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PubMedDate not supplied

Communication strategies used during pediatric dental treatment: a pilot study.

PURPOSE: Effective verbal communication is essential for successful dental treatment. The purpose of this study was to qualitatively and quantitatively examine communication techniques used by pediatric postdoctoral students during treatment. The operation of a communication model comprised of three linguistic approaches-permissive, empathic and personal-together with other strategies common to all three, was examined. METHODS: The study group consisted of 24 children (14 boys and 10 girls), 3 to 12 years of age. All four dentists were 2nd year residents in pediatric dentistry. Conversations were taped and analyzed linguistically and statistically. The frequency of use of each approach was tabulated and correlated to the children's reported anxiety, cooperation during treatment, success of treatment, and mood at the end of treatment. RESULTS: All dentists used the three approaches; the permissive approach, which supplied procedural information, was the most frequently used approach. The empathic approach was the least frequently used. Correlation tests showed that the empathic approach was most significantly related to the success of the treatment. Components of the permissive approach that contributed to the success of treatment were sensory information and supplying reasons. CONCLUSIONS: Although generalization is limited because of the small sample, improving verbal conversational skills, emphasizing certain strategies, and improving linguistic abilities will contribute to better communication between child and pediatric dentist and to better cooperation and success in treatment.

Affect↗

PubMed1995

From psychiatric science to folk psychology: an ordinary-language model of the mind for mental health nurses.

In this paper it is argued that, if mental health nurses are to integrate the skills necessary to accomplish the diverse tasks that comprise their professional role, then what is required is a conception of mind independent of any particular paradigm in the biophysical and psychosocial sciences. This is proposed as a necessary condition of articulating the professional autonomy of mental health nurses. A four-part model of mental functioning is presented and developed, drawing on the ordinary language of folk psychology. Objections to this strategy are anticipated and answered. The utility of the model is demonstrated by deploying it to analyse emotional states and to show how subjective experience is a necessary component of mental ill-health, which is why empathic understanding is a necessary skill for mental health nurses. Finally, the major research paradigms associated with scientific approaches to the care and treatment of mental ill-health are aligned with the elements of the model to demonstrate the potential of that model for clarifying the rationale of theoretically divergent treatment approaches for the benefit of both nurses and their clients. It is emphasized that the proposed model is 'theory' only in the weak sense of being a 'systematic account' of the mental life.

Behavior Therapy↗

PubMed2005

Motor coordination, empathy, and social behaviour in school-aged children.

Children with motor coordination problems are known to have emotional difficulties and poor social skills. The current study investigated whether children with poor motor ability have poor emotion recognition skills, and whether these could be linked to problems in social behaviour. It was hypothesized that difficulties in empathic ability might be related to the poor visuo-spatial processing ability identified in children with developmental coordination disorder (as defined by the American Psychiatric Association). The relationship between motor coordination, emotion recognition, and social behaviour was examined in a sample of 234 children (113 males, 121 females; mean age 9y 7mo, [SD 1y 8mo] age range 6y 8mo to 12y 11mo). From this sample two groups of 39 children each (17 females, 22 males), one group with motor difficulties (mean age 9y 11mo [SD 2y], range 6y 11mo to 12y 11mo) and the other of control children (mean age 10y [SD ly 11mo], range 6y 11mo to 12y 11mo), matched for age and sex, were compared using a set of six emotion recognition scales that measured both verbal and perceptual aspects of empathic ability. Children with motor difficulties were found to perform more poorly on scales measuring the ability to recognize static and changing facial expressions of emotion. This difference remained even when visuo-spatial processing was controlled. When controlling for emotion recognition and visuo-spatial organization, a child's motor ability remained a significant predictor of social behaviour.

Adolescent↗

PubMed2006

The appeal of violent video games to lower educated aggressive adolescent boys from two countries.

The objective of this study was to test the effect of individual differences on appeal and use of video games. Participants were 299 adolescent boys from lower and higher secondary schools in the Netherlands and Belgium. In general, boys were most attracted to violent video games. Boys that scored higher in trait aggressiveness and lower in empathy were especially attracted to violent games and spent more time playing video games than did boys lower in trait aggressiveness. Lower educated boys showed more appreciation for both violent and nonviolent games and spent more time playing them than did higher educated boys. The present study showed that aggressive and less empathic boys were most attracted to violent games. The fact that heavy users of violent games show less empathy and higher aggressiveness suggests the possibility of desensitization. Other studies have shown that playing violent games increases aggressiveness and decreases empathy. These results combined suggest the possibility of a violence cycle. Aggressive individuals are attracted to violent games. Playing violent games increases aggressiveness and decreases empathy, which in turn leads to increased appreciation and use of violent games.

