Clinical Examples (clinical + example)

Distribution by Scientific Domains
Distribution within Psychology

Selected Abstracts

Pulsed Z-spectroscopic imaging of cross-relaxation parameters in tissues for human MRI: Theory and clinical applications

Vasily L. Yarnykh
Abstract A new method of pulsed Z-spectroscopic imaging is proposed for in vivo visualization and quantification of the parameters describing cross-relaxation between protons with liquid-like and solid-like relaxation properties in tissues. The method is based on analysis of the magnetization transfer (MT) effect as a function of the offset frequency and amplitude of a pulsed off- resonance saturation incorporated in a spoiled gradient-echo MRI pulse sequence. The theoretical concept of the method relies on an approximated analytical model of pulsed MT that provides a simple three-parameter equation for a pulsed steady-state Z-spectrum taken far from resonance. Using this model, the parametric images of cross-relaxation rate constant, content, and T2 of the semisolid proton fraction can be reconstructed from a series of MT-weighted images and a coregistered T1 map. The method was implemented on a 0.5 T clinical MRI scanner, and it provided high-quality 3D parametric maps within an acceptable scanning time. The estimates of cross-relaxation parameters in brain tissues were shown to be quantitatively consistent with the literature data. Clinical examples of the parametric images of human brain pathologies (multiple sclerosis and glioma) demonstrated high tissue contrast and clear visualization of the lesions. Magn Reson Med 47:929,939, 2002. © 2002 Wiley-Liss, Inc. [source]

Diabetes control in pregnancy: who takes responsibility for what?

Dr J Josse FRCPsych Sessional Consultant Psychotherapist
Abstract At our diabetes team meetings in Peterborough, which included a psychotherapist, the issues involved in who takes responsibility for the birth of a healthy baby from a diabetic mother were explored. Traditional prescriptive approaches were compared with the empowerment model in the specific instance of pregnancy, when the needs of the fetus have to be considered as well as those of the mother. Clinical examples are given to illustrate the dilemmas over who takes responsibility with different models, and questions are raised for debate. The empowerment model of diabetes care may not be entirely applicable to the pregnant diabetic woman. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Incorporation of an invasive object

The author discusses the experience of ,being invaded' that is sometimes communicated by certain severely disturbed patients. The complaint can sometimes be couched in terms of bodily suffering and such patients may state that they have the experience of a ,foreign body' inside. It is suggested that these patients have suffered severe early failure of containment of their projections, while at the same time they have incorporated primitive characteristics of the object that have been powerfully projected into them. An object that invades in this way, it is suggested, experiences a compulsive need to expel unbearable states of mind using others as a repository. The infant incorporates these violent projections as part of his own mental representational system, and normal identifi cation processes are disrupted. There follows impairment of the development of the sense of self. Clinical examples of how the invasive experience manifests itself in the analytic setting and in the transference and countertransference are presented. It is argued that this highly complex form of early subject-object interaction (prior to the differentiation of psyche-soma) is more likely to be found in severely narcissistically disturbed individuals. Some refl ections on the origins of invasive phenomena are given. [source]

Cleveland 20 years on: what have we learned about intervening in child sexual abuse?

Heather Bacon
Abstract This is the first of two linked papers. It examines the main changes in approach to child sexual abuse that have occurred since the events in Cleveland 20 years ago. Comparison between estimated prevalence rates and registrations for sexual abuse suggests that we are aware of only the tip of the iceberg. It is argued that in many cases uncertainty may have to be accepted, and that protection may be better achieved through a protective parent than through the child protection system. Clinical examples of cases presenting to a specialist child and adolescent mental health service are given. It is argued that, although society is now more willing to recognise the existence of child sexual abuse and professionals are better at dealing with families, outcomes for this group of children are not much improved. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Partners in treatment: relational psychoanalysis and harm reduction therapy

Debra Rothschild
Abstract A relational psychoanalytic harm reduction orientation to the treatment of substance misusers is presented and illustrated with a clinical example. Both harm reduction therapy and relational psychoanalysis rely on a two-person model in which the therapist and client are collaborators in the treatment. In both, substance use is seen in the context of the user's internal psychodynamics and external environment, and there is an emphasis on treating the person as a whole individual whose substance use is one aspect of life, rather than focusing on the substance use itself as was often done in the past. Historically, psychoanalysis and substance abuse treatment were so different from each other that their paths rarely crossed. The introduction of harm reduction therapy to substance abuse and the relational orientation in psychoanalysis have brought the fields closer together such that the valuable contributions that each can make to the other can now be appreciated. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66: 1,14, 2010. [source]

Determination of pseudophakic accommodation with translation lenses using Purkinje image analysis

