When the analyst is physically ill: Vicissitudes in the analytical relationship

Something that happened to one of the authors recently led them to refl ect upon what the analyst's falling ill may represent and the problems it may give rise to in the analytic relationship. Such an eventuality injects a massive dose of the analyst's personal reality into the analytic space, thereby allowing the patient a glimpse of images of vulnerability, frailty and loss, and mobilizing emotions, fantasies and defences in both the analyst and the patient. The authors' survey of the literature ranges between two different theoretical perspectives intrapsychic and intersubjective that, in their most radical formulations on technique, call for maintaining either the strictest neutrality and anonymity or symmetrical relationality. In both cases, that which is denied is the unconscious communication that enables the analyst, irrespective of his conscious intentions, to allow either parts of himself or inner objects of the patient to act in the relationship. In closing, the authors shall illustrate the concept discussed through three clinical vignettes.     

Effect of four aspects of rational statements on expected satisfaction with a close relationship

This study tested whether each of the four main aspects of rational thinking decreased expected relationship dissatisfaction when imagining having a serious disagreement with either a romantic partner or closest friend. The four features, common to cognitive theories of therapy, were the tendency not to exaggerate negative effects, not to demand that one's wishes should always be met, not to globally rate individuals or relationships and not to over-generalise that these experiences always have happened or will happen. Only when combined together did the four aspects significantly decrease expected relationship dissatisfaction in comparison to a control condition in which a serious disagreement was simply reiterated. This combined condition also significantly decreased the irrational tendency to agree that disagreements are destructive.     

Clergy Dual Relationships,Boundaries, and Attachment

Male and female clergy, primarily rabbis, scored similarly on a measure of attachment related anxiety and avoidance although men scored as significantly more compartmentalized than women on a boundary measure. Rabbis scored as significantly less comfortable depending on others and opening up to others than Gentile clergy. Finally, this study delineates four clergy approaches to dual relationships and the tendency of clergy boundaries to thicken with experience in the field.     

Quality of Relationships Between Youth and Community Service Providers: Reliability and Validity of the Trusting Relationship Questionnaire

We examined the factor structure and psychometric properties of the Trusting Relationship Questionnaire, a brief measure of relationship quality between youth and community-based service providers involved in their care. Data on youth residing in Therapeutic Foster Care and in Group Homes (N = 296) were collected. We identified a one-factor solution for the child version of the measure and a two-factor structure for the adult version: child's perception of the relationship and adult's perception of the relationship. Both versions appear to be highly reliable and possess adequate levels of construct, criterion, and discriminative validity. While no statistically significant age differences were noted on the parent version, on the child version, older youth were more likely to report lower relationship scores. Gender differences were found on both versions: Female youth reported higher scores on the child version as did adults reporters of relationships with female youth, but only for the first factor—child's perception of the relationship. Overall, the TRQ appears to capture the quality of the relationship between service providers and youth in their care, thus bridging a gap in assessment measures.     

When One Plus One Equals Three: The Role of Relationships and Context in Community Research

This paper explores the role of relationships within and between the community of the researchers and the community of the research participants, as they relate to qualitative, community psychology research. Although relationships are salient to all research, their role is particularly prominent in qualitative research, in which a closer rapport is established between researcher and research participant than in quantitative research, and the impact of both sides of this interaction on the research process is acknowledged. Instead of merely looking at the community and relationships of the participants, the usual focus of research, this paper also explores the often-overlooked community and relationships of the researchers and then goes on to look at the impact on the research process of the interaction of these two separate communities. This inside story, while seldom explicitly explored or articulated, has implications for community research in general and particularly for applied research.     

The Impact of Physical Maltreatment History on the Adolescent Mother–Infant Relationship: Mediating and Moderating Effects During the Transition to Early Parenthood

Using attachment theory as a framework, this paper examines how pregnant adolescents' experiences of physical maltreatment during childhood influence the subsequent mother-infant relationship in 203 low-income adolescents followed from the 3rd trimester of pregnancy through the 1st year of parenthood. The relation between physical maltreatment history and early difficulty in the mother-infant relationship was mediated by adolescents' evaluations of the relationship with their primary caretaker and the feelings they associated with motherhood measured prior to childbirth. In addition, a supportive romantic relationship during pregnancy acted as a protective factor by moderating the impact of maltreatment history on the quality of the subsequent mother-infant relationship. Findings support the importance of assessments and interventions that consider the social context and relational history of pregnant and parenting adolescents.     

Desires in Palliative Medicine. Five Models of the Physician‐Patient Interaction on Palliative Treatment Related to Hellenistic Therapies of Desire

In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches to desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has.     

Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians

There has been growing concern about the effects on the patient–physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called double agency. Various authors have proposed ways to restore patient centeredness to the patient–physician interaction. We have previously discussed the need to establish a patient–physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug doctor; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient–physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.     

Re-Evaluating Professional Autonomy in Health Care

Professional autonomy, as the symbol of the traditional freedom ofdecision-making of medical professionals is criticized. This essayexamines the critique. It analyses the underlying assumption that theautonomy of health professionals is incompatible with the need fororganisation and management in order to control rising health carecosts. It is argued that the concept of professional autonomy should beredefined, not through restricting the decision-making freedom ofindividual health professionals, but through expanding the concept intothe sphere of management, so that managers will take responsibility forpatient care.