures and Theories
• Edward Tolman and Latent Learning
• Chomsky and the Role of Language in
Cognition
• George Miller: The Cognitive Revolution
• Von Neumann and McCulloch: A Conceptual
Leap From Computers to the Mind
• Describe the contributions of the social learning theorists Julian Rotter, Albert Bandura, and Walter Mischel and
their contributions to such concepts as reward value, behavioral expectancies, self-efficacy, self-regulation, self-verification,
and motivated reasoning.
• Describe the process of modeling in both human and animal models.
• Compare and contrast the cognitive theories of Albert Ellis, Aaron Beck, and Marsha Linehan.
• Name and briefly describe some of the more commonly employed assessment tools used in the cognitive perspective.
Lec81110_06_c06_163-194.indd 163 5/21/15 12:39 PM
CHAPTER 6
Introduction
“There are no facts, only interpretations.” F. Nietzche
It’s December 14, 2012, at approximately 9:30 a.m. It’s an otherwise normal day
at Sandy Hook Elementary School in the small town of Newtown, Connecticut.
Then, 20-year-old Adam Lanza arrives on the scene carrying an arsenal of high-
capacity weapons, and he proceeds to gun down 20 helpless children and 6 adults
and terrorize many more. Authorities would later discover that Lanza had also
shot and killed his mother prior to coming to the school. Unfortunately, the mas-
sacre was not an isolated incident in American history, but it was the second dead-
liest school shooting in American history. Some claim that this incident points to
the disturbed nature of some individuals. Others point to the need for stricter gun
control to limit access to high-capacity weapons. Still others suggest that violence
in the media or video games were to blame. What was your take on these events?
If the goal were to predict your behavioral response to this event, could we do
so simply by understanding the environment in which you were brought up in
and currently live, or would we also need to understand how you cognitively pro-.
This document discusses several sociological theories related to human action and agency. It begins by introducing action theories as micro-level approaches that focus on individual actions and interactions, in contrast to structural theories. It then summarizes key aspects of social action theory proposed by Weber, who saw both structural and action approaches as necessary. The document also discusses symbolic interactionism and how meanings arise through social interactions. Finally, it evaluates attempts to combine structural and action approaches, such as Giddens' structuration theory.
ViewpointsSocial work and social problemsA contribution f.docxlillie234567
Viewpoints
Social work and social problems:
A contribution from systems theory
and constructionism
Michailakis D., Schirmer W. Social work and social problems:
A contribution from systems theory and constructionism
Social work builds its identity on social problems. The goal is
to generate knowledge about causes, consequences and solu-
tions. However, there is a lack of theory of social problems.
We suggest that research on social problems can benefit
by ‘bringing the observer in’: Loseke’s constructionist frame-
work and Luhmann’s systems theory. According to Loseke,
social problems appear differently when constructed by dif-
ferent observers. Constructions vary in terms of morality,
conditions, victims/villains and solutions. From Luhmann we
learn that modern society consists of a multitude of social
systems (e.g. politics, science, economy etc.), each operating
with their own communicative codes. Combining both
approaches, we hypothesise that any social system constructs
its own (version of) social problems. Illustrating with
the empirical case ‘suicide among mentally ill people’, we
examine how a phenomenon is constructed differently as a
social problem by four different social systems: the disability
movement, politics, medicine and social work.
Dimitris Michailakis1, Werner Schirmer1,2
1 TEFSA – Platform for Theory-driven Research in Social
Work, University of Linköping, Norrköping, Sweden
2 Center for Social Theory, Department of Sociology, Ghent
University, Ghent, Belgium
Key words: constructionism, Luhmann, social problems, social
work theory, systems theory, suicide
Werner Schirmer, TEFSA – Platform for Theory-driven
Research in Social Work, Department of Social and Welfare
Studies, University of Linköping, SE 60174 Norrköping,
Sweden
E-mail: [email protected]
Accepted for publication 8 January 2014
Introduction
The academic discipline social work builds its identity
on the study of social problems. The goal is to generate
knowledge about causes, consequences and potential
solutions for social problems. This knowledge is
expected to be useful to practitioners working with
clients affected by different adverse conditions. In
empirical social work research on poverty, discrimina-
tion, social exclusion, homelessness, juvenile delin-
quency, domestic violence and human trafficking, it is
usually taken for granted what the ‘social problem’ is.
The social problem is treated as a deplorable circum-
stance about which something must be done (Holstein
& Miller, 1993a). It is therefore considered to be a
deviation from a desirable condition (how society ought
to be), how exposed groups suffer from these condi-
tions (Gould & Baldwin, 2004; Healy, 2001; Korpi,
Nelson, & Stenberg, 2007; Payne, 2005b; Trevithick,
2007) and what social work practitioners need to take
into consideration when dealing with those bearing the
symptoms of such conditions.
What this kind of research has in common is that it
addresses ‘what’ questions (What is .
MidTerm Exam 1Subject Differential EquationNote This e.docxARIV4
This document contains lecture materials on theory development from a course. It defines what a theory is, discusses the key components and characteristics of theories, and different forms theories can take. It also covers philosophical bases of theories and provides exercises for students to develop their own theories on a given topic.
Discussion Individual vs. Structural-Cultural TheoriesTheorwiddowsonerica
Discussion: Individual vs. Structural-Cultural Theories
Theories
help frame more than presenting problems—they also frame social problems, and both types of problems can be linked in relation to client issues. For example, many scholars and social workers have attempted to understand the social problem of poverty. Turner and Lehning (2007) classified various psychological theories to explain poverty under two headings: (1) individual-related theories or (2) structural/cultural-related theories. In other words, think of these two headings as lenses in viewing poverty. In this Discussion, you apply lenses through which to understand a client's problem in relation to social problems.
To prepare:
Read this article listed in the Learning Resources: Turner, K., & Lehning, A. J. (2007). Psychological
theories
of poverty.
Journal of Human Behavior in the Social Environment, 16
(1/2), 57–72. doi:10.1300/J137v16n01-05
Select a
theory
under the individual-related
theories
and a theory under the structural/cultural-related theories.
Complete the handout “Comparing Individual-Related and Structural/Cultural-Related
Theories
” to help you craft your response. (
Note:
You do
not
need to upload the handout to the Discussion forum. The handout is intended to assist you in writing your Discussion post.)
By Day 3
Post:
Describe how a social worker would conceptualize a presenting problem of poverty from the two
theories
you selected.
Explain how this conceptualization differs from an individual-related versus a structural/cultural-related theoretical lens.
Compare how the two theoretical lenses differ in terms of how the social worker would approach the client and the problem and how the social worker would intervene.
By Day 5
Respond
to at least two colleagues:
Evaluate one identified strength and one identified limitation your colleague may encounter when employing an individual-related
theory
and a structural/cultural-related theory to formulating interventions for poverty.
Assignment: Application of Systems Theory to a Case Study
In this course, you will be asked to select one case study and to use it throughout the entire course. By doing this, you will have the opportunity to see how
theories
guide your view of a client and the client’s presenting problem. Although the case may be the same, each time you use a different
theory
, your perspective of the problem changes, which then changes how you go about asking the assessment questions and how you intervene.
The first theoretical approach you will use to apply to a case study is systems
theory
. In other words, your theoretical orientation—your lens—will be systems theory as you analyze a social work case study.
Different
theories
can be used to take a systems approach. For example, Bertalanffy’s General Systems
Theory
considers how a
system
is made of smaller
subsystems
that
influence each other
and seek
homeostasis
, whereas Brofennerbrenner’s Eco ...
This document discusses paradigmatic qualitative research and how it differs from other approaches. Some key points:
1) Qualitative research is a scientific paradigm focused on studying socially constructed realities through narratives, actions, and discourse rather than quantifying individual attributes.
2) In qualitative research, explanations are located in social practices rather than within individuals. Reality and concepts are sustained through shared social practices rather than objective facts.
3) The goal of qualitative research is to develop increasingly dense narratives about topics rather than arriving at final or objective truths. Knowledge is seen as socially constructed rather than independent of social influences.
This article aims to contribute to clarifying the emerging field of "resistance studies" by exploring definitions of "resistance" and proposing analytical categories for studying it. It first discusses existing understandings of resistance in literature, noting disagreements around whether an act needs to be recognized by the actor, target, or observer to be considered resistance. The article then proposes examining resistance without requiring intent, as unintended acts can still undermine power relations. It concludes by suggesting resistance be defined as any act opposing power relations, whether recognized as such or not, to provide a framework for further empirical study while maintaining resistance as a plural concept.
