Psychotherapy research is known for its pursuit of evidence-based treatment. Psychotherapeutic efficacy is assessed by calculation of aggregated differences between pre treatment- and post treatment symptom levels. As this ‘gold standard methodology’ is regarded as ‘procedurally objective’, the efficacy number that results from the procedure is taken as a valid indicator of treatment efficacy. However, I argue that the assumption of procedural objectivity is not justified, as the methodology is build upon a problematic numerical basis. I use an empirical case (...) study to show how measurement problems practically occur in the first step of data collection, i.e. in individual symptom measurement. These problems have been discussed and acknowledged for decades, but still measurement is regarded as the best epistemic means to gain evidence on psychotherapeutic efficacy. Therefore, I show how initial measurement problems are overlooked in the remainder of the methodological procedure, which harms the ‘evidence-base’ of psychotherapeutic EBT. Via this applied analysis, I exhibit concerns that are increasingly raised in the literature in an empirical way, to emphasize the need for a non-idealized consideration of the ‘gold standard methodology’ as a means towards its clinical end. (shrink)

Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores (...) that indicate no reliable change in depression symptoms with a qualitative inquiry of patients’ perspectives. Methods: The study took place in the context of a Randomized Controlled Trial evaluating time-limited psychodynamic and cognitive behavioural therapy for major depression. A mixed methods study was conducted including patients’ pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients’ interviews. Findings: From the patients’ perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients’ resistance and impossibility and the context as a source of distress. “No change” in outcome scores therefore seems to involve a “partial change” when considering the patients’ perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed. (shrink)

In psychotherapy research, treatment efficacy is commonly studied by means of self-report questionnaires to gain quantitative data on symptom development. The data serve as input for statistical analyses up to the level of evidence-based treatment. We analyzed how a patient in a psychotherapy study experienced the translation of her story into quantitative data by combining a phenomenological qualitative analysis of her therapeutic narrative and a visual analysis of her extensively annotated paper-andpencil questionnaires. Our findings provide a practical empirical illustration of (...) the nature and impact of known validity issues. Beyond, we found the act of questionnaire administration affected the primary complaint such that it became performative toward the symptoms under study. We discuss the epistemic consequences for the validity of data, and we argue that valid data collection requires qualitative scrutiny of meaning within data and a concept of validity that allows for consideration of performativity of data collection. (shrink)

With its focus on evidence, psychology has grown into a mature, professional, and scientifically supported practice over the last decades. In general, psychotherapy and psychological counselling have shown to be more efficacious than waiting it out and a staggering 350 specific treatments have been scientifically supported as effective. Although, evidencebased treatments seem to work equally well, not all people benefit from evidence-based treatments, and it often remains unclear why. This raised the field-wide concern of what works for whom and sparked (...) a wealth of research on specific ingredients, common factors, process factors, and intra- and... (shrink)

