Being right vs. getting it right: orientation to being recorded in psychotherapeutic interaction as disaffiliative vs. affiliative practice.

Introduction: The study focuses on the orientation to being recorded in therapy sessions, emphasizing that these practices adapt to specific circumstances and influence subsequent actions. The study suggests a way to deal with the insolubility of the "observer paradox": to accept that observation has an impact on the observed, but that the recorder is not necessarily a negative determinant. Furthermore, the study builds on the idea that participants' orientations to the recorder can be seen as actions. Methods: The data included in this study were collected from four psychodynamic therapies. A total of 472 sessions were searched for orientation to be recorded. Twenty-three passages were found and transcribed according to GAT2. Of the 23 transcripts, six excerpts have been analyzed as part of this article. The analysis of this study was done through Conversation Analysis. Results: The study explores how participants use the orientation to be recorded to initiate or alter actions within conversations, which can help achieve therapeutic goals, but can also hinder the emergence of a shared attentional space as the potential to disrupt the therapist-patient relationship. The study identifies both affiliative and disaffiliative practices, noting that managing orientation to be recorded in a retrospective design consistently leads to disruptive effects. Moreover, it highlights the difference between seeking epistemic authority ("being right") and managing recording situations ("getting it right") in therapeutic interactions as a means of initiating patients' self-exploration. Discussion: The integration of recordings into therapeutic studies faces challenges, but it's important to acknowledge positive and negative effects. Participants' awareness of recording technologies prompts the need for a theory of observation in therapeutic interactions that allows therapists to visualize intuitive practices, incorporate active contributions, counteract interpretive filtering effects, facilitate expert exchange, ensure quality assurance, and enhance the comprehensibility of therapeutic processes. These aspects outline significant variables that provide a starting point for therapists using recordings in therapeutic interactions.

"Death drive" scientifically reconsidered: Not a drive but a collection of trauma-induced auto-addictive diseases.

Over the last 102 years, a lot of discussion was being held about the psychoanalytic conception of the "death drive," but still with inconclusive results. In this paper, we start with a brief review of Freud's conception, followed by a comprised overview of its subsequent support or criticisms. The core of our argument is a systematic review of current biochemical research about two proposed manifestations of the "death drive," which could hopefully move the discussion to the realm of science. It was already established that drive satisfaction leads to the secretion of beta-endorphins, and research evidence also shows that the same biochemical mechanisms get activated in the case of masochism and the gambling disorder but only if they are preceded by chronic frustration of the essential drives. We conclude that the actual situation is more complex than Freud hypothesized, and that a fundamental revision of the psychoanalytic drive theory is necessary.

CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic. / CoRad-19 ­ Modulare Digitale Lehre während der SARS-CoV-2-Pandemie.

PURPOSE: During the SARS-CoV-2 pandemic, higher education worldwide had to switch to digital formats. The purpose of this study was to evaluate CoRad-19, a digital teaching tool created by the German Radiological Society for medical students during the COVID-19 pandemic. MATERIALS AND METHODS: A total of 13 German-speaking universities implemented CoRad-19 in their curriculum and partially or completely replaced their classes with the online courses. Previous experience and contact with radiology and the participants' opinions regarding the medium of e-learning were surveyed using a custom questionnaire. The subjective level of knowledge regarding the individual modules was also surveyed before and after participation to measure learning effects. The data of 994 medical students from the participating sites were analyzed and compared intraindividually using the Friedman test. RESULTS: From 4/1/2020-10/1/2020, 451 complete data sets from a total of 994 surveys were included. E-learning was rated "very useful" both before and after course participation (4 [IQR 3-4], p = 0.527, r = 0.16). E-learning as a method was also rated as a "very good" medium both before and after participation (4 [IQR 3-4], p = 0.414, r = 0.17). After participation, participants rated radiology as particularly suitable for digital teaching (before: 3 [IQR 3-4] vs. after 4 [IQR 3-4], p = 0.005, r = 0.6). Significant learning gains were measurable in all course modules (p ≤ 0.009). Post-hoc analysis showed interest in radiology to increase significantly after course participation (p = 0.02). CONCLUSION: In the representative survey, significant learning effects were observed in all course modules. In addition, it should be particularly emphasized that the students' interest in radiology was increased by course participation. Thus, the German Radiological Society provided significant support to German-speaking medical faculties with respect to maintaining excellent education using CoRad-19. KEY POINT: · Co-Rad-19 course participation results in measurable subjective learning effects and increases student interest in radiology.. CITATION FORMAT: · Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; 194: 644 - 651.

