True Integration Research Articles

ON DUALITY, SYMMETRY AND SYMMETRY LOST IN SOLID MECHANICS

The paper recalls the concept of duality in mathematics and extends it to solid mechanics. One important application of duality is to restore some symmetry between current fields and their adjoint ones. This leads to many alternative schemes for numerical analyses, different from the classical one as used in classical formulation of boundary value problems (finite element method). Usually, conservation laws in fracture mechanics make use of the current fields, displacement and stress. Many conservation laws of this type are not free of the source term. Consequently, one cannot derive path-independent integrals for use in fracture mechanics. The introduction of variables and dual or adjoint variables leads to true path-independent integrals. Duality also introduces some anti-symmetry in current fields and adjoint ones for some boundary value problems. The symmetry is lost between fields and adjoint fields. The last notion enables us to derive new variational formulation on dual subspaces and to exactly solve inverse problems for detecting cracks and volume defects.

Shale Gas Drives Vertical Integration

Guest editorial The November issue of JPT quotes the views of Mary Van Domelen, senior engineering advisor at Performance Technologies, given in her presentation “The Pros and Cons of Vertical Integration” in shale gas-related operations. All her examples of current activity are in the realm of the vertical with the operator and a service company offering fracturing and other drilling or completion services. Her presentation was part of the SPE Liquids-Rich Basins Conference, held in September 2013 in Midland, Texas. Interestingly, both dry and wet gas can benefit immensely from a different form of vertical integration provided certain new technologies take hold. This is a vertical involving the producer and a service that monetizes low-value portions of fluids in unique ways. Wet Gas Today, almost all the profit is in the wet gas component. But a subplot is that ethane usually makes up nearly half the volume of natural gas liquids (NGLs). Unlike the bigger molecules, such as propane and butane, ethane has no direct use until cracked to make ethylene. Thirty-three of the 36 crackers in the United States are located on the Gulf Coast, about 1,200 miles from the Marcellus shale in Pennsylvania. Consequently, there is an ethane glut, resulting in low prices. Dow Chemical’s David Bem reported in December that ethane dropped to natural gas price levels in 2013 and had begun to track with it (Fig. 1). This would be a windfall for ethylene producers except that the crackers are located at a distance. Local cracking seemed to be where matters were headed. However, early in November 2013, Shell announced that it had shelved plans to build a cracker in Pennsylvania. This leaves the ethane stranded absent a pipeline to transport it down to the Gulf of Mexico. A better solution would be small crackers, 50 to 100 times smaller than conventional plants, distributed close to the production. Development is in progress to realize this “GTL Lite” concept. The definition of liquid in this context is broad: It could be any high-value liquid, not just diesel that traditionally comes from larger GTL plants. Security of supply is much simpler with small units, particularly because a lot of the producers themselves are small. And it is immensely simpler if the producer and cracking process owner are vertically integrated. Even long-term pricing would not be a contractual hurdle. But true vertical integration is hampered by the fact that the producer has no domain understanding of the other area, which is essentially downstream in character. For unconventional hydrocarbons, including heavy oil, a blurring of the upstream, midstream, and downstream sectors is occurring. Small footprint processing, when commonly available, will only serve to hasten this blurring.

Persistence in the banking industry: Fractional integration and breaks in memory

Certain “spurious long memory” processes mimic the behavior of fractional integration in that the variance of their sample mean behaves like that of a fractionally integrated process of some order D . We show, however, experimentally that a fractional integration test may discriminate between spurious long memory of order D and integration of order D . Further, we suggest a test for the null hypothesis that the order of integration does not change from one subperiod to another. It simply builds on the difference of the estimates from the respective subsamples that are split exogenously. Upon appropriate normalization a limiting standard normal distribution arises. With these methods we tackle the question whether international and sectoral bank equity index returns are fractionally integrated and whether the memory parameters have changed. The daily data are split into three regimes: one pre-crises subsample, a second including the collapse of the Lehman Brothers bank, and a third covering the Euro area sovereign debt crisis. In particular, we provide evidence that both turmoils had differing international effects. • Integration test may discriminate between spurious long memory and true fractional integration. • Test for the null hypothesis that the order of integration does not change. • International and sectoral bank equity index return. • Collapse of the Lehman Brothers bank and the Euro area sovereign debt crisis had differing effects.

