Desire and the female analyst

The literature on erotic transference and countertransference between female analyst and male patient is reviewed and discussed. It is known that female analysts are less likely than their male colleagues to act out sexually with their patients. It has been claimed that a) male patients do not experience sustained erotic transferences, and b) female analysts do not experience erotic countertransferences with female or male patients. These views are challenged and it is argued that, if there is less sexual acting out by female analysts, it is not because of an absence of eros in the therapeutic relationship. The literature review covers material drawn from psychoanalysis, feminist psychotherapy, Jungian analysis, as well as some sociological and cultural sources. It is organized under the following headings: the gender of the analyst, sexual acting out, erotic transference, maternal and paternal transference, gender and power, counter-transference, incest taboo - mothers and sons and sexual themes in the transference.     

DISCRIMINATIVE CONTROL OF THERAPISTS' PERFORMANCE1

In order to examine therapists' discriminative responding to normal and idiosyncratic patient responses, naive subjects were presented with a simulated “patient” for treatment. The subjects were made to believe they were reinforcing normal verbalizations emitted by this patient In fact, they were listening to a tape on which normal and idiosyncratic verbalizations had been recorded. Different probabilities of normal and idiosyncratic “patient” verbalizations could be presented to the subjects by means of a digital programming unit. In one of a number of conditions, the subjects' accurate reinforcing responses were followed by an increased probability of the patient's normal verbalizations. Accurate reinforcing responses emitted by the subjects were brought under the control of normal and idiosyncratic patient responses, by use of contingent feedback, change in patient responding, and monetary reinforcers. When the patient's normal verbalizations increased in probability, so did the subjects' accurate reinforcing responses following the patient's normal verbalizations, and to a lesser degree, the subjects' inaccurate reinforcing responses following the patient's idiosyncratic verbalizations. When the patient's idiosyncratic verbalizations increased in probability, the subjects' accurate and inaccurate reinforcing responses decreased in probability. The clinical implications of these tendencies are discussed.     

Test-retest reliability and concurrent validity of the Morrow Assessment of Nausea and Emesis (MANE) for the assessment of cancer chemotherapy-related nausea and vomiting

The present study evaluated the concurrent validity of two assessment approaches for the measurement of cancer chemotherapy-related nausea and vomiting. The results indicated that the concurrent validity between the Morrow Assessment of Nausea and Emesis (MANE; Morrow, 1984b) and continuous self-monitoring and the reliability on the MANE were moderate. The heterotrait-monomethod and heterotrait-heteromethod matrices demonstrated moderate correlations among the frequency, severity, and duration of anticipatory nausea and vomiting as well as high correlations among the frequency, severity, and duration of posttreatment nausea and vomiting. Additionally, the heterotrait-monomethod matrices show a number of correlations above chance between anticipatory and posttreatment symptoms. The results are discussed in light of future research endeavors.This research was supported in part by Research Grant IN-150 from the American Cancer Society.     

Evaluation of self-contained training procedures for the Time-Sample Behavioral Checklist

The comparative effectiveness of two time-limited modes of training observers to code the behavior of clients in residential treatment programs on the Time-Sample Behavioral Checklist (TSBC) was evaluated. The susceptibility of training procedures to consensual observer drift and the predictability of TSBC mastery from trainee characteristics were also examined. Two equated groups of undergraduate students (N=15 each) participated in full-time training on the TSBC and another instrument for 27 days, followed by criterion testingin vivo and on videotapes. One group was trained by experienced personnel using procedures known to be effective but potentially subject to consensual observer drift. The other group was trained using a previously untested set of written and videotape procedures that do not rely on experienced personnel. Comparative effectiveness and observer drift were evaluated by multivariate and univariate ANOVAs on mastery scores reflecting both pattern agreement and level differences between each trainee and criterion codings. The new, more efficient training procedures were found to be as effective as the original training procedures in the degree of mastery achieved by trainees. Original training procedures were found to be resistant to consensual observer drift, with such a phenomenon appearing in only 1 instance of 156 opportunities. The high degree of mastery achieved by trainees during the time-limited training period was comparable to that previously achieved with the original training procedures. No meaningful predictions of coding mastery were found, with only one trainee characteristic being significantly related to one of six mastery criteria. The results document procedures that are both efficient and resistant to invalidity for training observers in the use of multidimensional observational systems, as well as providing guidelines for the development of standardized procedures.This article is based on a thesis submitted to the Graduate College of the University of Illinois at Urbana-Champaign in partial fulfillment of the requirements for the Ph.D. degree in psychology by the first author and under direction of the second author. The third and fourth authors also participated as supervisors. Appreciation is extended to other members of the thesis committee, Fred Kanfer, Ross Parke, and Julian Rappaport, and to John Gottman and W. Robert Nay for their comments and recommendations. This study was partially supported by Public Health Service Grants MH-25464 and MH-14257 from the National Institute of Mental Health and by grants from the Joyce Foundation, the MacArthur Foundation, and the Illinois Department of Mental Health and Developmental Disabilities.     

