bluuebunny/crossref_metadata_2025 huggingface dataset:
In Search of a New Ethic for Treating Patients with Chronic Pain: What Can Medical Boards Do?
Authors: Martino Ann M.
Published: June 2007

A decade ago, conventional wisdom in the medical establishment was that physicians treating chronic pain with opioid analgesics were at a substantial risk of being sanctioned for overprescribing by state medical regulatory boards. Dozens of articles written since have alluded to this risk as an obstacle to effective pain re1ief. In the early 1990s, a number of high profile cases in which physicians were disciplined by regulatory boards for overprescribing to patients with chronic pain were reported in the press. Although the board actions in many of these cases were eventually overturned by state judiciaries, the publicity heightened practitioners’. sensitivity to the regulatory risks associated with prescribing opioids.

A review of the available data on state medical board actions nationwide for the period from 1990 to 1996 reveals that the perception of regulatory risk far exceeds the reality. Indeed, relatively few (less than 5 percent) of the disciplinary actions taken for overprescribing by state medical boards in any given year directly concern the treatment of chronic pain—malignant or nonmalignant—in patients.
The Emerging Technology and Application of Preimplantation Genetic Diagnosis
Authors: Tasca Richard J. , McClure Michael E.
Published: June 2007

Efforts to improve the means to diagnose and treat human genetic diseases have a long history in biomedical research and medicine. Now, preimplantation genetic diagnosis (PGD) provides a new way to prevent the transmission of certain types of human genetic diseases to the next generation. It is an alternative to elective termination of pregnancies.

PGD is used to test for genetic diseases that are due to defective single genes or abnormal chromosomes within days of fertilization and prior to the establishment of pregnancy. The procedure essentially begins with the biopsy of one or more cells of a cleavage stage or blastocyst stage preimplantation human embryo that has been produced by in vitro fertilization (IVF). In certain cases, PGD can be done on polar bodies—discarded by-products of egg formation containing excess chromosomes—of unfertilized eggs. Then, the cell(s), or a polar body, is placed into a tube for single gene analysis (DNA analysis by polymerase chain reaction (PCR)), or for chromosome analysis by spreading the nucleus of the cell on a microscope slide (fluorescence in situ hybridization (FISH)).
The Moral Underpinning of the Proxy-Provider Relationship: Issues of Trust and Distrust
Authors: Collopy Bart J.
Published: June 2007

Despite clear legislative and judicial support, a well established ethical consensus, and increased efforts at information dissemination and education, proxy decision making for incapacitated patients continues to produce moral muddle and poor resolutions in end-of-life care.

In her analysis of the proxy-doctor relationship, Nancy Dubler spells out the institutionalized patterns that keep the promise of proxy directives so often unrealized. Facing medically complex care of an incapacitated patient, health care teams are apt to view the proxy as a potentially indecisive or unrealistically demanding decision-maker, less a stand-in for the patient than an interloper whose improper, misguided, or self-interested decisions will work against the patient's best interests. So perceived, proxies are routinely relegated to the edges of care planning discussions, left relatively uninformed and unconsulted, and then suddenly thrust center stage to face decisions they find overwhelming. Confronting such decisions, proxies need support and compassion. What they often find is isolation and distrust, a web of professional and institutional practices that trammel their efforts to understand and execute their role.
Extubating Mrs. K: Psychological Aspects of Surrogate Decision Making
Authors: Powell Tia
Published: June 2007

Mrs. K is a thirty-one-year-old Russian-speaking mother of two, who was brought in by ambulance after attempting suicide by jumping in front of train. Probable depression x months. Stressor: lost custody battle over older child. Current status: deep coma, ventilator-dependent, and prognosis grim. Next of kin is estranged husband; he demands participation in medical decision making. Legal proxy is patient's boyfriend; forcibly removed from the intensive care unit (ICU) for agitated behavior and alcohol intoxication.

I magine the difficulty for the ICU staff as it tries to patch together the broken body of Mrs. K, described above. If, as appears likely, the physicians’ efforts begin to fail, who will speak for this patient, who can no longer speak for herself, and determine the appropriate goals and limits of intensive medical care?
Pursuing Reform in Clinical Research: Lessons from Women's Experience
Authors: Eckenwiler Lisa A.
Published: June 2007

In a White House ceremony on May 16, 1997, President Clinton issued an apology on behalf of the nation for the Tuskegee Syphilis Study, a forty-year research project in which African-American men were deceived and denied treatment in order to document the natural course of syphilis. Reflection on this occasion can give us pause to take pride in the progress made toward more ethical research with humans. The President's apology is perhaps the most public of a number of recent events representing a renewed attention to ethics in research with human participants. Alongside it stand the efforts of treatment activists for people with acquired immune deficiency syndrome (AIDS) and the revelations of the human radiation experiments. In 1995, President Clinton called for the creation of the National Bioethics Advisory Commission, which was charged with a host of projects aimed at investigating the organization and function of the federal system for overseeing human subjects research in the United States, and giving guidance on specific forms of research.
Compassionate Release from New York State Prisons: Why are So Few Getting Out?
Authors: Beck John A.
Published: June 2007