The Context document explores theories related to gender and commu.docxchristalgrieg
The Context document explores theories related to gender and communication. Take time to review the document for an overview of key communication-style theories, including the following:
· Symbolic Interaction Theory.
· Performative Theory.
· Standpoint Theory.
context
Theories About Gender and Communication
According to Fixmer-Oraiz and Wood, a theory is a "way to describe, explain, and predict relationships among phenomena" (Fixmer-Oraiz & Wood, 2019, p. 34). Specifically, theories help make sense of the world around us. "Although we are not always aware of the theories we hold, they still shape how we act and how we expect others to act" (Fixmer-Oraiz & Wood, 2019, p. 34). Moreover, theories are a practical way of explaining what goes on around us, and although we sometimes believe theories are removed from the real world, they are directly connected to our everyday actions (Fixmer-Oraiz & Wood, 2019). It is important to remember the following:
· A theory represents a particular viewpoint as an attempt to understand phenomena.
· A theory offers more than explanations; it also influences attitudes and behaviors.
· One theory should not be considered the theory on gender development; multiple theories work together to create a fuller picture.
The study of theoretical approaches to gender development and communication has been on the focus of researchers for many years. Before we can truly understand how males and females communicate, we must understand why we communicate a certain way. To do this we must study the theoretical approaches to gender development and communication.
Specifically, gender is a social construct shaped by a number of social characteristics, larger normative expectations, personal experiences, and socializations. As communicators we must recognize the power of language and communication. We must understand why we use this to perceive, judge, and evaluate others.
Communication Style Theories
Following are some of the main theories that help us better understand the why behind our communication styles:
Symbolic Interaction Theory
Symbolic interaction theory helps us negotiate and define a situation. It helps us understand questions such as the following:
· Who am I?
· What should I do?
· What can I expect from you?
· What does this behavior mean?
The symbolic interaction theory suggests that cultural definitions of gender follow us into the workplace, along with specific value placed on "masculine" versus "feminine" behaviors. It suggests that, because you must interpret a new situation based on previous experience, you may have to "feel uncomfortable" to create the perception that is important to you. This discomfort comes from breaking social norms, that is, you are requiring others to actively negotiate a new definition of the situation.
Performative Theory
The performative theory suggests that gender is an expression of identity. Language and how we communicate are part of how we perform this identity. It suggests ...
This study compared cognitive rigidity and differentiation in patients with depression alone and patients with comorbid depression and fibromyalgia. Thirty-one patients with both depression and fibromyalgia were matched with 31 patients who had depression alone based on age, sex, and number of depressive episodes. Patients completed measures of depressive symptoms and cognitive structure using repertory grid technique. Results showed that depressed patients with fibromyalgia had higher levels of depressive symptoms, greater cognitive rigidity, and lower cognitive differentiation compared to depressed patients without fibromyalgia. This suggests more extreme and polarized thinking patterns in patients with comorbid depression and chronic pain. The findings could help inform future treatment approaches for this patient group.
Indicadores de Conflicto Cognitivo en la Técnica de Rejilla y su Relación con...Guillem Feixas
Este estudio examinó los indicadores de conflicto cognitivo en la técnica de rejilla y su relación con la sintomatología medida por el SCL-90-R en una muestra de 545 voluntarios. Los resultados mostraron que la presencia de dilemas implicativos y constructos dilemáticos se asoció con mayores puntuaciones en escalas del SCL-90-R, especialmente depresión. Además, una baja autoestima predijo mayores puntuaciones en todas las escalas, mientras que un mayor aislamiento social autoper
Konflikt poznawczy w psychoterapii: perspektywa konstruktywistyczna [El confl...Guillem Feixas
Jasiński, M. y Feixas, G. (2015, octubre). Konflikt poznawczy w psychoterapii: perspektywa konstruktywistyczna [El conflicto cognitivo en psicoterapia: perspectiva constructivista]. Comunicación presentada en el Simposio W poszuiwaniu znaczeń en el Konferencja Trzech Sekcji. Między dobrem pacjenta, dobrem terapeuty a dobrem systemu: dylematy etyczne w psychoterapii [Entre el bien del paciente, terapeuta y sistema: dilemas éticos en psicoterapia], Cracovia, Polonia.
A Constructivist-Process View of (De-)Radicalisation: A Person-Context DiagramGuillem Feixas
A general schema by Guillem Feixas & David A. Winter, 2016
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Negative views of self or internal conflictsGuillem Feixas
Feixas, G. y Montesano, A. (2015, Marzo). Negative Views of Self or Internal Conflicts as Targets of Psychotherapy, In G. Feixas (Chair), Conflict in Meaning Systems: Perspectives and Implications for Mental Health and Psychotherapy del International Convention of Psychological Science, Amsterdam, Holanda.
Efectividad de un programa terapéutico integrado para trastornos graves de la...Guillem Feixas
Abstract
Introducción
En los últimos 25 años varios estudios han mostrado la eficacia de diversas intervenciones psicológicas para los trastornos graves de la personalidad. Sin embargo, la generalización de estos resultados positivos desde entornos con larga tradición investigadora a condiciones de práctica habitual ha sido cuestionada, reclamándose la replicación en estudios pragmáticos.
Métodos
Este estudio pragmático compara las hospitalizaciones y las visitas a Urgencias antes y durante un programa terapéutico de 6 meses para trastornos graves de la personalidad y 36 meses después del inicio. El programa terapéutico, que integra varias intervenciones específicas en un encuadre coherente, se realizó en un entorno de práctica habitual. Se incluyeron 51 pacientes evaluados de acuerdo con criterios DSM-IV por medio de la versión española de la Entrevista Clínica Estructurada para Trastornos de la Personalidad (SCID-II).
Resultados
Las características clínicas evidenciaron un grupo de pacientes muy graves, de los que el 78,4% cumplía criterios de trastorno límite de la personalidad. El porcentaje de pacientes hospitalizados y que visitaron Urgencias, así como el número de días de hospitalización y de visitas a Urgencias, se redujo significativamente durante el tratamiento, y esta mejoría se mantuvo en el tiempo.
Conclusiones
Un tratamiento integrado para trastornos graves de la personalidad puede ser efectivo para reducir las readmisiones o las estancias hospitalarias prolongadas cuando es implementado por clínicos en condiciones de práctica habitual.
Abstract
Introduction
Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies.
Methods
This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included.
Results
The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout.
Conclusions
An integrated treatment for severe personality disorders could be ef
Tanto con las tareas como en los rituales se trata de que varios miembros de la familia hagan cosas conjuntamente. Enalgunas ocasiones, estas tareas se ponen al servicio de
la promoción de alianzasalternativas a las existentes, en lo que se denomina reestructuración de límites.A veces también permiten manifestar simbólicamente significados familiaresno explícitos. Podemos distinguir varias modalidades.
Reformulación. Tal y como Watzlawick, Weakland y Fisch (1974) lo describen en su obra Cambio:
… reformular significa cambiar el fondo o la visión conceptual y/o emocional en relación con la cual se experimenta una situación poniéndola dentro de otro
marco que se adapta, tan bien o mejor que aquél, a los “hechos” de la misma situación concreta, cambiando así completamente su significado.
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Madness and the sociology of disablement: tensions and possibilities by Helen Spandler - a presentation from the symposium on social movements and their contributions to sociological knowledge on mental health at the University of Wolverhampton. Held on 13 June 2014.
Mario TamaGetty Images NewsGetty ImagesLearning Objectiv.docxendawalling
Mario Tama/Getty Images News/Getty Images
Learning Objectives
After reading this chapter, you should be
able to:
• Explain how Tolman’s concept of latent learn-
ing sparked a need for theoretical accounts
that went beyond basic classical and operant
conditioning models.
• Describe the beginning of the cognitive revo-
lution and the importance of George Miller’s
memory studies.
• Explain how the computer has been used as
a metaphor for the way the mind processes
information.
• Describe how the cognitive counterrevolution
was different from the behavioral revolution
before it.
• List and define some of the foundational
concepts of cognitive approaches.
• Characterize George Kelly’s personal construct
theory and his view of humans as scientists.
Cognitive and Cognitive-Behavioral
Approaches to Personality 6
Chapter Outline
Introduction
6.1 Metacognition: Thinking About Your
Thinking
6.2 Major Historical Figures and Theories
• Edward Tolman and Latent Learning
• Chomsky and the Role of Language in
Cognition
• George Miller: The Cognitive Revolution
• Von Neumann and McCulloch: A Conceptual
Leap From Computers to the Mind
• Describe the contributions of the social learning theorists Julian Rotter, Albert Bandura, and Walter Mischel and
their contributions to such concepts as reward value, behavioral expectancies, self-efficacy, self-regulation, self-verification,
and motivated reasoning.
