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 The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes.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.     

Newborns modulate their crawling in response to their native language but not another language

Human newborns can propel themselves to their mother's breast when positioned skin to skin on her abdomen just after birth. For decades, researchers have considered this primitive crawling behavior a spinal reflex, immune to supra spinal control. However, recent research suggests that neonatal crawling is already responsive to visual and olfactory stimuli processed at a supra spinal level. Here we report that a few hours post birth, French newborns can also modulate their crawling in response to their native language – a source of information that is processed supra-spinally. The crawling patterns of 23 French-born newborns were recorded on video and via an infrared motion capture system during two randomly ordered 2-min trials. The newborns were secured on a mini skateboard to facilitate arm and leg movements during their crawling propulsion. They heard a repetitive sequence of the same sentences either in French, their native language, or in English, a rhythmically different and hence discriminable unfamiliar language, on each trial. In French, compared to English, crawling was enhanced, with significantly more arm and leg steps and significantly more and larger trunk rotations in the cephalo-caudal axis. Moreover, newborns rotated their heads and trunk toward the appropriate loud speaker when hearing French but not English. These preliminary findings suggest that newborn crawling is not a simple stereotyped reflex under spinal control, but a complex pattern that can be modulated in response to higher-order, supra-spinally processed stimuli. The findings open fascinating questions about the range of stimuli to which newborn crawling is responsive.     

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.     

Educational and interpersonal uses of home computers by adolescents with and without specific language impairment

Many uses of new media entail processing language content, yet little is known about the relationship between language ability and media use in young people. This study compares educational versus interpersonal uses of home computers in adolescents with and without a history of specific language impairment (SLI). Participants were 55 17‐year‐olds with SLI and 72 typically developing peers. Measures of frequency and ease of computer use were obtained as well as assessments of participants' psycholinguistic skills. Results showed a strong preference for interpersonal computer use in both groups. Virtually all participants engaged with interpersonal new media, finding them relatively easy to use. In contrast, one third of adolescents with SLI did not use educational applications during a typical week. Regression analyses revealed that lower frequency of educational use was associated with poorer language and literacy skills. However, in adolescents with SLI, this association was mediated by perceived ease of use. The findings show that language ability contributes to new media use and that adolescents with SLI are at a greater risk of low levels of engagement with educational technology.     

Risk Factors for Suicide and Suicidal Behavior Relevant to Emergency Health Care Settings: A Systematic Review of Post‐2007 Reviews

Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high‐quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.     

Toward an integrative model of suicide attempt: a cognitive psychological approach.

Applying a cognitive approach, the purpose of the present study was to expand previous research on stress-vulnerability models of depression and problem-solving deficits, as it relates to suicide attempt. Structural equation modelling, involving latent variables, was used to evaluate (a) whether low self-esteem, a low sense of self-efficacy, loneliness, and divorce constituted vulnerability factors for the development of depression; (b) whether hopelessness and suicidal ideation mediated the relationship between depression and suicide attempt; and (c) whether problem-solving deficits mediated the relationship between the vulnerability factors and suicide attempt, separate from depression/hopelessness. A total of 123 individuals, aged 18-75 years, participated in the study (72 suicide attempters and 51 psychiatric outpatients with no history of suicidal behavior). The results indicated a two path model of suicide attempt. The first path began with low self-esteem, loneliness, and separation or divorce, which advanced to depression, and was further mediated by hopelessness and suicidal ideation which led to suicide attempt. The second path developed from low self-esteem and a low sense of self-efficacy and advanced to suicide attempt, mediated by a negative appraisal of one's own problem-solving capacity, and poor interpersonal problem-solving skills. The importance of addressing both depression/hopelessness, and problem-solving deficits when working with suicide attempters is noted.