Group Analytic Psychotherapy in Brazil.

Group analytic practice in Brazil began quite early. Highly influenced by the Argentinean Pichon-Rivière, it enjoyed a major development from the 1950s to the early 1980s. Beginning in the 1970s, different factors undermined its development and eventually led to its steep decline. From the mid 1980s on, the number of people looking for either group analytic psychotherapy or group analytic training decreased considerably. Group analytic psychotherapy societies struggled to survive and most of them had to close their doors in the 1990s and the following decade. Psychiatric reform and the new public health system have stimulated a new demand for groups in Brazil. Developments in the public and not-for-profit sectors, combined with theoretical and practical research in universities, present promising new perspectives for group analytic psychotherapy in Brazil nowadays.

Thinking without knowing--child psychoanalytic psychotherapy in the UK and evidence-based practice.

BACKGROUND: Child psychoanalytic psychotherapy has been criticized for its reluctance to embrace evidence-based practice. This study aims to explore the historical narrative of a sample of child psychoanalytic psychotherapists about progress in developing the evidence base. METHODS: Fourteen psychotherapists were interviewed and the transcripts analysed for common themes about evidence-based practice. RESULTS: Child psychoanalytic psychotherapists were generally positive about developing evidence-based practice but had reservations about the narrowness of hierarchies used by commissioners to assess evidence. CONCLUSION: The child psychoanalytical psychotherapists interviewed for this study recognized the need to promote evidence-based practice, in particular, to inform commissioners of Child Mental Health Services.

Epiphanies and research in the field of mental health.

In this paper I will argue that investigating our professional experiences can enrich our understanding, widen our perspective, transform our inner lives and create an endless source of discovery about ourselves, society and the professional discursive systems that we inhabit. I will call such events, after Denzin's work in 1989, epiphanies. In order to develop the theme I will give an account of my own experience of two such epiphanies on a psychoanalytic training course in counselling. I will then present my reflexive analysis of these events over the years, including my reflections on the peer review comments for this paper, and finish with some questions arising out of the study relating to the current status of nursing as an academic profession.

A qualitative analysis of student Balint groups in medical education: contexts and triggers of case presentations and discussion themes.

OBJECTIVE: No previous rigorous qualitative studies exist on student Balint groups. The aim of this study was to explore the contexts and triggers of cases presented in student Balint groups and to clarify the themes in the group discussions. METHODS: Fifteen student Balint sessions in two groups were organised. Nine female students participated. A grounded theory-based approach with thematic content analysis of the field notes was used. RESULTS: We identified five triggers for case narrations (witnessing injustice, value conflict, difficult human relationships, incurable patient, role confusion) that originated from three distinct contexts (patient encounters, confusing experiences in medical education, tension between privacy and profession). Four main discussion themes could be identified (feelings related to patients, building professional identity, negative role models, cooperation with other medical professionals). CONCLUSION: The concept of case in student Balint groups was wider than in traditional Balint groups. Feelings related to patients and to one's own role as a doctor were openly discussed in groups. The discussions often touched on professional growth and future professional identity as doctors. PRACTICE IMPLICATIONS: The Balint groups may support medical students' professional growth process. This topic warrants further study in more heterogeneous student groups.

Supervision and imagination.

This paper explores the role of imagination for the supervisor and examines the differences between the supervisor's use of creative and defensive imagination. It is suggested that reverie and imagining play a central role in supervision but that these need to be harnessed in the service of the reality principle. It is argued that the Jungian emphasis on the ego-self relationship provides a context for this process. A clinical example of work with a supervisee is described in which hidden aspects of a strong erotic transference/countertransference were revealed in the supervisor's imagining and became available for reflection.

The art of the tincture: analytical supervision.

Using the alchemical metaphor, effective supervision can be seen as an excellent example of the tincture: a little goes a long way. This paper offers a model of the dynamics in analytical supervision: a mirroring of the professional-self of the supervisee, the opportunity to learn through empirical factual knowledge, and, most importantly, experiential, interactive and dynamic learning. The container of supervision will be amplified using an image of the triple vessel of alchemy. The materia of supervision is discussed as 'amalgams' of complex related material. The supervisory field is seen in a triadic intersubjective and interimaginal manner. Jung's diagram of all the possible conscious and unconscious connections between patient and therapist is expanded to include the supervisory situation. Moving beyond projective identification as explanatory process, the concept of the mundus imaginalis is used as the medium for this triadic structure. The 'analytic third' expands to include the 'supervisory fourth' while incorporating the supervisor's imaginings of the patient as the quintessential experience of the imaginal other. The supervisor's attitude and state of mind are seen through the paradigm of active imagination. This state of mind is called supervisory reverie.

Researching emotion: the need for coherence between focus, theory and methodology.