Doing Contrariness: Therapeutic Talk-In-Interaction in a Single Therapy Session With a Traumatized Child.

Conversation analysis (CA) of children-adult-interaction in various contexts has become an established field of research. However, child therapy has received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley, 2006). Psychotherapy process researchers in adult therapy (Stiles et al., 2015) have found that therapists "invent" a new therapy for each patient (Norcross and Wampold, 2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of "unexplainable rage." The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe "doing contrariness," as a conversational practice producing epistemic and affiliative disruptions, while "avoiding doing contrariness" and "remedying contrariness" are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding.

On the Nature of the Mother-Infant Tie and Its Interaction With Freudian Drives.

The affective bond between an infant and its caregiver, the so-called mother-infant tie, was analyzed by various reputable psychologists (e.g., Ainsworth, Clark, Erikson, Anna Freud, Harlow, Klein, Spitz, and Winnicott) but both the basic tenets of the bond and the importance of the trauma of maternal deprivation for personality disorders in adults were introduced by Bowlby. Although Bowlby was a trained psychoanalyst, he rejected central cornerstones of Freudian theory (esp. drive theory) and used concepts promulgated by renowned ethologists (Tinbergen and Lorenz) to establish his framework of "instinctive behavior" that has been developed further into the concept of "attachment theory" under the influence of Mary Ainsworth. However, since any precise experimental facts were lacking when Bowlby formulated his ideas on the concept of instinctive behavior, the whole framework is a descriptive, category-driven approach (like the ones of Freudian drives). In order to connect the mother-infant tie - as propounded by Bowlby - with experimental data, this manuscript undertakes a biochemical analysis of it because this strategy proved somewhat successful in relation to Freudian drives. The analysis unfolded that the neurochemical oxytocin, released by the action of sensory nerves, is of utmost importance for the operation of the mother-infant tie. Furthermore, multiple evidences have been presented to the fact that there is strong interaction between unconsciously operating Freudian drives and the consciously acting mother-infant tie (that is now classified as a drive). The outlined interaction in conjunction with the classification of attachment urges as drives gave a very detailed insight into how a SEEKING-derived reward can be evoked during operation of the mother-infant tie. In summary, there is no need to marginalize either the mother-infant tie or Freudian drives but rather there is need to respect both (principally different) impulses in moving toward a more extensive description.

Psychodynamic Psychotherapy Process Research: A quick ride through what you should know about process (research).

This paper gives an overview of psychoanalytic process research, which brings to light the complexity of psychotherapy sessions. This complexity is so rich that many instruments intended to make the process measurable failed in the past because they initially used a strategy of complexity reduction. This method however did not help to further our understanding of the complexity involved. Three former presidents of the Society for Psychotherapy Research (Stiles, Hill, Elliot 2015) decided to solve the following equivalence paradox: many therapies work successfully though they all follow different theories, produce a heterogeneity of processes and often enough a misfit between what theories maintain to be a good process and their realization in the treatment room. As theories are often compared to maps, a driver would wonder which route to take. But therapists-as-drivers go undaunted - and nevertheless achieve their goals together with their patients. Norcross and Wampold (2018) found that good therapists invent new therapies with every new patient. They hypothesize that it is because of conversation. This is in accord with the 3 former presidents' proposal to return to detailed single case analyses including the micro-analytic power of conversation analysis of which a few insights are outlined in this article.

Cet article donne une vue d'ensemble de la recherche sur le processus psychanalytique, qui met en lumière la complexité des séances de psychothérapie. Cette complexité est si riche que dans le passé beaucoup d'instruments conçus pour rendre le processus mesurable ont échoué parce qu'initialement une stratégie de réduction de la complexité était utilisée. Cette méthode n'a cependant pas aidé à améliorer notre compréhension de la complexité en question. Trois anciens présidents de la Société pour la Recherche en Psychothérapie (Stiles, Hill, Elliot 2015) décidèrent de résoudre le paradoxe de l'équivalence suivante: beaucoup de thérapies fonctionnent avec succès bien qu'elles suivent des théories diverses, elles produisent une hétérogénéité de processus et assez souvent une inadéquation entre ce que les théories entendent par bon processus et leur concrétisation dans la salle de consultation. Comme les théories sont souvent comparées à des cartes, un conducteur se demanderait quelle route prendre. Mais les thérapeutes-en-tant-que-conducteurs avancent imperturbables - et atteignent pourtant leurs objectifs, en coopération avec leurs patients. Norcross et Wampold (2018) ont trouvé que les bons thérapeutes inventent de nouvelles thérapies avec chaque nouveau patient. Ils font l'hypothèse que cela est dû à la conversation. Ceci va dans le sens de la proposition des trois anciens présidents de revenir aux analyses détaillées de cas uniques ce qui comprend la puissance micro-analytique de l'analyse conversationnelle dont quelques aperçus sont exposés dans cet article.