Berlin on My Mind: An Anti-Memoir

Berlin on My Mind: An Anti-Memoir Derek Cohen (bio) Though I’ve never been to Berlin, the city has loomed large in my life. Growing up in South Africa just after the war, I acquired an idea of Berlin primarily formed by Jewish people there who had felt the threat of Hitler to their families and friends—those who had been directly touched by the war. Berlin was the location of many large and formidable pro-Nazi rallies that spelled danger to all Jews: it was there that many aspects of the twentieth-century war of horror were nurtured and kindled. Berlin provided the backdrop for the Night of Broken Glass, or Kristallnacht—that violent chaotic commencement of the Nazi war against the Jews. In my mind the Berlin of World War ii is a big bullying city of lethal size and deadly foreboding. I cannot think about Berlin without thinking about men in storm-trooper uniforms, lounging against large, black, shiny, and menacing Mercedes Benzes, their jackboots gleaming as they smirk into the cameras aimed at them, their guns and clubs casually draped over their arms, ready for use (they obviously relish being photographed). These men are the muscle of Nazism, and they belong to my Berlin. There are, of course, other Berlins, though none so dominant in my mind as this one. But Berlin is exciting in many ways: it is a playground for the rich and famous, and the headquarters of German money, political power, and old traditions. There is also the Berlin of backstreets and brothels and gorgeous blondes in slit skirts and high heels—a louche, decadent, suggestive, sexy, and exciting city, known to me only through books and pictures. It is impossible to separate the tantalizing sexual swamp of this underworld Berlin from the larger ideas of the city as a place of war and death. The Berlin of the war, in all its facets, is a paradoxical place of order and chaos. Nazi Berlin, dedicated to unswerving political power and conformity, is also a chaotic place of brutality and turbulence. Images of the ss careening around the city in their cars proudly assaulting those who do not conform: Jews, Gypsies, homosexuals are fair prey for the men in uniform who [End Page 245] seem thirsty for violent action. The ss bring order to the city, an order maintained by the rule of fear. The prevalence of this kind of order suggests that beneath its surface lies chaos seeking release. The ss is as strong and violent as the photographs show. Someone, another ss man, is taking those pictures with an eye to presenting the men in jackboots as heroes, their victims as vermin. The Berlin of this period is, as Berlin always has been, a place of culture. The arts thrive, though deformed by the imperatives of “useful” art dedicated to the betterment and celebration of the state that—it is decreed—this art must serve. In fear for their lives many true artists of Berlin leave the country to practice their trades in places where they will not be impeded by rules, laws, and terror. Berlin’s leading citizens and city managers pride themselves on their city’s cultural superiority and encourage the arts in which they profess to believe. Culture flourishes, despite Hanns Johst’s infamous remark that the word makes him reach for his revolver. To be sure, the culture of Nazi Germany is perverted by political imperatives; but an arrogance informs the ideal, as if culture can be ordered like a new suit or modified like an engine in its design and direction. Subversive, satirical, underground culture is soon quashed. The art of Nazi Berlin is infected with a brutal moral superiority; an insufferable hauteur pervades officially approved culture while cultural nonconformity is threatened and persecuted for its betrayal of the Nazi state. And the threats are not idle: violence is the wages of the individuality and independence that true artistic integrity requires. There is political correctness with a vengeance in this Berlin, a grinding and authoritative insistence that drives the makers of culture—the artists, poets, and musicians—in a single direction: the validation of the...

Le management du travail, condition de réussite du management de la diversité

Confrontées à de nouvelles obligations légales en matière d’égalité professionnelle mais aussi en matière d’intégration des séniors et des personnes en situation de handicap, les directions d’entreprise adoptent des attitudes variées, allant d’une attitude réactive minimaliste à une approche proactive consistant à réaliser une véritable politique d’intégration professionnelle. S’appuyant sur 31 entretiens semi-directifs réalisés auprès de DRH et de chargés de mission diversité, cette étude montre comment la réussite d’un management proactif de la diversité tient à l’importance accordée par la Direction à une approche managériale du travail et non à une approche catégorielle ou psychologisante de la diversité.

