bluuebunny/crossref_metadata_2025 huggingface dataset:
Avoiding Family Feuds: Responding to Surrogate Demands for Life-Sustaining Interventions
Authors: Alpers Ann , Lo Bernard
Published: June 2007

The laws and ethical guidelines governing decision making for incompetent patients evolved from controversies in which family members refused life-sustaining interventions. These cases led to a consensus that advance directives to limit interventions should be respected and that a surrogate designated by the patient or specified by statute could refuse interventions, even when other relatives disagreed. Surrogate decision-making statutes and ethical principles about respect for delegated autonomy promote an active role for family members or other surrogates in medical decisions for incompetent patients. Inviting surrogates to participate actively in medical decisions recognizes the importance of the patient's personal community and assures that decisions will reflect the patient's own preferences and values.

The standard approach to decisions for incompetent adults gives advance directives priority over a surrogate's substituted judgment, which in turn has priority over assessments of the patient's best interest. A patient may express advance directives by appointing a proxy, stating specific preferences, or articulating general values. We use case examples to illustrate the limitations of all three types of advance directives.
Guidelines for IRB Review of International Collaborative Medical Research: A Proposal
Authors: White Mary Terrell
Published: June 2007

The increase in the scope of international collaborative medical research involving human subjects is raising the problem of whether and how to maintain Western ethical standards when research is conducted in countries with very different social and ethical values. Existing international ethical guidelines for research largely reflect Western concepts of human rights, focusing on the bioethical principles of respect for persons, beneficence, and justice. However, in countries and societies where these values are understood differently or are not expressed in local cultures and institutions, it may be impossible or of no practical value to insert them into the research setting.

In the United States, individual informed consent is considered ethically imperative for research involving human subjects. However, this imperative may be difficult to instill in societies that define persons by their relations to others, and important decisions are commonly made by heads of households or group leaders rather than by individuals. The baseline economic and health care conditions in foreign communities may also create ethical conflicts.
Non-Heart-Beating Organ Donation: A Defense of the Required Determination of Death
Authors: DuBois James M.
Published: June 2007

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved.

Many people now consider such cases of non-heart-beating organ donation to be ethically permissible. However, widespread disagreement persists as tohowsuch practices are to be justified and whether such practices are compatible with the Uniform Declaration of Death Act (UDDA). In this paper, I argue that non-heart-beating organ donation can be ethically justified, that in the justified cases the patients are in fact dead, and that the early declarations of death required for such donation do comply with the UDDA.
Survey of State EMS-DNR Laws and Protocols
Authors: Sabatino Charles P.
Published: June 2007

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate (DNR) orders effective in nonhospital settings. Applicable primarily to emergency medical services (EMS) personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly calledout-of-hospitalorprehospital DNR orders,although one state-Virginia-recently amended its DNR law to establish adurableDNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably asout-of hospital DNR protocolsorEMS-DNR protocols.The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999.
Ethical and Legal Aspects of Sperm Retrieval after Death or Persistent Vegetative State
Authors: Strong Carson
Published: June 2007

Several methods have been reported for extracting sperm from a man after he dies or enters a persistent vegetative state (PVS). Although such sperm retrieval could be performed for nonprocreative purposes, such as research, in this paper I focus on cases involving procreative intent. Since 1980, more than ninety cases have occurred in which family members requested sperm retrieval from patients who died or were irreversibly unconscious, with the intent that a wife, girlfriend, or other woman would be inseminated. Recently, the first report of pregnancy and birth following postmortem sperm retrieval appeared in the media.

In these cases, death or PVS typically is caused by anoxic injuries, trauma, or rapidly progressing infections.
From Public Health to Population Health: How Law Can Redefine the Playing Field
Authors: Fox Daniel M. , Kramer Mary , Standish Marion
Published: June 2007

Today’s panel is about the expanding boundary of population health policy, what that expanding boundary has to do with law, and what kinds of challenges and opportunities come out of it. What I want to do for the next few minutes is talk to you about the notion of population health as it exists where law and policy are made, rather than where it exists in a spectacular international theoretical literature. Then I want to introduce our panelists. In the process, I will explain why the Honorable John Nilson, is not with us, which tells you a great deal about not only the real world of the politics of population health, but also about the kind of trouble you can get into if you are a first class lawyer involved in population health.
Public Health Law: The Values of Global Collaboration
Authors: Sohn Myongsei
Published: June 2007

I would like to extend my appreciation to the planning committee of this outstanding conference, the Centers for Disease Control and Prevention (CDC) and the American Society of Law, Medicine & Ethics (ASLME) for allowing me to have this great opportunity to share my experience in teaching and studying medical and public health law and ethics with my U.S. colleagues. This morning, USA Today is reporting that Brundtland, the Director General of the World Health Organization (WHO), finally declared that the aggressive control measures have stopped SARS. I think it is a special achievement on her part as she departs the WHO in less than two weeks. The new Director General of the WHO, JW Lee, is a close friend of mine.
The Role of Law in Health Services Delivery: Diabetes and State-Mandated Benefits
Authors: Hartsfield DeKeely , Vinicor Frank
Published: June 2007

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes (5.9 million of which are undiagnosed), and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes (i.e., altered diet and physical activity) can prevent or delay the onset of Type 2 diabetes for high-risk individuals.