• Describe the process of modeling in both human and animal models.
• Compare and contrast the cognitive theories of Albert Ellis, Aaron Beck, and Marsha Linehan.
• Name and briefly describe some of the more commonly employed assessment tools used in the cognitive perspective.
Lec81110_06_c06_163-194.indd 163 5/21/15 12:39 PM
CHAPTER 6
Introduction
“There are no facts, only interpretations.” F. Nietzche
It’s December 14, 2012, at approximately 9:30 a.m. It’s an otherwise normal day
at Sandy Hook Elementary School in the small town of Newtown, Connecticut.
Then, 20-year-old Adam Lanza arrives on the scene carrying an arsenal of high-
capacity weapons, and he proceeds to gun down 20 helpless children and 6 adults
and terrorize many more. Authorities would later discover that Lanza had also
shot and killed his mother prior to coming to the school. Unfortunately, the mas-
sacre was not an isolated incident in American history, but it was the second dead-
liest school shooting in American history. Some claim that this incident points to
the disturbed nature of some individuals. Others point to the need for stricter gun
control to limit access to high-capacity weapons. Still others suggest that violence
in the media or video games were to blame. What was your take on these events?
If the goal were to predict your behavioral response to this event, could we do
so simply by understanding the environment in which you were brought up in
and currently live, or would we also need to understand how you cognitively pro-.
Mario TamaGetty Images NewsGetty ImagesLearning Objectiv.docxalfredacavx97
Mario Tama/Getty Images News/Getty Images
Learning Objectives
After reading this chapter, you should be
able to:
• Explain how Tolman’s concept of latent learn-
ing sparked a need for theoretical accounts
that went beyond basic classical and operant
conditioning models.
• Describe the beginning of the cognitive revo-
lution and the importance of George Miller’s
memory studies.
• Explain how the computer has been used as
a metaphor for the way the mind processes
information.
• Describe how the cognitive counterrevolution
was different from the behavioral revolution
before it.
• List and define some of the foundational
concepts of cognitive approaches.
• Characterize George Kelly’s personal construct
theory and his view of humans as scientists.
Cognitive and Cognitive-Behavioral
Approaches to Personality 6
Chapter Outline
Introduction
6.1 Metacognition: Thinking About Your
Thinking
6.2 Major Historical Figures and Theories
• Edward Tolman and Latent Learning
• Chomsky and the Role of Language in
Cognition
• George Miller: The Cognitive Revolution
• Von Neumann and McCulloch: A Conceptual
Leap From Computers to the Mind
• Describe the contributions of the social learning theorists Julian Rotter, Albert Bandura, and Walter Mischel and
their contributions to such concepts as reward value, behavioral expectancies, self-efficacy, self-regulation, self-verification,
and motivated reasoning.
• Describe the process of modeling in both human and animal models.
• Compare and contrast the cognitive theories of Albert Ellis, Aaron Beck, and Marsha Linehan.
• Name and briefly describe some of the more commonly employed assessment tools used in the cognitive perspective.
Lec81110_06_c06_163-194.indd 163 5/21/15 12:39 PM
CHAPTER 6
Introduction
“There are no facts, only interpretations.” F. Nietzche
It’s December 14, 2012, at approximately 9:30 a.m. It’s an otherwise normal day
at Sandy Hook Elementary School in the small town of Newtown, Connecticut.
Then, 20-year-old Adam Lanza arrives on the scene carrying an arsenal of high-
capacity weapons, and he proceeds to gun down 20 helpless children and 6 adults
and terrorize many more. Authorities would later discover that Lanza had also
shot and killed his mother prior to coming to the school. Unfortunately, the mas-
sacre was not an isolated incident in American history, but it was the second dead-
liest school shooting in American history. Some claim that this incident points to
the disturbed nature of some individuals. Others point to the need for stricter gun
control to limit access to high-capacity weapons. Still others suggest that violence
in the media or video games were to blame. What was your take on these events?
If the goal were to predict your behavioral response to this event, could we do
so simply by understanding the environment in which you were brought up in
and currently live, or would we also need to understand how you cognitively pro-.
This document discusses several sociological theories related to human action and agency. It begins by introducing action theories as micro-level approaches that focus on individual actions and interactions, in contrast to structural theories. It then summarizes key aspects of social action theory proposed by Weber, who saw both structural and action approaches as necessary. The document also discusses symbolic interactionism and how meanings arise through social interactions. Finally, it evaluates attempts to combine structural and action approaches, such as Giddens' structuration theory.
ViewpointsSocial work and social problemsA contribution f.docxlillie234567
Viewpoints
Social work and social problems:
A contribution from systems theory
and constructionism
Michailakis D., Schirmer W. Social work and social problems:
A contribution from systems theory and constructionism
Social work builds its identity on social problems. The goal is
to generate knowledge about causes, consequences and solu-
tions. However, there is a lack of theory of social problems.
We suggest that research on social problems can benefit
by ‘bringing the observer in’: Loseke’s constructionist frame-
work and Luhmann’s systems theory. According to Loseke,
social problems appear differently when constructed by dif-
ferent observers. Constructions vary in terms of morality,
conditions, victims/villains and solutions. From Luhmann we
learn that modern society consists of a multitude of social
systems (e.g. politics, science, economy etc.), each operating
with their own communicative codes. Combining both
approaches, we hypothesise that any social system constructs
its own (version of) social problems. Illustrating with
the empirical case ‘suicide among mentally ill people’, we
examine how a phenomenon is constructed differently as a
social problem by four different social systems: the disability
movement, politics, medicine and social work.
Dimitris Michailakis1, Werner Schirmer1,2
1 TEFSA – Platform for Theory-driven Research in Social
Work, University of Linköping, Norrköping, Sweden
2 Center for Social Theory, Department of Sociology, Ghent
University, Ghent, Belgium
Key words: constructionism, Luhmann, social problems, social
work theory, systems theory, suicide
Werner Schirmer, TEFSA – Platform for Theory-driven
Research in Social Work, Department of Social and Welfare
Studies, University of Linköping, SE 60174 Norrköping,
Sweden
E-mail: [email protected]
Accepted for publication 8 January 2014
Introduction
The academic discipline social work builds its identity
on the study of social problems. The goal is to generate
knowledge about causes, consequences and potential
solutions for social problems. This knowledge is
expected to be useful to practitioners working with
clients affected by different adverse conditions. In
empirical social work research on poverty, discrimina-
tion, social exclusion, homelessness, juvenile delin-
quency, domestic violence and human trafficking, it is
usually taken for granted what the ‘social problem’ is.
The social problem is treated as a deplorable circum-
stance about which something must be done (Holstein
& Miller, 1993a). It is therefore considered to be a
deviation from a desirable condition (how society ought
to be), how exposed groups suffer from these condi-
tions (Gould & Baldwin, 2004; Healy, 2001; Korpi,
Nelson, & Stenberg, 2007; Payne, 2005b; Trevithick,
2007) and what social work practitioners need to take
into consideration when dealing with those bearing the
symptoms of such conditions.
What this kind of research has in common is that it
addresses ‘what’ questions (What is .
MidTerm Exam 1Subject Differential EquationNote This e.docxARIV4
This document contains lecture materials on theory development from a course. It defines what a theory is, discusses the key components and characteristics of theories, and different forms theories can take. It also covers philosophical bases of theories and provides exercises for students to develop their own theories on a given topic.
Discussion Individual vs. Structural-Cultural TheoriesTheorwiddowsonerica
Discussion: Individual vs. Structural-Cultural Theories
Theories
help frame more than presenting problems—they also frame social problems, and both types of problems can be linked in relation to client issues. For example, many scholars and social workers have attempted to understand the social problem of poverty. Turner and Lehning (2007) classified various psychological theories to explain poverty under two headings: (1) individual-related theories or (2) structural/cultural-related theories. In other words, think of these two headings as lenses in viewing poverty. In this Discussion, you apply lenses through which to understand a client's problem in relation to social problems.
To prepare:
Read this article listed in the Learning Resources: Turner, K., & Lehning, A. J. (2007). Psychological
theories
of poverty.
