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The goal of this book is to shed psychoanalytic light on a concept—informed consent—that has transformed the delivery of health care in the United States. Examining the concept of informed consent in the context of psychoanalysis, the book first summarizes the law and literature on this topic. Is informed consent required as a matter of positive law? Apart from statutes and cases, what do the professional organizations say about this? Second, the book looks at informed consent as a theoretical matter. It addresses such questions as: What would be the elements of a robust informed consent in psychoanalysis? Is informed consent even possible here? Can patients really understand, say, transference or regression before they experience them, and is it too late once they have? Is informed consent therapeutic or countertherapeutic? Can a “process view” of informed consent make sense here? Third, the book reviews data on the topic. A lengthy questionnaire answered by sixty-two analysts reveals their practices in this regard. Do they obtain a statement of informed consent from their patients? What do they disclose? Why do they disclose it? Do they think it is possible to obtain informed consent in psychoanalysis at all? Do they think the practice is therapeutic or countertherapeutic, and in what ways? Do they think there should or should not be an informed consent requirement for psychoanalysis? The book should appeal above all to therapists interested in the ethical dimensions of their practice.
The distinguished contributors to Confidentiality probe the ethical, legal, and clinical implications of a deceptively simple proposition: Psychoanalytic treatment requires a confidential relationship between analyst and analysand. But how, they ask, should we understand confidentiality in a psychoanalytically meaningful way? Is confidentiality a therapeutic requisite of psychoanalysis, an ethical precept independent of psychoanalytic principles, or simply a legal accommodation with the powers that be? In wrestling with these questions, the contributors to Confidentiality are responding to a professional, ethical, and political crisis in the field of mental health. Psychotherapy - especially long-term psychotherapy in its psychoanalytic variants - has been undermined by an erosion of personal privacy that has become part of our cultural zeitgeist. The heightened demand for public transparency has forced caregivers from all walks of professional life to submit to increasing bureaucratic regulation. For the contributors to this collection, the need for confidentiality is centrally involved in the relationship of the psychotherapeutic professions both to society and to the law. No less importantly, the requirement of confidentiality brings a clarifying perspective to debates within the psychotherapeutic literature about the relationship of theory to practice. It thereby provides a framework for shaping a set of ethical principles specifically adapted to the psychotherapeutic, and especially to the psychoanalytic, relationship. Linking general issues of privacy to the intimate details of psychotherapeutic encounter, Confidentiality will serve as a basic guide to a wide range of professionals, including lawyers, social scientists, philosophers, and, of course, psychotherapists. Therapy patients, policy makers, and the wider public will also find it instructive to know more about the special protected conditions under which one can better come to "know thyself."
Winner of the 2010 Goethe Award for Psychoanalytic and Psychodynamic Scholarship! This book builds a key clinical bridge between attachment theory and psychoanalysis, deploying Holmes' unique capacity to weld empirical evidence, psychoanalytic theory and consulting room experience into a coherent and convincing whole. Starting from the theory–practice gap in psychoanalytic psychotherapy, the book demonstrates how attachment theory can help practitioners better understand what they intuitively do in the consulting room, how this benefits clients, and informs evidence-based practice. Divided into two sections, theory and practice, Exploring in Security discusses the concept of mentalising and considers three components of effective therapy – the therapeutic relationship, meaning making and change promotion – from both attachment and psychoanalytic perspectives. The second part of the book applies attachment theory to a number of clinical situations including: working with borderline clients suicide and deliberate self-harm sex and sexuality dreams ending therapy. Throughout the book theoretical discussion is vividly illustrated with clinical material, personal experience and examples from literature and film, making this an accessible yet authoritative text for psychotherapy practitioners at all levels, including psychoanalysts, psychiatrists, clinical psychologists, mental health nurses and counsellors.
Addressing the issue of professional ethics in the field of psychotherapy, this volume uses classical vignettes and discussions to examine the complexities faced by a therapeutic clinician in dealing with patients. Either hypothetical, generic, or composite situations, the examples are designed to help clinicians better recognize and respond to the ethical issues they will likely encounter in the field.