The Division of Diabetes Translation at the Centers for Disease Control and Prevention undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes.
When Public Health Meets the Judiciary
Authors: Murphy Michael J. , Murphy Anne M. , Conner Maureen E. , Chezem Linda
Published: June 2007

The conflict between courts and medicine is best shown in the mental health cases requiring judgment of whether a person should be confined, and whether they should be medicated or left free to decide for themselves. In such cases, deprivation of liberty for noncriminal offenders is at question, but if they are released, they may be exposed to injury or injure others. “Clear and convincing” evidence is hard to prove in such cases.

The TOPOFF 2 terrorism preparedness exercise was two years in planning, but the courts were involved only seven days before the exercise (because quarantine issues were added to that exercise only two weeks beforehand). Judge Murphy was put in charge of the Circuit Court building and was asked to stop all court proceedings to stop people from going into a building that might have been contaminated.
Applying the Regulatory Powers of Public Health
Authors: Monson Angela Z. , Pauls Jake , Leverett Michelle
Published: June 2007

The advent of sales over the Internet has led to interesting developments in sales tax policy as states attempt to monitor, control, and collect revenue from illusive Internet tobacco vendors. Tobacco sales have been successfully monitored and regulated, to some extent, in convenience stores, grocery stores, and smoke shops, and in most cases sales taxes are collected. The Internet, however, is extremely difficult to regulate. States could use their regulatory powers to ban the sale of products such as tobacco and alcohol over the Internet, but enforcement would be nearly impossible.

The issue of enforcement of Internet sales is extremely difficult. Keeping the products out of the wrong hands, under aged children for example, is difficult. Also, it is difficult in terms of tax policy.
Land Use and Zoning for the Public’s Health
Authors: Bragg Bruce , Galloway Thomas , Spohn Doug B. , Trotter Donne E.
Published: June 2007

It is important to re-engage public health professionals, after an absence of almost a half a century, in the issues of land development and community design. Resources should be devoted to processes that directly engaged diverse communities in defining their idea of good public health. In Michigan, within demographic communities, the idea or definition is slightly different, but an agreement was reached that activities should be developed around four basic environmental areas: food, air, water, and land use. Resource teams were developed around each of these areas, and an attempt was made to describe the current status of environmental conditions and identify major health problems. The community was engaged in a dialogue and a strategy for improvements was developed. The Michigan Land Use Resource Team identified land trends, described water and air quality, and even mapped automobile injuries, including pedestrian injuries and deaths.
New Developments in Public Health Case Law
Authors: Thiel Karen Smith
Published: June 2007

In recent years, public health law has seen some important court decisions. Those are presented below.

In Pelman v. McDonaldS Corporation, the court dismissed a complaint filed by three children who claimed that McDonald’s practices in making and selling its products were deceptive. This deception, the children alleged, caused them to consume McDonald’s products with great frequency and become obese, thereby injuring their health. The plaintiffs pled five causes of action against McDonald’s, alleging that McDonald’s: 1) failed to adequately disclose the ingredients and health effects of its products and described their food as nutritious without disclosing detrimental health effects; 2) engaged in marketing techniques geared toward inducing children to consume their products; 3) acted negligently in selling foods high in fat, cholesterol, salt, and sugar when studies show that foods containing these ingredients cause obesity and detrimental health effects; 4) failed to warn consumers of the quantity and qualities of levels of fat, cholesterol, salt, and sugar in its products or of the detrimental health effects of such foods; and 5) acted negligently in marketing foods that were physically and psychologically addictive.
Using the Turning Point Model State Public Health Law
Authors: Gostin Lawrence O. , Safford Glen , Erickson Deborah
Published: June 2007

The Turning Point Initiative is an initiative for which the Robert Wood Johnson (RWJ) and W.K. Kellogg foundations partnered in order to fund a group of states and a number of communities within each of those states to work through a planning process to look at ways to strengthen their public health systems at the state and local levels. Out of that process, the states and communities would come together at the national level to talk about what they had been learning and what the issues were. There were a number of issues that resonated with all of the states.
Understanding Contemporary Millenarian Violence
Authors: Walliss John
Published: June 2007

