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Conversation Escalation Make Small Talk Sexy

In this ground-breaking program you'll learn the subtleties of conversation to pinpoint the specific problems that are ruining your chances with women. You'll learn how to draw people out to talk about more interesting topics in a more natural way instead dragging it out of them. And the mindset tricks so that you can Always be in the zone with women whenever you're talking to them. What's unique about this course is that its based on examples and application and is filled with hundred of little bite size game changers that you'll be able to see an immediate impact on your conversations tonight. Read more...

Conversation Escalation Make Small Talk Sexy Summary


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Special Autopsy Techniques

The surgeon or one surgical assistant who participated in the operation should attend the autopsy. If this cannot be arranged, a telephone conversation, prior to the autopsy, between pathologist and surgeon is essential. Frequently, the main questions of the surgeon are not at all obvious from the written notes.

Research Vs Clinical Care Instruments

To illustrate this concept further, consider the following set of events, which actually occurred. A conversation with a colleague revealed that her division had recently switched pain assessment tools because validity data seemed to be better in studies of populations similar to the clinic's population. To the dismay of this colleague, the division had switched back to the old scale because it was so commonly used in studies in the rheumatology field. There was concern that studies submitted for review might be jeopardized by using a scale that was less common or less familiar to potential reviewers. At a bureaucratic level, the fundamental importance was on recognition of an instrument rather than on the quality of the pain assessment.

Learning in Adulthood

As was emphasized earlier in the chapter, maintaining an interest in the physical and social environment and continuing to use one's problemsolving skills can help arrest declines in intellectual functioning with age. Whatever their age may be, adults who keep up with current events and continue to explore their world through reading, conversations, course work, and hobbies experience less decline in cognitive abilities (Jarvik & Bank, 1983 Schaie, 1983 Siegler, 1983). Furthermore, the effects of heredity on cognition abilities persist into late life. Environment and heredity are equally influential in the ability to think and remember even after age 80 (McClearn et al., 1977).

Crosscultural Issues And Spirituality

To the Muslim, God is the ultimate healer. Islam teaches that the patient must be treated with respect and compassion, and that the physical, mental, and spiritual dimensions of the illness must be taken into account. Many Muslims invoke the name of God in daily conversation, pray five times a day facing Mecca, and wash prior to prayer. They believe that their actions are accountable and subject to ultimate judgment (16).

Autonomy Of The Dying Person Best Interests And Substituted Judgment

Shared values of a hypothetical ''reasonable'' person. Factors such as relief of suffering, the usefulness or futility of an intervention, risks, benefits, and burdens are considered to provide an objective test. Such considerations may or may not reflect a patient's own preferences. By contrast, the substituted-judgment standard calls on surrogates to replicate the decision the patient would have made had the patient been capable. A substituted-judgment decision is based on the patient's own values, beliefs, and treatment wishes. For this reason, it is called a subjective test. The better a patient's own views and anticipated treatment decisions are known, the greater the likelihood that the surrogate decision can replicate the patient's decision. Patients may express their views through living-will documents, through conversations about the experiences of others, or through subscription to sets of beliefs, religious or not. Some persons may not have expressed such views or not have...

Threats to patient privacy in the health care setting

There are many ways in which the provision of modern health care and the machine of modern medicine can invade privacy. The use of wards to care for patients provides an example. A system that places patients together in the same room with no separation between them save a flimsy curtain affords easy access to their persons, yet some of the most personal moments of one's life are experienced in hospitals. Conversations about diagnosis, prognosis and treatment can be overheard, notes are left at the end of patients' beds where they can easily be read, and generally, the practice of everyday medicine is conducted before an audience consisting not only of other patients, but also of their families and friends and other visitors to the institution. The position is not much an unreasonably intrusive investigation was directly actionable as an invasion of privacy. Similarly, in Shulman v. Group W. Productions Inc.5 the California Supreme Court upheld as triable the plaintiff's argument that...

Entitlement And Ethics Economics And Incommensurability

The language of entitlement we choose to use in this context has enormous ethical consequences. The range of options we have where this choice is concerned, and how far ethical issues can enter the conversation here, and on what terms, are all strongly influenced by recent technological advances which render copying cheap, easy and difficult to police. According to the president of the Pharmaceutical Manufacturers Association, Gerald J. Mossinghoff, in 1986 it took a company about ten years, spending over US 125,000,000, to discover, test and secure approval for a new drug in the United States (Mossinghoff, 1987). But another pharmaceutical company in a country where patent protection differs from that in the United States may be able to lawfully copy and sell this drug for the equivalent of a few United States cents. Pfizer, the multinational pharmaceutical company, reported in 1986 that whereas it had sold US 47,000,000 worth of specific pharmaceuticals in one year, 'pirates' who...

The Language of Direct Experience

Egocentric deixis directly encodes the perspective of the speaker. The spatial position of the speaker becomes the deictic center or here. Locations away from this deictic center are there. In face-to-face conversation, the deictic center can include both speaker and listener as a single deictic center. In this case, here can refer to the general position of the speaker and listener, and there can refer to a position away from the speaker and listener. Other terms that are grounded in the self's position and perspective include forward, backward, up, down, left, and right.

