The elephant tied up with string: a clinical case study showing the importance of NHS provision of intensive,time-limited psychoanalytic psychotherapy treatments

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments.     

The eureka process: A structure for the creative experience in science and engineering

Abstract:

There is little in the literature that focuses on both the thoughts and feelings of scientists and engineers when they are in the throes of scientific creation or invention. This investigation was performed to address the question: What is the experience of modeling natural phenomena? Special emphasis was placed on mathematical modeling. A formal heuristic procedure was used to gather data from 12 scientists and engineers. The interviews were tape recorded, transcribed, and analyzed for general themes and points of view. The data, represented primarily in the form of a structural flow diagram, emphasize both the cognitive and emotional features of the process. The major features that emerged include the existence of creative feedback loops, unipolar‐positive phases of both illumination and acceptance, and unipolar negative phases of blockages to the attainment of the positive poles. Implications and applications emerged in the areas of creativity, validation, education, and motivation. It was concluded that far too little emphasis has been placed on the role that feelings play in the creative process, and it was suggested that it is important to understand, teach, and recognize emotions in order to learn to trust our own natural abilities and intuition.     

Psychologists' attitudes toward aids

Abstract

Practicing psychologists in all areas of the country will see an increasing number of persons at risk for AIDS, or with AIDS-related illnesses. Previous research has shown that AIDS elicits negative reactions from the general public and from certain health care professionals. In the current study, a national sample of randomly selected practicing psychologists completed attitude measures after reading vignettes that described a male patient with either AIDS or leukemia who was either homosexual or heterosexual. Respondents evaluated the AIDS patient more negatively and reported less willingness to interact with him in a professional role or in casual social situations. It is important to develop training and continuing education programs to prepare psychologists to deal with persons affected by AIDS.     

“Test-Tube Baby” procedures: Stress and judgements under uncertainty

Patients participating in an in vim fertilisation with embryo transfer (IVF and ET) programme face uncertainty at each stage of the procedure. Research on heuristics and on stress lead to predictions about behaviour in situations of uncertainty. It was predicted that IVF and ET participants would overestimate the likelihood of success, due to publicity the process has received, and would underestimate the likelihood of an earlier, less publicised. stage in the procedure. Both predictions were confirmed in a total of 70 participants (26 women at out-patient clines, 23 of their partners and 21 surgical in-patients). All the men and all but one woman overestimated the likelihood of becoming pregnant and having a baby. and most of the surgical patients underestimated the likelihood of egg recovery. Estimates were not related to patients' confidence about their information, confirming previous evidence about confidence in inaccurate judgements based on heuristics. Data on patients' distress as indicated by mood rating show high anxiety at points of uncertainty and Pailure, as found in other studies of stress. While the couples shared their inaccurate judgements. they did not necessarily share their distress. The results are discussed in terms of patients' decision making. coping strategies and the implications for doctor-patient communication.     

De se belief and rational choice

The Sleeping Beauty puzzle has dramatized the divisive question of how de se beliefs should be integrated into formal theories of rational belief change. In this paper, I look ahead to a related question: how should de se beliefs be integrated into formal theories of rational choice? I argue that standard decision theoretic frameworks fail in special cases of de se uncertainty, like Sleeping Beauty. The nature of the failure reveals that sometimes rational choices are determined independently of one’s credences in the kinds of ‘narrow’ de se propositions that Sleepy Beauty has set in relief. Consequently, in addition to pinpointing a failure of standard decision theoretic frameworks, this result casts doubt on a large class of strategies for determining principles for the rationally updating de se beliefs in cases like Sleeping Beauty, and also calls into question the importance of making such a determination at all.     

Gamma- and theta-band synchronization during semantic priming reflect local and long-range lexical–semantic networks

Anterior and posterior brain areas are involved in the storage and retrieval of semantic representations, but it is not known how these areas dynamically interact during semantic processing. We hypothesized that long-range theta-band coherence would reflect coupling of these areas and examined the oscillatory dynamics of lexical–semantic processing using a semantic priming paradigm with a delayed letter-search task while recording subjects’ EEG. Time–frequency analysis revealed facilitation of semantic processing for Related compared to Unrelated conditions, which resulted in a reduced N400 and reduced gamma power from 150 to 450 ms. Moreover, we observed greater anterior–posterior theta coherence for Unrelated compared to Related conditions over the time windows 150–425 ms and 600–900 ms. We suggest that while gamma power reflects activation of local functional networks supporting semantic representations, theta coherence indicates dynamic coupling of anterior and posterior areas for retrieval and post-retrieval processing and possibly an interaction between semantic relatedness and working memory.     

Analysis of Citations to Biomedical Articles Affected by Scientific Misconduct

We describe the ongoing citations to biomedical articles affected by scientific misconduct, and characterize the papers that cite these affected articles. The citations to 102 articles named in official findings of scientific misconduct during the period of 1993 and 2001 were identified through the Institute for Scientific Information Web of Science database. Using a stratified random sampling strategy, we performed a content analysis of 603 of the 5,393 citing papers to identify indications of awareness that the cited articles affected by scientific misconduct had validity issues, and to examine how the citing papers referred to the affected articles. Fewer than 5% of citing papers indicated any awareness that the cited article was retracted or named in a finding of misconduct. We also tested the hypothesis that affected articles would have fewer citations than a comparison sample; this was not supported. Most articles affected by misconduct were published in basic science journals, and we found little cause for concern that such articles may have affected clinical equipoise or clinical care.     

Face in profile view reduces perceived facial expression intensity: An eye-tracking study

Recent studies measuring the facial expressions of emotion have focused primarily on the perception of frontal face images. As we frequently encounter expressive faces from different viewing angles, having a mechanism which allows invariant expression perception would be advantageous to our social interactions. Although a couple of studies have indicated comparable expression categorization accuracy across viewpoints, it is unknown how perceived expression intensity and associated gaze behaviour change across viewing angles. Differences could arise because diagnostic cues from local facial features for decoding expressions could vary with viewpoints. Here we manipulated orientation of faces (frontal, mid-profile, and profile view) displaying six common facial expressions of emotion, and measured participants' expression categorization accuracy, perceived expression intensity and associated gaze patterns. In comparison with frontal faces, profile faces slightly reduced identification rates for disgust and sad expressions, but significantly decreased perceived intensity for all tested expressions. Although quantitatively viewpoint had expression-specific influence on the proportion of fixations directed at local facial features, the qualitative gaze distribution within facial features (e.g., the eyes tended to attract the highest proportion of fixations, followed by the nose and then the mouth region) was independent of viewpoint and expression type. Our results suggest that the viewpoint-invariant facial expression processing is categorical perception, which could be linked to a viewpoint-invariant holistic gaze strategy for extracting expressive facial cues.     

The Mania of Existence: Klein,Winnicott, and Heidegger's Concept of Inauthenticity

This paper offers a new interpretation of Heidegger's concept of inauthenticity (Uneigentlichkeit) in Being and Time. It breaks from the “conformity interpretation” of inauthenticity, according to which the anonymity of the inauthentic person is due to her conformity to das Man. Rather, it argues that the anonymity of the inauthentic person is due to “existential mania” – a state in which a person denies her death and anxiety, understands her abilities to be limitless, and is perpetually active. It shows how this existential mania – and the anonymity to which it gives rise – is analogous to the mania described by the object relations psychoanalyst Melanie Klein. Finally, drawing on D. W. Winnicott's discussion of mania, it shows how both the inauthentic person's conformity to das Man, and her existential mania, give rise to anonymity.