The last quarter of the twentieth century witnessed several incidents of collective violence involving millenarian/apocalyptic New Religious Movements. This article reviews the academic literature that has emerged over the last few decades on millenarian violence, focusing on the key recurring characteristics and dynamics that have been highlighted by commentators as playing a significant role in both predisposing millenarian groups to volatility/violence, and also in precipitating these incidents of collective violence.
Crossing Boundaries, Crossing Scales: The Evolution of Environment and Resource Co‐Management
Authors: Plummer Ryan , Armitage Derek
Published: June 2007

As an approach to mediating human–environment interactions, the co‐management of natural resources influences a diverse array of geographic endeavors. This article chronicles the development of the concept from its historical roots to the more recent past, where it has gained prominence as a tenable solution in situations of competing property claims and as a model of environmental governance. In surveying more that 15 years of experience with co‐management, we draw attention to several points of contention or debate, including concerns about power‐sharing and representation in co‐management arrangements, and the imprecise use of the term. Despite these tensions, the concept of co‐management continues to evolve and is attracting increasing attention. In probing the frontier of this subject, we highlight theoretical developments, evaluative challenges, cultural and ethical sensitivities, and the need to embrace uncertainty and complexity through adaptation and learning. Concluding reflections recognize the multifaceted nature of co‐management, potential benefits, and importance to geographers.
Transference and Counter‐Transference in Practice
Authors: Hahn Herbert
Published: June 2007

This paper looks at some psycho‐analytic definitions of transference and counter‐transference, notes aspects of the wider application of these concepts and offers three examples from professional practice which relate to the theme.
The Impact of Research on the Practice of Psychotherapy
Authors: Firth Jenny , Shapiro David A. , Parry Glenys
Published: June 2007

ABSTRACT Psychotherapists may avoid clinical research partly because they perceive much of it to have little relevance to practice and partly because they feel that any methodologically sound research will produce deleterious effects upon the process and outcome of therapy. This paper describes a research project designed to overcome some of the problems involved. It focusses in particular upon the research procedures which affect, for better or for worse, the process and outcome of the therapy. The issues raised by aspects of research such as assessments, tape recordings, and strict time‐limits, are discussed using clients’comments and therapists’experiences. It is concluded that tackling the issues as they arise in therapy, rather than denying them, can often enhance the therapy and obviate any negative overall effects.
Possession Anxiety: The Other Side of the Castration Complex
Authors: Sabbadini Andrea
Published: June 2007

ABSTRACT Castration anxiety ‐ which is related to the expectation of the loss of a precious object ‐ is only one aspect of the castration complex. Attention is here drawn to its other side, so far neglected in psychoanalytic theory, which I propose to term‘possession anxiety’. Possession anxiety relates to the presence of an ambivalently charged object, which can take its power from the person possessing it. The person will then fear losing control over the object. Possession anxiety is a normal phenomenon, though it is most evident in sexual perversions and anorexia nervosa. It is symbolically represented by the phallus and is associated to the genital stage of psychosexual development.

I briefly examine this concept from the viewpoint of its temporal connotations and in its psychotherapeutic significance for the understanding of the transference. I use as illustration fragments from child observation and from my clinical work with analytic patients.
From Envy to Therapeutic Empathy
Authors: Mester Roberto
Published: June 2007

ABSTRACT Envy and empathy are both object‐related manifestations. The therapist's experience of envy in the course of the therapeutic process is potentially a springboard to the empathic understanding of the patient's immediate psychological state. Fragments of psychotherapies illustrate: (1) the gradual transmutation of the therapist's internalised image of the patient through the progressive understanding of the therapist's own envy; (2) how the resolution of the therapist's envy opens the way to therapeutic empathy.

Countertransferential envy may block the road to therapeutic empathy. The blockage in the cases discussed in this paper function mainly through the use of projection, projective identification and extensive denial. The activation of such mechanisms was rooted in: (1) fear of loneliness and abandonment; (2) anxiety about losing control of aggressive impulses; (3) narcissistic pain. The detection and elaboration by the therapist of his/her own envy removed the blockage to understanding and permitted the empathic analysis of the envied qualities of the patients.
Sexual Abuse in Schools
Authors: Gaitonde Alison
Published: June 2007

The frequency of both allegations and overt sexual abuse within schools could not be established because no records are kept apart from the Department of Education and Science who hold figures of prosecuted cases. In contrast, the daily press suggests sexual abuse in schools is frequent. Research of paedophiles indicates their preference for work in schools.

