Therapists' use of metaphor in psychotherapy is ubiquitous. However, compared to theoretical and clinical claims about the potential effectiveness of using metaphor, research investigations pose ...challenges and remain relatively sparse. We provide examples of metaphors in sessions and then systematically review the empirical literature. This research suggests that collaborative coelaboration of metaphors with clients is related to positive in-session client outcomes, particularly cognitive engagement. Future research might benefit from a more in-depth focus on the process and impacts of using metaphors. We draw out implications from the research for clinical training and psychotherapy practice.
Clinical Impact Statement
Question: Psychotherapists and their clients often use conventional metaphors (e.g., "You seem down today") and, on occasion, novel metaphors (e.g., "I stab people with my voice") over the course of treatment. Here, we review the sparse evidence for the links between metaphors and outcomes. Findings: Tentative links between collaborative coelaboration of metaphors and client cognitive processes such as problem-setting, reflecting, and connecting have been established. Meaning: Collaboratively working with clients to develop metaphors related to major themes of therapy can be an effective intervention. Next Steps: Additional research that brings together therapists, clients, and researchers for in-depth analyses of metaphor use over the course of psychotherapy is needed.
Critiques of antidepressants in public spaces such as print media, blogs, social media, websites, and radio and television programs are now commonplace. Such critiques typically center on issues such ...as the side effects and risks of antidepressants, overblown claims of effectiveness, the fallacy of the chemical imbalance hypothesis, overprescribing, and the availability of equally or more effective nonmedication interventions for depression. In this article, we employ a discursive analysis to show how online commenters fashion a particular counter-argument to these critiques. Prominent in this counter-argument is that only “real” depression benefits from antidepressants, and that a “one-size-does-not-fit-all” understanding of these medications is needed. We argue that, while this nuanced counter-critique contains features that make it difficult to undermine, it simultaneously embeds many unanswered questions.
In this manuscript, we report the design and development of a fast, reliable instrument to run gel-based cassette polymerase chain reactions (PCR). Here termed the GelCycler Mark II, our instrument ...is a miniaturized molecular testing system that is fast, low cost and sensitive. Cassette PCR utilizes capillary reaction units that carry all reagents needed for PCR, including primers and Taq polymerase, except the sample, which is loaded at the time of testing. Cassette PCR carries out real time quantitative PCR followed by melt curve analysis (MCA) to verify amplicon identity at the expected melt temperature (Tm). The cassette PCR technology is well developed, particularly for detecting pathogens, and has been rigorously validated for detecting pathogenic Escherichia coli in meat samples. However, the work has been hindered by the lack of a robust and stable instrument to carry out the PCR, which requires fast and accurate temperature regulation, improved light delivery and fluorescent recording, and faster PCR reactions that maintain a high sensitivity of detection. Here, we report design and testing of a new instrument to address these shortcomings and to enable standardized testing by cassette PCR and commercial manufacture of a robust and accurate instrument that can be mass produced to deliver consistent performance. As a corollary to our new instrument development, we also report the use of an improved design approach using a machined aluminum cassette to meet the new instrument standards, prevent any light bleed across different trenches in each cassette, and allow testing of a larger number of samples for more targets in a single run. The GelCycler Mark II can detect and report E. coli contamination in 41 minutes. Sample positives are defined in as having a melt curve comparable to the internal positive control, with peak height exceeding that of the internal negative control. In a fractional analysis, as little as 1 bacterium per capillary reaction unit is directly detectable, with no enrichment step, in 35 cycles of PCR/MCA, in a total time of 53 minutes, making this instrument and technology among the very best for speed and sensitivity in screening food for pathogenic contamination.
Over a one year period, swabs of 820 beef carcasses were tested for the presence of Shiga toxin-producing Escherichia coli by performing Polymerase Chain Reaction (PCR) in a novel technology termed ..."cassette PCR", in comparison to conventional liquid PCR. Cassette PCR is inexpensive and ready-to-use. The operator need only add the sample and press "go". Cassette PCR can simultaneously test multiple samples for multiple targets. Carcass swab samples were first tested for the presence of STEC genes (O157, eae, stx1 and stx2). Samples were considered to be pathogenic if positive for eae plus stx1 and/or stx2. For samples scored as pathogenic, further testing screened for 6 additional high frequency O-antigens (O26, O45, O103, O111, O121, and O145).
