The role of emotion in psychotherapeutic change for medically unexplained symptoms.

OBJECTIVES: Evidence of the contribution of emotional processes to the emergence, maintenance, and experience of medically unexplained symptoms (MUS) suggests that clinical approaches which target these processes could be beneficial. In this study, qualitative methods were used to examine patients' perspectives and subjective experiences of emotional processes in the context of a psychotherapy assessment and treatment service for MUS provided in a hospital emergency department (ED). METHODS: Seven semi-structured interviews were conducted with ED patients presenting with MUS who received a course of intensive short-term dynamic psychotherapy treatment. RESULTS: Interpretative phenomenological analysis was employed with three superordinate themes emerging: Barriers to examining emotional processes; reflections on the therapeutic process; psychological change; and improved well-being. Obstacles to clinical engagement in treatment for MUS were described in relation to patients' and therapists' ability to identify, address, and utilize emotion processes. Specific elements of this work were identified as integral components of the psychotherapy change process for MUS. CONCLUSIONS: Directly observing the physical effects of emotional experiencing in MUS provides sensory evidence that can enable patients to make mind-body connections. Psycho-emotional processes warrant further study to explore the applicability to other conceptual models for assessing and treating MUS. Clinical and methodological significance: In this article, we highlight that Medically Unexplained Symptoms (MUS) are a priority area for both physical and mental health care services. We present findings relevant to the effectiveness of a novel psychotherapy innovation within a hospital emergency department (ED). The use of interpretative phenomenological analysis to study the experiences of ED clients with MUS offers an established qualitative method for exploring the processes underlying therapeutic change. The results provide new insights around obstacles to engagement alongside potential solutions when addressing the psychological needs of clients with MUS. Although emotion processes have been described as a potentially important change process for MUS and in psychotherapy more generally, little empirical research has studied these two areas collectively.

Relational schemas as mediators of innovative moments in symptom improvement in major depression.

OBJECTIVES: Innovative moments (IMs) are exceptions to the maladaptive framework of meaning that typically motivates clients to seek psychotherapy, and previous studies have shown that IMs are associated with psychotherapy outcomes. While IMs are exceptions that occur at the level of the therapeutic conversation, relational schemas are more stable patterns, and their increased flexibility may facilitate change during psychotherapy. With this in mind, we tested the hypothesis that IMs contribute to outcomes by improving the flexibility of relational schemas. METHOD: The Core Conflictual Relationship Theme (CCRT) was used to assess relational schemas. IMs were evaluated using the Innovative Moments Coding System. The sample included 22 clients diagnosed with major depressive disorder. The flexibility of the three components of the CCRT (Wishes, responses of the self (RS), and responses of others (RO)) were tested as mediators between IMs and outcomes. RESULTS: The flexibility of the RS was a mediator between IMs and outcomes, but Wishes and RO were not. CONCLUSION: These findings align with previous research showing that RS is the component most open to change, whereas the other components seem less sensitive to change during brief therapy. Clinical or methodological significance of this article: This study shows the mediation role of relational schemas in the association between in-session events (innovative moments (IMs)) and the symptoms improvement. It contributes to the literature that emphasizes the importance of relational schemas in psychotherapy by using a mediation model, which has rarely been tested.

[German-language translation of the PANELVIEW instrument to evaluate the guideline development process from the perspective of the guideline group]. / Deutschsprachige Übersetzung des PANELVIEW Instruments zur Evaluierung des Prozesses der Leitlinienentwicklung aus der Perspektive der Leitliniengruppe.

INTRODUCTION: The development process for clinical guidelines is influenced by factors that are relevant to the validity of a guideline but often are not captured sufficiently in the final guideline documents. PANELVIEW is an English-language tool that can be used to explore the guideline development process from the perspective of guideline group members. Our aim was to translate the PANELVIEW tool into German, taking into account national contexts and linguistic differences. METHODS: The PANELVIEW tool was initially translated by a core team, then refined and approved by a group of experts in a consensus-based Delphi process. The experts were selected on the basis of their experience in guideline development covering different fields (clinical, methodological, organisational, health professional, patient perspective) and geographical regions (Germany, Austria, Switzerland). A representative of the original PANELVIEW team was also involved. The Delphi steps included an online survey, an online consensus conference and final approval by circulating the results via email. Individual items were seen as generally agreed upon if the level of agreement in the respective steps was 75 % or more. RESULTS: The expert group consisted of 12 persons. Of these, 11 (92 %) participated in the online survey and 10 (83 %) in the subsequent consensus conference. After the first Delphi step, sufficient agreement was achieved for 19 of 34 items (56 %). The remaining 15 items were discussed in the consensus conference and finally obtained 100 % agreement. The discussion focused on clarifying and adapting terms whose meaning was ambiguous or inadequate in the German context, which led to a deviation from the original wording in some instances. DISCUSSION: The PANELVIEW tool was translated into German by means of a Delphi process. PANELVIEW complements existing instruments for assessing the methodological quality of guidelines by capturing the perspective of the guideline group. This will enable guideline developers and organisations to identify problems in the drafting process and avoid them in future projects. User testing and validation of the German-language PANELVIEW tool are planned for the future. CONCLUSION: The German-language translation of PANELVIEW will enable guideline developers in German-speaking countries to continuously evaluate and, where necessary, improve the process and methods of guideline development.