It is inevitable that some inmates in large state prison systems will suffer from terminal conditions and die while incarcerated. But how those inmates experience that event is primarily controlled by correctional policies and by the prison medical and correctional staff assigned to their care. Compassion for inmates who are dying cannot be legislated or mandated, but humane and compassionate care for the dying can be facilitated or thwarted by legislative and correctional policies, and by the manner in which correctional personnel interpret those policies.

Death in New York State prisons is a frequent event, occurring at a rate substantially higher than that in most other states. With a prison population that has risen to 70,000 inmates and with the nation’s highest rate of human immunodeficiency virus (HIV) infection, more than 2,817 inmates died in New York prisons during the period 1990-1998. In April 1992, in the face of an ever-increasing death rate in its prisons, the New York State legislature passed the Medical Parole Law, a measure designed to permit dying inmates to be released on parole prior to their normal release eligibility date.
Suicide in Adult Correctional Facilities: Key Ingredients to Prevention and Overcoming the Obstacles
Authors: Hayes Lindsay M.
Published: June 2007

Despite increased general awareness of suicide in U.S. adult correctional facilities as well as the availability of research and correctional standards that advocate increased attention and services to potentially suicidal inmates, prevention efforts within correctional facilities remain piecemeal and inmate suicide continues to be a serious public health problem. A robotic state of mind excuse, that inmate suicide is not preventable, impedes prevention efforts. In the following discussion, the key ingredients to comprehensive suicide prevention programming are offered to dispel these obstacles.

Suicide is a leading cause of death in jails across the United States, with well over 400 inmates taking their lives each year. In some urban jail facilities, deaths related to acquired immune deficiency syndrome (AIDS) slightly outnumber deaths by suicide. The rate of suicide in county jails is estimated to be approximately nine times greater than that of the general population. Overall, most jail suicide victims are young white males who have been arrested for nonviolent offenses and were intoxicated when arrested.
Death and Dying in Prison in Australia: National Overview, 1980–1998
Authors: Dalton Vicki
Published: June 2007

This paper discusses the role of the Australian Institute of Criminology (AIC) in monitoring inmate deaths in custody on a national basis. It also provides a descriptive overview of Australian Indigenous and non-Indigenous inmate deaths in custody during the eighteen-year period between 1980 and 1998.

In October 1987, the Royal Commission into Aboriginal Deaths in Custody (RCIADIC) commenced investigating the deaths of Australia's Indigenous people in custody throughout Australia between January 1, 1980 and May 31, 1989. RCIADIC's task was to examine the circumstances of the deaths; the actions taken by authorities; and the underlying causes of Indigenous deaths in custody, including social, cultural, and legal factors. The investigation found that the major factor contributing to the high number of Indigenous deaths in custody was the disproportionately higher rates at which Indigenous people come into contact with the criminal justice system. RCIADIC concluded that the most significant reason for this contact was the severely disadvantaged social, economic, and cultural position of many Indigenous people.
Fetal Protection in Wisconsin's Revised Child Abuse Law: Right Goal, Wrong Remedy
Authors: De Ville Kenneth A. , Kopelman Loretta M.
Published: June 2007

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the power to commit pregnant women involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy.
Commentary: Mal-Intentioned Illiteracy, Willful Ignorance, and Fetal Protection Laws: Is There a Lexicologist in the House?
Authors: Marshall Mary Faith
Published: June 2007

We should not investigate facts by the light of arguments, but arguments by the light of facts.

Myson of Chen, one of the Seven Sages ca. 600 B.C.

To settle scores as well as problems, to shake things up, to make people think about what they said and wrote, to be provocative without being unjust ...

Kingsley Amis

In their critique of Wisconsin's revised child protection Statute, Kenneth De Ville and Loretta Kopelman argue rightly that “words matter.” Word mongering infects most political dialogue and is nowhere more virulent than in the American abortion debate. Dichotomies such as “ unborn child” and “fetus,” expectant mother” and “pregnant woman,” “anti-choice’’ and “pro-choice,” “pregnancy termination” and “murder” symbolize the polarity of the abortion argument and the importance of language as a powerful conceptual weapon. The debate over reproductive rights is a war often fought on a linguistic battlefield. There, combatants forgo rules of engagement. Mal-intentioned illiteracy, ranging from the puerile to the vituperative, is always strategic.
Bajakajian: New Hope for Escaping Excessive Fines under the Civil False Claims Act
Authors: Ballengee Melissa
Published: June 2007

Ever since the U.S. Attorney General named health care fraud as the government's second highest priority after violent crime, the government has cracked down on health care fraud and abuse. Some of this crackdown has been needed. The General Accounting Office (GAO) estimates that as much as 10 percent of all government expenditures on health care are being siphoned out of the system because of fraud or abuse.