Understanding the Question

Yet understanding the words themselves gets the respondent only so far. Respondents must then discern the pragmatic meaning of a question. Often, a question that is clear in a literal sense can be interpreted in many different ways. When interpreting questions, respondents may try to infer what the experimenter had in mind. As Schwarz (1996) and others (e.g., Clark & Shober, 1992 Tourangeau et al., 2000) have noted, these inferences are often based on norms regarding how a conversation should progress (see Grice, 1975, 1989, for a detailed discussion of these principles). For instance, conversation participants implicitly expect that their counterparts will not provide nor expect redundant information. Thus, respondents who come across two similar questions in the same questionnaire may assume that the experimenter meant something different with each question unless there is some plausible explanation for the repetition. Strack et al.'s (1991) study provides important insight into the...

Learning To Interview

There are many ways to teach interviewing skills. In the interviewing class taught by the first author (Handler), students first practice using role playing and psychodrama techniques. Then they conduct videotaped interviews with student volunteers, and their interviews are watched and discussed by the class. Students learn to identify latent emotions produced in the interview, to handle their anxiety in productive ways, to manage the interviewee's anxiety, to go beyond mere chitchat with the interviewee, and to facilitate meaningful conversation. Students also learn to examine relevant life issues of the people they interview to conceptualize these issues and describe them in a report to ask open-ended questions rather than closed-ended questions, which can be answered with a brief yes or no to reflect the person's feelings and to encourage more open discussion.

The Use Of Gnotobiotic Animals In Studies Of The Gastrointestinal Microbiota In Farm Animals

Gnotobiotic animals proved to be a very useful model for studying the physiology of the digestive tract. They mainly enable observation of the role of microorganisms in the process of the functional and morphological development of the digestive tract and the investigation of bacterial interactions and their influence on the macroorganism. A key experimental strategy for defining the conversations that occur between microorganisms and their hosts is to first define cellular function in the absence of bacteria (under germ-free conditions) and then to evaluate the effects of adding a single or defined population of microbes. The power of germ-technology lies in the ability to control the composition of the environment in which a multicellular organism develops and functions. The combined use of genetically manipulatable model organisms and gnotobiotic has the potential to provide new and important information about how bacteria affect normal development, establishment and maintenance of...

Diseases of the Esophagus

Hypopharyngeal Carcinoma Barium Swallow

And his grandchildren have been complaining about grandpa's bad breath. He has brought one of them with him to help out with the test. Paul is just getting his first instructions on the art of fluoroscopy, the realtime x-ray examination of the intestinal tract. Dr. Llewellyn, a dyed-in-the-wool, old-school specialist in gastrointestinal imaging, watches him carefully while he sets out to do the examination. The clinical information given by Wiggle's general practitioner and the conversation with Mr. Wiggle as well as the young man who accompanies him have not provided any definite clues as to what is going on.

Impact of Cultural Values

Misunderstandings within the therapeutic relationship not only occur because of the language-related issues covered earlier, but result as well from differences in the experience and expression of affect. As indicated, Indians and Natives are less likely to separate aspects of themselves such as their physical, mental, and social selves (Richardson, 1981). Typically, affect is more contextual and related to interpersonal difficulties rather than the ego-oriented, context-less self-statements of dysphoria (e.g., I feel blue) or worry (e.g., I fear things) (p. 490) present in more egocentric cultures (Manson, 1995). Discussing difficulties in determining the presence of depressed affect among American Indian Vietnam Veterans, Norton (1997) wrote, It is as if the interviewer and veteran are having two separate conversations, the interviewer is asking about an interior life of emotions, and the veteran is telling her about an outer life of social relationships (p. 26). Thus, if a...

Some Alternative Metrics

Even though many of our most popular constructs are attitudes (e.g., job satisfaction, organizational commitment, justice), little work has been done on accessibility within the field of I O. When a participant in a study answers Yes to the query, Are your coworkers boring we do not know whether they constantly evaluate their coworkers as boring and avoid them as much as possible, or whether they just escaped from a long and boring conversation with colleagues. Of course, on average, we'd expect people with more negative overall evaluations to respond affirmatively more often. However, the modest relations between attitudes and relevant behaviors suggest attention paid to accessibility of attitudes might pay substantial dividends in the strength and generality of relations between job attitudes and behaviors. It is also possible that less-accessible attitudes represent an independent pool of variance that is reliably related to different outcomes than chronically accessible attitudes.

Linguistic Inquiry and Word Count

Negative life experiences that predict subsequent health improvements (Pennebaker & Francis, 1996 Pennebaker, Mayne, & Francis, 1997). More recently LIWC has been used to analyze language use in a wide variety of text sources including literature, personal narratives, press conferences, and transcripts of everyday conversations (Pennebaker et al., 2003).

Framing The Problem 21 Life in the Grid City

The intervention described here aims to retrofit the layout of the grid city by integrating public gathering places into the public realm. These gathering places aim to reinstate the town commons that historically had been the geographic glue of community stewardship. These restorative public places with interactive art installations are intended to inspire a sense of belonging and identity, trigger conversations among strangers, spark creativity, cultivate civic capacity, and even stimulate local economic vitality. These commons are essential parts of the democratic process to facilitate collective responsibility and tolerance. The approach has been implemented by the local non-profit organization The City Repair Project, and has been field-tested and evaluated at numerous sites.

Auditory Nerve Pathways

Equilibrium Pathway Ear

On the decibel scale, a whisper has an intensity of about 40 dB, normal conversation measures 60-70 dB, and heavy traffic produces about 80 dB. A sound of 120 dB, such as that commonly produced by the amplified sound at a rock concert, produces discomfort, and a sound of 140 dB, such as that emitted by a jet plane at takeoff, causes pain. Frequent or prolonged exposure to sounds with intensities above 90 dB can cause permanent hearing loss.