Achim Langenbucher
Abstract Purpose:, To determine pseudophakic accommodation of an accommodating posterior chamber intraocular lens (translation lens) using Purkinje image analysis and linear matrix methods in the paraxial space. Methods:, A 2 × 2 system matrix was defined for each Purkinje image I to IV using refraction, translation and mirror matrices. Image size (m) and axial image position (z) was determined as an example for an off-axis object (a 0.2 m off-axis object located 0.5 m in front of the cornea.). First, our method was applied to the phakic relaxed (emmetropic) and accommodated (6.96 D) Le Grand eye. Secondly, for demonstration of the applicability of the calculation scheme to the pseudophakic eye, we provide a clinical example where we determine the accommodation amplitude of the translation lens (1 CU, HumanOptics, Erlangen, Germany) from photographed Purkinje images in the relaxed and accommodated state. From the biometric data: axial length 23.7 mm, corneal power 43.5, corneal thickness 550 microns, implanted intraocular lens (IOL) with a refractive power of 20.5 D (shape equi-biconvex, refractive index 1.46), and refractive indices of the cornea, aqueous and vitreous from the Le Grand model eye, we calculated the refractive state and the sizes of Purkinje images I and III initiated from two off-axis light sources. Results:, For the Le Grand model eye, Purkinje image II (z/m = 3.5850 mm/0.0064) is slightly smaller than and directly in front of image I (z/m = 3.8698 mm/0.0077). Purkinje image III (z/m = 10.6097 mm/0.0151) is nearly double the size of image I and during accommodation it moves from the vitreous into the crystalline lens. Purkinje IV (z/m = 4.3244 mm/,0.0059) is inverted, three quarters the size of image I, lies in the crystalline lens and moves slightly towards the retina. For the pseudophakic eye, pseudophakic accommodation of 1.10 D was calculated from the proportion of distances between both Purkinje images I and III in the relaxed (3.04) and accommodated (2.75) state, which is in contrast to the total subjective accommodation of 2.875 D evaluated with an accommodometer. Conclusions:, We present a straightforward mathematical strategy for calculation of the Purkinje images I,IV. Results of our model calculation resemble the values provided by Le Grand. In addition, this approach yields a simple en bloc scheme for determination of pseudophakic accommodation in pseudophakic eyes with accommodative lenses (translation lenses) using Purkinje image photography. [source]

Bodily centered protections in adolescence: An extension of the work of Frances Tustin

Judith L. Mitrani
In this paper, the author discusses the recurrence of infantile, proto-mental functioning in adolescence mainly in the context of the work of Frances Tustin. She demonstrates, through clinical example, how the tendency to resort to bodily centered and sensation-dominated protections is reactivated on a grand scale when the internal and external physical and psychological changes, brought on in puberty, are felt to be potentially overwhelming. She also demonstrates how, when the capacity for adequate mental and emotional development is stultified, sensation and action once again come to the rescue as the adolescent's way of attenuating anxieties unconsciously experienced as resonating with those unmentalized happenings of early infancy and how the psychoanalytic relationship may be pivotal in setting previously derailed mental and emotional growth back on track. [source]

The profession of ferryman: Considerations on the analyst's internal attitude in consultation and in referral,

Psychoanalytic consultation is an interview with a patient who will not be taken in treatment by the consultant analyst, but who will be sent to another, perhaps specifi cally chosen, colleague after one or more assessment sessions. This practice is becoming increasingly important since, besides traditional private relationships between consultant and patient, it is now common in many specialized centres affi liated to offi cial psychoanalytical institutions. The author explores some fundamental aspects of the analyst's internal attitude in consultation: motivation to know; a ,concave' attitude to listening; responsibility in proposing suitable technical choices and referral to a further specialist; empathy and partial identifi cation; the balance between authentic experience in the consultation and risks of seduction; internal links within the community of colleagues; the technique for sending patients on. He presents a clinical example, specifi cally aimed at reproducing the internal attitude of the analyst, together with the necessary work that allows a diffi cult patient to initiate psychoanalytic treatment. [source]