Of the 820 samples, 41% were pathogenic and 30% were O157 positive. Of these, 19% of samples were positive for O157 and carried potentially pathogenic E. coli (eae plus stx1 and/or stx2). Of all samples identified as carrying pathogenic E. coli, 18.9, 38.8, 41.4, 0, 36.1, and 4.1% respectively were positive for O26, O45, O103, O111, O121, and O145. To validate cassette PCR testing, conventional PCR using STEC primers was performed on each of the 820 samples. Only 148 of 3280 cassette PCR tests were discordant with conventional PCR results. However, further fractional testing showed that 110 of these 148 PCRs reflected low numbers of E. coli in the enrichment broth and could be explained as due to Poisson limiting dilution of the template, affecting both cassette PCR and conventional PCR. Of the remaining 38 discordant tests, 27 initial capillary PCRs and 10 initial conventional tests were nominally discordant between cassette and conventional PCR, perhaps reflecting human/technical error on both sides of the comparison.
Contaminated beef carcass swabs were often complex, likely harboring more than one strain of pathogenic E. coli. Cassette PCR had 98.8% concordance with parallel conventional PCR for detection of STEC genes. This indicates that cassette PCR is highly reliable for detecting multiple pathogens in beef carcass swabs from processing plants.
Fast molecular detection methods benefit from ready-to-run lab-on-a-chip molecular assays with minimum preparation time. Detection efficiency of such methods can improve if multiple targets are ...detected simultaneously per given reaction. Detection of food pathogens, i.e. Escherichia coli (E. coli), is generally performed in two stages with the detection of multiple targets in each stage.With simultaneous testing, screening for pathogens is fast and efficient.
In this study, we show the application of multiplex PCR performed on a ready-made cassette to detect 10 targets each for eight samples known to harbor E. coli. In cassette PCR, the aluminum cassette (38.6 mm × 31.4 mm) contains 10 trenches having a total of 50 capillaries with microliter volumes of desiccated acrylamide gels holding all reagents required for the PCR including internal positive and negative controls. The gel contains LCGreen dye to detect double stranded DNA. Fluorescence monitoring allows the detection of the amplified products by melt curve analysis. In this application, each of the five capillaries in a given trench contains two of the primer sets for the detection of 10 targets in pathogenic E. coli, namely, O157, Eae, Stx1, Stx2 and six O-antigen genes. Primer specificity was confirmed. Each trench tests one sample. Eight minimally processed enriched beef carcass swab samples were analyzed for parallel detection of 10 targets within 1 h and 15 min. Samples were delivered to the capillaries by capillary forces thereby hydrating the gels. Multiplex cassette PCR results were confirmed with conventional multiplex PCRs performed in a commercial real-time PCR system.
Cassette PCR technology is ideally suited to multi-target detection of pathogens in food products. The cassette performs multiple PCR reactions in parallel, with multiplex detection of targets within each reaction unit. Cassette PCR/ melt curve analysis results for the simultaneous detection of 10 targets of pathogenic E.coli in beef carcass swab samples were confirmed with a conventional real-time PCR/ melt curve analysis as well as with agarose gel electrophoresis. Although designed for the detection of E. coli, this multiplex cassette PCR technique can be applied to any other assay where the fast detection of multiple targets is required.