Study Skills For Anatomy And Physiology

Recording and recitation An auditory learner can benefit by recording lectures and review sessions with a cassette recorder. Many students listen to the taped sessions as they drive or just before going to bed. Reading your notes aloud can help also. Explain the material to anyone (even if there are no listeners). Talk about anatomy and physiology in everyday conversations.

Causes and symptoms

IED is characterized by violent behaviors that are impulsive as well as assaultive. One example involved a man who felt insulted by another customer in a neighborhood bar during a conversation that had lasted for several minutes. Instead of finding out whether the other customer intended his remark to be insulting, or answering the insult verbally, the man impulsively punched the other customer in the mouth. Within a few minutes, however, he felt ashamed of his violent act. As this example indicates, the urge to commit the impulsive aggressive act may occur from minutes to hours before the acting out and is characterized by the buildup of tension. After the outburst, the IED patient experiences a sense of relief from the tension. While many patients with IED blame someone else for causing their violent out-

Auditory Scene Analysis

The root of the auditory scene analysis problem is derived from the inherent complexity of our everyday acoustic environment. At any given moment, we may be surrounded by multiple sound-generating elements such as a radio playing music, or a group of people speaking, with several of these elements producing acoustic energy simultaneously. In order to make sense of the environment, we must parse the incoming acoustic waveform into separate mental representations called auditory objects or, if they persist over time, auditory streams. The problem is compounded by the fact that each ear has access to only a single pressure wave that comprises acoustic energy coming from all active sound sources. The cocktail party problem, which is a classic example of speech perception in an adverse listening situation, can therefore be viewed as a real-world auditory scene analysis problem in which individuals must attempt to separate the various, simultaneously active sound sources while trying to...

The Behaviour of a Liar

Researchers have examined a variety of different non-verbal behaviours, including gaze aversion (looking away from the conversation partner), smiling, illustrators (hand and arm movements that accompany speech and illustrate it), self-manipulations (touching or scratching body or face, playing with own hair, playing with objects), subtle movements of hands and fingers, speech rate, pauses in speech, speech latency (period between question being asked and answer being given), speech fillers (um's and er's), stutters (repetitions of words, correcting sentences, and so on), and pitch of voice. Vrij (2000) reviewed more than 40 studies concerning such behavioural indicators of deception. The review revealed that deception is not related to a unique pattern of specific behaviours. In other words, there is nothing like Pinocchio's nose. Some behaviours, however, are more likely to occur during deception than others. Liars tend to speak with a higher-pitched voice, speak slower, pause longer...

Countertransference issues

The exchange of information and the professional conversation around genetic counselling is a human encounter in the service of the patient but, the counsellor is also there as a real person. The experienced and secure counsellor will have little difficulty acknowledging personal reactions but, sometimes, the less experienced or insecure can regard their personal emotional reactions as a lack of professionalism which needs to be hidden or denied. All counsellors are at risk of being disturbed at some point or another and they may experience physical sensations or feelings. Headaches, tiredness, or being depleted or stressed are common physical complaints depression, anxiety or feeling unexpectedly angry, common emotional reactions. These feelings and sensations are unpleasant but can be understood, alleviated or even prevented by a deeper understanding of the delicate, interactional processes by which individuals affect one another. This involves addressing counter-transference...

Frontotemporal Dementia

Supportive behavioral features include a decline in personal hygiene, mental inflexibility, distractibility, hyperorality, stereotyped behavior, and stimulus-bound utilization behavior. Cognitively, FTD patients have impairments of executive cognitive function including difficulties with planning, sequencing, and set shifting. However, early in the disease course, orientation, memory, and visual-spatial skills are preserved. Typically, these behavioral and cognitive symptoms are associated with decreased speech output, characterized by FTD patients not initiating conversation as often when they do respond to questions, they often reply only in short phrases or stereotyped utterances. Rarely, the opposite can occur and patients may monopolize conversations. Decreased speech output progresses to mutism over time in most patients. Incontinence and primitive reflexes, such as grasp, snout, and sucking reflexes, are common.

Acoustic Measures of Abnormal Voice and Speech in Parkinsons Disease

They found that vocSPL declined more rapidly in PD than in normal, age-matched speakers during syllable repetition speech diadochokinesis (DDK) . They also found that in some of the individuals with PD, there were abnormally abrupt changes in vocSPL during conversation. However, during sustained vowel phonation, vocSPL did not show decay more than that of normal controls. Some early studies (36,37) did not confirm a reduction in vocSPL even though the speech of individuals with PD was perceptually characterized by reduced loudness. The reasons for these discrepant findings are not clear. The presence or absence of vocal decay in parkinsonian speech is related, at least partially, to the specific speech task being performed (35), as well as to the severity of hypokinetic dysarthria (34).

S Risks Risk Minimization and Prophylactic Measures

Radiographers Causing Harm Patients

The starting point is different for every patient. Because of the radiation dose incurred, computed tomography of the abdomen in a young woman three months pregnant will only be performed in a life-threatening emergency, for example, after severe trauma to the abdomen. In an elderly cancer patient scheduled for radiation therapy, on the other hand, the radiation dose administered during an abdominal CT is without clinical relevance. The cancellation of a study naturally also carries risks a tumor may go undetected or an inadequate or wrong therapy might be chosen. Thus there are many reasons to take the time for a comprehensive and personal conversation with the patient and to remind yourself of the risks and relevance of your own actions. In most countries, obtaining signed informed consent of the patient or his her legal representative (e.g., for children) is an obligatory prerequisite prior to performing procedures that carry a higher risk (administration of contrast media,...

