James Tobin, Ph.D. argues that the goals of problem-solving, progression, and resolution have been over-emphasized in current views of psychotherapy. Instead, he argues that a significant aim of clinical treatment should be the expansion of the ego's contact with reality, which leads to an enhanced capacity for joy and tolerance of loss and mourning. Such a view also emphasizes accountability and reckoning as important aims in therapy; they are progressive in that the patient gradually comes to evaluate more accurately how his or her motives and actions led to consequences.
A Therapy Hour: Revisiting Winnicott's Notion of "Object Usage" James Tobin
In this presentation, James Tobin, Ph.D. argues that the psychotherapist must be able to accept and tolerate the patient's acting on the therapist vs. the the therapist acting on the patient. Using Winnicott's notions of object usage and object relatedness, Dr. Tobin highlights the ubiquitous nature of the patient's resistance to advanced forms of intersubjectivity and the narcissistic ambitions of the therapist.
Negotiating the Enduring Trauma Imprint in Critical IncidentsPaulaFenn
I presented this slide deck at the BACP conference on critical Incidents held in Edinburgh in April 2018. Those that are interested in this field of work may find it useful.
Toward a View of "Positive Resistance": One Perspective on Change in Psychoan...James Tobin
Resistance has been a vital element of psychoanalytic psychotherapy since Freud, traditionally conceived of as a hindrance to the patient's use of the analyst's interpretation. Nevertheless, in this presentation, James Tobin, Ph.D. re-conceptualizes "positive resistance" as an important moment in the analytic relationship when the patient claims identity components that exist outside of the analyst's epistemology and conceptualization. Dr. Tobin portrays a notion of progressive "change" in which the patient is perceived by self and other as mysterious, enigmatic, and complex, thus marking a necessary transition of intersubjectivity.
A Therapy Hour: Revisiting Winnicott's Notion of "Object Usage" James Tobin
In this presentation, James Tobin, Ph.D. argues that the psychotherapist must be able to accept and tolerate the patient's acting on the therapist vs. the the therapist acting on the patient. Using Winnicott's notions of object usage and object relatedness, Dr. Tobin highlights the ubiquitous nature of the patient's resistance to advanced forms of intersubjectivity and the narcissistic ambitions of the therapist.
Negotiating the Enduring Trauma Imprint in Critical IncidentsPaulaFenn
I presented this slide deck at the BACP conference on critical Incidents held in Edinburgh in April 2018. Those that are interested in this field of work may find it useful.
Toward a View of "Positive Resistance": One Perspective on Change in Psychoan...James Tobin
Resistance has been a vital element of psychoanalytic psychotherapy since Freud, traditionally conceived of as a hindrance to the patient's use of the analyst's interpretation. Nevertheless, in this presentation, James Tobin, Ph.D. re-conceptualizes "positive resistance" as an important moment in the analytic relationship when the patient claims identity components that exist outside of the analyst's epistemology and conceptualization. Dr. Tobin portrays a notion of progressive "change" in which the patient is perceived by self and other as mysterious, enigmatic, and complex, thus marking a necessary transition of intersubjectivity.
креативная компетентность педагога как условие развития читательской культурыliuviu
«Креативная компетентность педагога как условие развития читательской культуры и креативных способностей учащихся»
Брякова Ирина Евгеньевна доктор педагогических наук, профессор кафедры литературы и методики преподавания литературы ОГПУ, Оренбург
We're giving away our FULL 96-page 2nd edition of the South African Trend-Spotting report over the next few days. (The one here is a sample of the report).
We had overwhelming demand for the 1st edition and used the feedback to improve our offering across the board.
Each month, we tap into our community of 180,000 advertising agency pros to find South Africa's top 20-50 minds that are working with the best brands on thousands of campaigns.
Our monthly report gives you insights into brand and agency activity across South Africa, as well as hyper-localized trends rising and falling. Going beyond big data, we tap into the deep wisdom of the experienced agency eye - ranging from brand strategists, heads of social media to copywriters and creative directors with 5-20 years experience.
Please drop me a request on this post and I will send you the link for free. Would love your feedback.
Книжная выставка ко Дню Культуры, гимназия № 278 Санкт-Петербурга 2016 годliuviu
ГБОУ гимназия №278 имени Б.Б. Голицына
Адмиралтейского района Санкт-Петербурга
Оформление выставочного пространства
Книжно-иллюстративная выставка
«Прекрасное есть щит от зла»
В рамках проведения Дня Культуры 15 апреля
Автор-организатор выставки: заведующая библиотекой
ШИРОКОВА Ирина Ивановна
Санкт-Петербург - 2016
Promoting the Patient's Capacity to Suffer: A Revision of Contemporary Notion...James Tobin, Ph.D.
