Background: Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. Methods: This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a (...) semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. Results: We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: respecting the patient’s pace and perceived coercion; patient health needs to be first priority; clarity in roles and responsibilities; and the art of communication – between transparency and unchecked information sharing. Discussion: Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings. (shrink)

Malpractice issues in psychotherapy and psychological treatments refer to the unethical behavior of a psychologist or psychotherapist toward the patient. The current study reviewed complaints directed at psychologists and psychotherapists in Sweden with regard to possible incidents of malpractice. Eligible cases were retrieved from a database managed by the Health and Social Care Inspectorate [Inspektionen för vård och omsorg (IVO)], an administrative authority responsible for the safety and quality of healthcare and social services delivery. These cases were analyzed (...) using thematic analysis. In total, 33 complaints matched the keywords proposed by IVO, and were scrutinized in detail. The cases primarily involved psychiatric care by a psychologist in outpatient settings, although many cases comprised multiple healthcare providers responsible for the patient’s care, or targeted the healthcare unit as a whole. The results demonstrated that different forms of malpractice occur, and can be classified in two general themes, Incorrect administration and implementation and Attitude and behavior, which involve organizational aspects as well as examples of malpractice and unethical behavior. Implications for clinical practice and future research include further training in ethics and malpractice, video recording or auditing sessions, routine outcome monitoring, and providing patients with information on how to file complaints. (shrink)

The current investigation examines the incidence of clients telling their psychotherapists of committing violent crimes for which they have not been prosecuted. Thirteen percent of the psychologists surveyed indicated that on at least one occasion a client self-disclosed to them during a psychotherapy session that he/she had murdered someone, not including the killing of another person in the line of duty in the military or as a public peace officer. One third of the psychologists had clients self-disclose an unprosecuted incident (...) of a sexual assault, and more than two thirds had clients self-disclose an unprosecuted incident of a physical assault during a psychotherapy session. Data are reported on psychotherapists' views of the impact of such disclosures on the psychotherapy relationship, adequacy of being informed regarding legal obligations after hearing such reports of violence, and adequacy of graduate preparation to deal with these clinical situations. (shrink)

Studies report that psychotherapists overestimate their own performance. This study aimed to examine if the self-assessment bias in psychotherapists differs between therapeutic orientations and/or between social comparison groups. Psychotherapists gave subjective estimations of their professional performance compared to two social comparison groups. They further rated the proportion of their patients recovering, improving, not changing, or deteriorating. In total, N = 229 Austrian psychotherapists participated in the online survey. Psychotherapists rated their own performance on average at M = 79.11 relative to (...) “all psychotherapists” vs. at M = 77.76 relative to “psychotherapists with the same therapeutic approach”. This was not significantly different between therapeutic orientations. A significant interaction between social comparison group and therapeutic orientation revealed a drop of self-assessement bias in social comparison group “same approach” vs. “all psychotherapists” in psychodynamic and humanistic therapists. Psychotherapists overestimated the proportion of patients recovering, improving and underestimated the proportion of patients not changing and deteriorating, with no differences between orientations. The self-assessment bias did not differ between therapeutic orientations, but the social comparison group appears to be an important variable. A major drawback is that results have not been connected to patient-reported outcome or objectively rated performance parameters. (shrink)

There is increasing recognition within psychoanalysis and related therapies that awareness of the body is important in understanding and treating patients. Psychic Threats and Somatic Shelters explores the ways in which adults and children become acquainted with the range of physical issues that arise within their psychoanalytic or psychological treatments. Nitza Yarom discusses in a practical and clinically focused way the large variety of physical outlets which today's person uses to shelter from the many troubles and restrictions that are placed (...) on everyday life. Her book is divided into two main sections: Somatic shelters, which explores the variety of physical symptoms encountered by patients, including problems with weight and eating; with sensation through sight, sound, smell and taste; in movement through hyper activity or rigidity and through the communication of physical pain. Embodied dialogue, in which the author updates the use of the basic technical principles of psychoanalysis to involve the body in the treatment including transference and counter-transference between analyst and patient. In Psychic Threats and Somatic Shelters the emotional communication of these body narratives are vividly demonstrated in the treatments presented, here the interaction in the consulting room is revealed in bodily resonance and its therapeutic effects. This book is written for psychoanalysts and psychotherapists, psychologists, body therapists, family therapists, social workers and art/movement therapists. (shrink)

This study explored relations between willingness to disclose in 5 psychotherapy scenarios and 2 independent variables. Scenarios involved suicidal, gravely disabled, physically abusive, and sexually abusive patients, and a police officer patient who shot a suspect. For each of the 5 scenarios, participants in the privilege condition had significantly higher willingness-to-disclose scores than participants in the no-privilege condition. There were no significant differences between willingness-to-disclose scores of participants with and without therapy experience; neither was there a significant interaction between (...) privilege condition and therapy experience. Privilege condition was more predictive of willingness to disclose than personal characteristics or therapy experience. Results provide empirical support for the U.S. Supreme Court's recognition of the psychotherapist-patient privilege in Jaffee v. Redmond. (shrink)

