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)

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)

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)

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)

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)

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)

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)

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)

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.

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)

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)

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)

Zemyarska MS. Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it? J Med Ethics 2019;45:346–50. doi: 10.1136/medethics-2018-104983. The Acknowledgements section of ….

How patients and nurses experience the acute care psychiatric environment The concept of the therapeutic milieu was developed when patients’ hospitalizations were long, medications were few, and one‐to‐one nurse–patient interactions were the norm. However, it is not clear how the notion of ‘therapeutic milieu’ is experienced in American acute psychiatric environments today. This phenomenological study explored the experience of patients and nurses in an acute care psychiatric unit in the USA, by asking them, ‘What stands out to you about (...) this psychiatric hospital environment?’ Three figural themes emerged, contextualized by time, which was a source of stress to both groups: for patients there was boredom, and for nurses, pressure and chaos. Although they shared some themes, nurses and patients experienced them differently. For instance, nurses felt caged‐in by the Plexiglas‐enclosed nursing station, and patients felt caged‐in by the locked doors of the unit. The findings from this US study do not support the existence of the therapeutic milieu as described in the literature. Furthermore, although the nurse–patient relationship was yearned for by nurses, it was nearly absent from patients’ descriptions. The caring experienced by patients was mainly derived from interactions with other patients. (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)

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)

Dheensa S, Fenwick A, Lucassen A.‘Is this knowledge mine ….

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)

Objective: The value of spontaneous EEG oscillations in distinguishing patients in vegetative and minimally conscious states was studied. Methods: We quantified dynamic repertoire of EEG oscillations in resting condition with closed eyes in patients in vegetative and minimally conscious states (VS and MCS). The exact composition of EEG oscillations was assessed by the probability-classification analysis of short-term EEG spectral patterns. Results: The probability of delta, theta and slow-alpha oscillations occurrence was smaller for patients in MCS than for VS. Additionally, only (...) patients in MCS demonstrated fast-alpha oscillation occurrence. Depending on the type and composition of EEG oscillations, the probability of their occurrence was either aetiology dependent or independent. The probability of EEG oscillations occurrence differentiated brain injuries with different aetiologies. Conclusions: Spontaneous EEG oscillations have a potential value in distinguishing patients in VS and MCS. Significance: This work may have implications for clinical care, rehabilitative programs and medical–legal decisions in patients with impaired consciousness states following coma due to acute brain injuries. (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)

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)

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)

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)

While the presence or absence of consciousness plays the central role in the moral/ethical decisions when dealing with patients with disorders of consciousness (DOC), recently it is criticized as not adequate due to number of reasons, among which are the lack of the uniform definition of consciousness and consequently uncertainty of diagnostic criteria for it, as well as irrelevance of some forms of consciousness for determining a patient’s interests and wishes. In her article, Dr. Specker Sullivan reexamined the meaning (...) of consciousness in the DOC taxonomy and proposed to go away from the routinely used clinical definition of consciousness as “wakeful awareness”, and adopt the meaning that is common in the Eastern tradition which is a form of “pure experience” (Specker Sullivan 2018). She further argued that understanding consciousness as a “pure experience” is ethically relevant for DOC patients. This suggestion is original, novel and important since it preserves the importance of the notion of consciousness for the clinical practice while simultaneously offering an additional ethical tool for the moral decisions in medicine. At the same time, without placing such Eastern notion in the Western tradition it is difficult to see how pure experience could be usefully operationalized to make sense in the clinical practice with DOC patients. It is so because pure experience is a subjective phenomenon which is completely inaccessible in noncommunicative DOC patients and also it does not express behaviorally (Monti et al 2010), therefore some objective-like operationalization is needed. This is why the fusion of Eastern and Western traditions is required to gain the full potential of Dr. Specker Sullivan’s suggestion. We propose that such fusion could be achieved on the basis of the Operational Architectonics (OA) theory of brain-mind functioning (Fingelkurts et al. 2010; 2013a) which suits ideally the purpose due its compatibility with both Western and Eastern traditions of consciousness. (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)

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)

_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)

Dr. Vukov analyzing patients with disorders of consciousness, proposed that medical well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness (minimally conscious state – MCS versus vegetative state – VS), but that they can be justified by looking to patients’ potential for consciousness. One objective way to estimate this potential (actual physical possibility) is to consider a neurophysiologically informed strategy. Ideally such strategy would utilize objective brain activity markers of consciousness/unconsciousness. The Operational Architectonics (OA) (...) theory of brain-mind functioning is an example of such a strategy. Besides being mathematically simple, neurophysiologically accurate, and compatible with the cognitive/phenomenal perspectives on consciousness, application of OA strategy to quantitative EEG analysis of patients in VS and MCS revealed that the absence of consciousness in VS is paralleled by impairment of overall EEG operational architecture. Specifically, neuronal assemblies become smaller, their life span shortened, and they became highly unstable and functionally disconnected (desynchronized). At the same time, fluctuating (minimal) awareness in patients in MCS was paralleled by partial restoration of EEG operational architecture (increased size, life span, and stability of neuronal assemblies, together with an increased number and strength of functional connections among them), approaching the level found in healthy fully conscious participants. Moreover OA strategy to EEG analysis allowed predicting the emergence of consciousness in VS patients after six years following the brain trauma. Therefore, the OA methodology could reliably predict which patients may regain consciousness, and thus determine which patients may have the potential for consciousness. (shrink)