In this presentation, Dr. Tobin argues that the era of evidence-based treatment has inadvertently placed too much pressure and responsibility on the part of the clinician to "heal" the patient. Symptom reduction and characterologoical transformation are perspectives on therapeutic transformation that oversimplify the clinical situation. According to Dr. Tobin, a principle focus of psychodynamic treatment is increasing the patient's capacity to contact, tolerate, and represent his or her contributions to experience; learning by suffering denotes a psychological competency in which denial, minimization, and other defensive modes of distortion are replaced by more accurate appraisals of reality.
The Anatomy of Discovery in Psychotherapy: "Something So Familiar, It is Stra...James Tobin, Ph.D.
In this talk, presented at the Western Psychological Association Annual Convention in April, 2014, Dr. Tobin cautions that the current environment of empirically-based treatment may foreclose on the discovery process psychotherapy affords. According to Dr. Tobin, psychotherapy is most successful when the patient's self-observing capacities are supported by the therapist. If the therapist can avoid narcissistic ambitions and instrumental fictions employed to understand the patient prematurely, the conditions may allow for the patient to connect with dissociated memories, cognitions, and affects. Dr. Tobin utilizes movie clips from the feature films "Ordinary People" and "9 1/2 Weeks" to illustrate his perspective.
In this presentation, Dr. Tobin utilizes Alice Miller's characterization of the "gifted child" to suggest that many graduate students in clinical psychology and psychotherapy trainees have suffered early emotional trauma. A consequence of this trauma is a psychological and emotional investment in the mental healthcare professions as a means of continuing to adhere to a particular relational role. For Dr. Tobin, what is problematic about this professional aspiration is the characterological residue from early deprivations which often emerges in trainees' narcissistic and/or co-dependent tendencies as they begin to engage in the therapeutic role. Breaking from these tendencies affords greater perceptional and relational freedoms, an important training and supervisory milestone for trainees and early-career psychotherapists.
Finding the "Subversive" in the Persona of the TherapistJames Tobin, Ph.D.
In this talk, I present my view of the psychotherapeutic process as a shift from the conventions of typical social reality into a therapeutic space oriented toward self-expression and self-experience. This shift is usually a significant challenge both for the patient and therapist, particularly therapists-in-training or early in their careers. The therapeutic couple may collude in an avoidance of deeper levels of the patient's experience and of the therapist's capacity to articulate what he/she observes or feels about the patient. This presentation attempts to conceptualize how the identity of the therapist needs to be altered into a "therapeutic persona" that subverts conventional relational and attachment tendencies in order to liberate the patient's recognition of oneself.
One Way Out of Enactment: The Patient's Differentiation from the TherapistJames Tobin, Ph.D.
In his important work “Partners in Thought: Working with Unformulated Experience, Dissociation, and Enactment” (2010), Donnel Stern posits, “All experience is subjective, the analyst’s as well as the patient’s … We must now understand that we all continuously, necessarily, and without awareness apply ourselves to the task of selecting one, or several, particular views of another person from among a much larger set of possibilities” (p. 8). For Stern, enactment gradually evolves as each participant in the clinical situation constructs the other more narrowly and rigidly, thus limiting the “freedom” of relatedness and mutual meaning-making. But in any attempt to interrupt, understand, and move beyond the current enactment circumstance, how does the therapist recognize the mistaken components of his subjective construction of the patient and alter that construction to one that is more true, more real? My answer to this question involves an attunement to the patient’s necessary differentiation from the therapist’s own metapsychology, i.e., the therapist’s mind and relatedness. Differentiation relies on the therapist’s capacity to shift from a subjective to an objective stance which is, in essence, the capacity to apprehend disconfirmation in the clinical moment. It also requires that the therapist has done enough to enable the patient to disconfirm. I will describe several cases in which enactments are penetrated by a mode of listening that emphasizes the therapist’s management of states of truth and non-truth, the movement between subjectivity and objectivity. It will be demonstrated that aspects of clinical technique in this endeavor are secondary to the therapist’s tolerance of discontinuous emotional, cognitive and interpersonal experience. Differentiation will be conceived of as a significant relational development in psychodynamic and psychoanalytic treatment that promotes the patient’s receptivity to intrapsychic conflict and self-discontinuity.
