A Qualitative Study of Health Professionals' Views Regarding Provision of Information About Health-Protective Behaviors During Genetic Consultation for Breast Cancer

This study aimed to explore health professionals' views and practice regarding the provision of information about health-protective behaviors (e.g., exercise, alcohol consumption, diet) during genetic consultation for breast cancer. Ten genetic counselors participated in three focus groups, and seven medical specialists were interviewed in a focus group or individually. Data was analyzed using the constant comparative method. Findings suggested that health professionals held differing, often opposing, views about the value of health-protective behaviors for women at increased risk of breast cancer. The content and extent of information provided about health-protective behaviors varied widely, and participants expressed a need to form consensus regarding information provision both within and across clinics. The main barriers to providing information regarding health-protective behaviors included the lack of research evidence regarding the impact of these factors and higher priority of other information need to be provided in the limited consultation time. Participants generally did not consider it their role to promote health-protective behaviors, and were concerned about the psychological impact of providing information about behavioral risk factors during genetic consultations.     

The UK Hybrid Embryo Controversy: Delegitimising Counterpublics

The UK Human Fertilisation and Embryology Act of 1990 was revised in 2008 in response to legal challenges, societal changes and clinical advances since 1990. A provision permitting the creation of animal–human hybrid embryos was the subject of an extremely effective public relations (PR) campaign by embryo scientists and other supporters of such experimentation. In response, science correspondents of the ‘serious’ or ‘quality’ press commented favourably on these PR activities; this validation supplemented key messages in their press releases. The approval conferred on attempts to shape public opinion was explicitly contrasted with the public consultation exercise conducted by the UK Department of Health in 2005. Press coverage of the campaign demonstrated asymmetrical framings of the representativeness of public opinion and scientists' accounts of their proposed research. Scientists' views were represented as objective and therefore a legitimate basis for policymaking, in contrast with subjective views of putatively uninformed or opposed publics. Such opponents were cast as a counterpublic. The public interest was limited to evaluating the science on its own terms, thus pre-empting consideration of the possibility that public interests and scientists' interests may not coincide.     

The devil and the deep blue sea: dyadic narcissism and the problem of individuation 1

This paper addresses issues of infantile gender identity as they are demonstrated through group processes amongst the carers of disturbed adolescents. It uses this and other clinical material to explore gender narcissism – both male and female. It examines how such narcissism is linked to sado-masochism, and how it can impede a healthy development towards bisexual and triadic functioning.     

Accidental Communities: Race,Emergency Medicine,and the Problem of PolyHeme®

This article focuses on emergency medical care in black urban populations, suggesting that the classification of a “community” within clinical trial language is problematic. The article references a cultural history of black Americans with pre-hospital emergency medical treatment as relevant to contemporary emergency medicine paradigms. Part I explores a relationship between “autonomy” and “community.” The idea of community emerges as a displacement for the ethical principle of autonomy precisely at the moment that institutionalized medicine focuses on diversity. Part II examines a clinical trial for the blood substitute PolyHeme^® (Northfield Laboratories, Inc., Evanston, IL). It illustrates the ways in which bias in research paradigms and Institutional Review Board decisions attach to the notion and utility of the language of “community.” The conclusion's contemporary anecdote makes apparent the vitality of the issues of prehospital emergency medical care and the ways in which decisions and practices fall too easily into a narrative of culturally biased treatment.     

Combining Explicit Timing with an Interdependent Group Contingency Program to Decrease Transition Times

ABSTRACT

A sixth-grade teacher and consultant serving as a behavioral specialist developed, implemented, and evaluated the Timely Transitions Game (TTG), a procedure designed to reduce room-to-room transition times. The TTG combined several procedures that have been shown to alter student behavior including explicit timing procedures and an interdependent, group-oriented reward program with randomly selected criteria. Five transition times were measured and recorded each day. At the end of the school day, the teacher randomly selected a transition and a criterion (seconds taken to transition). If the class completed the randomly selected transition in less time than the randomly selected criterion, they earned a letter. When students earned enough letters (e.g., the five letters that spell M-U-S-I-C), they received access to the reward (e.g., listening to music during independent seat-work). Results indicated immediate and sustained decreases in transition times following the implementation of the intervention. Although methodological concerns prevent drawing cause-and-effect conclusions, the current study shows how educators can adapt and combine empirically validated strategies and procedures to remedy presenting problems.     

Children with Attention Deficit Hyperactivity Disorder

ABSTRACT

It is estimated that there have been over 4,000 articles in the literature on the subject of attentional problems, addressing its etiology, epidemiology, assessment, diagnosis, and treatment. This article reviews recent and relevant literature with an eye toward functional conclusions and linkages between assessment and intervention. The article concludes by providing a problem-solving model that integrates parent or teachers' referral concerns, reasons for these concerns, assessment methods, and intervention strategies. In the end, four definitive conclusions are drawn, and the importance of multimodal strategies that collaboratively involve home, school, and community settings is emphasized.     

Miscarriages of psychoanalytic treatment with suicidal patients2

The author describes a particularly perilous frontier on the psychoanalytic landscape‐ namely, the treatment of suicidal patients with serious personality disorders. Using a clinical example of egregious boundary violations by an analyst, he describes specific countertransference pitfalls that lead to mishandling the patients' expressions of suicidal despair. These include disidentification with the aggressor, failure of mentalization, collapse of the analytic play space, reactions to loss in the analyst's personal life, omnipotence, envy of the patient and masochistic surrender. The author emphasizes the unique vulnerabilities that accompany analytic treatment of such patients.     

A fertile matrix: the birth of the Forensic Psychotherapy Society

This paper traces some aspects of the fertile matrix within which, over many years, the application of a psychoanalytic perspective to clinical work with the most severely mentally ill, difficult and at times frightening patients in secure and community settings has evolved and now led to the recent inauguration of the Forensic Psychotherapy Society (FPS), a new Member Institution of the British Psychoanalytic Council. The Society provides both a framework for a national, multidisciplinary professional training in psychodynamic forensic psychotherapy and the potential launching pad for an active post-qualification organisation supporting CPD and all other forms of professional development. The particular contributions to the birth of the FPS of the Forensic Psychotherapy Department at West London Mental Health NHS Trust, partly because we know it best but also because it is part of the largest forensic psychiatric service in the United Kingdom, are described.