El presente trabajo ofrece una reseña de un proceso de investigación en psicoanálisis, el cual da cuenta de la complejidad de las sesiones psicoterapéuticas. Esta complejidad es de tanta riqueza que muchos instrumentos con los que se intentó medir el proceso, en el pasado, fracasaron utilizaron inicialmente una estrategia que reducía la complejidad. Este método sin embargo no ayudó a promover nuestra compresión sobre la complejidad allí implicada. Tres ex presidentes de la Sociedad para la Investigación de Psicoterapia (Stiles, Hill, Elliot 2015) decidieron resolver la siguiente paradoja de equivalencia: muchas terapias trabajan con éxito aunque siguen diversas teorías, producen una heterogeneidad de procesos y bastante a menudo un desajuste entre lo que las teorías sostienen que es un buen proceso y su realización en el consultorio. Si se compara a las teorías con los mapas, un conductor se preguntaría que ruta tomar. Pero los terapeutas-como-conductores impertérritos - logran no obstante sus metas junto con sus pacientes. Norcross y Wampold (2018) encontraron que los buenos terapeutas inventan nuevas terapias con cada nuevo paciente. Ellos hipotetizaron que era debido a la conversación. Esto se encuentra en sintonía con las propuesta de los tres ex presidentes de retornar al análisis del caso único detallado incluyendo el potencial micro-analítico del análisis conversacional del cual se subrayan algunos insights en el presente artículo.

Multicentre standardisation of chest MRI as radiation-free outcome measure of lung disease in young children with cystic fibrosis.

BACKGROUND: A recent single-centre study demonstrated that MRI is sensitive to detect early abnormalities in the lung and response to therapy in infants and preschool children with cystic fibrosis (CF) supporting MRI as an outcome measure of early CF lung disease. However, the feasibility of multicentre standardisation remains unknown. OBJECTIVE: To determine the feasibility of multicentre standardisation of chest MRI in infants and preschool children with CF. METHODS: A standardised chest 1.5T MRI protocol was implemented across four specialised CF centres. Following training and initiation visits, 42 infants and preschool children (mean age 3.2±1.5years, range 0-6years) with clinically stable CF underwent MRI and chest X-ray (CXR). Image quality and lung abnormalities were assessed using a standardised questionnaire and an established CF MRI and CXR score. RESULTS: MRI was successfully performed with diagnostic quality in all patients (100%). Incomplete lung coverage was observed in 6% and artefacts also in 6% of sequence acquisitions, but these were compensated by remaining sequences in all patients. The range of the MRI score in CF patients was similar across centres with a mean global MRI score of 13.3±5.8. Cross-validation of the MRI against the CXR score revealed a moderate correlation (r=0.43-0.50, p<0.01). CONCLUSION: Our results demonstrate that multicentre standardisation of chest MRI is feasible and support its use as radiation-free outcome measure of lung disease in infants and preschool children with CF.

From turn-by-turn to larger chunks of talk: An exploratory study in psychotherapeutic micro-processes using conversation analysis.