Journal of Human Behavior in the Social Environment, 16
(1/2), 57–72. doi:10.1300/J137v16n01-05
Select a
theory
under the individual-related
theories
and a theory under the structural/cultural-related theories.
Complete the handout “Comparing Individual-Related and Structural/Cultural-Related
Theories
” to help you craft your response. (
Note:
You do
not
need to upload the handout to the Discussion forum. The handout is intended to assist you in writing your Discussion post.)
By Day 3
Post:
Describe how a social worker would conceptualize a presenting problem of poverty from the two
theories
you selected.
Explain how this conceptualization differs from an individual-related versus a structural/cultural-related theoretical lens.
Compare how the two theoretical lenses differ in terms of how the social worker would approach the client and the problem and how the social worker would intervene.
By Day 5
Respond
to at least two colleagues:
Evaluate one identified strength and one identified limitation your colleague may encounter when employing an individual-related
theory
and a structural/cultural-related theory to formulating interventions for poverty.
Assignment: Application of Systems Theory to a Case Study
In this course, you will be asked to select one case study and to use it throughout the entire course. By doing this, you will have the opportunity to see how
theories
guide your view of a client and the client’s presenting problem. Although the case may be the same, each time you use a different
theory
, your perspective of the problem changes, which then changes how you go about asking the assessment questions and how you intervene.
The first theoretical approach you will use to apply to a case study is systems
theory
. In other words, your theoretical orientation—your lens—will be systems theory as you analyze a social work case study.
Different
theories
can be used to take a systems approach. For example, Bertalanffy’s General Systems
Theory
considers how a
system
is made of smaller
subsystems
that
influence each other
and seek
homeostasis
, whereas Brofennerbrenner’s Eco ...
This document discusses paradigmatic qualitative research and how it differs from other approaches. Some key points:
1) Qualitative research is a scientific paradigm focused on studying socially constructed realities through narratives, actions, and discourse rather than quantifying individual attributes.
2) In qualitative research, explanations are located in social practices rather than within individuals. Reality and concepts are sustained through shared social practices rather than objective facts.
3) The goal of qualitative research is to develop increasingly dense narratives about topics rather than arriving at final or objective truths. Knowledge is seen as socially constructed rather than independent of social influences.
This article aims to contribute to clarifying the emerging field of "resistance studies" by exploring definitions of "resistance" and proposing analytical categories for studying it. It first discusses existing understandings of resistance in literature, noting disagreements around whether an act needs to be recognized by the actor, target, or observer to be considered resistance. The article then proposes examining resistance without requiring intent, as unintended acts can still undermine power relations. It concludes by suggesting resistance be defined as any act opposing power relations, whether recognized as such or not, to provide a framework for further empirical study while maintaining resistance as a plural concept.
The Context document explores theories related to gender and commu.docxchristalgrieg
The Context document explores theories related to gender and communication. Take time to review the document for an overview of key communication-style theories, including the following:
· Symbolic Interaction Theory.
· Performative Theory.
· Standpoint Theory.
context
Theories About Gender and Communication
According to Fixmer-Oraiz and Wood, a theory is a "way to describe, explain, and predict relationships among phenomena" (Fixmer-Oraiz & Wood, 2019, p. 34). Specifically, theories help make sense of the world around us. "Although we are not always aware of the theories we hold, they still shape how we act and how we expect others to act" (Fixmer-Oraiz & Wood, 2019, p. 34). Moreover, theories are a practical way of explaining what goes on around us, and although we sometimes believe theories are removed from the real world, they are directly connected to our everyday actions (Fixmer-Oraiz & Wood, 2019). It is important to remember the following:
· A theory represents a particular viewpoint as an attempt to understand phenomena.
· A theory offers more than explanations; it also influences attitudes and behaviors.
· One theory should not be considered the theory on gender development; multiple theories work together to create a fuller picture.
The study of theoretical approaches to gender development and communication has been on the focus of researchers for many years. Before we can truly understand how males and females communicate, we must understand why we communicate a certain way. To do this we must study the theoretical approaches to gender development and communication.
Specifically, gender is a social construct shaped by a number of social characteristics, larger normative expectations, personal experiences, and socializations. As communicators we must recognize the power of language and communication. We must understand why we use this to perceive, judge, and evaluate others.
Communication Style Theories
Following are some of the main theories that help us better understand the why behind our communication styles:
Symbolic Interaction Theory
Symbolic interaction theory helps us negotiate and define a situation. It helps us understand questions such as the following:
· Who am I?
· What should I do?
· What can I expect from you?
· What does this behavior mean?
The symbolic interaction theory suggests that cultural definitions of gender follow us into the workplace, along with specific value placed on "masculine" versus "feminine" behaviors. It suggests that, because you must interpret a new situation based on previous experience, you may have to "feel uncomfortable" to create the perception that is important to you. This discomfort comes from breaking social norms, that is, you are requiring others to actively negotiate a new definition of the situation.
Performative Theory
The performative theory suggests that gender is an expression of identity. Language and how we communicate are part of how we perform this identity. It suggests ...
Similar to 2005 resolution of dilemmas by personal construct psychotherapy (13)
This study compared cognitive rigidity and differentiation in patients with depression alone and patients with comorbid depression and fibromyalgia. Thirty-one patients with both depression and fibromyalgia were matched with 31 patients who had depression alone based on age, sex, and number of depressive episodes. Patients completed measures of depressive symptoms and cognitive structure using repertory grid technique. Results showed that depressed patients with fibromyalgia had higher levels of depressive symptoms, greater cognitive rigidity, and lower cognitive differentiation compared to depressed patients without fibromyalgia. This suggests more extreme and polarized thinking patterns in patients with comorbid depression and chronic pain. The findings could help inform future treatment approaches for this patient group.
Indicadores de Conflicto Cognitivo en la Técnica de Rejilla y su Relación con...Guillem Feixas
Este estudio examinó los indicadores de conflicto cognitivo en la técnica de rejilla y su relación con la sintomatología medida por el SCL-90-R en una muestra de 545 voluntarios. Los resultados mostraron que la presencia de dilemas implicativos y constructos dilemáticos se asoció con mayores puntuaciones en escalas del SCL-90-R, especialmente depresión. Además, una baja autoestima predijo mayores puntuaciones en todas las escalas, mientras que un mayor aislamiento social autoper
Konflikt poznawczy w psychoterapii: perspektywa konstruktywistyczna [El confl...Guillem Feixas
Jasiński, M. y Feixas, G. (2015, octubre). Konflikt poznawczy w psychoterapii: perspektywa konstruktywistyczna [El conflicto cognitivo en psicoterapia: perspectiva constructivista]. Comunicación presentada en el Simposio W poszuiwaniu znaczeń en el Konferencja Trzech Sekcji. Między dobrem pacjenta, dobrem terapeuty a dobrem systemu: dylematy etyczne w psychoterapii [Entre el bien del paciente, terapeuta y sistema: dilemas éticos en psicoterapia], Cracovia, Polonia.
A Constructivist-Process View of (De-)Radicalisation: A Person-Context DiagramGuillem Feixas
A general schema by Guillem Feixas & David A. Winter, 2016
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Negative views of self or internal conflictsGuillem Feixas
Feixas, G. y Montesano, A. (2015, Marzo). Negative Views of Self or Internal Conflicts as Targets of Psychotherapy, In G. Feixas (Chair), Conflict in Meaning Systems: Perspectives and Implications for Mental Health and Psychotherapy del International Convention of Psychological Science, Amsterdam, Holanda.
Efectividad de un programa terapéutico integrado para trastornos graves de la...Guillem Feixas
Abstract
Introducción
En los últimos 25 años varios estudios han mostrado la eficacia de diversas intervenciones psicológicas para los trastornos graves de la personalidad. Sin embargo, la generalización de estos resultados positivos desde entornos con larga tradición investigadora a condiciones de práctica habitual ha sido cuestionada, reclamándose la replicación en estudios pragmáticos.
Métodos
Este estudio pragmático compara las hospitalizaciones y las visitas a Urgencias antes y durante un programa terapéutico de 6 meses para trastornos graves de la personalidad y 36 meses después del inicio. El programa terapéutico, que integra varias intervenciones específicas en un encuadre coherente, se realizó en un entorno de práctica habitual. Se incluyeron 51 pacientes evaluados de acuerdo con criterios DSM-IV por medio de la versión española de la Entrevista Clínica Estructurada para Trastornos de la Personalidad (SCID-II).