The extreme measures taken to curb health care abuse have raised eyebrows, however. The American Medical Association and the American Hospital Association both have been vocal in their disapproval, describing the current enforcement initiative as “absolutely out of control.” The associations even went so far as to file suit to enjoin the government's actions.
Symposium on Public Health Law Surveillance: The Nexus of Information Technology and Public Health Law
Authors: McGowan Angela , Schooley Michael , Narvasa Helen , Rankin Jocelyn , Sosin Daniel M.
Published: June 2007

The Centers for Disease Control and Prevention’s (CDC) goal is to develop a surveillance system of public health laws that would both support research and analysis among policymakers and legislators, and support the scientific basis for public health law. This session was convened, in part, to discuss the value of creating an electronic system to track public health legal information. Public health surveillance is the “ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health. Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses.” There is currently no system available that meets the goals of this definition of “surveillance” for public health laws.
Public Health Preparedness and the Law in Communities of Color
Authors: Randall Vernellia R. , Safford Glen , Williams Walter W.
Published: June 2007

Public health preparedness must use a comprehensive approach that includes both communities and public health systems. There are three basic questions that should be asked when evaluating public health preparedness in communities of color: 1) Is the community basically healthy?; 2) Does the community have access, to necessary information, resources and services?; and 3) Are the information, resources and services available and provided to the community in a nondiscriminatory manner?

Racial-based health disparities is a well documented fact for many communities of color. Individuals from these communities tend to have more morbidity and higher mortality. This health disparity is race based and not just a function of social class. Similarly, access to basic goods and health care is racialized and class based.
Approaches to Implementing the Olmstead ADA (Americans with Disabilities Act) Ruling
Authors: Jackson Shelley R. , Hafner Gayle , O’Brien Daniel , Benjamin Georges
Published: June 2007

The Department of Health and Human Services, Office for Civil Rights (OCR) enforces Section 504 of the 1973 Rehabilitation Act and Title II of the Americans with Disabilities Act. OCR works through complaint investigations and compliance reviews, as well as outreach, technical assistance, and public education to promote voluntary compliance. In the Olmstead decision of June 1999, the Supreme Court held that the ADA’s “integration regulation” requires state and local government to administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. The decision changed the focus from whether a right to more integrated services exists, to under what circumstances and how services will be provided. The New Freedom Initiative announced by President Bush in February 2001 is a broadbased initiative to remove barriers to community living for people with disabilities and promote swift implementation of the Olmstead decision.
Health Care and Public Health Lawyers: Reclaiming the Historical Role
Authors: Mudron Maureen , Honssinger Cynthia , Meadows Rod G. , Spencer Lori
Published: June 2007

Traditionally, hospital emergency readiness plans primarily addressed natural disasters, but because of preparations for year 2000, the arrival of terrorism in the United States, and the potential for mass casualties, hospitals were prompted to bring together new partners and create new emergency readiness plans. These new plans, however, give rise to a number of important issues hospitals must consider. First, hospitals must consider legal liability that might arise during an emergency. For example, what liability might arise when decision are made regarding the provision of individual treatment versus mass triage? Second, hospitals must be cognizant of relevant privacy rules, such as the Health Insurance Portability and Accountability Act (HIPAA), as they apply to public health emergencies activities. Third, hospitals must be aware of the Emergency Medical Treatment and Active Labor Act (EMTALA) which requires Medicarefunded hospitals to screen patients for emergency medical conditions and prohibits their transfer until they are stabilized.
New Directions for Health Insurance Design: Implications for Public Health Policy and Practice
Authors: Rosenbaum Sara
Published: June 2007

National attention on issues of public health preparedness necessarily brings into sharp focus the question of how to assure adequate, community-wide health care financing for preventive, acute care, and long-term medical care responses to public health threats. In the U.S., public and private health insurance represents the principal means by which medical care is financed. Beyond the threshold challenge of the many persons without any, or a stable form of, coverage lie challenges related to the structure and characteristics of health insurance itself, particularly the commercial industry and its newly emerging market of consumer-driven health plans. States vary significantly in how they approach the regulation of insurance and in their willingness to support various types of insurance markets. This variation is attributable to the size and robustness of the insurance market, the political environment, and regulatory tradition and custom. Reconciling health insurance markets with public health-related health care financing needs arising from public health threats should be viewed as a major dimension of national health reform.
Particle Verbs and Argument Structure
Authors: McIntyre Andrew
Published: June 2007