Adolescent↗

PubMed1999

Victimization of women and its impact on assessment and treatment in the psychiatric emergency setting.

An understanding of victimization is critical to the practice of emergency psychiatry. Victimization histories are disturbingly common among women presenting to the PES, particularly among frequent service users. The sequelae of victimization are both psychological and physical and often impair health and functioning across numerous domains. PTSD, BPD, and substance-use disorders are often seen among women with victimization histories, which can be particularly challenging for PES providers. Screening for trauma on PES presentation or history should not be overlooked in any person, including severely mentally ill, homeless, disabled, or elderly women. PES clinicians should remember to ask about victimization and pose questions privately in a direct and an open-ended format while conveying empathic validation. Clinical assessment of women with victimization histories in the PES should be guided by the principles of standard emergency psychiatry and be informed by an understanding of trauma. This includes a working knowledge of trauma dynamics, adherence to sound professional boundaries, and care not to retraumatize patients or re-enact perpetrator-victim dynamics. Voyeurism and regression should be avoided, particularly when eliciting trauma history. The PES should be a place for screening and acute intervention, not for conducting intensive trauma therapy. In the PES, the focus should remain on triage and treatment priorities, those of safety and stabilization, and carefully evaluating for substance use and psychosis. The PES ideally provides a "holding environment" that affords a balance of nurturing, limits, consistency, and communication. A basic knowledge of cognitive-behavioral interventions affording "crisis survival strategies," such as DBT, can be particularly useful to PES clinicians. Clinicians also need to monitor issues of countertransference and the potential to be dismissive to these women with complex, comorbid, and chronic problems and diseases. The role for the use of psychotropic medication in PES cohorts with victimization histories should target acute symptoms. Involving regular providers of these decisions is advised to coordinate care and minimize splitting and risks of polypharmacy. Although the SSRIs are effective in symptom management of disorders related to victimization, patients must be reminded of the side-effect profile, particularly sexual dysfunction and withdrawal and discontinuation syndromes.

Age Factors↗

PubMedDate not supplied

Personal tutor encounters: understanding the experience.

AIM: To investigate the lived experience of the 'support' relationship between students and their personal tutors. METHOD: The purposive sample comprised 36 personal tutors and 44 pre-registration undergraduate nursing students on diploma and degree-level courses (adult, mental health and child branch) from a London university school of nursing and a northern university school of nursing. Private audiotaped interviews were conducted with the participants. Data analysis was undertaken to identify important themes. FINDINGS: The tutees varied in their readiness to learn, define, discuss and negotiate support. Positive encounters were when the tutees felt supported. Tutors had an overwhelming feeling of frustration when tutees lacked study skills and came unprepared to tutorials. However, some tutors indicated a high level of empathic understanding for tutees and spent much of their personal time supporting them. CONCLUSION: The study illuminated the complexity and skill required to be a tutee and a tutor. Tutors' individual support style reflected tutees' expectations and perceptions to varying degrees. A positive experience by tutees and tutors was perceived when each had a shared understanding of the support concept. Mutual trust, engagement, respect and accepting responsibilities were important elements of the personal tutor and tutee relationship.

Adaptation, Psychological↗

PubMed1994

On limit and limit setting.

This article investigates the role of limit and limit setting within the psychoanalytic situation. Limit is understood to be a boundary between self and others, established as an interactional dimension of experience. Disorders of limit are here understood within the context of Winnicott's conception of the "anti-social tendency." Limit setting is proposed as a necessary and authentic response to the patient's acting out via holding and empathic responsiveness, viewed here as a form of boundary delineation. It is proposed that the patient attempts to repair his or her boundary problem through a seeking of secure limits within the analyst. The setting of secure and appropriate limits must arise from a working through of the analyst's own countertransference response to the patient. It is critical that this response be evoked by, and arise from, the immediate therapeutic interaction so that the patient can experience limit setting as simultaneously personal and authentic.