Individual analysis: a failure or a shared experience of social justice.

The process of Jungian analysis is reviewed and considered as inexorably intertwined with our lives in society and with aspects of our social interactions that long for interpersonal and restorative justice. Various models are reviewed, including Fanon, Gambini, Kimbles, Levine, Saban - each with an eye toward Jung's injunction that we must move beyond 'knowledge' toward 'eating and digesting', thereby metabolizing and shifting our way of living. Dissociated aspects of the analytic couple are discussed, both as represented by and articulating transgenerational issues, phantoms, and as presented in often neglected aspects of embodiment. Jeremy Harris's Slave Play is offered as an amplification of ubiquitous and unacknowledged transgenerational presences in our analytic interactions. Clinical examples explore countertransference aspects that illustrate Jung's challenge, such as an unwitting prejudice toward analysis as equalling transformation and integrating resolution, or toward analysis as leaving unexamined the presumptions of class structures and privilege. A personal dream is offered to illustrate a necessary reorientation of the analyst's ego toward an attitude in which rebirth comes only in and through interaction with the collective. It is argued that only with such interaction, which manifests movement toward social justice, is there an efficacious analysis.

L'article examine le processus de l'analyse Jungienne et le considère comme entremêlé inexorablement avec nos vies dans la société et les aspects de nos interactions sociales qui désirent ardemment une justice interpersonnelle et réparatrice. Plusieurs modèles sont examinés, entre autres Fanon, Gambini, Kimbles, Levine, Saban - chacun dans la perspective de l'injonction de Jung que nous devons avancer au-delà du « savoir ¼ et vers « manger et digérer ¼ - métabolisant et de ce fait décalant notre façon de vivre. Les aspects dissociés du couple analytique sont examinés, représentés par les questions et fantômes transgénérationnels et articulant ces mêmes questions. Mais aussi comme présents dans des aspects d'incarnation souvent négligés. La pièce de théâtre Slave Play de Jeremy Harris est donnée comme une amplification des présences transgénérationnelles non-reconnues mais omniprésentes dans nos interactions analytiques. Des exemples cliniques explorent les aspects contre-transférentiels qui illustrent le défi de Jung, tels qu'un préjugé non intentionnel; de considérer que l'analyse égalise la transformation et va vers une résolution qui intègre, ou bien d'envisager l'analyse comme laissant non examinées les présomptions de structures de classe et les privilèges. Un rêve personnel est donné comme illustration de la nécessaire réorientation du moi de l'analyste vers une attitude dans laquelle la renaissance arrive seulement dans et à travers l'interaction avec le collectif. Il est soutenu que c'est seulement avec une telle interaction, qui montre le mouvement vers la justice sociale, qu'une analyse efficace est possible.

Se revisa y considera el proceso de análisis Junguiano en su interconexión inexorable con nuestra vida en sociedad y con aspectos de nuestras interacciones sociales que anhelan por una justicia interpersonal reparadora. Se revisan varios modelos, incluyendo a Fanon, Gambini, Kimbles, Levine, Saban - cada uno con la mirada puesta sobre el mandato de Jung acerca de que debemos movernos más allá del 'conocimiento' hacia 'el comer y la digestión' - metabolizando y por lo tanto modificando nuestra forma de vida. Se discuten los aspectos disociados de la pareja analítica, tanto al ser representados, como a través de su articulación con cuestiones transgeneracionales, fantasmas, y al presentarse en aspectos a menudo negados del cuerpo. La obra teatral Slave Play de Jeremy Harris es ofrecida como amplificación de presencias transgeneracionales no reconocidas y omnipresentes en nuestras interacciones en el análisis. Ejemplos clínicos exploran aspectos de la contratransferencia que ilustran el desafío de Jung, como el prejuicio involuntario hacia el análisis como equivalente de una resolución transformadora e integradora, o hacia el análisis que deja sin examinar los supuestos basados en estructura y privilegios de clase. Se ofrece un sueño personal como ilustración de una reorientación necesaria del ego del analista hacia una actitud en la cual el renacer puede suceder solamente en y a través de la interacción con lo colectivo. Se argumenta que solamente junto a esta interacción, la cual manifiesta movimientos hacia la justicia social, puede haber un análisis eficaz.

