Continuing the dialogue: a reply to Bernard Gert

Continuing the dialogue begun in the March 2006 issue of the Kennedy Institute of Ethics Journal, I suggest that Bernard Gert's response to my paper does not adequately address the criticisms I make of his theory's application to bioethics cases.     

Meditative dialogue: tuning in to the music of family therapy

Meditative dialogue is a mindfulness method through which families and their therapists are able to access the present moment and develop acceptance, non‐judgmental attitudes and attunement with one another and with the music that is always present in their lives. This process can be used to deepen empathic connections, tap into creative forces and loosen and encourage embodied and flexible interactions that alter patterns and cultivate openness to possibility and to change.     

Frank in mind: a journey to self

Abstract

This paper describes two years’ intensive psychotherapy with an 11 year old boy I shall call Lou, who as a result of traumatic experiences in his early life, struggled to integrate a robust sense of self and in particular to find accord with a sense of himself as male. The impact of maternal depression, paternal gender dysphoria and domestic violence are discussed in relation to this young boy’s capacity to resolve the ordinary Oedipal challenge and find narcissistic value in a male body image to consolidate his gender identity. Concomitant difficulties with separation from his mother and aggression towards himself and others significantly impacted his ability to manage in a mainstream school environment and he was excluded at the time the therapy began. A clinical narrative is presented which illustrates Lou’s journey in psychotherapy, where he began to engage and allow links to be made. He sought to understand his position in a world that did not make sense to him, to face a hitherto ‘unthinkable’ past and to integrate disparate aspects of himself including a male gender identity. Notably Lou’s creation of ‘Frank’ constructed from dead, lost and reanimated objects is described and the actual and symbolic functions of this therapy object are discussed in relation to his internal development and the progress of the work. Parallels are drawn with Mary Shelley’s novel Frankenstein, where the creature strives for psychological birth and understanding. Lou and I struggled in the paradox of the themes of his narrative; a male/female father; potency and castration; corruption and repair and how to be a boy, held and helped in part through the paternal function of a female therapist.     

Transforming negative parent-adolescent interactions: from impasse to dialogue

This treatment development, process research study focuses on resolving in-session, parent-adolescent conflicts characterized by negative exchanges, emotional disengagement, and poor problem solving. These processes have been empirically linked to poor developmental outcomes, and clinically linked to poor therapeutic progress. Specifically, we examined how a shift of therapeutic focus from behavior management to interpersonal relationship failures could resolve this impasse and resuscitate therapeutic momentum. A task analysis approach was used to verify the presence of the impasse, to illuminate its core features, and to define the therapist and client behaviors associated with resolving it. In Part 1 of this two-part series, we presented the final performance map that represented that family's cognitive, emotional and behavioral interactions necessary to resolve the impasse. This article, Part II, focuses on the theoretical foundation of the intervention strategies, the phenomenology of the impasse, and the therapist's skills needed to facilitate it.     

A fact-finder's journey to Europe

The author undertook a trip to sixteen cities in eight European countries to study Continental models of integrating spiritual development and mental health and to look at training programs in pastoral counseling. He found a growing secularization of clergy who want to offer human services and cannot do so within established church hierarchies. In Roman Catholic areas he found pastoral counseling services directed to the religious professional rather than to the laity or the public. Training programs have yet to be fully developed. Only the Swedish model, in its history and multidisciplinary character, resembles the situation in the United States.     

Suicide across the Life Span: Pathways to Prevention

As reflected in a recent series of highly visible suicide awareness and prevention activities, the call for a comprehensive suicide prevention strategy has never been stronger, nor more unified. Using the framework provided by the transactional model of human development, the author illustrates the central implications that a developmental perspective has for suicide prevention, emphasizing the need to consider multiple pathways to prevention, to place renewed emphasis on prevention strategies that have their impact earlier in the life course and earlier in the course of mental disorder, and to collaborate with prevention specialists and advocates in related fields.     

From monologue to dialogue: a transition in psychoanalytic practice

During the latter part of the twentieth century, psychoanalysts of various stripes espoused the move from free association and neutrality to various forms of intersubjectivity and dialogue. This shift is studied from the vantage point of conversational rules in terms of the shift from monologue to dialogue, using the concepts of semantics, syntax, and pragmatics. Viewing the data of analysis in this manner offers a means of evaluating the contributions of both monologue and dialogue to our understanding of the conduct of an analysis and the kind of information that can be expected to emerge. Exclusive devotion to either stance, it is argued, renders less understanding than would emerge from a balanced use of both.     

Pathways to Careers: A Videotape Review

Pathways to Careers produced by the Pennsylvania Occupational Information Coordinating Committee (POICC), Pennsylvania Department of Labor and Industry; Harrisburg, PA. 1994, 60 minutes, $15.00. A “Career Development Awareness Guide” accompanies the video.