Adolescent↗

PubMed2001

Advancing advanced mind-reading tests: empathic accuracy in adults with a pervasive developmental disorder.

Research using advanced but static mind-reading tests with high-functioning adults with a pervasive developmental disorder (PDD) provided evidence for subtle social cognitive deficits. In the present study, adults with PDD were unimpaired on such tasks, relative to individually matched normal controls. Significant differences between the two groups were, however, found on a more naturalistic empathic accuracy task developed for this study. Participants viewed two videotaped interactions that both depicted a male and female stranger having an initial conversation and were asked to infer the unexpressed thoughts and feelings of the four targets. Subjects with PDD performed significantly worse on the second video. These findings suggest that the mind-reading deficit of a subgroup of able adults with PDD may only be apparent when a sufficiently complex naturalistic assessment method is being used.

Adolescent↗

PubMed2004

[Chronic fatigue syndrome in a cognitive perspective. A therapeutic model].

The cognitive approach to the treatment of chronic fatigue syndrome (CSF) is based on a multifactor etiological hypothesis, i.e. inaccurate beliefs and attitudes to the illness interact with pathophysiological processes, ineffective coping behaviours, negative states of mood, social problem, to perpetuate the illness. Patients suffering from CFS are supposed to be hypervigilant to somatic sensations and to interpret them as signs of impending physical catastrophe. The aim of the this paper is to describe the clinical implementation of principles of cognitive therapy in the treatment of CFS. Basic to the treatment approach is a collaborative, listening and empathic attitude, sensitive to the patient's personal beliefs and potential threats to self-esteem. The aim is to develop more useful, functional, formulations of the illness. The patient and the therapist work together to look at how the patient thinks about herself/himself and the illness, detect unhelpful attitudes, thoughts and mental images about the illness, and to make them accessible to Socratic reasoning. Graded behavioural interventions are planned in order to disconfirm unhelpful beliefs and reverse the spiral of tiredness, demoralization and reduced activity. The treatment is structured according to the general principles of cognitive therapy.

Attitude to Health↗

PubMed1978

Explorations in the uses of language in psychotherapy: simple empathic statements.

I submit these ideas with hesitation. They seem to rest on a particular assumption widely at variance with contemporary practice and itself difficult to state. The prevailing assumption has been that the content of a person's mental life, symptoms, or experience lay in that person's mind, and that by asking questions, listening, in various ways making ourselves receptive, we could penetrate that mental life. In this traditional manner of thinking, the language of penetration has been secondary to the material being reached. In contrast, I suspect that the language of investigation and therapy is as important as the matter being investigated or treated--that in fact the two bear a symbiotic relationship to each other.

Adult↗

PubMed2004

Understanding perpetrators of nonphysical sexual coercion: characteristics of those who cross the line.

Sexual coercion is defined here as a form of male sexual misconduct in which nonphysical tactics (e.g., verbal pressure) are utilized to gain sexual contact with an unwilling female partner. This study compares the risk characteristics of sexually coercive (n=81) and nonoffending college males (n=223) across several domains. Results revealed that sexual coercers differed from nonoffenders in that they more often subscribed to rape myths, viewed interpersonal violence as more acceptable, reported greater hostility toward females, and perceived male-female relationships as more inherently adversarial. In addition, compared to nonoffenders, sexually coercive males showed stronger indicators of promiscuity and delinquency, reported more psychopathic personality traits, had more empathic deficits, and were more likely to have experienced certain forms of childhood abuse. In most respects, coercers did not differ from those who reported engaging in more severe forms of sexual assault involving the use of physical force. These results suggest important differences between nonoffending males and those who "cross the line" by engaging in sexually coercive acts. In addition, consistent parallels can be drawn between the predictors of sexual coercion identified in this study and those documented in the sexual aggression (e.g., forcible rape) literature.

Antisocial Personality Disorder↗

PubMed1976

Assessing intertrainer effects on the Empathic Understanding Scale: training the trainer.

