Resolving Alliance Ruptures from an Attachment-Informed Perspective.

In this article, we examine how the different attachment patterns enable or hinder the resolution of ruptures in the therapeutic alliance. We try to show that secure and insecure patients alike may experience ruptures in the therapeutic alliance, but that their ability to participate in resolving such ruptures differ markedly. Recent findings with the Patient Attachment Coding System (PACS) show that attachment classifications manifest in psychotherapy as distinct ways of communicating about present internal experience. Secure patients disclose their present experience openly and invite attunement from the therapist, while insecure patients either minimize their contributions to the dialogue (avoidant) or the contributions of the therapist (preoccupied). Using examples from session transcripts, we demonstrate how secure patients are particularly responsive to resolution strategies that focus on here-and-now experience, while insecure patients' characteristic ways of communicating pose significant challenges to the resolution process

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

<p>Abstract</p> <p>Background</p> <p>The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.</p> <p>Methods</p> <p>The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.</p> <p>Results</p> <p>Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.</p> <p>Conclusion</p> <p>It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.</p

El tratamiento de la depresión y el proceso de cambio afectivo

This article examines the different depressive processes as the distinctions of behavioral systems. According to, cognitive therapy responds to the situation, cognitive-affective depressive sequences, in association with self-criticism, emotional work processing, the form of intervention is discussed from an emotional perspective.En este articulo se examinan los distintos procesos depresivos como las distinciones&nbsp; de los sistemas de comportamiento . De acuerdo , a la terapia cognitiva&nbsp; se&nbsp; da respuesta a la situacion, las secuencias depresivas cognitivo - afectivas, en asociacion con la autocritica,&nbsp;el procesamiento emocional de trabajo , se discute la forma de intervencion desde una perspectiva emocional. &nbsp; &nbsp

AGENCY, SURRENDER, AND GRACE IN PSYCHOANALYSIS

There is a vital dialectic between agency and surrender in life and in the analytic process. Without an ability to will, one cannot choose one&apos;s actions; one becomes a passive victim of circumstances rather than an agent who can influence one&apos;s own destiny. On the other hand, an exaggerated sense of agency fails to take into account the limits of our ability to control life, and is associated with a type of narcissistic omnipotence that can be linked with an experience of isolation. In this article I explore some of the subtleties of the interplay between willing and surrendering in the analytic process. I also examine the way in which an inability to surrender can impede the patient&apos;s ability to take in what the analyst has to offer. And finally I adapt the concept of grace from theological discourse to highlight a dimension of the analytic process that involves an emergence of the patient&apos;s capacity to make constructive use of the analyst&apos;s interventions