Embodied female experience through the lens of imagination

Sharon R. Green
Abstract:, In 1971, I made a film entitled,Self Portrait of a Nude Model Turned Cinematographer,in which I explore the objectifying ,male' gaze on my body in contrast to the subjective lived experience of my body. The film was a radical challenge to the gaze that objectifies woman , and thus imprisons her , which had hitherto dominated narrative cinema. Since the objectification of women has largely excluded us from the privileged phallogocentric discourses, in this paper I hope to bring into the psychoanalytic dialogue a woman's lived experience. I will approach this by exploring how remembering this film has become a personally transformative experience as I look back on it through the lens of postmodern and feminist discourses that have emerged since it was made. In addition, I will explore how this process of imaginatively looking back on an artistic creation to generate new discourses in the present is similar to the transformative process of analysis. Lastly, I will present a clinical example, where my embodied countertransference response to a patient's subjection to the objectifying male gaze opens space for a new discourse about her body to emerge. Translations of Abstract En 1971, j'ai réalisé un film intitulé,Autoportrait d'un modèle nu transformé en cinéaste.,J'y explorais le contraste entre un regard « mâle » objectalisant sur mon corps nu et l'expérience subjective de mon corps vécu. Ce film était un défi radical lancé au regard objectalisant sur la femme, regard qui l'emprisonne et qui avait largement prédominé jusque-là dans la fiction cinématographique. Dans la mesure où l'objectalisation des femmes nous a largement exclues des discours phallogocentriques, j'espère dans cet article contribuer au dialogue psychanalytique, en y apportant l'expérience personnelle vécue d'une femme. J'y analyserai la manière dont la réminiscence de ce film est devenue pour moi une expérience de transformation, à mesure que je le reconsidérais à travers le prisme des discours postmodernes et féministes qui ont émergé depuis. Puis, je m'attacherai à examiner comment ce retour imaginatif sur une création artistique pour générer de nouveaux discours, présente des similitudes avec le processus de transformation analytique. Enfin, je présenterai un exemple clinique au cours duquel, une réponse contre-transférentielle incarnée de ma part à la sujétion d'une patiente au regard masculin objectalisant, ouvrit chez elle l'espace permettant l'émergence d'un discours nouveau à propos de son corps. 1971 machte ich einen Film mit dem Titel,Selbstporträit eines Nacktmodells, zur Kamerafrau,geworden in dem ich den objektifizierenden ,männlichen' Blick auf meinen Körper untersuche im Kontrast zu der subjektiv gelebten Erfahrung meines Körpers. Der Film stellte eine radikale Herausforderung dar für den Blick, der Frauen objektiviert , und sie dadurch gefangennimmt , welcher bis dahin das Erzählkino dominierte. Da uns die Objektifizierung von Frauen weitgehend von den phallozentrischen Diskursen ausgeschlossen hat hoffe ich, mit diesem Text die gelebte persönliche Erfahrung einer Frau in den psychoanalytischen Diskurs einzubringen. Ich werde mich dem annähern über die Untersuchung der Frage, wie die Erinnerungen an diesen Film zu einer persönlichen transformativen Erfahrung wurden. Dazu bediene ich mich einer Rückschau durch die Linse des postmodernen und feministischen Diskurses, wie er sich seit der Entstehung des Filmes herausgebildet hat. Desweiteren werde ich untersuchen, wie ähnlich dieser Prozeß der imaginativen Rückschau auf einen künstlerischen Schaffensvorgang zur Erzeugung neuer Diskurse in der Gegenwart den transformativen Prozessen in der Analyse ist. Schließlich werde ich ein klinisches Beispiel vorstellen, in dem meine körperliche Gegenübertragungsreaktion auf die Unterwerfung einer Patientin unter den objektifizierenden männlichen Blick einen Raum für eine neue Art von Diskurs über ihren Körper eröffnet. Nel 1971 girai un film intitolato "Autoritratto di una modella nuda trasformatasi in operatore cinematografico" in cui esploravo il contrasto tra lo sguardo "maschile" reificante sul mio corpo e l'esperienza soggettiva del mio corpo vivente. Il film era una sfida radicale allo sguardo che reifica la donna,e quindi la imprigiona,che aveva finora dominato la narrativa cinematografica. Poiché la reificazione delle donne ci aveva largamente escluse dai discorsi fallocentrici privilegiati, spero di portare nel dialogo psicoanalitico la personale esperienza vivente di una donna. Lo farò esaminando in che modo il ricordo di questo film sia divenuto un'esperienza personalmente trasformativa mentre lo riguardavo con le lenti dei discorsi femministi e postmoderni che sono emersi dopo che questo venne fatto. Inoltre analizzerò in che modo questo processo immaginale di ricordare una creazione artistica per generare nuovi discorsi nel presente sia simile al processo trasformativo dell'analisi. Infine presenterò un caso clinico in cui la mia risposta controtransferale alla soggezione di una paziente allo sguardo maschile deificante apre uno spazio in cui può emergere un nuovo discorso sul suo corpo. En 1971, hice una película,Auto Retrato de un Modelo Desnudo que se convirtió Cinematógrafo, donde exploro la objetivización de mirada ,masculina' sobre mi cuerpo en contraste a la experiencia subjetiva vivida de mi cuerpo. La película fue un desafío radical a la mirada que objetiva a mujer ,y así la encarcela , que había dominado hasta ahora al cine narrativo. Desde que la objetivación de mujeres se nos ha excluido en gran parte del privilegio del discursosde falocéntrico, espero con este trabajo traer la experiencia vivida ypersonal de la mujer al diálogo psicoanalítico. Me acercaré a ellos explorando cómo el recordar esta película ha llegado a ser una experiencia personal de transformación tal como yo lo recuerdo a la vista de los discursos postmodernos y feministas surgidos desde entonces. Además, exploraré cómo este proceso de recordar con imaginación una creación artística al engendrar nuevos discursos en el presente, es semejantes al proceso del transformador del análisis. Por último, presentaré un caso clínico, donde mi corporeizada respuesta contratransferencial del sometimiento de una paciente a la objetivización de la mirada masculina abre el espacio para que pueda surgir un nuevo discurso acerca de su cuerpo. [source]

Experience and inference: how far will science carry us?