Resultados
Las características clínicas evidenciaron un grupo de pacientes muy graves, de los que el 78,4% cumplía criterios de trastorno límite de la personalidad. El porcentaje de pacientes hospitalizados y que visitaron Urgencias, así como el número de días de hospitalización y de visitas a Urgencias, se redujo significativamente durante el tratamiento, y esta mejoría se mantuvo en el tiempo.
Conclusiones
Un tratamiento integrado para trastornos graves de la personalidad puede ser efectivo para reducir las readmisiones o las estancias hospitalarias prolongadas cuando es implementado por clínicos en condiciones de práctica habitual.
Abstract
Introduction
Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies.
Methods
This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included.
Results
The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout.
Conclusions
An integrated treatment for severe personality disorders could be ef
Tanto con las tareas como en los rituales se trata de que varios miembros de la familia hagan cosas conjuntamente. Enalgunas ocasiones, estas tareas se ponen al servicio de
la promoción de alianzasalternativas a las existentes, en lo que se denomina reestructuración de límites.A veces también permiten manifestar simbólicamente significados familiaresno explícitos. Podemos distinguir varias modalidades.
Reformulación. Tal y como Watzlawick, Weakland y Fisch (1974) lo describen en su obra Cambio:
… reformular significa cambiar el fondo o la visión conceptual y/o emocional en relación con la cual se experimenta una situación poniéndola dentro de otro
marco que se adapta, tan bien o mejor que aquél, a los “hechos” de la misma situación concreta, cambiando así completamente su significado.
El genograma en terapia familiar sistémica Guillem Feixas
El genograma es una representación gráfica (en forma de árbol genealógico) de la información básica de, al menos, tres generaciones de una familia. Incluye información
sobre su estructura, los datos demográficos de los miembros y las relaciones que mantienen entre ellos. De esta forma, proporciona a “golpe de vista” una gran
cantidad de información, lo que permite no sólo conocer a la familia, sino realizar hipótesis acerca de la relación entre el problema y el contexto familiar, la evolución del
problema a lo largo del tiempo, su relación con el ciclo vital de la familia, etc.
La efectividad de la psicoterapia es un campo de interés que ha generado numerosas investigaciones. Diversas variables como son la alianza terapéutica, el estilo de convivencia o comunicación familiar, así como la percepción del ajuste marital han sido estudiadas para valorar el efecto que la psicoterapia ejerce. A continuación exponemos brevemente algunos instrumentos de medida que permiten evaluar el cambio terapéutico en el marco de la terapia familiar y de pareja.
El equipo como instrumento de intervención Guillem Feixas
El documento describe las diferentes funciones que puede cumplir un equipo terapéutico en terapia familiar sistémica, incluyendo actuar como grupo observador, ofrecer ayuda al terapeuta, e intervenir directamente con la familia. El equipo puede intervenir estableciendo contacto directo o indirecto a través del terapeuta, y ofrecer diferentes perspectivas o puntos de vista a la familia después de la sesión para ayudar a clarificar dilemas o fomentar una mayor flexibilidad.
Partiendo de la idea de familia como sistema, el síntoma se concibe dentro del contexto familiar en el que se da, dentro del patrón interaccional en el que se produce. En este sentido, comprender el síntoma implica conocer cómo se concatena con todas las demás conductas de la familia (causalidad circular).
Las cartas terapéuticas en el modelo sistémico Guillem Feixas
Las cartas terapéuticas son un recurso narrativo de gran interés en la terapia. Pueden encontrarse muchos antecedentes del uso de cartas en los inicios del modelo sistémico.
Conflictos cognitivos en síndrome del intestino irritable (SII), un estudio e...Guillem Feixas
En este estudio descriptivo transversal se exploran algunas características cognitivas y sintomáticas de 13 pacientes consultantes con Síndrome del Intestino Irritable (SII) comparados con una muestra de 63 sujetos no consultantes sin síntomas del SII ni psicopatológicos. El 92% de los primeros cumple criterios para algún trastorno
del eje I del DSM-IV y su diagnóstico principal puede agruparse en dos categorías: trastornos por ansiedad y por somatización. En conjunto, los pacientes con SII
muestran más conflictos cognitivos detectados mediante la Técnica de Rejilla (TR) de Kelly que los sujetos normales. Considerando el subgrupo de trastorno por somatización, se observa una tendencia mucho más acentuada a mostrar mayor número de estos conflictos, así como una tendencia clara a presentar mayor polarización y, a su vez, menor complejidad cognitiva (diferenciación), con respecto tanto a los sujetos asintomáticos como a los diagnosticados por trastorno de ansiedad; por su parte, éstos muestran una menor autoestima.
The multi center dilemma project, an investigation on the role of cognitive c...Guillem Feixas
The Multi-Center Dilemma Project is a collaborative research endeavour aimed at determining the role of dilemmas —a kind of cognitive conflict, detected by using an adaptation of Kelly’s Repertory Grid Technique— in a variety of clinical conditions. Implicative dilemmas appear in one third of the non-clinical group (n = 321) and in about
half of the clinical group (n = 286), the latter having a proportion of dilemmas that doubles that of the non-clinical sample. Within the clinical group, we studied 87 subjects, after completing a psychotherapy process, and found that therapy helps to dissolve those dilemmas. We also studied, independently, a group of subjects diagnosed with social phobia (n = 13) and a group diagnosed with irritable bowel syndrome (n = 13) in comparison to non-clinical groups. In both health related problems, dilemmas seem to be quite relevant. Altogether, these studies, though preliminary (and with a small group size in some cases), yield a promising perspective to the unexplored area of the role of cognitive conflicts as an issue to consider when trying to understand some clinical conditions, as well as a focus to be dealt with in psychotherapy when dilemmas are identified.
Dilemas implicativos e ajustamento psicológico, um estudo com alunos recém ch...Guillem Feixas
Neste artigo apresentamos uma investigação focalizada no ajustamento psicológico e na experiência pessoal de alunos recém-chegados à Universidade. O nosso objectivo consistiu, por um lado, em analisar as dificuldades no ajustamento psicológico que estes alunos manifestam, quer através da presença de sintomatologia psicopatológica quer através das dificuldades na resolução de problemas de vida, e por outro, analisar se estas dimensões estão relacionadas com a presença de dilemas
implicativos. Participaram neste estudo descritivo transversal 48 alunos que frequentavam pela primeira vez a Universidade do Minho. Os dilemas implicativos foram identificados através da Grelha de Repertório de Kelly, os sintomas psicopatológicos foram avaliados através do SCL-90-R e as dificuldades na resolução de problemas foram identificadas com o Inventário de Resolução de Problemas. Os resultados indicam uma correlação negativa e altamente significativa entre a presença de sintomatologia psicopatológica e as competências de resolução de problemas. Os resultados sugerem, ainda, que a relação entre a presença de dilemas e a sintomatologia psicopatológica, e a relação entre presença de dilemas e dificuldades na resolução de problemas, embora não significativas, são no sentido esperado. Discutimos as implicações destes resultados
para a compreensão dos desafios que a transição para a Universidade pode constituir no ajustamento psicológico dos estudantes.
Manual de intervención en dilemas implicativosGuillem Feixas
Este documento presenta un manual de intervención psicoterapéutica centrado en la resolución de dilemas implicativos. El manual propone una intervención estructurada de 15 sesiones basada en la Terapia de Constructos Personales. Los dilemas implicativos surgen cuando hay una asociación fuerte entre un constructo con el que el cliente está satisfecho y otro que desea cambiar, lo que bloquea el cambio deseado. El manual busca identificar estos dilemas a través de la Técnica de Rejilla y trabajarlos para permitir el cambio dese
Somatización y conflictos cognitivos, estudio exploratorio con una muestr cli...Guillem Feixas
Este documento describe un estudio que investiga la relación entre la somatización y los conflictos cognitivos en una muestra clínica. Específicamente, examina la asociación entre los síntomas de somatización reportados por los pacientes y la presencia de "dilemas implicativos", un tipo de conflicto cognitivo identificado a través de la Técnica de Rejilla. Los resultados preliminares sugieren que los pacientes con dilemas implicativos tienden a reportar niveles más altos de somatización, y que la presencia de est
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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2005 resolution of dilemmas by personal construct psychotherapy
1. In D. Winter & L. Viney (eds.), Personal Construct Psychotherapy: Advances in
Theory, Practice and Research (pp. 136-147). London: Whurr/Wiley. ISBN: 1-86156-
394-9. (http://eu.wiley.com/WileyCDA/WileyTitle/productCd-1861563949.html)
NOT FOR COMMERCIAL USE. Authors’ personal pre-publication copy.
