1,721,223 research outputs found
Psychological Scaffolding in the Healthcare Relationship: A Methodological Proposal
No full textPsychological scaffolding in healthcare relationships allows the system to
guarantee a gradual and progressive way to meet medical goals. From a
psychological point of view, you cannot separate these goals from how they
are reached and from the experience the patients have within the clinical
relationship.
Ownership is another important concept, and it is marked by patient
empowerment within the clinical relationship. The owner of a relationship
is not the patient who passively awaits and accepts treatment. In any medical dialogue, everyone can “own” a point of view or a proposal that
can influence the dynamics of the clinical relationship. Active ownership
and partnership are not prerequisites for the relationship but come about
as the relationship progresses.
Consensus involves moving from a passive attitude of informed consensus
and medical authority to the possibility of bringing together different
points of view, evaluation perspectives, and ways of describing the illness.
Consensus can take place when ownership of the technical, pragmatic,
cognitive, emotional, cultural, and social contents is integrated. Bringing
different points of view together leads to the sharing, development, and
experience of new ways of integrating meaning (consensus) of the illness
and its treatment (Freda et al., 2014; Gleijeses & Freda, 2009; Zaccaro &
Freda, 2011). Consensus implies a continual exchange between the health
system and the patients and their families (Jankovic & Masera, 2012).
In dealing with concordance, we look at ways of dealing with one of the
most difficult aspects of the clinical relationship: uncertainty. Accepting
uncertainty and negotiating between reality and hope can be problematic.
Decision making allows us to make decisions for the future. By sharing the
process of decision making, the healing process is shared in the longer
term (including past, present, and future). In doing so, we move away from
events and actions and towards processes. Thanks to ownership and consensus,
the future is no longer seen in terms of diagnostic probability but as
shared meaning in which both the biological outcomes and the subjective,
social, cultural, and economic outcomes of the healthcare relationship are
considered. By understanding the multidimensional and multitemporal
aspects of the illness (Freda, De Luca Picione & Martino, 2015), choices
and responsibilities that were once taken for granted can become shared.
Psychological intervention does not limit itself to creating a harmonious
atmosphere between doctors and patients but rather works towards greater
competency and autonomy in all participants through dialogue and the
semiotic translation of all meaningful aspects of the relationship. Psychological
scaffolding is a dynamic process where new ways of organizing and
developing the relationship can be tested, so that effective decisions and
communication can be made taking into account medical, physiological,
and personal issues
HEALTHCARE AND CULTURE: SUBJECTIVITY IN THE HEALTHCARE CONTEXTS.
No full textThe book deals with current issues, pertinent every healthcare relationship. Changes in medicine as well as some constant aspects over time arise within a cultural ground and generate new questions and issues that are not only purely medical, but also bioethical, social, political, economic and psychological of course.
On the one hand, changes in medicine generate new questions for society, on the other hand, the society poses new questions to the medicine, new challenges, and in some cases they can conflict with consolidated models and practices. Never the progress of Western medicine and its therapeutic practices have been as significant as in the last decades but the increase of specific competence and effectiveness of medical treatments are not linearly translated into an increase of consensus, dialogue and alliance between medicine and society. How does psychology take on a position of interlocutor towards medicine and its transformations? How does Cultural Psychology, Health Psychology, Clinical Psychology confront themselves with the processes of meaning making generated by medicine?
The interest of the book is aimed to grasp the construction of processes of cultural, relational and subjective meaning in the dialogical encounter between medicine and society, between doctor and patient. The book intends to focus in particular on two specific plans: on the one hand, to present a reflection and analysis on contemporary medicine and its on‐going transformations of the healthcare relationship; on the other hand, to present and discuss experiences of intervention and possible models of intervention addressed to healthcare and doctor‐patient relationships during its crucial steps (consultation, formulation and communication of diagnosis, therapy, conclusion). The book’s purposes are aimed to discuss crucial and current issues on the borders between medicine and psychology: consensus and sharing, decision‐making and autonomy, subjectivity and narration, emotions and affectivity, medical semeiotics and cultural semiotics, training of physicians, and epistemological, theoretical and methodological issues.