O processo de análise junguiana é revisado e considerado como inexoravelmente entrelaçado com nossas vidas na sociedade e aspectos de nossas interações sociais que anseiam por justiça interpessoal e restauradora. Vários modelos são revisados, incluindo Fanon, Gambini, Kimbles, Levine, Saban - cada um com um olhar na determinação de Jung de que devemos ir além do "conhecimento" em direção a "comer e digerir" - metabolizando e, assim, mudar nosso modo de viver. Aspectos dissociados do casal analítico são discutidos, tanto como representados e articulando questões transgeracionais, fantasmas, quanto como apresentados em aspectos frequentemente negligenciados da representação. Slave Play de Jeremy Harris é oferecido como uma amplificação de presenças transgeracionais onipresentes e não reconhecidas em nossas interações analíticas. Exemplos clínicos exploram aspectos de contratransferência que ilustram o desafio de Jung, como um preconceito involuntário em relação à análise como igualar transformação e integração de resolução, ou em relação à análise, como deixar inexaminadas, as presunções de estruturas de classe e privilégios. Um sonho pessoal é oferecido na ilustração de uma reorientação necessária do ego do analista em direção a uma atitude em que o renascimento entra apenas e através da interação com o coletivo. Argumenta-se que somente com essa interação, que manifesta movimento em direção à justiça social, há uma análise eficaz.

Bastard children of the avant-garde: artistic expression in the Cubist and Abstract Expressionist movements and the psychoanalytic process.

The art movements of Cubism and Abstract Expressionism, influenced by Jung and Freud, emerged as a symbolic representation of the collective unconscious, and became an expression of the challenging times of a culture in transition. Similar to the technique of interpretation in psychoanalysis, Cubist painting was a method of demarcation, rather than an imitation of what was seen in the physical world. Also, as an expression of collective experience, the avant-garde movement of Abstract Expressionism emerged out of Cubism. It moved away from the logical idealism of Cubism into an expression of felt experience. This paper will review the art of the avant-garde Cubist and Abstract Expressionist movements. The psychology of the artistic process will be explored in relation to psychoanalysis and collective experience.

Les mouvements artistiques du Cubisme et de l'Expressionnisme Abstrait, influencés par Jung et Freud, ont émergé comme représentation symbolique de l'inconscient collectif, et sont devenus une expression d'une époque difficile d'une culture en transition. Comme la technique de l'interprétation en psychanalyse, la peinture Cubiste est une méthode de démarcation, plutôt qu'une imitation de ce qui était perçu dans le monde physique. Le mouvement avant-garde de l'Expressionnisme Abstrait a émergé du Cubisme, et est également l'expression d'une expérience collective. Il a évolué à partir de l'idéalisme logique du Cubisme vers l'expression d'une expérience ressentie. Cet article passera en revue l'art de l'avant-garde du Cubisme et de l'Expressionnisme Abstrait. La psychologie du processus artistique sera étudiée en relation avec la psychanalyse et l'expérience collective.

Los movimientos de arte Cubista y Expresionismo Abstracto, influenciados por Jung y Freud, emergieron como representación simbólica del inconsciente colectivo, y devinieron en la expresión de una cultura en transición en tiempos desafiantes. De manera similar a la técnica de interpretación en psicoanálisis, la pintura Cubista fue un método de demarcación, en lugar de una imitación de aquello visto en el mundo físico. También, como expresión de la experiencia colectiva, el movimiento vanguardista del Expresionismo Abstracto emergió desde el Cubismo. Se alejó del idealismo lógico del Cubismo hacia una expresión de la experiencia sentida. El presenta trabajo revisa los movimientos de arte de vanguardia Cubista y Expresionista Abstracto. Se explora la psicología del proceso artístico, con relación al psicoanálisis y a la experiencia colectiva.