One Way Out of Enactment: The Patient's Differentiation from the Therapist James Tobin
James Tobin, Ph.D. argues that a common countertransference occurrence is the therapist's identification with aspects of the patient's personhood. This identification mobilizes empathy but, ultimately must be severed by the patient's de-identification and differentiation from the therapist.
Socializing the Psychotherapist-in-Training to an Alternative Form of Related...James Tobin, Ph.D.
According to Dr. Tobin, the supervision of psychologists-in-training must facilitate a central transition for the trainee. A major aspect of the trainee is socially-normed attitudes and tendencies which infiltrate the clinical situation and typically impede the development of a distinct "space" or interpersonal field on which psychotherapy relies. Dr. contends that the the supervisory situation and the unfolding dynamics between the supervisor and trainee should optimally support the trainee's capacity to experience him- or herself, and the other, in a more refined mode that liberates the dyad from the psychological and emotional restraints and inhibitions associated with social conventionality.
The standards of care of the modern mental health system all but insist that a therapist use force in working with clients diagnosed with severe psychiatric problems—especially those labeled with schizophrenia or bipolar disorder. The mental health practitioner is taught to be skeptical of their judgment, their self-control, and thus their wishes.
Toward a View of Positive Resistance: One Perspective on Change in Psychoanal...James Tobin, Ph.D.
According to Dr. Tobin, psychoanalytic psychotherapy features patterns of relational engagement between therapist and patient in which each contacts, adjusts, and conforms to the other, often due to simultaneously prosocial and defensive motives. Yet, as the intersubjective process unfolds and rigidifie throughout the course of therapy, the dyadic system is inevitably altered as determined by new strivings on the part of one or both partners. At these junctures, it is erroneous to characterize the patient as "resistant," especially in the context of the patient's emerging realization that he or she cannot be fully and accurately conceptualized by the clinician's mind. Rather, "positive resistance" more aptly captures an advancement in the patient's psychological and interpersonal functioning marked by an acknowledgment of what the other distorts or fails to comprehend about the self.
Therapy Without Force: A Treatment Model for Severe Psychiatric ProblemsAhmed YaGoub
The standards of care of the modern mental health system all but insist that a therapist use force in working with clients diagnosed with severe psychiatric problems—especially those labeled with schizophrenia or bipolar disorder. The mental health practitioner is taught to be skeptical of their judgment, their self-control, and thus their wishes.
креативная компетентность педагога как условие развития читательской культурыliuviu
«Креативная компетентность педагога как условие развития читательской культуры и креативных способностей учащихся»
Брякова Ирина Евгеньевна доктор педагогических наук, профессор кафедры литературы и методики преподавания литературы ОГПУ, Оренбург
We're giving away our FULL 96-page 2nd edition of the South African Trend-Spotting report over the next few days. (The one here is a sample of the report).
We had overwhelming demand for the 1st edition and used the feedback to improve our offering across the board.
Each month, we tap into our community of 180,000 advertising agency pros to find South Africa's top 20-50 minds that are working with the best brands on thousands of campaigns.
Our monthly report gives you insights into brand and agency activity across South Africa, as well as hyper-localized trends rising and falling. Going beyond big data, we tap into the deep wisdom of the experienced agency eye - ranging from brand strategists, heads of social media to copywriters and creative directors with 5-20 years experience.
Please drop me a request on this post and I will send you the link for free. Would love your feedback.
Книжная выставка ко Дню Культуры, гимназия № 278 Санкт-Петербурга 2016 годliuviu
ГБОУ гимназия №278 имени Б.Б. Голицына
Адмиралтейского района Санкт-Петербурга
Оформление выставочного пространства
Книжно-иллюстративная выставка
«Прекрасное есть щит от зла»
В рамках проведения Дня Культуры 15 апреля
Автор-организатор выставки: заведующая библиотекой
ШИРОКОВА Ирина Ивановна
Санкт-Петербург - 2016
Promoting the Patient's Capacity to Suffer: A Revision of Contemporary Notion...James Tobin, Ph.D.
In this presentation, Dr. Tobin argues that the era of evidence-based treatment has inadvertently placed too much pressure and responsibility on the part of the clinician to "heal" the patient. Symptom reduction and characterologoical transformation are perspectives on therapeutic transformation that oversimplify the clinical situation. According to Dr. Tobin, a principle focus of psychodynamic treatment is increasing the patient's capacity to contact, tolerate, and represent his or her contributions to experience; learning by suffering denotes a psychological competency in which denial, minimization, and other defensive modes of distortion are replaced by more accurate appraisals of reality.
