Psychoanalytic supervision of the difficult patient

Control cases from the broad group of non-neurotic but potentially analyzable patients appear with increasing frequency. The intense, complex transferences they develop place great stress on the psychoanalytic relationship and evoke marked countertransference reactions in psychoanalytic candidates, which reverberate within the supervisory relationship. Through application of a case study method, common themes emerge in the candidate-supervisor dyad: idealization of the supervisor and of classical technique, identification with the patient, parallel process enactments, difficulty maintaining the analytic frame, and the importance of concurrent training analysis. Classical supervisory techniques must be adapted to the "difficult" (non-neurotic) control case. Complex countertransference issues must be carefully addressed while maintaining the teach/treat boundary.     

The Mad and the Past: Retrospective Diagnosis, Post-Coloniality, Discourse Analysis and the Asylum Archive

Before attempting to use as a historical source the Lucknow Lunatic Asylum case notes of the British colonial period in India, it is necessary to determine which methodological approach is most viable. The approach of historians, who attempt retrospectively to diagnose the patients of the past from the clinical details of case notes, does not satisfactorily deal with the criticism that data on medical case notes is less a series of objective observations and more a product of the power relations of the period. In contrast, medical and postcolonial historians treat the information on the case notes as a set of discursive constructions rather than a series of objective observations. By tracing the discourses in operation during construction of the Lucknow case notes, this paper identifies the ways in which the notes can be read as a series of colonial and medical discursive representations rather than as a set of clinical data.     

A Both-And Approach: An Application of Narrative Interventions from a Modern Perspective

A contentious debate between the modern and postmodern epistemologies continue to wage on since the rise of constructivism and social constructionism in the 1990s. This debate has led to both modern and postmodernists falling into an either/or mindset. Others have proposed a solution, the both-and approach, that emphasizes integration of different therapeutic camps. Intentionality is a core component of this approach, as therapists must understand how employed interventions flow from the epistemology and theoretical orientation under which they operate. Another core component of this approach is tailoring the integration to the specific context of the client case. With this understanding and tailoring, therapists can utilize methods across the modern/postmodern divide, as they will coherently flow from their original epistemology and theoretical orientation. Applying methods from both modernism and postmodernism, then, enhances therapists’ therapeutic repertoire, allowing for more opportunities to adapt treatment to each client case. Altogether, the quality of services improve and the amount of clients therapists can help increases as well. This paper will provide an application of the both-and approach to a case study to provide an example of how the said method can be employed in therapy.

     

Assessment typology and intervention with the survivors of stalking

This review article proposes use of a case example to explore a therapeutic framework that utilizes short-term crisis intervention to assist the survivor of the stalking experience. Legal sanctions and laws to protect these victims have been criticized as lacking, and many times in the past mental health professionals have been accused of allowing survivors of stalking to slip through the cracks. This article was written to provide the reader with the basic information needed to begin to understand, diagnose, and treat the survivor exposed to this type of phenomenon.     

Killing Two Birds With One Stone: Exposure Simultaneously Addressing Panic Disorder and Obsessive-Compulsive Disorder

Massed exposure has gained acceptance as an effective method to treat anxiety disorders. When using this intervention in patients presenting with more than one anxiety disorder, specific treatment options need to be discussed. Should exposure be applied in sequential order for each of the comorbid disorders? Or can exposure sessions also be designed to simultaneously target both problem areas? We report on the cognitive-behavioral treatment of a 28-year-old woman with obsessive-compulsive disorder (OCD) and severe panic disorder with agoraphobia (PDA). A series of behavioral experiments based on prolonged exposure was planned. Due to the fact that avoided situations elicited both agoraphobic and contamination fears, we decided to combine exposure for PDA and OCD to optimize therapeutic transfer. Twelve sessions of this exposure resulted in a long-term reduction of both PDA and OCD symptoms. The case illustrates that two comorbid conditions can be effectively combined under one therapeutic rationale. Capabilities and limitations of the method and implications for current theoretical debates on exposure therapy are discussed.     

