Writing about patients: II. Patients' reading about themselves and their analysts' perceptions of its effect

Thirty American analysts who have published articles that include clinical material were interviewed about their methods for ensuring patient confidentiality. Eight of these analysts had patients who had read about themselves or heard their cases presented, though their analyst had not requested permission to use this material. Eighteen patients had been asked and gave their consent to have their material used. Twelve of these patients were shown the material written about them. The analysts' thoughts and reactions to their experiences of obtaining consent and having their patients read material about themselves, and of disguising material without asking consent and then having it inadvertently discovered and read by their patients, are discussed. Their views of the effect on their patients of reading written material about themselves are elaborated with case illustrations.     

Writing about patients: I. Ways of protecting confidentiality and analysts' conflicts over choice of method

Thirty American psychoanalysts who have published articles using clinical material from their patients were interviewed about their method for ensuring confidentiality. Almost twice as many analysts chose to disguise material as regularly requested permission for the use of patients' material. The other analysts in the sample varied their approach, depending on circumstances, between using disguise alone and using disguise but also requesting consent. Methods of disguise, the timing of request for permission in relation to the phase of analysis, and changes in analysts' ideas about the benefits and detrimental effects of these choices are discussed and illustrated. Each decision is reconsidered in light of its potential effect on patients and their analysis. The dilemma posed by the importance of writing about patients for the health and growth of psychoanalysis as a field and the potential negative consequences for patients and their analyses is considered.     

Confidentiality, privacy, and the facilitating role of psychoanalytic organizations

Burgeoning external threats to confidentiality by claims to clinical information create unprecedented challenges for psychoanalysts. Internal threats arise from the use of clinical material for educational, scientific and historical purposes. Traditionally, confidentiality is considered a patient's right and an analyst's obligation; privacy is not usually stated as a professional requirement. Little consideration has been given to the impact of the confidentiality and privacy dilemmas that analysts encounter throughout their careers. There has been no systematic examination of the confidentiality policies of psychoanalytic organizations, nor has their role in facilitating maintenance of patient confidentiality and analysts' privacy been made explicit. The research reported here was undertaken to address these issues and to obtain baseline information about the current confidentiality policies and practices of psychoanalytic organizations in three English-speaking countries (Britain, Canada and the USA). The author discusses survey results in the light of the challenges which arise at each phase of the analytic career. She makes suggestions as to how psychoanalytic organizations can and should facilitate analysts' resolutions of contemporary confidentiality and privacy dilemmas.     

Psychoanalytic attitudes towards homosexuality: An empirical research

Homosexuality is a challenging subject for the psychoanalytic community, which is now rethinking some of its basic theoretical and institutional assumptions. In recent decades psychoanalytic theory has changed, and the classical psychosexual model has been challenged. After a short review of major psychoanalytical theories of homosexuality, the authors focus on the existence of contrasting attitudes towards homosexuality. This plurality of theories and their clinical and institutional consequences stimulated the authors to investigate the relationship between the individual analyst's theoretical model and his/her clinical practice. The authors present the results of empirical research conducted in the Italian psychoanalytic community on the attitude of psychoanalysts towards homosexuality and the implications for cultural, theoretical and institutional issues. A questionnaire was sent to 600 psychoanalysts (206 of which responded), members of the five main Italian psychoanalytic institutions. First, analysts' personal characteristics and preferred theoretical models were investigated. Second, the respondents responded to statements eliciting their theoretical and clinical approach towards homosexuality. Results indicate that: a) cultural and theoretical background influences the analysts' attitudes towards homosexuality more than gender; b) there is a discrepancy between analysts' theoretical position and their clinical practice; and c) IPA institutes are more discriminatory towards homosexual colleagues than are Jungian ones.     