Patient perspectives of an integrated program of medical care and substance use treatment.

The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs.

Patient-Physician Interactions and Electronic Health Records

To the Editor In their recent Viewpoint, Drs White and Danis 1 discussed using the electronic health record (EHR) to enhance patient-physician interactions. Whereas others have argued that the EHR can hinder patient-physician communication, 2 the authors hold a more optimistic view that expanded uses (such as inviting patients to participate in EHR viewing during the clinical encounter) are untapped tools for patient activation. We share the optimism of White and Danis for health care information technology. During an era of technology innovation and adoption in all aspects of daily life, patients as well as medical professionals are, in general, becoming increasingly familiar with computer use during the clinical encounter. Current EHR systems, however, can be awkward to use, and there is a lack of standardized data structure for true integration of patient data across different EHR platforms. 3 These issues are technical and will likely be overcome through innovations in EHR technology, allowing expanded EHR use to further enhance patient care. Additionally, there is a growing repertoire of technologybased tools for patient activation that can complement the EHR. The relatively nascent web-based patient portals allow patients to securely log in and access their personal health information. The portal pulls data from the patient’s EHR and can support items such as screening reminders and patient-physician messaging. One study showed that patient portals in conjunction with an EHR may improve patient engagement. 4 Health care–focused social networks also offer a platform for patient activation. Patients can post questions online about their health condition. Physicians registered with the network can then post answers, which can be peer reviewed by other registered physicians. As medical students, we believe proper EHR usage instruction during medical education is important. Patientphysician communication is a part of the standard curriculum at most medical schools. For example, during our preclinical years, we learned a patient-centered model of patient interviewing. These interviews can serve as opportunities for students to practice using the EHR in a way to enhance the interaction. Appropriate use of the EHR to enhance patient activation can thus be taught concurrently with patient communication. 2,5 Ultimately, EHR education

Patient-Physician Interactions and Electronic Health Records

To the Editor In their recent Viewpoint, Drs White and Danis 1 discussed using the electronic health record (EHR) to enhance patient-physician interactions. Whereas others have argued that the EHR can hinder patient-physician communication, 2 the authors hold a more optimistic view that expanded uses (such as inviting patients to participate in EHR viewing during the clinical encounter) are untapped tools for patient activation. We share the optimism of White and Danis for health care information technology. During an era of technology innovation and adoption in all aspects of daily life, patients as well as medical professionals are, in general, becoming increasingly familiar with computer use during the clinical encounter. Current EHR systems, however, can be awkward to use, and there is a lack of standardized data structure for true integration of patient data across different EHR platforms. 3 These issues are technical and will likely be overcome through innovations in EHR technology, allowing expanded EHR use to further enhance patient care. Additionally, there is a growing repertoire of technologybased tools for patient activation that can complement the EHR. The relatively nascent web-based patient portals allow patients to securely log in and access their personal health information. The portal pulls data from the patient’s EHR and can support items such as screening reminders and patient-physician messaging. One study showed that patient portals in conjunction with an EHR may improve patient engagement. 4 Health care–focused social networks also offer a platform for patient activation. Patients can post questions online about their health condition. Physicians registered with the network can then post answers, which can be peer reviewed by other registered physicians. As medical students, we believe proper EHR usage instruction during medical education is important. Patientphysician communication is a part of the standard curriculum at most medical schools. For example, during our preclinical years, we learned a patient-centered model of patient interviewing. These interviews can serve as opportunities for students to practice using the EHR in a way to enhance the interaction. Appropriate use of the EHR to enhance patient activation can thus be taught concurrently with patient communication. 2,5 Ultimately, EHR education

The Virtual Prototyping Design and Evaluation of Ergonomic Gymnastic Based on CATIA

Simulate the computer-aided design of gymnastic device in the pre-development stage by applying CATIA V6 software, and explore the matching degree between gymnastic device design and human body database using the theory and data of Ergonomics. Build the improved model of gymnastic device based on CATIA V6 virtual human data and explore the best evaluation method of man-machine simulation for gymnastic device design after the analysis of man-machine operational processes for computer-aided gymnastic product design and the experiment of human data measurement specimens. The experiment of arm strength gymnastic device for shoulder shows that the application of CATIA V6 software platform not only further shortens the product development cycle and improves the degree of match between gymnastic device and human body, but also enhance the true integration of gymnastic device development and design system from 3D, design and simulation to manufacture.

