The patient,the nurse,his life and her mother: Psychodynamic influences in nurse education and practice

Using the film The Cook, the Thief His Wife and her Lover (from which this paper's title is borrowed) as a powerful illustration, the paper examines some of the unconscious processes which form part of everyday life for nurses working in the community, particularly on the wards of our hospitals. It is an attempt to describe some of these processes and to understand the conditions that promote them. With acknowledgements to the pioneers in this sort of work, such as Main, Menzies-Lyth, Trist, Bamforth and Jaques, the paper looks at the ethology of institutions and at activity that takes place on the boundaries between self and other, between the inner world and external reality, and between various levels in the hierarchy.

The paper identifies some of the ‘routines’ which grew up in nursing (and those which have replaced them), the unconscious purpose of which is to safeguard the emotional and psychological integrity of the nurse, through creating a distance between herself and her patients. The paper argues against removing these necessary defences until more helpful alternatives are in place. To fulfil this aim, it recommends that clinical supervision and support seminars should become a regular part of all nurse-training programmes, and should continue throughout the professional life of the nurse.     

"Without being in psychoanalysis I would never have dared to become pregnant": psychoanalytical observations in a multidisciplinary study concerning a woman undergoing prenatal diagnostics

As is well known, Freud described the clinical practice of psychoanalysis as the 'loam' of his cultural-theoretical work, an assessment which is shared by many psychoanalysts up to the present, including the authors of this paper. The complex interplay between unconscious phantasies on the one hand, and the real experiences arising from the new possibilities opened up by prenatal diagnostics on the other, is described with reference to a report of an intensive, long psychoanalysis with an analysand from a family burdened with a genetically transmitted illness (haemophilia). The holding and containing function of the analyst enabled this analysand, despite traumatic experiences with the miscarriage of a healthy child triggered by a prenatal diagnosis and the later abortion of a haemophiliac baby, nevertheless to have the courage to go through another pregnancy and give birth to a healthy girl. The intensive clinical investigation of the unconscious phantasies, conflicts and traumas around the prenatal diagnostics proved to be not only therapeutically fruitful for the analysand, Ms F. It also facilitated insights into those individual chances and risks which appear to be an integral part of the opportunities presented by todays prenatal diagnostics and, through them, it lead to a cultural-critical look at the ambivalence of medical-technical progress. These insights, which are only attainable through psychoanalysis, can represent a distinctive contribution of psychoanalysis to a multi-disciplinary dialogue with medical practitioners, geneticists, ethicists and health policy-makers. By referring to a large EU study on 'Ethical Dilemmas due to Prenatal and Genetic Diagnostics', this paper gives a practical example of such a discussion. Ms F. was psychoanalytically interviewed as part of this study, 16 years after the conclusion of her analysis. The summary of these interviews, which is set against the account of the treatment, offers an impressive insight not only into the long-term effects of a psychoanalysis under very particular personal circumstances, but also into the lasting consequences of decisions made in the context of prenatal diagnostics. Finally, the results of the individual case study are brought together with the clinical outcomes of the EU study, and some considerations are formulated concerning the protective and risk factors facing women during and after prenatal diagnostics. The paper is an appeal to psychoanalysts, with their specific competence in dealing with unconscious phantasies and conflicts and their high level of professionalism in dealing with traumatised patients, to get involved in fresh dialogue with prenatal diagnosticians and their patients.     

The Understanding and Treatment of Immigrant Trauma Survivors: Finding the Right Mix

This paper reviews attempts by three authors to describe psychoanalytic conceptualizations and treatment of torture victims. It argues that because the transference-countertransference configuration with immigrants who have not suffered torture is very similar to that of torture survivors, that no special diagnostic categories, theories, or treatment methods are needed to work with torture survivors. Second, the paper contends that newer psychoanalytic paradigms such as Hoffman's Social Constructivism may assist clinicians to capture the richness and complexity of clinical work with torture survivors better than do traditional analytic conceptions such as neutrality. Via an analysis of the three papers in this volume, I conclude with a consideration of the strengths and the weaknesses of the field of cross-cultural psychotherapy in general.     

The social unconscious in persons,groups and societies,Vol 1: mainly theory; and Trauma and organizations

This paper considers the emotional life of the infant in the incubator and develops a new psychological theory which is called the ‘incubator psyche’. Theory building is advanced from three main discourses: (1) psychoanalysis, (2) neo-natal nursing and (3) psychology. A case study of Corey, a 7-year-old boy, who had been delivered prematurely, with a hole in his heart, and spent the first 6 weeks of post-natal life in an incubator, is presented to illustrate how aspects of an incubator psyche might be clinically manifest. The concept of an incubator psyche is advanced with reference to a particular kind of second-skin formation (Bick, 1968, The experience of the skin in early object relations, The International Journal of Psychoanalysis, 49, 484–486). It is proposed that the incubator psyche characterises a client's mental functioning exercised as an environmental sensibility that could be understood in terms of the total transference situation (Klein, 1952, The origins of transference, International Journal of Psychoanalysis, 33, 433–438; Joseph, 1985, Transference: The total situation, International Journal of Psychoanalysis, 66, 447–454). Implications for practice are considered advocating particular attention to the setting.     

