Contribution to the Discussion on the Analytic Frame

Our conception of the analytic frame or setting has changed over the years, partly as a necessary response to the changes in the pace and conditions of modern life, but also as a consequence of our deeper understanding of the analytic relationship and the patients' emotional needs. The shape taken by the setting at any moment of the treatment is a co-construction—partly conscious and partly unconscious—of the pair. However, the manifest setting, its impact on the parties, and its unconscious meanings are also something to be explicitly analyzed during the analytic dialogue. I present a brief clinical vignette of an analysis in which the changes in the setting, determined by external factors, later revealed their unconscious relational meaning. The various stages of this treatment were (a) a standard four-sessions-a-week analysis on the couch, (b) a condensed analysis with two double-sessions held once a week on a same day, and (c) a telephonic analysis interparsed with some occasional presential sessions. I discuss the tranference–countertransference implications of this evolution.     

Transformative Learning: A Case for Using Grounded Theory as an Assessment Analytic

Transformative Learning Theory and pedagogies leverage disruptive experiences as catalysts for learning and teaching. By facilitating processes of critical analysis and reflection that challenge assumptions, transformative learning reframes what counts as knowledge and the sources and processes for gaining and producing it. Students develop a broader range of perspectives on and entry points for learning and behavior change engaging cognition, embodiment, aesthetics, emotions, and ethics (see Mezirow 1991 and Figures 1 and 2). The open‐inquiry, multi‐modal nature of transformative learning defies most traditional assessment strategies. This article demonstrates that grounded theory offers the rigorous qualitative analysis needed to document and track transformative learning outcomes in practice. By applying a grounded theory approach to data from over eighty student portfolios across several iterations of a Religion and Ecology course at Emory University, this article demonstrates a successful and replicable assessment of transformative learning pedagogies.     

Analyzing the Muddles of Analysis: (Some of) What Analytic Theologians Can Learn from the History of Analytic Feminism

Analytic theologians have ironically experienced difficulties in precisely defining the meaning of ‘analytic’ with respect to their style of theology. In this article, I turn to the history of a similar research project, analytic feminism, to see how it went about defining ‘analytic’ in relation to the typically non-analytic subject area of feminist studies. I then consider two commonly referred to attempts to define analytic theology, one methodological and the other socio-historical, and discuss shortcomings of each. I close with a new definition of analytic theology that aims to incorporate all the insights in the discussions which precede it.     

Negotiating the moral order: paradoxes of ethics consultation

Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society.     

Negotiating Plausibility: Intervening in the Future of Nanotechnology

The national-level scenarios project NanoFutures focuses on the social, political, economic, and ethical implications of nanotechnology, and is initiated by the Center for Nanotechnology in Society at Arizona State University (CNS-ASU). The project involves novel methods for the development of plausible visions of nanotechnology-enabled futures, elucidates public preferences for various alternatives, and, using such preferences, helps refine future visions for research and outreach. In doing so, the NanoFutures project aims to address a central question: how to deliberate the social implications of an emergent technology whose outcomes are not known. The solution pursued by the NanoFutures project is twofold. First, NanoFutures limits speculation about the technology to plausible visions. This ambition introduces a host of concerns about the limits of prediction, the nature of plausibility, and how to establish plausibility. Second, it subjects these visions to democratic assessment by a range of stakeholders, thus raising methodological questions as to who are relevant stakeholders and how to activate different communities so as to engage the far future. This article makes the dilemmas posed by decisions about such methodological issues transparent and therefore articulates the role of plausibility in anticipatory governance.     

Finding Sandra: Dr. Beebe’s Second as Analytic Third: A Discussion of “A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback”

Larry Sandberg and Beatrice Beebe (this issue) offer a moving account of their work with Sandra, a gaze-averse woman with a painful and traumatic childhood history. Drs. Sandberg and Beebe describe their work together in the context of an innovative conjoint treatment model including psychotherapy, video feedback consultation, and dance movement therapy. Dr. Beebe’s Interventions at the sensorial, bodily, and affective register facilitated Sandra’s movements from being in the grips of a terrifying object world, to an experience of companioning with Dr. Beebe, giving her a greater sense of holding and emotional security. Further, “Dr. Beebe’s Second,” an image from Dr. Beebe’s own reverie offered Sandra an “emotional third”; a new found internal experience of herself-with-others that helped her lift her gaze to the future.     