The article describes the data and literature pertaining to the argument‐structural behaviour of verb–particle combinations in Germanic languages. This topic is of interest for theories of complex verb formation and of verbal and prepositional argument structure. While serving as an introductory text for readers unfamiliar with particle verbs, the article should also interest particle specialists because it highlights problems with existing theories and provides a broader taxonomy of the argument‐structural effects of particles and their interactions with other arguments than has hitherto been offered.
How Linguistics Has Influenced Schools in England1
Authors: Hudson Richard
Published: June 2007

The article reviews a number of changes in English schools that can be attributed to the influence of linguistics. The most obvious one is the introduction of a course on the English language, which occupies about a third of the last 2 years of secondary school (A‐level English language) and which has proved extremely popular with pupils. Other changes are due to two influential ideas: language awareness (the subject ‘language’ unites English and foreign‐language classes and pupils should learn about its general characteristics) and knowledge about language (pupils should learn explicitly about language structure). These two ideas have had a major impact on recent changes in the teaching of both first‐language English and foreign languages, both of which have emerged from a ‘grammarless’ period; the teaching of grammar (and other aspects of language structure) is now required by official documents, although it is not always easy for teachers who themselves know little grammar.
Myths and Modes of Motherhood
Authors: Raphael‐Lef Joan
Published: June 2007

ABSTRACT: It is postulated that some metapsychological concepts, once popularized, acquire the reified status of a Myth which may outlive its usefulness and/or validity and yd remain influential beyond its time.

Ten psychoanalytical ‘myths’ relating to femininity, mothers and motherhood are to examined in the tight of historical, social and theoretical developments:

1. The myth of the castrated mother

2. ‘Anatomy is destiny’

3, Female passivity and masochism

4. Baby = penis

5. Femininity is unfulfilled before motherhood

6. Maternal instinct

7. There is a right way to mother

8. Asocial, antisocial or sociable infant?

9. Mother‐baby symmetry of needs

10. Mothering the exclusive, full‐time commitment of the biological mother.

Two contrasting modes of mothering are formulated, each illustrating different elements of these myths.

The conclusion is that a theoretical framework describing or prescribing femininity and/or motherhood a single, static entity, inevitably obscures the complex Variations between women and mother, in their personal and historical development over time, Adherenre to outdated myths prejudices our psychotherapeutic work with female patience.
Surviving Trauma ‐ Dilemmas in the Psychotherapy of Traumatised Children
Authors: Lanyado Monica
Published: June 2007

The therapeutic process that was significant for the recovery of two traumatised children is described. Exploration of the meaning of the trauma for the children led me to believe that they had experienced it as their internal and external parents failing to protect them from disaster. In addition to this, they felt that their parents had further failed them by being unable to contain their children's distress after the event.

The therapy developed in such a way that I found that I had to be in a state of mind which was like that of the devoted mother's reverie for her infant. This helped the children to feel totally contained again and, having re‐introjected this experience, they slowly started to recover and face the demands of growing up. Attention is drawn to the similarities of this therapeutic process to normal family development.

Both children had extreme difficulty in talking about their traumatic experience, and could only communicate it to me by projection in the transference relationship. In view of their immaturity, verbalisation may not be as important or helpful for these children as containment of the non‐verbal communication.
The Pregnant Psychotherapist's Experience: Colleagues’and Patients’Reactions to the Author's First Pregnancy
Authors: Clementel‐Jones Cecilia
Published: June 2007

ABSTRACT:The reactions of individual psychotherapy patients and colleagues to the first pregnancy of the author are discussed within the framework of the limited literature avail‐able. The associations to the pregnancy theme in both staff groups and therapy groups are discussed. The view is put forward that evident avoidance of this area of clinical observation in the literature is linked to a need to defend an outdated view of analytic neutrality.
Supervision of the Therapeutic Large Group
Authors: Pullen G. P.
Published: June 2007

ABSTRACT: The “Oxford Large Group Study Group” has regularly discussed the large groups taking place in seven local psychiatric facilities. Psychodynamic and other anthropological concepts have proved of value in attempting to understand the complex events presented, with the central role of the “theme” being confirmed. The extension of psychotherapy supervision to the large group appears to have been of value to the study group's members and may also have helped the participating units.
Incest: the Pathological Taboo
Authors: Domon Isobel
Published: June 2007

ABSTRACT: The little boy wants to kill his mother so as to have his mother all to himself. The little girl attempts to push her mother away so as to enjoy her father on her own. This is the oedipus complex, generally accepted as inevitable, even normal. The terminology, however, has not been chosen at random: a complex is a symptom pointing to an illness (depression‐neurosis‐psychosis) which needs treatment. George Dubai, a psychoanalyst from Geneva has put the cat among the pigeons by asking: why accept the fatality of the oedipus complex which gives so much pain to humanity? He states the following:‘The oedipus complex would not develop if parents could accept fully the incestuous feelings of their small child towards them and vice versa’. Dubai attacks the taboo… with a plea for love.
Some Thoughts on the Similarities between Psychotherapy and Theatre Scenarios
Authors: Antinucci‐Mark Giuseppina
Published: June 2007