This dissertation is focused on the validity of “the data” that are collected in psychotherapy research for the purpose of evidencing treatment efficacy. In the ‘Evidence Based Treatment’ paradigm, researchers rely on the so-called ‘gold standard methodology’ to gather sound and trustworthy evidence, which increasingly influences the organization of mental health care worldwide. In the gold standard, data are collected by quantified self-report measures, to assess the presence and severity of symptoms before and after treatment. When the pre-post difference is (...) larger for a group of people that received the treatment of interest and a group of people who received no or an alternative treatment, the treatment of interest is called effective. In this methodological procedure, researchers tend to assume that when this gold standard methodology is conducted properly, “the data” will speak for themselves. However, when evidence is based on data, that evidence is principally limited by that data. In other words: output depends on input. That implies that when input is flawed, output will be flawed, even when the very best methods of analysis would be used. So what if “the data” yield validity issues despite being collected by validated measures? When “the data” do not straightforwardly evidence treatment effects, will the subsequent steps in the analysis of these data be enough to secure that the evidence in the end does evidence treatment efficacy? In this dissertation, the focus is turned to validity of “the data” that are concretely provided by patient-participants by scoring their own experienced symptoms in self-report questionnaires, in function of evidencing treatment efficacy. A series of empirical case studies were conducted to scrutinize how patient-participants in a randomized controlled psychotherapy study experienced the process of data collection, and how these experiences affected the data that they provided. Each of the studied patient-participants experienced a substantial effect of the questionnaire administration on their complaints. This impacted the level of complaints, but also changed the way in which the complaints were understood at all, and how patient-participants perceived themselves. Thus, rather than neutrally measuring symptoms, questionnaire administration changed the experienced complaints ‘performatively’, which turned measurement into a clinical intervention of its own. Consequently, what is measured cannot straightforwardly be called ‘treatment efficacy’, as it may be entangled with, enabled by or even obstructed by effects of measurement and research. Therefore, the act of measurement itself can pose a vital threat to the validity of “the data”. This way, the empirical case studies exhibited that data can yield validity problems despite the use of validated measures. Consequently, the validity of a measure as such is no guarantee for the validity of data. Nonetheless, in gold standard research, the data are straightforwardly taken as input for analyses of general treatment efficacy. The question is what happens with those validity issues on the level of individual data, when they pursue their journey towards becoming evidence. In this dissertation, it was argued that the validity issues are not sufficiently solved in the methodological steps after data collection, so when data are invalid in the beginning, these validity issues will simply become part of the data set that forms the input for analysis of the final evidence. This urges that validity issues should be solved on the level of individually provided data, as the validity issues will otherwise become inherent to “the data”. Put formally: valid data is a precondition for evidence in EBT. In conclusion, it is crucial for a sound evidence-base to scrutinize the validity of data in function of the overall goal and utility of the research. For this, it is important not to take “the data” as speaking for themselves, but to regard them as clinical narratives, which are framed in a specific format to be communicated between researcher and respondent in a research context. This emphasizes that the choice for a certain format determines what can be evidenced, so it is vital that these choices indeed allow for obtaining evidence that is useful and valid to serve the clinical goal of EBT. (shrink)

Moral philosophers agree that welfare matters. But they disagree about what it is, or how much it matters. In this vital new work, Wayne Sumner presents an original theory of welfare, investigating its nature and discussing its importance. He considers and rejects all notable theories of welfare, both objective and subjective, including hedonism and theories founded on desire or preference. His own theory connects welfare closely with happiness or life satisfaction. Reacting against the value pluralism that currently dominates moral philosophy, (...) he advances welfare as the only basic ethical value. He concludes by discussing the implications of this thesis for ethical and political theory. Written in clear, non-technical language, and including a definitive survey of other work in this area, Sumner's book is essential reading for moral philosophers, political theorists, and welfare economists. (shrink)

What does it mean for someone to have a moral right to something? What kinds of creatures can have rights, and which rights can they have? While rights are indispensable to our moral and political thinking, they are also mysterious and controversial; as long as these controversies remain unsolved, rights will remain vulnerable to skepticism. Here, Sumner constructs both a coherent concept of a moral right and a workable substantive theory of rights to provide the moral foundation necessary to dispel (...) such doubts. (shrink)

Philosophers of experiment have acknowledged that experiments are often more than mere hypothesis-tests, once thought to be an experiment's exclusive calling. Drawing on examples from contemporary biology, I make an additional amendment to our understanding of experiment by examining the way that `wide' instrumentation can, for reasons of efficiency, lead scientists away from traditional hypothesis-directed methods of experimentation and towards exploratory methods.

US Supreme Court rulings concerning sanctions for juvenile offenders have drawn on the science of brain development and concluded that adolescents are inherently less mature than adults in ways that render them less culpable. This conclusion departs from arguments made in cases involving the mature minor doctrine, in which teenagers have been portrayed as comparable to adults in their capacity to make medical decisions. I attempt to reconcile these apparently incompatible views of adolescents’ decision-making competence. Adolescents are indeed less mature (...) than adults when making decisions under conditions that are characterized by emotional arousal and peer pressure, but adolescents aged 15 and older are just as mature as adults when emotional arousal is minimized and when they are not under the influence of peers, conditions that typically characterize medical decision-making. The mature minor doctrine, as applied to individuals 15 and older, is thus consistent with recent research on adolescent development. (shrink)

Counterfactual analyses of causation can provide elegant analyses of many cases of causation. However, they fail to give intuitively correct analyses of cases involving a commonplace variety of late preemptive causation. I argue that a small emendation can solve the problem.

