The Clinical Stance and the Nurturing Stance: Therapeutic Responses to Harmful Conduct by Service Users in Mental Healthcare

In this article, we discuss what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this conduct in a detached sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing

Introduction: self-knowledge in perspective

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Early Social Cognition: Alternatives to Implicit Mindreading

According to the BD-model of mindreading, we primarily understand others in terms of beliefs and desires. In this article we review a number of objections against explicit versions of the BD-model, and discuss the prospects of using its implicit counterpart as an explanatory model of early emerging socio-cognitive abilities. Focusing on recent findings on so-called ‘implicit’ false belief understanding, we put forward a number of considerations against the adoption of an implicit BD-model. Finally, we explore a different way to make sense of implicit false belief understanding in terms of keeping track of affordances

Self-Knowledge in Psychotherapy: Adopting a Dual Perspective on One’s Own Mental States

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Self-knowledge in personality disorder: Self-referentiality as a stepping stone for psychotherapeutic understanding

This article provides a philosophical framework to help unpack varieties of self-knowledge in clinical practice. We start from a hermeneutical conception of “the self,” according to which the self is not interpreted as some fixed entity, but as embedded in and emerging from our relating to and interacting with our own conditions and activities, others, and the world. The notion of “self-referentiality” is introduced to further unpack how this self-relational activity can become manifest in one’s emotions, speech acts, gestures, and actions. Self-referentiality exemplifies what emotions themselves implicitly signify about the person having them. In the remainder of the article, we distinguish among three different ways in which the selfrelational activity can become manifest in therapy. Our model is intended to facilitate therapists’ understanding of their patients’ self-relational activity in therapy, when jointly attending to the self-referential meaning of what their patients feel, say, and do

Self-knowledge and personality disorders: Introduction

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