The Anatomy of Discovery in Psychotherapy: "Something So Familiar, It is Stra...James Tobin, Ph.D.
In this talk, presented at the Western Psychological Association Annual Convention in April, 2014, Dr. Tobin cautions that the current environment of empirically-based treatment may foreclose on the discovery process psychotherapy affords. According to Dr. Tobin, psychotherapy is most successful when the patient's self-observing capacities are supported by the therapist. If the therapist can avoid narcissistic ambitions and instrumental fictions employed to understand the patient prematurely, the conditions may allow for the patient to connect with dissociated memories, cognitions, and affects. Dr. Tobin utilizes movie clips from the feature films "Ordinary People" and "9 1/2 Weeks" to illustrate his perspective.
In this presentation, Dr. Tobin utilizes Alice Miller's characterization of the "gifted child" to suggest that many graduate students in clinical psychology and psychotherapy trainees have suffered early emotional trauma. A consequence of this trauma is a psychological and emotional investment in the mental healthcare professions as a means of continuing to adhere to a particular relational role. For Dr. Tobin, what is problematic about this professional aspiration is the characterological residue from early deprivations which often emerges in trainees' narcissistic and/or co-dependent tendencies as they begin to engage in the therapeutic role. Breaking from these tendencies affords greater perceptional and relational freedoms, an important training and supervisory milestone for trainees and early-career psychotherapists.
Finding the "Subversive" in the Persona of the TherapistJames Tobin, Ph.D.
In this talk, I present my view of the psychotherapeutic process as a shift from the conventions of typical social reality into a therapeutic space oriented toward self-expression and self-experience. This shift is usually a significant challenge both for the patient and therapist, particularly therapists-in-training or early in their careers. The therapeutic couple may collude in an avoidance of deeper levels of the patient's experience and of the therapist's capacity to articulate what he/she observes or feels about the patient. This presentation attempts to conceptualize how the identity of the therapist needs to be altered into a "therapeutic persona" that subverts conventional relational and attachment tendencies in order to liberate the patient's recognition of oneself.
One Way Out of Enactment: The Patient's Differentiation from the TherapistJames Tobin, Ph.D.
In his important work “Partners in Thought: Working with Unformulated Experience, Dissociation, and Enactment” (2010), Donnel Stern posits, “All experience is subjective, the analyst’s as well as the patient’s … We must now understand that we all continuously, necessarily, and without awareness apply ourselves to the task of selecting one, or several, particular views of another person from among a much larger set of possibilities” (p. 8). For Stern, enactment gradually evolves as each participant in the clinical situation constructs the other more narrowly and rigidly, thus limiting the “freedom” of relatedness and mutual meaning-making. But in any attempt to interrupt, understand, and move beyond the current enactment circumstance, how does the therapist recognize the mistaken components of his subjective construction of the patient and alter that construction to one that is more true, more real? My answer to this question involves an attunement to the patient’s necessary differentiation from the therapist’s own metapsychology, i.e., the therapist’s mind and relatedness. Differentiation relies on the therapist’s capacity to shift from a subjective to an objective stance which is, in essence, the capacity to apprehend disconfirmation in the clinical moment. It also requires that the therapist has done enough to enable the patient to disconfirm. I will describe several cases in which enactments are penetrated by a mode of listening that emphasizes the therapist’s management of states of truth and non-truth, the movement between subjectivity and objectivity. It will be demonstrated that aspects of clinical technique in this endeavor are secondary to the therapist’s tolerance of discontinuous emotional, cognitive and interpersonal experience. Differentiation will be conceived of as a significant relational development in psychodynamic and psychoanalytic treatment that promotes the patient’s receptivity to intrapsychic conflict and self-discontinuity.
One Way Out of Enactment: The Patient's Differentiation from the Therapist James Tobin
James Tobin, Ph.D. argues that a common countertransference occurrence is the therapist's identification with aspects of the patient's personhood. This identification mobilizes empathy but, ultimately must be severed by the patient's de-identification and differentiation from the therapist.
Socializing the Psychotherapist-in-Training to an Alternative Form of Related...James Tobin, Ph.D.