CONTENTS
Series Editor’s Preface: Caring for Health Care: Cultural Processes in Medicine, Jaan Valsiner. Introduction: The Meaning Making Processes of Healthcare Relationship in the Current Scenario, Maria Francesca Freda and Raffaele De Luca Picione. PART I: HEALTHCARE RELATIONSHIP AS ARENA OF MEANING. FROM CULTURAL ISSUE TO SUBJECTIVE CONSTRUCTION OF ILLNESS. Medicine as a Complex Set of Cultural Systems of Meanings, Raffaele De Luca Picione. The Border Into Wonderland: When Words Between Doctor and Patient Is Not Enough, Jensine Nedergaard. Autonomy: A Concept at the Crossroads of Medicine and Psychology, Giovanni Guerra. The Role of the Meaning‐Making Process in the Management of Hereditary Angioedema, Livia Savarese, Maria Bova, Raffaella Falco, Maria Domenica Guarino, Gerarda Siani, Paolo Valerio, and Maria Francesca Freda. PART II: HEALTHCARE RELATIONSHIP AS ARENA OF TRANSFORMATION: FROM COMMUNICATION TO DIALOGUE. Psychological Scaffolding in the Healthcare Relationship: A Methodological Proposal, Maria Francesca Freda, Raffaele De Luca Picione, and Francesca Dicè. Breaking Bad News: Theory and Practice for Healthcare Professionals’ Training, Giulia Lamiani, Daniela Leone, Elaine C. Meyer, and Elena Vegni. Psychologists and Family Physicians in an Experience of Collaborative Care in Italy: An Effort Towards Integration and Against Stigma, Luigi Solano, Barbara Cordella, Michela Di Trani, Rosa Ferri, and Alessia Renzi. Clinical Psychology in Hospital Setting, Renzo Carli, Rosa Maria Paniccia, Silvia Policelli, and Andrea Caputo. PART III: MENTAL HEALTHCARE AS PARADIGMATIC ARENA TO UNDERSTAND THE COMPLEXITY OF HUMAN RELATION. From Psychopathology to Service. A New View of the Clinical Psychology Intervention, Sergio Salvatore, Claudia Venuleo, Valeria Pace, Marianna Puglisi, Mari Tandoi, Annalisa Venezia, Rossano Grassi, and Gianna Mangeli. Recovery, Paternalism and Narrative Understanding in Mental Healthcare, Tim Thornton. “Why Do You Then Not Shit?” Diagnosis and the Semiotic Sphere, Yair Neuman. PART IV: PREGNANCY AND MOTHERHOOD: A CHALLENGING ARENA FOR DIALOGUE BETWEEN MEDICINE AND PSYCHOLOGY. Birth Experience as Socially and Culturally Regulated Event, Kristiina Uriko. The Generative Function of a Healthcare System: Linking Meanings Between Chronic Illness and Motherhood, Giorgia Margherita, Maria Carlino, and Francesca Tessitore.Doctor‐Patient Relationship in Face of Grief/Mourning: The Case of Gestational Losses, Vivian Volkmer Pontes and Ana Cecília Bastos.Conclusion: Healthcare Relationship: An Open Space Dialogue in Search of Its Own Forms, Maria Francesca Freda and Raffaele De Luca Picione. About the Authors
Illness Narratives And Modal Articulation: An Innovative Methodological and Clinical Proposal
No full textWe propose modal articulation as a sensemaking device that a person adoperates in subjective way to construct a relational positioning by defining possibilities, opportunities, needs, constraints, wishes, intentions to act, and interactions with others in an experiential context (De Luca Picione & Freda, 2016; Freda & Martino, 2015; De Luca Picione, Martino & Freda, in press).
This proposal fill a gap relative to a poverty of studies, in a psychological framework, about the use of modal categories. According to us, the main modal use functions and their articulation from a semiotic and psychodynamic psychological perspective, is relevant along three issues:
The connection function Modals have a connective function between affective primary matrix of the subject and its first discretization in a symbolic form (Greimas, 1983; Salvatore, 2016; Valsiner, 2014).The mediation function Modals make complex the relationships between social partners. They allow for the construction of a dialectics between subjectivity and alterity, the construction of a subject-in-relationship. Modal articulation gives shape and direction to interpersonal positioning (Harrè, 2011).The vectorial function Modal operators contribute to the action orientation (enabling and/or blocking) in space and time. They are inherently temporal and contextual. Modal operators contribute to construct sense of agency for the subject (Caston, 2010).
