Some reflections on empathy and reciprocity in the use of countertransference between supervisor and supervisee

Reciprocity refers in its general meaning to a mutual give and take. It is a background feature of all productive supervisory relationships. In this essay I want to bring it into the foreground. I will describe it by contrasting supervision and analysis. For, in my view, that is exactly what reciprocity is in the supervisory relationship: it is an attitude of mind in which the supervisor performs the task of differentiating internally the supervisory from the analytic vertex, in the context of the asymmetry of the supervisory relationship.     

Recognizing Racit Knowledge in Medical Epistemology

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.An erratum to this article can be found at     

A conversation with Dr Michael Fordham. Interview by James Astor

In this interview in Dr Fordham's 83rd year he describes how he started to work with children, and how Mrs Jung was supportive. He talks about the initial suspicion this interest generated in the wider Jungian community. He refers to his acceptance of and interest in the psychotic elements in child analysis and his transference-based approach to working with these elements. He reflects on his own birth, his work with evacuee children in hostels during the war years and the politics of supervision. He describes the core Jungian concepts which underpinned his work and the theoretical differences from the Kleinian and Anna Freudian positions.     

Michael Balint's Group Approach: The Boston Balint Group

Michael Balint was a physician/psychoanalyst who trained in Hungary and emigrated to England in 1939 when Nazi Germany began to dominate Europe. At the Tavistock Clinic, he and his wife met with social workers and physicians around case discussion seminars. With his strong interest in medicine and his curiosity about the patient-physician relationship, he initiated research/training groups with interested physicians, which ultimately led to publication of the now-classic The Doctor, His Patient, and the Illness, a rich text that has become a virtual staple of family practice residencies, along with Balint Groups for training. Balint refrained from considering his groups psychotherapy in order to minimize resistance of his physician-students. But because the groups lasted sometimes for years and explored transference and countertransference in patient-physician relationships, he acknowledged that the result was personal growth of the participants. His techniques are described and an example of a Balint Group (Boston Group) are presented here.     

FROM BELIEF TO UNBELIEF AND BACK TO BELIEF: A RESPONSE TO MICHAEL RUSE

Abstract. Michael Ruse's rejection of religious belief is questioned at two levels. First, on the metaethical level of analysis, evolutionary ethics cannot account for moral behavior that is based on a "strong version" of the Love Command. Second, agnosticism is discussed as a form of belief. Insights from religious forms of life that are inclusive, pluralistic, and expansive are contrasted with exclusivistic, closed, and fundamentalist forms of religion in order to develop criteria for "genuine religion." Theistic agnosticism is presented as a prolegomena to belief.     

Age and outstanding occupational achievement: Lehman revisited

The findings of H. C. Lehman's (1953, Age and achievement, Princeton, NJ: Princeton Univ. Press) study of age and outstanding occupational achievement were reviewed along with the explanations which have been put forth to account for the finding that major contributions are most likely to occur in young adulthood. Subsequently, an alternative explanation was proposed based on the central developmental tasks facing individuals in young adulthood and middle age. More specifically, it is argued, in accordance with N. Haan (1981, in R. M. Lerner & N. A. Busch-Rossnagel (Eds.), Individuals as producers of their own development: A life span perspective, New York, Academic Press), that young adults employ an accommodating adaptive style, and that the cognitive and behavioral concomitants of this style may increase the likelihood of major contributions. It is also noted that the realistic, controlling adaptive style of the middle aged would tend to facilitate minor contributions. Finally, the broader literature was reviewed in relation to these hypotheses, and certain practical implications of this reinterpretation were laid out.     

Intrusions and perseverations

Twenty-two subjects with presumed senile dementia of the Alzheimer's type (SDAT), twenty-two with dementia other than SDAT, twenty with aphasia, and seventeen healthy controls over 50 years of age were examined for intrusions and perseverations. Perseverations were defined as the immediate inappropriate repetition of a prior response whereas intrusions were defined as the inappropriate repetition of prior responses after intervening stimuli. Intrusions and perseverations occurred in demented and aphasic subjects, but were rare in controls. Intrusions occurred most often in SDAT or Wernicke aphasia, but also in dementia other than SDAT. Intrusions were not correlated with dementia severity. Intrusions are a useful sign of dementia, but they cannot be considered pathognomonic of SDAT. They appear to arise when subjects are unable to access correct responses from long-term memory and instead substitute erroneous responses selected from short-term memory. Perseverations were most common in the Wernicke aphasics and subjects with dementia due to communicating hydrocephalus. Although frontal lobe dysfunction is prominent in communicating hydrocephalus, it is absent in cases of Wernicke aphasia. Thus, we have confirmed prior suggestions that perseveration can occur in the absence of frontal lobe injury. Failure to self-monitor speech as well as an inability to change mental set probably plays an important role in the genesis of perseverations. There was no statistically significant correlation between dementia severity and number of perseverations. Low correlations were found between intrusions and perseverations suggesting that these seemingly similar behaviors are distinct and are probably produced by separate neuropsychological mechanisms.     

Commitment,ego-involvement,and resistance to attack

Subjects with initially extreme or moderate positions (based on a median split) recorded a consonant speech under public, private, or no commitment and later received a strong, mild, or no attack on their position. Extremes were more ego-involved in terms of wider latitudes of rejection, narrower latitudes of non-commitment, and greater resistance to attack, relative to moderates. Commitment had no effect for extremes, suggesting a ceiling effect on changes in the latitudes and resistance to attack for initially high levels of ego-involvement. For moderates, commitment resulted in narrower latitudes of noncommitment, wider latitudes of rejection (greater rejection of discrepant positions), and greater resistance to attack, suggesting that commitment may elevate ego-involvement with the issue. Commitment and ego-involvement may increase the salience of one's attitude position in later situations, thereby increasing the probability of attitudeconsistent behavior.     

The role of the perioral reflex in lip motor control for speech.

The analysis of spinal and brainstem reflexes has been shown to be a useful method of quantifying the various inputs to motoneuron pools involved in voluntary motor control. This work is selectively reviewed as a background to a discussion of the role of the perioral reflex in lip motor control for speech. Data on the sensorimotor innervation of the lips and the static and dynamic properties of the perioral reflex are presented in support of the notions that (1) perioral reflex analysis provides a viable technique for analyzing brainstem excitability changes underlying lip muscle contraction for speech, and (2) the perioral reflex loop is an important functional element in lip motor control for speech.