Linking the Shared Treatment Plan to Clinical and Decision-Support Systems

Based on previous experiences of educating patients about their medications, and through an iterative process involving all key stakeholders, a shared treatment plan tool has been developed for MonDossierMedical.ch, a service of the e-toile regional health information exchange (HIE) platform. It is based on the secure architecture of federated documents, and is organised in a modular way to enable various interfaces with existing prescription and dispensing systems. Although the first phase provided only a web-interface on the MonDossierMedical.ch portal, the second phase introduces integration mechanisms that are used to streamline processes around medication reconciliation. A true integration of this tool into existing environments and systems (hospital information systems, private practices, pharmacies, etc.) then becomes possible. Support for the integration with larger projects such as epSOS, the European-wide interoperability eHealth platform, is also one of the objectives of this second phase. In addition to communication with external stakeholders, decision support system services are integrated into the global process for providing valuable advice to prescribers.

The emerging synthesis of evolution with ecology in fisheries science

Fisheries science is currently being transformed through a true integration of ecological and evolutionary perspectives. Many questions are emerging from the recognition that human-induced evolutionary change can elicit ecological change on short time scales, in some cases equal to or exceeding the changes brought on by classical ecological effects. For instance, to what extent does evolutionary change associated with size-selective harvesting, supplementation, captive breeding, aquaculture escapees, and related fisheries activities directly or indirectly affect species demography (persistence, productivity, or recovery), community structure, and ecosystem functioning? Under what conditions do feedbacks between evolution and ecology matter most for managing fisheries activities? Do such feedbacks generate predictable outcomes, and are they reversible? Although as yet, little consensus has been reached on the answers to these questions, it is clear that a synthesis of evolutionary and ecological perspectives holds great promise for improving and generating more biologically realistic modeling, monitoring, rebuilding, and management of fish populations, fish species, and aquatic ecosystems.

How dointensive carenurses perceive families in intensive care? Insights from the United Kingdom and Australia

To compare how intensive care nurses in the UK and Australia (AU) perceive families in intensive care units (ICUs). International healthcare research and practice is often based on an underlying assumption of a person- or family-centred ideology. While nurses in ICUs acknowledge the importance of patients' families, a true integration of families as units of care is often not realised. Data from ICU nurses from two international studies: (1) a constructivist grounded theory study in the UK and (2) a quasi-experimental non-equivalent clinical study in AU. Data were collected in tertiary adult ICUs in the UK and AU. Nurse-to-patient ratio for high-acuity patients was 1:1 in both units. Twenty ICU nurses in five focus groups (UK study) and 197 surveys were sent out to ICU nurses in AU (response rate 26%). Evidence from both studies makes visible the contribution of family care in adult ICUs. Nurses remaining in control and initiating family member care involvement are less likely to perceive families as a burden. The AU study indicated that when nurses partner with families to deliver care, there was a minimal effect on their workload. The nurses concluded that inviting family members to be a part of the patient's care should be usual practice in ICUs. Nurses should promote, facilitate and invite the integration of families in care in today's healthcare system. This is mandatory as families are the caring resource for these patients during an often prolonged recovery trajectory. Families are more likely to be successfully integrated into a more active involvement with ICU patients when they are not perceived as a burden. Inviting and supporting family members is not necessarily time-consuming and starts the journey of supporting ICU survivors' recovery journey.

