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This paper discusses a case vignette that captures an ethically challenging situation in qualitative research. The study was about families who had experienced a life-saving bone marrow transplantation between siblings, who were children at the time of transplantation. A difficult situation emerged during a joint family interview that took place a few years after the transplantation. Parents, donor and the recipient were present, both still children. This interview technique produced unique, rich, and nuanced data about the family dynamics, about how the family constructed relationships and identity (“doing family”). The difficulties included a confrontation of the 10-year old donor child with accusations and pejorative statements from the other family members and his sidelining from the conversation. The interviewers have been acutely aware that their presence in this situation in this moment was an intrusion into family dynamics. In his commentary, Simon Woods emphasizes a model of ethical reflexivity, which shows how reflexive researchers can incorporate moral reflection at the different stages of the research process. Tim Henning argues for a morally engaged interviewer: the researcher should not stay uninvolved and should show willingness to actually engage in a moral discourse with the participants. Since the actual harms were caused not during the interviews but long before, it may be beneficial to bring them out in the open, as a matter for discussion, painful though it may be. The authors of the vignette (Madeleine Herzog, Martina Jürgensen, Christoph Rehmann-Sutter and Christina Schües) respond to the commentaries by endorsing the model of the reflexive researcher while rejecting (for methodological and moral reasons) the model of the morally engaged researcher.

In this article, the core concepts of family-centred care will be discussed in relation to family-centred Music Therapy with preterm babies and their parents in the neonatal intensive care unit. Then, the basic pillars of a family-centred Music Therapy programme at the neonatal intensive care unit of the Hospital Centro Policlínico del Olaya in Bogotá, Colombia, will be illustrated by selected case vignettes. Parents are considered to be an important ally in caring for their baby in the neonatal intensive care unit and family-centred Music Therapy actively seeks to provide early relational and communicative experiences between parents and their babies. However, family-centred Music Therapy goes beyond the integration of parents and needs to carefully balance out the fluctuating needs of the babies, parents and the emerging relationship between them.

Background: Black people are over represented in mental health services and prescribing of antipsychotics differs by race in some countries. Our previous UK research into the prescribing of antipsychotics in large, multicentre studies found no important differences for black and white patients. However, we received several comments challenging our findings. We wanted to test the validity of these anecdotes by devising two case vignettes that differed only by race and asking prescribers to choose antipsychotic treatment. Method: A case study was sent to all medical prescribers in the South London and Maudsley NHS Trust. Half of the prescribers for each grade of staff were sent the case study where the ethnicity of the patient was white and the other half where the ethnicity was black. Participants were asked to describe what they would prescribe for the patient. Outcomes were total percentage maximum dose, high dose, type of antipsychotic, route of administration and antipsychotic polypharmacy. Results: We received 123 completed case studies and demographic data forms from prescribers. There were no differences in percentage maximum dose, high dose, type, route and number of antipsychotics prescribed by case study ethnicity. Conclusions: Prescribing for UK black and white patients is broadly similar when tested in clinical and theoretical studies.

We describe a balance beam aid for instruction in diagnosis (BBAID) and demonstrate its potential use in supplementing the training of medical students to diagnose acute chest pain. We suggest the BBAID helps students understand the process of diagnosis because the impact of tokens (weights and helium balloons) attached to a beam at different distances from the fulcrum is analogous to the impact of evidence to the relative support for 2 diseases. The BBAID presents a list of potential findings and allows students to specify whether each is present, absent, or unknown. It displays the likelihood ratios corresponding to a positive (LR+) or negative (LR–) observation for each symptom, for any pair of diseases. For each specified finding, a token is placed on the beam at a location whose distance from the fulcrum is proportional to the finding’s log(LR): a downward force (a weight) if the finding is present and a lifting force (a balloon) if it is absent. Combining the physical torques of multiple tokens is mathematically identical to applying Bayes’ theorem to multiple independent findings, so the balance beam is a high-fidelity metaphor. Seven first-year medical students and 3 faculty members consulted the BBAID while diagnosing brief patient case vignettes. Student comments indicated the program is usable, helpful for understanding pertinent positive and negative findings’ usefulness in particular situations, and welcome as a reference or self-test. All students attended the effect of the tokens on the beam, although some stated they did not use the numerical statistics. Faculty noted the BBAID might be particularly helpful in reminding students of diseases that should not be missed and identifying pertinent findings to ask for.