We constructed a method of analysis used with six illness narratives to deepen the modal articulation construct within each narrative. In order to analyze the use and function of modal verbs (Can, Must, Will, to Know) we used T-lab quali-quantitative linguistic software to perform statistical analysis: relative index of single and general modality frequencies and Markovian analysis. Results are discussed in clinical terms inasmuch we found specific subjective narrative configurations of modal articulation: modal dispersion, plasticity, focusing, rigidity and poverty
L’Intelligenza artificiale al vostro servizio. Sfide, opportunità e falsi miti di una sperimentazione nel settore pubblico
No full textL’intelligenza artificiale (IA) sta trasformando profondamente la nostra società, penetrando in molteplici aspetti della vita quotidiana e rimodellando il tessuto economico e sociale. Gli esiti incerti e poten-zialmente perversi di questo nuovo approccio tecnologico (Calise, Musella, 2023) sollevano questioni di natura non solo tecnica e inge-gneristica, ma soprattutto di tipo etico e sociale, noti come human-sware (Cosenza, Giannini, Pescape, 2023). D’altra parte, i dilemmi posti dall’epistemologia del digitale (Amaturo, Aragona, 2019) sugge-riscono di rafforzare la partecipazione pubblica e la conoscenza con-divisa di processi e implementazioni avanzate come l’IA, proprio per mitigare l’opacità dei meccanismi algoritmici dietro a tali dispositivi (De Luca Picione, Fortini, Trezza, 2024). Questo studio esplora la prima fase implementativa di Govern-AI (Governance assistance for social areas by AI) una sperimentazione di un’applicazione digitale basata sull’Intelligenza Artificiale Generativa (IAG) per l’assistenza a professionisti e decisori del settore del welfare
Introduction: The Meaning Making Processes of Healthcare Relationship in the Current Scenario
No full textMedicine, from a general and wide-ranging point of view, is a therapeutic
activity based on a system of knowledge and practice, locally and historically
connoted (Beneduce & Roudinesco, 2005; Federspil et al., 2008; Good,
1994; Kleinmann, 1998). It changes over time. On the one hand, we see
the transformation of medicine over its subjects, and on the other hand, we
see the transformations of medicine in the relationship between its agents
(doctors, patients, researchers, educational and research institutions, etc.).
Therefore, the evolution and transformation of medicine and its progress
do not pertain exclusively to the relationship it builds with its specific subjects
(think of the increasingly precise definition of diseases and research
for increasingly more effective and efficient therapeutic treatments); the
change of medicine over time also has a side we call relational, and it is built
through the methods of organizing relations amongst its participants. In
the valuable contributions of this book, attention focuses mainly on that
transformative side of medicine, given that the current cultural and social processes within Westernized societies raise questions with regard to medicine
and the ways it carries out its practices. The transformation of medical
practice within the current social and cultural landscapes of the Westernized
societies puts an emphasis on the issue of the medical relationship between
the doctor and the patient
Conclusion: Healthcare Relationship: An Open Space Dialogue in Search of Its Own Forms
No full textThere are many paths defined by the authors who have participated in this
book—all paths that lead towards the same sea. These waters are turbulent,
moved by continuous currents, tides, and undertows. This is the sea
of countless possibilities and endless forms that subjectivity can take on
in different contexts of disease and care. Through their descriptions, the
authors reflect on and discuss the importance of the construction of subjectivity
within the system of relationships of healthcare that makes possible
its emergence. Subjectivity is not just considered as an entity that a priori
characterizes a person, but as a singular and original process that develops
over time through the experiences with one’s own body, with others, and
with the world
Dare Senso Alla Malattia: Esplorando Il Nesso Tra Temporalità E Articolazione Modale
No full textLa malattia rappresenta una discontinuità dei processi di significazione della persona. Molti studi in ambito narrativo sono stati condotti su tale questione (Brockmeier, 2000; Bruner, 1990; Frank, 1995; Freda, De Luca Picione, Martino, 2015; Valsiner, 2007; Zittoun, 2006). La discontinuità dell'esperienza pone l'esigenza di un processo di ri-significazione che chiama in causa la prospettiva soggettiva temporale quale cornice di senso entro cui collocare gli eventi della propria vita. Entro tale prospettiva teorica, il nostro contributo intende approfondire l'articolazione modale quale indicatore del posizionamento del soggetto rispetto alla organizzazione della propria prospettiva temporale. Per articolazione modale infatti intendiamo l'uso degli operatori semiotici modali (dovere, volere, potere, sapere - Greimas, 1983) e la loro interconnessione reciproca nel racconto di malattia. Riteniamo che l'organizzazione narrativa della prospettiva temporale si avvalga dell'utilizzo di configurazioni modali capaci di connettere e orientare il senso delle proprie azioni nel fluire del tempo. Entro un corpus di 30 narrazioni di malattia di soggetti al termine di trattamenti medici oncologici, abbiamo selezionato 6 narrazioni, una per ogni modello temporale (lineare, circolare, frammentario, statico, ciclico e spirale) di Brockmeier (2000). Tale corpus è stato sottoposto ad una analisi delle sequenze (catene markoviane) attraverso il software T-Lab (Lancia, 2004; 2008). I risultati consentono di mettere in luce un continuum che oscilla tra la plasticità modale cui si associa una capacità di riconfigurare il rapporto temporale tra soggetto e contesto e la rigidità modale cui si associa una reiterazione di una specifica modalità nel rapporto tra soggetto e contesto. Entro tale continuum si collocano le specifiche costellazioni temporali-modali di ogni narratore. È proprio questa dialettica tra fissità e dinamicità della articolazione temporale-modale che rappresenta per noi un utile ancoraggio clinico nei processi di presa in carico della malattia e della sua possibilità di essere risignificata
New public management for Adult School Centers
No full textThinking sociologically through education is a preparatory part in the constitution of an interdisciplinary approach capable of making discussions on the geographies of globalization and knowledge society meaningful (Thiem, 2009). This work present the perspective in which those interventions can be understood - the evolution of Adult Education in the “social investment welfare state” (Giddens, 2014) - through a case of study that analyses the new public management of educational institutions in Italy.
