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.     

TRAINING AND GENERALIZATION OF LAUNDRY SKILLS: A MULTIPLE PROBE EVALUATION WITH HANDICAPPED PERSONS

An instructional procedure composed of a graded sequence of prompts and token reinforcement was used to train a complex chain of behaviors which included sorting, washing, and drying clothes. A multiple probe design with sequential instruction across seven major components of the laundering routine was used to demonstrate experimental control. Students were taught to launder clothing using machines located in their school and generalization was assessed later on machines located in the public laundromat. A comparison of students' laundry skills with those of normal peers indicated similar levels of proficiency. Follow-up probes demonstrated maintenance of laundry skills over a 10-month period.     

Getting real in analysis

The author uses a detailed clinical example to illustrate how reality testing can create rather than foreclose opportunities for analytic investigation. He proposes that authentic analysis of transference within the treatment relationship requires close and explicit attention to be paid to considerations of reality, but in a way that does not require the patient to defer to the analyst's view. The author reconsiders certain conceptions of a special psychoanalytic reality, of regression in clinical analysis, and of the nature of free association, suggesting that they tend to discourage the realism necessary to effective psychoanalytic work. In this context, he underlines the importance of ongoing reference to therapeutic outcome as an aspect of reality, and reflects upon the impact of the reality of the analytic treatment setting and the question of termination.     

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。     

Hemispheric asymmetries for temporal information processing: transient detection versus sustained monitoring

This study investigated functional differences in the processing of visual temporal information between the left and right hemispheres (LH and RH). Participants indicated whether or not a checkerboard pattern contained a temporal gap lasting between 10 and 40 ms. When the stimulus contained a temporal signal (i.e. a gap), responses were more accurate for the right visual field-left hemisphere (RVF-LH) than for the left visual field-right hemisphere (LVF-RH). This RVF-LH advantage was larger for the shorter gap durations (Experiments 1 and 2), suggesting that the LH has finer temporal resolution than the RH, and is efficient for transient detection. In contrast, for noise trials (i.e. trial without temporal signals), there was a LVF-RH advantage. This LVF-RH advantage was observed when the entire stimulus duration was long (240 ms, Experiment 1), but was eliminated when the duration was short (120 ms, Experiment 2). In Experiment 3, where the gap was placed toward the end of the stimulus presentation, a LVF-RH advantage was found for noise trials whereas the RVF-LH advantage was eliminated for signal trials. It is likely that participants needed to monitor the stimulus for a longer period of time when the gap was absent (i.e. noise trials) or was placed toward the end of the presentation. The RH may therefore be more efficient in the sustained monitoring of visual temporal information whereas the LH is more efficient for transient detection.     

SELF-ADMINISTERED WRITTEN PROMPTS TO TEACH HOME ACCIDENT PREVENTION SKILLS TO ADULTS WITH BRAIN INJURIES

This study evaluated the use of written checklists and task analyses as self-administered prompts to teach home accident prevention skills to 4 adults with brain injuries. Subsequent to baseline, participants used written checklists that identified potential in-home hazards but did not prompt behaviors necessary for hazard remediation. Written individualized task analyses, incorporating specific behavioral steps for correcting hazards that participants had failed to remediate during the checklist phase, were used to prompt appropriate responding when necessary. These were subsequently faded to transfer stimulus control to the natural conditions. A multiple probe technique across participants and settings was used. Results indicated that the checklist alone was sufficient to increase appropriate responses to many of the potential hazards. Individualized task analyses, when needed, resulted in appropriate remediation of all potential hazards. Generalization to untrained potential hazards occurred to some degree for all participants. Follow-up results showed that most skills trained were maintained over a 1-month period.     

The case of Marcello: transference and the unfolding of the analytical relationship

The analytical process of a male patient is herein described, the main focus being on the phase when the transference develops and transference projections are modified, leading to a transformation of the personality, which was previously characterized by severe obsessional defences. The specific aim of the discussion is to evaluate when and what to interpret, in relation to the importance of the transferential patterns and with regard to the role of the analyst as a container.     

动词隐含因果性对代词加工的影响

本研究探讨了在汉语句子理解中动词隐含因果性对代词指认的影响。在实验一巾,被试进行自定步速的阅读．结果发现当动词隐含因果性和句中代词实际所指一致时阅读时间较短,不一致时阅读时间较长。实验二采用眼动技术,句中两个参与者性别不同,代词上提供性别线索,结果显示了动词隐含因果性在代词加工上微弱的即时效应。     

在发展中求善：动脉粥样硬化影像诊断技术不断演进的思索

动脉粥样硬化疾病是严重危害人类健康的一大类疾病,涉及人体全身各个部位,影响多个器官。动脉粥样硬化的影像诊断经历了从有创到无创、从局部到全身、从单一技术到整体化优势一系列过程,充分体现了影像技术在动脉粥样硬化诊断中的动态发展观、整体原则及个体化原则。     

PiCCO与Swan—Ganz导管监测的比较与思考

在工程技术的推动下,Swan-Ganz导管监测和PiCCO先后产生并应用于有创血流动力学监测。通过对比两者的操作性能、监测指标、并发症及费用等方面,展示PiCCO的优越性及安全性,思考现代医疗活动中的社会价值和人文体现,从科技发展方向和医学价值回归的角度分析临床决策,为广大临床工作者提供借鉴。