Lines of advance in psychoanalytic psychotherapy

Freud's 1919 paper is taken as a starting-point to review how far we have advanced towards fulfilment of his prophetic remarks about the need to develop psychoanalytic psychotherapy for the masses. A glance is taken back to some of the circumstances and characters involved in Budapest where the paper was given at the 1918 congress, where there was much talk about the need to do something about the war neuroses. Similar pressures led to the founding of the Tavistock Clinic and Cassel Hospital in the UK, long before the start of the NHS. The pressures of both world wars advanced the applications of psychoanalysis; the next wave of pressures may come from NHS changes and entry into Europe. The history of psychoanalytic psychotherapy in the UK is also considered via looking briefly at the history and development of psychoanalytic publications, of the Tavistock Clinic, of psychoanalytic training, of child psychotherapy and the emergence of adult (non-medical) psychotherapy. There have always been tensions between exponents of the pure gold of analysis and the needs of its wider applications. More flexible arrangements and boundaries are necessary if we are to spread psychoanalysis beyond London and to fulfil Freud's own hopes about the large-scale application of psychoanalytic therapy.     

Assessing Parenting Behaviors in Euro–Canadian and East Asian Immigrant Mothers: Limitations to Observations of Responsiveness

The use of parenting measures that are developed for use with Western families without testing their validity among families from non-Western cultural backgrounds may not be appropriate. Similar parenting behaviors may affect child outcomes in different ways across different cultures. This study examined the cross-cultural validity of an observational Maternal Responsiveness coding system and of self-reports of lax/inconsistent parenting in Euro–Canadian (n = 23) and East Asian immigrant mothers (n = 23) of 4- to 7-year-old sons. In Euro–Canadian mothers, observed parenting responsiveness was associated with less lax/inconsistent parenting and fewer child behavior problems. In East Asian immigrant mothers, however, observations of greater responsiveness were not related to reports of lax/inconsistent parenting, and were associated with greater child behavior problems. Implications for the use of these parenting measures across culture groups are discussed.     

Mentalization-Based Treatment

The concept of mentalizing has captured the interest and imagination of an astonishing range of people—from psychoanalysts to neuroscientists, from child development researchers to geneticists, from existential philosophers to phenomenologists—all of whom seem to have found it useful. According to the Thompson Reuter maintained Web of Science, the use of the term in titles and abstracts of scientific papers increased from 10 to 2,750 between 1991 and 2011. Clinicians in particular have enthusiastically embraced the idea, and have put it to innovative use in their practices. Mentalization-based treatment (MBT)—making mentalizing a core focus of therapy—was initially developed for the treatment of borderline personality disorder (BPD) in routine clinical services delivered in group and individual modalities. Therapy with mentalizing as a central component is currently being developed for treatment of numerous groups, including people with antisocial personality disorder, substance abuse, eating disorders, and at-risk mothers with infants and children (A. Bateman & Fonagy, 2011). It is also being used with families and adolescents, in schools, and in managing social groups (Asen & Fonagy, 2011; Fonagy et al., 2009; Twemlow, Fonagy, & Sacco, 2005a Twemlow, S. W., Fonagy, P. and Sacco, F. C. 2005a. A developmental approach to mentalizing communities: I. A model for social change. Bull. Menninger Clin, 69(4): 265–281. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar], 2005b). In this article, we focus on MBT in the treatment of BPD.     