Other Forms of Momentary Data Capture

Finally, investigators have developed means of sampling the auditory environment of individuals as they go about their normal activities, including conversations with others as well as ambient sounds (Mehl & Pennebaker, 2003). From these short recordings, made by a specially modified

Cartwright D S 1957 Annoted Bibliography Of Research And Theory

Changing conversations a constructivist model of training for psychotherapists. In G. Dunnett (ed.), Working with People Clinical Uses of Personal Construct Psychology (pp. 140157). London Routledge. Thomas, L. & Harri-Augstein, S. (1983). The self-organized learner as personal scientist A conversational technology for reflecting on behavior and experience. In J. Adams-Webber & J.C. Mancuso (eds), Applications of Personal Construct Theory (pp. 331-363). Toronto Academic Press.

Experiences from Daily Practice

Even if the indication for HAART seems obvious, a conversation with the patient should clarify whether he or she is indeed prepared to start treatment. The problem is not the initiation of HAART, but its continuity, day after day, month after month. The decision to initiate treatment is often made prematurely. In some cases, patients put themselves under pressure unnecessarily, or let others do so. A single lower CD4 count value, a prolonged case of flu seeming to indicate a weakened immune system ( I never had anything like that before ), springtime lethargy, new study results, a promising new drug in the newspaper ( I've heard so much about X ), a partner who has started therapy - none of these are indications for initiation of treatment.

Sex Differences in Friendships

Not only do women of all ages have more friends than men, but the nature and functions of those friendships are different. Women are more likely to initiate social interactions both within and outside the family and to develop deeper and longer-lasting friendships than men (Dickens & Perlman, 1981 Wright, 1989). Compared with men, women are more socially interdependent and more likely to engage in self-disclosure (Gilligan, 1982). Their friendships are characterized by the sharing of feelings and concerns and the giving and receiving of emotional support and suggestions (Fox, Gibbs, & Auerbach, 1985 Reisman, 1981). They talk more often and more openly and intimately to their friends, using conversation to make connections and share Unlike women, men base their friendships on shared interests and activities, such as going fishing, drinking and telling stories, and engaging in competitive sports and other minicompetitions. Whereas women explore relationships in their conversational...

Unravelling family conflict around testing for a genetic disorder

The consultation began with introductions and the history of the disorder. The mother was the main spokesperson, with the father agreeing and seeming actively-involved. The counsellor then spoke to Andrew the older boy and asked when he had been told about the family history. The conversation continued as follows.

Practice makes perfect

But the most important was, to my surprise, Patch Adams' autobiography3. Put the Hollywood interpretation out of your mind and focus on Adams' central skill how to connect with anyone, instantly. He did this by constantly practising and putting himself in unusual situations. He conducted his favourite ''assay'' in lifts. How many floors would it take for a conversation with a complete stranger in the confines of an elevator to arrive at a personal and meaningful topic By putting himself in such situations and trying many different techniques, he developed his own highly effective style.

Implications Of These Frameworks For Analysis Of Genetic Issues

The complexity of the BRCA1 and BRCA2 breast cancer mutations is another case of providing genetic information in a situation of great uncertainty, misconception and misunderstanding. There is disagreement about the risks associated with the mutations and about prophylactic treatments that might be appropriate. A good case of impulsive and misguided action in such a situation is that reported in the Jerusalem Post of a thirteen year old girl who got pregnant, believing that this would protect her against the cancers predicted for those with the BRCA mutations (Shiloh, 1997). Given the complexity and uncertainty of genetic information, as outlined above, health care providers cannot be seen as neutral dispensers of genetic information and procedures. There needs to be careful conversation about the meaning of genetic information, about the accuracy and predictability of such information and it needs to be explained and understood in the lived context of those who must make the...

Personal History of Untreated Depression or Anxiety or Prior Suicidal Ideation or Attempt

However, because people who present for cancer genetic counseling are representative of the general population, about 10 to 25 may have a personal history of mental health problems, and some will be untreated (59). Many cancer genetic centers, as part of a larger facility, administer questionnaires that assess current mental health as part of the intake. However, it is also part of the psychosocial assessment during the initial counseling session, and when untreated mental health problems are identified, many counselors frame the conversation as one of readiness as they encourage patients to seek mental health-care services prior to learning their result. If the patient is already connected with a therapist, in some circumstances, with the permission of the patient, that therapist can be included in the provision of the result to assure that the patient response will be as healthy as possible.

Suggested Outline of Sections The Clinical Interview

The test situation may reflect in microcosm the psychological and behavioral functioning of the patient in daily life. Consequently, the psychologist's conversation with the patient has a special purpose and is not idle and random. Both the test material and the interview stimulate responses from the patient that can be analyzed to provide insight and understanding about the patient's internal conflicts and problems with interpersonal relating. Thus, the interview is designed in such a manner that the first hypotheses about the patient's particular personality construction are distilled from it.

The structure of the interview

Time, with an attitude appropriate to an understanding relationship, creates somewhere different where the conversation is different, and people can talk about extremely painful issues. With this approach patients can bring what is relevant of their lives into the genetic counselling consultation. The interview may offer a freedom to talk meaningfully but, paradoxically, the freedom can only exist within the containment and boundary of a time limit. The function of maintaining a time frame is not simply a rigid framework which makes sure others are not kept waiting, as it is a way of containing anxiety.