This paper demonstrates how ubuntu relational philosophy may be used to ground beneficial coercive care without necessarily violating a patient’s dignity. Specifically, it argues that ubuntu philosophy is a useful theory for developing necessary conditions for determining a patient’s potential dangerousness; setting reasonable limits to the duty to protect; balancing the long-term good of providing unimpeded therapy for patients who need it with the short-term good of protecting at-risk parties; and advancing a framework for future case law and (...) appropriate regulations in the care of psychotherapy patients. Issues regarding the decision to breach medical confidentiality in psychotherapeutic care are ultimately reserved for the courts. Professional assessment might be an important first step in this process, and court rulings govern most aspects of this assessment. However, current case law, especially in the United States, places an unreasonable expectation on psychotherapists to protect all at-risk parties or foresee that a patient intends to follow through on said threats. It has largely failed to guarantee psychotherapy patients unlimited access to care, while potentially inhibiting future honest communication between patients and health professionals and endangering the safety of others. Of these decisions, the two most prominent are the 1976 Tarasoff decision and the 2016 Volk decision. This paper argues for the possibility of grounding good laws in ubuntu African philosophy in a way that protects others from harm and ensures unimpeded access to care without necessarily breaching medical confidentiality. (shrink)

Life Witness is a blueprint for the formative evolution of a psychotherapist: from beginner/technician who practices a single school of therapy to a seasoned clinician with a transtheoretical paradigm. Ultimately such a clinician, by transcending the field of psychotherapy itself, becomes a master psychotherapist and addresses the larger dilemmas of human existence -- the context within which all patients' psychological conflicts are experienced. -- from book jacket.

Over the past decade, psychotherapy and counselling have become more and more popular, with many people turning to therapists in the hope of finding a better, happier, more fulfilling life. In this cogently argued and beautifully written book, Peter Lomas, argues that as psychotherapy enters the mainstream, therapists have become dependent on the technical aspects of their profession at the expense of the many moral issues involved. Indeed, they have become so afraid of moralizing or of departing from what Lomas (...) views as a spurious scientific neutrality that the dialogue between therapist and patient tends to be distorted, potentially confusing, and too remote from the healthy reality of ordinary conversation. In this provocative analysis, drawing on his day-to-day experience of working with patients, Peter Lomas explores the consequences of this dichotomy, such as the loss of spontaneity and avoidance of closeness which may hinder rather than help the healing process. He looks at the problems associated with issues of power, and its abuse, which is central to psychotherapy, and explores the dilemmas involved when there is a clash of moral beliefs between the two people. This is a lucid and thought-provoking addition to the literature on psychotherapy, and will appeal both to trainee and practising therapists and counsellors, for people in therapy, and for those considering embarking upon it. (shrink)

Are psychopaths morally responsible? Should we argue with them? Remonstrate with them, blame them, sometimes even praise them? Is it worth trying to change them, or should we just try to prevent them from causing harm? In this book, Jim Baxter aims to find serious answers to these deep philosophical questions, drawing on contemporary insights from psychiatry, psychology, neuroscience and law. Moral Responsibility and the Psychopath is the first sustained, book-length philosophical work on this important and fascinating topic, and will (...) be of deep interest and importance to researchers in these fields – not to mention anyone who has had to interact with a psychopath in their everyday life. (shrink)

Out of a concern for keeping suicidal patients alive, some psychotherapists may use hard persuasion or coercion to keep them in treatment. However, more recent evidence-supported interventions have made respect for patient autonomy a cornerstone, showing that the effective interventions that promote the wellbeing of suicidal patients also prioritize respect for patient autonomy. This article details how psychotherapists can incorporate respect for patient autonomy in the effective treatment of suicidal patients by listening to them, explaining treatments to (...) them, involving them in decisions, and inviting evaluations from them on the process and progress of their treatment. It also describes how processes that respect patient autonomy can supplement interventions that directly address some of the drivers of suicide. (shrink)

Since the 1980s, psychoanalysis and psychotherapy have attracted great interest in Chinese society, and in parallel, the psychotherapist as a character has emerged in Chinese literature. Through four novels by three Chinese authors, namely, Xu Xiaobin 徐小斌, Ke Yunlu 柯云路, and Bi Shumin 毕淑敏, this article studies the evolution of the image of the psychotherapist in contemporary Chinese literature, which reflects the reception of psychoanalysis as well as the development of psychotherapy in China. In Xu Xiaobin’s novel, two (...) psychology students attempt to cure a psychotic patient through “transference therapy” based on a complete misunderstanding of the notion; Ke Yunlu features a “life counselor” who, like typical good counselors in Chinese classical novels, simply gives advice without caring about the patients’ needs and desires; and the two novels by Bi Shumin show a significant change in the writer’s understanding of the profession and therapeutic methods, as well as the current, unregulated situation of psychotherapy in China. (shrink)

Psychotherapy helps one enact ideas about a good life, and therapists practice orientations rooted in their chosen approach. A 'good life' can therefore mean different things depending on the therapy. Building on the philosophy of Charles Taylor, Smith examines the link between therapy, ethics and the root of therapeutic views in comparison to modern, Western ideas about 'living well'. This is one of two complementary volumes. This volume builds on the last to explore what it means to engage the different (...) ethics of different therapies by offering a deeper explication of therapeutic ethics. Utilizing Taylor's work on practical reasoning, Smith explores topics like the nature of the ethical argument, the role of ethical intuitions and the value of framing ethical debate as ongoing dialogue. He applies this to therapeutics ethics to show how vital it is to consider the ethical proposals that are present in current theories and practices in order to understand the psychotherapies. A key text for upper level undergraduate, postgraduate students and professionals in the field of psychotherapy, psychoanalysis, theoretical psychology and philosophy of the mind. (shrink)

