Trust and the Healing Encounter: An Examination of an Unorthodox Healing Performance

Just why a patient should trust a particular healer isa question that has not been adequately explored inthe literature on healing. This ethnographiccase-report examines the healing performance of achiropractor and proposes that it contains fourintrinsic claims to trustworthiness: he claims to bea qualified and sincere healer who is inpossession of knowledge and techniques that derivetheir power from their truth content and whichempower him to make beneficial changes in thepatient. Taking each claim in turn I described thenature of the claim, how it might be adequatelyvalidated, ways in which his healing performance mightvalidate it and how he might be assisted by thepatient, and how their actual validation may bedistorted by the healer and patient. It is suggestedthat while unusual in many regards, this unorthodoxhealing performance may be a foil by which toexamine other more orthodox healing performances.     

Is it acceptable for a physician to break confidentiality in the case of sexually transmitted diseases? A mapping of young Kuwaiti's views

IntroductionConfidentiality is essential for the establishment of trust between physicians and their patients.ObjectivesThe circumstances under which it is acceptable to young Kuwaiti for a physician to break confidentiality to protect the spouse of a patient with a sexually transmitted disease (STD) were examined.MethodA sample of 263 young Kuwaiti indicated the acceptability of breaking confidentiality in 48 scenarios that were all possible combinations of five factors: disease severity, time taken by the physician to discuss with the patient, the patient's intent to inform the spouse about the disease, the patient's intent to adopt protective behaviors, and the decision to seek the advice of an expert in infectious diseases before breaking confidentiality.ResultsThrough cluster analysis, four qualitatively different positions were found: Quite never acceptable (6% of the sample, mostly males), Depends on husband's willingness to inform (3%), Depends on husband's protective behavior (29%, mostly females), and Quite always acceptable (32%). The remaining participants did not express any clear view.ConclusionIn Kuwait, students’ trust in the medical profession is, therefore, not likely to be seriously undermined if, from time to time, and in well-specified cases, individual physicians decide to break confidentiality when facing dilemmas of the kind examined in the current study.     

Curious bedfellows: Psychoanalytic understanding and old age psychiatry

SUMMARY

The author outlines an approach to assessment, or as she prefers to call it, psychoanalytic consultation, in the Health Service. This involves giving the patient an experience of the analytic process, which they can then assess in a way, while the assessor gains information about a number of categories that can be thought of hierarchically, which inform the advice given the patient and the referrer about management and treatment. The safety of the patient is paramount, as psychoanalytic psychotherapy is a powerful and disruptive treatment. However it is argued that, on the whole, ‘suitability for psychotherapy’ should be on the basis of exclusion rather than involving the patient passing a sort of ‘suitability test’. The latter may enable public psychotherapy services to deny the incompleteness of what they are able to offer.     

Ordinary Unconscious Communication in the Therapist/Patient Relationship

ABSTRACT

In this article, I consider the ways in which unconscious communication between therapist and patient is omnipresent in psychoanalytic work. To consider unconscious communication between therapist and patient is to consider psychoanalysis, at its core. The phenomenon of unconscious communication between patient and therapist is a quotidian event. It defines its essential listening stance, with variations associated with different theoretical perspectives. I present several clinical vignettes to illustrate the phenomenon and consider some different theoretical perspectives that bear on the therapist’s uses of self in engaging the ways that one unconscious informs another.     

Receptivity,or Going on (Not) Being: Commentary on Paper by Robert Grossmark

“The treatment hinged on my being able to live with him in this ongoing non-existence and know it and tolerate it, and expect no more,” writes Dr. Robert Grossmark about himself and his patient, Kyle (pp. 637–638). This is a key sentence, outlining the core of the enlightening analytic work done. I comment on the linkage between living the ongoing nonexistence and going-on-(not)-being, then reflect about the distinction between what I call the “outward” technique, which is everything Grossmark describes about treating Kyle, and the “inward” technique, which is all that occurred within him, in an inner, hidden, powerful, unconscious dialogue with the patient, and which is only hinted at. In this context, with patients like Kyle, who bring to the analyst physical sensations and actions for dreaming, the analyst's corporeality, by which I mean his experience of his body and his capacity to connect it to emotion, thereby lending it meaning, has a critical importance. I bring, in a nutshell, references to several psychoanalytic writers about the subject of corporeality in analytic treatment and use a vignette from an analysis to demonstrate the point.     

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Abstract

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.

Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master^® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.

Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.

Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.     

Enactment as Unconscious Communication

ABSTRACT

I explore the way in which unconscious primitive and nonsymbolic experience is communicated to the analyst’s unconscious through enactment. As the analyst receives the projections unconsciously, she is encouraged to enact aspects of the patient’s internal world. The analytic work then is through the understanding of these subtle and ubiquitous enactments. I value the work of understanding enactments as a rich and subtle pathway into the deepest levels of the patient’s unconscious. I explore the nature of this work and illustrate my point with clinical examples.     