A fathers attempt to protect his child from experiencing a disappointment similar to his own

These extracts of the conversation between the counsellor and the family reveal the amount of anguish the father felt. Hospital visits for monitoring would be a reminder that his child could have the same disorder as himself and that she may have to confront the same issues. The over-riding theme was that the father did not want his daughter to have her heart broken and prevented from fulfilling a dream. His greatest desire was to protect his child from future emotional pain and to relieve himself and his wife from the pain of uncertainty. The counsellor had a considerable task of laying the debate in front of the family and working within the context of the particular experiences and individual life story. The most obvious intervention for the genetic counsellor was educative, presenting the ethical dilemma of balancing the child's right to privacy against the parents' right to know and, to observe the effect of that educative intervention. The theme which repeatedly emerged in the...

Interviewing Those Suspected Of Crime

Gudjonsson (2002) is one of the few researchers who has successfully contended, in court cases, that interviewees have been adversely affected by tactics. However, almost no research has gathered information about this from suspects themselves. Holmberg and Christianson (in press) recently conducted a pioneering study involving a questionnaire completed by men who were in prison for murder or for serious sexual offences. This postal questionnaire involved the prisoners rating, on seven-point scales, their judgements perceptions of the behaviour manner attitudes of the police officers who had interviewed them during the (relevant) investigation. The questionnaire also asked the prisoners to rate their emotional reactions to the interviewers' behaviour. The data revealed that only a few 'perceived their interviewers as having shown a great personal interest and having tried to create a personal conversation' or 'perceived their interviewers as highly sympathetic and empathetic' (p. 10)....

Drug Discourses Functional Or Dysfunctional

A Scottish Office-funded study reported by Davies1 (1997b, 1997c) analysed minimally structured conversations with drug users in the Central Belt of Scotland, SouthWest Scotland, and the North-East of England. Initial (first) interviews were carried out with 275 subjects second follow-up interviews with 197 of these and third interviews with 76. All interviews were cued by the question 'So what are you on, what are you using at the moment ' Thereafter, the interview took its own course, but with the interviewer exploring any attributional statements that emerged. All interviews were tape recorded, transcribed in full, and coded for attributional content. The full details of the process are given in Davies (1997c) together with the dimensions derived, and the inter-rater reliabilities. Regression analysis of the dimensions suggested that five different conversational types could be identified reliably. The full typology is given in Davies (1997c) but may be summarised briefly as...

Institutional Management

From an urban planning perspective, there are three primary organizational relationships that define intra- and inter-organizational relationships that apply to urban health agencies and researchers dealing with other agencies or organizations cooperation, collaboration, and conflict (following Gaber, 1996). The first type of response, cooperation, is more reactive, and would for example occur when urban health professionals provided information when requested and insulation from urban design, economic development, or other urban planning researchers, practitioners, or policy makers. Cooperation might also be the response from urban planning agencies or researchers when approached by urban health professionals or scholars. The second type of behaviour, collaboration, entails a more proactive approach, for example, urban health professionals initiating conversations and then working with urban planning agencies to develop standardized procedures and data reporting methods across health...

The elements of a therapeutic professional relationship

The term 'potential space' is related to the 'facilitating environment' and is the interactional space created within the relationship. It is a shared space where the conversation takes place and an understanding of each other can be achieved. It refers to the potential for exploration, thought and creativity to develop when there is a degree of confidence, trust, interest and reliability in the relationship. Winnicott quotes the importance of the capacity of 'if I were in your shoes ' and in so doing is pointing out that the essential ingredient in establishing a 'facilitating environment' with 'potential space' is empathy.

Proxy Designation Clause

The range of expression of one's wishes can, at one extreme, amount to an oral advance directive before witnesses or, at the other extreme, to very indirect and indeterminate accounts about expressions of preferences. Letters, diaries, messages, and reports of formal or casual conversations with family, friends, clerics, and professionals (social workers, lawyers, health care providers) form the primary sources for this information. The credence that decision makers give to such information can range from full confidence to having little or no force. We all know of situations where a person says, ''I would not want to be kept alive like that,'' but what status or significance such remarks will have when they are brought to the attention of those asked to exercise ''substituted judgment'' rightly will have everything to do with the context and the extent, gravity, depth, force, and consistency with the subject's value set about life that the collection of remarks (testimony) reflects....

Preventing Promoting And Maintaining

Collective meaning systems and so contributes to the experience of ''decultur-alization,'' can offer little guidance about what it means to grow old (T. R. Cole, 1997). This conversation is foundational to calls to draw on the elder's own strengths. Thus, families and communities have a moral responsibility to recognize and elicit these strengths, both as resources for elders' well-being and as barriers against needless deterioration of their mental health. Further, Gutmann's (1992) observations about the devastating effects of ''deculturation'' on the older population would argue for the ethical desirability of cultural and communal interventions, such as efforts to restore or create anew significant roles and responsibilities for elders in their communities.

