Notes on Psychoanalysis,Psychotherapy and Methodology

Abstract

Technical innovations always carry with them clinical and scientific challenges. The aim of this paper is to provide a context for exploring the consequences of technical innovations for psychoanalysis as an interrelated method of observation, treatment, and body of knowledge about mental functioning. The problems are approached from a methodological perspective because scientific progress requires methodological clarity. The inquiry begins with a methodological investigation of the technical and theoretical consequences of first principles, that is, the consequences of the assumptions and methods we adopt for the kind of data that are obtained by their application and for the theory required to understand and unify the resulting observations. The conclusion suggests that if one organizes a doctor-patient relationship around the clinical-historical and free-association methods with the aim of removing all obstacles to communication, if the understandings that emerge include a full range of dynamic, structural, genetic and adaptive propositions, one is engaged in psychoanalytic inquiry. The circumstances under which Rothstein's technical recommendations enable such understandings to develop are an important topic for future research.     

Commentary: Psychodynamics and Social Cognition—Notes on the Fusion of Psychoanalysis and Psychology

ABSTRACT Interest in linking psychoanalysis with scientific psychology waxes and wanes. In part, the difficulties have been caused by the preference of psychoanalysts for Freud's clinical theory (and its emphasis on narrative truth) as opposed to his metapsychology (with its requirement for historical truth). Even though contemporary scientific psychology evolved largely independently of psychoanalysis, the articles on object relations, transference, and defense published in this special issue show that the theory remains a source of inspiration, observations, and hypotheses.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群.为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗.以往,手术治疗和化疗的应用随着年龄的增高而明显减少.我们一直以为老年人手术和化疗的效果不令人满意.近期的研究改变了这一认识.证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的.即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益.所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效.腹腔镜下结肠癌根治术是对老年人安全有效的手术技术.我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

Anxiety Disorders Among Older Primary Care Patients

Data from the 1997 National Ambulatory Medical Care Survey (NAMCS) were accessed to obtain information about naturalistic patterns of recognition, service utilization, and treatment for late-life anxiety in primary care. The NAMCS is a national probability sample survey of office visits to non-Federal, U.S. physicians engaged in patient care. The survey was conducted by the Division of Health Care Statistics, National Center for Health Statistics, and Centers for Disease Control and Prevention (CDC). Data are now in the public domain. For the current report, all cases indicating office visits for patients age 60 and older were selected (n = 7,687). Anxiety disorders were assigned for 1.3% (n = 99) of these visits, with anxiety disorder NOS the most frequent diagnosis. For 20.2% of these visits (n = 20), a coexistent depressive disorder also was diagnosed. Depression without coexistent anxiety was diagnosed for 2.3% of all visits (n = 176). These figures suggest that late-life anxiety may often go unrecognized and may be more difficult to detect than depression. Nevertheless, other data indicate that appropriate pharmacological treatment and mental health services or referrals are often provided when anxiety or depression is recognized. However, visits wherein these disorders are recognized require increased physician time, and significant proportions of patients in some groups may still not receive appropriate mental health care. Results are discussed in terms of the nature of usual care for late-life anxiety and the needs for future research.     

Psychoanalysis of the older patient

A small informal poll of local colleagues revealed that despite their interest in the subject, many had doubts about the possibility of analyzing persons aged sixty or over successfully. Their specific questions are collated and are offered as a sample of the questions in the minds of many analysts everywhere. Selected material from the ongoing analysis of a sixty-four-year-old patient is presented that bears on some of the questions raised. In addition, changes in the patient are noted. These are discussed in terms of changes in function, which are equated with structural change. The major thrust of the paper is that development continues throughout the life course, and that the criteria for analyzability remain constant. The chronological age of the adult by itself is not an indicator of eligibility or of suitability for psychoanalysis.     

Treating Depression in Older Medical Patients with Psychotherapy

This purpose of this paper is to discuss the effectiveness of psychotherapy for treating depression in older, primary care patients. This paper highlights the feasibility of implementing psychotherapy in primary care settings, patient preference for psychotherapy, and the utility of primary care versions of therapy in treating depression in older adults. The discussion is supported with examples from three ongoing research projects, specifically the San Francisco General Hospital Depression in Late Life Study, the Hartford Foundation/California Healthcare Foundation IMPACT study, and the NIMH PROSPECT study. The findings presented here support the value of offering psychotherapy as a treatment alternative in primary care medicine.     

The American Impact on Psychoanalysis

This paper discusses what the author feels are the principal American influences on contemporary psychoanalysis. These include a growing tendency for nonhierarchical relationships in treatment, some extension of freedom of speech to clinicians, a place for management in the structuring of clinical relationships, and an increasing emphasis on aspirations and the future.