ABSTRACT. From the theoretical starting point of similarities between theatrical and psychotherapeutic scenarios, I have tried to draw parallels, firstly by exploring some of the implications of the settings and secondly by applying the same analysis to their contents. With regard to the settings I have focused my attention mainly on the devices which constitute the spatial and temporal boundaries. With regard to the contents I have explored a few themes from Pirandello's play Six Characters in Search of an Author.
CLINICAL COMMENTARY
Authors: Sidoli Mara
Published: June 2007

ABSTRACT: My impression on reading this observation is that the mother does not hold the baby enough in her mind. She does not hold him in her arms either and generally conveys the impression of experiencing him as clinging and potentially dangerous. He seems to use his muscles to hold himself together and appears compliant and does not protest by crying in several instances where crying might have been appropriate. His skin rash and snuffling are in my view somatisations of his feeling unheld and distanced by mother. Note that mother associates her cold and bronchitis with the loss of her father. Jimmy seems to be somatising the loss of the breast.

This mother and baby couple appear very often not to be in tune with each other. The only good and rewarding experience for Jimmy appears to be the bottle‐feeding although again mother interrupts before he has finished.
Adolescent Loneliness, Solitude and Psychotherapy
Authors: Holmes Jeremy
Published: June 2007

Abstract. Loneliness, a lack, and solitude, a self‐sufficiency, are distinguished. Winnicott's concept of the capacity‐to‐be‐alone is described as the basis of solitude. A child who is watched over non‐intrusively by a good‐enough mother acquires the foundations of solitude in later life. Where the capacity to be alone has not developed adolescent breakdown may occur. The lonely adolescent encounters bodily phantasies which he may be unable to tolerate. Loneliness is then avoided by clinging or isolation. In psychotherapy the importance of these adolescent experiences is often neglected. Part of the therapist's task is to create a setting in which the patient feels‘held’enough to be able to tolerate loneliness and so, eventually, to enjoy solitude.
The Outcome of Maritally Focused Psychotherapy offered as a Possible Model for Marital Psychotherapy Outcome Studies
Authors: Balfour Frederick , Clulow Christopher , Dearnley Barbara
Published: June 2007

Abstract. A model for describing and judging change in a couple relationship is set out, drawing on a follow‐up method established at the Tavistock Clinic for the assessment of change in individual patients. We present the follow‐up work done with the couple in the chronological order in which it occurred.

Our aim is to show how a psychodynamic formulation of a relationship can be made by using the concept of the shared unconscious phantasy as a factor which describes and justifies treating separate individuals as part of a single system. We suggest that such a framework provides an economic method of formulating a base from which to assess change.
Handling Overdetermination in Short‐Term Dynamic Psychotherapy
Authors: Pierloot R. A.
Published: June 2007

In psychoanalytic conceptions the overdetermination of symptoms by preoedipal as well as oedipal conflicts has been stressed. This entails the necessity of analysing successively the unconscious contents with relation to the different stages of infantile development. This can be realized in a classic analysis, prolonged over a long period of time.

In short‐term dynamic psychotherapy focusing on one crucial conflict is essential in limiting the length of the therapy. But what about other conflicts, co‐determining the disorder? A possible solution is offered by Malan, by introducing in a systematic way the separation‐individuation conflict in the endphase of the therapy.

Another possibility for the problem of overdetermination consists of integrating some elements of other conflicts in the analysis of the focal conflict. This is justified by the idea that in childhood development the working up of later conflicts is impregnated with fixations in former stages. So the elaboration of the oedipal conflict is often coloured by elements of oral fixation. Also negative and positive oedipal desires are often mixed up. This creates the possibility that, although focusing on an oedipal conflict, some aspects of deeper conflict material are revealed. These ideas are illustrated by two case‐histories.
Shame and Envy
Authors: Berke Joseph H.
Published: June 2007

‘In this paper I have discussed the nature of shame and its relation to envy. Shame arises from a sudden unwelcome awareness about oneself, while envy is provoked by the painful perception of discrepancies between oneself and another. Both shame and envy aim to eliminate the subsequent tormenting inner tension by rageful, destructive attacks on the real or imagined causes of the torment. However, with shame it is the tension itself which most people recognise as shame, while with envy it is the angry discharge which follows. In fact the model is the same for both which leads to the conclusion that shameful tension is a variation of, as well as a contributor to, envy.
The Metaphor of Twinship in Personality Development
Authors: Fisher Susan
Published: June 2007