Independent of theoretical orientation therapies of all kind are talk-in-interaction. Influential overall conceptualizations (as e.g. intervention) belong to a certain model of medicalizing the psychotherapeutic endeavor. Talk-in-interaction is the base for applying Conversation Analysis (CA) in psychotherapeutic process research. CA is a powerful tool originating from social science taking data, hypotheses and theories from careful observing in a similar way as infant observers did. The common discovery is that conversation precedes language. Some features of infantile proto-conversation survive in adult life. CA has directed careful attention to processes like turn-taking, repair, conditional relevances, etc. in observing the rules of interaction. However, in studying psychotherapy process turn-by-turn analysis alone does not suffice. It can be completed by a new model of common ground activities and package-by-package analysis turning attention to new objects of observation in therapeutic conversation (allusions, metaphorical framing activities). We propose a methodology for both kinds of analyses based on transcribed examples from the CEMPP-Project. This exploratory designed project (Conversation analysis of empathy in Psychotherapy Process; supported by the Köhler Foundation, Germany) compared psychoanalytic, psychodynamic and cognitive-behavioral treatments in five dyads each taking transcribed sessions from the beginning, the middle phase and the end; our database includes 45 transcribed sessions.

Imaging, endoscopy and diagnostic surgery.

Imaging of the inner genitalia and the gonads is part of the diagnostic work-up and is essential for an individualized approach to the disorder of sex development individual. Ultrasound is used as a first-line modality to detect the presence of a uterus and gonads. Magnetic resonance imaging can reveal the sex duct anatomy and details of prostate and pelvic muscle anatomy. Laparoscopy is an invasive surgical procedure that adds valuable information in gonadal dysgenesis and situations of diagnostic uncertainty.

Patterns of empathy as embodied practice in clinical conversation-a musical dimension.

Cognitive linguistics and conversation analysis (a) converge in the analysis of category bound activities and (b) in viewing thinking and talking as embodied activities. The first aim of this paper is to outline these powerful theories as useful tools for the analysis of enacting empathy. The second aim is to outline these theories as useful tools for the analysis of how empathy is co-enacted in clinical conversation documented in transcripts. Cognitive Linguistics and Conversation Analysis converge in detecting patterns of I-You-relationships with roots in early preverbal embodied protoconversation continuing to more symbolic conversational level. The paper proposes to describe this continuity of empathic conversation in musical metaphors like balance, rhythm and resonance. In a first section transcripts from therapeutic sessions are presented. In a second section linguistic and other research data are presented in order to bring empirical data to this new conception of how empathy can be understood, how it is done and how two participants cooperate to enact empathy. Ideas for further research are outlined.

Zscan4 is regulated by PI3-kinase and DNA-damaging agents and directly interacts with the transcriptional repressors LSD1 and CtBP2 in mouse embryonic stem cells.

The Zscan4 family of genes, encoding SCAN-domain and zinc finger-containing proteins, has been implicated in the control of early mammalian embryogenesis as well as the regulation of pluripotency and maintenance of genome integrity in mouse embryonic stem cells. However, many features of this enigmatic family of genes are poorly understood. Here we show that undifferentiated mouse embryonic stem cell (ESC) lines simultaneously express multiple members of the Zscan4 gene family, with Zscan4c, Zscan4f and Zscan4-ps2 consistently being the most abundant. Despite this, between only 0.1 and 0.7% of undifferentiated mouse pluripotent stem cells express Zscan4 protein at a given time, consistent with a very restricted pattern of Zscan4 transcripts reported previously. Herein we demonstrate that Zscan4 expression is regulated by the p110α catalytic isoform of phosphoinositide 3-kinases and is induced following exposure to a sub-class of DNA-damage-inducing agents, including Zeocin and Cisplatin. Furthermore, we observe that Zscan4 protein expression peaks during the G2 phase of the cell cycle, suggesting that it may play a critical role at this checkpoint. Studies with GAL4-fusion proteins suggest a role for Zscan4 in transcriptional regulation, further supported by the fact that protein interaction analyses demonstrate that Zscan4 interacts with both LSD1 and CtBP2 in ESC nuclei. This study advances and extends our understanding of Zscan4 expression, regulation and mechanism of action. Based on our data we propose that Zscan4 may regulate gene transcription in mouse ES cells through interaction with LSD1 and CtBP2.

Chronic bilateral T1 denervation in women with macromastia.

INTRODUCTION: The objective of this study was to identify the pattern of neurological deficits and document electrophysiological changes in women with macromastia. METHODS: Patients with macromastia and neurological complaints underwent clinical evaluation and electrodiagnostic (EDx) studies of the upper limbs. RESULTS: Findings include low-amplitude medial antebrachial cutaneous (MACN) sensory nerve action potentials (SNAPs) and median compound muscle action potentials (CMAPs) and chronic denervation changes in the bilateral abductor pollicis brevis (APB) muscles on needle electrode examination (NEE), indicating axonal loss in the bilateral T1 distribution. CONCLUSIONS: The EDx data are in keeping with lesions involving bilateral T1 anterior primary rami (APR). Potential sites of compromise of the T1 APR are discussed. Further study of the effect of treatment for macromastia on the clinical and EDx findings is proposed.

