A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

The role of pre‐oedipal and oedipal factors in psychic life1

The Oedipus complex, a basic concept in Freudian theory, is an essential factor in the constitution of the human subject. It plays a key role in the structuring of the personality and in the orientation of desire. It is the oedipal triangular structure that precedes the pre‐oedipal situation (in a logical, not chronological, order), and not vice versa. The oedipal structure exists before the infant's biological birth. It is present in the parents' desires and identifi cations, which inexorably fall upon each subject. That is why the author believes that it is necessary to leave behind a solipsistic reading of the nuclear complex of neuroses‐a reading that is based solely on Oedipus's drive nucleus‐and take a joint and comprehensive view of Laius's and Jocasta's histories and traumatic experiences, which were invested in their son. Among these three vertices, a dynamic set of forces emerges whereby a basic, original unconscious fi eld phantasy is created that bears a unique narrative and an invisible and hermetic web made of passions and beliefs, scandals and secrets. This phantasy gives shape to an unrepeatable oedipal structure in each subject, a structure that articulates with the effects of the narcissistic and fraternal dynamic and may determine the subject's fate. This paper develops the following issues: 1) Oedipus, victimizer or victim? 2) the generational confrontation as dynamic fi eld; and 3) neuroses with a preponderance of dualistic relationships.     

How elevated blood alcohol concentration level and identification format affect eyewitness memory: A field study

Research shows that alcohol has a small and inconsistent effect on eyewitness recall and no effect on witnesses' lineup decisions. Much of this literature has tested participants with low‐to‐moderate blood alcohol concentration (BAC) levels, and no study has directly examined how identification procedure impacts intoxicated witnesses' decisions. In the present study, bar patrons' (N = 132) BAC levels were recorded before participating in a task. Midway through the task, they were interrupted by an intruder. Participants then recalled the incident via a staged interview and attempted to identify the intruder from a target‐present or target‐absent showup or lineup. Although elevated BAC levels (high as 0.24%) reduced the quantity and quality of information provided, BAC had no effect on witnesses' identification decisions regardless of format. Results highlight the importance of testing witness memory across a broad BAC spectrum and provide evidence that alcohol does not affect witnesses' identification ability.     

Accessing the multitude within: A psychoanalytic perspective on the transformation of masculinity at mid‐life1

This paper reflects upon the essential components of male identity that commonly are reworked in middle age. The author argues that healthy masculine gender identity involves an ongoing, plastic process of destabilization and reconstruction at various pivotal developmental stages, particularly during middle adulthood. In essence, a man's mature transformation of his sense of masculinity results when finite concepts of gender identity are superseded by an awareness of the complexity of one's multiple, early and diverse gender identifications. A clinical case provides insight into how psychoanalytic treatment can contribute to a new experience of masculinity. The case illustrates how a maturing man, meeting an altered sense of identity in mid‐life, relies less on gender splitting and more on reuniting previously antithetical intrapsychic elements. Why this more pluralistic, polythreaded masculinity frequently must wait until mid‐life is further clarified. Specific importance is attached to the early development of male gender identity as it is founded on the boy's unique struggles in separating from his mother. The foundation for male gender identity formation is reconsidered as the author questions the ‘dis‐identification’ model while explicating how the boy's striving for narcissistic completion shapes the gendered masculine ego ideal. Classically termed ‘phallicism’ is understood both to facilitate and obstruct a man's adult development, while the concept of ‘genitality’ is augmented by the postclassical notion of ‘interiority’. At mid‐life, ‘phallic’ ego ideals (resting on omnipotence, desires for narcissistic completion and gender splitting) are transformed into more realistic, ‘genital’ ego ideals (synthesizing autonomy and connection). The achievement of a mature, less sharply gendered ‘masculine’ ego ideal (revitalizing the foreclosed dimensions of both the early maternal and paternal imagos) occurs as the balance of forces shifts in the direction of true genitality rather than defensive phallicism.     

