Attention is an acknowledged component of the therapeutic relationship that is the heart of clini... more Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician"s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. Though one person is awarded the degree of Doctor of Philosophy, the accomplishment belongs to many. Each member of my thesis committee has uniquely contributed to my success: Committee Chair Professor Marion Bogo"s inspiration when I needed support, her organization and structure, and the useful and exciting discussions that assisted me in clarifying my thoughts when I felt lost in the process; Professor Aron Shlonsky"s knowledge of mindfulness, his support for its incorporation into my research and his methodological rigour; Professor Evan Thompson"s knowledge of phenomenology and mindfulness, his support in keeping me true to phenomenology, clarifying the link between phenomenology and mindfulness and connecting me with Dr. Petitmengin; and Professor Maurice Legault"s knowledge of explicitation interviewing, the training he provided, and his ongoing support. I acknowledge the useful comments, questions and contributions from the Internal and External Examiners, Professors Adrienne Chambon and Phebe Sessions. My appreciation to Dr. Claire Petitmengin, not a formal committee member, who dedicated countless hours in her willingness to assist me in understanding explicitation and applying it to interviewing, and who validated my growing interviewing and analytic competence and put me in touch with Professor Legault. I am also grateful to the doctoral fellowships provided by the Factor-Inwentash Faculty of Social Work, University of Toronto and to the Mind and Life Institute for granting me a Francisco J. Varela Research Award for Contemplative Science Research. I deeply appreciate the willingness of those who gave of their time and energy to participate in interviews: the fourteen official respondents, three additional clinicians who provided extended pilot interviews and three work colleagues who agreed to test early versions of the interview I gradually developed. The interviews in which we engaged together were incredible learning opportunities for me both in learning how to conduct research interviews and in having opportunities to deeply explore clinical work. I feel fortunate to have been able to have such honest and intimate clinical conversations. My workplace, the Hincks-Dellcrest Centre, agreed to my part-time leave during my doctoral work, supporting my research. Librarian Rita Bondi provided invaluable assistance in library searches to locate inaccessible material. I also acknowledge Caversham Booksellers who ordered in countless books. I express a deep sense of gratitude to my two teachers, Sensei Taigen Henderson and Ross Gray who have challenged, supported and sustained my mindfulness practice and my spiritual development over the last twelve years of my personal exploration of Buddhist practice. Their instruction and guidance have been foundational to my own explorations of mindful attention. Most important, I acknowledge and thank my family. My parents, Dorothy and Julio Laufer, expressed constant interest and encouragement, and performed many material tasks without which I could not have completed the doctoral program. My sister, Marcy Laufer, and brother-in-law, Jim Pelton, listened to story after story of where I was in the research process. My children, Sarah and Miriam, and stepchildren, Tova and Ben, expressed continual interest in hearing about my work, provided emotional support, and celebrated the milestones along the way. My biggest supporter has been my husband, Jim McCall, who initially encouraged me to apply to the doctoral program and has supported me emotionally through the whole process. His constant faith in my ability brought me through times when I would have otherwise abandoned the process. I am deeply grateful and appreciative to everyone.
Objectives: To evaluate an objective structured clinical examination (OSCE) adapted for social wo... more Objectives: To evaluate an objective structured clinical examination (OSCE) adapted for social work in a lab course and examine the degree to which it predicts competence in the practicum. Method: 125 Masters students participated in a one-scenario OSCE and wrote responses to standardized reflection questions. OSCE performance and reflections were rated on previously standardized scales, competence in field was evaluated using the online practice-based evaluation. Results: A wide range of scores on OSCE scales indicate that differences in student competencies were captured. Correlational analyses revealed an association between OSCE scales and field final evaluations. Nevertheless, a number of students who performed poorly on the OSCE did well in the practicum. Conclusions: The OSCE method of evaluation warrants cautious optimism and requires further replication and adaptation for social work educational outcomes assessment.
Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown a... more Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown and evolved. However, romantic adult attachment is still understood within a monogamous construct, where insecurely attached individuals are stigmatized. The attachment literature describes those who exhibit dimensions of avoidant attachment as desiring multiple relationships with little emotional depth and commitment. However, empirical research illustrates that polyamorous individuals are predominantly securely or anxiously attached. Securely attached individuals are better able to communicate about intimate subjects, which often occurs in polyamory, while anxiously attached individuals thrive in an environment where intimacy is plentiful. This article provides an overview regarding attachment theory and polyamory and examines the contention that avoidantly attached individuals are attracted to CNM. While attachment theory is an empirically validated framework, modifications will be required in order to accommodate the polyamorous community.
Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown a... more Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown and evolved. However, romantic adult attachment is still understood within a monogamous construct, where insecurely attached individuals are stigmatized. The attachment literature describes those who exhibit dimensions of avoidant attachment as desiring multiple relationships with little emotional depth and commitment. However, empirical research illustrates that polyamorous individuals are predominantly securely or anxiously attached. Securely attached individuals are better able to communicate about intimate subjects, which often occurs in polyamory, while anxiously attached individuals thrive in an environment where intimacy is plentiful. This article provides an overview regarding attachment theory and polyamory and examines the contention that avoidantly attached individuals are attracted to CNM. While attachment theory is an empirically validated framework, modifications will be required in order to accommodate the polyamorous community.
Attention is an acknowledged component of the therapeutic relationship that is the heart of clini... more Attention is an acknowledged component of the therapeutic relationship that is the heart of clinical work and the base of competence. The centrality of the therapeutic relationship itself has been recognized throughout the history of clinical work. The clinician"s work is based, in part, in attending to the client by actively and openly listening to the client with attention and engagement. However, attention has been lacking within mental health disciplines to what occurs within the process of clinical attention. As a result, little knowledge exists about the structure of clinical attention itself. This dissertation studied the structure of clinical attention to understand what occurs when clinicians attend to their clients in sessions. The thesis focused on the internal processes occurring within the clinician, not on actions or interventions taken in sessions. The literature review grounded the study theoretically in mind science and contemplative science, the study of reality grounded in both objective and subjective experience. The literature review also conceptualized attention in its sub processes of mindfulness, meditation, reflective practice and affect regulation, examining literature relevant to those constructs as well as to the history, philosophy and psychology of attention. The literature revealed a lack of knowledge of the structure and process of clinical attention. Using the extant literature, a new theoretical framework of attention was constructed. Attention was conceptualized as composed of levels of pre-reflective and reflective attention as related to the attention sub processes. Though one person is awarded the degree of Doctor of Philosophy, the accomplishment belongs to many. Each member of my thesis committee has uniquely contributed to my success: Committee Chair Professor Marion Bogo"s inspiration when I needed support, her organization and structure, and the useful and exciting discussions that assisted me in clarifying my thoughts when I felt lost in the process; Professor Aron Shlonsky"s knowledge of mindfulness, his support for its incorporation into my research and his methodological rigour; Professor Evan Thompson"s knowledge of phenomenology and mindfulness, his support in keeping me true to phenomenology, clarifying the link between phenomenology and mindfulness and connecting me with Dr. Petitmengin; and Professor Maurice Legault"s knowledge of explicitation interviewing, the training he provided, and his ongoing support. I acknowledge the useful comments, questions and contributions from the Internal and External Examiners, Professors Adrienne Chambon and Phebe Sessions. My appreciation to Dr. Claire Petitmengin, not a formal committee member, who dedicated countless hours in her willingness to assist me in understanding explicitation and applying it to interviewing, and who validated my growing interviewing and analytic competence and put me in touch with Professor Legault. I am also grateful to the doctoral fellowships provided by the Factor-Inwentash Faculty of Social Work, University of Toronto and to the Mind and Life Institute for granting me a Francisco J. Varela Research Award for Contemplative Science