A Century of Psychoanalysis: Critical Retrospect and Prospect

Abstract

The distinction between having mode and being mode would seem to be the basis of the Frommian clinical approach, which finds its main application in the “center-to-center” relatedness between analyst and patient. The analyst can understand the patient because he/she experiences what the patient experiences. The dialogue is based on emotional and conceptual responses and reactions which are reciprocally communicated; both identities come into play. Psychoanalytic treatment which is not inspired by biophilia can only compile an inventory of data upon data, imposing interpretations and reconstructions. Biophilia makes psychoanalysis an art because it is applied to living things. The psychoanalytic session can save itself from the having mode by addressing the patient's living memory, which represents the past relived in the present, according to the being mode. The author comments on a psychoanalytic session.     

Impact d’une prise en charge par hypnose sur le vécu et l’observances des recommandations hydriques en hémodialyse : résultats d’un protocole à cas unique chez deux patients

IntroductionHemodialysis is associated with dietary and fluid restrictions, which can be a source of frustration, suffering and non-compliance in many patients. Hypnosis, a booming therapeutic tool in the health field, could improve patients’ feelings. The objective of this study is to assess the effect of hypnosis on fluid restrictions experience.MethodThe effectiveness of the hypnotic intervention was evaluated using a single-case protocol (ABA type) with two patients. A protocol in 3 phases of 3 weeks was used with three sessions of hypnosis. Several measurement tools have been used: the KDQoL-36 for quality of life, the Health-Specific Self-Efficacy Scales (adapted for dialysis patients) for self-efficacy, and numeric scales for therapeutic compliance and thirst.ResultsSome significant changes were observed with maintenance of the effects after hypnosis: improvement in the global quality of life for patient 1, improvement of self-efficacy (barrier) for patient 2. The visual analysis showed improvements but without significant effect as alleviation of thirst and discomfort, improvement of perceived compliance.ConclusionThese preliminary results concerning the effects of hypnosis on the experience of fluid restrictions are mixed reflecting variability between patients. However, these results are encouraging and show the need to continue this evaluation with more patients thanks to the advantages of the single-case protocol method.     

Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behaviour in persons with chronic illness. Longer term trajectories have not been previously explored.

Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course.

Design: The study design was a longitudinal, comparative cohort study with five time points during a one-year follow-up, using repeated measures analysis of variance.

Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year.

Main outcome measure: The General Self-Efficacy Scale was the main outcome.

Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory.

Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across time.     

Empathy and emotional dissonance: Impact on organizational citizenship behaviors

IntroductionThe ability of nurses to hold competing emotions is at the heart of a number of recent studies. Empathy is an emotional resource in nurse-patient interactions and promotes positive experiences at work. On the contrary, emotional dissonance resulting from nurse/patient interactions is usually considered to lead to negative outcomes, such as job dissatisfaction (Brotherigde & Grandey, 2002).ObjectiveThe aim of this study is to investigate the extent to which empathy and emotional dissonance are associated with organizational citizenship behavior among a group of Italian nurses.MethodA questionnaire was distributed to 222 nurses, working in two multidisciplinary hospitals in a North region of Italy.ResultsResults support the hypothesis that both cognitive and emotional empathy have significant effects on nurses’ organizational citizenship behavior directed at the organization. Cognitive empathy explained significant variance in organizational citizenship directed only at specific individuals.ConclusionThese findings confirm that cognitive and emotional empathy have different impact on nurses’ organizational citizenship behavior. Further studies are required to inform education or for application in clinical settings.     

Male and female internal images in a case of frigidity

Abstract

This is the case of a young woman suffering from a narcissistic personality disturbance with Oedipal aspects. The development of the analytic treatment is stressed through the analysis of her dreams. The analytic setting provided an appropriate mirroring Self-object. Thereby the patient has had the opportunity to express her own defective female grandiose Self, which was at the base of her disturbances.     

Pertinence clinique en population dépressive d’un médiateur thérapeutique axé sur les ressources personnelles : évaluation par protocole individuel de type arrêt—reprise sur une patiente hospitalisée pour dépression

IntroductionThe low to moderate benefit of current care on optimal functioning in depressed patient encourages the development and evaluation of new interventions in this area.ObjectiveThis study aims at the clinical evaluation by single case of a serious game focused on personal resources in depressed population.MethodThe recommendations of the Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) Statement were respected to design and report the results of this single-case research (Tate et al., 2016). A Withdrawal/Reversal ABA design has been applied to a young patient hospitalized for depression. Each phase contained 3 measurement opportunities spaced 7 to 10 days apart. In intervention phase B, a serious game was introduced in positive psychotherapy workshops without replacing the patient's usual care.ResultsIn the patient, serious game had a clinically significant benefit on depression, psychological well-being and affects. On the other hand, an increase in stress and anxiety levels, as well as a progressive decrease in the feeling of autonomy were also observed.ConclusionSerious game as a therapeutic mediator seems to have demonstrated its effectiveness for the patient. The reduction in depression coupled with the increase in stress and anxiety points out a favourable progression of the patient's problem. Elements specific to the patient's intra-individual problem were highlighted and could shed light on her clinical management.     