Clinical cases are described illustrating different types of sexual relationship and group processes within a school following an allegation. The difficulty of establishing the truth is discussed. It is suggested that children may not be properly protected at present.
The Psychotic Adolescent in the Group
Authors: Kwiatkowski Richard M.
Published: June 2007

ABSTRACT: The transition from troubled adolescent to working group member is rarely achieved with ease. The adolescent psychotherapy group with its tendency towards higher group anxiety levels and subsequent skilled defences, and its dependence on behavioural rather than verbal expression requires particular attention. When a psychotic psychopathology is then superimposed upon an already turbulent adolescent process the difficult task of integrating the adolescent into the therapeutic group is massively intensified.

In this paper I shall address myself both to the Psychotic Adolescent in the context of the therapeutic community and more specifically in the psychotherapy group.
The Treatment of Acute Schizophrenic Patients in Private Practice
Authors: Karon Bertram P.
Published: June 2007

There are more schizophrenic patients outside hospitals than in them. Acute schizophrenics are a varied group of patients who very frequently may be best treated in outpatient office practice. They need a therapist who is strong enough to be a protective object and an auxiliary ego and who will deal with the unconscious meaning of the hallucinatory and delusional experiences. Relatives may provide support and housing for patients who would otherwise be hospitalised. Relatives can tolerate a psychotic individual surprisingly well if they see this as a response to an emergency situation which will be necessary for only a month or two at most. The availability of the therapist to the patient by telephone also permits the patient to deal with experiences and situations that would otherwise overwhelm him and require hospitalisation, or end in suicide. How to deal with patients without medication or how optimally to use medication, if that is the therapist's or the patient's preference, is discussed. In the light of current evidence it is clear that prolonged and continuous medication is not neurologically in the patient's best interest.
The Concept of Alexithymia in the Light of the Work of Bion
Authors: Graham Richard
Published: June 2007

ABSTRACT. Bion's work on the genesis, agenesis and dysgenesis of thought, and its subsequent development, allows us to delineate two fundamental mechanisms which are used to avoid the painful anxieties associated with the birth of a thought. These anxieties, which are perhaps best covered by the term catastrophic anxiety, may be avoided by evacuation of the elements that thought is born from, or by the conversion of these elements into pseudo‐elements or lies. The clinical concept of alexithymia, which evolved from work with psychosomatic patients, illustrates how these mechanisms may be manifested clinically by disordered thought and psychosomatic illness.
Humour in Psychotherapy
Authors: Golan Gabriel , Rosenhein Eliyahu , Jaffe Yoram
Published: June 2007

ABSTRACT. Utilisation of humour by psychotherapists attracts increased interest. While the constructive and untoward potential of the use of humour in therapy has been discussed in the clinical literature, the issue has hardly been investigated empirically. The present study explored the reactions of patients to therapist interventions which employed humorous as compared to nonhumorous control reactions. The sample consisted of 60 female patients, of three personality types: obsessive, hysterical and depressive. They were asked to rate on 8‐point scales twelve simulated, tape‐recorded therapist interventions of three functional categories: anxiety reduction, perspective building and emotional confrontation. The results indicated a persistent preference for the nonhumorous over the humorous intervention. Statistical analysis revealed no main effects of either personality type or kind of humour, but these two variables were shown to interact significantly in determining the extent of preference for the nonhumorous over the humorous communications. Analysis of open‐ended responses indicated more ambivalent attitudes toward the use of humour by patients. The implications of the findings for therapeutic theory and practice are discussed.
Psychoanalysis and Psychotherapy: Comments on the Analytic Attitude
Authors: Smith Joseph H.
Published: June 2007

SUMMARY. In this paper I have suggested that the analytic attitude is the contribution to psychiatry generally and should, at least to the extent of respecting the significance of and the security provided by symptoms in terms of the patient's psychic reality, characterise every form of psychotherapeutic intervention. I have also sought to make explicit and extend understanding of non‐defensive passivity. The latter is implicit in Schafer's advocacy of action language and specifically referred to in his mention of excessive claiming of agency, and in his references to necessity, accidents and happenings (1982, pp. 100, 106).
The Use of the Analyst as a Dream Symbol
Authors: Eyre Dean
Published: June 2007

SUMMARY. Many psychoanalysts have written on the appearance of undisguised dreams of the analyst in the course of treatment. Reasons for the appearance of these dreams have ranged from a breach in analytic neutrality to a degree of difficulty in symbolisation. It is clear from reviewing the literature that there is no one single cause for these dreams but that nevertheless they are an important event in the course of treatment. In the case described there was a difficulty in symbolisation leading to a serious clinical impasse which was gradually resolved through an oscillation in the therapy which led to a differentiation of the‘me’and‘not me’. Such a sign of change in the patient's analysis was denoted by the appearance of the undisguised analyst dream, re. the use of the analyst as a dream symbol.
The Rediscovery of the Lost Twin: An account of therapy for a child and his parents
Authors: Small Jacqueline , Greenway Muriel
Published: June 2007