Joseph Lichtenberg
Abstract:, This paper begins with a view of the remarkable understanding of infant and child development that has evolved from research and observation. The limitations of this contribution from science to the multi-dimensional context-based individuality of each human in his or her intersubjective realm are then considered. For a contemporary view we must recognize the influence of the variability of experiences and the inferences drawn from them. Inferences involve symbolization and culturally derived archetypes as illustrated in a clinical example. [source]

Daimonic elements in early trauma

Donald E. Kalsched
Abstract: This paper explores some of the ,daimonic' elements of unconscious mentation that emerge both in dreams and in the transference/countertransference field with early-trauma patients and illustrates these with an extended clinical example. An archaic and typical (archetypal) ,trauma complex' is articulated (with diagram) as a bi-polar structure consisting of divine child protected and/or persecuted by an inner ,guardian angel'. Sources of this structure and its mythological inner objects are traced to trauma at the stage of what Winnicott calls ,unintegration' and to flooding by dis­integration anxiety at a time before nascent ego-structure has formed. In an extended case example, the author shows how the patient's traumatized innocence and desire for a new start, thwarted by self-attacking defences, pulls him into playing the inflated role of her guardian angel, leading to re-traumatization in the transference. Working through is seen as the necessary disillusionment and humanization of these daimonic structures as they are projected, suffered, and transmuted by the analytic partners in the stormy process of psychotherapy. [source]

The alienness of the unconscious: on Laplanche's theory of seduction

Michael Rotmann
In this paper the author uses a clinical example as a focus for an exploration of his thesis that the parent is the ,other' who implants his or her unconscious message into the child by means of seduction. As the other is alien, the unconscious of the child cannot any longer be considered the centre of the person but is decentred by the implanted alienness. The author draws on Laplanche's seduction theory to argue that the unconscious message of seduction by the other is exclusively sexual and that it cannot be translated nor symbolized because an interpretative system shared by subject and object is lacking. The decentred alterity of the unconscious allows for comparison with a third object and hence a structural triangulation of the mind which is a prerequisite for symbolization. The role of the analyst in permitting a transference enactment and so facilitating the beginning of sexual symbolization is discussed in relation to the clinical example given at the start of the paper. [source]

Applications of cone-beam computed tomography in fractures of the maxillofacial complex

Werner H. Shintaku
Several studies support the use of conventional two-dimensional imaging for traumas involving mainly the mandible, but for more complex situations advanced imaging modalities such as computed tomography (CT) and magnetic resonance imaging have higher indication. Nowadays, besides CT, cone-beam computed tomography (CBCT) has appeared as a reasonable and reliable alternative considering radiation dosage, image quality and comfort for the patient. The purpose of this study was to review the fracture patterns involving the maxillofacial complex, provide a technical and practical comparison between CT and CBCT, and finally present the potential applications of CBCT illustrated with clinical examples. [source]

Reflective practice in infant mental health training and consultation

Julie A. Larrieu
This article describes models of training in infant mental health that utilize reflective supervision as a fundamental component of the educational and clinical experiences. The design and structure of these programs, offered by two medical centers, are described. Benefits and challenges to the adoption of infant mental health practice by trainees are outlined. Incorporation of reflective supervision in the training is discussed, and clinical examples are provided to illustrate its essential role in the development of the infant mental health clinician. [source]

Clinical governance in practice: closing the loop with integrated audit systems

L. TAYLOR ba hons rmn
Clinical governance has been acknowledged as the driving force behind National Health Service (NHS) reform since the government white paper outlined a new style of NHS in the UK in 1997. The framework of clinical governance ensures that NHS organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will develop. A major component of a clinical governance framework requires utilizing audit procedures, which assess the effectiveness of current systems and ultimately direct continual quality improvement. This paper describes the audit component of a local clinical governance framework designed for a unit based within an NHS trust, which has utilized a multidisciplinary approach to assess the effectiveness of a newly commissioned service and its impact on the residents and staff. The unit is a 12-bedded, low-secure-intensive rehabilitation unit for clients with severe and enduring mental illness. Using recognized and standardized psychometric outcome measures, information was collected on clinical symptoms, social functioning, social behaviour, quality of life, relationship quality with named nurses and medication side-effects. Additionally, confidential staff measures were included to assess levels of burnout, identify expressed emotion and assess staff perception of models of illness. The paper includes a comprehensive account of how managerial commitment, teaching processes and application of technology ensured prompt data collection and maintained the momentum through the audit timescale. Data analysis and presentation of data in both clinical reviews and in senior management meetings within the unit are discussed. Findings highlight the full integration of the audit system into the processes of the unit. Clinically, the paper highlights the enhancement of the knowledge base of the client group and the influence on clinical decision-making processes and care delivery as a result of the audit. Brief clinical examples are given. In conclusion, the impact of the audit on unit strategy and organizational efficiency are discussed to highlight the importance of closing the audit loop and completing the cycle of clinical governance. The audit system has positive implications for replication in other services. [source]