Objective: To assess whether willingness to disclose experience of a mental disorder and treatment, and awareness of others’ experiences have changed over a 16-year period. Methods: In 2011, telephone interviews were carried out with 6019 Australians aged 15+. The survey interview used the same questions as those of the 1995 and 2003/4 national mental health literacy surveys, in which participants were presented with a case vignette describing either depression, depression with suicidal thoughts (2003/4 only), early schizophrenia or chronic schizophrenia (2003/4 only). Participants were asked whether they had a close friend or family member who had experienced a problem similar to that described in the vignette and whether the person received professional help. They were also asked whether they had experienced such a problem and whether they received professional help. Results: The numbers of those disclosing experiences of depression and early schizophrenia, and of having received professional help for depression, have increased since 1995. Awareness of a family member or close friend with experiences of depression and early schizophrenia also increased between these years, as did awareness that the person received professional help. Conclusions: The numbers of those disclosing experiences of and treatment for mental disorders has increased in the last 16 years. This is likely to be due to increased willingness to disclose rather than increased prevalence of disorders or increased rates of help-seeking.

The search for meaning in bereavement is a topic of increasing scholarly interest. Nonetheless, literature has not yet appeared that examines the intersections of diverse theories of meaning, corresponding empirical findings, and clinical implications for counseling psychologists engaged in cancer-related bereavement psychotherapy. Meaning theories drawn from several domains of scholarship including existential, spirituality, stress, and bereavement are surveyed followed by a review of related empirical trends in the scholarship. A hypothetical case vignette is then presented to highlight potential strategies for counseling psychologists to integrate a broadened meaning-based approach to bereavement psychotherapy related to the loss of a loved one from cancer. The article concludes by identifying limitations of a meaning-based approach, as well as directions for further research.

Objective: This second paper follows an exploration of the nature of blame and addresses the balance between a ‘blame-free’ health culture and appropriate accountability. This paper aims to define and describe accountability as a key component of clinical governance and a responsive, fair and transparent health culture. Methods: The literature is examined and the concept of a fair and transparent health culture is explored. The case vignette in Part 1 is used to illustrate a particular issue of accountability. Results: The place of accountability in relation to clinicians and health organisations is elucidated. Conclusions: The necessary conditions for an accountable, responsive, fair and transparent health culture are proposed.

This paper looks at the power of professionals and carers' beliefs systems and how these can cause ‘problem saturation’ for a teenage girl, in addressing her difficulty with managing her anger. The study illustrates how the client was able to utilise the concept of externalisation in Narrative Therapy to revise her unhelpful and problem saturated story. By using the Dramatherapy notions of embodiment, story and role, a re-authored narrative was created to help the client to separate and distance herself from the dominant story. Through the dramatisation of a fairytale, the client was able to author a new story that enabled her to have a different perception of herself and increase her range of self-expression.

This paper describes the experiences of five women relating to the public performance of their work created in music therapy. Performance within this project included the recording of their work and a subsequent live performance at the launch of a CD created within the project. Programme participants were interviewed and asked to describe their experiences of the song writing process, including recording and the public performance of their work. All participants in the programme had experienced childhood abuse and as such their song creations were intensely personal and at times included painful memories. The women reported many different feelings during the recording and performance process. Overall, all participants found this process to be worthwhile. Case vignettes present the experiences of the women involved in the programme. The paper concludes with considerations for music therapy practitioners.

In this article we reflect on the use of humour in music therapy on a children's psychiatric unit. We review the current literature and, by providing detailed case vignettes, identify four characteristics of humour in music therapy in this context as well as listing the main functions of humour here. We find that humour is a highly subjective experience and that due consideration of the intention behind any use of humour by the music therapist is crucial. Awareness and attunement to one's client are considered vital when dealing with such a powerful multi-faceted phenomenon.