To develop one's own separate identity and sense of personal authority is a particularly difficult task within a twinship relationship. Twinship creates the additional obstacle of separating from a need‐satisfying sibling before progressing to the struggle for separation from mother. This paper examines these difficulties within the metaphor of twinship, linking them to the development of identical twins, object relationships and psychotherapeutic practice. Twinship is discussed as a schizoid phenomenon, with reference to reality, narcissism, relatedness, mirroring, dependency needs, boundaries and space.
An Integrative Approach to Couple Therapy: Altering the Treatment Modality to Resolve an Impasse
Authors: Cohn Barbara R.
Published: June 2007

In this article the author demonstrates an integrative approach to couple therapy in order to resolve a treatment impasse. The systematic alternation of individual and couple sessions was introduced into an ongoing couple treatment. This change in treatment modality enabled necessary work on the self systems of members of the couple which in turn improved the couple relationship. The author uses an understanding of object relations, self psychology, and systems thinking both to explore the dynamics of the couple and to explain why the restructuring of the treatment was useful.
Issues for Men Working with Sexually Abused Children
Authors: Frosh Stephen
Published: June 2007

This paper outlines some issues facing men who work with children who have been sexually abused. It is argued that there is an intrinsic connection between child sexual abuse and masculine sexuality. Working with abused children faces men with our own potentially abusive tendencies. To some extent commitment to child sexual abuse work can be understood as a response to this situation expressing, for example, reaction formations or reparative urges. Two case examples are given to demonstrate the importance of recognition of these factors and the way such recognition may contribute to therapeutic utilisation of transference and counter‐transference emotions.
Whither‘Rugby’? ‐ Towards a Profession of Psychotherapy
Authors: Dyne Deryck
Published: June 2007

HISTORY

The Foster Report on Scientology (HMSO 1971) concluded that psychotherapy in the UK should be controlled by legislation. The analysts, psychiatrists and behaviourists approached the DHSS (1974) to be told (1975) that there was no hope of legislation. Between 1975‐8 the Profession's Working Party conferred widely within the field and proposed indicative legislation and a psychotherapy council (Sieghart 1978). In 1981 a private member's bill to create a Council of Psychotherapy (the Bright Bill) was talked out (House of Commons), and the DHSS stated that until the profession could agree on the need for a register of practitioners and who should be on it the government would not act. In January 1982 the BAC conducted (in Rugby) a symposium for interested parties to discuss the issues raised by the DHSS's position; a working party was formed to arrange a conference. The issue of registration was put on hold whilst participants developed a dialogue to create the basis for a Standing Conference. Since 1982 the conference has met annually under its working party, trying through discussion to develop a constitution all can accept.
Personal Therapy in the Training of the Psychotherapist: Is it Effective?
Authors: Macaskill Norman D.
Published: June 2007

SUMMARY: Personal therapy for therapists is generally seen as an invaluable component of training. A review of the empirical literature on personal therapy in training found that approximately two‐thirds of trainees find their personal therapy satisfactory. 15‐40% however, report unsatisfactory outcomes or negative effects. Personal therapy in the early stages of training may have a deleterious effect on the therapist's work with patients. No evidence was found to support the view that personal therapy significantly enhances therapeutic effectiveness. Some reasons for this negative conclusion are mentioned and suggestions are offered for further research in this area.
The Shape of Change
Authors: Moore Norah
Published: June 2007

SUMMARY: This paper considers patterns of change that occur in analysis, in terms of image or of model, with clinical examples. Linear and spiral models of individuation are discussed, and Jung's notion of enantiodromia between opposite parts of the psyche is related to Thom's catastrophe theory.

Change is crucially important for an analyst whether in the patient or in himself, or in his dialectic with the patient. He may not actively foster change nor set it as a goal, but if there is stasis he knows that vitality has gone.

In this paper I look, not at how change is effected, but at the shape of change itself.

Some years ago the phrase‘the shape of change’was used by a biologist while investigating the variation of biological behaviour (Gorman 1976). I use it in a similar way in exploring the patterns the course of analysis or of life may take.
Dolls and Bears: From Symbolic Equation to Symbol The Significance of Different Play Material for Sexually Abused Children and Others
Authors: Sinason Valerie
Published: June 2007

SUMMARY. Finding that a significant number of children were unable to touch or play with the standard doll families and animals available, the therapist brought into the therapy room large and ordinary sized dolls and teddy bears (black, white, baby, teenaged). To her surprise these were quickly used to reveal and explore incidents of sexual and physical abuse. This led her to the conclusion that children who have experienced concrete attacks need different material to help them regain their capacity to symbolise. In this paper she focusses on the meaning of the new toys for two children in particular. She now includes a range of different‐sized dolls as standard equipment for all children and adolescents and comments on their applicability.
Are Psychotherapists Out of Touch?
Authors: Woodmansey A. C.
Published: June 2007

ABSTRACT. Touching ‐ as well as not touching ‐ conveys messages‐ It also constitutes aprimary experience with emotional and trophic effect Both functions arc important for psychotherapy.