According to Dr. Tobin, the supervision of psychologists-in-training must facilitate a central transition for the trainee. A major aspect of the trainee is socially-normed attitudes and tendencies which infiltrate the clinical situation and typically impede the development of a distinct "space" or interpersonal field on which psychotherapy relies. Dr. contends that the the supervisory situation and the unfolding dynamics between the supervisor and trainee should optimally support the trainee's capacity to experience him- or herself, and the other, in a more refined mode that liberates the dyad from the psychological and emotional restraints and inhibitions associated with social conventionality.
The standards of care of the modern mental health system all but insist that a therapist use force in working with clients diagnosed with severe psychiatric problems—especially those labeled with schizophrenia or bipolar disorder. The mental health practitioner is taught to be skeptical of their judgment, their self-control, and thus their wishes.
Toward a View of Positive Resistance: One Perspective on Change in Psychoanal...James Tobin, Ph.D.
According to Dr. Tobin, psychoanalytic psychotherapy features patterns of relational engagement between therapist and patient in which each contacts, adjusts, and conforms to the other, often due to simultaneously prosocial and defensive motives. Yet, as the intersubjective process unfolds and rigidifie throughout the course of therapy, the dyadic system is inevitably altered as determined by new strivings on the part of one or both partners. At these junctures, it is erroneous to characterize the patient as "resistant," especially in the context of the patient's emerging realization that he or she cannot be fully and accurately conceptualized by the clinician's mind. Rather, "positive resistance" more aptly captures an advancement in the patient's psychological and interpersonal functioning marked by an acknowledgment of what the other distorts or fails to comprehend about the self.
Therapy Without Force: A Treatment Model for Severe Psychiatric ProblemsAhmed YaGoub
The standards of care of the modern mental health system all but insist that a therapist use force in working with clients diagnosed with severe psychiatric problems—especially those labeled with schizophrenia or bipolar disorder. The mental health practitioner is taught to be skeptical of their judgment, their self-control, and thus their wishes.
It is an interpersonal interaction between the nurse and the patient during which the nurse focuses on the patient’s specific needs to promote an effective exchange of information.
Pre-Therapy (Contact) orientated, nature based. June 2022.pptxRabErskine1
This PowerPoint presentation was developed by Rab Erskine and was offered to the tPCA's Practitioner Conference, Alfreton in June 2022. The slides highlight aspects of offering a Contact-Orientated counselling/therapy model in nature and are based on Rab's learning over the years..
Rab has lived and worked as a therapist, in the Tweed Valley (Scottish Borders Region) for over thirty five years. His initial experience of working therapeutically started in 1985, while employed at a pioneering therapeutic-community project. After qualifying in 1993 as a counsellor and psychotherapist, and alongside working as a counsellor in primary care, he set up a small company offering nature-based short term residential experiences to individuals and groups. From 2004 to 2016, he was commissioned to run the nature-based project for the Adult Mental Health Psychiatric Rehabilitation service. For a number of years he also worked as a trainer and supervisor. He presently runs a nature based private practice alongside mentoring and working with charities that support adults with complex trauma.
Rab describes his work in the following way:
"Although most counselling and psychotherapy takes place indoors, there are times when there is a need for a more natural working environment than the often, somewhat ‘clinical’ indoor therapeutic space.
This much larger working environment sometimes known as Eco-Therapy, Nature Therapy, Eco-Psychology, can assist in the creation of a gentle yet powerful therapeutic encounter, often useful when there is trauma or deep seated emotional experiences to be worked with.
A way of engaging therapeutically which (Rab believes) understands the individuals’ need for a supportive, non judgemental, less intrusive, compassionate environment within which to explore and better understand him/her self.
This very humanistic way of engaging therapeutically, works well with the nature based working context of ecotherapy.
Professionalism is the basis of medicine’s social contract with society
Professionalism demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health
Empathy is the capacity to recognize and experience feelings that are being experienced by another.
“It is the intrapersonal realization of another’s plight that illuminates the potential consequences of one’s own actions on the lives of others.” (Hollingsworth, 2003)
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Promoting the Patient's Capacity to Suffer: A Revision of Contemporary Notions of Psychotherapeutic Aim
1. Promoting the Patient’s Capacity to Suffer:
A Revision of Contemporary Notions of
Psychotherapeutic Aim
James Tobin, Ph.D.