RESOLUTION OF DILEMMAS BY PERSONAL CONSTRUCT
PSYCHOTHERAPY
Guillem Feixas
Universitat de Barcelona gfeixas@ub.edu
Luis Ángel Saúl
UNED-Universidad Nacional de Educación a Distancia, Madrid
Like other constructivist approaches, Personal Construct Theory (PCT) views human
activity as a meaning creating process. What human organisms do, is informed by the
way they construe events, and in turn assign meaning to those events. Symptoms are a
rare, but legitimate part of their activity. They challenge our everyday conceptions
regarding human behaviour. From a personal construct perspective, however, they are
not an exception to the laws of behaviour, or, an error of nature but activities embedded
in a meaning making process.
PCT has elaborated several hypotheses for understanding symptoms as related to the
construing process. For example, Fransella (1970), in her study with individuals who
stutter, suggested that symptoms could end up being a way of life for the client by
becoming a central structure in his/her construct system or identity. In this situation,
abandoning the symptoms would involve abandoning a core meaning structure which
could be essential for making sense of oneself and the world. Lack of predictability
within the construct system would be experienced as anxiety by the person. In terms of
Kelly (1995) “Even an obviously invalid part of a construction system may be
preferable to the void of anxiety which might be caused by its elimination altogether"
(p. 831).
Another type of hypothesis derived from PCT for the understanding of symptoms as
related to meaning, focuses on the threat that a change would involve. For some clients,
symptom loss, while desirable, may carry negative implications. That is, construing the
self with a symptomatic pole of a construct is a way of maintaining their present
position in positive poles of other, more central, constructs. This is because the
symptomatic construct for which the change is desirable, is linked in their construct
system to other constructs for which change is not desirable. For example, Winter
(1988, 1989) studied clients with social anxiety problems for whom social competence
carried negative implications, and the more pronounced these implications, the more
negative the outcome in social skills training groups. He suggests that improvement or
symptom reduction may confront these clients with guilt (Winter, 1989), which Kelly
described as the experience of dislodgement from one’s core role (our way of relating to
others).
In previous studies (Feixas, Saúl, Avila-Espada, & Sánchez, 2001; Feixas, Saúl, &
Sánchez, 2000), we described a way of identifying implicative dilemmas from the
1
2. repertory grid which has been implemented in the GRIDCOR (version 4.0) programme
(Feixas & Cornejo, 2002). For that, two different types of construct are differentiated;
discrepant and congruent constructs. The former type refers to those constructs for
which the subject rates the self now and the ideal self at different ends of the construct
poles. For example, on a 7-point Likert scale, the difference would have to be greater
than 3 points to meet the criteria for a discrepant construct. A difference of less than 2
would be considered as a congruent construct, i.e. the subject rates the self now and
ideal self elements similarly.
Discrepant constructs (e.g. timid vs sociable) indicate areas of dissatisfaction for the
individual, areas in which the subject would like to experience substantial change.
Often, they represent symptomatic aspects of the person. Conversely, congruent
constructs (e.g. modest vs arrogant) reveal areas of satisfaction for the subject. They
refer to personal qualities (i.e. modesty) that are not felt to require change, the subject
may even be proud of them. The dilemma appears when the desired change in a
discrepant construct (becoming sociable) implies an undesired change (i.e. becoming
arrogant) in a congruent construct (as measured by a correlation between these two
constructs, set up at the minimum level of 20, for clinical practice, or at the level of 0.35
in our research studies). We used the term implicative dilemmas (see figure 1 for a
graphical disposition of it) to refer to this type of conflict.
Figure 1. Basic structure of an implicative dilemma derived from repertory grid
data.
As far as we know, Hinkle (1965,) was the first to employ the term implicative
dilemma, however, he was using it in a different sense from ours. For Hinkle, this term
referred to a particular form of implication between two constructs (A-B, and X-Y), one
that he named “ambiguous”:
“A and B imply X, and B implies Y; also A implies X and Y, and B implies X
and Y. One subject, for example, when relating desirable-undesirable and
realism-idealism, said that realism and idealism both implied desirable and
undesirable aspects for him. Conflict theory and double-bind theory relate to
these implicative dilemmas” (pp. 18-19, underlined in the original)
2
3. Although, this definition also focuses on the conflictive relationship between two
constructs, our definition is different. Our use of the term retains the dilemmatic nature
of the phenomena described by Hinkle (1965), but we consider the location of the self
now and the ideal self elements as central to the concept. In his definition, Hinkle
considered the types of implication between two constructs regardless of where the self
and other elements were located. Later, however, he based his laddering and implication
methods upon the preferred pole of a construct for a given subject, which is a way of
taking into account the ideal self. In light of his method, we think that our use of the
term “implicative dilemma”, although not exactly as Hinkle defined it, is legitimate
within PCT.
Ryle (1979) defined the term implicative dilemma in a way that is more commonly
understood nowadays, and the one we use in our present work:
"Dilemmas can be expressed in the form of "either/or" (false dichotomies that
restrict the range of choice), or of "if/then" (false assumptions of association that
similarly inhibit change). Two common dilemmas could be expressed as
follows: 1) "in relationships I am either close to someone and feel smothered, or
I am cut off and feel lonely"; (…) 2) "I feel that if I am masculine then I have to
be insensitive" (italics in the original).
Another author who expresses even more clearly what we mean by dilemma is Rowe
(1970) with the case of a chronically depressed patient embracing a construction
whereby her choice was either being depressed and humane or being a destructive and
unpleasant person. In general, dilemmas occur when the apparent alternatives available
in the construct system are seen both as undesirable. In this vein, Tschudi’s (1977) ABC
technique is based on this very same idea, that is, that change, although desirable from
the viewpoint of a given set of constructs, becomes undesirable from the perspective of
another constructs.
Therapeutic practice
By understanding the symptoms as a part of a meaning-making process, PCT allows
both client and therapist to look at distress from an alternative perspective. Often clients
present their symptoms in a way which suggests that they do not carry any meaning for
them, except for the inconveniences that they cause in their lives. As if the part or aspect
of their functioning which is wrong is not related to their sense of identity. Accordingly,
mainstream therapists are inclined to consider the problem in terms of its external
manifestations, associate them to a clinical diagnosis, and struggle to eliminate the
symptoms as quickly as possible. Rather, constructivist approaches direct their efforts in
searching for the meanings involved in the problem, that is, to understand the
constructions the client erects for him or herself, the problem and how these relate to the
problem itself. In particular, the therapy method we propose is addressed to those cases
where the problem poses a particular dilemma for the client, from the perspective of his
or her construct system.
The first step in our personal construct approach for dealing with dilemmas begins with
reframing the problem in terms of the dilemma. Thus, the client's problem is
reformulated as a conflict between the desire for change and the difficulty to do that,
which results in a blocking of the client’s development with considerable suffering and
3
4. symptoms. In our experience, it is useful to show to the client that his or her "impasse"
reflects a coherence, an internal logic, rather than being a sign of incompetence,
stupidity, or madness, as many clients (and some therapists) believe.
The problem is presented to the client as related to the way of being, or the type of
person that the client has chosen to be. Thus, a connection is suggested between the
symptoms and the client’s self image or personal style. It is suggested also that the
“impasse” is a coherent and wise position that the client chooses to uphold, because a
change (e.g., becoming social) might involve the abandonment of some of his or her
own self-definitions (e.g., modesty) and a shift to their opposite poles (arrogance),
which would be undesirable for the client’s core structure. In fact, it may be the case
that every time explores (in actions or fantasy) the possibility of allocating him or
herself in the desired pole (e.g., social) he or she might experience guilt. He or she may
begun to construe him or herself outside his o her core role structure (e.g., modesty).
Retreat to timidity is the easiest way to alleviate the guilt by returning to his or her
“usual” self. In the therapy session, examples of that process are highlighted to help the
client realise how this issue constitutes a dilemma in his or her life.
Some clients, after understanding the dilemma pose a question of the type “Would it be
possible to become social without having to be arrogant?”, to which the therapist
replies: “Mmmm…. it seems an interesting question, maybe a project to be
implemented. How would you do in the following days to be social without being
arrogant?”. The later question constitutes in itself a therapy program for the following
sessions without pursuing further work on comprehending the dilemma. On the other
hand, for some clients the formulation of the dilemma appears as a truth that they
already knew but which was never spelled before; for others, as a new construction
about their problem, a new perspective that needs to be explored.