Motivational goals,group identifications,and psychosocial adjustment of returning migrants: The case of Jews returning to Russia

The present study investigated the motivational goals, group identifications, and psychosocial adjustment of Jews who returned to Russia after emigrating from the republics of the Former Soviet Union to different countries (n = 151). To gain a deeper understanding of these returning migrants, their traits were compared with those of Jews living in Russia who did not emigrate (n = 935). Compared to locals, returnees reported a higher preference for the openness to change and self‐enhancement values and a lower preference for the conservation values; there was no difference in the self‐transcendence values. Returning migrants had a relatively weak affiliation with the home country: they had a weaker identification with the home country than with the country of emigration, their identification with Russians was weaker than that among Jews who did not emigrate from Russia, and their intention to emigrate (again) from Russia was greater than that among locals. However, the Jewish identification of returning migrants was similar to that of locals. The adjustment of returning migrants varied across different dimensions: their economic adjustment was better than that of locals; however, the interpersonal adjustment of returnees was less successful than among locals.     

Relationships between organizational justice, identification with organization and work unit, and group-related outcomes

This research examined the differential antecedents and consequences of organizational identification and work-unit identification. Specifically, we hypothesized that organization-focused procedural justice and distributive justice would be positively related to organizational identification, whereas supervisor-focused interactional justice would be positively related to work-unit identification. A further hypothesis was that organizational identification would relate to organization-focused outcomes (turnover intentions and extra-role behavior toward the organization), and work-unit identification to work-unit-focused outcomes (extra-role behavior toward the work unit). Our results from a sample of 160 employees of a research institution supported these hypotheses. In addition, we found some evidence that organizational identification and work-unit identification differentially mediated the relationships between organization-focused and supervisor-focused justice, and organization-focused and work-unit-focused outcomes. We discuss our findings in terms of their implications for social-identity research on organizational identification, and for research on organizational justice.     

Witnesses’ memory for events and faces under elevated levels of intoxication

Research on alcohol and witness memory has burgeoned over the last decade. However, most studies have tested participants at relatively low breath alcohol concentration (BAC) levels, unrepresentative of those encountered by officers in the field. To examine how higher intoxication levels might impair witness memory for events and faces, the current research tested participants’ ability to recall a mock crime at elevated BAC levels (>.08%). The BAC levels of bar patrons (N?=?138) were recorded before witnessing a video-taped mock crime. Participants were then interviewed using free recall and cued questions and shown a six-person target-present or target-absent lineup. Results show that alcohol negatively affected both the quantity and quality of recall. Regardless of question format, alcohol also reduced the percentage of accurate information elicited from witnesses; however, only cued questions increased the percentage of inaccurate information reported. Intoxication had no effect on identification accuracy. These findings suggest that the encoding and storage systems for faces and events may be impacted differently by alcohol. Our results also highlight the importance of including higher BAC levels when examining the effects of alcohol on witness memory.     

How trainees develop an initial theory of practice: A process model of tentative identifications

Aim: The increasing importance of integrative practice highlights the need to explore how trainees develop their theoretical stance. This investigation explored the experiences of trainees to elaborate a model of how they developed their personal theories of practice. Method: Seventeen Masters level trainee counsellors kept weekly journals recording how they developed a working theory of practice. Grounded theory analysis of the journals was used to develop a model of the process. Findings: The resulting Process Model of Tentative Identifications illustrates how a personal theory developed through trainees' tentative identifications with theories of practice, and how factors such as reading, personal philosophy, practice, and supervision interact to produce the identifications. A diagram of the model highlights the relationships among a variety of personal and professional factors that ranged from highly abstract to concrete and practice-based. Discussion: The model is consistent with several factors identified in previous research and highlights how trainees develop working theories of practice.     

The temporal dimension of national identification: An empirical investigation in South Korea and Australia

We argue that national identification can be framed temporally, such that people may differently identify with their nation's past or present. Further, we argue that temporal national identification has important consequences for attitudes towards social changes. Within this new theoretical framing, we tested the empirical separability and predictive utility of past national identification and present national identification in South Korea and Australia. Results showed that, in both countries, past and present national identifications are correlated but empirically distinct constructs, which independently contribute to general national identification. Past and present national identifications were also shown to be grounded in distinct notions of national continuity. Most importantly, in both countries, present national identification positively predicted favourable attitudes towards social changes and globalization, whereas past national identification negatively predicted these attitudes. These findings suggest that temporally framed national identification is an important construct in the domain of social identification and in research on social changes and globalization.     

Identity and Cultural Narrative in a Lesbian Relationship

SUMMARY

The dynamics of a specific lesbian couple are explored in terms of identifications, identity, and cultural narratives. Problems within couples can arise from challenges to the organization of identifications and to identity within and between the individuals as a couple moves from one cultural narrative to another. Female masculinity is especially vulnerable to these transitions, as it lacks legitimization from the culture at large.