The mainstreaming of disability cricket in England and Wales: Integration ‘One Game’ at a time

Disability sport in Great Britain has, since its genesis over sixty years ago, gained greater public profile with each passing decade. Arguably, this is a result of a more direct, interventionist approach from the British government and the Sport Councils into the field of disability sport over the past twenty years. In this paper we highlight a case of integration within sport by examining the process of mainstreaming disability cricket within England and Wales. Following a review of the extant literature in this area we will draw upon Bourdieu's practice theory in order to examine the impact of the implementation of policy on the management of issues of disability in mainstream cricket. Longitudinal ethnographic data (including participant observation and semi-structured interviews) was collected on the organizations involved in this mainstreaming process. Informants were either involved in the delivery of disability cricket or in the management of disability sports partnerships. Preliminary findings suggest that true integration is still unrealized. Whether the policy seeks true integration or whether mainstreaming is simply another modernizing process seeking greater efficiencies from sport organizations is unclear. Nevertheless a number of institutional pressures from the proximal and distal external environments have provided support for generating mainstreaming initiatives at management levels. In addition to these findings we argue that an additional outcome of this research is to demonstrate the suitability of a relational approach for conceptualizing policy, its interpretation by sport managers and the implementation strategies that follow.

SUPPORTING ABSORPTIVE CAPACITY FOR KNOWLEDGE BROKERS: EVIDENCE OF CANADIAN HEALTH ORGANIZATIONS

The importance of using healthcare evidence by policy-makers is widely recognized [Lavis (2006), Ward et al. (2009)]. For over a decade, several strategies to improve the use of knowledge by policy-makers have been promoted [Landry et al. (2006); Amara et al. (2004)]. Among them, the use of individuals called "intermediaries" or "knowledge brokers" is presented as a potential strategy [Hargadon (2002); Lomas (2007)]. Situated at the organizational interface, these actors benefit from a strategic position allowing easier access to external knowledge [Cohen and Levinthal (1990)]. Therefore, they must develop good skills to be able to properly enjoy all opportunities to create value for their organization. In fact, many authors consider brokers as true knowledge integrators that assess, interpret, synthesize, exploit and transfer pertinent knowledge. Despite the presence of several studies that stress the importance of the multifaceted role of brokers, few have explored how these actors concretely integrate or absorb knowledge and especially, what skills are necessary for the success of their activities. The aims of this paper are: to propose a new conceptual model on research integration by knowledge brokers and to provide an empirical testing of this proposed model. The conceptual framework to be presented in this study builds on recent theoretical developments on the concept of knowledge absorptive capacity [Todorova and Durisin (2007)]. To test the conceptual framework, we collected survey data. The sample of 297 respondents was composed of professionals and managers involved at different levels of health services in Canada. To be eligible, respondents had to be engaged in knowledge brokering activities. Data analysis allowed presenting a first portrait of the profile of knowledge brokers working in health organizations in Canada. In this perspective, several descriptive analyses, such as the distribution of knowledge brokers according to their membership organizations, their status, education, experience, etc., were completed. Other confirmatory analyses with EQS were completed to confirm the theoretical validity of the dimensions of the broker's absorptive capacity. Finally, bivariate analyses were used with these dimensions to compare knowledge brokers regarding their absorptive capacity and the explanatory variables documented in the literature. In the last part of this paper, we discuss the implications of the results on the role of knowledge brokers regarding the use of evidence in health organizations and public policy.

Learning to walk before we run: what can medical education learn from the human body about integrated care?

True integration requires a shift in all levels of medical and allied health education; one that emphasizes team learning, practicing, and evaluating from the beginning of each students' educational experience whether that is as physician, nurse, psychologist, or any other health profession. Integration of healthcare services will not occur until medical education focuses, like the human body, on each system working inter-dependently and cohesively to maintain balance through continual change and adaptation. The human body develops and maintains homeostasis by a process of communication: true integrated care relies on learned interprofessionality and ensures shared responsibility and practice.

Teaching Histology in Integrated Curricula: Challenges and Opportunities

Approximately half of AAMC medical schools now teach histology as part of an integrated program in which individual basic science disciplines have no distinct identity. Challenges of this approach include that histology content can be too scattered and too superficial to support mastery, and the true integration rather than simple juxtaposition that is required is time consuming and therefore costly. Also, because it is a difficult but fractional part of their work, students can choose to selectively ignore histology and still pass exams. Opportunities arising out of the integrative approach include that the necessary collaboration of faculty across discipline boundaries can foster collaboration in other arenas such as research. In addition, melding histology with bordering disciplines of anatomy, physiology and pathology gives tremendous scope for building a clinically‐relevant context that is more motivating for students and may also be more effective in supporting transfer of knowledge to clinical settings. Moreover, interdisciplinary content is ideally suited for case‐based student‐centered learning formats including problem‐based learning, team‐based learning, audience participation via response systems, online case study, etc. Specific examples illustrating these challenges and opportunities including incorporation of histology into a variety of learning formats will be presented.

