‘Does class count?’ Social class and counselling

This article explores the importance attached to social class by experienced practitioners taking part in a co‐operative inquiry group. A review of the literature from the last thirty years indicates that there is very little research on class in relation to counselling and psychotherapy reported in the UK. Both authors position themselves as coming from working class origins. Nine co‐researchers from both middle and working class origins joined the group. Eight meetings took place over a period of nine months. Extracts from the group's discussions are represented and integrated with ‘presentational knowing’ drawn from contemporary culture, including poetry and popular music. This study suggests that social class is a neglected aspect of diversity in the counselling field. Implications of the study have relevance for the language of counselling and psychotherapy and class based values; social class and its impact on initial education; and ongoing counselling practice and access to therapy for working class people.     

Psychoanalysis and change: Between curiosity and faith1

The IPA recently announced that it now recognized three sessions per week as a valid frequency for psychoanalytic treatment. From the debate that has ensued over the problems this decision is expected to cause, important insights can be gained into the current crisis of identity affl icting psychoanalysis. Technical aspects of therapy that were once considered peripheral have gradually acquired the status of core theoretical parameters. Freud was a man of science who was concerned with universal human phenomena. His disagreements with followers such as Jung and Adler centred on the major theoretical issues of the sexual nature of the libido and the existence of the unconscious. It is also interesting to note that Freud never distinguished between psychoanalysis and psychoanalytic psychotherapy. Where he did make a distinction, it was between psychoanalysis and the consciousness‐based psychotherapies, or those that used suggestion as a major tool. When the point has been reached where the frequency of sessions or the use of a couch is used to defi ne whether a treatment is psychoanalytic, some consideration of whether the right direction is being pursued is called for. A serious risk is being run of sacrifi cing our spirit of curiosity for the sake of tradition, becoming more concerned with repeating the formal aspects of practice than with the real purpose of psychoanalysis, the investigation of the most profound workings of human nature.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

Learning from experience in case conference: A Bionian approach to teaching and consulting

In case conferences as well as didactic seminars, the power of the group can bring psychoanalytic education to life. However, primitive anxieties activated by group dynamics may also interfere with teaching and learning. The authors offer the example of a stalemated private practice case conference that had unconsciously organized against learning as the members began to read Bion's work. The case conference leader, an analyst, presented her case conference, which was mired in basic assumption dependency dynamics, to our peer consultation group. Drawing upon Bion's early contributions on groups, as well as his later ideas about thinking and mental growth, the peer group facilitated the case conference's return to work-group functioning and learning from experience. Activated in the peer group, commensal container↔contained processes gradually spread throughout the entire relational system of peer group, case-conference leader, case-conference members, and patients. This example underscores the importance of promoting within our institutes a culture in which faculty view themselves as part of an evolving intersubjective matrix that works to foster the containing capacities of candidates, patients, and faculty alike.     

Counseling Outcomes for Youth With Oppositional Behavior: A Meta‐Analysis

This meta‐analysis of clinical trials explored the effectiveness of treatments targeted at changing oppositional behavior. The meta‐analysis included 31 peer‐reviewed treatment studies with school‐age youth ages 6–17 years identified as having oppositional defiant disorder. Results were synthesized using a random effects model for mean difference and mean gain effect size estimates. Findings suggest that counseling/psychotherapy is effective in treating oppositional behavior in school‐age youth at termination, but the long‐term efficacy of such treatment is less stable.     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

患者异常心理致阴茎尿道异物伤诊治体会

分析各种类型阴茎尿道异物伤的治疗原则及治疗方法,并结合病例就非正常酊慰相关心理因素问题进行探讨。回顾性分析11例不同类型阴茎尿道异物伤患者临床资料,其中阴茎异物嵌顿伤7例,尿道异物伤3例,阴茎内异物植入1例。11例均成功取出异物,随访无明显异常。不同类型阴茎尿道异物伤通过选择适当的治疗方法,大多可获得满意的结果。此类阴茎尿道异物伤属非正常自慰行为,患者大多伴有心理障碍,术后需要进行必要的心理疏导。     

心理疗法在针灸治疗中的应用

随着疾病谱和死亡谱的改变,生物医学模式逐渐地不能满足医学发展的需要,取而代之的是生物心理社会医学模式。现代医学模式全方位探求影响人类健康与疾病的因果关系,认为生物学、心理学及社会学因素是人类致病共同的重要因素。针灸是中国传统医学同时也是西方辅助与替代医学的重要内容。针灸医护人员应大力宣传针灸知识,应用生物心理社会医学模式去对待每一位患者。本文试述心理疗法如支持性心理治疗、认知行为疗法、放松疗法在针灸临床的应用,展现针灸心身同治的诊疗特点。