BackgroundThe legal and ethical guidelines of psychological professional associations stipulate that informed consent by patients is an essential prerequisite for psychotherapy. Despite this awareness of the importance of informed consent, there is little empirical evidence on what psychotherapists’ attitudes towards informed consent are and how informed consent is implemented in psychotherapeutic practice.Methods155 psychotherapists in Switzerland completed an online survey assessing their attitudes regarding informed consent. ResultsAmong the surveyed psychotherapists, there was a high consensus on important information that should be communicated (...) to patients in the context of informed consent. Almost all psychotherapists rated confidentiality and its exemptions (95%) and self-determined decision-making (97%) as important. The importance to disclose information regarding fees and the empirical effectiveness of the provided treatment, were both seen as important by more than 80% of participants. The disclosure of personal information about the therapist was rated as important by 60%. Other aspects, which are not direct components of informed consent but rather overarching goals, were also evaluated rather homogeneously: self-determined decision making of the patient was rated as important by almost all of the surveyed psychotherapists (97%). The following components were also judged as important by a majority of the participants: promotion of hope (80%) and discussion of treatment goals (93%). Most psychotherapists described the implementation of informed consent as an ongoing process, rather than a one-time event during the first session of therapy. Therapists’ age, postgraduate training, treated patient group, and setting influenced attitudes towards informed consent.ConclusionsThe present study shows that informed consent is perceived by psychotherapists as both a challenge and a resource. The implementation of informed consent in psychotherapy requires further research from a clinical and ethical perspective. (shrink)

This paper articulates a radical feminist analysis of psychotherapist-patient sexual exploitation, a problem that has affected an estimated one million North American women. I argue that such exploitation is rooted in misogynous attitudes that pervade the major institutions in contemporary culture, including the mental health professions. I examine ways that mental health professionals use sexist constructs and language to blame victims for their abuse. Through textual analysis of a series of letters and articles by prominent psychiatrists, I show (...) that the male writers attempted to silence victims and their female advocates by subjugating the women's voices to their rhetorical control and by indirectly drawing on the power of deeply-held cultural stereotypes of women. This analysis of therapist-patient sexual exploitation and the blaming of its victims points to the broader problem of oppressive androcentric bias in psychiatry's ideology, epistemology, and discourse. The article closes with a suggestion for correcting psychiatry's harmful biases and with recommended strategies for preventing psychotherapist-patient sexual exploitation. (shrink)

In the present contribution, we argue that all health care professionals and particularly psychotherapists should provide a plausible rationale for their treatment including an etiological model and a model of unique and common change mechanisms. The provision of a plausible rationale has two goals: (1) meet the ethical challenge of informed consent, and (2) to improve treatment outcome by fostering the meaning response. In the course of the ethical and a legal obligation of psychotherapists to obtain patients’ informed consent before (...) initiating psychotherapy, patients have the right to receive maximally comprehensive information for providing their consent, which - among other information about the treatment (such as general psychotherapeutic approach, setting, and procedures) – should include a plausible treatment rationale. A useful concept in conceptualizing and communicating a treatment rationale as part of the informed consent procedure is Moerman’s general notion of the meaning response as the physiological or psychological effects of meaning in the course and treatment of an illness. The more compelling the rational explanation of the targeted treatment effects, the stronger the meaning response is expected to be. As the mechanisms of change in psychotherapy are known to be quite abstract and considered common to all approaches to a large extent, it seems especially important to provide a convincing treatment rationale to strengthen trust in the therapist and potentially foster positive expectations of process and outcome. To that extent, strengthening a patient`s meaning response to information provided at the beginning of psychotherapy may be central to activating common therapeutic factors. (shrink)

ObjectivesAs the largest cohort of healthcare workers and nurses can practice as psychotherapists to integrate the psychotherapeutic interventions as part of routine care. The present study aims to evaluate the effectiveness of supportive psychotherapy on patients who had been scheduled to undergo a fiberoptic bronchoscopy procedure.MethodsThis study retrospectively analyzed 92 patients who underwent FOB, which was divided into the SPT group and usual-care group based on whether patients were given SPT interventions or not. The Patient Health Questionnaire-9 and Hospital (...) Anxiety and Depression Scale were used to determine the severity of depression and anxiety, as well as the 36-Item Short-Form Health Survey questionnaire to evaluate the health-related quality of life. Moreover, the patients' satisfaction was assessed based on the Likert 5-Point Scale.ResultsThe baseline status of anxiety, depression, and HRQoL in patients was similar in the SPT group and the usual-care group with no significant difference. Both PHQ-9 score and HADS-D score in the SPT group after intervention were lower than that in the usual-care group, accompanied by the deceased HADS-A subscale. Moreover, the improved HRQoL was found in the patients undergoing FOB after SPT interventions as compared to those receiving conventional nursing care using the SF-36 score. Additionally, the patient satisfaction in the SPT group was higher than in the usual-care group.ConclusionsThe study demonstrated that anxiety and depression, as negative emotions, can be reduced by supportive psychotherapy in patients receiving FOB with improved mental health and satisfaction with nursing care. (shrink)