Once the client recognises the existence of the dilemma, and the constructs involved, for
many clients it is convenient to explore the implications of each of these constructs. For
that, we can explore their ascending and descending implications using laddering
procedures. Exploring the implications of the dilemma in terms of other, related,
constructs allows for a wider understanding of it. It also makes possible to identify new
constructs related to the dilemma (other than those obtained during the repertory grid
elicitation), and explore new “advantages” for keeping the present position and not
changing.
Another central aspect of this work for the elaboration of the dilemma is based on the
elements: identifying the prototypical figures that occupy the two positions of the
dilemma. On the one hand, the figure(s) who is construed using the undesired pole in
the discrepant construct but the preferred pole in the congruent construct (e.g., timid and
modest), and on the other hand, the one(s) who is construed according the desired pole
in the discrepant construct but under the undesirable pole of the congruent construct
(e.g., social and arrogant). Thus, the dilemma can be phrased in terms of the types of
person that each prototypical figures represent.
In one of our cases1, Laia, a 24-year old girl presenting with problems of insecurity and
lack of confidence in engaging in master level courses, she recalled that in her family it
was commonly assumed that his brother Josep was bright in school while she was “a
1
The therapist for this case was Guillem Feixas. Client names used in this chapter have been changed to
protect their confidentiality.
4
5. good person”. Her family (including herself) did not expect her to have good grades at
school. Instead, they expected her to take care of her younger sister while their mother
was a t work, or even joining the father for an excursion day during the weekend. For
Laia, achieving good success in the University was equated to resembling her brother
Josep who was also described by her as an “uncaring” and “selfish” kind of person.
The exploration of the dilemma stimulated the client memories and narratives about the
dilemma and its prototypical figures, which is a common process in other cases as well.
Then, when these figures are identified the therapist asks “Do you think that if you
would become successful in your studies you would also become similar to your brother
as a person?”. Laia replies that that is probably so although never thought of it in that
way. At this point, the dilemma can be phrased in terms of a change that would involve
a change in the type of person one has always been to become a different type of person,
one which is not preferred since the prototypical figure that represents it (e.g., the
brother) is disliked in many senses.
One interesting development that might follow, is finding out whether the client can
think of figures situated both in the congruent and the desired poles of the dilemma
(e.g., people who is social and also modest). This exploration may lead to realise that
that path has already been walked, and to discuss whether that is a viable option for the
client him or herself.
All this work with the dilemma is made in a way that underlines the coherence of the
symptom by clarifying its function of validating the client’s values and sense of
identity. Tschudi’s (1977) ABC technique can be of great help in this process because
in it the disadvantages of change are also made evident. Besides, it may serve to clarify
the symptom's function, or the aspect to change in the actual context of its construction.
With that, new constructs related to the dilemma, unforeseen advantages, or previously
undetected constructs may also appear. These conversational procedures allow us to go
beyond the construct universe delimited by the repertory grid.
Once the dilemma is a accepted as a new construction about the problem by the client,
and its implications have been explored, controlled elaboration can be a useful option.
Suggested by Kelly (1955), it can be defined as the attempt to make consistent and
communicable one part of the client's construct system to make it possible to contrast its
validity. To use controlled elaboration to work with dilemmas we suggest to begin by
focussing the conversation on the dilemma theme, accompanying the client on the
experience cycle, phase by phase (e.g., noticing which constructs are being validated or
invalidated, etc.). To weigh up each construct of the dilemma with the client, exploring
the conditions in which is being validated or invalidated, working with the ascending
and descending implications of those constructs. This process may help the client to
elaborate his/her thoughts and feelings related to the dilemma with more care and
precision than in the normal flow of life, that is, to promote the observer role, the
client’s self-observation (Guidano, 1991).
Although in many cases it is not necessary to promote change, in some it might be
useful to explore the origins (the primary focus of convenience) of the dilemma in order
to erect an historical reconstruction of it. For this client and therapist can search for
past episodes which exemplify the dilemma across the client's life. This process can be
exemplified by the case of Laia (see above) whose memories of the family’s
construction (Procter, 1981) of her as a “good person” and her brother Josep as “bright”
5
6. refer to the time of her being 8 or 9 years old. Often, this exploration of past events,
many of them back in infancy, provoke intense emotional expressions.
This historical perspective on the dilemma permits the client to contemplate him or
herself from a different position that both facilitates understanding of his or her personal
evolution and allows to envision new alternatives. At this point, it is useful to
acknowledge that the dilemma was structured in that way according to a given
historical, emotional, and relational context. However, in the present, things can be seen
differently (Kelly’s, 1955, “time binding”).
At different moments of this process, generation of alternatives to explore non-
dilemmatic solutions are promoted. In sum, all this process is aimed at creating a live
without the dilemma. For that, it is convenient for the client to be aware of the existence
of possible alternatives to dilemma construction and theses alternatives are not better o
worse than others. They are simply other possible alternatives. As with the brain
storming technique, it is a good idea not to evaluate these new alternatives too quickly.
Rather, they can be explored using imagination or role playing.
Finally, an optional phase in the dilemma resolution work is engaging the client in fixed
role of the solved dilemma, an adaptation of Kelly's original technique (1955). The
client is asked to represent a role, designed by the therapist, which includes among
others characteristics, the congruent and desired poles of the dilemma are present. So in
this role the dilemma is not present. With this, it is intended to provide the client with a
lived experience, in his or her habitual environment, of him or herself living without the
dilemma.
THE CASE OF TERESA
This patient is in the final year of her degree on chemical sciences. She was treated by
the psychological care services of the University of Salamanca. At the initial assessment
she displayed somatization, depressive symptoms, and a high level of interpersonal
sensitivity according to the scales of SCL-90-R (Derogatis, 1977). Although Teresa
proves to be an excellent student, she reveals serious doubts about her self worth. She
cries frequently, and has great difficulty in meeting others, even though she has a
boyfriend who is extremely supportive. The relationship between her and her parents is
very strained, she describes her mother as a very dependent person who puts a great deal
of pressure on her. Her parents live 80 Km from the city. At the moment of the
consultation, Teresa lives with her brother, but the two of them have not been on
speaking terms for three months.
The first time that I interviewed her2, she explained to me that in a few weeks time she
would be travelling 600 km from home to work into a firm that would allow her to gain
work experience in a field related to her studies. Teresa displays great insecurities
regarding her departure, she questions whether or not she should go, but she is aware
that it is necessary for her to go ahead with her plans. We would have two support
sessions before her departure where I would focus on preparing the patient to realise the
benefits of this upcoming experience.
2
The therapist for this case is Luis Ángel Saúl.
6
7. After analysing the client’s grid we identified two implicative dilemmas related to her
depressive symptoms (see figure 2).
7
8. Figure 2. Implicative Dilemmas identified in the initial grid of Teresa.
The patient associates the construct pole “does not get depressed easily” with two
construct poles that she considers opposite to her self-definition:
1) To be “selfish” (vs. concerned about others)
2) 2) To be the kind of person that “pretends to be stronger than one is” (vs.
natural).
The aim of therapy was to sever these associations, as at present, they were
preventing the client from forming alternative definitions of her self i.e. as a person
who does not get depressed easily. As a consequence of implicative dilemma
resolution, the client would be alleviated of her depressive symptoms.
According to our therapeutic hypothesis, we should help the patient to elaborate in
alternative ways the implications of her nuclear constructs and to facilitate a wider
perspective in which to view herself. Loosening the implications of her nuclear
constructs would help Teresa to see herself as a person who is natural, concerned about
others, (the opposite of a “selfish” person and one who pretends “to be stronger than
one is”) whilst at the same time “does not get depressed easily”.
The period of time between the first and the last grid was only four months. The therapy
had to end just before the academic holidays, so we didn't have much time to work.
However, the patient began to show signs of elaboration (expansion) of some of her
nuclear constructs. She started to appreciate that “concern about others” also implies
concern about oneself. Thus, the construct became more permeable so to include the
self among the range of its elements. Probably as a consequence of this reconstruction,
the client’s psychological well being was enhanced and therefore her depression
reduced as denoted by the assessment at the end of therapy.
We can observe the changes in Teresa’s construing by looking at the correlations among
the constructs forming the dilemma at the end of therapy (figure 3 ) and comparing
them to those of initial assessment (figure 2).
8
9. Figure 3. The implicative of dilemmas of Teresa’s post-therapy grid.
As it can be seen, a reduction has been achieved in the degree of association between
those constructs which formed dilemmas. Although these correlations are still positive
after therapy the reduction of their intensity is noticeable. In addition, it was found that
reduction in the intensity of the dilemmas was accompanied by symptom reduction.