Upper limb hypertonicity management is a complex domain, in which there is limited high level evidence to support treatment approaches. Therefore, it is important to identify clinical experts to assist practice development. This study aimed to investigate the relationship between the factors related to clinical experience and the development of expertise in this area. Through correspondence, 29 therapists were asked to choose the most appropriate intervention for 60 case vignettes. The responses were examined using the Cochran-Weiss-Shanteau Index of Performance, and were analysed in regard to therapists' ability to prescribe differing interventions based on differences in the vignettes and on their consistency when vignettes were unknowingly repeated. The number of professional development activities that the therapists had undertaken since attaining occupational therapy qualifications was the only factor significantly associated with increased levels of expertise. The factors not significantly associated with increased expertise included therapists' work setting, years of experience and current proportion of caseload comprising hypertonicity. The results indicated that expertise gained in the area of hypertonicity was not specific to clients' age or condition because, although all vignettes presented were those of children with cerebral palsy, there was no significant difference in the expertise found between paediatric and adult therapists. Further research is warranted to investigate the forms of professional development that best support the development of expertise in this area.

The author explores the psychological dynamics of feedback to clients by examining the method and processes of organizational diagnosis and change. In so doing, the concept of the unthought known is introduced along with several other psychological concepts to help explain the clients' initial response to consultant feedback. In particular, the author submits that it is not so much that clients do not know what consultants tell them at this stage of the process of organizational change as much as it is the case that they had not thought of it. This understanding of the change process and feedback to clients has important implications for working effectively with clients' inevitable defensive resistances and anxieties. Two case vignettes are offered as illustrations of defensive resistance and the unthought known in organizational change consultations.

Based on clinical experience with Ethiopian patients referred to a Mental Health Center the authors observed a “double” cultural discrepancy: On one hand discrepancy between cultural and mourning practices as practiced by Jews in Ethiopia and Israel, and on the other between the professional team and their Ethiopian patients. The article discusses social displacement related to death, mourning customs and rituals as experienced by Ethiopian Jewish immigrants. A number of culturally sensitive elements pertinent to professionals intervening with displaced and bereaved individuals and families are identified and elaborated. Mourning rituals and customs as practiced by the Jewish community in Ethiopia, in particular, breaking bad news and purity customs are compared with those practiced in Israel which often appear to be different, and at times exemplify cultural insensitivity. Case vignettes describing the Ethiopian community in Israel are presented to illustrate complications resulting from a lack of cultural sensitivity. The importance of introducing culturally sensitive procedures involving an Ethiopian Jewish community member or a cultural broker who will similarly arrange to break the bad news to members of the community is proposed.

The recovery of individuals with very severe chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) is possible with successful multidisciplinary management. This case vignette aims to highlight the beneficial outcome of using occupational therapy lifestyle management and the Canadian Occupational Performance Measure to identify perceived problems in occupational performance and indicate change. The current management strategies in CFS/ME are discussed briefly and the challenges of the management of severe CFS/ME are described, indicating a need for a supportive team and specialist inpatient services. In 2003, the Department of Health released funds in England to develop more widely accessible CFS/ME services. This case study illustrates a positive outcome for one individual with severe CFS/ME, following admission to a specialist inpatient facility. It is hoped that it may aid other therapists working with and developing services for people with severe presentations of CFS/ME.

This article explores the important role that religion and spirituality often play in the helping relationship when a client is experiencing grief and loss. Employing personal reflection, case vignettes, and survey data, the author stresses the centrality of spiritual assessment, forgiveness, and ethical guidelines when working with people who have been bereaved.

This article examines the family roles and ethics of first-generation college students and their families through discussion of a case vignette. London's family roles applied to first-generation college students are discussed. Narrative therapy practices and an ethical model that examines the value process of counselors are explored as possible solutions.

A qualitative study, investigating the representations and explanatory models of `madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood `madness' as spiritual or physiological, whereas religious healers also held psychological models. Healers' understandings of `madness' are inextricably linked with the historical and sociopolitical context and may be useful to individuals with psychotic experiences, however, it is likely that these models are dynamic and continually changing.