In the article I ask the question about the place of an emancipatory task within various forms of psychotherapy and psychoanalysis, where conversations with the patient play an important role. This task arises on discovering that an important source of the patient’s problems are views inherited fom cultural traditions, ones which inhibit a proper assessment of various traumatic situations fom the past and the forms of dependence on others. Then psychotherapists and psychoanalysts are inevitably faced with the task (...) of making the patient aware of these limitations and forms of dependence, for only then is therapeutic progress possible. I provide three characteristic examples of similar cases fom Polish psychiatric tradition, in which we can speak of a similarly binding role of cultural tradition in the process of therapy. I point out that the difcult situation the therapist then fnds themselves in lies in the fact that, on the one hand, they have to depart fom the postulate of maintaining world-view neutrality in their approach to the patient while, on the other hand, they cannot directly impose their own position on the patient. The therapist has to fnd a third, middle way betwee. (shrink)

This book addresses a range of fundamental questions around the nature of Psychoanalysis. It distinguishes how Psychoanalysis differs from other forms of therapy, explores the ways in which insights into the unconscious can be used to support and help people, and asks questions around any claim for scientific validity. Informed by Bion's ideas on containment, group functioning and the fundamental need for truth, this book cites research in infant communication to assert that unconscious communication is present from birth. It goes (...) on to explores the dynamics of communication between psychoanalyst and patient, using these findings to distinguish the practice of Psychoanalysis from suggestion. Moreover, the book asserts that Psychoanalysis is uniquely placed to foster the psychological development made possible by this communication. Exploring the relationship between unconscious communication, group dynamics, containment and psychological development in a highly original way, Bion and the Language of the Unconscious: Psychoanalysis, Suggestion, and Thoughts Too Deep for Words will be of great interest to psychotherapists, psychologists and psychoanalysts who are interested in the relationship between psychoanalysis and suggestion. (shrink)

_Seeing and Being Seen: Emerging from a Psychic Retreat_ examines the themes that surface when considering clinical situations where patients feel stuck and where a failure to develop impedes the progress of analysis. This book analyses the anxieties and challenges confronted by patients as they begin to emerge from the protection of psychic retreats. Divided into three parts, areas of discussion include: embarrassment, shame, and humiliation helplessness, power, and dominance mourning, melancholia, and the repetition compulsion. As well as offering fresh (...) ideas, Steiner bases his creative and integrative efforts on previous contributions by psychoanalysts including Freud, Klein, Rosenfeld, and Bion. As such, this book will be of interest to psychoanalysts, clinical psychotherapists, and all those with an interest in the psychoanalytic field. (shrink)

Preface : how and why the stories came to be -- Introduction : self-deception and red flags -- Sammy meets the wolf : meet the characters who will decide the cases -- I'm not your monkey : loss of control with a difficult client -- Junk yard therapy : self-delusion and exploitation -- Rats! : warring colleagues -- The John : a predator at work and play -- The raid on Hollywood Boulevard : the professional role vs. the right to (...) a private life -- Kill the boss : when clients threaten physical harm -- Broken : Bartering gone bad -- Baby steps off a cliff : the slippery slope to sexual exploitation -- Car crash : a simple disclosure with unforeseen consequences -- Mad FAX : what not to do when clients don't pay -- The star catcher : the undoing of a troubled psychotherapist -- Vampire : Countertransference exploding -- Epilogue : a transformed Dr. Halsey goes home. (shrink)

Addressing the needs of both professionals and laypersons and drawn from the author's varied experiences in psychiatry, this study attempts to locate and describe the elusive therapeutic environment within which psychological healing most effectively takes place.

_The Practice of Psychotherapy_ brings together Jung's essays on general questions of analytic therapy and dream analysis. It also contains his profoundly interesting parallel between the transference phenomena and alchemical processes. The transference is illustrated and interpreted by means of a set of symbolic pictures, and the bond between psychotherapist and patient is shown to be a function of the kinship libido. Far from being pathological in its effects, kinship libido has an essential role to play in the (...) work of individuation and in establishing an organic society based on the psychic connection of its members with one another and with their own roots. (shrink)

_Demons in the Consulting Room: Echoes of Genocide, Slavery and Extreme Trauma in Psychoanalytic Practice_ isthe second of two volumes addressing the overwhelming, often unmetabolizable feelings related to mourning, both on an individual and mass scale. Authors in this volume explore the potency of ghosts, ghostliness and the darker, often grotesque aspects of these phenomena. While ghosts can be spectral presences that we feel protective of, demons haunt in a particularly virulent way, distorting experience, our sense of reality and our (...) character. Bringing together a collection of clinical and theoretical papers, _emons in the Consulting Room_, reveals how the most extreme types of trauma can continue to have effects across generations, and how these effects manifest in the consulting room. Essays in this volume consider traumas that have affected multiple generations of people, such as the Holocaust, experiences in the gulags, and the experience of slavery. Authors here consider the clinical challenges of working with the demonic force in severe childhood abuse and the effects of serious and prolonged physical injury and illness. Inevitably, there is in such difficult clinical work, the combined effects of hauntings in the analysts and in patients and often in the surrounding culture. In this book, distinguished psychoanalysts explore the myriad forms of ghosts and the demonic, which interfere and disrupt the endlessly difficult psychic work of mourning. It will be of interest to psychotherapists and psychoanalysts, as well as social workers, family therapists, psychologists, and psychiatrists. _emons in the Consulting Room _ill appeal to those specializing in bereavement and trauma and, on a broader level, to sociologists and historians interested in understanding means of coping with loss and grief on both an individual and larger scale basis. (shrink)

