Psychoanalysis and evaluation: a stratified model focused on the uniqueness of the case

ABSTRACT

Objectives: This article addresses the methodological controversies surrounding the issue of how to evaluate the psychotherapies. It proposes to identify the principles of an integrative and stratified model in order to report the results of analytical therapy (its efficacy) based on the very effectiveness of its processes. Thus, the uniqueness of the case is put at the center of the evaluation setting.

Methods: Drawing on science studies, the authors engage in a reflexive exercise on the problem of psychoanalysis’ evaluation based on methodological questions raised in the field over time and current issues related to practice.

Results: First, the regularly asserted opposition between the norms of analytical practice and those governing standard evaluation procedures is reinterpreted as the effect of a lack of intermediate epistemic patterns.

Second, the fundamental principles of an integrative model are considered so as to translate and articulate a set of heterogeneous requirements into distinct strata.

Discussion: Since psychoanalysis is fundamentally a case-by-case practice characterized by inequivalence and unexpectedness, its utmost aim is to use a type of effectiveness based on the singularity of the case. However, this does not prevent it from being evaluable provided that the epistemic levels of the evaluation are clearly differentiated.     

Experiences of surgery readiness assessments in British Columbia

Abstract

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard.

Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate.

Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia.

Results: We developed three main themes to capture participants’ narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps.

Discussion: These narratives demonstrate how much variation exists among people’s experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.     

Non-safety Assessments of Genome-Edited Organisms: Should They be Included in Regulation?

Science and Engineering Ethics - This article presents and evaluates arguments supporting that an approval procedure for genome-edited organisms for food or feed should include a broad assessment...     

What enhances the development of emotion understanding in young children? A longitudinal study of interpersonal predictors

We studied potential determinants of the development of children's emotion understanding (EU) from age 4 to 6 in a Norwegian community sample (N = 974) using the Test of Emotion Comprehension. Interpersonal predictors included the accuracy of parental mentalization, parental emotional availability, and teacher‐reported child social skills. Intrapersonal child factors were child gender and verbal skills. Overall, children's EU increased significantly over time. After adjusting for child gender, age‐4 EU, and parental socio‐economic status, greater child verbal and social skills and greater parental mentalization each uniquely predicted growth in EU. Results are discussed in terms of theory and research on children's EU and parents' emotion socialization.     

Cognition and daily activities in a general population sample aged +55

ABSTRACT

Objective: We tested the association of individual cognitive domains measured with the Mini-Mental State Examination (MMSE) and disability.

Method: Cross-sectional study in a population-based cohort aged ≥55 years (n = 4,803). Sample was divided into two groups: individuals with cognition within the normal range (CNR) (n = 4,057) and those with cognitive impairment (CI) (n = 746). Main outcome measures: The MMSE, the Katz Index (Basic Activities of Daily Living, bADL), the Lawton and Brody Scale (Instrumental Activities of Daily Living, iADL), and the Geriatric Mental State (GMS-AGECAT).

Results: MMSE-orientation was associated with disability in bADL, iADL and a decrease in social participation, regardless of cognitive status. MMSE-attention was associated with disability in iADL, but only in CNR. MMSE-language was associated with disability in bADL, iADL and with reduced social participation, but only in CI. Conclusions: The associations observed between disability and orientation may have clinical and public health implications.