Problematic Engagement Research Articles

Acceptability of a Clinician-Assisted Computerized Psychological Intervention for Comorbid Mental Health and Substance Use Problems: Treatment Adherence Data from a Randomized Controlled Trial

Background Computer-delivered psychological treatments have great potential, particularly for individuals who cannot access traditional approaches. Little is known about the acceptability of computer-delivered treatment, especially among those with comorbid mental health and substance use problems.ObjectiveThe objective of our study was to assess the acceptability of a clinician-assisted computer-based (CAC) psychological treatment (delivered on DVD in a clinic-setting) for comorbid depression and alcohol or cannabis use problems relative to a therapist-delivered equivalent and a brief intervention control.MethodsWe compared treatment acceptability, in terms of treatment dropout/participation and therapeutic alliance, of therapist-delivered versus CAC psychological treatment. We randomly assigned 97 participants with current depression and problematic alcohol/cannabis use to three conditions: brief intervention (BI, one individual session delivered face to face), therapist-delivered (one initial face-to-face session plus 9 individual sessions delivered by a therapist), and CAC interventions (one initial face-to-face session plus 9 individual CAC sessions). Randomization occurred following baseline and provision of the initial session, and therapeutic alliance ratings were obtained from participants following completion of the initial session, and at sessions 5 and 10 among the therapist-delivered and CAC conditions.Results Treatment retention and attendance rates were equal between therapist-delivered and CAC conditions, with 51% (34/67) completing all 10 treatment sessions. No significant differences existed between participants in therapist-delivered and CAC conditions at any point in therapy on the majority of therapeutic alliance subscales. However, relative to therapist-delivered treatment, the subscale of Client Initiative was rated significantly higher among participants allocated to the BI (F2,54 = 4.86, P = .01) and CAC participants after session 5 (F1,29 = 9.24, P = .005), and this domain was related to better alcohol outcomes. Linear regression modeled therapeutic alliance over all sessions, with treatment allocation, retention, other demographic factors, and baseline symptoms exhibiting no predictive value.Conclusions Participants in a trial of CAC versus therapist-delivered treatment were equally able to engage, bond, and commit to treatment, despite comorbidity typically being associated with increased treatment dropout, problematic engagement, and complexities in treatment planning. The extent to which a client feels that they are directing therapy (Client initiative) may be an important component of change in BI and CAC intervention, especially for hazardous alcohol use.Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12607000437460; http://www.anzctr.org.au/trial_view.aspx?ID=82228 (Archived by WebCite at http://www.webcitation.org/5ubuRsULu)

Islam, politics, anthropology

In this paper, we consider anthropology's long and, at times, problematic engagement with the study of Islam and Muslim societies. Specifically, we reflect critically on ongoing anthropological debates about the relationship between Islam and politics and suggest new terms of analysis. Although we pay attention to the state and formal politics, involving various social actors and organizations, we are also interested in everyday politics and micropolitics, arenas where anthropology proves especially adept. It is at the intersection of these multiple levels and where the field of politics is constituted in practice that we situate the analytical focus of the anthropology of Islam and politics in this Special Issue of theJournal of the Royal Anthropological Institute.RésuméLes auteurs s’intéressent ici à la longue, et parfois problématique histoire, de l’étude de l’islam et des sociétés musulmanes par l’anthropologie. L’accent est mis plus précisément sur une réflexion critique relative aux débats anthropologiques actuels sur les liens entre islam et politique, et sur l’exploration de nouveaux termes d’analyse. Tout en prêtant de l’attention à l’État et aux institutions politiques, impliquant différents acteurs sociaux et organisations, nous nous intéressons également à la politique au quotidien et à la micropolitique, domaines dans lesquels l’anthropologie s’avère particulièrement compétente. C’est à l’intersection de ces multiples niveaux, et là où le champ du politique est constitué dans la pratique, que nous situons le point focal de l’analyse anthropologique de l’islam et du politique dans ce numéro spécial duJournal of the Royal Anthropological Institute.

Coming Home to Homer: Gogol's Odyssey

In V. V. Veresaev's encyclopedic compendium of Gogoliana, Gogol' v iizni, one anecdote stands out in its brilliant encapsulation of Gogol's problematic engagement with all things Classical. It is a story taken from V. N. Repnina's 1890 account of Gogol's life: Foronib paccKa3bIBan', 'TO B HexKHHCKOM rHnee 6buI y HHX npoceccop rpexiecKOrO M3bIKa, rpeK /H. H. Heponec/. OH InHTaI CTyJeHTaM FoMepa, KOToporO HHKTO H3 HHX He HOHHMaRI. UHpOrMTaB HeCKOJIbKO CTpOK, OH HOJHOCHJ ABa naJabla KO pTy, meJIKHeT H, OTBOJR flnaJblbI, rOBOpHT: xIyJecHO!-C CHJIbHbIM rpexIeCKHM BbIrOBpOM. HOTOM, npOIrTaB O KaKOM-TO cpaxeHHH, OH nepeBen rpexecKHi TeKCT CJIOBaMH: OHH OJIO)KHJIH )KHBOTHKH CBOH Ha HOXCHKH, H BeCb Knacc pa3pa3HJICn rpOMKHM CMexOM. TorAa npo eccop cKa3aJi: Ho-pyccKH 3TO CMeIlHO, a no-rpeiecKH OIeHb )KaJIKO.9' This anecdote from Gogol's less than prodigious secondary school career possesses for all its brevity a bit of that sly and sudden pathos which so often surfaces in Gogol's stories. In the end, after all, the joke turns unexpectedly to one of Gogol's lifelong dilemmas: how to translate the epic tradition into Russian without it becoming inadvertently comic-the butt, as it were, of schoolboy snickers. The problem was not translation in the literal sense (for Gogol could hardly claim, with V. K. Kjuxel'beker, that Homer in the original was son pain quotidien2), but rather a matter of finding a way of translating the cultural and spiritual resonance of the epic mode into Gogol's peculiar idiom, a task at which the writer failed repeatedly, but in, of course, the most splendid way.3 The adult Gogol would continually find himself in the awkward position of the teacher who cannot find a way to translate epic glories into a suitably lofty language, i.e., one strong enough to escape the deadly undertow of the comic. Yet it was terribly important to Gogol that Russia be at in the epic tradition, and indeed, he believed that epic models could serve as a beacon to Russia in its search for a way home to the great national destiny of the Orthodox Slavs. He greeted Zukovskij's translation of the Odyssey (1842-1848, published 1849) with great pleasure, although we cannot be certain that he ever actually read it all the way through.4 In an