This article discusses the influence of culture on human emotions and behavior and its significance in understanding the nuances of distress in intergenerational conflicts among Chinese immigrant parents and their children. In examining the differences in values and norms between the two generations, and the inherent conflicts associated with acculturation in immigrant families, this article focuses on the culturally specific experience and expression of emotions underlying these issues. Case vignettes illustrate how cultural meanings often accentuate the interpretation of antagonistic and rejecting behavior as well as how they camouflage the need for validation between parents and children. Intervention approaches that aim to resolve the emotional impasse within the families are illustrated and discussed.

In the post-welfare reform era, increased discretion has been given to frontline staff for day-today welfare policy implementation. To determine how frontline staff address the complex needs of welfare program participants in this new policy environment, the decision-making processes of welfare staff (N = 52) in 11 San Francisco Bay Area county social service agencies were assessed through a case vignette using a Web-based survey design. We examined staff decision making in four areas: problem recognition, goal formulation, information search processes, and evaluation. The results suggest that the high level of staff discretion apparent in the day-to-day implementation of welfare policy may have important implications for participants. Several recommendations for policy, practice, and future research are presented.

The aim of art therapy is to facilitate positive change through engagement with the therapist and the art materials in a safe environment. This article will explore how art therapy is used to help children with emotional, developmental and behavioural problems. It will show how change occurs during the process of physical involvement with the materials; through the making of a significant art object; through sublimation of feelings into the images; and through communication with the therapist via the art object. The article is illustrated with case vignettes which demonstrate how the theories underpinning art therapy are put into practice, drawing attention to the changes that occur as a result.

The second part of this two-section series presents three case vignettes that promote an ethical dialogue related to diagnosis within the context of marriage and family counseling. Ethical dilemmas are articulated. Important issues to consider are outlined to spark a discourse in the field on the double bind inherent in diagnosing in marriage and family counseling.

The increasing influence of third-party payers over the diagnostic and treatment practices in the field of mental health counseling has created several ethical dilemmas for marriage and family counselors. In particular, the required use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for diagnoses places counselors in the position of misdiagnosing individuals in order to provide counseling for the family. This article is the first of two and overviews some of the primary ethical dilemmas associated with diagnosis in the field of marriage and family counseling. Part 2 will introduce case vignettes and apply an ethical lens to the issues described in the overview.

This study examines the effect of students' ethnicity on teachers' educational decision making. A total of 207 elementary school teachers from a large midwestern city participated in this study. All participants were randomly assigned to one of three treatment conditions. Each group was provided with a short case vignette describing a gifted child. One third of the teachers read a vignette describing a European American student, one third read a vignette describing an African American student, and one third served as a control group and received no information about the student's ethnicity. After reading the vignette, all participants were asked to respond to two questions. The results of this study indicated that the student's ethnicity did make a difference in the teachers' referral decisions.

Surveying 60 Vietnamese patients with either current or past post-traumatic stress disorder, this article aims to phenomenologically characterize the syndrome of `hit by the wind' in a multidimensional manner. This includes determining the patient conceptualization of the disorder, profiling `hit by the wind' episodes suffered by patients in the previous month, and presenting case vignettes. Eighteen of the 60 patients (30%) suffered at least one episode of `hit by the wind' in the last month; all 18 patients had at least one episode of `hit by the wind' in the last month that met panic attack criteria. For the 18 patients, 33 episodes of `hit by the wind' that met panic attack criteria were experienced in the previous month. For these 33 episodes, the most frequently reported DSM-IV panic attack symptoms were chills (100%; 33/33) and dizziness (88%; 29/33). Flashbacks played a role in the `hit by the wind' episodes for 5 of the 18 patients (28%). In the discussion, a model of how the syndrome of `hit by the wind' generates panic is adduced; also, possible Chinese origins of the disorder are discussed.

This paper summarises the problem of the recognition and management of sepsis in in-patients. A case vignette describes a common scenario faced by trainees, in which timely and effective care is difficult to deliver. We offer suggestions for possible changes in hospital systems and care delivery that are likely to lead to better outcomes.