ABSTRACT. A tame‐year‐old

boy whose twin brother had died at birth presented will longstanding, severe psychosomatic symptoms previously resistant to treatment. A combination of milieu and an therapy for the child together with parent and family interviews proud asst in allowing suppressed grief to be acknowledged by parents and child, with consequential alleviation of his symptoms and resumption of normal development and social progress.
‘Therapy Contained Suicide’in the Inpatient Treatment of a Schizophrenic Adolescent ‐ Vicissitudes of Countertransference
Authors: Hazan Yoram
Published: June 2007

In the treatment of an adolescent in a psychoanalytically‐oriented ward a unique schizophrenic experience emerged which allowed for an interaction with the therapist through which we were able to learn of therapists’inner experiences in reaction to the suicide of a patient. The dynamic process of the schizophrenic experience is presented as well a as comparison of the therapists’descriptions of the feelings after the death of a patient with the feelings that arose in this treatment. Through these presentations we shall attempt to understand better the emotional, no of such an encounter.
A Relation Called Father Part 2: The Father and his Children
Authors: Samuels Andrew
Published: June 2007

SUMMARY. In Par, I an analysis was made of the neglect of the father in depth psychology. This was followed by an attempt to find meaning and purpose in incestuous fantasy and behaviour. The role of the father in the formation of gender identity in his sons and his daughters was discussed. In Pan 2 it is proposed that clinicians begin to think of an optimally erotic relation between Lather and daughter, and of the father as transforming the aggression of the son. A further new concept is introduced, that of unconscious‘gender certainty’. The paper includes some reflections on the general cultural aspects of the ideas raised.
Psychotherapy, Suggestion and Sexuality: Historical and Epistemological Considerations
Authors: Chertok Leon
Published: June 2007

ABSTRACT. This paper explores the reasons for the resistance against investigation of the close affective ties which arise between patient and therapist in psychotherapy. It holds that a confusion between attachment and sexuality may be one reason why psychoanalysts do not study the role of suggestion ‐ defined as an archaic, preverbal affective relationship ‐in psychotherapy. While American writers have investigated the question of sexual relations between therapist and patient, ever since the advent of animal magnetism 200 years ago provoked fears of erotic involvement, the deep affective sources of change in psychotherapy have been masked by the taboos of sexuality.
Infancy and Childhood: A Jungian Vertex
Authors: Sidoli Mara.
Published: June 2007

SUMMARY. In this paper I have tried to give an account of the way in when a Jungian approach to infancy and childhood has developed and is still evolving, beginning with Jung's early on childhood as a stage of adaptation to the demands made on the child by the external world, and his idea that the child is, as it were, still enclosed in the psychic atmosphere of his parents until the onset of adolescence when lie consciously begins m separate from them. Into, United States Frances Wicker was a contemporary of Jung who worked with children, but her ideas on the subject entered very little from Jung's own.

It was Michael Fordham who, in the 19501 made a great contribution to the field of Jungian child analytical psychology by applying Jung's theories of the self, the archetype and individuation to infancy and childhood. He conceptualised a primal self, the totality of psychesoma in a germinal stage from the tarp start of intrauterine life, a steady state of integration from which the child's psyche and his physical growth will unfold through a dynamic process which he named deintegration‐reintegration processes. Applying the theory of archetypes to infancy means that a predisposition exists in the child to develop archaic ideas, feeling and phantasies without their being implanted in him and without his interesting then.

Following Fordham, I proceed to discuss how the instinctual discharges in Infancy get modified by the experience of being mothered, and how the baby discovers background images which both fit and evoke his experience. I compare Fordham's definition of a‘primary integrated state’with concepts used by both Bion and Meltier to describe a similar primitive state of affairs then consider the function of the mother as the container of the baby's body and mind, as well as an orientating cents which enables the baby to build up his internal and external sense of space and time. From this point go on to consider the process o took separation individuation and quote an example from an infant observation of a baby girl who took along time to come to life.
How the Infant Develops a Sense of Time
Authors: Sabbadinil Andrea
Published: June 2007

SUMMARY. The initial lack of differentiation between self and object, the predominance of the pleasure principle, of primary process functioning and of primitive narcissism are reflected in the infant's experience of time as a mono‐dimensional omnipresent, related to the timelessness of the Unconscious.