The Philadelphia Association is always linked with the name of R. D. Laing, one of its founders, but very little is known about its unorthodox contribution to the development of psychoanalysis. Founded in 1965, it took as its aim the relief of mental illnesss of all desciptions, in particular schizophrenia. At its inception it was a focus for people, with a diversity of backgrounds and interests, concerned with 'mental illness' and how society defines it. Its members - who included psychoanalysis, (...) psychiatrists and artists - developed a philosophical critique of psychoanalysis grounded in phenomenology, and an 'anti-psychiatry' critique of the institutional treatment of the mentally ill. They favoured the setting up of therapeutic community households of which the best known was Kingsley Hall. The PA was then very much part of the counter culture - it staged, for example, the famous Dialectics of Liberation Congress at London's Roundhouse in 1967. The psychotherapists who currently belong to the Philadelphia Association continue to work with community households and to offer a psychotherapy training. Here the authors share their innovative and distinctive approach on a number of interrelated themes: the herapeutic community and differend ways it can be understood; work with deeply regresed patients; the concept of identity in a social context; the debate between Lacan and Derrida on Poe's 'The Purloined Letter'; the phenomenology of knowledge and transference and authority. Together, they offer a cogent critique of many psychiatric and psychonalaytic assumptions. The contributors are Robin Cooper, Joseph friedman, Steven Gans, John Heaton, Chris Oakley, Haya Oakley and Paul Zeal. They are all psychotherapists and members of the Philadelphia Association. (shrink)

Breakdown and Breakthrough examines the essential role of regression in the patient's recovery from mental illness. In light of this Nathan Field reassesses the role of the therapist tracing psychotherapy back to its earliest spiritual roots and comparing modern analytic methods with ancient practices of healing and exorcism. The author uses vivid examples from his psychotherapeutic practice to show how, with the apparent breakdown of the therapeutic method itself, patients can break through to a new level of functioning. The (...) book goes on to consider how psychotherapy has been affected by fundamental developments in twentieth century science, such as the move from old, classical assumptions of linear causation to non-linear complexity from reductionism to a holistic systems approach and from mental mechanisms to acknowledging the mysteries of unconscious interaction. Taking up the radical vision originally proposed by Carl Jung and later fostered by eminent psychotherapists such as Winnicott and Bion, the author shows how psychotherapy can be reframed to admit the existence of a psychological fourth dimension. Nathan Field reappraises ideas of health and pathology, psychoanalysis and healing, sex and spirituality in light of a dramatic shift in the way we understand ourselves. How this shift alters the shape of psychotherapy in the twenty-first century is the challenge the practitioners, teachers and trainees must all address. (shrink)

The author, a consultant psychotherapist who works with dying patients in a National Health Service (NHS) hospital, argues that the moral issue is not simply whether or not to tell cancer patients the truth, but more importantly how to do so. Lies and the bald unprepared-for truth may both be damaging. Time and trouble is needed to understand patients and help them understand their situation. Dr Goldie warns that putting oneself into the patient's shoes, as doctors so often (...) do, is the best way of not knowing what another feels. Such misunderstanding may lead to medical decisions based on `nothing more than fantasies - uninspired guesses about what other people think and feel. It is the equivalent of prescribing for patients without examination'. (shrink)

_Emotional Presence in Psychoanalysis_ provides a detailed look at the intricacies of attaining emotional presence in psychoanalytic work. John Madonna and a distinguished group of contributors draw on both the relational and modern psychoanalytic schools of thought to examine a variety of different problems commonly experienced in achieving emotional resonance between analyst and patient, setting out ways in which such difficulties may be overcome in psychoanalytic treatment, practical clinical settings and in training contexts. A focused review of relevant comparative (...) literature is followed by chapters featuring individual clinical case studies, each illustrating particularly challenging aspects. The uniqueness of this book lays not simply in the espousal of the commonly accepted importance of emotional resonance between analyst and patient; rather it is in the way in which emotional presence is registered by both participants, requiring a working through, which at times can be not only difficult but dangerous. Such efforts involve a theory which enables the lens to understanding, an effective methodology which guides intervention. The book also calls for the art of the analyst to construct with patients meanings which heal, and possess the heart to persist in commitment despite the odds. _Emotional Presence in Psychoanalysis_ is about patients who suffer, struggle, resist and prevail. It offers distinctive, transparently told accounts of analysts who engage with patients, navigating through states of confusion, hatred and more controversial feelings of love. Emotional Presence in Psychoanalysis features highly compelling material written in an accessible and easily understood style. It will be a valuable resource for psychoanalysts and psychoanalytic psychotherapists, psychologists and clinical social workers as well as teachers, trainers and students seeking to understand the power and potential of the analytic process and the resistances to it. (shrink)

_Memory, Myth, and Seduction_ reveals the development and evolution of Jean-Georges Schimek's thinking on unconscious fantasy and the interpretive process derived from a close reading of Freud as well as contemporary psychoanalysis. Contributing richly to North American psychoanalytic thought, Schimek challenges local views from the perspective of continental discourse. A practicing psychoanalyst, teacher, and consummate Freud scholar, Schimek sought to clarify Freud's concepts and theories and to disentangle complexities borne of inconsistencies in Freud's assumptions and expositions. This book is divided (...) thematically into three sections. The first concerns fantasy and interpretation as they play out in the analytic situation, and the manner in which analyst and patient coconstruct meaning and reconstruct and recover memory. The second consists of two seminal papers which provide the sequence of steps in the five revisions in Freud's seduction theory. Schimek's careful scholarship lays out the data of Freud's writing, which allows one to draw one's own conclusions about the implications of the changes in the theory that he made. In the third, more theoretical section, he provides a foundation for understanding many of today's discussions about unconscious fantasy, dreaming, remembering, consciousness, affect, self-reflection, mentalization, and implicit relational knowing. He clarifies and illustrates Freud's original formulations through a careful reading of sections of _The Interpretation of Dreams_, and a study of Freud's famous Signorelli parapraxis. Skillfully arranged and carefully edited by Deborah Browning and including a foreword by Alan Bass, this collection of Schimek's published and unpublished papers will be of interest to practicing psychoanalysts, psychoanalytically-oriented psychotherapists, and students of the history of ideas and philosophy who have a particular interest in fantasy, interpretation, and Freud. (shrink)

