This article explored the idea of a relational unconscious, which presumes three interconnected ideas about human interaction. First, meaning and understanding are coconstructed and intersubjective and not universal, absolute, and preformed.Second, there is a fluid boundary between conscious and unconscious experience that is intersubjectively mediated. Third, language is basic to human experience, whether or not a particular experience can be verbally expressed. This view of unconscious experience suggests that a therapist's participation is a major determining influence on the generation, awareness, and expression of a patient's unconscious experience. In applying a relational view of unconscious processes, self-disclosure is used to consider the usefulness of therapeutic interventions, to think critically about the nature of human interaction, and to specify how the therapeutic relationship promotes healing and growth.In his acceptance speech for the Nobel Prize in literature at Stockholm in 1950, William Faulkner depicted the writer's primary duty as that of
Surgical wound infections are the most common hospital-acquired infections among patients who undergo inpatient surgery. Risk of infection is a function of both patient susceptibility and exposure. The authors studied all discharges in Pennsylvania from October 1, 2004, through September 30, 2005, in which a circulatory (n= 65 940), neurological (n= 6706), or orthopedic (n = 107 825) procedure was performed using data from the Pennsylvania Health Care Cost Containment Council. They estimated the impact of patient-specific factors on risk of infection and compared the ability of these factors to predict infections relative to hospital effects. Results suggested that for all 3 types of procedures, patient-specific factors were a significant determinant of risk of surgical wound infection. However, prediction of infection was improved by 23% to 33% when hospital fixed effects were included. Although patient-specific factors had a statistically significant association with risk of infections, much of the risk of surgical wound infections is determined by hospital factors.
Contemporary psychoanalysis does not have a consistent view on language. Some view language as the bedrock of all communication, whereas others argue that the nonverbal is constitutive of human experience. These divergent points of view are given voice in a recent exchange in this journal between two prominent post-Freudian analysts, Doris Silverman and Stephen Mitchell. The present article suggests that a broader conceptualization of language is needed. The author endorses the hermeneutic view that language is the primary and fundamental medium through which culture, tradition, and custom are transmitted down through history. He reviews the work of psychoanalytic writers who reflect a hermeneutic sensibility and then offers a view of language for psychoanalysis based in hermeneutic principles.A tension exists within psychoanalysis about the role of language within human experience. Some writers (e.g., Loewald, 1980;Ogden, 1997aOgden, , 1997bStern, 1997) insist that language is fluid and creative, forming a
Becoming a psychotherapist is a challenging and exciting process. There are many important facets of training in the development of a skilled therapist. Emotional availability and personal allegiances are two interrelated areas of a therapist's development that might be underemphasized relative to other areas of training in many graduate clinical training programs. This article offers a conceptualization for emotional availability and personal allegiances, presents a view of the treatment process that places emotional availability at the center of therapeutic responsiveness, and argues that personal allegiances may limit a student-therapist's emotional availability with clients. This article addresses the concepts of emotional availability and personal allegiances primarily from a contemporary psychodynamic theoretical perspective, but key ideas from the cognitivebehavioral viewpoint are also used to illustrate their significance in a therapist's development, however. These concepts are suggested to have relevance for students, supervisors, and more seasoned therapists of varying theoretical orientations.
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