Falling off the couch

The patient's therapeutic regression intensifies certain unconscious meanings of the analytic couch. In addition to representing the analysis or the analyst in general, the couch can represent the unconscious, or it may take on the symbolic significance of the analyst's or mother's arms, lap, breasts, or womb. When the genetic roots of the patient's transference include substantial experiences of disappointment, narcissistic injury, and mistrust, the theme of falling from the couch may emerge as a dream, an association, or even an enactment. This theme usually implies the presence of a deepening but mistrustful transference, based on earlier disappointments by the patient's primary objects. Falling off the couch may be associated with being dropped as an infant, rolling out of bed as a child, birth, miscarriage, castration, death, termination, defending against passive wishes, punishment for sexual or aggressive transgressions, escaping an attack, descending into the unconscious, or wanting to be picked up and comforted.     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

The patient's own pillow on the couch

Material is presented from two hypochondriacal patients who insisted on using their own pillows on top of the bolster-pillow on the analyst's couch. A number of important transference fantasies are seen as underlying this unusual resistance to the progress of the analysis. In addition, the analyst's countertransference feelings are described.     

REM sleep and the analytic process: a psychophysiologic bridge.

Recent research on the physiology of REM sleep has supported the hypothesis that it serves processes of psychologic adaptation. This study examines the relationship between physiologic parameters of REM sleep and evidence in analytic material of the need for adaptation. Significant correlations were found between defensive strain before sleep and REM latency, and between change in defensive strain from evening to morning and total REM time.     

The couch as icon

The couch has always been an integral part of psychoanalytic practice. It has even become a cultural icon representing psychoanalysis itself. However, minimal evidence exists in the psychoanalytic literature that using the couch is necessary or even necessarily helpful to establish a psychoanalytic process and conduct an analysis. Furthermore, it can potentially be harmful to patients such as those who have experienced early loss and trauma or who have significant ego organizational problems. Therefore, the use of the couch per se does not seem well suited as a defining criterion of psychoanalysis. To the extent that it may be clinically valuable, the use of the couch should be more carefully considered and critically examined.     

病人角色的社会心理学思考

病人角色是一个角色丛,患者在诊断治疗过程中,可能扮演医疗自助者、医疗求助合作者、医疗拒助者、医疗失助者、医疗反助者或医疗受试者等不同角色.医疗卫生工作者对病人角色内涵的理解,直接影响着医学认知、医学教育改革、医患关系及以病人为中心的落实.     

论患者隐私权的伦理价值

什么是隐私权 ?为什么要保护隐私权 ?如何保护隐私权 ?本文将就这些问题做一探讨。1　隐私权的基本含义隐私权一词 ,源于英文的 ｐｒｉｖａｃｙ,意为秘密、私事、私生活、宁静不受干扰或侵犯的自由。按照《韦氏大辞典》的解释 ,主要含义有三 :一是指独立于其他公司或其他人的性质或状态 ;二是指不受未经批准的监视或视察 ;三解释为隐居、私宅、私人事务、私密环境等。《不列颠百科全书》(国际中文版 )中规定 :“隐私权是民事侵权行为法和美国宪法上的一个概念。在侵权行为中 ,隐私权是一种不受这样一些行为给与的精神上的伤害的权利 ;这些行…     

The Psychodynamics of the Patient's Active Episodes

The phenomenon of the patient as active change agent is a critically important, but new and understudied one. This paper attempts to explore and to illustrate with clinical examples the psychodynamic foundations of the patient's activity. The concept of an active episode on the part of the patient is introduced and defined. The paper illustrates the ways that active episodes of self-change on the part of the patient can determine the outcome of psychoanalytic therapy.     

癌症患者临床决策倾向性的研究

为了解癌症患者对医生、自己和家属意见的临床决策倾向性,采取问卷调查和半结构访谈相结合的方法,调查120例住院癌症患者的临床决策倾向性.结果显示,(1)生活习惯相关决策,实际和理想的患者自己倾向性构成比值最高,为40%和33%;求医行为方面家属最高.实际和理想均为50%;常规检查、总体治疗方案、手术、化疗和放疗相关决策方面均为医生最高,分别为100%、90%、100%、90%和100%;(2)癌症患者理想和实际的临床决策倾向性构成比值均无差异(P>0.05),但访谈显示29.17%的患者认为目前决策状态不理想.提示:(1)癌症患者在不同方面的临床决策倾向性有所不同.(2)癌症患者对临床决策状态基本满意,但有患者希望医生参与沟通更多或自己参与更多.     

Isakower-like experience on the couch: a contribution to the psychoanalytic understanding of regressive ego phenomena

Since Isakower's original contribution of 1938, Isakower phenomena have been viewed as primitive experiences involving maternal breast, womb, and face imagery. This clinical report harks back to the less well-known hypothesis with which Isakower concluded his paper: he suggested that these perceptual experiences are related to childhood oedipal masturbatory fantasies at the time of going to sleep. In this paper four Isakower-like phenomena experienced by a patient on the couch are reported in the dynamic context in which they occurred. It is argued that these phenomena constitute a type of regressive ego experience that defends against oedipal conflict.     

医护人员对患者权利的保护情况调查分析

采用现场问卷方式调查统计结果表明:大部分医护人员了解患者的相应权利,对患者权利具有一定的保护意识,但部分患者权利保护不足,存在易发生医患纠纷隐患,需要引起临床医护人员的重视,不断加强法制观念教育.