Does Lack of “Genetic-Relative Family Health History” Represent a Potentially Avoidable Health Disparity for Adoptees?

Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as (for older adopted children) language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history (GRFHx). Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. In this article, we draw out common features of traditionally understood “health disparities” in order to identify analogous features in the context of adoptees’ lack of GRFHx.     

Clinical applications of Matte Blanco's thinking

Ignacio Matte Blanco (1908–1995) left very few specific indications about the applications of his theoretical notions to his interpretative style. The author shows how he uses Matte Blanco to formulate some of his own interpretations. The first part of the paper uses clinical vignettes to illustrate some of Matte‐Blanco's concepts. Their theoretical vocabulary is thus made explicit. Then two psychoanalytic sessions are discussed at greater length, together with one from a therapy, so that the use of Matte‐Blanco's notions can be seen clearly, allowing for a fresh perspective on areas of psychoanalytic theory, particularly dreams, psychopathology viewed according to the proportions of asymmetrical and symmetrical functioning in the patient's bi‐logical mental system, the multidimensionality of the unconscious, the structural unconscious, the emotion‐thought relationship, projective identification, resistance, and negative therapeutic reaction. The practical consequences of all this are elaborated, particularly the ensuing possibility of ‘thinking with the patient' in the session. This enables the patient to introject a form of mental functioning in which the asymmetrical mode is not invaded by the symmetric mode (a parallel can be seen here with the Bionian concept of dialogue between the psychotic and non‐psychotic parts of the mind).     

Claiming Subjectivity: Re-Storying Clinical Psychology and Myself

This article explores becoming a clinical psychologist later in life. Drawing on the author’s experience as a developmental psychologist who becomes a clinical respecialization student, it traces shifts in narratives of identity, belongingness, perspectives on psychology, and ways of knowing that both influence and construct her perspective on age and midlife. The paradigm shifts of going from professor, to student and intern, and philosophical shifts, transitioning from a stance of objectivity, to one informed by deep subjectivity, are considered. The ways that age matters is pondered as an artifact of the larger social construction of aging. The article proposes that a rich later-in-life perspective often includes the capacity to utilize self-knowledge and affective interpretation that nurtures subjectivity. The capacity to summon subjectivity facilitates rich authentic empathic connection with patients in clinical practice. The author explores the process of learning and re-storying herself in a manner that draws on self-reflection, clinical subjectivities, the life-learned ability to be humble, and a theory-informed lens of clinical psychology that is truly different from developmental psychology. The promise for future contributions to both clinical work and the greater field by “new” clinicians at midlife is explored.     

Proneness for exercise,cognitive and psychophysiological consequences of action observation

ObjectivesPhysical exercise has benefits that go beyond health and well-being, namely in cognitive, motor and psychophysiological areas. The discovery of a shared neural network between action observation and execution (Action-Observation Network) led us to hypothesize that watching human motor action might improve cognitive and motor aspects of performance and proneness for exercise.Design/MethodsSixty participants viewed a Motor (M) (n = 30) or a Non-Motor (NM) (n = 30) movie with strong or weak content of motoric features of human action, respectively. Performance in d2 Attention test, Fitts' Motor task, and a Proneness for Exercise Visual Analog Scale was assessed before and after movie visualization, in a cross-sectional study. Psychophysiological measures were recorded throughout the experiment.ResultsOur results demonstrate an increase in proneness for exercise, and greater improvement in attention-related cognitive aspects in the M group. The aforementioned benefits of action observation did not modulate motor performance. A mental effort deployment was associated to the decrease in heart rate variability after visualization of the NM movie. This was not conducive to attention channeling on task performance. Conversely, M movie observation seemed to be associated to a cognitive load release, affording attention deployment for the resolution of the subsequent tasks.ConclusionsIt seems that some benefits associated to physical practice can result from the mere visualization of movies with human motor action content. These are the improvement in attention-related cognitive skills associated to psychophysiological changes that support a disengagement from mental effort. Crucially, the observation of exercise behavior seems to be a key factor for exercise adherence.     

Experiences of Countertransference: Reports of Clinical Psychology Students

While historically linked with psychoanalysis, countertransference is recognised as an important component of the experience of therapists, regardless of the therapeutic modality. This study considers the implications of this for the training of psychologists. Fifty‐five clinical psychology trainees from four university training programmes completed an anonymous questionnaire that collected written reports of countertransference experiences, ratings of confidence in managing these responses, and supervision in this regard. The reports were analysed using a process of thematic analysis. Several themes emerged including a desire to protect or rescue clients, feeling criticised or controlled by clients, feeling helpless, and feeling disengaged. Trainees varied in their reports of awareness of countertransference and the regularity of supervision in this regard. The majority reported a lack of confidence in managing their responses, and all reported interest in learning about countertransference. The implications for reflective practice in postgraduate psychology training are discussed.     

Entering the Sacred: Using Motivational Interviewing to Address Spirituality in Counseling

Despite the salience of spirituality in the lives of many clients, counselors are often hesitant to explore spiritual issues in counseling, largely out of a valid concern of imposing values on the client. Motivational interviewing provides a framework within which a counselor can both assess spirituality and facilitate client exploration of spiritual issues without fear of imposing values.     

What's not being said? Recollections of nondisclosure in clinical supervision while in training

The aim of this qualitative study was to retrospectively examine nondisclosure in individual supervision while in training. Interviews were conducted with supervisees two years post-qualification. Specific nondisclosures were examined and reasons for these nondisclosures were explored. Six in-depth semi-structured interviews were conducted and data analysis drew on Consensual Qualitative Research. The findings revealed four categories relating to: (i) the nature of the difficulty; (ii) reasons for nondisclosure; (iii) the supervisory relationship; and (iv) facilitative factors. The quality of the supervisory relationship was a significant element in nondisclosure. A key recommendation was that role induction for supervisees should be incorporated into training programmes to assist supervisees in learning how to use supervision more effectively. Limitations of the study and further research are provided in light of current findings.     

Not starting psychotherapy is more often initiated by the therapist than the patient

The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.