Quentin Smith has argued that the new tenseless theory of time is faced with insurmountable problems and should be abandoned in favour of the tensed theory of time. Smith;s main argument attacks the fundamental premise of the tenseless theory: that tenseless truth conditions for tokens of tensed sentences adequately capture the meaning of tensed sentences. His position is that tenseless truth conditions cannot explain the logical relations between tensed sentences, thus the tensed theory must be accepted. Against Smith, this paper (...) adopts an alternative approach to the explanation of the entailment relations between sentences which contain indexicals. The approach drops the reliance upon tokens and instead relies on the evaluation of sentence types with respect to a context rather than upon actual or possible utterances of tokens of the types. This (new) version of the tenseless theory of time can adequately explain the relevant entailment relations between tensed sentences. (shrink)

The paper discusses whether codes of ethics are Kantian notions through an analysis of their intention and structure. The article also discusses some of the ideas put forward by William Starr in his article, Codes of Ethics — Towards a Rule-Utilitarian Justification,Journal of Business Ethics 2(2) (May 1983).The paper refers to recent definitions of codes of ethics and considers reasons for the proliferation of such codes. It examines the moral justification for these codes and analyses the underlying ethical theory particularly (...) in relation to Kantian ethics. There is an account of how Kant''s views of the source of morality and moral obligation, the structure and nature of Kantian moral law and the role of the individual and his/her relationship with others, which is relevant to the development of a theoretical base for codes of ethics. There is some discussion of potential problems in the practical application of Kantian ethics to a specific code. (shrink)

My purpose in what follows is not so much to defend the basic principle of utilitarianism as to indicate the form of it which seems most promising as a basic moral and political position. I shall take the principle of utility as offering a criterion for two different sorts of evaluation: first, the merits of acts of government, social policies, and social institutions, and secondly, the ultimate moral evaluation of the actions of individuals. I do not take it as implying (...) that the individual should live his life on the basis of constant evaluations of this sort. For there are different levels of decision making each with its appropriate criteria. For example, we each inevitably make many of our decisions from the point of view of our own personal self-fulfilment and this cannot regularly take a directly utilitarian form, nor should the utilitarian want it to do so. His claim is at most that we should sometimes review our life from the point of view of a kind of impersonal moral truth of a universalistic utilitarian character. (shrink)

Abstract. We argue that all human beings have a special type of dignity which is the basis for (1) the obligation all of us have not to kill them, (2) the obligation to take their well-being into account when we act, and (3) even the obligation to treat them as we would have them treat us, and indeed, that all human beings are equal in fundamental dignity. We give reasons to oppose the position that only some human beings, because of (...) their possession of certain characteristics in addition to their humanity (for example, an immediately exercisable capacity for self-consciousness, or for rational deliberation), have full moral worth. What distinguishes human beings from other animals, what makes human beings persons rather than things, is their rational nature, and human beings are rational creatures by virtue of possessing natural capacities for conceptual thought, deliberation, and free choice, that is, the natural capacity to shape their own lives. (shrink)

In _Civilization and Its Discontents_, Freud made abundantly clear what he thought about the biblical injunction, first articulated in Leviticus 19:18 and then elaborated in Christian teachings, to love one's neighbor as oneself. "Let us adopt a naive attitude towards it," he proposed, "as though we were hearing it for the first time; we shall be unable then to suppress a feeling of surprise and bewilderment." After the horrors of World War II, the Holocaust, Stalinism, and Yugoslavia, Leviticus 19:18 seems (...) even less conceivable—but all the more urgent now—than Freud imagined. In _The Neighbor_, three of the most significant intellectuals working in psychoanalysis and critical theory collaborate to show how this problem of neighbor-love opens questions that are fundamental to ethical inquiry and that suggest a new theological configuration of political theory. Their three extended essays explore today's central historical problem: the persistence of the theological in the political. In "Towards a Political Theology of the Neighbor," Kenneth Reinhard supplements Carl Schmitt's political theology of the enemy and friend with a political theology of the neighbor based in psychoanalysis. In "Miracles Happen," Eric L. Santner extends the book's exploration of neighbor-love through a bracing reassessment of Benjamin and Rosenzweig. And in an impassioned plea for ethical violence, Slavoj Žižek's "Neighbors and Other Monsters" reconsiders the idea of excess to rehabilitate a positive sense of the inhuman and challenge the influence of Levinas on contemporary ethical thought. A rich and suggestive account of the interplay between love and hate, self and other, personal and political, _The Neighbor_ will prove to be a touchstone across the humanities and a crucial text for understanding the persistence of political theology in secular modernity. (shrink)