Attachment theory logically implies (and experience confirms) that patients who lacked adequate mothering in early life require ‐ like children ‐ actual physical cam‐giving. It may he necessary to communicate with some patients by touch before treatment can start, whereas others are at first afraid to be touched. However, an essential pan of psychotherapy is enabling patients to lose their fear of accepting what they need.

Objections m therapeutic touching are subjective and due largely to sexual fears. Problems in this area emphasise the imperative need for all psychotherapists to have regular access to therapeutic supervision.
Child Sexual Abuse ‐ The Child's Experience
Authors: Vizard Eileen
Published: June 2007

SUMMARY. This paper looks at child sexual abuse from a child's viewpoint, and postulates three levels at which the child experiences the abuse, both at the time fit, occurrence and during later development. It is suggested that the greater the child's difficulty in integrating the experiences from these three different levels the poorer the healing process after abuse and the worse the effectwill be on the child's subsequent mental health. Clinical examples are given of some of theconcepts described.
Treatment of Early Narcissistic Disturbance
Authors: Corney M.J.R.
Published: June 2007

ABSTRACT. Patients who have experienced severe disturbance in their early maternal care and who were disallowed narcissistic experience prove very difficult to treat in a therapeutic context. The nature of the problem, clinical implications and traditional treatment methods are explored. This group of patients, although very often seen as‘worthwhile’, do not seem to get better in any fundamental way and are often rejected as untreatable. Whilst some therapists have explored the area of encouraging a patient's creativity, this has typically been done to improve morale or in an attempt to‘make whole’rather schizoid personalities. It is argued here that the patient needs to be helped to become the good‐enough and non‐contemptuous parent to himself, and that the creative sphere is the area for this. The patient's artistic efforts can be mothered, and are immune to the damaging influence to which real children would be subject. Narcissistically disturbed patients often have clinically envious personalities. Encouraging their creativity also provides a valuable psychological space in which they are able to show gratitude, and have this received in a safe way.

Caution is expressed about need to‘hold’this process whilst working with the patient in this way and about some of the dangers inherent in the creative process, using the work of a gifted poet as an illustration.
The Transformation Function in Light of a New Model of the Mind
Authors: Langs Robert
Published: June 2007

SUMMARY. The paper introduces a new model of the mind based on psychoanalytic listening which attends carefully to the distinctions between derivative and nonderivative communication, and the three levels of meaning in messages ‐ manifest, implication and encoded. The model forms a basis for revising Freud's theory of primary and secondary process thinking as well as notions of unconscious communication, experience and information processing.

The paper then conceptualises a particular subsystem of the model ‐ the transformation subsystem (TSS). The transformation function safeguards processing which takes place in the deep unconscious system at a high level of perceptiveness and intelligence. The information processed is coated with anxiety and terror, and the transformation function assures that the images involved will not gain direct access to awareness. Displacement and symbolisation are the essential components of this processing system.

On this basis, patients are classified as transformers or nontransformers, and factors in this aspect of communicative style are presented. The basic flaw in the human mind to which the transformation function contributes, namely, that information derived from the processing which takes place in the deep unconscious system is not available for conscious adaptation, is identified and discussed. Nonetheless, the transformation function is seen as a safeguard against somatisation, acting out and, more fundamentally, as a modulating factor in the human psyche. The means by which the transformation function safeguards against symptom formation is articulated, as is the means by which the therapist may assist the patient in expressing him or herself in this fashion.

The paper concludes with a comparison between Bion's Alpha function theory and the present theory of transformations. Brief mention is made of the dysfunctions in the TSS in schizophrenic patients.
The Extra‐Analytic Transference and the Analytic Triad
Authors: Fine Reuben
Published: June 2007

SUMMARY. This paper highlights some neglected aspects of transference. It may be summed up as follows:

In the psychoanalytic process, there is always an analytic triad consisting of the patient, the analyst and one other significant person in the patient's life. This other person may vary from time to time, thus calling into existence various extra‐analytic transferences.

While these extra‐analytic transferences have on the whole been neglected in theory, in practice they are exceedingly relevant. Since there are always two transferences, one to the analyst and one to an outside figure, working through the transference to the analyst cannot be done properly without also working through the extra‐analytic transference(s).

In this procedure the real relationship to the analyst has to be given due weight as well as the transference relationship to the‘real’outside person. As Greenson has pointed out,‘real’and transference’become relative terms in both cases; the‘transference’relationship has many real elements; the‘real’relationship has many transference elements.