Michael J Spivey Daniel C Richardson and Monica Gonzalez Marquez

Use, e.g., descriptions of far away scenes, gossip about people who are absent, discussions of abstract concepts, do not involve explicit reference to visible elements of the situational context of the conversation. Will scanning of the visuo-spatial backdrop that is available to a listener be at all relevant during comprehension of language that refers to things that are not copresent Is space as important to language as the objects that fill it up

Preface to the First Edition

I also have been lucky to have had conversations or correspondence with many individuals who gave me useful information, their unpublished works, letters, insights, and important references. Among them, I am grateful to Bill Atchley, David Wake, Bj rn Kurten, Lars Werdelin, Steve Orzack, John Maynard Smith, Brian Charlesworth, Michael Bell, Pete Bretsky, Gabriel Dover, Steve Farris, Steve Stanley, Doug Futuyma, Walter Eanes, Curt Teichert, George Oster, Richard Reyment, J rgen Sch bel, Max Hecht, Russell Lande, Art Boucot, Ledyard Stebbins, Vjaldar Jaanusson, Ernst Mayr, George Gaylord Simpson, Jack Sepkoski, and Urj Haila.

Who attends the consultation

The questions which have been proposed are examples of what family therapists call 'circular interviewing'. The interviewing technique follows a circular or spiralling pattern where the feedback to the counsellor's question shapes the next question and so on. The counsellor is then both conducting the interview and responding to the family. It is perhaps important to point out that the technique applies to the conversation between counsellor and individual as it does to the interaction between counsellor and family.

Developments in family therapy from neutrality to curiosity the use of narrative and a notknowing position

Narrative therapy also links with modern psychoanalysis and, as Larner (2000) has pointed out, the narrative journey is undertaken in the context of a two-person relationship. The term inter-subjectivity is used to describe this conversation between two people. The modern analyst no longer behaves like a blank screen interpreting from a position of expertise but, like the family therapist, is interested in developing a conversation where the analyst is collaborating with their patient to jointly develop an understanding together (referred to earlier as co-construction in Chapter 4). These ideas from family therapy and psychoanalysis are in sympathy with the aim of genetic counselling where the collaborative conversation is directed towards helping the patient develop a narrative about their personal genetic inheritance. The most recent development in both family therapy and psychoanalysis is the adoption of a position of'not-knowing'. This is not a position of ignorance, but means...

An Algorithm For Determining The Underlying Causes Of Behavioral Problems

Of course, problematic behaviors produced by overstimulation are generally approached by reducing the level of stimulation impinging on the person with dementia. Long-term care units can often be extremely noisy places, with call bells and alarms ringing throughout the day. Playing music can be a cause of overstimulation if it is too loud, especially if the music being played fits the tastes of staff as opposed to residents. Music played during meals should be subtle and subdued. Trying to have a meal and a conversation in an atmosphere that is too noisy is an uncomfortable experience, whether dining out in a restaurant or having lunch on a long-term care unit.

Optimal Endoflife Care

By far, the majority of patients highly prioritize comfort as a goal throughout the course of illness. However, patients with germ cell tumors, often being young, are also likely to be willing to undergo aggressive treatment regimens, including early experimental trials with curative goals. This stance may change over time in the setting of disease progression and certainly should never be assumed. Health care providers will need to be knowledgeable about the state of developing therapies for germ cell tumors but also about how to treat symptoms, whether the symptoms occur as part of the disease or as unusual side effects of novel treatments. With a patient who chooses to consider a clinical trial, frank conversations, prior to the patient's enrollment, about the goals of care and the purpose of research with human subjects are important to ensure truly informed consent and to prevent any therapeutic misconception on the part of the patient and the patient's family. Physicians caring...

Sensorimotor and Perceptual Deficits Underlying Motor Dysfunction in Parkinsons Disease

Ho et al. (27) compared voice loudness perception in individuals with PD and hypophonic dysarthria with that of neurologically normal speakers. They found that unlike the normal speakers, the patients overestimated the loudness of their speech during both reading and conversation. They interpreted these findings to suggest that either impaired speech production is driven by a basic perceptual fault or that abnormal speech perception is a consequence of impaired mechanisms involved in the generation of soft speech. The latter explanation may be related to the phenomenon of central inhibitory influences of the vocal motor system, via feed-forward mechanisms, on auditory cortical activity during self-produced vocalization.

Communication Problems

Communicating with persons with dementia is often challenging as expressive and receptive communication skills decline over the course of dementing illnesses. Interventions in this area focus on caregiver training and or enhancing the abilities of persons with dementia. Several programs to enhance caregivers' communication skills with persons with dementia have been developed (e.g., Bourgeois, 1992a, 1992b, 1997 Clark, 1997 Orange & Colton-Hudson, 1998 Orange, Ryan, Meredith, & MacLean, 1995 Richter, Roberto, & Bottenberg, 1995 Ripich, 1994 Ripich, Kercher, Wykle, Sloan, & Ziol, 1998 Ripich & Wykle, 1996 Ripich, Wykle, & Niles, 1995 Tomoeda & Bayles, 1990). Most involve educating caregivers about changes in communication abilities that accompany dementia. As part of this education process, caregivers are shown how previous communication styles must be adapted and new ways of communication must be developed to communicate more effectively with the individual with dementia. For...

Samples of Behavior

Throughout the testing sequence, different samples of the patient's behavior are generated in response to questioning, conversation, and test administration. Each approach taken with the patient, including those afforded by different testing techniques, evokes samples of the patient's ways of responding, defending, and functioning. What this unequivocally reveals is that the behavior of the patient during the clinical interview is not random and is certainly not extraneous information. Rather, the interview is a purposeful way of obtaining a sample of the patient's behavior in order to develop a beginning understanding of the patient's total experience.


