Theory, Research and Clinical Applications
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Item Bibliography(IU Conscience Project, 2002-02-05) IU Conscience ProjectItem The Conscience Project 1982-2003(2003) IU Conscience ProjectItem A Conscience Sensitive Approach to Moral Injury(IU Conscience Project, 2021-02-03) Galvin, Matthew R.; IU Conscience ProjectItem Conscience Sensitive Psychiatric Diagnosis of Maltreated Children and Adolescents(Indiana University Conscience Project, 2001) Galvin, Matthew R.; Stilwell, Barbara; Adinamis, Ann; Kohn, ArleneThe sequelae of maltreatment are conceptualized according to the DSM IV multiaxial system expanded for heuristic purposes. Axis I and Axis IV are expanded to take into account important variables of maltreatment. Differential Axis I diagnoses are identified with special emphasis placed on PTSD, Dissociation, Depression and Disruptive Behavior Disorders. Axes II and III are heuristically expanded to call attention to developmental psychopathology, particularly in the domains of conscience, and associated putative neurobiological sequelae of maltreatment, indicating a pathway to the psychobiology of conscience. Conscience sensitive assessment of maltreated children is illustrated with two case vignettes and selected conscience drawings. A ‘transaxial,’ conscience sensitive approach to DSM nosology is recommended as a corrective. There will likely be additional implications for the psychobiology of conscience as neuroimaging and assessment of conscience functions in health and psychopathology become more refined.Item The Conscience-in-Adversity Data Collection for the Further Study of Moral Injury(IU Conscience Project, 2020) Galvin, Matthew R.Background. In matters of conscience, we are always learning. When conscience becomes a casualty of adverse life experiences, we are called upon in our healing professions to bind the moral wounds and attend the moral injuries we encounter in the light of whatever knowledge of moral nature and nurture we have acquired, meager as it may be. Objective. To enable further studies of the continuum of casualty in personal conscience that will enlarge and transmit the fund of knowledge in our healing professions. Method. Presentation of a data collection comprised of 125 identity-protected cases, developed from conscience sensitive psychiatric interviews conducted, consecutively, over a three-year period in a residential treatment center which was dedicated to youth who had been reared in adverse life circumstances.Item Five Domains of Conscience(IU Conscience Project, 2005-02-05) IU Conscience ProjectItem Global Assessment of Psychopathological Interference to Conscience Functioning(IU Conscience Project, 1999-12-02) Stilwell, Barbara M.Item Preliminary Observations and Reflections on Conscience Sensitive Group Therapy(The Indiana University Conscience Project, 2005) Galvin, Matthew R.; Gaffney, Margaret M.; Stilwell, Barbara M.Objective: This is the first in a series of articles to characterize and critically consider recently employed forms of conscience sensitive psychiatric treatment of children and adolescents. Method: Modules were designed based upon domains of conscience functioning identified in empirical research and applied to recognized benchmarks for interventions in the treatment of psychopathology. Each module was designed to be sufficiently complete such that full participation from persons entering the cycle of modules at any point would not be compromised. One of the authors paired with interested, experienced therapists in existing programs to conduct and refine interventions in a group psycho-educational therapy format. Results: Over one hundred and fifty hours of conscience sensitive psycho-educational group therapy were conducted in therapeutic loci within a well-established, community-based continuum of care. The therapeutic loci ranged from a child and adolescent psychiatry outpatient clinic to a closed youth residential setting and included adolescent psychiatric intensive outpatient and partial hospitalization programs. Number of participants in any module varied from one in the outpatient locus to fifteen in the intensive outpatient locus. Age of participants varied from school age to late adolescent. Formal intellectual testing was not uniformly available for participants. Most however appeared to be average intellectually. Each participant had, at minimum, an initial assessment by a mental health clinician yielding a DSM IV multiaxial psychiatric diagnosis. No restrictions were placed upon participants in terms of principal or secondary diagnoses or severity of impairment although all had sufficiently severe impairment to be deemed in need of the aforementioned current and standard psychiatric or psychosocial interventions. Length of time for each of the seven modules was permitted to vary according to the stability of the participant population. Individual modules conducted in the adolescent psychiatric intensive outpatient program were limited to one hour each, whereas some modules conducted in the residential and youth day school settings extended over several sessions held once weekly. Seven modules were eventually developed and refined to comprise a full course of conscience sensitive psycho-educational group therapy. Conclusions: Each of the seven modules in its current stage of development and refinement is characterized in terms of praxis, but also considered critically in terms of treatment philosophy. Conscience sensitive group psycho-educational therapy can be conducted in child adolescent psychiatric therapeutic loci ranging from outpatient to closed residential programs. Constraining variables were encountered in the adolescent intensive outpatient program when census became large, and turnover rapid, in consequence of which the full cycle of seven modules conducted at a frequency of one per week could not be completed by many participants. This could be remedied by conducting sessions more frequently, perhaps two to three times per week, and offering a sufficient number of groups to ensure that the number of participants in each group does not exceed eight. In the outpatient setting, there were fewer referrals than had been hoped, perhaps because of limitations upon reimbursement for the total number and/or kind of therapeutic interventions, a condition which, in the local mental health community, favors individual psychotherapy over group psychotherapy. However, the possibility cannot be excluded that there have been referral biases or parental preferences in favor of groups with a more readily recognizable focus such as anger management or social skills over a novel, less familiar approach.Item Progress in conscience-sensitive psychiatry: assessment, diagnosis and treatment planning(IU Conscience Project, 2006) Stilwell, Barbara M.; Galvin, Matthew R.; Gaffney, Margaret M.Study of the relationship between episodic or continuous moral malfunctioning and psychopathology is an undeveloped field in child and adolescent psychiatry. An empirically derived theory of conscience provides a normative base from which to launch such studies. This work reviews five normative stages of functioning within five domains of conscience: conceptualization, moralization of attachment, moral-emotional responsiveness, moral valuation, and moral volition. Current professional guidelines for the doctor-patient relationship, psychiatric assessment, diagnostic categorization, and treatment planning address conscience functioning sometimes directly, sometimes indirectly, and sometimes not at all. A case report is provided to illustrate progress already made in conscience sensitive clinical psychiatry. Further advances may begin with consideration of proposed hypothetical models, comporting with recent research, which describe progressive impairment involving both delay and deviancy in conscience functioning.Item Prototypical Vignettes of Stages in Normal Conscience Development(2002-01-27) Stilwell, Barbara M.