Research. I deeply appreciate the willingness of those who gave of their time and energy to participate in interviews: the fourteen official respondents, three additional clinicians who provided extended pilot interviews and three work colleagues who agreed to test early versions of the interview I gradually developed. The interviews in which we engaged together were incredible learning opportunities for me both in learning how to conduct research interviews and in having opportunities to deeply explore clinical work. I feel fortunate to have been able to have such honest and intimate clinical conversations. My workplace, the Hincks-Dellcrest Centre, agreed to my part-time leave during my doctoral work, supporting my research. Librarian Rita Bondi provided invaluable assistance in library searches to locate inaccessible material. I also acknowledge Caversham Booksellers who ordered in countless books. I express a deep sense of gratitude to my two teachers, Sensei Taigen Henderson and Ross Gray who have challenged, supported and sustained my mindfulness practice and my spiritual development over the last twelve years of my personal exploration of Buddhist practice. Their instruction and guidance have been foundational to my own explorations of mindful attention. Most important, I acknowledge and thank my family. My parents, Dorothy and Julio Laufer, expressed constant interest and encouragement, and performed many material tasks without which I could not have completed the doctoral program. My sister, Marcy Laufer, and brother-in-law, Jim Pelton, listened to story after story of where I was in the research process. My children, Sarah and Miriam, and stepchildren, Tova and Ben, expressed continual interest in hearing about my work, provided emotional support, and celebrated the milestones along the way. My biggest supporter has been my husband, Jim McCall, who initially encouraged me to apply to the doctoral program and has supported me emotionally through the whole process. His constant faith in my ability brought me through times when I would have otherwise abandoned the process. I am deeply grateful and appreciative to everyone.
Objectives: To evaluate an objective structured clinical examination (OSCE) adapted for social wo... more Objectives: To evaluate an objective structured clinical examination (OSCE) adapted for social work in a lab course and examine the degree to which it predicts competence in the practicum. Method: 125 Masters students participated in a one-scenario OSCE and wrote responses to standardized reflection questions. OSCE performance and reflections were rated on previously standardized scales, competence in field was evaluated using the online practice-based evaluation. Results: A wide range of scores on OSCE scales indicate that differences in student competencies were captured. Correlational analyses revealed an association between OSCE scales and field final evaluations. Nevertheless, a number of students who performed poorly on the OSCE did well in the practicum. Conclusions: The OSCE method of evaluation warrants cautious optimism and requires further replication and adaptation for social work educational outcomes assessment.
Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown a... more Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown and evolved. However, romantic adult attachment is still understood within a monogamous construct, where insecurely attached individuals are stigmatized. The attachment literature describes those who exhibit dimensions of avoidant attachment as desiring multiple relationships with little emotional depth and commitment. However, empirical research illustrates that polyamorous individuals are predominantly securely or anxiously attached. Securely attached individuals are better able to communicate about intimate subjects, which often occurs in polyamory, while anxiously attached individuals thrive in an environment where intimacy is plentiful. This article provides an overview regarding attachment theory and polyamory and examines the contention that avoidantly attached individuals are attracted to CNM. While attachment theory is an empirically validated framework, modifications will be required in order to accommodate the polyamorous community.
Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown a... more Interest in attachment theory and polyamory, a form of consensual non-monogamy (CNM), has grown and evolved. However, romantic adult attachment is still understood within a monogamous construct, where insecurely attached individuals are stigmatized. The attachment literature describes those who exhibit dimensions of avoidant attachment as desiring multiple relationships with little emotional depth and commitment. However, empirical research illustrates that polyamorous individuals are predominantly securely or anxiously attached. Securely attached individuals are better able to communicate about intimate subjects, which often occurs in polyamory, while anxiously attached individuals thrive in an environment where intimacy is plentiful. This article provides an overview regarding attachment theory and polyamory and examines the contention that avoidantly attached individuals are attracted to CNM. While attachment theory is an empirically validated framework, modifications will be required in order to accommodate the polyamorous community.
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