Evidence-based medicine,psychoanalysis and psychotherapy

SUMMARY

The scientific status of psychoanalysis is a matter of importance to both theorists and clinicians in psychiatry. The empirical evidence for both the theory and the practice of psychodynamic practice is much greater than is generally recognised. There is strong evidence for the effectiveness of psychoanalysis and psychoanalytically oriented therapy. the future of psychoanalysis depends on this evidence. We will discuss both the evidence and reasons why it is overlooked in certain quarters, and review the developing neuro-cognitive understanding of the mechanisms that underlie psychoanalytical processes.     

Psychotherapy training in a changing world: A Swedish perspective

The City and Hackney Primary Care Psychotherapy Consultation Service is an innovative, public sector service designed to support GPs in meeting the needs of patients with complex psychological/physical health issues throughout the London Boroughs of Hackney and the City. This paper provides an account of how this new model for the National Health Service (NHS) developed in the context of psychotherapy provision within the NHS, within the national and local context in the UK and gives an overview of some the service's key features and how it differs from other services operating in primary and secondary care. A linked paper, in this journal, explores the reality within which the service functions and describes clinical outcomes, health economic data, the modifications to the original model and prospects for the future.     

Counsellor facial expression and client-perceived rapport

The effects of counsellors’ facial expressions upon the degree of rapport experienced by a Standardized Client (STC) was assessed via examination of 59 counselling interviews conducted by graduate students in counselling. Izard's (1971 Izard, CE. 1971. The face of emotion, New York: Appleton-Century-Crofts.  [Google Scholar]) Affex system of classifying facial expressions was used to operationalize the independent variable of facial expression, with STC ratings of rapport on a five-point scale each minute of the interviews constituting the dependent variable. Data indicated that there was significant more (in seconds/minute) counsellor facial expression of the categories “Interest-excitement” and “Enjoyment-joy” during minutes rated as high in rapport than in minutes rated as low in rapport, but that there was significantly less of the counsellor facial expression “Hypothesized Interest” in high rapport minutes. Implications for the development of effective training procedures for counsellors, plus the need to emphasize the building of emotional engagement between counsellor and client are discussed.     

Heidegger’s resonance with engineering: The primacy of practice

This paper describes how some aspects of Martin Heidegger’s philosophy resonate strongly with an engineering outlook. He argued that practice was more “primordial” than theory, though preserving an important role for theoretical understanding as well, thus speaking to the gap between engineering education (highly theoretical) and engineering practice (mostly empirical). He also underlined the reality of “average” practices into which we are socialized, though affirming the potential for original work and action too, thus providing the grounds for self-actualization whether within the routine or in transcending it. His notion of “thrownness” emphasizes the importance of context, with which engineers are constantly engaged. While all this relates to the idea of our “being”, Heidegger also dealt with the influence of time on our practices. Future death could be seen as spurring innovation, cultural history as a source for critiquing current practice and the present “situation” as the immediate context for corrective action. His major book is appropriately called “Being and Time”.¹     

(Not) giving credit where credit is due: Citation of data sets

Adequate Citation of data sets is crucial to the encouragement of data sharing, to the integrity and cost-effectiveness of science and to easy access to the work of others. The citation behavior of social scientists who have published based on shared data was examined and found to be inconsistent with important ideals of science. Insights gained from the social sciences, where data sharing is somewhat customary, suggest policies and incentives that would foster adequate citation by secondary users, and greater openness and sharing in other disciplines.     

Ethical aspects of the safety of medicines and other social chemicals

The historical background of the discovery of adverse health effects of medicines, food additives, pesticides, and other chemicals is reviewed, and the development of national and international regulations and testing procedures to protect the public against the toxic effects of these drugs and chemicals is outlined. Ethical considerations of the safety evaluation of drugs and chemicals by human experimentation and animal toxicity studies, ethical problems associated with clinical trials, with the falsification of clinical and toxicological data, and with inadequate experimental methodology, are reviewed, and the ethics of the marketing of drugs and their post-marketing surveillance, are similarly considered. These ethical problems are illustrated with many specific examples, including the drugs neoarsphenamine, chloramphenicol, thalidomide, diethyl stilboestrol and benoxaprofen.     

Decision analysis: An approach for multidisciplinary teams in planning special service programs

A decision analytic approach for use by multidisciplinary teams (MDTs) in planning special service programs is described, and formative evaluation information on its application by MDTs in planning individualized education programs (IEPs) is presented. Decision analysis is applied following initial determination of program goals and objectives. In using the approach, an MDT engages in a six-step process: (a) delineation of program alternatives, (b) determination of program outcomes, (c) assessment of probabilities, (d) assessment of utilities, (e) determination of overall program values, and (f) selection of the program to be developed. Utilization of the approach allows a complex program planning situation to be disaggregated into its essential elements, with discussion of program alternatives occurring relative to specific decision criteria. Strengths and limitations of the approach also are discussed, and future directions for research are briefly noted.