Os movimentos artísticos do Cubismo e do Expressionismo Abstrato, influenciados por Jung e Freud, surgiram como uma representação simbólica do inconsciente coletivo e se tornaram uma expressão de tempos desafiadores de uma cultura em transição. Semelhante à técnica de interpretação na psicanálise, a pintura cubista era um método de demarcação, em vez de uma imitação do que era visto no mundo físico. Além disso, como expressão da experiência coletiva, o movimento de vanguarda do Expressionismo Abstrato emergiu do Cubismo. Afastou-se do idealismo lógico do cubismo para uma expressão de experiência sentida. Este artigo revisará a arte dos movimentos cubistas e expressionistas abstratos de vanguarda. A psicologia do processo artístico será explorada, em relação à psicanálise e à experiência coletiva.

A personal commentary on J.W. Perry, M.D., and introduction to 'Reconstitutive process in the psychopathology of the Self'.

John Weir Perry's influence on the understanding of the psychotic process through his research in San Francisco between 1950 and 1981 was groundbreaking, because it both verified and expanded upon C.G. Jung's research at the Burghölzli Hospital in Switzerland in the early 1900's. The author explores both the brilliance of Perry's contribution as a psychiatrist and Jungian analyst and also shows the flawed human, who, with his rare sensitivity to the psychotic process, devoted his life work to the schizophrenic population and their often ill-fated search for meaning. She tells how his creative engagement with the analytic processes of Self discovery eventually led to analytic boundary violations, which ultimately resulted in his indefinite suspension from membership in his local Jungian community. Further, this paper describes her reflections on the innovative work that influenced both the treatment of this population, as well as educating candidates in analytical training to be receptive to and cognizant of psychotic affects and imagery. The archetypal field of the psychotic process, its influence on the development of analytical psychology relative to the psychotic process, and one man's impact on the analytic community are considered.

L'influence de John Weir Perry sur la compréhension du processus psychotique à travers ses recherches à San Francisco entre 1950 et 1981 fut considérable. Elle confirma et élargit les recherches de C.G. Jung au Burghölzli en Suisse au début du XXème siècle. L'auteur explore d'une part l'intelligence de la contribution de Perry en tant que psychiatre et analyste Jungien et d'autre part l'être humain imparfait qui, avec sa sensibilité rare au processus psychiatrique a consacré l'œuvre de sa vie aux patients schizophrènes et à leur recherche de sens souvent tragique. Elle évoque comment son engagement créatif avec les processus analytiques de découverte du Soi l'ont finalement conduit à des violations du cadre analytique, ce qui eut pour conséquence ultime la suspension définitive de son appartenance à sa communauté Jungienne locale. De plus, cet article décrit les réflexions de l'auteur sur le travail innovant qui influença à la fois le traitement des schizophrènes et l'éducation des candidats dans la formation analytique pour qu'ils deviennent réceptifs et informés en ce qui concerne les affects et l'imagerie psychotiques. L'article s'intéresse au champ archétypal du processus psychotique, à son influence sur le développement de la psychologie analytique dans le domaine du processus psychotique, et à l'impact d'un homme sur la communauté analytique.

La influencia de John Weir Perry a la comprensión de los procesos psicóticos a través de su investigación en San Francisco entre 1950 y 1981 fue pionera, al verificar y expandir las investigaciones de C.G. Jung en el Hospital Bürgholzli, en Suiza a comienzos de l900. La autora explora tanto la brillantez de las contribuciones de Perry como psiquiatra y analista Junguiano, y también muestra al humano imperfecto, quien, con su rara sensibilidad al proceso psicótico, dedicó su trabajo de vida a la población esquizofrénica y a sus - a menudo inútiles - búsquedas de sentido. Ella cuenta como su compromiso creativo con el proceso analítico de autodescubrimiento condujo eventualmente a violaciones de los límites analíticos, las cuales resultaron en la suspensión indefinida de su membresía en la comunidad Junguiana local. A su vez, el presente trabajo describe las reflexiones de la autora, sobre el innovador trabajo que ha influenciado tanto el tratamiento de dicha población, como también el educar a los candidatos en formación analítica, a ser receptivos y conscientes de la imaginería y de las emociones en la psicosis. Son considerados el campo arquetípico en el proceso psicótico, su influencia en el desarrollo de la psicología analítica relativa al proceso psicótico y el impacto de un hombre en la comunidad analítica.

[Evidence-based policy-making? The meaning of scientific knowledge in policy processes]. / Evidence-based policy-making? Die Bedeutung wissenschaftlicher Erkenntnisse in politischen Prozessen.

Scientific findings are often not adopted and utilized as assumed and intended by their producers and mediators. These gaps in the uptake and use of scientific "evidence" induce reflections on the communication between science and its addressees in society. If "politics" is conceived as an addressee, could its members be identified as a "target group"? What are the knowledge needs of policy-makers? What do they expect not only in terms of "the evidence" provided, but also with regard to the role that its producers play in processes of counselling? And how do these expectations fit together with the models of counselling and communication that producers of scientific knowledge presuppose in the framework of evidence-based policy-making?