The institutional dimension of lifelong learning policies have the new feature of the Adult School Centers, link between the education system entrusted to the state and the training system entrusted to the Regions. The Adult School Centers as eterotopic space? Although Foucault describes heterotopia as a actually existent utopia (1984), the conception is not tied to a space that promotes any promise, or any form of change.
The research design has proposed an analysis of the mechanisms and of the processes that led the Campanian institutions’ activities to build an integrated education and lifelong learning system. The legal and institutional dimension has highlighted the contextual conditions and the survey tools. Starting with the interviews to “preferential witnesses” about the implementation of administrative procedures, used both as categorical overall framework as well as specific “medium of communication” (De Luca Picione, 2017).
The empirical results present the role played by the institutional actors and the learners of the adult evening classes to understand what kind of people reenters in educational processes (Formenti, West & Horsdal, 2014). The participation of people belonging to very different social categories – including those very far from some social vulnerability stereotypes – shows Adult Education becoming meaningful also in the perspective of an investment in active citizenship and not just as a means of individual empowerment in the labor market, and defines some possible action models on the territory in order to encourage to return adults to training. The target is to contribute to the discussion about the results of the policies in the public sphere, by sharing the elements of the produced analysis with the scientific community
Utilizzo di indicatori semiotico-linguistici per la lettura patemica di narrazioni di malattia.
No full textIl processo di significazione della esperienza di malattia è un processo che si organizza attraverso la mediazione di istanze soggettive, intersoggettive e culturali. Ogni malattia infatti rappresenta una rottura della propria continuità di vita, ma allo stesso tempo i significati offerti dalla medicina e dalla cultura offrono un reinserimento in processi di significazione più ampi. Diagnosi, sperimentazione, teorie e paradigmi scientifici ma anche pratiche discorsive informali sono modi attraverso cui l’esperienza di rottura e frammentazione viene ricomposta in traiettorie intersoggettive più ampie. Il processo di significazione della malattia non è un processo che si esaurisce tutto nella sfera razionale e cognitiva, ma è un processo patemico ed emotivo (Freda, 2008; Salvatore & Freda, 2011; De Luca Picione & Freda, 2012). In una prospettiva semiotica intendiamo mostrare l’individuazione e l’utilizzo di indicatori linguistici di soggettività per osservare il processo di significazione di una esperienza di malattia come una mediazione intra-soggettiva/inter-soggettiva e come modo emotivo di abitare i significati culturali. A tal proposito utilizzeremo le interviste narrative di genitori con figli affetti da disturbi di intersessualità mostrando come una diagnosi di DSD generi una rottura/discontinuità semiotica fortemente emotiva e una ricerca di significazione dell’evento al fine di ricostruire la propria esperienza nella continuità delle categorie più ampie di significazione culturale
ANALISYS OF THE MODAL ARTICULATION AMONG NARRATIVES OF ONCOLOGICAL PATIENTS: A CLINICAL REFLECTION
No full textThe narrative provides an opportunity to deal with the traumatic experience
of oncological illness (Brockmeier, 2000; Bruner, 1990; Frank, 1995; Freda,
De Luca Picione, Martino, 2015; Freda & Martino, 2015; Valsiner, 2007;
Zittoun, 2006). The crisis of meaning produced by trauma generates a
temporal discontinuity in the process of signification of the person.
Regarding the experiences, the narrator is placed in a subjective and specific
mode in the flow of time. Within a semiotic and constructivist perspective,
our aim is to explore the modal articulation as a marker of the positioning of
the subject regarding their temporal perspective organization within their
relational context. As modal articulation we intend the use of modal
semiotic operators (namely following verbs: Must, Can, to Know, Will -
Greimas, 1983; Weizsacker, 1956) within the processes of connection and
articulation of the contents of the narrative of the illness. We analyze a
corpus of 30 narratives of oncological patients linked to the temporal
models of Brockmeier with the study and analysis of the modal verbs used
by the subjects in the narrative processes. It was performed a qualiquantitative
analysis of sequences (Markova’s chains) through the T-lab
software (Lancia, 2004; 2008). It is highlighted a continuum of positioning
that goes from rigid and fixed modal polarity of meaning-making of their
experience, through levels of flexibility and elasticity, to arrive at a chaotic
and fragmented modalities. We discuss the results within a clinical
perspective aimed at grasping the possible implications in the processes of
care and subjective response to the illness
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