Resilience is the capacity to bounce back in the face of adversity and to go on to live functional lives with a sense of well-being. People can become resilient even though they may have lived in stressful and neglectful family and community environments. The author describes three case vignettes that illustrate how therapists and clients working together in a resilience framework can discover and bolster strengths that can lead to more enhanced and satisfying lives.

Stigma attached to individuals with schizophrenia may be derived from its diag nostic label. Two forms of a questionnaire were distributed to 189 Japanese university students. Each questionnaire contains case vignettes of schizophrenia and major depression. In one form, the students were told at the close of each vignette the diagnostic label assigned to that case (the label group) whereas in another form, they were not done so (the control group). The students were also asked to rate negative image of the case in four items each. The label group was significantly higher than the control group in three of the four negative image items for the vignette of schizophrenia. They did not differ in any of the negative image items for the vignette of depression. This suggests that the label of schizophrenia (the Japanese translation Seishin-bunretsu-byou) has stigmatizing effect. We discussed these findings in the light of the implications of a relabeling, and argued for a change of name.

A survey was carried out in order to ascertain the treatment approaches used in stroke care by senior I occupational therapists in the Trent Region of the United Kingdom. A random selection of these therapists was subsequently interviewed using semi-structured interviews and a case vignette in order to obtain more detailed information. Of the 83 questionnaires sent, 61 (73%) were returned; 14 therapists were interviewed. The two most common approaches identified were the functional approach and the Bobath approach. The main indications for the choice of approach were the age of the patient, progress with other approaches and discharge date. Of concern in the current climate of evidence-based practice was the high number of occupational therapists who were unfamiliar with standardised assessments and unable to describe adequately the theoretical basis for the treatment used.

This paper is an attempt to explore the psychiatric and psychological issues associated with being deaf or hearing impaired and from a minority culture. The need for and provision of mental health services for deaf children from non-English speaking backgrounds (NESB), and the adequacy of these services, will be assessed. In this paper, we aim to briefly explore psychiatric and psychological aspects of hearing impairment in children as revealed by a literature review and selected case vignettes. During this process, some of the mental health needs of deaf children and their families, and the best means of meeting these needs will be highlighted. In particular, children from NESB and their particular needs and vulnerabilities will be discussed. Brief mention will also be made of the current services available in Sydney and the adequacy or otherwise of these services. The exploration of Deaf NESB populations is the second in a series of snapshots to illustrate mental health issues for the Deaf community in Australia.

Peer culture reflects the unique social worlds children construct out of everyday experiences with one another. This study explored the peer cultures of children with diverse abilities, backgrounds, and needs—focusing on 10 children with significant disabilities—in six inclusive preschool programs. Using a multi-method approach that included both qualitative and quantitative measures, themes were generated that portrayed how children with disabilities (1) expressed the desire to participate in peer culture through a range of social-communicative and symbolic behavior; (2) experienced inclusion in peer culture by coordinating social activity and establishing reciprocal relationships; and (3) experienced exclusion from peer culture through different forms of neglect, social-communicative breakdown, conflict, and rejection. Case vignettes and quotes serve to support and illustrate themes. The findings are discussed in terms of related sociocultural influences, implications for educational practice, and future directions in research.

Our sense of self and its integrity is not a given, but is dependent on the groups to which we belong. The rapidly changing nature of work organizations since the Second World War has had a profound impact on our identity. This is explored through a number of case vignettes.

Previous research has demonstrated that client issues related to death and dying are more problematic than other serious client issues for beginning counselors. The present study attempts to ascertain whether this holds true for counselors who have considerable experience counseling on issues of death or loss, and whether counselor comfort with and empathy toward death-related situations is related to demographic, professional, or personal variables such as death anxiety. Seventy-one experienced death counselors were asked to rate their degree of comfort with a variety of presenting client scenarios. Counselors were also asked to respond to four case vignettes, two of which were death related and two of which were serious, but non-death related. Results indicated that the experienced death counselors in our study were actually more comfortable and empathic with counseling vignettes that involved death and dying issues and that their level of empathy with such clients was positively correlated with their years of professional training and years of experience with death counseling. However, our findings also suggest that counselors whose case loads consist principally of the dying or bereaved may be less comfortable and empathic with other presenting problems.