The place of once-weekly treatment in the work of an analytically trained child psychotherapist

In this paper, I explore how we might link ideas about clinical facts to current issues in child psychotherapy research. I consider what our understanding of clinical facts might contribute to our research methods and how our research methods might better represent the clinical facts. The paper introduces a selection of psychoanalytic writers' formulations of the concept and describes some of the debates about the shortcomings of the traditional style of case reporting. The importance of keeping emotional experience central in our research is discussed. I describe a research method that I believe has the potential to capture and describe some of the complicated processes of change in psychotherapy. This is the concept of the ‘turning point’ session. Introducing the paradigm of complexity theory, I briefly explore how we might think about and understand the relationship between processes revealed through detailed analysis of a single session and change over a longer period of therapy.     

基于眼动数据的一例角色书信疗法临床案例的分析与启示

采用眼动法,探究来访者阅读去信与回信时认知信息的变化,以及新手型咨询师与来访者在阅读角色书信时认知信息的差异。结果表明,来访者阅读回信时,对去信中诱发不良情绪的部分认知因素予以回应;新手型咨询师的注视时间显著短于来访者,注视次数多于来访者,热点区域不同于来访者。结果说明,往复的角色书信可以促进来访者转变不良认知;新手型咨询师对角色书信的理解与来访者存在不同。     

Aggressive Outcomes and Videogame Play: The Role of Length of Play and the Mechanisms at Work

We conducted three experiments to rectify methodological limitations of prior studies on selective exposure to music and, thereby, clarify the nature of the impact of sad mood on music preference. In all studies, we experimentally manipulated mood (sad vs. neutral in Experiments 1 and 2; sad vs. neutral vs. happy in Experiment 3) and then assessed participants' preferences for expressively happy versus sad musical selections. To further help illuminate the reasons for their music preferences, we also asked participants to indicate how they believed listening to each song would affect their current emotional state as well as how appropriate they felt it would be to select a given song. Results suggested that individuals in sad moods were not reliably inclined to listen to sad songs, but rather, were strongly averse to listening to happy songs, apparently out of concern that choosing such songs would feel inappropriate. We discuss implications of these findings for theories of selective media exposure and emotion regulation.     

The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.     

Light and color in a void: The analysis of a special needs child

This clinical report comes from the five year, four day a week analysis of a male child. What is special is that this treatment is of a child with marked mental retardation. I have retained this nomenclature because that is how Ricardo's parents described his mental capacity. What they meant was that he was greatly impaired in his cognition and this could be seen in Ricardo's severe cognitive, social, behavioral, and relational improprieties. I have privileged the function of psychoanalytic understanding and the role of transference to bring about modifications in this child's internal world. And I have considered the patient's psychotic mental state to be in need of psychoanalytic treatment not withstanding his psychosis's connection to his cognitive handicap. I have also added information I have received after the analysis, information that demonstrates continued integration coming from the analytic process. Owing to Ricardo's limited mental capacities, this article advances clinical information that is not often found in analyses of children. There are possibly many other children like him who nonetheless would benefit from dynamic psychoanalytic understanding. On the other hand, I shall not discuss this matter theoretically, even though some theoretic considerations are necessary. Clinical practice and the transferential relation are this report's principal material.     

案例教学的医学伦理学再造

我国医学伦理学采用案例教学法已经有二十余年的历史了。在此期间,案例教学得到了一定的发展,却也受到了诸多因素的限制。当前,中国医学伦理学的案例教学朝哪里去、怎么去等一系列新的问题摆在我们面前,这些问题必须依赖于加强我国医学伦理学软件环境的建设并对案例教学进行医学伦理学的再造方能加以解决。     

Elasticity of Technique: The Psychoanalytic Project and the Trajectory of Ferenczi's Life

The object of this paper is the Elasticity of Psychoanalytic Technique in the work of Sándor Ferenczi. The author sustains that this can be considered neither as an ultimate arrival point nor as a particular stage of Ferenczi's clinical–theoretical body of work, but rather as an ensemble of affective qualities, attitudes and values, which he gradually developed through experience, signalling a paradigm shift in the history of psychoanalysis. The following areas will be explored: the new sensitivity demonstrated by Ferenczi concerning the relational and communicative factors present in the analytic session, his subtle and acute attention to the participation of the analyst's own subjectivity in the therapeutic process, and how these enduring elements of Ferenczi's technique anticipate several significant future developments in psychoanalysis.     

