Expertise in Clinical Psychology. The Effects of University Training and Practical Experience on Expertise in Clinical Psychology

How do university training and subsequent practical experience affect expertise in clinical psychology? To answer this question we developed methods to assess psychological knowledge and the competence to diagnose, construct case conceptualizations, and plan psychotherapeutic treatment: a knowledge test and short case studies in a first study, and a complex, dynamically evolving case study in the second study. In our cross-sectional studies, psychology students, trainees in a certified postgraduate psychotherapist curriculum, and behavior therapists with more than 10 years of experience were tested (100 in total: 20 each of novice, intermediate, and advanced university students, postgraduate trainees, and therapists). Clinical knowledge and competence increased up to the level of trainees but unexpectedly decreased at the level of experienced therapists. We discuss the results against the background of expertise research and the training of clinical psychologists (in Germany). Important factors for the continuing professional development of psychotherapists are proposed.

Legal Implications of the Use of Export Taxes in Addressing Carbon Leakage: Competing Border Adjustment Measures

The prevailing uncertainties about the future of the post-Kyoto international legal framework for climate mitigation and adaptation increase the likelihood of unilateral trade interventions that aim to address climate policy concerns, as exemplified by the controversial European Union initiative to include the aviation industry in its emissions trading system. The emerging literature suggests that border carbon adjustment (BCA) measures imposed by importing countries would lead to substantial legal complications in relation to World Trade Organization law and hence to possible trade disputes. Lack of legal clarity on BCAs is exacerbated by potential counter or pre-emptive export restrictions that exporting countries might impose on carbon-intensive products. In this context, this paper investigates the interface between legal and welfare implications of competing unilateral BCA measures. It argues that carbon export taxes will be an inevitable part of the future climate change regime in the absence of a multilateral agreement. It also describes the channels through which competing BCAs may lead to trade conflicts and political complications as a result of their distributional and welfare impacts at the domestic and global levels.

Carbon-related Border Adjustment and WTO Law

By expounding the legal foundations of border tax adjustments in international trade regulation, this book lays out the scope and limitations within which border carbon adjustments need to operate. The author examines the extent to which countries can lawfully impose border adjustment measures in relation to the carbon footprint of products on importation and exportation. In doing so, she provides a thorough analysis of the provisions of the WTO Agreement applicable to border carbon adjustments, offers a comprehensive review of relevant case law and engages with the extensive literature on the subject. Given the probability of conflict with non-discrimination rules of the GATT and uncertainty over justification of different designs of carbon-related border adjustment schemes under the exceptions of GATT Article XX, the book argues for a negotiated solution and discusses the possibility of the use of border carbon adjustments under preferential trade agreements.

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

PURPOSE In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment. METHODS In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed. RESULTS During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. CONCLUSION A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

Analysis of sport psychology consultancy at three Olympic Games: Facts and figures

Objectives Despite many reports on best practises regarding onsite psychological services, little research has attempted to systematically explore the frequency, issues, nature and client groups of onsite sport psychology consultancy at the Olympic Games. The present paper will fill this gap through a systematic analysis of the sport psychology consultancy of the Swiss team for the Olympic Games of 2006 in Turin, 2008 in Beijing and 2010 in Vancouver. Design Descriptive research design. Methods The day reports of the official sport psychologist were analysed. Intervention issues were labelled using categories derived from previous research and divided into the following four intervention-issue dimensions: “general performance”, “specific Olympic performance”, “organisational” and “personal” issues. Data were analysed using descriptive statistics, chi square statistics and odds ratios. Results Across the Olympic Games, between 11% and 25% of the Swiss delegation used the sport psychology services. On average, the sport psychologist provided between 2.1 and 4.6 interventions per day. Around 50% of the interventions were informal interventions. Around 30% of the clients were coaches. The most commonly addressed issues were performance related. An association was observed between previous collaboration, intervention likelihood and intervention theme. Conclusions Sport psychologists working at the Olympic Games are fully engaged with daily interventions and should have developed ideally long-term relationships with clients to truly help athletes with general performance issues. Critical incidents, working with coaches, brief contact interventions and team conflicts are specific features of the onsite consultancy. Practitioners should be trained to deal with these sorts of challenges.

How do different aspects of self-regulation predict successful adaptation to school?

Self-regulation plays an important role in successful adaptation to preschool and school contexts as well as in later academic achievement. The current study relates different aspects of self-regulation such as temperamental effortful control and executive functions (updating, inhibition, and shifting) to different aspects of adaptation to school such as learning-related behavior, school grades, and performance in standardized achievement tests. The relationship between executive functions/effortful control and academic achievement has been established in previous studies; however, little is known about their unique contributions to different aspects of adaptation to school and the interplay of these factors in young school children. Results of a 1-year longitudinal study (N = 459) revealed that unique contributions of effortful control (parental report) to school grades were fully mediated by children’s learning-related behavior. On the other hand, the unique contributions of executive functions (performance on tasks) to school grades were only partially mediated by children’s learning-related behavior. Moreover, executive functions predicted performance in standardized achievement tests exclusively, with comparable predictive power for mathematical and reading/writing skills. Controlling for fluid intelligence did not change the pattern of prediction substantially, and fluid intelligence did not explain any variance above that of the two included aspects of self-regulation. Although effortful control and executive functions were not significantly related to each other, both aspects of self-regulation were shown to be important for fostering early learning and good classroom adjustment in children around transition to school.