Environnement lumineux et anxiété des patients en service d’IRM

BackgroundMagnetic Resonance Imaging (MRI) is a medical imagery exam, which is considered stressful/worrying for patients. This anxiety is related to several factors: negative beliefs linked to the lack of knowledge about the procedure of the exam, duration, noise of the MRI, etc. Several interventions, before and during the MRI were proposed and evaluated with the aim of reducing anxiety for patients (information given to patients, psychological preparation before the exam and hypnosis, aromatherapy, sedation, environment and positioning of the patient). While the health service is more and more centered on cost-efficiency and pressure for greater patient throughput, it is important to find appropriate interventions to improve patient tolerance of MRIs.ObjectiveThe objective of this study was to compare anxiety of patients based on the MRI luminous environment.Methods208 patients aged 18–70 years participated in the study. Four subgroups were created according to the presence or absence of luminous environment, screen and music: G1 (60 participants, with luminous environment, without screen, music with fast tempo); G2 (60 participants, with luminous environment, with screen, music with slow tempo); G3 (27 participants, without luminous environment, without music); G4 (61 participants, without luminous environment, music with fast tempo). All participants completed a questionnaire to evaluate their anxiety regarding the exam (anxiety-state, AE) and in everyday life (anxiety-trait, AT): STAI-Y. Open questions were also asked to participants in order to gain an understanding of their experience of the exam (positive points and suggestions for improvements).ResultsThe results showed a significant difference between the groups of the AE: patients of group G1 showed more AE than patients in group G2 (p = 0.037), patients of group G2 showed less AE than those of group G3 (p = 0.001), and patients of group G3 showed more AE than patients in group G4 (p = 0.019). No significative difference was found between the 3 groups in the AT. The participants who underwent exams in a room with a luminous environment equipped with a screen with slow tempo music reported more satisfaction and offered fewer suggestions for improvement compared with the two other groups.ConclusionThis study has revealed that the environment in which patients undergo their exam affects their level of anxiety during the exam. A luminous environment equipped with a screen led to a considerable decrease in patient anxiety during the MRI exam. Technological innovations are allowing the patient to be the center of radiographers focus more and more. Trying to priorities improvement of patient well-being consequently facilitates their work. Taking into account the cost and increasing number of medical imagery exams, prevention of anxiety and its undesirable side-effects is not only important for patients, but also avoids wastage of staff and of time. The results of this study should encourage health centers to invest in these new installations, keeping in mind that new technologies can never replace information and support offered before the exam by radiologists and radiographers.     

Emotional Communication and the Unconscious in the Analytic Setting

ABSTRACT

One type of unconscious communication is conceptualized as a form of emotional communication, the channel of communication that conveys information about a person’s emotional state through the nonsymbolic expression of feelings and is experienced as feeling in the receiver. Some of the analyst’s feelings are attuned responses to the patient’s unconscious communications; others are disjunctive and related only to the analyst’s unconscious. Attuned feelings can be identified by their congruence—similarities, consistencies, and analogies—with the patient’s verbal material, which reveals the meaning that the analyst’s feeling has within the patient’s subjectivity. Attuned feelings also have a meaning within the analyst’s subjectivity. Two cases are discussed, one in which the analyst experiences the patient’s unconscious communication within the symbolism of one of her own childhood memories. The other illustrates the risk of confusing disjunctive feelings emanating from the analyst’s own unconscious with unconscious communication from the patient.     

A Story of a Split and Hope

ABSTRACT

This article, written by the analyst and his supervisor, presents the handling of a persistent obstruction of the analyst’s empathic capability. The mutual activation of a relentless empathic search led to the obstruction’s dissolution through the revelation of a personal part of the analyst’s life, and its connection to the patient’s inner life. The recognition of the split that existed in the analyst and the joy of finding the lost empathy and expanding it opened a new path in the analysis and enabled the beginning of a psychic transformation in the patient, which main essence is Hope.     

Qu’est-ce que les professionnels dévoilent d’eux-mêmes dans la relation thérapeutique avec les personnes atteintes de schizophrénie ?

IntroductionHealth professionals’ self-disclosure is a common practice, but there is still controversy regarding when it is appropriate, what the extent and content of self-disclosure should be, and what the clinical consequences are.ObjectivesThis qualitative study aimed to investigate self-disclosure in health and social-care professionals.MethodThirteen in-depth interviews with group leaders of an intervention to improve pleasure and motivation in schizophrenia. The interviews were subjected to thematic analysis.ResultsProfessionals describe their personal disclosures as authentic sharing of lived experiences. From a content point of view, professionals select simple events from their personal or professional life, which they find easy to share with patients, in a group. The selection criteria for these experiences mainly concern the therapeutic value and are formulated in terms of relevance of the content and the usefulness envisioned for the patient as well as authenticity. Self-disclosure generates a redefinition of the places in interaction and a more egalitarian relationship.ConclusionSelf-disclosure is found to be a tool for developing and maintaining the therapeutic relationship. Further studies of the phenomenon would be useful to design training and supervision for professionals.