Might Relationship “Techniques” Extend the Reach, Efficacy, and Efficiency of the Psychotherapies? The Challenge of Treatment-Resistant Outpatients

Study-based clinical observations and two premises are presented as indications for a need to identify therapeutic relationship techniques or the like that can extend the reach and efficiency of the psychotherapies. The premises are: (1) advances in psychotherapy practice and research now highlight one of the field's most longstanding challenges, signified by terms like treatment resistance; and (2) some proportion of outpatients whose problems are resistant to the psychotherapies (and medications) have marked limitations in the capacity to relate positively and productively to others, including therapists. Thus, ironically, they cannot optimally utilize a treatment modality that largely has developed to ameliorate problems relating to others.     

The countertransference impact of autistic defence in an otherwise neurotic patient

This paper investigates the question of why, in the psychoanalytic psychotherapy of a patient with encapsulated autistic pathology, the steady maintenance of a therapeutically neutral stance can be especially difficult. Transference and countertransference vicissitudes are examined. The author notices that the patient's intolerance of ‘opposites’ (cf. Tustin, 1986), combined with extreme antipathy to having that intolerance noticed, can elicit corresponding, and potentially destabilizing, countertransference reactions. These reactions comprise an unstable tension between co‐existing pressures towards fusion with, or expulsion of, the patient, their co‐existence under further pressure to remain unnoticed. Until perceived, this state of affairs risks collusion with the pressure either to merge with or to expel the patient, and compromises the capacity to notice the detail of the transference process and even to notice co‐existent positive and negative transference images. Detailed clinical illustration is given, including a session where it was difficult to notice the patient's experience of a couple as a combined object. The author finds these observations of bipolar countertransference tensions illuminated by Green's concepts of positive and negative narcissism and of the disobjectalizing function, and specifically accounted for by Ribas's theory of autism as radical drive defusion.     

Career Counselling: The Usefulness of the Career Interest Profile (CIP)

This study reports the findings from exploratory career counselling with Italian undergraduate university students using the Career Interest Profile (CIP). The participants (n = 178, females = 51.69%; mean age 22.28, SD = 1.59 years) received elective career counselling on campus. The students completed the CIP and the Self-Directed Search (SDS). Data were analyzed using both qualitative and quantitative approaches. The CIP yielded satisfactory results with regard to trustworthiness and intercorrelations with the SDS and provides career counsellors with a useful instrument for the identification of interest profiles of Italian undergraduate university students. Participants reported being enabled to explore prospective career interest areas using career-story narratives for constructing life trajectories and enhanced development of their career stories.     

The primal scene and symbol formation

This article discusses the meaning of the primal scene for symbol formation by exploring its way of processing in a child's play. The author questions the notion that a sadomasochistic way of processing is the only possible one. A model of an alternative mode of processing is being presented. It is suggested that both ways of processing intertwine in the “fabric of life” (D. Laub). Two clinical vignettes, one from an analytic child psychotherapy and the other from the analysis of a 30 year‐old female patient, illustrate how the primal scene is being played out in the form of a terzet. The author explores whether the sadomasochistic way of processing actually precedes the “primal scene as a terzet”. She discusses if it could even be regarded as a precondition for the formation of the latter or, alternatively, if the “combined parent‐figure” gives rise to ways of processing. The question is being left open. Finally, it is shown how both modes of experiencing the primal scene underlie the discoursive and presentative symbol formation, respectively.     

伦理的经济意义新论

讨论效率的经济意义不能仅仅局限于伦理的工具价值 ,而应当将伦理的内在价值和工具价值两者结合起来。伦理本身也是一种效率 ,同样是企业值得欲求的目标 ,只有这样 ,才能有助于一种综合效率的提升。     

中西医结合若干问题的比较思考

讨论中西医结合对西医临床思维的影响。对于慢性病中医注意病人的主观症状,与病人就医的缘由一致;西医重视客观的功能和结构异常,其判断结果有时未必能被病人接受。近年来西医开始重视病人的生活质量,其实中医的辨证指标有很多就是针对病人的生活质量。中医的整体观念同样体现在急性感染的治疗中,现代研究显示,清热解毒法除祛邪外也兼顾扶正。中西医结合促进了中西药合用,但须注意合理应用,避免合用的不良效果。     

3-6岁儿童汉字字形认知的发展

以汉字、一般线条图、似字线条图和笔画组合为材料,采用字典判断任务考察3-6岁儿童汉字字形认知的发展特点。结果发现儿童辨别汉字与似字符号的能力随年龄增长显著提高。3岁儿童较难区分汉字与各类似字符号。4-5岁儿童对汉字笔画特征有了一定意识。6岁儿童对汉字组合模式的认识显著提高。笔画意识出现较早且发展速度较快,组合模式意识出现较晚且发展速度较慢。5岁和6岁是汉字字形认知发展的重要时期。     

特征类型在组合概念范畴效应中的作用

组合概念范畴效应是指,人们解释不同范畴组合概念的策略存在差异。本研究通过特征列举实验和建构路径模型,检验概念的特征类型在组合概念范畴效应中的作用。特征列举实验的结果表明,生物的实体特征比率高于人造物,而人造物的情境特征比率高于生物。路径分析的结果表明：⑴修饰词的实体特征比率显著影响属性解释比率,修饰词具有较多实体特征的组合概念得到属性解释的比率较高;⑵主名词的情境特征比率对关系解释比率的影响不显著;⑶将特征类型引入路径模型后,范畴对解释策略的影响依然显著。因此,范畴间的特征类型差异会影响组合概念范畴效应,但还存在其他影响因素有待进一步研究。     

洛铂与顺铂联合培美曲塞一线治疗晚期肺腺癌的临床观察

观察洛铂与顺铂联合培美曲塞治疗晚期肺腺癌的疗效和不良反应。将64例肺腺癌患者分为PL组（培美曲塞＋洛铂）和PC组（培美曲塞＋顺铂）,每2个周期评价疗效,观察不良反应。结果两组疗效无显著差异。PL组恶心、呕吐、腹泻较轻,口腔黏膜炎反应较重。结论两组疗效相当,但洛铂组不良反应较轻,耐受性好。