Metamotivational complexity: The case of Justin,obscene phone caller

An individual's motivational state at any one moment in time is complex. In working to treat dysfunction, anti-social behaviour or deviance, the counsellor needs to understand this complexity and design a treatment strategy that takes full account of the effects of treatment upon the complex of motivational states. This paper examines this jprocess in the case of justin, an obscene phone-caller. The theory of psychological reversals is used as a basis for the case analysis. Interventions are described in terms of their impact on the motivational state of the client.     

Between psychology and pedagogy: "moral orthopedics" and case studies of children in fin-de-siècle French medicine

In the latter decades of the 19th century, European physicians debated a controversial practice that mixed placebos with suggestion therapy to treat children diagnosed with neurotic disorders and behavioral problems. Designed to optimize suggestibility in juvenile patients, this "moral orthopedics" offered parents and therapists the message that children could be saved from becoming victims of their own personalities, of familial neuroses, or even of public health problems. Case studies, published in medical journals and books, circulated accounts of innovative strategies to treat childhood hysteria and to change habits that were considered destructive. Moral orthopedics actualized the insight that suggestibility could be therapeutically productive for juvenile subjects. However, because its adherents sought to manipulate patients' behavior and health by influencing unconscious thought, moral orthopedics provoked questions of expertise and disciplinary propriety among domains of medicine, law, and philosophy. This article reconstructs the controversy surrounding moral orthopedics by examining case studies. I argue that adherents of moral orthopedics did overcome philosophical objections raised against the method, and that they did so through what physician Edgar B6rillon referred to as "education of the will."     

环肺静脉消融策略在房颤治疗中地位的思考

房颤是临床上最常见的快速心律失常之一,对患者危害极大。由于对它发病机制的认识不同导致了临床上不同的治疗方法。肺静脉及环肺静脉开口的肺静脉前庭在房颤的发生和维持中的作用已引起人们的共识。本文通过对房颤机制认识的回顾及治疗方法进展,来探讨环肺静脉消融在临床实践中的重要性,为将来的治疗策略提供依据。     

Beyond the Frying Pan: Addressing Work Issues with Women in Therapy

In recent years, mental health practitioners have been exploring how women are balancing work and family. Given how this issue affects womens experiences in the corporate world and at home, marriage and family therapists are attempting to consider this concern as they treat female clients individually and within relational systems. Few articles and studies have examined the issues female employees face in the workplace and how the issues influence the therapeutic process. In this article, the authors examine the organizational, sociological, and cultural challenges women deal with at work and apply these areas to the therapeutic context. The authors present a case study of a female client enduring a difficult work situation, discussing how to view and approach this case from a feminist family therapy perspective.     

Justice for Irregular Migrants,Refugees and Temporary Workers: Some Issues for Carens

The Ethics of Immigration is a wonderfully comprehensive and insightful journey through all the major contemporary ethical issues concerning immigration. Through this outstandingly well‐crafted work, Carens builds a compelling case for many important positions on how we should treat migrants. Nevertheless, I believe there are some tensions in his arguments that could do with more analysis. I present some of these issues in this article. These include some important problems with arguments for the right to education for children of irregular migrants and those concerning admission, his general position on refugees, and his views about what is required in order to treat temporary workers fairly.     

Medical ethics' appropriation of moral philosophy: the case of the sympathetic and the unsympathetic physician

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced.     

Bias in Favor of the Status Quo

People favor the existing and longstanding states of the world. Rational explanations for status quo maintenance are complemented by a number of non‐rational mechanisms; loss aversion, regret avoidance, repeated exposure, and rationalization create a preference for existing states. We show that the status quo also benefits from a simple assumption of goodness due to mere existence and longevity; people treat existence as a prima facie case for goodness, aesthetic and ethical Longevity increases this preference. These biases operate heuristically, forming barriers to cognitive and social change.     