Childhood Trauma and Self-Control: The Mediating Role of Depletion Sensitivity

Journal of Child and Family Studies - Previous research demonstrated that childhood trauma was associated with self-control deficit from adolescence to adulthood. However, the underlying mechanism...     

应该发挥医院、医生在慢性病预防中的作用

从必要性分析、可行性分析、预防效果分析及存在的问题等方面探讨在我国必须要发挥医院、医生在慢性病预防中的作用,只有整合医疗资源与疾病预防控制资源,才能更好地预防慢性病。     

On the nature and standing of psychoanalytic psychotherapy

In this paper, I offer some reflections on the standing of psychoanalytic psychotherapy in the National Health Service (NHS), with special reference to contemporary forms of evidence-based thinking. I consider what may follow when a narrow view of science or psychotherapeutic practice becomes conventional wisdom and assumes dominance. I place stress on the potential loss to NHS psychology and psychiatry if psychoanalytic psychotherapy becomes increasingly marginalized on the one hand, or overly standardized on the other.     

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.     

The Unique Role of Spirituality in the Process of Growth Following Stress and Trauma

This study investigated the unique contributions and moderating effects of positive and negative experiences of spirituality in predicting variance in stress-related growth and positive affect over and above the variance explained by the domains of the Five-Factor Model of Personality, social support, perceived stress, and gender in a sample of 109 male and 320 female volunteers. Responses were analyzed using hierarchical linear regression. Results indicated that faith maturity predicted unique variance in stress-related growth after controlling for the influence of personality and gender; faith maturity and spiritual struggle predicted significant unique additional variance in positive affect over and above the variance predicted by personality, social support, and stress-related growth; and spiritual struggle moderated the relationship between stress-related growth and positive affect. The implications of these results are discussed in light of Park’s (Journal of Social Issues 61:707–729, 2005) model of religion as a meaning-making framework.     

‘The essay method’ a qualitative method for studying therapeutic dialogues

ABSTRACT

This paper presents a qualitative research method for analysing therapeutic dialogues called ‘the essay method’. A central part of the method uses the format of the literary essay as a model. The method consists of a close monitoring of clinical material guided by an overall psychoanalytic/psychodynamic theoretical frame. It combines both clinical details and global patterns of clinical material and is especially fitted for studying relational qualities of psychotherapeutic dialogues. In this paper, the background for qualitative analysis in studying psychoanalytic material is discussed, and the procedures for using the method are demonstrated. A study of therapeutic competence in a group of student therapists is used as an example of the method in practice, demonstrating that the essay method may have potential for revising theory and establishing new concepts based on empirical findings. The essay method is compared with other qualitative methods, and it is argued that it is suitable for psychoanalytic research.     

Relationship Between Childhood Trauma and Sleep Disturbances: The Role of Perceived Stress as a Mediator

The main objective of the current study was to analyze the mediating role of perceived stress on the relationship between childhood trauma and sleep disturbances among the adult population. The sample of this cross-sectional study was composed of 987 Portuguese adults with sleep disturbances, who completed a self-administered questionnaire about childhood trauma, sleep disturbances, and perceived stress. The results of analyses found that in the model that included the variables childhood trauma and perceived stress, both variables were predictors of sleep disturbances; however, perceived stress was the strongest predictor. Regarding the model with the subtypes of maltreatment, only Emotional Abuse predicted sleep problems. Results of the Path Analysis model showed that perceived stress partly mediates the effect of childhood trauma on adult sleep disturbances. This study has clinical implications, supporting the importance of taking into account childhood trauma and perceived stress during the assessment and intervention of sleep disturbances.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder

An increased awareness of the spiritual aspects of health and illness has recently led to changes in psychiatry residency training as well as hospital accreditation requirements. The spiritual impact of trauma has been an area of particular interest, as trauma evokes certain existential questions and crises. It is estimated that from 5–11% of trauma survivors will go on to develop posttraumatic stress disorder (PTSD). Given the spiritual challenges of the experience of trauma, patients with PTSD could benefit from spiritual assessment and intervention as part of their overall treatment plan, and clergy can be utilized to perform this. The literature exploring the spiritual impact of trauma and the use of clergy in the treatment of trauma survivors is reviewed. The methods used by three chaplains in a residential treatment program for PTSD at one facility are described and discussed. Both the literature and the experiences of the clergy suggest that exploration of trauma-related existential conflicts in patients with PTSD is beneficial. However, there is a notable dearth of controlled scientific studies evaluating the effectiveness of spiritual interventions with this treatment population. The need for controlled studies to verify the usefulness of spiritual assessment and intervention in patients with PTSD is noted, and a more rigorous analysis of how clergy can best serve this treatment population is encouraged.