The aim of this paper is to offer an additional perspective to the understanding of educational change processes by clarifying the significance of identity learning. Today’s innovations require changes in teachers’ professional identity. Identity learning involves a relation between social‐cognitive construction of new meanings and individual, emotional sense‐making of new experiences. This relationship between cognition and emotion asks for a strong learning environment: the question is whether schools provide these strong learning environments. To answer this question, the paper provides an (...) overview of the existing knowledge about schools as contexts for teacher learning and change. It will become clear that the emotional side of the change process has been overlooked. A model for identity learning is presented, involving both meaning‐giving and sense‐making. Building on this model, it is discussed how school leaders can build strategies for the identity learning of teachers. (shrink)

In response to counterexamples involving late preemption, David Lewis (1986) revised his original (1973) counterfactual analysis of causation to include the notion of quasi-dependence. Jonardon Ganeri, Paul Noordhof and Murali Ramachandran (1998) argue that their ‘PCA*-analysis’ of causation solves the problem of late preemption and is superior to Lewis’s analysis. I show that neither quasi-dependence nor the PCA*-analysis solves the problem of late preemption.

The federal government is funding a sea change in health care by investing in interventions targeting social determinants of health, which are significant contributors to illness and health inequity. This funding power has encouraged states, professional and accreditation organizations, health care entities, and providers to focus heavily on social determinants. We examine how this shift in focus affects clinical practice in the fields of oncology and emergency medicine, and highlight potential areas of reform.

Pickering & Garrod's (P&G's) integrated model of production and comprehension includes no explicit role for nonlinguistic cognitive processes. Yet, how domain-general cognitive functions contribute to language processing has become clearer with well-specified theories and supporting data. We therefore believe that their account can benefit by incorporating functions like working memory and cognitive control into a unified model of language processing.

The present paper discusses a proposal which says,roughly and with several qualifications, that thecollection of mathematical truths is identical withthe set of theorems of ZFC. It is argued that thisproposal is not as easily dismissed as outright falseor philosophically incoherent as one might think. Some morals of this are drawn for the concept ofmathematical knowledge.

Studies concerning the relationship between religion and mental health have provided substantial evidence for the existence of a positive relationship. Nevertheless, it remains largely unclear which aspects of both religion and mental health take part in this relationship. The present study uses multiple measures of religion and of mental health to obtain a more refined view of this relationship. The results show the importance of distinguishing between if a person believes and how a person believes. Religious persons who have a (...) symbolic attitude towards religion scored higher on positive aspects of mental health. No significant results were found for negative mental health. (shrink)

While central to the Christian religion, the act of faith has been notoriously difficult to define. This essay is an attempt to illuminate, with the aid of insights from cognitive science and process philosophy, what it means for a Christian to have faith, specifically in God. In doing so, the apriori and aposteriori aspects of faith are explored, along with its connections to science and empirical evidence, revelation, knowledge, doubt, morality, and additional Christian beliefs.

We offer a critique of one prominent understanding of the principle of respect for autonomy and of analyses of medical paternalism based on that understanding. Our main critique is that understanding respect for autonomy as respect for freedom from interference is mistaken because it is overly influenced by four-alarm cases, because it fails to appreciate the full dimensions of legal self-determination (one of its main sources), because it conflates the research and therapeutic settings, and because it fails to appreciate themes (...) of authority and power that have historically shaped the principle of respect for freedom from interference. We argue that respect for autonomy involves more than just freedom from interference and, on this basis, offer a critique of prevailing accounts of medical paternalism. (shrink)

L. Stasyuk «Projection of Humanistic and Reformational reception in Protestant Ortodoxy». There is performed a philosophical and theological reflection of the process in which main subjects of Renaissance and Reformation changes adhere to the principle of getting back to sources such as appeal, thorough rethinking, borrowing of the antique heritage within which a foundation of the Humanism philosophy is laid, as well as to the Holy Scriptures and to the teachings of spiritual and religious leaders of Christianity. There is made (...) a comparative analysis of the attitude to the antique philosophical and medieval scholastic achievements and to the philosophy as a way of thinking generally by representatives of Humanism and Protestant Orthodoxy which typify the spiritual paradigm of European history. (shrink)

The contributors to the volume discuss various approaches to bioethical thinking and the political and institutional contexts of bioethics, addressing underlying concerns about the purposes of its practice.

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must give (...) “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation passed by Parliament in March 2021 open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios. (shrink)