A history of psychoanalysis through the twentieth century, critiquing Freud as a scientist and as a creative thinker, and considering the political and social environment in which psychoanalysis was born and applied.

Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have (...) genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots. (shrink)

A stunning exploration of the relation between desire and psychopathology, The Death of Desireis a unique synthesis of the work of Laing, Freud, Nietzsche, and Heidegger that renders their often difficult concepts brilliantly accessible to and usable by psychotherapists of all persuasions. In bridging a critical gap between phenomenology and psychoanalysis, M. Guy Thompson, one of the leading existential psychoanalysts of our time, firmly re-situates the unconscious - what Freud called "the lost continent of repressed desires" - in phenomenology. In (...) so doing, he provides us with the richest, most compelling phenomenological treatment of the unconscious to date and also makes Freud's theory of the unconscious newly comprehensible. In this revised and updated second edition to the original published in 1985, M. Guy Thompson takes us inside his soul-searching seven-year apprenticeship with radical psychiatrist R. D. Laing and his cohorts as it unfolded in counterculture London of the 1970s. This rite de passage culminates with a four-year sojourn inside one of Laing's post-Kingsley Hall asylums, where Laing's unorthodox conception of treatment dispenses with conventional boundaries between "doctor" and "patient." In this unprecedented exploration, Thompson reveals the secret to Laing's astonishing alternative to the conventional psychiatric and psychoanalytic treatment schemes. Movingly written and deeply personal, Thompson shows why the very concept of "mental illness" is a misnomer and why sanity and madness should be understood instead as inherently puzzling stratagems that we devise in order to protect ourselves from intolerable mental anguish. The Death of Desireoffers a provocative and challenging reappraisal of depth psychotherapy from an existential perspective that will be of interest to psychoanalysts, psychotherapists, philosophers, social scientists, and students of the human condition. (shrink)

None of us will escape the experience of personal loss, illness, aging, or mortality. Yet, psychoanalysis seems to shy away from a discussion of these core human experiences. Existential vulnerability is painful and we all avoid this awareness in different ways. However, when analysts fail to explore the topic of mortality, their own and their patients, they may foreclose an important exploration and short-change patient and therapist. _Entering Night Country_ focuses on the existential condition, and explores how it penetrates (...) professional lives, analytic work, and theoretical formulations. Each chapter explores this topic, shifting the lens from analytic process, to include theoretical assumptions, and professional communities. _Stephanie Brody_ shows how the analytic process is a journey, no less profound than the epic journeys depicted in the classic literature of Homer and repeated in the patient’s own heroic and painful stories. Weaving literary references into the clinical experience of psychoanalysis, Brody reveals the transformative power of the analytic process for the patient and for the analyst. By relating the ancient past to our current struggles, psychoanalyst and patient together are guided to a destination, a life of meaning in the universe of possibilities. Clinical vignettes and personal reflections intersect with motifs from the epic poems and fantasy fiction, where the despair of loss and trauma do not extinguish the wish for change and the search for intimacy. __Entering Night Country__ highlights the common themes that arise for patient and analyst as any person entering an unknown territory. It is intended for psychoanalysts, psychoanalytically oriented psychotherapists, and mental health clinicians. It will also be accessible to those outside the clinical profession, even to individuals who have little understanding of psychoanalysis. (shrink)

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a disturbed (...) body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)

In the psychotherapist-patient relationship, the therapist-fiduciary must deal with ambiguity, assume risks, and make decisions without final appeal to psychiatric theory. Ambiguity regarding patient autonomy poses treatment paradoxes. Caregiving that aims at autonomy can end up undermining it. Additionally, pursuit of autonomy can put the patient’s well-being at risk.

_Treating Dissociative and Personality Disorders_ draws on major theorists and the very latest research to help formulate and introduce the Relational/Multi-Motivational Therapeutic Approach, a new model for treating such patients within a clinical psychoanalytic setting. Supported by her fellow contributors, Antonella Ivaldi provides an overview of existing theories and evidence for their effectiveness in practice, sets out her own theory in detail and provides rich clinical detail to demonstrate the advantages of the REMOTA model as applied in a clinical setting. (...) The narratives in this book show how it is possible to integrate different contributions within a multidimensional aetiopathogenic treatment model, which considers the mind as a manifestation of the relationship between body and world. From a conceptual perspective, according to which consciousness emerges and develops in the interpersonal dimension, this book shows how it becomes possible to understand, in the therapeutic space, what stands in the way of sound personal functioning, and how to create the conditions for improving this. Treating Dissociative and Personality Disorders will be highly useful in addressing the particular clusters of symptoms presented by patients, stimulating therapists of different backgrounds to explore the complexity of human nature. On reading this book, it will become clear that theories can truly become useful instruments, if approached with a critical mind and with humbleness, in order to venture into what we do not know and will never know completely: the relationship with the other, unique and irreplaceable. Treating Dissociative and Personality Disorders provides an integrative and comparative new approach that will be indispensable for combining relational clinical knowing and motivational theories. It_ _will appeal to psychoanalysts and psychotherapists, especially those in training, clinicians of different backgrounds interested in comparative psychotherapy, as well as social workers and graduate and postgraduate students. (shrink)

