Les méthodes d'études de cas en psychothérapie : perspectives actuelles

Les études de cas en psychothérapie connaissent une phase de renouveau auprès des chercheurs en psychothérapie et des psychothérapeutes. L'auteur discute de deux paradigmes qui ont grandement influencé ce nouvel intérêt : le paradigme pragmatique et le paradigme qui vise la construction d'une théorie. L'article présente les origines, les développements et les concepts clés des deux paradigmes et leurs spécificités méthodologiques et éthiques. Des exemples d'études de cas ou de modèles au sein des paradigmes sont évoqués. L'influence différentielle des courants postmodernes sur les deux paradigmes, et leurs apports respectifs dans le champ des méthodes d'études de cas, sont discutés et évalués par rapport aux implications pour le chercheur et le psychothérapeute.

Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment of borderline personality disorder: a randomized controlled trial.

Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. Methods: A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. Results: The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z55 = 0.99, p < 0.04). Conclusions: These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD. © 2014 S. Karger AG, Basel.

CUBN is a gene locus for albuminuria.

Identification of genetic risk factors for albuminuria may alter strategies for early prevention of CKD progression, particularly among patients with diabetes. Little is known about the influence of common genetic variants on albuminuria in both general and diabetic populations. We performed a meta-analysis of data from 63,153 individuals of European ancestry with genotype information from genome-wide association studies (CKDGen Consortium) and from a large candidate gene study (CARe Consortium) to identify susceptibility loci for the quantitative trait urinary albumin-to-creatinine ratio (UACR) and the clinical diagnosis microalbuminuria. We identified an association between a missense variant (I2984V) in the CUBN gene, which encodes cubilin, and both UACR (P = 1.1 × 10(-11)) and microalbuminuria (P = 0.001). We observed similar associations among 6981 African Americans in the CARe Consortium. The associations between this variant and both UACR and microalbuminuria were significant in individuals of European ancestry regardless of diabetes status. Finally, this variant associated with a 41% increased risk for the development of persistent microalbuminuria during 20 years of follow-up among 1304 participants with type 1 diabetes in the prospective DCCT/EDIC Study. In summary, we identified a missense CUBN variant that associates with levels of albuminuria in both the general population and in individuals with diabetes.

Innovations dans les traitements des troubles de la personnalité: une lecture integrative

L'interaction thérapeutique avec les patients présentant un trouble de la personnalité a été décrite comme difficile et volatile. Récemment, les thérapies cognitivo-comportementales (TCC) s'approchent de ces difficultés par des traitements manualisés et des modélisations complexes, ce qui tend à laisser dans l'ombre l'acteur principal du changement en psychothérapie : le patient. La présente lecture intégrative discute plusieurs mécanismes de changement actifs chez les patients avec trouble de la personnalité. Premièrement, il est décrit que les problèmes d'interaction, résumés sous le terme des jeux interactionnels, posent des défis spécifiques. Le thérapeute est ainsi amené à favoriser une interaction thérapeutique authentique, en utilisant notamment une forme individualisée d'intervention, la relation thérapeutique centrée sur les motifs. Deuxièmement, il est décrit que les problèmes de conscience et de différenciation émotionnelles entravent la qualité du traitement des troubles de la personnalité. Le thérapeute est ainsi conseillé d'utiliser des techniques empruntées aux thérapies néo-humanistes, notamment la directivité de processus, afin d'approfondir l'affect émergeant en séance. Troisièmement, il a été décrit qu'une identité sociale affirmée fait souvent défaut chez les patients avec trouble de la personnalité. Les thérapeutes avisés peuvent favoriser ce processus avec des interventions ciblées. En conclusion, une focalisation sur les comportements observables du patient - les processus réels en séance -, est productive, et elle permet au thérapeute d'affiner, de préciser et d'approfondir son intervention, au plus près du patient.

Psychotherapy for Personality Disorders in a Natural Setting: A Pilot Study over Two Years of Treatment.

Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural environment is an important task. Such research contributes to enlarge the practice-based evidence, embedded in broad collaborations between clinicians and researchers in psychotherapy for PDs. The present pilot study used rigorous assessment procedures and incorporated feedback loops of outcome information to the therapists in demonstrating the effects of psychotherapy for PD in a natural setting. The number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for any PD was the primary outcome (along with psychological distress, depression, impulsiveness, and quality of life as secondary measures), assessed at intake, 6, 12, 18, and 24 months of psychotherapy for N = 13 patients with PD. Data were analyzed using hierarchical linear modeling. Results demonstrated a large pre-post effect (d = 2.22) for the observer-rated measure (primary outcome), and small to medium effects for the secondary outcomes; these results were corroborated by a steady decrease of symptoms over all five time points, which was significant for several outcomes. These results add a piece to the literature by demonstrating the effects of long-term psychotherapy for PDs in increasingly diverse contexts and suggest that practice-oriented research can be carried out in a collaborative and systematic manner.

Creating Shared Value in India: How Indian Corporations Are Contributing to Inclusive Growth While. Strengthening Their Competitive Advantage

Competitividad y valor compartido

Measuring Shared Value: How to Unlock Value by Linking Social and Business Results

Competitividad y valor compartido

La creación de valor compartido

Competitividad y valor compartido

The Big idea: Creating Shared Value

Competitividad y valor compartido

Postglacial paleoecology and effects of European settlement on the environment of Lake Hunger and Lake Lisgar, Southwestern Ontario /

This investigation has three purposes I to make a comparative chemical study on sediment cores collected for Lake Lisgar (man-made lake in an urban center) and Lake Hunger (natural basin in a rural community) encompassing the time since European settlement I to determine the postglacial chemical history of Lake Hunger, and to determine the vegetational history of the Lake Hunger area from postglacial time to the present. The minus 80 mesh fraction of 108 soil samples and 18 stream sediment samples collected in the vicinity of Lakes' Lisgar and Hunger were analyzed for cold hydrochloric acid soluble lead, zinc, nickel, cobalt, copper, aluminum, sodium, potassium, calcium, magnesium, iron and manganese. Lacustrine sediments from 5 boreholes in the Lake Lisgar basin were collected. Boreholes 1, 2, 3, and 4 were analyzed for palynological and chemical information and Borehole 5 was subjected to pollen and ostracode analysis. Lacustrine sediments from 6 boreholes in the Lake Hunger basin were collected. Palyno- -logical and chemical analysis were performed on Boreholes 1, 2, 3, 4, and 6 and Borehole 5 was analyzed for pollen. In addition, radiocarbon dates were obtained on sediment samples from Boreholes 4 and 5. A total of 8 surface samples were collected from the margins of the Lake Hunger basin and these were chemically analyzed in the laboratory. All of the lacustrine sediments were ashed and analyzed for cold hydrochloric acid soluble lead, zinc, nickel, cobalt, copper, aluminum, sodium, potassium, calcium, magnesium, iron and manganese using a Perkin Elmer 40) Atomic Absorption spectrophotometer. The results . obtained for the 12 elements were expressed as parts per million in dry sediments. It was found that man's influence on the element distribution patterns in the sediments of Lake Lisgar appeared to be related to his urbanizing developments within the lake vicinity, whereas, the rural developments in the vicinity of lake Hunger appeared to have had little effect on the element distribution patterns in the lake sediments. The distribution patterns of lead, zinc, nickel, cobalt, aluminum, magnesium, sodium and potassium are similar to the % ash curve throughout postglacial time indicating that the rate of erosion in the drainage basin is the main factor which controls the concentration of these elements in the sediments of Lake Hunger. The vegetational history, from palynological analysis, of Lake Hunger from postglacial time to the present includes the following stages: tundra, open spruce forest, closed boreal forest, deciduous forest and the trend towards the re-establishment of pine following the clearing of land and the subsequent settlement of the Lake Hunger area by European settlers. The concentrations of some elements (cobalt, nickel, iron, manganese, calcium, magnesium, sodium and potassium) in the sediments of Lake Hunger appears to be higher during pre-cultural compared to post-cultural times. At least one complete postglacial record of the chemical history within a lake basin is necessary in order to accurately assess man's effects on his environment.

Study of heat capacity measurement methods for small samples

Methods of measuring specific heats of small samples were studied. Three automated methods were explored, two of which have shown promising results. The adiabatic continuous heating method, has provided smooth well behaved data but further work is presently underway to improve on the results obtained so far . The decay method has been success fully implemented demonstrating reasonable agreement with accepted data for a copper test sample.

