The analyst's anxieties in the first interview: Barriers against analytic presence

To answer the questions: why don't more people enter analysis and how do we get more people to do so? Attention is drawn to anxieties in the analyst that become obstacles to the initiation of analysis. The main focus of the paper is how to understand why analysts, irrespective of patient characteristics, seem to have resistances against embarking on analysis. Being a meeting between strangers the consultation activates strong emotional reactions in both parties. One way of coping is defensively to diagnose, assess and exclude instead of being present as an analyst. The analytic frame of a consultation is ambiguous, and a secure analytic function is needed in order to meet the openness and unpredictability of this frame. A fragile psychoanalytic identity is seen as central to analysts' failure to create an analytic practice; it takes years to develop and maintain a robust analytic function, and analytic work continues to cause disturbing emotional reactions in the analyst. Analysts' vulnerable identity is also linked to the history of psychoanalysis that has fostered an ideal of analytic practice that is omnipotent and impossible to reach. Therefore it is no wonder that attempts to reach a convinced recommendation of analysis can become diverted in the process of consultation. Confronting these inner impediments in order to strengthen the analytic identity is suggested as a better way to get more analytic patients than to keep looking for so‐called analysability in patients.     

Selecting a patient or initiating a psychoanalytic process?

The defences provoked in the analyst by the anxieties associated with the difficult tasks of ‘assessment’ and ‘selection’ for psychoanalysis can result in a tendency to think in terms of ‘hurdles to be cleared’ by potential psychoanalytic patients, rather than ‘opening the gates’. This can result in a diminution of the analyst's capacity to enlist and sustain a psychoanalytic stance. Only within a psychoanalytic frame can a meaningful psychoanalytic process unfold, at all stages of a potential patient's movement from their first contact through to, possibly, entering into an analysis. The author illustrates the value of this thinking by describing the work of the London Clinic of Psychoanalysis where there has been a shift of emphasis in psychoanalytic consultation towards working with individuals on their potential to initiate a psychoanalytic process, and away from the sole aim of ‘selection of a suitable patient’. In this paper, the author notes that when institutional culture and practice supports psychoanalytic identity, this makes it more possible to recognize and articulate the anxieties provoked by the ‘emotional storm’ inevitable in psychoanalytic consultation, and the draw towards unhelpful enactment that may otherwise obscure the initiation of a psychoanalytic process that may or may not result in analytic treatment. Illustrative case material from the Clinic is presented.     

咨询期望与人格特质的相关性及对临床心理干预的启示

本研究探析了人格因素与咨询期望的相关性及对临床工作的启示.通过方便抽样选取样本348人,用心理咨询预期简表、卡特尔16项人格因子问卷进行调查.咨询期望在性别之间无差异,心理咨询中的个人承诺与聪慧性、稳定性等人格因子呈正相关;与怀疑性、忧虑性等呈负相关.对咨询师专业性的期待与乐群性、稳定性等人格因子呈正相关;与怀疑性、忧虑性等呈负相关.人格中的有恒性、聪慧性等对个人承诺有正向影响,而忧虑性、怀疑性对其有负向影响.有恒性、乐群性对专业性期待有正向影响,而忧虑性则产生负向影响.在临床心理咨询中要想达到理想效果,需要依据来访者的人格特点,评估并适时调整咨询期望.     

Minimum Competency Testing of the Handicapped: A Review of Legal Challenges

The article reviews recent litigation involving minimum competency testing of the handicapped with regard to both constitutional and statutory challenges. Court decisions indicate that handicapped students will be required to pass state mandated competency tests as long as adequate notice of the test as a graduation requirement is provided. The importance of the Individualized Education Program, as well as implications for education and counseling of the handicapped, are discussed.     

Psychotropic Medication Consultation in Schools

Abstract

Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the complexity of medication issues for school psychologists. Training programs are encouraged to examine current curricular requirements to insure that graduates are exposed to evidenced-based treatments including pharmacological approaches. It is vital that school psychologists examine their own competencies as they work to ethically and legally consult with families and physicians to improve adaptive functioning in school-aged populations.     

Examining the Efficacy of School-Based Consultation: Recommendations for Improving Outcomes

SUMMARY

Schools are faced with the difficult task of educating students who present diverse learning and behavioral challenges. To meet student needs, schools tap the expertise of a variety of specialists who provide services through “pull-out” programs or consultation to general educators. Unfortunately, neither strategy has proved effective to date with respect to children and youth who present significant social behavior problems. A brief review of the literature points to the shortcomings as linked to multiple treatments with varying outcomes and inconsistent implementation of best practices. One option to address the challenges schools face in light of ineffective practices to date is the development of school-wide systems of positive behavior support (PBS). Effective implementation of school-wide systems of PBS will require moving the consultation process from individual cases to working with teams of educators. Key skills and possible measurement strategies to develop and sustain school-wide consultation efforts are discussed.     

A slow unfolding – at double speed: reflections on ways of working with parents and their young children within the Tavistock clinic's under fives service

This paper describes clinical work carried out as part of the Tavistock Clinic Under Fives Service, which offers brief focused psychoanalytically based interventions to families with young children, as well as longer-term work. It elaborates psychoanalyst Annette Watillon's idea that it is the dramatic way in which children enact their (and their family's) predicament in the consulting room which speeds up the process of change. The author clusters clinical cases into three categories, each cluster representing a different kind of ‘dramatic’ enactment and leading to a different kind of intervention relating to the therapist's role, the structure of the interventions and the ‘ports of entry’ for the work. The categories are defined as: ‘child-led drama’ with the therapist in the role of ‘therapeutic observer’; ‘internal parental drama’ with the therapist in the role of ‘therapeutic consultant’; and ‘external parental drama’ with the therapist in the role of ‘therapeutic modulator’. The author defines these categories, illustrating each category with clinical examples.     

‘Who owns my pain?’ An aspect of the complexity of working with looked after children

This paper underlines the difficulties of working with looked after children and their carers. The author discusses a particular approach to respond to the complexity of looked after children's emotional difficulties, and their impact on the network of professionals making decisions about their life in care. As their own parents are no longer in a position to take responsibility for them, their trauma and past abuse make for a lack of clarity amongst this network when establishing the responsible role in loco parentis. In order to provide effective therapeutic work with these children, it is crucial to consider their disturbance as affecting the network around them. Enabling the network to understand and process powerful feelings around the child enhances its self-reflective function, so crucial for thinking about the child's needs and emotional development.     

Ethics Consultation in Pediatrics: Long-Term Experience From a Pediatric Oncology Center

There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.     

Representing Blissymbols with a Young Child

This article describes a comparison of pencil embellishment cued, versus picture cued learning, in lhe establishment of an initial Blissymbol vocabulary. The design of the study followed N = 1 time series principles. The single subject represented an analog developmentally young individual. She was 2 years 10 months old at the commencement of the study and on a range of cognitive scales was of average ability. Within its restricted parameters, the study indicated superiority of pencil embellishment over pictures as simultaneous learning aids. Various speculative conclusions based on these findings are drawn.