_Time, Space, and Phantasy_ examines the connections between time, space, phantasy and sexuality in clinical practice. It explores the subtleties of the encounter between patient and analyst, addressing how aspects of the patient’s unconscious past are actualised in the present, producing new meanings that can be re-translated to the past. Perelberg’s analysis of Freud’s Multi-dimensional model of temporality suggests that he always viewed the constitution of the individual as non-linear. In Freud’s formulations, the individual is decentred and ruled (...) by different temporalities, most of which escape their consciousness. Perelberg identifies the similarities between this and Einstein’s theory of relativity which states that rather than being absolute, time depends on the relative position and speed of the observing individual suggesting that rather than being a reality, time is an abstraction, connecting objects and events. Throughout this text, Perelberg draws together connections between time, mental space, and phantasy showing how time is constantly reshaped in the light of new events and experiences. This book will be of interest to psychoanalysts, psychotherapists, psychologists, and social workers. (shrink)

This article explores the history of ‘subordination-authority-relation’ psychotherapy, a brand of psychotherapy largely forgotten today that was introduced and practised in inter-war Vienna by the psychiatrist Erwin Stransky. I situate ‘SAR’ psychotherapy in the medical, cultural and political context of the inter-war period and argue that – although Stransky’s approach had little impact on historical and present-day debates and reached only a very limited number of patients – it provides a particularly clear example for the political dimensions of psychotherapy. In (...) the early 20th century, the emerging field of psychotherapy was largely dominated by Freudian psychoanalysis and its Adlerian and Jungian offshoots. Psychotherapists’ relations with academic psychiatry were often uneasy, but the psychodynamic schools succeeded in establishing independent institutions for training and treatment. However, as this article shows, the gulf between mainstream psychiatry and psychotherapy was not as wide as many histories of the psy-disciplines in the early 20th century suggest. In inter-war Vienna, where these conflicts raged most fiercely, Stransky’s ‘SAR’ psychotherapy was intended as an academic psychiatrist’s response to the challenge posed by the emerging competitors. Moreover, Stransky also proposed a political alternative to the existing psychotherapeutic schools. Whereas psychoanalysis was a liberal project, and Adlerian individual psychology was closely affiliated with the socialist movement, ‘SAR’ psychotherapy with its focus on authority, subordination and social hierarchy tried to translate a right-wing, authoritarian understanding of society into a treatment for nervous disorders. (shrink)