With the gradual establishment of object relationships, object and self constancy, secondary process functioning and the reality principle, the child begins to experience time in a differentiated past/present/future perspective.

I briefly illustrate the connection between disturbances in the development of the sense of identity, time awareness and object relationships, with material from the analysis of two adult patients: a borderline artist and a‘replacement child’.
Schizophrenia, Genetics and Analytical Psychology
Authors: Royston Robin
Published: June 2007

A brief summary of genetic research into schizophrenia is followed by a résumé of Jung's ideas regarding the psychology of schizophrenia. The latter is then discussed in the light of recent biological findings followed by a discussion of the tendency to see psychological factors as causative. Finally, a model incorporating biological and psychological factors based on Jung's hypothesis is proposed.
The Origins of Transpersonal Psychology
Authors: Guest Hazel
Published: June 2007

This paper discusses some of the concepts in the theory and practice of transpersonal psychology and the sources from which they have been derived. The basic concept of the ‘self as distinct from the‘ego’is characteristic of most Eastern philosophies. The use of imagery as a means of contacting unconscious material can be traced back through the esoteric practices of both West and East, its recent applications having been developed by Carl Jung and Roberto Assagioli. Abraham Maslow began modern research into transcendental altered states of consciousness with his research on peak‐experiences.
Exploratory Therapy in Two‐Plus‐One Sessions I ‐ Rationale for a Brief Psychotherapy Model
Authors: Barkham Michael
Published: June 2007

This paper presents the rationale for a brief form of psychotherapy based on the Conversational Model of psychotherapy developed by R F Hobson. In the proposed model, termed Two‐Plus‐One Exploratory therapy, clients are seen for two sessions one week apart followed by a third session three months later. Issues pertaining to service delivery needs and client selection are discussed prior to presentation of (1) the clinical basis for the model, and (2) the research bases relating to number of treatment sessions, treatment span, and planned follow‐up. The implications of implementing the proposed model for both psychotherapy researchers and clinicians are discussed.
Exploratory Therapy in Two‐Plus‐One Sessions II ‐ A Single Case Study
Authors: Barkham Michael , Hobson Robert F.
Published: June 2007

This paper presents a single case study employing a model of brief Exploratory therapy, termed two‐plus‐one therapy, in which a client, Doris, presenting with an intense fear of thunder, was seen for two sessions one week apart followed by third session three months later. The therapist was Dr Robert Hobson and the three sessions were videotaped. The paper presents five central components of the model: (1) focus on the client's affect; (2) identification of a focal issue; (3) personal meaning of dream content; (4) emphasis on the interpersonal process in the ‘here and now’; and (5) identification of a narrative point of origin. These components are presented with extensive use of verbatim transcripts of the sessions to illustrate these components together with the techniques used in this mode of brief therapy. The changes achieved, and not achieved, in the client's pathology are discussed.
Incest: The Father and The Male Therapist
Authors: Mann David
Published: June 2007

This paper examines the special issues relating to a male therapist working with incest survivors. Recent literature is reviewed. The therapist/patient relationship is then looked at in general terms. Areas where the therapist may be identified with the aggressor father are then discussed. Finally erotic aspects of the relationship are examined in detail. It is proposed that incestuous attraction is part of a healthy maturational process. It is suggested that by dealing with his incestuous fantasies the therapist clarifies rather than blurs sexual boundaries. A male therapist may heal the primary lesion with male authority figures enabling the patient to experience an intimate relationship with a man that is non‐exploitative.
Pre‐Adoptive Diagnosis: The Meaning of a Crisis
Authors: Sabatello Ugo , Natali Paola , Giannotti Adriano
Published: June 2007

This paper focuses on, and illustrates with clinical material, some of the specific problems of adoption both for the parents and for the child. It also tries to define some of the psychological peculiarities characteristic of couples who ask for adoption. After this introduction, we explain the modalities of the pre‐adoptive diagnosis used by our Service with their theoretical background, their aims, the problems involved, and the results they intend to achieve.
Courses in Psychotherapy: Evolution and Current Trends
Authors: Pedder Jonathan R.
Published: June 2007

The evolution of courses in analytic and dynamic psychotherapy is discussed. A brief historical sketch of the Rugby Psychotherapy Conferences is included as a background. Three types of training are identified: independent analytic trainings, regional diploma courses and senior registrar trainings. Different levels of psychotherapy are emphasised and the idea of a three‐stage training: primary degree, core professional qualification and postgraduate specialist training. The position of the core professions and their relevance and significance are discussed in relation to the possible development of a new profession of adult non‐medical psychotherapists.
A Comment on Jonathan Pedder's ‘Courses in Psychotherapy’: A Future for Training in Psychotherapy*
Authors: Dyne Deryck , Figlio Karl
Published: June 2007