The effect of schooling on student self-concept /|nRonald S. Cowley. -- 260 St. Catharines [Ont. : s. n.],

The following research paper was a study into change in student academic and general self-concept with increase in grade level and age# The majority of literature found by this researcher dealt with self-concept and its relationship to achievement and interactions with others, Review, then, was in these two areas-particularily within the academic setting, but outside of it as well. It wrs hypothesized that there would be a decrease in both academic and general student self-concept with increase in grade level and age. Self-Appraisal inventories, measuring general and academic selfconcept, and Inferential Self-Reports, measuring only academic selfconcept, were the instruments used* Subjects were students, Trade 1 to 13, and ranging in age from 5 to 21„ Although al] Self-Appraisal inventories and all Self-1?eports were very similar, they differed according to three Grade levels: Primary (Grades 1 to 3)> Intermediate (Grades L to 8), and Secondary (Grades 9 to 13) • Students in the Primary division received only their respective Self-Appraisal inventory, while others v/ere administered both inventories designed for their grade level. Scores on the inventories were computed to percents and then mean percents were arrived at for epch grade, each of the three grade levels, each age, and each of three age intervals. In all of these instances Spearman1 s rank order coefficients (!lpff) were calculated and significance, at the *05 level, was determined by referring to a table of critical values for one-tailed tests* Similarily fftff scores were computed, but only for individual grades and ages, and significance was determined at the *0b level* In only one instance, the General Dimension for individual grades, was significance of overall decrease found* Consequently the hypotheses put forth did not gain support* The fltff scores, however, revealed some isolated significant changes for the Academic Dimension, which were generally decreases in mean percents from the last grade of one level to the first grade of the next* For age mean percents, significant changes generally took place at early (5 or 6) and late (20 or 21) ages* A number of reasons for the results were presented and were generally based upon the studentfs encounters, or lack of encounters, with achievement or success* No definite conclusions, relevant to the hypotheses stated^ could be made, although a number of isolated ones were drawn on the basis of significant fltff scores* As well, mention was made of the possible trends or tendencies that were revealed by the results, but that could not, or were not, proven significant by "t's11 or "p's"* Teaching methods stressing improvement in academic, as well as socially related, situations, were recommended and a model teaching approach was presented in Appendix B#

The effects of static and diurnally-cycling temperature acclimations on thermal tolerances of rainbow trout, Salmo gairdneri

:ofiedian lethal temperatures ( LT50' s ) were determined for rainbow trout, Salmo gairdnerii, acclimated for a minimum of 21 days at 5 c onstant temperatures between 4 and 20 0 C. and 2 diel temperature fluctuations ( sinewave curves of amplitudes ± 4 and ± 7 0 C. about a mean temperature of 12 0 C. ) . Twenty-four-, 48-, and 96-hour LT50 estimates were c alculated f ollowing standard flow-through aquatic bioassay techniques and probi t transformation of mortality data. The phenomenon of delayed thermal mortality was also investigated. Shifts in upper incipient lethal temperature occurred as a result of previous thermal conditioning. It was shown that increases in constant acclimation temperature result in proportional l inear increases in thermal tolerances. The increase i n estimated 96-hour LT50's was approximately 0.13 0 c. X 1 0 C:1 between 8 and 20 0 C. The effect of acclimation to both cyclic temperature regimes was an increase in LT50 to values between the mean and maximum constant equivalent daily temperatures of the cycles. Twenty-four-, 48-, and 96-hour LT50 estimates of both cycles corresponded approximately to the LT50 values of the 16 0 C. c onstant temperature equivalent . This increase i n thermal tolerance was further demonstrated by the delayed thermal mortality experiments . Cycle amplitudes appeared to i nfluence thermal resistance through alterations in initi al mortality since mortality patterns characteristic of base temperature acclimations re-appeared after approximately 68 hours exposure to test temperatures for the 12 + 4 0 C. group, whereas mortality patterns stabilized and remained constant for a period greater than 192 hours with the larger therma l cycle ( 12 + 7 0 C. ). NO s ignificant corre lations between s pecimen weight and time-to-death was apparent. Data are discussed in relation to the establishment of thermal criteria for important commercial and sport fishes , such as the salmonids , as is the question whether previously reported values on lethal temperature s may have been under estimated.