Development and Feasibility of a Group Cognitive-Behavioral Therapy for Fear of Cancer Recurrence

This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session.Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment.These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach.This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR.     

Predictors of adherence to aerobic exercise in rectal cancer patients during and after neoadjuvant chemoradiotherapy

This pilot study explored predictors of adherence to exercise during and after neoadjuvant chemoradiotherapy (NACRT) in rectal cancer patients. Eighteen rectal cancer patients were prescribed three supervised aerobic exercise sessions/week during NACRT followed by ≥150 min/week of unsupervised aerobic exercise after NACRT. Although not statistically significant, adherence to supervised exercise during NACRT was meaningfully better for patients who were women (d = .82; P = .12), younger (d = ?.62; P = .30), married (d = .62; P = .42), with better mental health (r = .32; P = .21), fewer diarrhea symptoms (r = .48; P = .052), and higher anticipated enjoyment (r = .31; P = .23), support (r = .32; P = .22), and motivation (r = .31; P = .23). After NACRT, adherence was significantly better for patients who reported worse mental health (r = ?.56; P = .046) and meaningfully better for patients who were women (d = .54; P = .38), better educated (d = .77; P = .22), had no comorbidities (d = ?.63; P = .17), and exercised at baseline (d = 1.05; P = .12). Demographics, tumor side effects, and motivational variables may predict adherence to exercise during and after NACRT.     

Provider Conscientious Refusal of Abortion,Obstetrical Emergencies,and Criminal Homicide Law

Catholic doctrine’s strict prohibition on abortion can lead clinicians or institutions to conscientiously refuse to provide abortion, although a legal duty to provide abortion would apply to anyone who refused. Conscientious refusals by clinicians to end a pregnancy can constitute murder or reckless homicide under American law if a woman dies as a result of such a refusal. Such refusals are not immunized from criminal liability by the constitutional right to the free exercise of religion or by statutes that confer immunity from criminal homicide prosecution. Core principles of the rule of law require the state to protect the lives of all persons equally and to place the life and health of persons above any the interests of providers have in moral integrity or in respecting the moral status of prenatal humans. In some states criminal liability related to conscientious objection also applies to corporate hospital officials.     

末期癌症患者的临终关怀

临终关怀与末期癌症关系密切,末期癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容。作为发展中的学科,本文对临终关怀的发展、目的、内容及其在末期癌症患者中的实施作一综述。     

台湾地区姑息医学制度的建立及法律实践

姑息治疗在提高晚期癌症患者生活质量、实施临终关怀、给予病人及其家属全面周到的照顾诸方面起着重要作用。在台湾,已为姑息治疗立法并实施了10年,积累了丰富的经验。这项法律本身及其细则、附件等配套文件使姑息治疗更加规范可行。研究规范的姑息治疗及台湾的相关法律可以帮助我们更好的理解姑息治疗的理念,帮助发展大陆同道构建有效实用的...     

对T1G3膀胱癌治疗方法的探讨

T1G3膀胱癌有高复发和进展倾向,选择恰当的治疗方法成为难题。使用BCG治疗可促肿瘤进展和转移,但可保留膀胱。膀胱切除也许提供了最好的治疗方案,但膀胱切除仍会复发且具有手术风险,且被认为是过度治疗。此文从哲学角度来探讨T1G3膀胱癌的治疗方法,以便为临床实践和进一步的研究提供思路。