What kind of discipline is psychoanalysis?

Current controversies involving clinical, conceptual and empirical research shed light on how psychoanalysis confronts its nature and its future. Some relevant debates in which Wallerstein, Green, Hoffman, Eagle and Wolitzky, Safran, Stern, Blass and Carmeli, and Panksepp have participated are examined regarding the characteristics of their argumentation. Agreements and disagreements are explored to find ways that could have allowed the discussion to progress. Two foci are highlighted in these debates: (a) whether a clinical common ground exists in psychoanalysis and what kind of procedure could contribute to further clarification; (b) complementation of in‐clinical and extra‐clinical evidence. Both aspects are scrutinized: the possibility of complementing diverse methodologies, and the nature of the shared clinical evidence examined in clinical discussion groups such as those promoted by the IPA Clinical Observation Committee. The importance of triangulation and consilience is brought to bear regarding their contribution to the robustness of psychoanalysis. So as to strengthen a critical perspective that enhances the discipline's argumentative field, psychoanalysis should take into account arguments from different sources according to their specific merits. By doing this, psychoanalysis increases its relevance within the current interdisciplinary dialogue.     

Delving into the ‘emotional storms’: A thematic analysis of psychoanalysts’ initial consultation reports

Psychoanalysts’ written reports on initial consultations are a window into the complexities of a crucial aspect of psychoanalytic work. However, systematic research in this area has largely focused on patients’ demographic factors or standardized measures. The present study looked at reports of all the consultations taking place at the London Clinic of Psychoanalysis over one calendar year (N = 100). The aim was to explore psychoanalysts’ different explicit styles of working and reporting as well as further understanding implicit processes used in thinking and writing about each particular consultation experience. A thematic analysis revealed a set of themes that related to a style of working and thinking about the consultation process as a dyadic experience, where the interaction, affective reactions and contact made between the two are the focus when thinking of making a recommendation for psychoanalysis. The majority of the reports had an open, exploratory quality. The writing of reports appears to give the analyst an opportunity to process the consultation experience and arrive at a more triangular position. Writing reports is a more valuable part of the consultation process than has formally been recognized and acknowledged. The limitations of this study as well as the relevance of these findings for future research are discussed.     

On Murray Jackson's 1961 ‘Chair,couch and countertransference’

One of the problems facing psychoanalysts of all schools is that theory has evolved at a much faster pace than practice. Whereas there has been an explosion of theory, practice has remained, at least officially, static and unchanging. It is in this sense that Murray Jackson's 1961 paper is still relevant today. Despite the rise of the new relational and intersubjective paradigms, most psychoanalysts, and not a few Jungian analysts, still seem to feel that the couch is an essential component of the analytical setting and process. If the use of the couch is usually justified by the argument that it favours regression, facilitates analytical reverie and protects the patient from the influence of the analyst, over time many important psychoanalysts have come to challenge this position. Increasingly these analysts suggest that the use of the couch may actually be incompatible with the newer theoretical models. This contention is strengthened by some of the findings coming from the neurosciences and infant research. This underlines the necessity of empirical research to verify the clinical effectiveness of these different positions, couch or face‐to‐face, but it is exactly this type of research that is lacking.     

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY

Research has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.     

抱怨行为的形成机制：基于质性访谈

为了解个体的抱怨行为特点,研究采用质性访谈法,分别对13位抱怨者和配对的26位倾听者进行半结构式访谈,并运用扎根理论分析程序对访谈资料进行三级编码。结果发现,抱怨行为在本质、内容、动机、对象选择、表现形式、效果以及影响因素七大方面具有一般特征;抱怨的本质是在情绪性动机或工具性动机驱使下产生的间接性行为,这些间接性行为可能会产生负能量,传递给第三者。研究从实证角度为抱怨的双重路径模型提供了证据支撑,同时也深化了对日常情景中的抱怨的认识。     

《中国科学技术史·年表卷》北宋部分医学内容再考

作为一部重要的年表类工具书,《中国科学技术史·年表卷》概述了北宋时期出现的医学重大事件、方书著作、医政制度等,绝大多数条目都附有引用文献,但其中部分内容偏离了历史史实,引用文献也屡现差错。通过查找相关原始文献、二手文献,重新辨析相关医学事件发生年代、书籍名称、作者姓名、官方医学教育、机构名称等方面的谬误,包括时代混淆、文字讹漏等。建议编撰时应尽可能地将相关古籍的不同版本搜集殆尽,从而比较其内容的文字差异性,并针对现代研究文献列出的数据,应尽量仔细核对其真实性。

     

乳腺癌患者夫妻疾病沟通影响因素的质性研究

为了解乳腺癌患者夫妻疾病沟通的影响因素,采用目的抽样法于2021年12月~2022年1月选取12例女性乳腺癌患者进行半结构式访谈。共归纳出2个主题：疾病因素(包括配偶照顾负担、病耻感、疾病恐惧、经济压力、养育忧虑、疾病接受度)、非疾病因素(包括主动沟通意识、沟通技巧、沟通热情)。可见,乳腺癌患者夫妻疾病沟通受多种因素影响,医护人员应深入剖析患者消极内心体验,加强心理疏导,并增强其主动沟通意识,提高其沟通技能和沟通热情,从而改善沟通状况。

     

当代医学伦理学的四种研究进路及其反思

当代中国医学伦理学尚未形成统一的学科范式,但主要有四种研究进路：应用伦理学进路、经验主义进路、道德教育进路和生命伦理学进路。这四种进路在学术界占据着主导地位,构成了医学伦理学的基本知识图景。但是任何未经反思的知识前提都是不可靠的,需要从本体论、知识论和价值论的层面对它们进行认真的反思,以构建更加科学和系统的理论体系。在本体论上,需要考虑伦理学概念的本质属性及其与医学实践的联系。在知识论上,需要质疑伦理理论和具体应用之间的适用性和相关性。在价值论上,需要考虑伦理学研究和实践中所涉及的价值取向。

     

非医疗卫生机构医学伦理委员会现状及挑战

我国非医疗卫生机构正处于建立健全伦理委员会的阶段,其伦理委员会常见问题包括无针对性的伦理审查规范,审查能力无法匹配需求,伦理监管难以护航创新,可参考的指南和标准操作规程有限,研究者伦理知识有待提高,跟踪审查落实困难。鉴于此,建议落实法规基本规定,建立健全伦理委员会,人财物支持,提升委员审查能力,实行研究者准入制,建立伦理委员会认证制度和借鉴国外高等院校经验,以期加快非医疗卫生机构伦理委员会建设。