Clinical wisdom in psychoanalysis and psychodynamic psychotherapy: a philosophical and qualitative analysis

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom.     

The impact of emotion on prospective memory and monitoring: No pain, big gain

The emotionally enhanced memory effect is robust across studies of retrospective memory, with heightened recall for items with emotional content (e.g., words like ??murder??) relative to neutral items (e.g., words like ??envelope??). Only a handful of studies have examined the influence of emotion on prospective memory (PM), with mixed results. In some cases emotion enhances PM, and in others it impairs PM. Interpretation of these findings is clouded by methodological differences across studies and by the fact that, to date, no study has examined the impact of emotion on PM monitoring. In our study, we assessed PM performance when PM targets were neutral, negative, and positive, and also investigated monitoring across these different PM target types. Participants showed heightened PM performance for positive and negative relative to neutral targets, yet there was no evidence of additional monitoring for emotional targets. In fact, measures of monitoring were significantly reduced when the PM targets were emotional rather than neutral. Our findings suggest that it is possible to boost PM performance in a focal task using emotional cues, and that the use of emotional cues reduces the need for monitoring.     

Bridging the Gap Between Hospital and Community-Based Mental Health Services

Depression and anxiety affect a person’s ability to move from hospital to community and engage in valued occupations. The purpose of this study was to understand the effectiveness of an occupational therapist-led transitional service for people with mood and anxiety disorders. Using a mixed-method design consisting of retrospective pre-post analysis of outcome measures and qualitative analysis of interviews with key stakeholders, statistically and clinically significant improvements were seen in depression and anxiety symptoms as well as occupational engagement after completion of the service. This study highlights the unique contributions of occupational therapist-led programing in mental health recovery.     

Political Liberalism and Male Supremacy

In Equal Citizenship and Public Reason, Watson and Hartley dispute the claim that Rawls’s doctrine of political liberalism must tolerate gender hierarchy because it counts conservative and orthodox religions as reasonable comprehensive doctrines. I argue that their defense in fact contains two arguments, both of which fail. The first, which I call the ‘Deliberative Equality Argument’, fails because it does not establish conclusively that political liberalism’s demand for equal citizenship forbids social practices of domination, as the authors contend. The second, which I call the ‘Equal Liberties Argument’, fails because it supports a particular version of political liberalism and not the doctrine itself.     

Daily mood, partner support, sexual interest, and sexual activity among adolescent women.

The main objective of this study was to examine day-to-day associations of coitus, sexual interest, partner emotional support, negative mood, and positive mood among adolescent women. Diaries assessed partner interactions, sexual activity, substance use, and mood. Participants were 146 adolescent women who provided 28,376 diary days. Correlates of coitus on a given day included age, increased coital frequency in previous week, coitus on the previous day, partner support, increased same-day sexual interest, and decreased same-day negative mood. The data demonstrate complex associations of sexual interest, mood, partner interactions, and sexual activity. The findings extend understanding of the sexuality of adolescent women and have implications for a variety of interventions to reduce sexually transmitted infections and unplanned pregnancies.