Continuous Glucose Monitoring in Dogs and Cats

C.E. Wiedmeyer
Use of continuous glucose monitoring in veterinary medicine is gaining popularity. Through use of a commercially available continuous glucose monitor system, insights into daily glucose changes in dogs and cats are achievable. The continuous glucose monitoring system measures glucose concentrations in the interstitial fluid of the subcutaneous space by use of a small, flexible probe. When placed in the subcutaneous tissue, the probe is connected to a recording device that is attached to the animal and records the interstitial fluid glucose concentration every 5 minutes (288 readings per 24 hours). Once attached and properly calibrated, the instrument can remain in place for several days, hospitalization of the patient is not necessary, and the normal daily routine of the animal can be maintained. The data from the recording device are then downloaded and a very detailed picture of the interstitial fluid glucose concentration over that time period can be obtained. Subcutaneous interstitial fluid glucose concentrations have a good correlation to blood glucose concentrations within a defined range. The continuous glucose monitoring system has distinct advantages over traditional blood glucose curves and is a valuable tool for managing diabetic dogs and cats. In addition, other clinical uses for continuous glucose monitoring are being developed. This review is designed to outline the technology behind the continuous glucose monitoring system, describe the clinical use of the instrument, provide clinical examples in which it may be useful, and discuss future directions for continuous glucose monitoring in dogs and cats. [source]

Computerized calculation scheme for bitoric eikonic intraocular lenses

Achim Langenbucher
Abstract Despite full correction of the corneal astigmatism with toric intraocular lenses, the retinal image is distorted and the lateral image-object magnification is different in different meridians. The purpose of this study is to describe an iteration strategy for tracing an axial pencil of rays through the ,optical system eye' containing astigmatic refractive surfaces with their axes at random to calculate a thick bitoric lens implant which eliminates image distortion. The capabilities of this computing scheme are demonstrated with two clinical examples. We present a mathematically straightforward computer-based strategy for the calculation of thick bitoric eikonic lens implants. The iteration algorithm is initialized with a spherical front and a toric back surface and stepwise decreases the image distortion by adding cylinder lenses to the front lens surface corrected by the toric lens back surface. Total magnification can be modulated by varying the front-to-back surface power of the thick lens. [source]

Violent crimes and their relationship to personality disorders,

Michael H. Stone
Persons committing murder and other forms of violent crime are likely to exhibit a personality disorder (PD) of one type or another. Essentially any personality disorder can be associated with violent crime, with the possible exception of avoidant PD. This includes those described in DSM as well as other disorders such as sadistic PD and psychopathy. The latter two, along with antisocial and paranoid PDs, are the most common personality accompaniments of violent crime. Narcissistic traits (if not narcissistic PD (NPD) itself) are almost universal in this domain, since violent offenders usually place their own desires and urges far above those of other persons. While admixtures of traits from several disorders are common among violent offenders, certain ones are likely to be the main disorder: antisocial PD, Psychopathy, Sadistic PD, Paranoid PD and NPD. Instrumental (as opposed to impulsive) spousal murders are strongly associated with NPD. Men committing serial sexual homicide usually show psychopathy and sadistic PD; half these men also show schizoid PD. Mass murderers usually show strong paranoid traits. With a focus on murder, clinical examples drawn from the crime literature and from the author's personal interviews reflect 14 varieties of personality disorder. Animal torture before adulthood is an important predictor of future violent (including sadistic) crime. Whereas many antisocial persons are eventually capable of rehabilitation, this is rarely the case with psychopathic or sadistic persons. Suggestions for future research are offered. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Murdered father; dead father: Revisiting the Oedipus complex,

Rosine J. Perelberg
This paper recovers the notion of the sacrifice of sexuality as the central, tragic, element of the oedipal structure. This notion has been largely abandoned in the psychoanalytic literature that has tended to reduce the oedipal structure to processes of exclusion. The paper traces the development of the theoretical and clinical transformations of Freud,'s ideas on the role of the father and suggests that they allow us to more fully comprehend the Oedipus complex proposed by Freud. A paradox is explored: the killing of the father is, in Freud,'s view, the requirement for the creation of the social order which, from then on, prohibits all killings. The father, however, has to be killed metaphorically only, as the actual exclusion of the father lies at the origin of so many psychopathologies from violence to the psychoses and perversions. The paper analyses the fundamental asymmetry that is present in the Oedipal structure and suggests that the three elements of the oedipal triangle constitute the law (of the dead father, that institutes the sacrifice of sexuality), desire (for the lost object) and identification (with both father and mother). Two clinical examples are discussed. In the first, one can identify a perverse structure in which the father has been murdered; in the second, there is a progressive construction of the dead (symbolic) father in the analytic process. [source]