The roots of much of Western medicine lie in the Christian monastic tradition and its commitment to nonstigmatizing compassionate care throughout the life cycle and to the ideal of empathic personal connection between physicians, patients, and the communities and relationships in which both of these are embedded. In the modern West, these Christianly informed aspects of medicine are increasingly being undercut as medical care becomes ever more specialized, technologized, and depersonalized. At the same time, there exist a variety of efforts (...) to counter these tendencies and to foster a practice of medicine that is more sensitive to the personal, relational, familial, and narrative dimensions of health, illness, and medical care. There are, in particular, considerable numbers of physicians, psychologists, and psychotherapists working at the intersections of biomedical and psychosocial care, of care for individuals and care for families, and of the body and the mind. Given the natural affinity that Christian bioethicists might be expected to have to communitarian, narrative, and family-oriented approaches to health care, it is thus remarkable that there appears to be no work of Christian bioethics that interacts in any discernible way with this psychotherapeutic literature concerning health, illness, families, and the mind-body interface. Instead, Christian bioethicists appear to endorse a narrowly reductionistic biomedical view of health and illness while either ignoring the psychosocial, integrative, and collaborative literature, or actively blaming and shaming those pastors or lay Christians who might have anything to do with psychotherapy or psychosocial care. This is unbecoming and unhelpful. In the fragmented, complex, and potentially dehumanizing world that is modern medical care, those who would think Christianly about the care of the sick cannot afford to despise psychology and psychosocial care. On the contrary, the church needs psychotherapy. In this article, I will thus consider, first, what the state of the conversation is where Christian bioethics and psychosocial and psychotherapeutic care are concerned. I will then turn to some of the principal landmarks in the professional literature concerning psychotherapeutic work with the sick, the disabled, the dying, and the bereaved, particularly as these are considered in contexts that include families and lay and professional caregivers. I will then identify a few opportunities for practical and theological reflection that present themselves in this literature, and will conclude with a few comments on the substance and relationship of salvation and health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Liberating BreathElizabeth DotsenkoFunding. Elizabeth Dotsenko, MD, is supported by the Loyola University Chicago–Ukrainian Catholic University Bioethics Fellowship Program, funded by the National Institutes of Health Fogarty International Center (D43TW011506).The war in Ukraine started not in 2022, but in 2014. Some of my relatives have been living under occupation for the past nine years. After a year of occupation, parts of Ukrainian society stopped paying attention.But on February 24th (...) 2022, that changed. The whole country was awakened by missile attacks in almost every region. Kyiv, the capital, was heavily shelled by air strikes, and from the North, South, and Eastern borders, Russian troops entered our territory with long convoys of military vehicles. In one moment, we all woke up in a country at war.I have experience working in conflict zones. In 2017, I worked in Iraq in Internally Displaced Persons (IDP) camps for one year. On the 25th of February, 2022, my colleagues and founders of STEP-IN, the NGO with whom I used to work in Iraq, initiated a Zoom call. We decided immediately to start work in Ukraine—without any funding. Although my only previous work experience was being a doctor, I ended up taking on managerial responsibilities and established a Ukrainian branch of STEP-IN. I was also mother of a 1.5-year-old girl in a country of war. To say it was challenging is an understatement.In the first week of the full-scale invasion, STEP-IN opened a crisis intervention point on the Ukrainian-Slovak border crossing, where people could get psychological help and warm meals. We provided shelter and a place to sleep for those waiting in overcrowded border points.As soon as we received our first grant, we started a mobile medical team in the Western part of Ukraine, where thousands of IDPs were relocated. They were living in schools, huge sports halls without any privacy, kindergartens, churches, and at the end, any building that could provide shelter from winter weather.My colleague and I assessed the region and settled on ten permanent, consistent locations for biweekly visits. Aside from my role as coordinator, I also worked as a doctor for the first few weeks because we struggled to recruit any Ukrainian doctors. However, within a month, we had a full team with a psychotherapist and medical doctor. The team traveled through the Trascarpathian region in Western Ukraine and provided free consultations with physicians and psychotherapists as well as medicines, hygiene kits, and social services.After the de-occupation of northern Ukraine, the tension and hopelessness seem to have decreased. People started smiling on the streets. I feel like I can finally breathe and live. At the beginning of the war, my husband and I, with our young daughter, fled from Kyiv and were not sure we would ever be able to return. After the de-occupation, life started to feel more stable. During one of STEP-IN’s assessment trips, my husband and I visited our home. In such a situation, very small things unexpectedly become [End Page E1] very valuable to me. I was so happy to see pictures on the wall, a ceramic bowl I brought from Iraq and our child’s favorite toys.The project in the Transcarpathian region had been ongoing for a few months, and in October 2022, I went to work there for a week as a physician to cover for someone else. We were searching for a new candidate and didn’t want our beneficiaries to remain without medical help, especially in the peak flu season.There is a day that I remember vividly in all its details. I remember the smell in the room and how the light from the window lay on my patient’s face. It was Tuesday, and each Tuesday, we went to the Protestant church guesthouse, where around sixty IDPs were hosted. The church was one of my favorite places to work because the administration was very supportive and caring toward IDPs. Unfortunately, that was not the case everywhere. From the moment I arrived at a location, it was apparent how the IDPs were treated. Their eyes were the best... (shrink)

In the Netherlands religion on the one hand and mental health care on the other, have grown apart in the process of secularisation. Nowadays however one can witness a growing need amongst counselors and psychotherapists to be educated in the field of religion, meaning giving and world views . That religion is back in the focus of attention can also be concluded from the fact that in the latest version of the diagnostic bible, the DSM IV, a separate code has (...) been included for religious or spiritual problems . The case study of a patient with an obsessive-compulsive disorder, which we will present is meant as a contribution to this educational process. We will show how important it is to look at the religious frame of reference of a patient and how this can be handled in the psychotherapeutic treatment. The case will be put within the theoretical perspective of symbolic interactionism. (shrink)

Values in dialogue offers a practical and theoretical model for ethics in care, that has grown from experience and research. The foundation of this ethical model is laid in the care relationship and in relational personalism. It consists of three pillars: values, dialogue, and attitudes. On this basis, a practical model for ethical reflection is developed. The aim is to empower professionals in their own ethical reflection and responsibility in concrete care situations. The model is applied on several topics, such (...) as collaboration between professionals, collaboration with clients and significant others, restriction of freedom and use of coercion, and exchange of information and confidentiality. 'Values in dialogue' is written for care professionals in their daily practice and in ethics commitees, but also for teachers and students in ethics courses. It focuses in particular on mental healthcare, support for people with mental disabilities, and care for elderly persons. (shrink)

Philosophers and bioethicists have mostly given up on human dignity. As a concept, dignity has seemed obscure and unintelligible, or forbidden because of its connection with theology. Here I take a fresh look, and identify two families of dignity concepts: dignity as arche and dignity as telos. Arche draws on the idea of an origin or source, as in ‘archetype’ or ‘archeology.’ Dignity as arche refers to the qualities inherent in a being that is the source (the arche) of our (...) duties to that being. Dignity as telos is the endpoint (telos) that we try to promote in our patients and in ourselves. I illustrate these ideas using examples from Frances Hodgson Burnett’s book for young readers, A Little Princess. Identifying these two families of dignity concepts helps to identify the dignity-related tasks for psychotherapists. These are to help patients recognise, connect with, and respect their own dignity as arche, and to help them realise their own dignity as telos. Revisiting Maslow’s hierarchy of needs helps us to see how these tasks also apply to the broader goals of healthcare. (shrink)

In the psychotherapist-patient relationship, the therapist-fiduciary must deal with ambiguity, assume risks, and make decisions without final appeal to psychiatric theory. Ambiguity regarding patient autonomy poses treatment paradoxes. Caregiving that aims at autonomy can end up undermining it. Additionally, pursuit of autonomy can put the patient’s well-being at risk.