Career success after flexible training in psychiatry: a survey of former flexible trainees in the Thames regions.

This article outlines the findings of a study which indicate that flexible training in psychiatry was considered adequate to prepare doctors for both full-time and part-time work and that those wishing to work part time had no difficulty in finding jobs after accreditation. However, there was evidence to suggest that part-time consultants experienced more problems and less job satisfaction and that part-time training and working may restrict opportunities for an academic career.

The role of unrecognized ambivalence: the mirroring of family conflicts within the professional and legal network.

This paper raises some questions about the deleterious effects of unrecognized (unconscious) ambivalence running through child care systems, the Children Act and the adversarial legal system. It is postulated that unrecognized ambivalence may become one of the powerful unconscious dynamics contributing to the mirroring of the family conflicts within the professional network. A detailed clinical example, in which we acted as expert witnesses within a child psychiatry hospital team, is used to illustrate how the denial of ambivalence in a highly complex case, that of a large family involved in care proceedings, led to a state of polarization between the family and a team of professionals which was replicated and amplified within the wider welfare and legal system. It is our view that a state of polarization is likely to produce 'all or nothing decisions' which may not be in the best interest of both children and parents. It is argued that the adversarial nature of the legal process and some underlying assumptions in the Children Act, may contribute to ambivalence being unrecognized. Then it is suggested that ambivalence is inevitable both for professionals and families, particularly in highly complex cases, but with its recognition, a resolution may take place. The conclusions contain some suggestions to promote this process.

Latency--a reappraisal.

This paper discusses the specific metapsychology and developmental tasks of the latency period. It offers a Kleinian view of the phase and compares it with other current psychoanalytic theories. The emphasis is on the importance of ego and superego growth and integration during latency resulting in better contact with both external and internal reality. Character formation, social integration and learning are discussed as the specific developmental tasks of the period. Freud's original formulation that the latency period is a consequence of the resolution of the Oedipus complex is evaluated in the light of contemporary developments. I draw on the ideas of Klein and others such as Loewald, Burgner, Holder, Tyson to describe it as a process of progressive and more complex elaboration throughout latency, interconnected with superego development. This process of gradual working through is considered to be a fundamental feature of the period. This model of progressive maturation is illustrated with clinical material. The clinical concept of pseudo-latency is used to distinguish between the developmental achievement represented by the establishment of the latency organisation in contrast to a defensive structure (pseudo-latency) which hides pathology.

The analyst's pregnancy and its consequences on her work.

In this paper I discuss with clinical examples how the analyst's pregnancy may affect the analysis in unique, subtle and at times unexpected ways to which the analyst must be alert. Like any major psychosocial crisis in the life cycle, pregnancy challenges the analyst's ability to hold on to the psychoanalytic attitude. It also confronts her with specific issues (primitive anxieties about the inside of the body, fears of loss of identity, of damage to the foetus etc.) which have to be acknowledged and which require consistent and at times painful working through. Overall, my experience was that by and large positive emotional growth took place, both in the patients and myself, during the pregnancy. I would suggest that the possible changes were not only due to the pregnancy per se but to the careful analysis of its effects which allowed for the psychoanalytic situation to be maintained.

The psychodynamics of the STD clinic: secrecy, splitting and isolation.

We introduce the idea of a professionally isolated and apparently disconnected agency. We describe how health professionals working in settings with good multi-agency links may not recognize the effect of the isolated agency system on the presentation of problems. In particular, we describe the setting of the Sexually Transmitted Diseases clinic (STD) in which confidentiality can be turned into secrecy by the patients at the service of their denial of the seriousness of their problems. The isolation of the STD clinic as an agency resonates with the patients' isolation from their own feelings and emotional contact with people. It also isolates the professional and the therapeutic network. By way of clinical examples, we describe how this may deskill the staff and lead to dangerous situations.