The purpose of this study was to develop a procedure that would provide a preliminary assessment of the level of intertrainer agreement on the Empathic Understanding scale. To illustrate the proposed procedure, a pilot study was undertaken in which 30 excerpts of helping interactions that included the client's statement, therapist response, and client's subsequent response were rated by experienced raters trained by a Carkhuff trainer and a non-Carkhuff trainer. Results indicated that raters trained by different trainers make significantly different judgments about the level of therapist empathy at high levels of empathy. Results of this study were discussed in light of possible scale reliability and construct validity problems. A detailed description and rationale of the proposed procedure was outlined.

Empathy↗

PubMed1986

Social evaluation and the empathy-altruism hypothesis.

Archer, Diaz-Loving, Gollwitzer, Davis, and Foushee (1981) suggested that feeling empathy for a person in need may lead to increased helping because the empathic individual wants to avoid negative social evaluation. As support for this suggestion, they claimed that empathy leads to increased helping only under socially evaluative circumstances. We conducted two studies to test this claim. In Study 1 subjects were led to believe that no one--including the person in need--would ever know if they declined to help. In this situation, which was designed to be totally devoid of the potential for negative social evaluation for not helping, there was still a positive relationship between self-reported empathic emotion and offering help. In Study 2 empathy (low versus high) and social evaluation (low versus high) were manipulated in a 2 X 2 design. Once again there was a positive relationship between empathy and offering help when the potential for social evaluation was low as well as high. Results of both studies, then, suggest that the motivation to help evoked by empathy is not egoistic motivation to avoid negative social evaluation. Instead, the observed pattern was what would be expected if empathy evokes altruistic motivation to reduce the victim's need.

Adult↗

PubMed1995

Verbal and facial measures of children's emotion and empathy.

The purpose of this study was to assess the relationship between two theoretically distinct aspects of children's emotional responses (Lewis & Michalson, 1983), their emotional experience (via verbal report) and emotional state (via nonverbal expression), in response to emotion-evoking stimuli. A related objective was to assess the concordance of these two verbal and nonverbal measures as indices of empathy, i.e., affective responses consistent with those of stimulus persons. Facial expressions of 60 10-year-old girls were unobtrusively videotaped while they individually viewed six stimulus vignettes. Half of these children pressed a button to indicate awareness of emotional arousal while viewing stimuli; half served as controls. Results indicated that emotional and empathic responses were not affected by the button press procedure, or by a social desirability response set. Expressive responses at button presses were microanalytically analyzed using AFFEX. Postviewing interviews assessed children's reported emotions and the affect match (empathy) between children's reported emotion for themselves and stimulus characters. Results indicated modest associations between the emotions children reported and those facially displayed and similar associations between children's verbal and facial empathy scores. Results address the concurrent validity of different measures of children's emotions, and contribute to the small number of extant multimethod studies on children's emotional responses and empathy.

Awareness↗

PubMed2006

Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview.

UNLABELLED: Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes. AIM: The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. METHODS: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. FINDINGS: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. CONCLUSION: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs.

Abortion, Legal↗

PubMed2002

Suicide attempts in patients with bipolar I disorder during acute and maintenance phases of intensive treatment with pharmacotherapy and adjunctive psychotherapy.

OBJECTIVE: Lifetime rates of suicide attempts among patients with bipolar I disorder were compared to rates during a 2-year period of intensive treatment with pharmacotherapy and with one of two adjunctive psychosocial interventions. METHOD: Subjects entered the study during an acute mood episode. Subjects were treated with primarily lithium pharmacotherapy and with either psychotherapy specific to bipolar disorder, which included help in regularizing daily routines, or nonspecific, intensive clinical management involving regular visits with empathic clinicians. Data on prior suicide attempts were obtained retrospectively from interviews with the NIMH-Life-Chart method. Data on suicide attempts during the clinical trial were collected systematically throughout the protocol. RESULTS: The rate of suicide attempts was 1.05 per 100 person-months before patients entered the trial. Patients experienced a threefold reduction in the rate of suicide attempts during the acute treatment phase (until the patient achieved stabilization, defined by completion of 4 weeks during which the patient had a mean score of < or =7 on the 17-item Hamilton Depression Rating Scale and < or =7 on the Bech-Rafaelsen Mania Scale) and a 17.5-fold reduction during maintenance treatment. Poisson loglinear regression analysis modeling the relationship between the observed rates and the three protocol stages (pretreatment, acute, and maintenance) showed that the reductions were significant in the acute and maintenance phases, compared with the pretreatment phase. No patient with one or more suicide attempts before entering the trial attempted suicide during the protocol. CONCLUSIONS: A treatment program in a maximally supportive clinical environment can significantly reduce suicidal behavior in high-risk patients with bipolar I disorder.