Analyzing intrapsychic conflict: compromise formation as an organizing principle

The author highlights the idea that analysts' recognition of intrapsychic conflict and compromise formation provides them with a most effective way to formulate their patients' problems. A clinical illustration is presented, with attention to the analyst's use of these concepts during the course of the patient's treatment. The author discusses ways in which his thinking about intrapsychic conflict, compromise formation, and unconscious fantasy informs his approach to clinical work. He emphasizes that viewing compromise formation as the organizing principle of much of mental life gives analysts an effective way to understand the underlying structure of the psychic phenomena in which they are interested.     

Writing to Learn the Reformation: Or,Who Was Ulrich Zwingli And Why Should I Care?

This article describes the use of “Writing to Learn” assignments in a course on the Theology of the Protestant and Catholic Reformations. These short, informal assignments promote active learning by focusing on writing as a process for critical thinking and as a way to learn the content of the course. They help students creatively engage with the texts, thoughtfully reflect on them, and critically assess their significance. This article describes the theory behind these assignments, provides examples of different types of assignments as well as excerpts from student papers, and concludes with an evaluation of their effectiveness. The students in the course found the assignments helpful in learning the content of the course and their attitude toward writing in this course significantly improved.     

Advancing the Field of Psychotherapy Through Innovation and Integration in Scholarly Works

Published articles on psychotherapy often incorporate a combination of integration and innovation, helping to advance the field through scholarly work. Many useful papers help to integrate the biological, psychological, and social or cultural factors that often play a role in the etiology and treatment of specific forms of mental illness. In addition, quality papers strive to integrate theory, science, and clinical applications throughout the text. Authors can encourage a series of minor innovations that could gradually shift the field over time. Useful papers often focus on a narrow topic that has a broad appeal to many members of the field. Authors can explore new ideas, expressing their opinions while supporting the ideas through various types of evidence. When submitting papers for publication, authors should expect it will require multiple revisions in order to sharpen the thinking and improve the writing.     

What happens before and after acute enactments? An exercise in clinical validation and the broadening of hypotheses

This paper seeks to validate clinical facts and theoretical hypotheses that have been discussed before and that address configurations involving chronic and acute enactments. Its validation process compares clinical material from psychoanalytic work in different psychoanalytic cultures - work from South America-Uruguay (Yardino), Europe-Spain (Sapisochin), South Africa (Ivey), Europe-UK (Bateman). It documents clinical facts described in four articles and confirms that during chronic enactments the analytic dyad gets caught up in a dual relationship that veils and congeals the triangular situation because acknowledging it would be traumatic. The lack of triangular space impedes the formation of symbols as well as dreaming and creates non-dreams-for-two. During chronic enactments analysts use their implicit alpha-function to assemble traumatic areas. These areas emerge as a mix of discharges and non-dreams that are dreamed through acute enactments. Acute enactments occur when chronic enactments dissolve and patients experience an abrupt contact with reality. The attenuated trauma is then dreamed alive. The linking of new symbols develops a network of symbolic thought and creates dreams-for-two and broadens the patient's mental universe. The validation process has deepened our vision concerning clinical facts, especially in relation to: (1) the wavering between acute and chronic enactments, (2) analysts' inhibitions and feelings of guilt, and (3) the influence of analysts' personalities on the configurations they describe. These theoretical hypotheses have been confirmed and broadened not only in relation to the vicissitudes of dream work in traumatic areas, but also in relation to defenses such as thin or thick skin, and in relation to listening in countertransferential detours.     

Family administered neonatal activities: An exploratory method for the integration of parental perceptions and newborn behavior

This article presents the theoretical basis, clinical model, and case illustrations of the Family Administered Neonatal Activities (FANA), a specialized application of the Neonatal Behavioral Assessment Scale (Brazelton, 1973), in which parents are guided in eliciting behaviors from their infant within the context of a specific clinical protocol that integrates the practices of short-term, psychotherapeutic interviewing with principles of an empowerment model. The protocol is designed to elicit from parents their initial perceptions of their newborn and then to use the behavior of the baby as the vehicle through which parents can affirm or challenge their initial perceptions. Case examples illustrate the use of the FANA for three purposes: family support, intervention, and assessment.     