Sometimes a psychotic patient's weakened ego controls are expressed through mood and affect that are inappropriate to the conversation taking place with the interviewer. For example, inappropriateness of affect may involve laughter in connection with a discussion of sad events, as distinct from smiling or nervous laughter signaling anxiety, a display of noticeably bizarre features in the patient's emotional expression, or in a sustained hypermanic enthusiasm and pressure. Such affective disturbances can provide broad diagnostic discriminations as to whether a psychotic process exists.


A second pitfall the reader should be careful to avoid is rejecting the relevance of the examples used in this chapter. Some might argue that the pathological patterns seen herein exist only in data from meta-analyses or reaction time experiments, or in educational data. Our own work with many types of data sets, and in conversations with psychologists in numerous specializations, suggests that these are not isolated or bizarre data sets but are quite common patterns. The reader is encouraged to reanalyze his or her own data using some of the techniques provided here before making judgments about the prevalence of messy data.

Brian Mac Whinney

Grammar emerges from conversation as a method for supporting accurate tracking and switching of perspective. This hypothesis builds on recent advances in cognitive linguistics, embodied cognition, cognitive neuroscience, anthropology, and developmental psychology. The Perspective Hypothesis represents a particular case of a more general type of analysis called emergentism (MacWhinney, 1999b, 2002). The general emergentist framework views emergence as operative on five time levels. The current article focuses on the online emergence of perspective during conversational processing, as highlighted in point (3). Developmental aspects of the emergence of perspective marking are discussed elsewhere (MacWhinney, 1999a).


These activities allowed the neighbors to build social capital and to create a public square where neighbors and by-passers can interact to get to know each other. By building social relationships and mutual cooperation around collective problem solving, they embarked on an urban experiment to modify the physical design of an intersection in the grid city, as a manifestation of reclaiming the neighborhood. These new features were designed for everybody to enjoy the richness of the urban experience at the Sunnyside Piazza. The community art projects sparked conversations among strangers and pedestrians were observed to interact with the new urban features (see below).

Morgans Smile

For those who investigated non-Mendelian heredity, its chief theoretical importance was not for the inheritance of acquired characteristics, but for resolving the paradox of cellular differentiation. How could cells become biochemically and morphologically different and yet possess the same chromosomal genes The extent to which this issue had polarized geneticists and embryologists is illustrated by Ephrussi's own recollection about a conversation with T. H. Morgan in the summer of 1934 at Woods Hole. Morgan's book Embryology and Genetics had just come off the press, and he gave a copy to Ephrussi with the request that he offer his frank opinion about it.49 Ephrussi returned a few days later and said that he found the book very interesting, but the title was misleading because he did not try to bridge the gap between embryology and genetics as he had promised in the title. As Ephrussi remembered, Morgan looked at me with a smile and said, 'You think the title is misleading What is the...

War And Terrorism

The victim is approached by one of the swindlers and engaged in a conversation on any sympathetic subject. Let's say the victim is an older man. When the swindler has gained his confidence, he or she mentions a large sum of money found by a second swindler who, at the moment, happens to pass by. The victim is led to believe that whoever lost the money probably came by it unlawfully. The swindlers discuss with the victim what to do with the money. One of the swindlers says that he or she works in the vicinity and decides to contact his or her employer for advice. He or she returns in a few minutes and states that the boss has counted the money and verified the amount and agrees that because the money undoubtedly was stolen or belonged to a gambler (or some such variation on a theme), they should keep and divide the money three ways, but that each should show evidence of financial responsibility and good faith before collecting a share. The victim is then induced to draw his good faith...

Swallowing Disorders

Dysphagia is not merely a sensorimotor disorder. As suggested by Leopold and Kagel (7), swallowing involves a five-stage process of ingestion preoral (anticipatory), preparatory, lingual, pharyngeal, and esophageal. The first stage involves an interaction of preoral motor, cognitive, psychosocial, and somataesthetic elements engendered by the meal. If deficits in internal cueing, sensorimotor gating, scaling of movement amplitude, and self-regulation of effort affect swallowing, especially during the preoral, preparatory, and lingual stages, and if mealtime is a social event, swallowing and conversation may be performed simultaneously or alternatively and might be especially problematic for individuals with PD creating a greater risk for dysphagia and aspiration.

Implicit Theories

First, people's day-to-day interactions are far more likely to be affected by their implicit theories than by any explicit theories. In job interviews, admission interviews, and even daily conversations, people are continually judging each other's intelligence, based not on any formal and explicit theories but on their own implicit theories of intelligence. Second, implicit theories are of interest in their own right. Part of the study of psychology is seeking an understanding


The clinical diagnosis of AD remains rooted in a thorough history and physical examination. The history must be obtained from both the patient and a reliable family member or historian and should include a review of centrally active medications and inquiries as to stroke, head trauma, alcoholism, educational and occupational attainment, and family history of neurologic or psychiatric disease. Cognitive decline, functional decline, behavioral changes, and impact on daily life should all be assessed. The onset of AD is insidious and difficult to pinpoint. Most patients recognize no or only minimal and insignificant cognitive deficits (anosagnosia), and this history often contrasts sharply with reports from family members. AD usually begins with difficulties with memory and orientation, with subsequent gradual and progressive decline in visuospatial skills, language and calculation, praxis ( learned motor skills), gnosis (perception), and frontal and executive functions, such as...