Numerous case illustrations from Freud, the general literature and the author's practice are cited to illustrate these points. The significance of these considerations for the analytic process is stressed.
The Explanation of Impulsive Action
Authors: Lansky Melvin
Published: June 2007

Impulsive action, such as binge eating or drinking, wrist‐slashing, compulsive promiscuity or chronically explosive marital conflict, presents serious problems for psychoanalysis. Such action evokes explanations both from the analyst and from the patient. The analyst may be held captive by explanatory notions that emphasise one aspect of impulsive action rather than the whole process. These explanations are based on our notions of drive pressure, adaptation, control and attack of intimate persons, ‘acting out,’ and the ‘compulsion to repeat’. The patient's explanations may be either consciously stated or inferred by the analyst as unconscious‘explanations’from associative material. If the patient's explanations dovetail with or adapt to those of the analyst, the analyst may take them as confirmatory, and the whole process of breakdown and restitution may escape analytic scrutiny.

This process includes: (1) a precipitant that is narcissistically wounding; (2) a prodrome consisting of an experience of lack or absence which the patient feels as persecution, and a restitutive phantasy of the lack as fillable by a consummatory act; (3) the act itself; (4) character defences that ward off mortification on awareness of personal disintegration (shame) or the consequences of the act (guilt); explanations emphasising guilt often screen those giving rise to shame; (5) an attempt to regulate distance to protect against narcissistic injury by keeping intimates from getting too close or too far away.

The therapist's tendencies to overemphasise the precipitant, the meaning of the act, or its distance regulating may convey an attitude of blame rather than understanding. Therapeutic emphasis on the subjective experience in an unintegrated way is sympathy, not empathy; sympathy is collusive and fosters splitting and impedes working with the negative transference. Blame or sympathy may be buttressed by the type of explanation accepted by analyst and patient. Explanatory preconceptions must be transcended to do effective interpretive work. Interpretation should convey understanding of a preoccupied ego that manifests its disorganising and restitutive propensities in the process of impulsive action.
Internal Conflict
Authors: Woodmansey Colin
Published: June 2007

… the extraordinary propensity of the human being to join hands with external forces in an attack upon his own existence is one of the most remarkable of biological phenomena (Menninger 1938)

The term 'superego’(which should perhaps be replaced by‘anti‐ego’) is used to denote a set of habitual response tendencies that are antagonistic to the self, and cause the subject to behave as if he were two separate persons at war with each other. The superego develops in early life and may be ‘punitive’or‘humiliating’or both. The former kind arises through learning to restrain the self from dangerously rebelling against overwhelming coercion, and the latter through intense striving to avoid parental scorn. The resultant‘internal’conflict resembles the external one between an actual child and a demanding parent; and the relative fortunes of the two antagonists provide a model for understanding the characteristics of many kinds of emotional and psychosomatic disorder. Superego behaviour is propagated from generation to generation; and perpetuates itself in the individual by preventing the responses that, by proving it unnecessary, would lead to its extinction. Self‐punitive conditions are therefore highly resistant to treatment, which must be specially directed to the particular needs of each of the patient's two conflicting parts in turn. To be able to do this, psychotherapists themselves need to be freed from their own internal conflicts during training and later.
The Proper Image of Mankind
Authors: Pedder Jonathan R.
Published: June 2007

Guntrip's (1977) vehement rejection of Erikson's (1965) image of man as centaur, particularly when the latter seemed so close to Freud's rider‐and‐horse metaphor for the ego and id, prompted a review of the appropriateness of these and similar metaphors or images of mankind such as centaur, fallen angel or irredeemable devil. This leads into the consideration of other issues such as whether psychoanalysis is a science or an art; whether it belongs in the rational or romantic tradition; whether it is a science at a pre‐scientific metaphorical stage or a new humanism in its own right.
Dream Work in Analytic Psychotherapy
Authors: Heller Mary Brownescombe
Published: June 2007

This paper explores the significance and meaning of a first dream brought into once a week psychotherapy. A variety of analytic models relating to the function of dreams is briefly described in order to provide a background to the general theory and practice of dream analysis and, more specifically, as aids in the understanding of this particular dream.
The Paralysis of Indecision
Authors: Lamprell Michael
Published: June 2007

Through clinical material ambivalence is explored as a defence by keeping differences apart or denying their existence, and as positive in the bringing together of differences. The therapist's own seductive feelings in the countertransference and aspects of the process are seen as important indicators of a primary relationship where the parental narcissism has caused the patient to become ‘ stuck’in ambivalence in order to fulfil the parental need for ‘sameness’. The child/patient, however, also resists ‘sameness’with controlling ambivalent behaviour and by being in control of nothing happening. For the convenience of style the therapist in this paper is referred to in the masculine and the patient in the feminine.