Empathy‐Promoting Counseling Strategies for Juvenile Sex Offenders: A Developmental Approach

Bridging research into practice, the authors propose a clinical model for use in the development of empathy in juvenile sex offenders. Case illustrations are provided.     

Capitalizing on the Self-Referencing Effect in General Psychology: A Preliminary Study

After reviewing the literature on the effect of personal relevance (self-schema, self-referencing effect, autobiographical significance, etc.), I implemented a constructivist narrative assignment for general psychology students. I hoped the assignment would enhance learning of and memory for psychological principles. Students wrote personal relevance papers in which they described psychological principles in their own words and provided examples of how the principles they chose were relevant in their own lives. Students assigned to write the papers produced higher exam scores. Moreover, student feedback revealed other benefits, including improved writing quality, higher grades, and increased motivation to learn.     

An innovative cognitive strategy to assist problem gamblers

The clinical and research literature suggests that cognitive and behavioural therapies are particularly helpful in assisting clients overcome problem gambling behaviour. Several articles have described the efficacy of a range of cognitive interventions, especially provision of information regarding rates of return and the odds of games and the exploration of irrational beliefs and myths and misconceptions regarding gambling activity. This paper describes in detail an innovative cognitive strategy which focuses on problem gambling clients' financial status. The strategy incorporates the use of illustrations, generally using a whiteboard, to highlight how problem gambling behaviour negatively impacts on financial wealth over time. Step by step instructions are provided, together with illustrations, to allow clinicians to incorporate the strategy in treatment with their own clients.     

On faces and fruit

Summaries of recently published papers of interest to cognitive scientists. Readers who would like to contribute to this section, by identifying appropriate papers and writing short summaries, should contact the Editor.     

Crossing Boundaries and Identification Processes

This article provides a commentary on seven papers published in a special issue led by J. Dahinden and T. Zittoun in this journal. The papers explore social polarisation, boundary making, inter-group dialogue and migrants’ movement between groups in the context of religion. The exploration is undertaken from different disciplinary backgrounds and in various countries across Europe as well as in Australia. A critical engagement is developed with some of the key issues raised by the papers. This engagement begins by drawing on critiques of ‘groupism’ and then proceeds to consider the role played by process, power, knowledge and governmentality in the context of both time and space. The discussion is supported by illustrations from the case studies provided by the papers. The discussion also links issues raised by the papers to developments within Britain over time and in urban space, which involve the state, Muslim community representatives and the everyday practices of Muslim citizens in London, particularly those concerned with the body.     

Spider detour route discrimination

Summaries of recently published papers of interest to cognitive scientists. Readers who would like to contribute to this section, by identifying appropriate papers and writing short summaries, should contact the Editor.     

Brain activity associated with visual awareness

Summaries of recently published papers of interest to cognitive scientists. Readers who would like to contribute to this section, by identifying appropriate papers and writing short summaries, should contact the Editor.     

On psychoanalytic writing

Analytic writing constitutes a literary genre of its own. It involves the linking of an analytic idea (developed in a scholarly manner) with an analytic experience created in the medium of language. What makes this literary genre so demanding is that experience-including analytic experience-does not come to us in words. This fact generates a paradox that lies at the core of analytic writing: analytic experience (which cannot be said or written) must be transformed into 'fi ction' (an imaginative rendering of experience in words) in order to convey to the reader something of what is true to the emotional experience that the analyst had with the patient. The author discusses a clinical passage from one of his recently published papers in an effort to demonstrate some of the conscious and unconscious thinking that goes into his writing. He then looks closely at the way the language works in a successful piece of theoretical analytic writing. The paper concludes with a discussion of a number of facets of the author's experience with analytic writing including the psychological 'state of writing', which is at once a meditation and a wrestling match with language; experimenting with the form (structure) of an analytic essay; and the question of originality in analytic writing.     

Monkey hears, monkey does - like infants?

Summaries of recently published papers of interest to cognitive scientists. Readers who would like to contribute to this section, by identifying appropriate papers and writing short summaries, should contact the Editor (tics@current-trends.com).