Detection sensitivity of cassette PCR was compared with a commercial BAX® PCR system for detection of eae and stx genes in Escherichia coli from 806 beef carcass swabs. Cassette PCR detects multiple ...genetic markers on multiple samples using PCR and melt curve analysis. Conventional PCR served as a gold standard. Overall, for positive and negative concordance, cassette PCR was 98.6% concordant with conventional PCR, and BAX PCR was 65.4% concordant. Of 806 beef carcass swabs, 339 by cassette PCR and 84 by BAX PCR harbored eae + stx+E. coli. For BAX PCR reactions, 84% of eae+ swabs, 79% of stx+ swabs, and 86% of eae + stx+ swabs were also detected by cassette PCR. For cassette PCR reactions, 457 swabs were eae+ with only 117 scored as eae+ using BAX PCR for 26% positive concordance. For stx primers, cassette PCR scored 480 samples as stx+ but only 215 samples were stx+ by BAX PCR, giving 45% positive concordance. Importantly, cassette PCR scored 339 swabs as harboring eae + stx+ E. coli, but BAX PCR detected only 71 positives giving only 21% positive concordance, with many false negatives. Cassette PCR is a highly sensitive method for detection of STEC genes in E. coli found in carcass swabs.
Models of patient–physician decision making are typically framed on a continuum of discourses and practices ranging from patient autonomy to physician paternalism, with the middle ground being ...occupied by terms such as shared decision making. Critiques of these models center on the gulf between these idealized models and actual practice and on how context influences decision-making practices. In this article I focus on how 11 Canadian family physicians talked about patient–physician decision making in interviews about their diagnostic and treatment practices for depression. I adopt a discursive approach to analyzing extracts from these interviews, and show how these physicians constructed themselves as engaging in acts of professional judgment and persuasion, and patients as having the final say in decision making about treatment for depression. I argue that whether the intertwining of discourses of physician influence and patient autonomy is understood as a balance of power between physicians and patients is an open question.
Although stand-alone courses in experimental and quasi-experimental research design and in statistics have been a core feature of Canadian and U.S. undergraduate psychology curricula for decades, ...similar courses in qualitative inquiry are relatively rare. I present a reflexive account of the history and components of a stand-alone course in qualitative inquiry that I have taught at the undergraduate level for more than a decade and consider the arguments for and against adopting this model, particularly in relation to calls for abandoning the qualitative-quantitative distinction and for integrating content domains and research training. I then present a skeletal outline of a restructured undergraduate psychology curriculum that might mitigate the "othering" of qualitative inquiry in our discipline and take up a few of the conceptual, pragmatic, and political issues related to its implementation.
The use of antidepressants has risen dramatically over the past few decades. This rise is attributable, in part, to the practice of off-label prescribing, that is, the use of antidepressants to treat ...conditions for which they were not designed, tested, or approved. Although there is a growing body of epidemiological data on off-label use of antidepressants, little is known about how those who are prescribed antidepressant medication for a diagnosis other than depression talk about this practice and, specifically, whether and how they invoke the topic of depression when asked to account for this practice. From a discursive analysis of interviews with 13 persons who were prescribed an antidepressant for a diagnosis other than depression (e.g., insomnia, postconcussive symptoms, new daily persistent headaches, multiple sclerosis, premenstrual syndrome), I show how the interviewees worked to decouple the relation between antidepressants and depression by (a) directly or indirectly denying one was characterologically or clinically depressed, (b) differentiating the nature of one's distress from depression, and (c) reconstructing the antidepressant. I argue that the participants drew on various discourses of depression and reconstructed the antidepressant along functional lines as a way of arguing against the possibility that they had been prescribed an antidepressant for the purposes of being treated for particular forms of depression.
Although qualitative inquiry is gaining recognition and legitimacy in the discipline of psychology, the teaching of such approaches to research-and the scholarship of such teaching - remains ...under-developed, particularly with respect to undergraduate psychology programs in American and Canadian universities. We begin this special issue with a counter-example to the American and Canadian contexts with a focus on the advances and challenges evident in qualitative research training in the U.K. We then feature examples of teaching qualitative inquiry in undergraduate psychology programs at selected American and Canadian universities. These examples illustrate various ways in which such teaching can occur, e.g., as a stand-alone course(s); as integrated into an existing course in a psychology curriculum; and as a lab-based, team experience outside of a formalized course. Our goal with this special issue is to recognize ongoing achievements and to encourage the creation of new practices in the teaching of qualitative inquiry in our undergraduate psychology programs - all in the service of making the optional obligatory.
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