This is a response to Dr Pedder's paper (this issue). We consider the possible impact of the European Community (EC) after 1992 and the role of the United Kingdom Standing Conference for Psychotherapy (UKSCP) in the training of psychotherapists. We agree that the core professions should be involved in trainings; we oppose a three tier system and suggest a part‐time modular MA/MSc degree; and we urge the UKSCP take on a major responsibility in an EC context. Whilst our main focus is analytical psychotherapy, we believe other orientations might be equally affected. Our comments draw on a paper in preparation for the British Journal of Psychotherapy.
Healing, Exorcism and Object Relations Theory
Authors: Field Nathan
Published: June 2007

From the earliest years of the psychoanalytic movement analysts have inclined to be either healers or exorcists. Jung, Ferençzi, Rank and Reich seem to speak with the characteristic voice of the healer. There is an implicit trust in the healing power of relationship, an emphasis on the patient's creative potential, a readiness to engage. Whereas those analysts, like Karl Abraham, who followed Freud's advocacy of analytic detachment, maintain a greater distance between themselves and their patient while focussing on the negative aspects of the infantile psyche. This tradition set the style of the classical analytic approach rigorously maintained by Melanie Klein and her followers. The Kleinian school actively challenges resistance, manipulation, seduction and all the carefully hidden expressions of negative transference. In their determination to‘name the devils’and their readiness to confront them, they, like Davanloo, take the characteristic stance of the exorcist.

While healing and exorcism are very different modes of functioning, it would be a false simplification to see them as mutually exclusive. The shaman, in reclaiming the lost soul, must at the same time do battle with the devils that hold it captive. The exorcist, even as he drives out the demons, prays earnestly for the soul of the sinner. An object relations analyst must be capable of controntation when the occasion warrants; equally the classical analyst heals through sensitive understanding and the maintenance of safe analytic boundaries. Healing alone will fail where no attempt is made to purge the patient of his bad inner objects. But, more fundamentally, the whole therapeutic enterprise is meaningful only to the degree that a truly human connection has been established. The difficulty is to move freely between the two modes and to see them as complementary aspects of a single process.
Psychotherapy with Adult Survivors of Child Sexual Abuse
Authors: Gardner Fiona
Published: June 2007

This paper explores issues raised in psychotherapeutic work with adult survivors of child sexual abuse. An analysis is made of the long‐term psychological effects of the trauma and the psychic dilemma as experienced by the patient. Four themes relevant to the therapist are explored: the problems raised by the seduction theory, the dangers of interpreting the patient's experience as fantasy, the potential abuse of power and control, and the implications of the gender of the therapist.
The Dispositional Nature of Transference
Authors: Whyte Chris
Published: June 2007

A case example is used to illustrate how Gilbert Ryle's concept of a disposition helps to understand the nature and function of transference interpretations.
A Retrospective Follow‐Up Study of 84 Patients Treated with Individual Psychoanalytic Psychotherapy. Outcome and Predictive Factors.
Authors: Clementel‐Jones Cecilia , Malan David , Trauer Tom
Published: June 2007

84 patients treated with individual psychoanalytic psychotherapy in the Adult Department of the Tavistock Clinic were followed up 3 to 9 years after the end of treatment. Adjustment level at intake and number of sessions were found to correlate with outcome. More specifically, capacity to relate and problem‐solving ability were found to be predictive of outcome. The significance of the findings is discussed within the context of the debate concerning the efficacy of psychotherapy.
Which Neurotic Patients Are Offered Which Psychotherapy?
Authors: Alexander David , Eagles John
Published: June 2007

Of the 336 new cases of neurosis referred to a regional psychiatric service 166 (49%) were offered supportive, dynamic or behavioural psychotherapy. The most frequently provided treatment was the first (40%); 34% of patients were offered dynamic psychotherapy and the remainder (261%) were allocated to behavioural psychotherapy. The factors related to the type of psychotherapy provided were diagnosis, duration of illness, the psychiatric team to which the patients had been referred, marital status and the distance the patients lived from the hospital.