[To what extent do reviewers of multiple-choice questions need to be trained? A comparison between handing out information sheets and brief workshop sessions]. / In welchem Umfang müssen Reviewer für Multiple-Choice-Aufgaben geschult werden? Ein Vergleich zwischen Merkblatt-Distribution und Kurztrainings.

BACKGROUND: A competent review process is crucial to ensure the quality of multiple-choice (MC) questions. However, the acquisition of reviewing skills should not cause any unnecessary additional burden for a medical staff that is already facing heavy workloads. METHODS: 100 MC questions, for which an expert review existed, were presented to 12 novices. In advance, six participants received a specific information sheet covering critical information for high-calibre review; the other six participants attended a 2.5-hour workshop covering the same information. The review results of both groups were analysed with a licensed version of the IBM software SPSS 19.0 (SPSS Inc., Chicago, IL). RESULTS: The results of the workshop group were distinctly closer to the experts' results (gold standard) than those of the information sheet group. For the quantitatively important category of medium quality MC questions, the results of the workshop group did not significantly differ from the experts' results. In the information sheet group the results were significantly poorer than the experts', regardless of the quality of the questions. CONCLUSIONS: Distributing specific information sheets to MC question reviewers is not sufficient for ensuring the quality of the review so that - regardless of the increased effort involved - a recommendation to conduct specific workshops must be made.

Intersubjectivity and the creation of meaning in the analytic process.

By means of a clinical illustration, the author describes how the intersubjective exchanges involved in an analytic process facilitate the representation of affects and memories which have been buried in the unconscious or indeed have never been available to consciousness. As a result of projective identificatory processes in the analytic relationship, in this example the analyst falls into a situation of helplessness which connects with his own traumatic experiences. Then he gets into a formal regression of the ego and responds with a so-to-speak hallucinatory reaction-an internal image which enables him to keep the analytic process on track and, later on, to construct an early traumatic experience of the analysand.

La construction de l'auteur. L'enjeu de l'écrit dans la psychose à partir d'un cas clinique / A construção do autor. A aposta da escrita na psicose a partir de um caso clínico / The construction of an author. Writing as a possibility in psychosis based on a clinical case / La construcción del autor. La apuesta de la escrita en la psicosis a partir de un caso clínico

A partir de la parole d'un patient psychotique, et en nous référant à théorie psychanalytique, nous interrogeons la valeur différentielle de la parole, de l'écrit et de la signature d'auteur dans le suivi d'un patient dans une institution de santé mentale. Les interventions du psychologue permettront une stabilisation symptomatique qui implique une limitation de la souffrance et une possibilité d'aménager un lien à l'autre et à la «réalité¼ qui soit moins envahissant.

A partir da palavra de um paciente psicótico, e aplicando conceitos psicanalíticos, questionamos o valor diferencial da palavra, da escrita e da assinatura do autor no tratamento de um paciente em uma instituição de saúde mental. as intervenções do psicólogo permitirão uma estabilização sintomática que implica uma limitação do sofrimento e a possibilidade de uma ligação a outros e a "realidade" menos intrusiva.

Based on a psychotic patient's words — and on applying psychoanalytic concepts —, we question the differential value of words, of writing and of the author's signature in the psychological treatment of a patient in a mental health institution. The psychologist's interventions allow for symptomatic stabilization, resulting in the limitation of suffering, in the possibility of bonding with other people, and to a less intrusive "reality".

A partir de la palabra de un paciente psicótico, y mediante la aplicación de conceptos psicoanalíticos, interrogamos el valor diferencial de la palabra, de la escrita y de la firma de autor en el tratamiento de un paciente dentro de una institución de salud mental. Las intervenciones del psicólogo permitirán una estabilización sintomática que implica una limitación del sufrimiento y la posibilidad de un lazo, menos invasivo, con los otros y con la "realidad".

Aufgrund des schriftlichen Ausdrucks eines psychotischen Patienten und der psychoanalytischen Konzepte, untersucht dieser Artikel den differenziellen Wert des Wortes, des schriftlichen Ausdrucks und der Unterschrift des Autors während der Behandlung eines Patienten in einer psychiatrischen Anstalt. Die Interventionen eines Psychologen erlaubten es, eine symptomatische Stabilisierung herzustellen, die zu einer Begrenzung des Leidens führte, zur Herstellung von Kontakten zu Anderen, sowie zu einer weniger intrusiven „Realität".