Analytic practice: Convergences and divergences1

The author discusses current convergences and divergences concerning analytic practice. After presenting a clinical vignette that can be understood differently according to different theoretical approaches, he discusses Wallerstein’s proposal of a common ground in psychoanalysis and suggests that the present state of the art indicates that psychoanalysis is a pluralistic discipline, with different ways of training and practising it, and that the main challenge is to improve our ability to listen to and to learn from different approaches.     

Philosophy of Education in a Poor Historical Moment: A Personal Account

Under the post-metaphysical sky “old” humanistic-oriented education is possible solely at the cost of its transformation into its negative, into a power that is determined to diminish human potentials for self-exaltation. Nothing less than total metamorphosis is needed to rescue the core of humanistic genesis: the quest for edifying Life and resistance to the call for “home-returning” into the total harmony that is promised to us within nothingness.     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.