心理学史教学与历史性思维的培养

历史性思维是指站在历史角度对历史事实进行综合分析的理论思维能力。作为一门史型课程,心理学史有其自身的特点,在培养学生历史性思维的过程中也会发挥重要作用,利用比较法、以心理学史的知识为载体以及重新建构心理学史的知识体系都是培养学生历史性思维的途径和方式。     

Immersion in the surface1

In order to treat patients with a narcissistic structure showing a rigid shell of defence together with a lack of inner differentiation – insufficient subject/object constitution – one has to deal with a split kind of transference. Their compelling need for distance corresponds to their fragile self‐esteem. They feel threatened by the analysis and the analytic relationship. Because the seeming normality of these patients’ thinking and language is deceptive, a variation of psychoanalytic technique to facilitate the work with them is described and explained in detail. To transform their two‐dimensional ‘inner’ world, which functions in a PS modus, it is helpful to show them, with changing viewpoints step by step, their own manoeuvres, misconceptions and manipulative use of language within the analytic relationship. The gratifying extension of their self‐awareness leads to the introjection of the analyst’s alpha‐function. This makes possible a more distinct separation of subject and object representations and a transformation to a three‐dimensional, oedipally structured world with a strengthened capacity to symbolize. This method of working is grounded in Bion’s theory of thinking. A case vignette illustrates a development of this kind.     

From structure to strategy with the families of solvent abusers

A psychiatric out-patient sample of forty-five teenage solvent abusers and their families is described. Most lived in socially deprived areas. In this necessarily unrepresentative clinic sample family psychopathology was characterized by (i) adult intimacy-avoidance and (ii) a powerful, collusive alliance between mother and adolescent. These were linked in a circular pattern of systemic dysfunction, social and generational influences tending to strengthen homeostatic rigidity. Structural and strategic treatment approaches are described with case illustrations and discussed. At the six-month follow-up a good outcome was recorded in three-quarters of the treated cases but the effects of sample bias and 'soft' evaluative data should be borne in mind.     

Turning a blind eye to double blind line‐ups

Although psychologists have urged police officers to use double blind line‐up procedures during their investigations, police officers state that these would be difficult to administer and most have been reluctant to implement this change. Four studies examine whether lay people's judgements about the guilt of a suspect vary according to whether a brief written summary of a case described the identification procedure as double blind or non‐double blind. The effects were all small (and almost all non‐significant). Most people do not treat double blind line‐ups differently from non‐double blind line‐ups when assessing the guilt of a defendant. Either police investigators should stop using this biased method or police investigators and others in the judicial system (e.g. jurors, judges) should be informed of this bias when evaluating results from any line‐up. Copyright © 2009 John Wiley & Sons, Ltd.     

Classical Christian Theism and the Criterion of Particularity

This article acknowledges the importance of doing theology proper under the guidance of special revelation and its particular conception of God and argues, against a common contemporary outlook, that the classical Christian theism of Aquinas and the Reformed tradition resonates with the criterion of particularity. To make this case, three features of classical Christian theism (the inference from creatio ex nihilo to the actuality of God, God's freedom from being in a genus and the tendency to treat the divine essence and attributes largely before the treatment of the Trinity) are examined and found to comport formally and materially with the rule of Christian particularity.     

On the importance of distinguishing between within- and between-subject effects in intransitive intertemporal choice

Most probabilistic paired comparison models treat inconsistent choices as caused by independent and random errors in the pairwise judgments. In this paper, we argue that this assumption is too restrictive for the analysis of paired comparison data obtained from multiple judges when transitivity violations are systematic. We present a new framework that contains the random error assumption as a special case but also allows for systematic changes in an option's utility assessments over the pairwise comparisons. Accounting for both between- and within-judge sources of variability, we demonstrate in an application on intertemporal choice that the proposed framework can capture systematic transitivity violations as well as individual taste differences.     

Domestic cats (Felis catus) do not show causal understanding in a string-pulling task

This study explored how domestic cats perform in a horizontal string-pulling task to determine whether they understand this case of physical causality. Fifteen cats were tested on their ability to retrieve an unreachable food treat in three different set-ups: (a) a single baited string, (b) two parallel strings where only one was baited and (c) two crossed strings where only one was baited. All cats succeeded at pulling a single string to obtain a treat, but none consistently chose the correct string when two strings were parallel. When tested with two crossed strings one cat chose the wrong string consistently and all others performed at chance level. There was no evidence that cats understand the function of the strings or their physical causality.