Risk adjustment in aging societies

Background In Switzerland, age is the predominant driver of solidarity transfers in risk adjustment (RA). Concerns have been voiced regarding growing imbalances in cost sharing between young and old insured due to demographic changes (larger fraction of elderly >65 years and rise in average age). Particularly young adults aged 19–25 with limited incomes have to shoulder increasing solidarity burdens. Between 1996 and 2011, monthly intergenerational solidarity payments for young adults have doubled from CHF 87 to CHF 182, which corresponds to the highest absolute transfer increase of all age groups. Results By constructing models for age-specific RA growth and for calculating the lifetime sum of RA transfers we investigated the causes and consequences of demographic changes on RA payments. The models suggest that the main driver for RA increases in the past was below average health care expenditure (HCE) growth in young adults, which was only half as high (average 2% per year) compared with older adults (average 4% per year). Shifts in age group distributions were only accountable for 2% of the CHF 95 rise in RA payments. Despite rising risk adjustment debts for young insured the balance of lifetime transfers remains positive as long as HCE growth rates are greater than the discount rate used in this model (3%). Moreover, the life-cycle model predicts that the lifetime rate of return on RA payments may even be further increased by demographic changes. Nevertheless, continued growth of RA contributions may overwhelm vulnerable age groups such as young adults. We therefore propose methods to limit the burden of social health insurance for specific age groups (e.g. young adults in Switzerland) by capping solidarity payments. Conclusions Taken together, our mathematical modelling framework helps to gain a better understanding of how demographic changes interact with risk adjustment and how redistribution of funds between age groups can be controlled without inducing further selection incentives. Those methods can help to construct more equitable systems of health financing in light of population aging.

"Beyond Freud and Jung": Sabina Spielrein's Contribution to Child Psychoanalysis and Developmental Psychology

Up to the present day, Sabina Spielrein has been seen as a means to deeper understanding of Freud and Jung and, in particular, the relationship between these two “great men”. This is also the reason why her scholarly achievements after her 1912 essay "Destruction as the Cause of Coming Into Being” are hardly taken into account. This study shows that Spielrein's main research work was in the areas of child analysis and developmental psychology���that is, beyond the work and the persons of Freud and Jung—and that she made numerous significant contributions to the field, so many of them ahead of her time.

Self-initiated expatriates and their career success

Purpose This paper aims to provide conceptual clarity by distinguishing self‐initiated expatriates (SIEs) from company‐assigned expatriates (AEs), and skilled migrants; most importantly, it introduces an overarching conceptual framework based on career capital theory to explain SIEs’ career success. Design/methodology/approach This conceptual framework is based on a review of the relevant literature on SIE, expatriation, career studies, cross‐cultural studies, migration, and other related areas. Findings Protean career attitude, career networks, and cultural intelligence are identified as three major types of career capital influencing SIEs career success positively; the predicting relationships between these are mediated by cultural adjustment in the host country. Cultural distance acts as the moderator, which highlights the influence of macro‐contextual factors on SIEs’ career development. Research limitations/implications The current paper applied career capital theory and did not integrate the impact of family and labour market situation on SIEs’ career development. Further research should test the proposed framework empirically, and integrate the impact of family‐ and career‐related factors into a holistic approach. Practical implications When constructing international talent acquisition and retention strategies, organizations and receiving countries should understand the different career development needs and provide SIEs with opportunities to increase career capital during expatriation. Furthermore, the current framework suggests how to adjust to the host country in order to meet career development goals. Originality/value The multi‐level and sequential framework adds value by identifying specific types of career capital for SIEs and providing a conceptual underpinning for explaining how they interact and foster SIEs’ career success. Moreover, the framework embraces SIEs from both developed and developing economies.

ACL reconstruction with physiological graft tension by intraoperative adjustment of the anteroposterior translation to the uninjured contralateral knee.

PURPOSE Fixation of anterior cruciate ligament (ACL) substitutes with non-physiological anteroposterior translation (APT) worsens outcome. The aim was to present a technique for physiological APT adjustment of the transplant in ACL reconstruction and its outcome at midterm. METHODS In a consecutive series of 28 patients (age 32 ± 11 years, 24 male), chronic ACL deficiency was treated by bone-patella-tendon-bone reconstruction. Transplant APT was adjusted to that of the contralateral uninjured ACL, measured 3, 6, and 12 months postoperatively using the Rolimeter. At a median follow-up of 5.3 years (3-8 years), 82% of the patients were re-evaluated with APT measurement and using IKDC-, Tegner-, Lysholm-Scores, conventional radiographs and MRI. RESULTS No differences in APT (mean ± SD) between uninjured and reconstructed knees were observed after adjustment (6 ± 1 versus 6 ± 1 mm, n.s.). Three months postoperatively, a statistically significant increase in APT (7 ± 1 mm) and a further increase at midterm (9 ± 2 mm) were observed. Patients scored "normal" or "nearly normal", respectively, in 79% (IKDC) and 4 (3-9) points (Tegner; median, range) or 89 ± 9 points (Lysholm; mean ± SD). Radiological evaluation showed no, minimal or moderate joint degeneration in 5, 20 and 75% of patients, respectively. MRI confirmed intact ACL transplants in all patients. CONCLUSION ACL reconstruction using the presented technique was considered successful, as patients did not suffer from subjective instability, radiographic analysis did not provide evidence for graft rupture at midterm. However, APT increase and occurrence of degenerative changes in reconstructed knees at the midterm might not be prevented even by restoration of a physiological APT in ACL reconstruction. The Rolimeter can be used for quick and easy intraoperative indirect control of the applied tension to the ACL transplant by measuring the APT to obtain physiological tensioning resulting in a satisfying outcome at midterm. LEVEL OF EVIDENCE IV.