Although variations in the SCL-90-R scales were not substantial, her BDI score
changed from 26 (at the start of therapy) to 9 (at the end of therapy).
Research
A multicentre research project was launched in 1999 to investigate the role of dilemmas
in different mental and physical health problems, and also to device and implement
therapeutic methods focussed in resolving those dilemmas (see more details in Feixas,
Saul & Sánchez, 2000; and in Internet: www.usal.es/tcp). Currently, various
Universities and clinical centres mainly from Spain but also from the United Kingdom,
Portugal, Italy and South America, are involved, at different levels, in this project.
A preliminary data report (Feixas & Saul, 2003) informs that dilemmas can be
identified in grids of one third (34%) of a non clinical sample of 321 subjects recruited
by psychology students after some training in grid administration and analysis. In a
clinical sample of 286 psychotherapy clients presenting with a wide variety of clinical
problems (excluding psychosis), dilemmas appear in more than one half (52,4%) of the
sample. This difference proved to be significant using a chi-squared test.
To further investigate the number of dilemmas appearing in each sample (amongst those
subjects who presented at least one), we computed the Percentage of Implicative
Dilemmas (PID) measure3. The clinical sample (4,37%) doubled the non-clinical
sample (2,11%), a significant difference.
3
Although the number of dilemmas in a given grid would seem an obvious measure, we
have found, in a pilot study, that the amount of dilemmas may increase with grid size.
Therefore, as grid size is not standardized, grids cannot be reliably compared.
9
10. This first exploratory result indicates that
a) The presence of dilemmas as captured by repertory grids is a usual, natural,
situation in humans at least to some degree.
b) Subjects consulting for clinical problems are more likely to present dilemmas
than subjects who don’t.
c) Grids of subjects presenting with psychological symptoms yield a greater
number of dilemmas.
Points (b) and (c) suggest that dilemmas are related to psychological distress but point
(a) cautions us against considering dilemmas necessarily as a pathological sign.
Altogether, our research seems to suggest that dilemmas are part of life but when not
addressed or excessive in number (and maybe in intensity) can be associated with
suffering and pathology. This can be seen as an argument in favour of the idea that there
is not a discrete line distinguishing between “normal” and “pathological” subjects.
Maybe we, as humans, develop symptoms (among many other reasons) when the
dilemmas we face are excessive, “in over our heads” (Kegan, 1994).
With respect to therapy and its influence in resolving dilemmas, Feixas and Saul’s
(2003) preliminary report informs of another study with 87 clinical patients, this
including a re-analysis of 46 neurotic clients which were part of the sample used by
Watson (1998). We examined the presence or absence of implicative dilemmas before
and after therapy. From the data, it can be observed that subjects who do not present
with implicative dilemmas at the start of therapy are unlikely to exhibit them when
therapy ends, only 7.9% of the patients who did not exhibit implicative dilemmas at the
start of therapy did so at the end. More than 2/3 (69.4%) of the sample who presented
with implicative dilemmas at the start of therapy did not present with implicative
dilemmas at the end. Finally, less than one third (30.6%) of subjects who presented with
implicative dilemmas at the start of therapy, presented with implicative dilemmas at the
end (less than 1/3 of the sample). This data suggest that psychological therapy, even
when it is not specifically addressed to resolve previously identified dilemmas,
produces a statistically significant reduction in the number of implicative dilemmas of
the patients (p < 0.001).
d
• 100
n!
2·[(n − 2)!]
d = number of dilemmas
n = number of constructs in the grid
A method was devised to counteract for this difficulty which takes account of the
number of constructs in the grid. The number of possible pairs of constructs was
calculated and used as the denominator in the formula. The result of this equation is
multiplied by 100, in order to establish the percentage.
10
11. Overall, we find that the percentage of patients who present with implicative dilemmas
after the therapeutic process is 20.7%. In comparison with 34% found in the non-
clinical sample mentioned above this is a lower profile of dilemmas for clients who
completed a psychotherapy process. This datum suggests that therapy decreases the
number of implicative dilemmas to a level below that of the general population. So,
psychotherapy does not merely return subjects to a normal level of conflict within their
construct system but actually serves to enhance or facilitate their construing to a level
more resolved and dilemma free than average.
Obviously, more research is needed for exploring differences among psychotherapy
approaches and their influence in decreasing the number of dilemmas, and, more
important, for assessing whether a brief therapy protocol focussed in resolving
previously identified dilemmas produces good outcomes both in terms of symptom
reduction and dilemma’s resolution.
CONCLUSIONS
Conceptualizing the problem presented by the client in terms of a dilemma, is way of
understanding it in terms of a meaning making process consistent with a constructivist
perspective. Thus, by inhabiting in the symptom pole the subject is validating other core
constructs about her or his identity which are associated with it. Change to the opposite
pole, the desired pole, would also imply abandoning part of his or her identity, which
would involve a central change in the construct system of the client.
Implicative dilemmas can be identified using the Repertory Grid Technique, and
assessed for each subject’s grid in terms of their presence (or not), and also the
proportion of dilemmas found.
The results so far obtained from the Multicentre Dilemma Project indicate that one third
of a non-clinical sample present with implicative dilemmas, which suggests that
dilemmas (even those detected using repertory grids) are part of tensions of “normal”
life. However, they are more common (and more numerous) for subjects asking for help
in psychotherapy services. Further data with therapy clients show that psychological
therapy, even when it is not specifically addressed to resolve previously identified
dilemmas, produces a statistically significant reduction in the number of implicative
dilemmas of the patients.
These results suggest that more attention should be paid to implicative dilemmas in the
therapy process. Personal construct therapy provides with a number of useful clinical
techniques (reframing, laddering, ABC, controlled elaboration, historical reconstruction,
generation of alternatives, fixed role, etc.) that can be adapted to work with these
dilemmas and dissolve them. In this way, the person can feel that change can be
consistent with his or her identity, and, thus, be more easily attainable.
References
Derogatis, L. R. (1977). SCL-90-R: Administration, Scoring and Procedures Manual I for the
Revised Version of the SCL-90. Baltimore, MD: John Hopkins University Press.
11
12. Feixas, G. & Saúl, L. A. (2003). Dilemma project internal report (Database, April, 2003).
Unpublished document.
Feixas, G., Saúl, L.A., Avila-Espada, A. y Sánchez, V. (2001). Implicaciones terapéuticas de los
conflictos cognitivos. Revista Argentina de Clínica Psicológica, vol. X (1), 5-13.
Feixas, G., Saúl, L. A., y Sánchez, V. (2000). Detection and analysis of implicative dilemmas:
Implications for the therapy process. En Joern W. Scheer (ed.), The Person in Society -
Challenges to a Constructivist Theory (págs. 391-399). Giessen: Psychosozial-Verlag.
Fransella, F. (1970). Stuttering not a symptom but a way of life. British Journal of
Communication Disorders, 5, 22-29.
Hinkle, D. N. (1965). The change of personal constructs from a view-point of a theory of
construct. Unpublished PhD Thesis. The Ohio State University.
Kegan, R. (1994). In over our heads: The mental demands of modern life. Cambridge, MA:
Harvard University Press.
Kelly, G. (1955). The psychology of personal constructs (2 vols.). New York: Norton (reprinted
by Routledge, London, 1991).
Procter, H. G. (1981). Family construct psychology an approach to understanding and treating
families. In S. Walrond-Skinner (Ed.), Developments in Family Therapy . London:
Routledge & Kegan Paul.
Ryle, A. (1979). The focus in the brief interpretative psychotherapy: Dilemmas, traps and snags
as target problems. British Journal of Psychiatry, 134, 46-54.
Tschudi, F. (1977). Loaded and honest questions a construct theory view of symptoms and
therapy. In D. Bannister (Ed.), New Perspectives in Personal Construct Theory .
London: Academic Press.
Watson, S. B. (1998) A process and outcome study of personal construct, cognitive and
psychodynamic therapies in a NHS Setting. Unpublished PhD. Tesis, University of
Hertfordshire.
Winter, D. A. (1988). Constructions in social skills training. In F. Fransella, & L. Thomas
(Eds.), Experimenting with Personal Construct Psychology (pp. 342-356). Londres
Routledge & Kagan Paul.
Winter, D. A. (1989). Resistance to therapy: Stubborn opposition or constructive choice? Paper
presented at 3rd European Conference on Psychotherapy Research, Bern.
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