The clinical experience of five attachment-based psychoanalytic psychotherapists is pooled in an exploration of how issues in relation to sexuality and attachment emerge in the consulting room. Our clinical experience shows that sexuality, far from being a powerful instinctual drive that invariably needs to be explored clinically, is far more a reflection of early attachment histories. Instead of the standard pressure cooker of sexuality, which if not expressed leads to pathological emotional conflict we identify a melancholy sexuality, a cold arctic-like desert unwarmed by human relationship that barely achieves expression. We find that a broader and more fluid conception of sexuality as not just genitally focused but as erotic helps us relate to difficulties around sexuality as having to do with conflicts in relation to or associated with desire for contact and connection linked to past histories of loss, abandonment and sexual abuse. We argue theoretically that the psychological dimension of the biological system of human reproductive capacities, that is to say, the actually lived experience of human sexuality cannot be separated from the psychological dynamics of attachment within a social and cultural context. We discuss clinical issues including the sequelae of primary erotic attachments and working with sexual fantasies and working with erotic transference/countertransference re-enactments. A clinical example illustrates in some detail how we work with an adult survivor of sexual abuse troubled by intrusive sexual fantasies.
I present an account of a post-graduate training module I have developed for psychotherapy training students at The Centre for Attachment-based Psychoanalytic Psychotherapy entitled From Attachment Theory to Clinical Practice. I situate my interest in this work in my own life and my background in education. In describing the curriculum content, I focus in particular on an educational process that enables students to engage with the concepts from attachment theory which are both relevant to their own lives and their future work as psychotherapists. I show how the findings of the Adult Attachment Interview can be understood more deeply through a project the students are asked to present and evaluate. The article also includes some personal reflections on my experience of attachment research training from a clinician's perspective as a way to think about the divide between these two worlds. I conclude with a consideration of the strengths and limitations of attachment theory to understanding the effects of inequalities of power relations on the formation of intimate bonds.
Background. Advances in screening and treatments for colorectal cancer (CRC) have improved survival rates, leading to a large population of CRC survivors. Treatment for CRC can cause longterm side-effects and functioning impairments. General practitioners (GPs) have a role in meeting survivorship care needs of this group of survivors. We explored CRC survivors' experiences of managing the consequences of treatment in the community and their perspective on the GP's role in post-treatment care. Methods. This was a qualitative study using an interpretive descriptive approach. Adult participants no longer actively receiving treatment for CRC were asked about: side-effects post-treatment; experiences of GP-coordinated care; perceived care gaps; and perceived GP role in post-treatment care. Thematic analysis was used for data analysis. Results. A total of 19 interviews were conducted. Participants experienced side-effects that significantly impacted their lives; many they felt ill-prepared for. Disappointment and frustration was expressed with the healthcare system when expectations about preparation for posttreatment effects were not met. The GP was considered vital in survivorship care. Participants' unmet needs led to self-management, self-directed information seeking and sourcing referral options, leaving them feeling like their own care coordinator. Disparities in post-treatment care between metropolitan and rural participants were observed. Conclusion. There is a need for improved discharge preparation and information for GPs, and earlier recognition of concerns following CRC treatment to ensure timely management and access to services in the community, supported by system-level initiatives and appropriate interventions.
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