Catholic curriculum: re-framing the conversation

This article provides a summary account of the book, A Mission to the Heart of Young People: Catholic Curriculum, published in Australia in 2012. To preserve the true mission and religious integrity of Catholic schools in the face of secularism and ‘national economic requirements’, it is argued that Catholic schools must possess a distinctive cultural heart which is an authentic Catholic curriculum. This curriculum must assist young people to engage constructively with the wisdom and faith of the Catholic community in a way that is meaningful to them. The principles and practices required to construct such a curriculum are outlined.

At the Heart of Integration: Aligning Physicians and Administrators to Create New Value

Because of its ability to create real incremental value for patients and providers, physician-hospital integration will continue to play a major role in transforming the way healthcare is delivered. Integration is more than a transaction, and without developing the right culture, new integrated organizations will struggle to transform their current model of care. Confronted with regulatory and specialty-specific environmental forces, cardiovascular physicians have integrated with health systems at a higher rate than other specialties have. In 2007, Piedmont Healthcare launched Piedmont Heart as the first integrated cardiovascular care delivery program affiliated with a community healthcare system in greater Atlanta. Piedmont Healthcare had successfully brought together hospitals and cardiovascular physicians in an organizational structure that allowed for the right culture, resulting in true integration and patient-centered care. Today, Piedmont Heart is one of the largest physician groups in the United States focused on delivering high-quality outcomes, aligning multidisciplinary cardiovascular initiatives, and allowing for smart, strategic growth. It has taken Piedmont Heart nearly five years to create new, incremental value from its center-of-excellence organizational structure, clinical pathways development, and Patient First program. Piedmont Heart had the advantage of starting earlier than many other physician-hospital integrated structures. As US healthcare moves from an industry driven by volume to one focused on value, it is organizations like Piedmont Heart that continue to drive smart integration forward and focus on innovation, despite potential disruption, that will be successful.

Query enhancement through the practical application of ontology: the IEDB and OBI

Ontologies categorize entities, express relationships between them, and provide standardized definitions. Thus, they can be used to present and enforce the specific relationships between database components. The Immune Epitope Database (IEDB, http://www.iedb.org) utilizes the Ontology for Biomedical Investigations (OBI) and several additional ontologies to represent immune epitope mapping experiments. Here, we describe our experiences utilizing this representation in order to provide enhanced database search functionality. We applied a simple approach to incorporate the benefits of the information captured in a formal ontology directly into the user web interface, resulting in an improved user experience with minimal changes to the database itself. The integration is easy to maintain, provides standardized terms and definitions, and allows for subsumption queries. In addition to these immediate benefits, our long-term goal is to enable true semantic integration of data and knowledge in the biomedical domain. We describe our progress towards that goal and what we perceive as the main obstacles.

Key process issues in Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Translation of an evidence-based model into clinical practice and training.

Our "desired outcome" in writing this article was to present not only key process issues stemming from the Cognitive Behavioral Analysis System of Psychotherapy (CBASP; McCullough, 2000), but to highlight those therapy maneuvers that we, a "seasoned" clinician/supervisor and a clinical trainee, find most useful in delivering treatment and in conducting supervision. We strongly believe that it is only through the translation of evidence-based therapeutic models, such as CBASP, into effective training that a true integration of science and practice can be obtained. Thus, the congruence of trainer's and trainee's views on what constitute top process issues in therapy is important in evaluating the reliability of a therapy model; with this in mind, we focus on three process issues, as follows: (1) problems are anchored to the "here and now" and to specific situational outcomes; (2) patients are encouraged to identify the role they play in affecting their distressing outcomes and to take responsibility for "fixing" them; and (3) the therapist planfully engages in the process of change via disciplined personal involvement. Research and theory supporting these maneuvers are presented, in conjunction with clinical examples.