Anecdotes from psychotherapy literature and personal experience are presented in support of the thesis that relational therapies are the evidenced, philosophical, ethical and moral rebuttal of ...mechanical psychotechnological therapies.
The tensions between traditional psychological healthcare and person-centered and experiential psychotherapies are reviewed. The following challenges to traditional medical-model dominated systems ...are proposed: (i) acknowledge and act on the understanding that the struggle for mental health and fulfillment involves addressing and changing the environment; (ii) understand that human beings grow in response to the environment and that growth is the best metaphor for change; (iii) put into practice the consequences of the uniqueness of each person; (iv) acknowledge that the only useful expertise in therapy consists of the ability to get out of the way of the client's healing process and accompany them, acknowledging and acting on the fact that the client is the expert, and refinement of the human ability to provide a good relationship; (v) stop the damaging activity of psychodiagnosis; (vi) clients must have a choice of treatments and psychological therapists must be nonjudgmental facilitators of that choice process; (vii) the application of individual relational techniques does not equal encounter; and (viii) psychologists must choose treatments that they believe to be moral, ethical and principled.
Key elements in the development of person-centered and experiential (PCE) therapies in Northern Europe are reviewed. Internal struggles in the search for identity to the establishment of an ...infrastructure of organizations, conferences, academic departments and publications are described. This paper particularly concentrates upon the fortunes of the approach in the United Kingdom and, to a lesser extent, mainland Northern Europe. It argues that thoughtful planning and strategy and an ethic of understanding, inclusion and celebration of diversity have ensured the good health of the approach since Carl Rogers' death
Abstract
Background
Lynch syndrome is a hereditary cancer disease resulting in an increased risk of colorectal cancer. Herein, findings are reported from an emergency clinical service implemented ...during the COVID-19 pandemic utilizing faecal immunochemical testing (‘FIT’) in Lynch syndrome patients to prioritize colonoscopy while endoscopy services were limited.
Methods
An emergency service protocol was designed to improve colonoscopic surveillance access throughout the COVID-19 pandemic in England for people with Lynch syndrome when services were extremely restricted (1 March 2020 to 31 March 2021) and promoted by the English National Health Service. Requests for faecal immunochemical testing from participating centres were sent to the National Health Service Bowel Cancer Screening South of England Hub and a faecal immunochemical testing kit, faecal immunochemical testing instructions, paper-based survey, and pre-paid return envelope were sent to patients. Reports with faecal haemoglobin results were returned electronically for clinical action. Risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg of haemoglobin/g of faeces (µg/g)—scheduled within 6–12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g—triaged via an urgent suspected cancer clinical pathway. Primary outcomes of interest included the identification of highest-risk Lynch syndrome patients and determining the impact of faecal immunochemical testing in risk-stratified colonoscopic surveillance.
Results
Fifteen centres participated from June 2020 to March 2021. Uptake was 68.8 per cent amongst 558 patients invited. For 339 eligible participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (17.7 per cent) had faecal haemoglobin greater than or equal to 10 µg/g. In the latter group, the diagnostic accuracy of faecal immunochemical testing was 65.9 per cent and escalation to colonoscopy was facilitated (median 49 versus 122 days, χ2 = 0.0003, P < 0.001).
Conclusion
Faecal immunochemical testing demonstrated clinical value for Lynch syndrome patients requiring colorectal cancer surveillance during the pandemic in this descriptive report of an emergency COVID-19 response service. Further longitudinal investigation on faecal immunochemical testing efficacy in Lynch syndrome is warranted and will be examined under the ‘FIT for Lynch’ study (ISRCTN15740250).
This was an emergency service protocol designed to improve access to colonoscopy using faecal immunochemical testing for risk-stratified triage during the height of the COVID-19 pandemic for people with Lynch syndrome when endoscopy services were extremely limited. Requests for faecal immunochemical testing for eligible Lynch syndrome patients were made by participating National Health Service Trusts, which triggered the sending of a faecal immunochemical testing kit, faecal immunochemical testing instructions, a paper-based survey, and pre-paid return envelope from the National Health Service Bowel Cancer Screening South of England Hub in Surrey to said patients, and risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg/g—schedule colonoscopy within 6–12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g—triage via an urgent suspected cancer clinical pathway. For 339 participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (177.0 per cent) met criteria for urgent triage (faecal haemoglobin greater than or equal to 10 µg/g), with escalation to colonoscopy facilitated in the latter group of patients, with a median wait of 49 days (versus 122 days for f-Hb less than 10), demonstrating the clinical value of faecal immunochemical testing for patients with Lynch syndrome requiring colorectal cancer surveillance during the pandemic.
There are several interesting and worthwhile points in van Blarikom (2006), A Person-Centered Approach to Schizophrenia, Person-Centered and Experiential Psychotherapies, 5, 155-173, however, this ...paper is a rebuttal of one of his central themes-that person-centered and experiential (PCE) therapists should accept that schizophrenia is an illness. A range of evidence refuting the illness metaphor favored by biological psychiatry and supporting social and psychological models is presented. It is argued that PCE philosophy and theory are essentially aligned with social psychiatry and psychology critical of the disease model of schizophrenia and PCE therapists would further marginalize themselves if they accepted van Blarikom's advice.
Traditional views of the possibilities of counselling at a distance, mediated by telecommunications technology, are challenged. The current status of telephone counselling is reviewed- it is proposed ...that the telephone is a vibrant innovative medium for therapeutic work. Computer involvement in therapeutic work is defined, and the issues confronting computer-mediated therapy are contrasted with developments in computer-supported co-operative work. It is concluded that active collaboration between therapists, social scientists and computer scientists is required to develop therapy-specific computer applications to mediate in therapy-at-a-distance.
Positions the telephone as a vibrant, innovative medium for therapeutic work. Defines computer-mediated therapy and explores issues confronting its development. Concludes that active collaboration ...between therapists, social scientists, and computer scientists is needed to develop therapy-specific computer applications to mediate in therapy-at-a-distance. (MKA)
