论医学人文精神的重塑

重塑医学人文精神是一个无法回避而又必须作出回答的紧迫问题。把现代医学技术放到人文哲学的大视野中去体认,从人学本体论意义上现代医学技术的价值理性,进一步澄清人们对医学技术无限崇拜的工具理性的错误认识;阐述了现代医学人文精神的内涵,认为以人为本,确立科学理性对医学技术的指导地位,适时约束医学技术行为应该成为现代医学人文精神的核心理念;提出了重塑现代医学人文精神的基本原则,即：坚持医学技术进步与人的全面发展相一致的原则,坚持医学技术进步与医学工作者道德健全相一致的原则,坚持医学进步与卫生事业持续、协调、健康发展相一致的原则。     

The week the couch arrived

Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development.     

The roots of empathy and aggression in analysis

Empathy and interpretation have complementary roles in analysis. Empathy diminishes psychological arousal, ego-defences, and promotes the therapeutic relationship. Interpretation, when adopted in the service of character analysis and the uncovering of unconscious conflict, represents one element of a larger set of interventions termed analytic aggression, whose primary goal is to promote insight. Psychoanalysis has been increasingly influenced by derivative theories that promote the therapeutic relationship. Clinical observations suggest that the application of analytic aggression has diminished and that many modern treatments may have become overly skewed towards empathic approaches. This paper explores ethical humanism, Jamesian typology, and feminine psychology, as factors that have contributed to the diminished emphasis on analytic aggression in practice. Eastern myth and Buddhist psychology are used to explicate the core features of narcissistic mental structuring and to support the continued importance of analytic aggression in its treatment. Case material is examined to elucidate the benefits and limits of analytic aggression.     

Relational-oriented character analysis

Referring to the diversity of psychoanalysis of today, a position called relational-oriented character analysis is discussed. It is stated that relation and character as concepts refer to different and partly contradictory points of view in psychoanalysis, the first one emphasising mobile, dynamic aspects of personality, the second underlining stable, structural aspects. The principle aim of the article is to argue how the two perspectives can be theoretically combined in an overriding object-relational (two-person) conception and to discuss some implications for analytic technique. Finally, convergences and differences with other positions or schools in contemporary psychoanalysis are suggested.     

Spitting,kicking and stripping: technical difficulties encountered in the treatment of deprived children

The technical difficulties posed for the child psychotherapist working with children who have themselves experienced violence and abuse are addressed. A distinction is drawn between violence in the service of communicating about such experiences and violence that arises from more perverse aspects of the patient. The therapist's need to pay close attention to his counter-transference is emphasized. From an example of a single session we see the therapist's struggle to receive the communicative aspects of extreme acting-out behaviour at the same time as creating a safe setting in which thinking can take place.     

Light and movement: making contact with a traumatised and embattled latency girl

This paper shows a child psychotherapist learning and developing her technique as she attempts to make contact with a child who is extremely hard to reach. It is based on the first two years of three-times-weekly intensive psychotherapy of a latency girl who had little faith in a helpful therapeutic relationship. Her defences against such a relationship were entrenched and hard to shift. In this clinical work, the psychotherapist relies on close observation and her countertransference to develop a relationship with the child, in order to begin to make sense of her non-verbal emotional experience and communication.     

Remarks on aggression

This paper attempts to draw attention to the difference between the states of mind and inner worlds of neurotic, borderline and psychopathic patients, with reference to different types of destructiveness: anger in the neurotic patient; desperate vengeful hatred in the borderline paranoid; and a cold addiction to violence in the psychopath. Discussion focuses on technical issues and the need to meet the psychopathic patient where he really is, in the inner bleak emotional cemetery he may be inhabiting. Although most patients refuse to stay put in the neat schematic categories outlined, they do seem to appreciate and to need the therapist's recognition of the specific quality of these vastly different states of mind.     

Eliciting Intelligence Using the Scharff‐Technique: Closing in on the Confirmation/Disconfirmation‐Tactic

The current study examined interview techniques aimed at eliciting intelligence from human sources. We compared two versions of the Scharff‐technique to the Direct Approach (a combination of open and direct questions). The Scharff conditions, conceptualised into four tactics, differed only with respect to the ‘confirmation/disconfirmation‐tactic’. The participants (N = 90) received background information and took the role as a source in a phone interview. They were instructed to strike a balance between not revealing too little and too much information. As predicted, the Scharff‐technique resulted in more new information than the Direct Approach. Importantly, the sources interviewed by the Scharff‐technique perceived that they had revealed less new information than they objectively did, whereas the sources interviewed by the Direct Approach perceived that they had revealed more new information than they objectively did. Furthermore, the interviewer's information objectives were better masked with the confirmation‐tactic than with the disconfirmation‐tactic. The results highlight the Scharff‐technique as a promising human intelligence gathering technique. Copyright © 2014 John Wiley & Sons, Ltd.