Unknowable, Unspeakable, and Unsprung delves into the mysteries of scandalous behavior- behavior that can seem shocking, unfathomable, or self-destructive - that is outrageous and offensive on the one hand, yet fascinating and exciting on the other. In the process, this anthology asks fundamental questions about the self: what the self is allowed to be and do, what must be disallowed, and what remains unknown. Clinicians strive to know their patients’ selves, and their own, as fully as possible, while also facing the inevitable riddles these selves present. Covering topics ranging from trauma, politics, the analyst’s subjectivity, and eating disorders and the body, to self-revelation, secrets, evil, and boundary issues, a distinguished group of authors bring the theory, practice, and application of contemporary psychoanalysis to life. In doing so, they use psychoanalytic perspectives not only to illuminate struggles that afflict patients seeking treatment, but to shed light, more broadly, on contemporary human dilemmas. This collection offers not a unified voice, but rather the sound of many, each in its own way trying to articulate the indescribable, the unwanted, and the off limits. It is a book that raises more questions than can be answered, complicates as much as clarifies, and contains the essential paradox of trying to talk about aspects of clinical and human experience that can never be fully seen or known. Unknowable, Unspeakable, and Unsprung offers invaluable reading to interested mental health professionals as well as to anyone intrigued by the secrets of the self.
In this second edition of Endings & Beginnings (Routledge, 2006), Herbert J. Schlesinger explores endings and beginnings within psychoanalysis and psychoanalytic therapy; both the obvious main endings and beginnings of any course in treatment, and the many little endings and beginnings that permeate analysis. The second edition contains new chapters including one on transference and counter-transference as sources of information about the process of therapy and as sources of difficulty in ending. It deals especially with the impact of prospective ending on the therapist, which if not understood and well handled, might interfere with working through and impede termination, if not ending itself. Another new chapter deals with the difficulties in terminating with especially narcissistic patients. One of the main criticisms against psychoanalysis and the psychotherapies derived from it is that it lacks criteria for when the patient has had enough. Herbert J. Schlesinger shows how we may view the process as a series of episodes each with an ending and possibly with a new beginning. He presents the way patients signal, even before they are aware of it, that ending is "in the air," and how it organizes how they experience the therapy. If alerted, the therapist can make use of these signals to locate self and patient in the process. So informed, the therapist is better able to discern when the therapy should end and help the patient work through the issues of separation and loss to terminate the treatment constructively. All patients tend to end psychotherapy in the way they end all other relationships. In several chapters on the problems related to severe regression, therapists can learn how to help vulnerable patients, for whom attachment is problematic, deal with separation non-traumatically. In Endings & Beginnings 2nd Edition, the theory of the continuous experience of ending and beginning and the array of landmarks that parse the clinical process are distinct advances to the technique of psychoanalysis and the psychotherapies derived from it. Schlesinger offers many clinical examples of ending and beginning with their technical problems and solutions. This contribution to the technique of ending and beginning psychotherapy electively will be useful to practicing psychotherapists and psychoanalysts, and to undergraduate and post-graduate students in clinical psychology, psychiatry and social work.
This book focuses on the professional ethics of medicine and psychiatry, to know whether psychoanalysis differs from brainwashing. It addresses a divergence—a choice between repression and splitting, and examines how the findings concerning a divided mind relate to philosophical issues.
Stephen A. Mitchell has been at the forefront of the broad paradigmatic shift in contemporary psychoanalysis from the traditional one-person model to a two-person, interactive, relational perspective. In Influence and Autonomy in Psychoanalysis, Mitchell provides a critical, comparative framework for exploring the broad array of concepts newly developed for understanding interactive processes between analysand and analyst. Drawing on the broad traditions of Kleinian theory and interpersonal psychoanalysis, as well as object relations and progressive Freudian thought, he considers in depth the therapeutic action of psychoanalysis, anachronistic ideals like anonymity and neutrality, the nature of analytic knowledge and authority, and the problems of gender and sexual orientation in the age of postmodernism. The problem of influence guides his discussion of these and other topics. How, Mitchell asks, can analytic clinicians best protect the patient’s autonomy and integrity in the context of our growing appreciation of the enormous personal impact of the analyst on the process? Although Mitchell explores many facets of the complexity of the psychoanalytic process, he presents his ideas in his customarily lucid, jargon-free style, making this book appealing not only to clinicians with various backgrounds and degrees of experience, but also to lay readers interested in the achievements of, and challenges before, contemporary psychoanalysis. A splendid effort to relate parallel lines of theorizing and derivative changes in clinical practice and informed by mature clinical judgment and broad scholarship into the history of psychoanalytic ideas, Influence and Autonomy in Psychoanalysis takes a well-deserved place alongside Mitchell’s previous books. It is a brilliant synthesis of converging insights that have transformed psychoanalysis in our time, and a touchstone for enlightened dialogue as psychoanalysis approaches the millennium.