There is a long history of dream work in the psychotherapeutic and healing traditions. This opinion piece examines how dreams can open people to a deep sense of meaning. It takes into consideration the potential for dream work in relation to therapy; the processes of change, creativity and empowerment that can emerge from therapeutic work using dreams, which are illustrated through two case vignettes; and the connection between dreaming and occupation.

This case vignette relates the unknown association between systemic capillary leak syndrome, namely Clarkson’s syndrome, and acute cardiac dysfunction. ‘Central extra-corporeal life support (ECLS)’ was needed for the management of an intractable cardiogenic shock. The acute cardiac condition completely resolved within few days. Pathology showed diffuse interstitial edema within the myocardium suggestive of cardiac involvement of the disease.

Paranoid defenses appear during most analyses, sometimes with great intensity, but often subtly, and require specific analytic attention. Preoedipal conflicts, inner fears around passivity, narcissistic injury and rage, and subsequent masochistic and projective defenses lie at the core of these patients' pathology. In addition, specific cognitive, object-relational, and affective distortions reflecting multiple developmental levels emerge during analysis. A case vignette is provided to demonstrate the analysis of a neurotic patient without borderline features who showed prominent paranoid formation.

The psychiatric knowledge and skills of forty six nurses working in a general hospital in Bangalore, India were evaluated objectively using Multiple Choice Questionnaire (MCQ) and case vignettes. The results revealed that these general nurses had less than satisfactory mental health knowledge and skills. The findings highlighted the need for systematic in-service training for nursing staff in mental health problems.

This article reviews current approaches to the diagnosis and management of children with attention deficit hyperactivity disorder in a multidisciplinary setting. The physician's role in terms of data collection, formulation of the diagnosis, and discussion of findings with the parents and child is reviewed. The use of psychostimulants in this condition is reviewed, and some case vignettes are presented. ( J Child Neurol 1991;6(Suppl):S49-S65).

The authors report the findings of a study of ethical decision making using case vignettes that posed ethical dilemmas. Responses among acute-care hospital social workers, child welfare protective service workers, and students in a school of social work are compared with the help of a cost–benefit decision-making framework. Findings indicate that workers are most comfortable when their decisions meet both client wishes and organizational requirements.

The disposal of a created piece, when art has been used as a medium for therapy, is a most important stage in the therapeutic process. This article reviews the theory regarding disposal and presents case vignettes outlining a variety of approaches. These approaches are discussed and a framework for intervention is offered.

The author examines some dilemmas raised by the increasing use of clomipramine in the treatment of obsessional disorders. He presents a case vignette to illustrate some diagnostic, therapeutic and ethical concerns and suggests that by asking certain questions, pitfalls can be avoided.

This study examined attitudes toward suicide survivors. Two variables were assessed: the impact of information on attitudes toward suicide survivors and whether the survivor's relationship to the victim affects the attitudes of others towards the survivor. Sixty participants responded to one of three fictional case histories that described a child's suicide, a spouse's suicide, or a parent's suicide. Prior to reading case vignettes, thirty of the participants read an article about suicide; the other thirty read death-related but not suicide-related materials. Results indicated that suicide information did not affect attitudes toward survivors. Further results indicated that reactions to suicide survivors are generally negative and the relationship of survivors to victims affects these reactions. Children of victims were seen least negatively; parents of a child who died by suicide received the most negative reactions.

The assumed connection between exhibitionist acts and indecent telephone calls is reviewed and questioned. Four case vignettes are provided where indecent telephone calls were made without the expression of other sexually deviant behaviors.

The relationship between the use of benzodiazepines and shoplifting behaviour is reviewed. Three case vignettes are presented in which shoplifting is temporally associated with benzodiazepine treatment. The mechanisms for this association are explored and the potentialfor reduction/releasefrom criminal responsibility is noted.