Grievance: The underlying oedipal configuration

Michael Feldman
In this paper the author describes some of the clinical features encountered in patients who seem to ,nurture' a persistent grievance. He gives clinical examples, and discusses the nature of the powerful underlying dynamics. He suggests that contained within the patient's grievance is a set of phantasies that constitute the expression of his fear and hatred of reality, particularly the reality of the oedipal situation, the child's relationship to the creative parental couple, which Money-Kyrle (1968, 1971) has characterised as an essential element of ,the facts of life'. The phantasies the patient has evolved serve to protect him from envy and jealousy, anxiety and guilt. The primitive oedipal phantasies on which the grievance rests also contribute to the excitement and gratification that are characteristic of the grievance. The analysis of the underlying state of mind helps to account for the persistent grip the grievance has on the patient, and the way this interferes with development. [source]

Narcissistic mortification of ageing men

Martin Teising
The development of a male gender identity involves the task of relinquishing the identification with the female primary object. If this separation is experienced as loss or expulsion, and responded to by the development and libidinous cathexis of phallic-narcissistic characteristics, a specifically male narcissistic vulnerability emerges, which can, particularly in ageing men, escalate to critical proportions. However, phallic-narcissistic crises in the ageing process also contain opportunities for development, provided the losses of age can be faced with mourning. The author sets out the statements on the subject of old age in the myth of Narcissus and makes use of the concepts of developmental psychology. He outlines clinical examples illustrating this problem. Finally, he brings to mind the narcissistic plight of the aged Oedipus. [source]

The act of interpretation,

The author understands the interpreting act as an attempt to perceive what happens in the transference/countertransference fi eld and not just what happens in the patient's mind. Interpretation transcends mere intellectual communication. It is also an experience in which analysts' emotions work as an important instrument in understanding their patients. Interpretation is seen to possess manifest as well as latent content; the latter would contain the analysts' feelings, emotions and personality. The unconscious content of an interpretation does not inconvenience or preclude the development of the analytic process, but, on the contrary, it allows new associative material to emerge, and it transforms the analytic session into a human relationship. Analysts' awareness of this content derived from patients' apperceptions is a signifi cant instrument for understanding what is happening in the analytic relationship, and what transpires in these sessions provides fundamental elements for analysts' self-analysis. Some clinical examples demonstrate these occurrences in analytic sessions, and how they can be apprehended and used for a better understanding of the patient. The author also mentions the occurrence of diffi culties during the analytic process. These diffi culties are often the result of lapses in an analyst's perception related to unconscious elements of the relationship. [source]

Psychoanalytic Controversies: The relationship between psychoanalysis and schizophrenia

Richard Lucas
In this article, the author considers psychoanalysts' current attitudes towards schizophrenia. After early optimism of a psychoanalytic approach, interest has waned, other than in the field of first-onset psychosis. This was because of poor outcome figures and regarding schizophrenia as now having a biological, rather than psychological, base. The author argues that there is a paradox, because only psychoanalysis offers a framework for relating to psychotic patients in a way that helps them to make sense of their experiences. A framework is described, with clinical examples, to illustrate the application of analytic thinking to patients with schizophrenia. Psychoanalysis needs to revitalise its attitude to psychosis, as it has a significant contribution to make within general psychiatry, not least in the training of the next generation of psychiatrists. [source]


Theodore J. Jacobs
This author focuses on an aspect of transference countertransference interaction that enacted covertly is often overlooked. He argues that conflicts, needs and biases that may go undetected for lengthy periods of time are not infrequently contained within the analyst's accurate and technically correct interventions and that for defensive reasons, patients often suppress, deny or rationalise their accurate perceptions of these countertransference elements and fail to confront their analysts with them. The mistakes, miscommunications and misperceptions that arise as a consequence of the unconscious collusions that develop between patient and analyst can have a profound effect on the analytic work. Several clinical examples are presented to illustrate the operation of such covert communications in analysis and their impact on the treatment process. [source]