How should deontological theories that prohibit actions of type K — such as intentionally killing an innocent person — deal with cases of uncertainty as to whether a particular action is of type K? Frank Jackson and Michael Smith, who raise this problem in their paper "Absolutist Moral Theories and Uncertainty" (2006), focus on a case where a skier is about to cause the death of ten innocent people — we don’t know for sure whether on purpose or not — (...) by causing an avalanche; and we can only save the people by shooting the skier. One possible deontological attitude towards such uncertainty is what Jackson and Smith call the threshold view, according to which whether or not the deontological constraint applies depends on our degree of (justified) certainty meets a given threshold. Jackson and Smith argue against the threshold view that it leads to implausible paradoxical moral dilemmas in a special kind of case. In this response, we show that the threshold view can avoid these implausible moral dilemmas, as long as the relevant deontological constraint is grounded in individualistic patient-based considerations, such as what an individual person is entitled to object to. (shrink)

Living in the Borderland addresses the evolution of Western consciousness and describes the emergence of the "Borderland," a spectrum of reality that is beyond the rational yet is palpable to an increasing number of individuals. Building on Jungian theory, Jerome Bernstein argues that a greater openness to transrational reality experienced by Borderland personalities allows new possibilities for understanding and healing confounding clinical and developmental enigmas." "Living in the Borderland challenges the standard clinical model, which views normality as an absence of (...) pathology and which equates normality with the rational. Jerome S. Bernstein describes how psychotherapy itself often contributes to the alienation of Borderland personalities by misperceiving the difference between the pathological and the sacred. The case studies included illustrate the potential this has for causing serious psychic and emotional damage to the patient." "This challenge to the orthodoxies and complacencies of western medicine's concept of pathology will interest Jungian Analysts, Psychotherapists, Psychiatrists and other physicians, as well as educators of children. (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.

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)

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)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy (...) and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (...) (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (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)

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)

ABSTRACT Accurate self‐administration of antiretroviral medication therapy for HIV/aids is a significant clinical and ethical concern because of its implications for individual morbidity and mortality, the health of the public, and escalating healthcare costs. However, the traditional construction of patient medication adherence is oversimplified, myopic, and ethically problematic. Adherence relies on existing social power structures and western normative assumptions about the proper roles of patients and providers, and principally focuses on patient variables, obscuring the powerful socioeconomic and institutional (...) influences on behaviour. Some professionals advocate for alternate approaches to adherence, but many of the available alternatives remain conceptually underdeveloped. Using HIV/aids as an exemplar, this paper presents medication practice as a theoretical reconstruction and explicates its conceptual and ethical evolution. We first propose that one of these alternatives, medication practice, broadens the understanding of individuals’ medication‐taking behaviour, speaks to the inherent power inequities in the patient‐provider interaction, and addresses the ethical shortcomings in the traditional construal. We then integrate medication practice with feminist thought, further validating individuals’ situated knowledge, choices, and multiple roles; more fully recognizing the individual as a multidimensional, autonomous human being; and reducing notions of obedience and deference to authority. Blame is thus extricated from the healthcare relationship, reshaping the traditionally adversarial components of the interaction, and eliminating the view of adherence as a patient problem in need of patient‐centred interventions. (shrink)

John V. Taylor was a missionary statesman, ecumenist, Africanist, onetime General Secretary of the Church Missionary Society, and later Anglican Bishop of Winchester. His work offers a theology and practice of Christian mission which is faithful to scripture while fully facing the facts of the contemporary world at the beginning of the third millennium. Does Christian evangelism promote sectarianism and violence, or can it contribute to harmony and peace in the global village? Can Christians extol the true significance of Jesus (...) Christ without demeaning others? Who is God and how does God's nature shape ours? This book tackles these and other vital issues by giving the first major account of the life and thought of one of the 20th century's greatest religious thinkers. Here is an example and tutor to any thoughtful Christian. Consistently incarnational and sacramental in his approach, Taylor seeks to live out the truths he discovers in his daily ministry as poet, priest and prophet - inviting those around him to share the way of Christ. Taylor is also author of major works such as "The Go-Between God", his book on the Holy Spirit, and "The Christlike God", where he outlines the distinctive Christian insight into God as the patient, generous, self-sacrificing love we see in Jesus. (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)

_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)

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)

This article explores the concept of minor or general psychotherapy championed by physicians seeking to popularise psychotherapy in the post-Stalin Soviet Union. Understood as a set of skills and principles meant to guide behaviour towards and around patients, this form of psychotherapy was portrayed as indispensable for physicians of all specialities as well as for all personnel of medical institutions. This article shows how, as a result of Soviet teaching on the power of suggestion to influence human organisms, every interaction (...) with patients was conceptualised as a form of psychotherapy, leading to the embrace of placebo as a legitimate form of therapy, and to the blurring of the boundary between therapy and other activities in the clinic. The principles of minor psychotherapy reveal a concept of psychotherapy that is much wider, and rooted in different priorities, than the dominant understanding of this type of treatment found in Western Europe and North America. This article addresses the ethical principles implicit in the Soviet perspective, demonstrating that despite fighting against the uncaring and dismissive attitude of other physicians, Soviet psychotherapists remained rooted in the paternalistic tradition. Finally, it traces the efforts to establish minor psychotherapy as standard practice in medical institutions, which, like many other plans and ambitions of Soviet psychotherapists, were constrained by a lack of resources in the healthcare system. (shrink)