How people make decisions about predictive genetic testing: An analogue study

Abstract

Persons scoring high on negative affectivity (NA) have more subjective health complaints. In this study, we tested the hypothesis that high NA persons are more likely to experience internal sensations as threatening signs of health problems. Low and high NA participants (N=44) were given four breathing trials: one room air trial followed by three trials containing 5.5% CO₂ which induced transient low intensity somatic sensations. Prior to each CO₂ trial, participants received either positive, negative or uncertain labelings of the sensations that might occur. Participants rated the (un)pleasantness of the experienced somatic sensations and the perceived intensity. Also respiratory responses were measured. During CO₂ trials, reliable main effects of information were found but no effects involving NA were observed, neither on pleasantness ratings nor on respiratory responses. However, during room air breathing, high NA participants reported more intense somatic sensations than low NA participants. Post-experimental data suggested that high NA participants had more negative meanings and worries about the consequences of the physical sensations. It is concluded that interpretational biases in high NA is situated at the level of attributional processes.     

Data Karaoke: Sensory and Bodily Skills in Conference Presentations

At the International Conference on Auditory Display (ICAD), an interdisciplinary conference dedicated to sonification and the use of non-speech sound to represent information, presenters make use of a variety of bodily skills and representations that appeal to the senses of their audience. In many established disciplines, the conventions that guide the use of these skills and representations are taken for granted; but within ICAD, they are often explicitly negotiated. The practice of ‘data karaoke', in which researchers mimic the sound of a sonification with their own voice, is particularly instructive for understanding these negotiations, and the ICAD community more generally. Data karaoke fulfils five functions: embodiment, highlighting, illustration, authorisation and integration. To make sense of data karaoke, we have to understand the institutional and intellectual environment in which this peculiar practice has emerged; but conversely, an understanding of data karaoke can help us throw new light on epistemological debates about the hierarchy of the senses: data karaoke is a multisensory skill engaging the whole body of the sonification researcher, and thus calls into question the dominant epistemological discourse within the ICAD community, in which the different sensory modalities are framed as competitors. The ICAD case shows that studying conferences as sites where bodies interact, and presentations as performances involving the bodies and senses of scientists, helps us to understand not only the conference cultures, but also the ideals about scientific scholarship and academic authority held by scientific communities.     

Is it time for Hippocrates and Freud to have a joint consultation? MUS patients – A reflection from the front line

Patients with ‘medically unexplained symptoms’ (MUS) remain an ongoing challenge to medical practitioners using conventional approaches to diagnosis and treatment. This challenge often creates tensions and defensive enactments in the doctor–patient relationship. In this viewpoint article, a personal reflection from current clinical practice is presented as a catalyst for further dialogue. In particular, psychoanalytic thinking around the issue of MUS is advocated as bringing a valuable focus by looking at ‘meanings’ behind symptoms. Medical practitioners may benefit considerably by working jointly with psychoanalytical practitioners. This could improve the care of patients with MUS and in addition bring beneficial understanding to the dynamics of the patient relationship.     

Countertransference issues in psychotherapy with lesbian and gay clients

This article briefly reviews literature on responses towards same-sex (lesbian and gay) sexualities from psychoanalytic and ‘lesbian and gay affirmative’ psychotherapeutic perspectives. An analysis is presented of reports of countertransferential reactions to lesbian and gay clients, obtained from interviews with fourteen psychotherapists who work in a lesbian and gay affirmative manner and eighteen clients who had received affirmative psychotherapy. Data were subjected to grounded analysis. Participants consistently attended to the thoughts, feelings and values that therapists held in relation to lesbian and gay clients and how these affected the meanings and practices available to them. These were linked with the therapist's sexual identity among other factors. Negative countertransferential reactions were regarded as potentially occurring among heterosexual and lesbian and gay therapists and were seen as arising from therapists’ conscious and unconscious fears about same-sex sexualities. These findings indicate a need to continue debating these issues more widely in the professional arena.     

Sources and management of resistance in child treatment

This paper traces the analytic work with a severely traumatised two-and-a-half-year-old girl Phoebe, whose early life was marked by chronic abuse and a violent murder she witnessed a few months prior to the beginning of treatment. Bringing the trauma in the room in a dissociative form, in line with post-traumatic stress disorder presentation, was Phoebe's unconscious means of communicating her pre-verbal encounters by projecting onto me the rage, shock and helplessness of her predicament. Thus, countertransference responses were a helpful window into her internal world, which was governed by cataclysmic losses and primitive states of fear. The importance of containment of the complex feelings aroused in the work and protecting against potential re-enactment of the abusive elements the patient, the family and often the professional network brought in the therapy is highlighted. The author hopes that this paper will encourage the offering of psychoanalytic psychotherapy to traumatised children particularly the under fives.     

Psychoanalytic witnessing as a prerequisite to psychotherapy with a severely sexually abused young adolescent male ex-inner city gang member

This paper discusses psychoanalytic witnessing as the prerequisite for psychoanalytic psychotherapy with a severely sexually traumatised young adolescent boy, Dean. This form of witnessing acted as a prior stage for treatment through the psychotherapist acknowledging Dean’s trauma, without seeking to symbolise its registration in the psychotherapeutic relationship. As sexual abuse is about something done to the person, this acknowledging crucially conveys belief in the truth of what has happened to the patient at the hands of the external world. My work with Dean taught me that such acknowledgment allows for such traumatised patients to then feel more able to accept interpretations based upon what they are doing to the external world, encapsulated in the transference to their psychotherapist. Because trauma is often so deeply felt, and leaves patients dissociated or fragmented, seeking evidence of its presence needs keen observation. Here the paper discusses an experience of bodily countertransference that alerted me to the location of Dean’s trauma’s registration in our relationship. Overall, the paper seeks to demonstrate the importance of psychoanalytic witnessing as a form of containment in itself, and the essential basis for psychotherapeutic work using symbolisation and the transference.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

Out of the body: embodiment and its vicissitudes

Body‐mind dualism and the consequent neglect of the body of the analyst can have important negative effects on the analytical process leading all too often to misinterpretations of the analysand's verbal and non‐verbal communications and to disturbances of analytical temporality. This is intensified when we are dealing with individuals where disembodiment and states of psychic deadness are central features. The paper explores the philosophical roots of the idea of a disembodied mind and the way in which this impacts our relationship with the world. While André Green's concept of the dead mother and disturbances in the sense of self‐agency have been held to play an important role in states of psychic deadness, I suggest that it is rather disturbances in the sense of body ownership and of the body image which are more central. The paper then discusses the particular kinds of countertransference that can be evoked in the analyst when we find ourselves dealing with this type of patient and suggests how we can use our embodied countertransference to become aware of and elaborate our own feelings of deadness in order to overcome the loss of temporality that is characteristic of such states. This is illustrated with reference to my work with a young man with a masochistic perversion and a severe disturbance of the body image with an accompanying profound sense of psychic deadness.     

On Countertransference

Drawing on non-clinical experience and with reference to relevant literature, this article examines countertransference and its impact on the development of a secure frame, focusing in particular on the countertransference dream and on its significance within the therapeutic relationship.