There is a longstanding awareness of the significance of emotion in nursing and yet it remains one of the more elusive areas of practice. Surprisingly, there has been little discussion in the nursing literature of how the phenomenon of emotion might be understood or studied. This paper gives an overview of theoretical and methodological approaches to emotion, and how the researcher's emotions may inform the research process. In addition, it draws on ethnographic research exploring the role of emotion in the practice and clinical supervision of a group of psychosexual nurses undergoing Balint seminar training to help highlight some of the inherent problems of researching emotion. The paper argues that these sorts of problems may be avoided or reduced by ensuring coherence between the research focus, the way emotion is theorised, and the methodological approach of the study.

A mixed bag: the realities of psychoanalytic practice.

For a variety of reasons, psychoanalytic training is done in somewhat of a vacuum. It teaches a theory and a way of practicing that does not always translate well to day-to-day private practice work. The clinical realities of psychoanalytic practice prove the psychoanalytic method to be one that provides help to a wider audience than classical psychoanalytic training programs might suggest. The psychoanalytic approach offers the analyst many special opportunities to work with and help a wide variety of patients. Analysts who accept both the limitations as well as the wide application and broad benefits of the psychoanalytic approach may have a more fulfilling experience than their training experiences might foster. At the same time, the analyst's level of therapeutic skill, the patient's diagnosis, and many multiple external factors create different limitations in the practice and outcome of psychoanalytic work. Extensive case material is used to show the broad range of patients who are helped by the psychoanalytic method. The clinical material also shows the less than perfect, but often good enough outcomes of these difficult cases with often severely disturbed patients.

The triadic intersubjective matrix in supervision: the use of disclosure to work through painful affects.

The use of the psychoanalyst's subjective reactions as a tool to better understand his/her patient has been a central feature of clinical thinking in recent decades. While there has been much discussion and debate about the analyst's use of countertransference in individual psychoanalysis, including possible disclosure of his/her feelings to the patient, the literature on supervision has been slower to consider such matters. The attention to parallel processes in supervision has been helpful in appreciating the impact of affects arising in either the analyst/patient or the supervisor/analyst dyads upon the analytic treatment and its supervision. This contribution addresses the ways in which overlapping aspects of the personalities of the supervisor, analyst and patient may intersect and create resistances in the treatment. That three-way intersection, described here as the triadic intersubjective matrix, is considered inevitable in all supervised treatments. A clinical example from the termination phase of a supervised analysis of an adolescent is offered to illustrate these points. Finally, the question of self-disclosure as an aspect of the supervisory alliance is also discussed.

'The crisis in psychoanalysis': what crisis are we talking about?

In this paper the author argues that the so-called crisis in psychoanalysis, often blamed on various external factors, is in fact an internal crisis brought about by intrinsic incongruities between the explicit intention of its educational model, which aspires to educate and train in a professional and scientific discipline, and its organisational structure, locally and internationally inextricable. Its isolated basic units of ecumenical control--its traditional 'societies/institutes of psychoanalysis'--implicitly and explicitly co-impose the monastic transmission of a preponderantly doctrinaire education and clinical practice. The dysfunctional elongation of our historical organisational syncretism continues to force us, one century later, to amalgamate in and superimpose on an endogamous supraordaining system (i.e. our International Psychoanalytic Association) prerogatives and functions so contradictory that they are ordinarily considered irreconcilable, such as: education and scientific research (tasks of universities); societal and political (tasks of an ordinary society of professionals and technicians); and 'as if' certification and accreditation (tasks of external, local, interinstitutional collegiate bodies and independent, multirepresentative, national coalitions and consortia, as well as of local governmental legislation). The pervasive collective regressive phenomena derived from this homogamous and secluding organisational and educational syncretism has had a retardatory impact along all the hierarchy of our institutional activities. The future of psychoanalysis as a science and a clinical discipline must be nothing other than one of evolution and transformation. The survival of its legendary psychoanalytic institutes and societies, as well as its local and international organisation, with its inherited but now untenable syncretism, is that which is being questioned (that is, psychoanalysis as a 'movement' and a 'cause').

Understanding the dynamics of the patient-physician relationship: balancing the fiduciary and stewardship roles of physicians.

There has been growing concern about the effects on the patient-physician relationship of the increasing demands on physicians to balance their fiduciary and stewardship responsibilities, what has been called "double agency." Various authors have proposed ways to restore patient centeredness to the patient-physician interaction. We have previously discussed the need to establish a patient-physician alliance to achieve this aim and to facilitate achieving this balance in mutual understanding. In this essay, we examine six concepts derived by Michael Balint from research seminars with primary care physicians. These six concepts are (a) the basic fault; (b) the physician's apostolic function; (c) the mutual investment company; (d) the drug "doctor"; (e) the deeper diagnosis; and (f) the conspiracy of anonymity. We believe these six concepts describe basic forces that shape the patient-physician relationship and allow for the development of an alliance between patients and physicians that can help preserve the essentials of the relationship.