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.     

Questioning the social intelligence hypothesis

The social intelligence hypothesis posits that complex cognition and enlarged "executive brains" evolved in response to challenges that are associated with social complexity. This hypothesis has been well supported, but some recent data are inconsistent with its predictions. It is becoming increasingly clear that multiple selective agents, and non-selective constraints, must have acted to shape cognitive abilities in humans and other animals. The task now is to develop a larger theoretical framework that takes into account both inter-specific differences and similarities in cognition. This new framework should facilitate consideration of how selection pressures that are associated with sociality interact with those that are imposed by non-social forms of environmental complexity, and how both types of functional demands interact with phylogenetic and developmental constraints.     

Empirical Support for an Evolutionary Model of Self‐Destructive Motivation

We tested predictions generated from an evolutionary account of self‐destructive motivation in two survey studies of 18–24‐year‐old university students. As hypothesized, hierarchical regressions showed that the positive relationship between perceived burden to family and suicide ideation was amplified for participants with low measured health and romantic relationship satisfaction, and for participants with relatively young mothers. The moderating effect of maternal age was also observed in logistic regressions of suicide attempts. These effects occurred independently of depression, hopelessness, and other relevant extraneous variables. Results have implications for understanding self‐destructive motivation, assessing suicide risk, and preventing suicidal thinking and behavior.     

Mind, Body, and Spirit: Family Physicians’ Beliefs, Attitudes, and Practices Regarding the Integration of Patient Spirituality into Medical Care

This study used a qualitative approach to explore family physicians’ beliefs, attitudes, and practices regarding the integration of patient spirituality into clinical care. Participants included family medicine residents completing training in the Southwest USA. The qualitative approach drew upon phenomenology and elements of grounded-theory. In-depth interviews were conducted with each participant. Interviews were recorded, transcribed and coded using grounded-theory techniques. Four main themes regarding physicians’ attitudes, beliefs, and practices were apparent from the analyses; (1) nature of spiritual assessment in practice, (2) experience connecting spirituality and medicine, (3) personal barriers to clinical practice, and (4) reflected strengths of an integrated approach. There was an almost unanimous conviction among respondents that openness to discussing spirituality contributes to better health and physician–patient relationships and addressing spiritual issues requires sensitivity, patience, tolerance for ambiguity, dealing with time constraints, and sensitivity to ones “own spiritual place.” The residents’ voices in this study reflect an awareness of religious diversity, a sensitivity to the degree to which their beliefs differ from those of their patients, and a deep respect for the individual beliefs of their patients. Implications for practice and education are discussed.Michael M. Olson, Ph.D., is a member of the Department of Family Medicine, University of Texas Medical Branch in Galveston.M. Kay Sandor, Ph.D., R.N., is in the School of Nursing.Victor Sierpina, M.D., is in the Department of Family Medicine.Harold Vanderpool, Ph.D., Th.M., represents the Institute for Medical Humanities at the university and Patricia Dayao, M.A., is a graduate student there.Funding for this study provided in part by the John G. and Marie Stella Kenedy Foundation and the George Washington Institute for Spirituality and Health/John Templeton Foundation. Correspondence to Michael M. Olson, mmolson@utmb.edu.     

An Existential Perspective of Body Beliefs and Health Assessment

Successful health assessments are ongoing and rely on a clinician/client interaction, which is influenced by both the client’s and the clinician’s beliefs about their bodies. These beliefs about the human body arise out of religious and cultural contexts. Theories often explain cultural context by comparison of differences and similarities between the client and the clinician and/or between the client and the dominant culture. This approach can carry a bias inherent in the comparison to dominant beliefs held by those with the most power and economic advantage. The author suggests an existential approach in which client and clinician bodies interact each as adept, autonomous individuals with a conglomerate of beliefs about body and health.The author is an Interdisciplinary PhD candidate in Music Therapy and Health Psychology at the University of Missouri-Kansas City Conservatory of Music. Her research goals include the interrelationship of music, spirituality, and cardiovascular health. She is a Board Certified music therapist and has served in that capacity since 1980 in mental health facilities, hospice, and private practice.