Support groups

Socialization, interpersonal relationships, and social support that can be gained through the group may not be available elsewhere, and as such, it can be a very positive experience for the participant. In a group situation, a participant can learn how to express feelings in a healthy and positive way, practice assertive communication, receive feedback about appropriate and inappropriate content for conversation, receive feedback about nonverbal communication, learn new ways to ask for help from others, be able to help others, learn how to form friendships, and learn new coping skills and behaviors.


In contrast, the following example is taken from an extract of a pure counselling consultation. The focus and role is set within the conversation and demonstrates that even in a session where the task is less crisply defined, there is still an identification of roles and focusing of the interview.


My psychological friends and colleagues have provided suggestions, support and encouragement, and tolerated my preoccupation with this project. In particular, Eddy Street, who has helped on many occasions with the macro-editing to help me find a meaningful structure to present the ideas. My thanks to my friends, Steve Bowkett, who has worked with me to improve phrase and construction and Helen Rowlands, who has the ability to detect missing links of thought. I have particularly valued the conversations with Mark Rivett, Srikant Sarangi and Jeremy Holmes. Some friends have not performed any particular role but helped sustain me.

Operant Techniques

The basic underlying principle of operant techniques is quite simple their aim is to reinforce desired behaviour while undesired behaviour is extinguished or punished. A prime example of a (usually inpatient) treatment based on operant principles is the token economy. In a token economy, the therapist distributes so-called tokens for occurrences of desired behaviour (like for example brushing teeth, being timely, conducting a conversation, cleaning the room) with the aim to reinforce this behaviour. Tokens are chips that function as secondary


The psychological sequelae of stroke, particularly post-stroke depression, have been extensively detailed in the research literature. Up to 40 of patients will suffer a depressive or anxiety disorder after stroke, with an associated negative impact on rehabilitation and increased mortality. Borrowing from the cancer literature, Lewis et al. (2001) found that fatalism and helplessness hopelessness were associated with reduced survival after stroke. Lincoln's group has contributed most of the small evidence base currently available for the use of psychotherapeutic treatment (CBT) in depressed patients following stroke. Following an initial successful but non-randomised pilot study, they demonstrated negative cognitions in these patients that are qualitatively similar to those of non-stroke depressed patients, supporting the use of CBT as an appropriate treatment. They progressed to a RCT of 123 depressed patients following stroke, randomly allocating 1 3 of patients respectively to CBT...

Behaviour Therapy

Social skills training became a hallmark psychosocial intervention and empirical science found support through results of clinical trials (Benton & Schroeder, 1990 Dilk & Bond, 1996). Not only did behavioural techniques improve social skills, there is also some evidence that this was retained in longer term follow-ups (Eckman et al., 1992 Wallace et al., 1992). Social skills training is a highly structured approach to learning very specific skills like making conversations, asking for help and living in the community. Role playing, rehearsal and modelling are used. The training can be delivered to individuals and groups. Although there are studies showing retention of skills up to one year after training (Eckman et al., 1992 Holmes, Hansen & St Lawrence, 1984 Mueser, Wallace & Liberman, 1995 Wallace et al., 1992), a recent meta-analysis focusing only on randomised controlled trials reported no benefits from social skills training (Pilling et al., 2002a). This may mean several things...

The context

It is a speciality which has arisen under the umbrella of general medicine, yet exploring the title genetic counselling gives some other clues about its nature. First, it is about a gene and therefore has a scientific component. Second, the use of the term counselling in the title conveys the fact that the speciality also involves a conversation, which means creating a psychological space for thinking about a dilemma. As a consequence, the speciality has three separate roots one in scientific research, another in clinical medicine and a further one in the human sphere of communication, where a thoughtful conversation between a professional and patient takes place. Genetic counselling is similar to counselling or psychotherapy in that both involve a conversation. In psychotherapy, the process is one of a conversation around a dilemma, a conflict, psychological distress or a physical or psychological symptom. The focus is on resolution through emotional processing and cognitive...

Clinical Vignette

A 62-year-old married woman who was born in Mexico as on previous occasions became tearful as she described a recent interaction with a married daughter who was going through a divorce. She spoke in English, although it is clearly not her best language, as she described a series of interactions where she invariably ended up being hurt or rejected, made to feel unloved, adding to her chronic sadness, bitterness, and unforgiving nature. I had heard her speak this way before many times, and perhaps with some exasperation, proceeded to make my intervention in a switch to Spanish as I encouraged her to try to be more understanding of her daughter's plight and not accumulate yet one more grudge. I did this because I sensed that by continuing our conversation in English I would not be able to reach her core self as well as in Spanish, which in this case felt to me like the more honest and mature voice (language).

Giving bad news

Brewin (1991) stresses the importance of the professional's manner in giving 'bad news' and considers that being kind and sad, giving the news gravely, or with too much sympathy and compassion, can lower morale. He advocates that good practice of giving bad news is in keeping with modern counselling and consists of a conversation rather than a prepared speech. It involves paying attention to the individual's personal characteristics and perception of the impact of the news, but, most importantly, reading the individual's immediate response. Seeing a glazed look in the individual's eyes is a cue for the counsellor to pause to try and understand the shock reaction. After an acknowledgement of the upset, the counsellor can then continue giving information which the individual may be able to take in.

Metabolic problems

He was tried on various medications, but was observed to deteriorate he appeared to develop thought blocking such that it was impossible to have a conversation he would volunteer no speech, and questions were answered, after a pause of a second or two, by an uncomprehending 'Eh '

Spontaneous Conversation

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