Secondary Revision: On Rethinking the Analytic Process and Analytic Technique

The author relates aspects of his own personal history and professional development in an effort to explain the changes in his way of thinking and working as an analyst that have evolved over the past thirty years. He also includes some of his current thinking on the questions of countertransference, the uses of memory, and contemporary analytic technique.     

Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership.     

从医疗活动的特点谈医患法律关系

医疗活动具有独特的特点,这就决定了医患双方会形成独特的法律关系.在诊疗康复关系和强制性的预防保健关系中,医患双方不能以合同关系论处,而在自愿性预防保健关系和特殊服务关系中,双方却只能用合同来调整.     

The Boundaries of the Analytic Encounter: Clinical and Ethical Dimensions: A Roundtable Discussion: January 15, 1998

The American Journal of Psychoanalysis -     

Negotiating Discourses: The Dialectical Identities of Survivor-Therapists

The psychiatric survivor movement is a political movement dedicated to fighting for human rights in the mental health system. People who identify as psychiatric survivors have experienced human rights abuses in the mental health system. A small number of psychiatric survivors have chosen to reenter the system as mental health professionals, and the current project focuses on the experiences of people with this dual-identity. The primary goal is to facilitate further dialogues between psychologists and the survivor movement by exploring the implications of identifying with both discourses. I interviewed five survivor-therapists, and asked how their identities as psychiatric survivors influence their approaches to therapy, and the nature of the relationship between these two identities.     

Negotiating the Double Bind: Interpersonal and Instrumental Evaluations of Dominance

The double bind of dominance—that it can help to attain status but might jeopardize social relationships—was investigated by examining evaluations based on interpersonal skill (e.g., getting along well with others) and instrumental skill (e.g., accomplishing a task). Role congruity theory (Eagly and Diekman 2005; Eagly and Karau 2002) posits that behavior will be evaluated more positively when it is congruent with valued social roles. Two experiments were conducted to explore the importance of context in evaluations of dominance. In both experiments, dominance was more devalued in contexts related to interpersonal skill than in those related to instrumental skill. Experiment 1 demonstrated that the penalty for dominant behavior decreased when the target also displayed warmth, thereby affirming diffuse prosocial roles. Experiment 2 demonstrated that dominant behavior incurred greater penalties in communal versus agentic occupations. The results support a contextual, role-based explanation of evaluative processes.     

Restarting the Imagination,Refinding the World: A Discussion of “Activating Lifeness in the Analytic Encounter” and “‘What If’ Dimensions of the Analytic Field”

Quite different in focus and intent, these two papers address, each in their own ways, an emerging current running through contemporary psychoanalysis. In her paper, Peltz (this issue) outlines the contours of a paradigm shift, in which the question of dehumanization come to the fore. Peltz highlights the importance of a kind of engagement and posture that she describes in terms of the vitalizing presence of the analyst. In exploring what he calls the “what-if” dimension of the clinical field, Cartwright (this issue) re-conceptualizes the imagination in terms of how it frees us up for renewed experience of the vitality of objects. Both papers draw attention to the importance of catalyzing a renewed perceptual engagement with the world of objects in an age of detachment and psychical disenchantment.     

Negotiating time: the significance of timing in ending inpatient work

This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person may be ready to leave and cope with the transition back to life outside the unit. Indications of medical stability, in patients where this has been an issue, is a factor of prime importance. Other important factors include family functioning; the availability of adequate ongoing local CAMHS support for the child and family; suitable school provision; and the identity of the child within a peer group. The reality of NHS resources and the demand for inpatient beds is another pressing consideration. The young person's own motivation emerges as crucial at this stage – towards the end of treatment – not only in terms of what is said, and therefore evident verbally, but also through signs of internal shifts in the child that indicate a capacity to re-engage with life outside in a lasting way. Decisions about when to stop are taken with all this in mind and when the decision does not seem straightforward, it can provoke considerable anxiety in the multi-disciplinary team. Clinical material from psychotherapy with a young adolescent boy with anorexia nervosa is used to illustrate some of the dilemmas.