The week the couch arrived

Robert F. Tyminski
Abstract:, Changes in the therapeutic environment can elicit intense and unpredictable responses from patients, who then react to the new elements with their own unique thoughts, fantasies, emotions and behaviours. When the change is very specific, and when it entails implications for the treatment itself, these patient responses can coalesce around more profound experiences of the transference as well as of the countertransference. The author, as a candidate or analyst-in-training, purchased an analytic couch for his office and observed the unfolding of what this new couch meant for existing treatments. Using clinical examples, he describes the three most common patient responses that occurred: rejecting, ambivalent, and embracing. The richly variant ideas and fantasies related to the analytic couch are described, and the couch's history within Freudian and Jungian contexts is reviewed. Personal determinants that could lead to the decision of whether to use a couch as part of analysis are considered from the standpoint of the analyst's preferences and own experience with the couch. The couch is discussed as a signifier of the analytic process with cultural meanings alluding not only to familiar stereotypes, but also to psychological healing and self-development. Translations of Abstract Des changements dans le lieu de la thérapie peuvent susciter des réactions intenses et imprévisibles chez les patients, chacun d'eux avec leurs propres pensées, fantasmes, émotions et attitudes. Quand le changement est très spécifique, et lorsqu'il porte des implications pour le traitement lui-même, les réactions de ces patients peuvent se combiner avec des vécus plus profonds du transfert ainsi que du contretransfert. L'auteur a acheté un divan pour son cabinet lorsqu'il a commencé sa formation analytique, et raconte ce qu'il a observé des effets juste de la présence de ce divan dans les traitements déjà en cours. A partir d'exemples cliniques il décrit les trois réactions les plus habituelles qui apparaissent chez les patients: rejet, ambivalence, adoption. Sont montrées les variations très riches dans les idées et fantasmes relatifs au divan. Une recension de l'histoire du divan dans les contextes freudiens et jungiens est faite. Les déterminants personnels qui peuvent amener à la décision de considérer le divan et son utilisation ou pas comme partie intégrante de l'analyse sont regardés du point de vue des préférences de l'analyste et de sa propre expérience du divan. Le divan est décrit comme étant un signifiant culturel du processus analytique se rapportant non seulement aux stereotypes connus, mais aussi à la détente et la cicatrisation psychologique ainsi qu'au développement du soi. Veränderungen in der therapeutischen Umgebung können intensive und unvorhersehbare Reaktionen der Patienten und Patientinnen hervorrufen, die auf das neue Element mit ihren eigenen einzigartigen Gedanken, Fantasien, Emotionen und Verhaltensweisen reagieren. Wenn es sich um eine sehr spezifische Veränderung handelt, die auch Implikationen für die Behandlung an sich beinhaltet, dann verbinden sich die Reaktionen der Patienten und Patientinnen mit tiefgehenden Erfahrungen in der Übertragung ebenso wie in der Gegenübertragung. Der Autor - als Kandidat oder Analytiker-in-Ausbildung - kaufte eine analytische Couch für seine Praxis und beobachtete, wie sich die Bedeutung dieser neuen Couch in den laufenden Behandlungen auswirkte und zeigte. Anhand klinischer Beispiele beschreibt er die drei am häufigsten vorkommenden Patientenreaktionen: zurückweisend, ambivalent und begeistert annehmend. Die sehr unterschiedlichen Ideen und Fantasien in bezug auf die analytische Couch werden beschrieben und die historische Bedeutung der Couch in Freudianischen und Jungianischen Zusammenhängen wird erörtert. Persönliche Determinanten, die zur Entscheidung führen könnten, ob eine Couch als ein Bestandteil der Analyse benutzt wird, werden vom Standpunkt der Präferenzen des Analytikers und der eigenen Erfahrung mit der Couch betrachtet. Die Couch wird als Signifikant des analytischen Prozesses diskutiert, in dem kulturelle Bedeutungen sich nicht nur auf vertraute Stereotypen beziehen, sondern auch auf psychische Heilung and Selbstverwirklichung. Cambiamenti nell'ambiente terapeutico possono elicitare risposte intense e imprevedibili da parte dei pazienti, che reagiscono allora ai nuovi elementi con i propri personali pensieri, fantasie, emozioni e comportamenti. Quando il cambiamento è molto specifico e quando comporta implicazioni per il trattamento stesso, le risposte di questi pazienti possono unirsi intorno a esperienze più profonde del transfert o del controtransfert. L'autore, quando era candidato e analista in training, acquistò un lettino analitico per il suo studio e osservò lo sviluppo di ciò che questo nuovo lettino significava per i trattamenti in corso. Usando esempi clinici, egli descrive le tre risposte più comuni dei pazienti: rifiuto, ambivalenza e accettazione. Vengono descritte le idee e le fantasie ricche di variazioni relative al lettino analitico e viene rivista la storia del lettino nei contesti freudiani e junghiani. Determinanti personali che potrebbe portare alla decisione se usare un lettino come parte dell'analisi vengono considerate dal punto di vista delle preferenze dell'analista e della sua personale esperienza del lettino. Il lettino viene discusso in quanto significante culturale del processo analitico, che incorpora regressione, rilassamento e il reclinare degli attaccamenti egoici precedentemente fissati. Los cambios en el entorno terapéutico pueden descubrir respuestas impredecibles en los pacientes, ellos reaccionan a los nuevos elementos con pensamientos, fantasías, emociones y conductas, estos son propios e individuales. Cuando el cambio es muy específico, y cuando connota implicaciones para el tratamiento en sí mismo, las respuestas de estos pacientes pueden estructurarse alrededor de experiencias aun mas profundas de la transferencia y así como en la contratransferencia. El autor, como candidato o analista en entrenamiento, compró un diván analítico para su oficinay observó lo que este diván significó para los tratamientos existentes. Mediante el uso de ejemplos clínicos, describe las tres respuestas que ocurren con mayor frecuencia: Rechazo, ambivalencia, y compromiso, Se describe la riquísima variedad de ideas y fantasías en relación con el diván, y se revisa la historia del diván en el contexto freudiano y junguiano. Se consideran los determinantes personales en la decisión para usar el diván como parte del análisis desde el p[unto de vista de las preferencias del analista y la experiencia personal con el diván. Se discute el diván como significante cultural del proceso analítico que incorpora a la respuesta regresiva y la declinación de las ataduras del ego fijadas previamente. [source]