Unusual case of dysphagia in a male.

Plummer Vinson Syndrome, a triad of dysphagia, esophageal web, and iron-deficiency anemia, is a rarely reported diagnosis in current literature. The exact etiology of the syndrome remains controversial, but it has been linked to complicated nutritional deficiencies, autoimmune disorders, and hereditary factors, and has a remarkably high female to male ratio. This paper describes an atypical case presentation in a 53-year-old male with a remote history of peptic ulcer disease surgery.

Soft tissue sarcoma with metastasis to the stomach: a case report.

Soft tissue sarcomas are unusual malignancies comprising 1% of cancer diagnoses in the United States. Undifferentiated pleomorphic sarcoma accounts for approximately 5% of sarcomas occurring in adults. The most common site of metastasis is the lung, with other sites being bone, the brain, and the liver. Metastasis to the gastrointestinal tract has rarely been documented. We present an unusual case of high-grade pleomorphic sarcoma with metastasis to the stomach, complicated by upper gastrointestinal bleeding.

Gender constructions of male sex offenders in Germany: narrative analysis from group psychotherapy.

This study was conducted to analyze how male sexual offenders construct mental images of masculinity and femininity to provide insight into therapeutic treatment for such patients. Thematerial examined in this studywas comprised of 21 videotaped prison group therapy sessions in which the participating sexual offenders talked about their crimes and biographies. Aqualitative data analysis softwarewas usedto apply a modified grounded theorymethodology to the transcribed sessions. The resulting categories can be understood as descriptions of how the imprisoned men constructed gender images, and were based on three narrative levels: the structure of narration, the narrative positions in the story, and the interaction between the narrator and the other participants. According to the categories describedin the narrative positions (the narrated self and the narrated significant male others), we constructed masculinity categorizations which corresponded to specific images of femininity (derived from the narrated significant female others).The constructionsprovided insight into the selfimage of the narrator, as well as the accountability and positioning of himself and the other in regard to perpetrator-victim constructions. The study further revealed whether the participants either accepted or rejected responsibility and guilt for their crimes; this is essential for psychotherapeutic process and treatment.

Magnetic resonance imaging of heterotaxis syndrome.

Failure to establish normal left-right body axis (LRA) formation during embryogenesis results in heterotaxis, a multi-malformation syndrome. We report on a 20-year-old young woman who presented to the emergency room with upper abdominal pain. On chest X-ray, dextrocardia was noted. Ultrasound was inconclusive. Barium studies demonstrated non-rotation of the intestine. Magnetic resonance imaging (MRI) of the abdomen confirmed heterotaxis with abnormal arrangement of abdominal organs and vasculature. This is the first radiographic description of LRA in MRI. It provides a unique contribution to the wide morphological variety of lateralization defects in a single examination within 15 min and without the risks of ionizing radiation. In addition, a literature overview over the genetic aspects, broad morphological spectrum, and possible therapeutic consequences is given.

Phosphorylation of StarD10 on serine 284 by casein kinase II modulates its lipid transfer activity.

StarD10 is a dual specificity lipid transfer protein capable of shuttling phosphatidylcholine and phosphatidylethanolamine between membranes in vitro. We now provide evidence that, in vivo, StarD10 is phosphorylated on serine 284. This novel phosphorylation site was identified by tandem mass spectrometry of immunoaffinity-purified StarD10 from lysates of HEK293T cells transiently expressing the protein. In vitro kinase assays revealed that casein kinase II was capable of phosphorylating wild-type StarD10 but not a S284A mutant protein. Interestingly, hypotonic extracts prepared from HEK293T cells expressing the serine to alanine mutant exhibited increased lipid transfer activity compared with those from wild-type StarD10-expressing cells, suggesting that, in a cellular context, phosphorylation on serine 284 negatively regulates StarD10 activity. Because casein kinase II phosphorylation also inhibited lipid transfer activity of the purified recombinant StarD10 protein, inhibition is not dependent on any cellular cofactors. Instead, our data show that C-terminal StarD10 phosphorylation on serine 284 regulates its association with cellular membranes.