Acute Disease↗

PubMed1988

Intimacy and mental disorder in late middle age. Report of the TURVA project.

This study, which was carried out as part of the TURVA project on psychosocial adaptation in old age, is concerned with the significance of social support to people approaching retirement age. The population consisted of 200 urban dwellers and 189 rural dwellers, who were studied at the age of 62. The subjects were either about to retire in the near future or had already retired, and it was assumed that this event causes a certain amount of stress, which may lead to mental disturbance regardless of the amount of social support available to the individual. Intimate relationship and close friendship served as the measures of social support. Mental disturbances were assessed on the basis of the General Health Questionnaire (36-item version) and the number of psychic and especially depressive symptoms. The prevalence of mental disturbance and depressive symptoms was lowest in those people who lived in a close marital relationship and who also described their spouse as empathic. Psychic symptoms were most common in those people who said their relationship to their spouse was distant and who described them as unempathic. The subjects who were not married fell in-between these 2 groups regardless of whether they had an intimate relationship with someone of the opposite sex. A positive marital relationship seemed to provide a shield against depression, while a negative marital relationship tended to make the individual more vulnerable to depression. The role of a close non-marital friendship depended on the respondent's sex. In women, it was associated with a high prevalence of depressive symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗

PubMed2005

[Disclosure of severe development disability: a survey of parents' experiences and preferences at an Israeli child development center].

BACKGROUND: Informing parents of a severe developmental disability (SDD) in their child is a frequent, yet extremely challenging part of care at any child developmental center. In this study, which was the first to address this issue in Israel, we asked parents for feedback on their experiences in receiving such news at our center, in order to help us develop a set of guidelines for improving clinical practice. OBJECTIVE: To obtain parents' perspectives on the meeting at which they were first informed that their child has a SDD. How satisfied were they with these encounters? What factors are associated with higher and lower levels of satisfaction with these meetings? DESIGN: Mixed-method (quantitative/qualitative) questionnaire survey. SETTING: Regional HMO Child Developmental Center. SUBJECTS: Study participants were 33 parents, constituting 62% of all those whose children first received a diagnosis of SDD (mental retardation, autism/PDD, cerebral palsy, or genetic syndromes) at our center over the past seven years. MEASUREMENTS: Parents were contacted by the social worker involved in their child's care to obtain initial consent for participation in the study. A 34-item self-report survey questionnaire, containing both closed- and open-ended questions, was sent to them by mail, to be completed anonymously. Questions were based on a survey of the literature and focused on the setting of the meeting, its contents, staff behavior, parents' satisfaction with the meeting and background characteristics of the family and child. RESULTS: Almost two-thirds (63%) of respondents reported a high or very high level of satisfaction with the meeting at which they first heard the diagnosis of SDD. Both content analysis of open questions and statistical analysis of correlations between satisfaction and a series of potential predictors pointed to three main areas affecting parental satisfaction with the meeting: (1) Amount and type of information conveyed: Parental satisfaction with the meeting was higher when detailed information was provided regarding a number of issues (diagnosis, treatment options, educational settings, rights for benefits and assistance etc.), when parents were referred to additional sources of information, and when the clinician was seen to be knowledgeable and confident. (2) Attitudes conveyed by staff regarding the child's condition: Parental satisfaction with the meeting was higher when the child's strengths were also addressed (and not only problems); when the general tone was not pessimistic and some hope and optimism were also conveyed; and when expected and possible future developments were specified. (3) Staffs approach to the parents: Parental satisfaction was higher when staff was attentive to parents and empathic; when they clearly expressed willingness to accompany and assist the family over time; when they were respectful toward parents and related to them as equal partners; and when parents felt that they had been informed of the diagnosis without delay and that no information had been withheld from them. CONCLUSIONS: Parents are not inevitably dissatisfied with meetings at which they are informed that their child has a SDD. Our findings point to concrete steps that clinicians can take in order to increase the chances of parental satisfaction with these meetings.

Adult↗