Parent-Child Interactions in Anxious Families

A considerable amount of research has examined factors associated with the etiology and maintenance of anxiety disorders in children. The familial nature of anxiety has been well-established, with genetic studies showing that approximately 30% of the variance is accounted for by genetic factors. Research into the family environment documents behavioral differences in interactions between non-anxious parent-child and anxious parent-child dyads, including less granting of autonomy, and parental withdrawal and disengagement. Recent theoretical work in the field of anxiety suggests that attachment models and coercive operant patterns could create a bi-directional coercive interaction pattern, similar to that seen in interactions of parents and aggressive children. The current study investigated parent and child behaviors coded from interaction tasks across four groups based on anxiety status: anxious parent/anxious child, non-anxious parent/anxious child, anxious parent/non-anxious child, and non-anxious parent/non-anxious child to empirically examine hypothesized interactive patterns. The study sample consisted of 158 parent-child (ages 3–12 years) dyads. Results support an interaction between parent and child anxiety on behavior within dyads. The current study provides an important step in identifying processes linked to familial anxiety.     

Use of an Antecedent Intervention to Decrease Vocal Stereotypy of a Student With Autism in the General Education Classroom

This study examined the use of an antecedent-based intervention to reduce the vocal stereotypy of a student diagnosed with Autism within the general education classroom. The student displayed frequent nonfunctional speech and disruptive vocal sounds. An antecedent-based intervention, involving the use of qualitatively different cards—to cue the student when it was appropriate or inappropriate to engage in vocal stereotypy—was designed and implemented. An adaptive alternating treatment design was utilized and conditions were randomized and counterbalanced across treatment sessions. Data on vocal stereotypy were collected using partial interval recording. The results indicated the participant was successful in discriminating between cues and decreased stereotypy during intervention compared to baseline conditions. Similar findings were found when the intervention was implemented across a second school setting.     

血液的法律属性及其侵权责任归责原则刍议——兼论《侵权责任法》中“不合格血液”问题

通过对血液法律属性的法理分析,得出血液归属于产品或非产品均有可能不利于衡平各方权益的结论。立足《侵权责任法》等法律基础,分析责任归责原则,认为在严格责任原则基础上,适当考虑公平责任原则,可以较好地解决血液法律属性分歧所带来的司法困惑,能有效维护各方权益。     

肿瘤姑息治疗的全程介入

恶性肿瘤严重威胁人类健康,肿瘤本身以及针对肿瘤的治疗不仅会对患者的生理和心理产生重要影响,同时也会对照顾患者的家人产生各种心理影响。现有医疗条件下短时间内难以提高治愈率,就应更加注重将姑息治疗贯穿于肿瘤治疗的始终,不仅要及早介入,甚至延伸至居丧期。在肿瘤治疗过程中不断对肿瘤患者进行评估和适时调整姑息治疗策略,可有效地提高患者生活质量同时降低医疗成本,最终患者能够在不同阶段和各种治疗手段中获得最大受益。     

人文关怀在消除IVF—ET患者心理压力中的作用

近年我国不少生殖医学中心在如何提高体外受精一胚胎移植（IVF—ET）治疗成功率问题上,都将注意力集中在临床用药的研究、控制性超促排卵方案的改进以及实验室条件的改善上,大多忽视IVF—ET患者心理方面的治疗。有研究表明：IVF—ET治疗的成功,不仅与患者自身的病理及生理状况有关,更与患者在治疗过程中产生的心理压力有关。因此,建议医护人员在给不孕症患者实施IVF-ET助孕治疗的全过程中,应给予患者更多人文关怀,这样不仅能够减少IVF—ET患者心理健康问题的发生,而且可以改善患者的身心状态和应对治疗能力,从而提高IVF—ET治疗成功率。     

人文关怀与临床思维的整合与互动——一例罕见病的诊治经过启示

医学人文关怀一直以来与医学技术相伴而生,相互依存.然而,在当代医学技术已进入后基因时代的今天,医学人文关怀还部分地被理解为“临终关怀”.事实上,做好医学人文关怀,不仅是人文、伦理的需要,同样对指导临床思维、提高诊疗水平有重要意义.但目前国内外医学教育和临床医疗实践中,关于人文关怀与临床思雏整合与互动的议题还极少见诸报道.而笔者近期在对一例罕见病的成功诊治经历中,体会到了医学人文关怀对临床诊疗水平的重要作用.