Sex, age, socio‐economic status, employment status and a history of alcohol abuse or of deliberate self harm had no association with the type of psychotherapy offered.
Exhibitionism
Authors: Lucas Christopher
Published: June 2007

Some features of a series of male genital exhibitionists seen at the Portman Clinic by the author over a seven‐year period are described. A brief historical background is provided and important changes in theoretical thinking are noted, in particular the shift in emphasis from explanatory models stressing castration anxiety to a framework in which anxiety and anger in earlier object relationships are seen as of central importance. Exhibiting behaviour may be regarded as a way of attempting to restore damaged self‐esteem by an act of sexualised revenge towards a symbolic mother, whilst at the same time challenging but seeking containment from a symbolic father.
Passionate Lethal Attachments
Authors: Sinason Valerie
Published: June 2007

Concerned by the lack of progress of three children seen in three different settings, an EBD School (school for children with emotional and behavioural disturbance), a Day Unit and a Clinic, the therapist noted a particularly destructive constellation in both their inner and outer worlds. Whilst physical and sexual abuse can now evoke speedy external action, emotional abuse is not given enough attention despite official guidelines. In the absence of a safe external structure to deal with this, the child is left far more at the mercy of internal attachments which can be lethal. Where a child is mentally or multiply handicapped it can be even harder to extricate himself from a destructive relationship.
Parapraxis, Counter‐Transference, Interpretation and Bi‐Logic
Authors: Fink Klaus
Published: June 2007

ABSTRACT. An introduction to Matte‐Blanco's ideas about symmetrical and asymmetrical logic and the existence of bi‐logical structures in the conscious and the unconscious mind is followed by a clinical vignette showing how a parapraxis caused by counter‐transference led to a transference interpretation.
The Mother‐Observer Relationship: An Examination of the Participant Role of the Observer in Mother‐Infant Observation
Authors: Coulter Helga
Published: June 2007

SUMMARY. The relationship between mother and observer in mother‐infant observation as described by Esther Bick is examined. Specifically, the question as to whether this relationship influences what is being observed is considered.

The author gives an account of her own relationship as an observer with a mother. The mother was an epileptic and fell with her baby (then six weeks old) causing the baby to suffer a broken skull. Exploration of events during the period of observation leads to the conclusion that the relationship between the mother and the observer was one of transference. Within this transference the observer seemed to be the mother of the one observed. This together with the effects on the observed mother's unconscious conflict with her own mother due to epilepsy is described.

Given transference in the mother‐observer relationship doubts are raised as to the tenability of the attitude of distance and non‐interference prescribed for the observer. The conclusion is drawn that, in any case, the role of the observer is a participant role, which poses the epistemological problem of the interference of the observer with the observed.
Thomas Szasz, Mental Illness and Psychotherapy
Authors: Brown Robin Gordon
Published: June 2007

Strictly speaking, disease or illness can only affect the body; hence there can be no mental illness.
If Oedipus was an Egyptian
Authors: Raphael‐Leff Joan
Published: June 2007

Freud's archaeological collection peopled his work rooms with sublimated expressions of eternal, universal desires. I suggest here that these tangible remnants from the long buried past resonated with psychic representations and dream figures in Freud's own internal world, which, nevertheless, were not always consciously available to him. Despite a fascination with Egyptology evidenced in his antiquities, library and less conventional works, Freud focused on aspects of the Greek oedipal legend in his theoretical writing, neglecting Egyptian myths associated with‘prehistoric’realms of the archaic mother and Osirian/Mosaic father. I argue that convergence of traumatic events in his early childhood contributed to this delimiting Graeco‐Roman filter, and that accessibility to the‘dark continent’was hampered by resistances his own self‐analysis could not penetrate but which may have been worked through in the transference had he had an analyst other than himself.
The Chronically Ill Child and the Parents’Marriage: Interactive Effects
Authors: Clulow Christopher
Published: June 2007

SUMMARY. It is hard to imagine a worse situation for a couple to face than the terminal illness of their child. High material standards and advanced medical technology have exposed few parents to first‐hand experience of losing a child. For some, however, they have converted the acute trauma of certain death into the long‐term stresses associated with chronic illness and its uncertain course. This paper describes the nature of some of the stresses on family members, paying particular attention to the parental couple. Through detailed consideration of one couple's experience, the internal ramifications for marriage of a child who is seriously and chronically ill are examined, and consideration is given to the effectiveness in these circumstances of anticipatory mourning and other forms of help.
Some Thoughts on Sibling Rivalry and Competitiveness
Authors: Mander Gertrud
Published: June 2007

SUMMARY. This paper was presented to the Fifth Conference of the Institute of Psychotherapy and Counselling whose overall subject was Envy. I chose the subject of sibling rivalry because I have always found it a burning personal issue. Surprisingly not much has been written about it; so I hoped it would be interesting for a change to think about an aspect of envy that is a universal experience and yet different from the primary envy which Melanie Klein located in the motherbaby relationship and the state of part object relating. Rivalry and competition begin in the later developmental phase when the infant has achieved unit status, and when the two‐person relationship has expanded into three‐ and multi‐person relationships where the issues are loss, exclusion and intrusion. Then the experience of difference and otherness has to be mastered so that socialisation can take place.