The trajectory of psychoanalysis: A prognosticationy3

I present an overview of the development to this point of psychoanalysis as a discipline'both as a theory of the mind and a treatment of the disorders of the mind' and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single‐handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences' not yet widely remarked' of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience‐near clinical theory, with implications, however, even for the level of experience‐distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.     

临床思维学的教学实践与理论探索

思维是人类理性活动的基本方式,思维能力是最具人类特色的能力,临床思维能力的培养是一个非常重要、然而又常为人们所忽视的问题,主要介绍临床思维学的课程设置、主要内容、教学目的和教学效果,通过对教学实践的阶段性总结,对理论体系进行初步的探索,以推动临床思维学的普及和发展,提高临床诊断治疗水平。     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

A framework and two sketches concerning psychoanalytical training and practice

The author discusses the mode of knowledge production in psychoanalysis based on a reflection on the psychoanalytical education and its relationship to clinical practice. She points out that there is a risk in a form of clinical activity found in our education, which, under the fascination of the analyst's power of operating in the metaphorical domain of words, loses sight of the material dimension of the clinical action. In other words, this form of clinical activity loses sight of the meeting with another human being, of the repertoire of theories and experiences that informs this action and the patient's and the analyst's concrete life situation. The author highlights the role of writing as a privileged way of dealing with the material and immaterial facts that constitute the clinical action and reflects on some of the forces that structure nowadays the reception of knowledge production inside the psychoanalytical field. She uses the notion of 'minor literature', by Franz Kafka, to express the possibility that a live circuit of writings exchanged among psychoanalysts can offer to an interchange of experiences and ideas that is the live expression of the history of the psychoanalytical groups. A clinical session is presented in order to promote considerations about the psychoanalytical education, theory and practice.     

THE IMPACT OF APPLIED BEHAVIOR ANALYSIS ON DIVERSE AREAS OF RESEARCH1

The impact of applied behavior analysis on various disciplines and areas of research was assessed through two major analyses. First, the relationship of applied behavior analysis to the general area of “behavior modification” was evaluated by examining the citation characteristics of journal articles in JABA and three other behavior-modification journals. Second, the penetration of applied behavior analysis into diverse areas and disciplines, including behavior modification, psychiatry, clinical psychology, education, special education, retardation, speech and hearing, counselling, and law enforcement and correction was assessed. Twenty-five journals representing diverse research areas were evaluated from 1968 to 1974 to assess the extent to which operant techniques were applied for therapeutic, rehabilitative, and educative purposes and the degree to which methodological desiderata of applied behavior analysis were met. The analyses revealed diverse publication outlets for applied behavior analysis in various disciplines.     

Trading Sex for Money or Compensation: Prevalence and Associated Characteristics from a Sexually Transmitted Infection (STI) Clinic Sample

The purpose of this study was to determine the prevalence and individual risk factors of people who trade or sell sex among sexually active individuals seeking HIV and sexually transmitted infection (STI) testing. Using electronic agency records, an analysis of the characteristics of 5,029 youth and adults who voluntarily obtained HIV and STI testing was conducted. Multiple imputation procedures for missing data from 3 variables and logistic regression were conducted. A total of 128 individuals reported having traded sex. Nine variables had statistically significant associations with trading sex. Individuals who identified as White and female had lesser odds of trading sex, whereas individuals who were transgender, were living in a shelter, had been sexually assaulted, had a previous STI, had high-risk sex, or used drugs had greater odds of trading sex. Elevated levels of high-risk behavior in addition to sexual trauma should be considered in intervention research and community health practice. Implications for service providers and researchers are discussed.     

Vicarious trauma: The psychological impact of working with survivors of trauma for South African psychologists

Traumatic events are highly prevalent in South African society and psychologists who work with survivors of trauma have been identified as particularly at risk of being adversely affected by their work, and experiencing vicarious trauma. This study aimed to explore the experiences of a group of South African psychologists who work predominantly with trauma survivors. Individual semi-structured interviews were conducted with six psychologists (females = 67%). The predominant type of trauma encountered by participants in clinical practice was interpersonal trauma in the form of physical and sexual abuse (83%). Data were analysed using thematic analysis. All participants reported symptoms of vicarious trauma including disruption in cognitive schemas, symptoms characteristic of post-traumatic stress disorder, and somatic symptoms. Participants also reported vicarious post-traumatic growth including an enhanced sense of interpersonal connectedness and positive changes in their philosophy of life and self-perceptions. The findings serve to sensitise psychologists to the impact of working with trauma survivors so as to enhance the efficiency of psychological service delivery to traumatised populations.     

‘… you kind of frantically go from one thing to the next and there isn’t any time for thinking any more’: a reflection on the impact of organisational change on relatedness in multidisciplinary teams

This paper reflects on the relational impact on Clinical Psychologists of NHS organisational change in the context of cuts and reorganisation. The reflections illustrate one theme drawn from a study of eight Clinical Psychologists working within adult Community Mental Health Multi-Disciplinary Teams. The paper considers the impact of competition and change in healthcare on the ability to engage in reflective practice potentially affecting client care due to reduced joint-working, consistency and creativity. The paper considers how acts of kindness (compassion) within organisational contexts at all levels can facilitate relatedness, reflection and more human care. It concludes by considering how shifting from short-term planning evaluating efficiencies based on perceived financial value, to thinking more widely and long-term about relational value may be of benefit to clinicians, clients and the system as a whole.