Individuation: finding oneself in analysis , taking risks and making sacrifices

Martin Schmidt
Abstract:, This paper looks at some of the processes that are at work in finding oneself in analysis. It explores Jung's unique contribution to our thinking about the self and its dynamic of individuation. The author attempts to show how the Self, in its quest for consciousness, requires the surrendering of ego inflation,the narcissistic delusion that the ego is the self. A case is made for seeing analysis as an individuation process which offers the opportunity for experiences of a more authentic sense of oneself. Jung stated that individuation requires the ego to enter into service of the Self. For this to happen, the author argues that both patient and analyst must be prepared to make sacrifices and take risks. Using clinical examples, he illustrates that, although purposive, the Self can be experienced as violent and destructive if the ego is unable to facilitate its expression. This may result in an individuation crisis for both analyst and patient. The paper demonstrates how impasse in analysis can evoke the transcendent function, which also requires sacrifices to be made and risks to be taken for analysis to proceed. [source]

Finding our way in the dark

John Beebe
Abstract:, Accepting the common lay definition of nightmare as any form of upsetting, dreamlike cognition occurring in the midst of sleep, the author argues for a classification of nightmares that would be based, not on physiological findings, but on what the upsetting nocturnal occurrence turns out to mean to the dreamer. Three types of nightmare identified on this basis are illustrated through dream sequences from classic Hollywood movies and amplified by clinical examples: (1) the dream that symbolizes the next stage of life as unusually daunting, (2) the dream that exposes the shadow of another person in a shocking way, and (3) the ,empathy dream', in which the dreamer experiences directly the anxieties of another subject. It is suggested that the accurate interpretation of a particular upsetting dream depends upon which type of nightmare the dream turns out to be. [source]

Principle of organization: a dynamic-systems view of the archetype-as-such

Maxson J. McDowell
The personality is a dynamic system. Like all other dynamic systems, it must be self-organized. In this paper I focus upon the archetype-as-such, that is, upon the essential core around which both an archetypal image and a complex are organized. I argue that an archetype-as-such is a pre-existing principle of organization. Within the personality that principle manifests itself as a psychological vortex (a complex) into which we are drawn. The vortex is impersonal. We mediate it through myths and rituals or through consciousness. In this paper I show that Jung's intuition about the archetype-as-such is supported by recent science. I evaluate other concepts of the archetype. My concept is different from that proposed recently by Saunders and Skar. My concept allows each archetype-as-such to be defined precisely in mathematical terms. It suggests a new interpretation of mythology. It also addresses our spiritual experience of an archetype. Because the archetypes-as-such are fundamental to the personality, the better we understand them the better we understand our patients. The paper is grounded with clinical examples. [source]

Microarray: an instrument for cancer surgeons of the future?

Matthew L. Broadhead
Abstract Microarray enables the study of thousands of genes simultaneously. While still in its infancy as a technique and with a number of barriers to be overcome, microarray is allowing scientists to thoroughly examine the molecular pathways of cancer pathogenesis. However, the adoption of microarray as a clinically applicable technique has been slow coming. Current literature suggests roles in the diagnosis of tumours of unknown origin, in the evaluation of prognostic markers, and in guiding treatment for recurrent and resistant malignancy. This review outlines the science of microarray and draws on clinical examples, including osteosarcoma, breast, prostate and pancreatic carcinomas, to highlight the potential of microarray as a technique of surgical importance. [source]

Superparamagnetic iron oxide particles: contrast media for magnetic resonance imaging,

Rüdiger Lawaczeck
Abstract The mainstream magnetic iron oxide particles used as contrast media for magnetic resonance (MR) imaging are composed of a magnetic iron oxide core surrounded by a dextran or carboxydextran coat. The core size ranges from 2 nm to less than 10 nm, and the hydrodynamic diameter ranges from 20 nm to about 120 nm. The coat prevents aggregation and sedimentation of the particles in aqueous solutions, achieves high biological tolerance, and prevents toxic side effects. Two kinds of particles are considered: (i) large particles (>30 nm), called superparamagnetic iron oxide particles (SPIOs) for liver imaging; (ii) smaller particles (<30 nm hydrodynamic diameter), called ultrasmall SPIOs (USPIOs), e.g. for MR angiography. To characterize the particles, Mössbauer spectra are presented for the two particle ensembles. These spectra allow insight into the magnetic coupling, the valency of the iron ions and a rough estimate of the core size to be deduced. On the basis of the concentration dependence of the MR signal intensities, two applications are discussed together with two representative clinical examples. Future indications for MR diagnostics, e.g. the labeling and tracking of stem cells during stem-cell therapy control, are outlined. Copyright © 2004 John Wiley & Sons, Ltd. [source]