Licensed Psychologist PSY 22074
220 Newport Center Drive, Suite 1
Newport Beach, CA 92660
949-338-4388
Assistant Professor of Clinical Psychology
601 South Lewis Street
Argosy University
Orange, CA 92868
714-620-3804
1
3. Evidence-Based Practice
• Evidenced-based practice and managed care.
• Symptom reduction and progress: “the standard
of care.”
• If progress doesn’t occur, something is wrong with
the psychotherapist’s abilities or the treatment
provided or both.
3
4. Enormous Pressures on Therapists-in-Training
• Not only to diagnose, intervene, and help, but
to cure (the helping profession has become
the curing profession).
• Traditional notions of “abstinence” have
practically been forgotten.
• The proliferation of pantheoretical notions of
the working alliance/relational theory often
don’t correspond to treatment outcomes.
4
5. The Helping Profession, the Curing Profession
• Therapist in training place enormous
expectations on themselves, many of which are
misguided (see xxx’s paper “Mistaken Beliefs of
Beginning Psychotherapists”), and many of which
come from unresolved historical issues re:
“treating/healing” a pathological caregiving figure.
• These characterological predispositions fit nicely
with the current environment of symptom
reduction and positive outcomes.
5
6. The Therapist’s Role:
To Help Relieve the Patient’s Suffering
• Assumptions and beliefs about therapeutic action
and the therapist’s role: coping and resilience.
• Relieving the patient of his/her “suffering”– we
want to help the patient feel better and do better.
• This is a narcissistic need, both personally and
professionally (we have a vision for the patient).
6
7. What are the Liabilities of This Way of Thinking
about the Therapist’s Role?
?
7
9. What are the Liabilities of This Way of Thinking
about the Therapist’s Role?
1. Affirming the patient’s subjective.
2. Avoiding CT and identifications (neutrality is a
hyper-focus).
3. The therapy space is ordinary, not extraordinary,
highly restricting what the therapist does with
the patient and feels about the patient
(featured in Stanley Kubrick’s films “The
Shining” and “2001: A Space Odyssey”).
4. The therapist is largely inhibited and the patient
is objectified!
9
10. The Curative Mindset = Inhibition
Chad Kelland’s recent quote:
“You mean we can tell the
patient what we really
think?”
10
11. The Curative Mindset Often Causes
a “Collusion of Resistance”
• These are “interactional resistances [that make
the] psychotherapeutic work [revolve]s around
noninsightful symptom relief, inappropriately
shared defenses, enactments and gratifications”
(Karlsson, 2004, p. 570).
• Karlsson (2004, p. 569) elaborates: “ … both [therapist
and patient] unconsciously avoid understanding
because they fear the understanding will create too
much psychological pain.”
11
12. Role Assignments in the Therapeutic Dyad
• Collusions of resistance not only have to do with
avoidance of pain, but also with pressure to stay in
accordance with role expectations.
• Therapist (omnipotent healer) and patient
(healing/healed).
• The illusion each holds can be viewed as really one in
the same: the role assignments will continue to be
maintained and compatible.
12
13. “Two-ness” and Disillusionment
• The inevitable reality of the “two-ness” of the
human condition (puts pressure on the role
assignments).
• Both clinical vignettes feature the emergence of
two-ness – disillusionment begins.
• The anxiety leads to the need to keep things
ordinary (inhibitions about the extraordinary).
13
14. Ordinary vs. Extraordinary
• The therapeutic dyad colludes in resistance vs. the
extraordinary (roles are maintained; illusion is
upheld).
• The need to keep things ordinary is very strong
and present even in more subtle clinical
interactions and intrapsychic experiences (what is
“intuited”).
• The phenomena are largely dissociative in quality.
14
15. Paralleling Dissociations in the First Vignette
• The patient dissociated from the full reality of his
experience (he did not see his own accountability).
• If he did not dissociate, his suffering would be
immense.
• The therapist dissociated from the obvious comment
emerging within her (out of her “two-ness”) to
maintain a role (to prevent the patient’s suffering).
• Full contact with experience is not possible
(illusions are maintained).
15
16. Given This All, What is the Therapist’s Role?
Here are My Recommendations:
1. The therapist must help the patient come into full
contact with the reality of his or her experience and
learn from it.
2. This will likely cause the patient (as well as the
therapist) incredible suffering both must bear.
3. The main therapeutic activity is to detect dissociated
material (internally and relationally) as it occurs and
offer it to the patient in the form of what Renik calls
“logical thinking” or alternative constructions of reality –
the patient compares/contrasts the therapist’s
constructions with his/her own.
16
17. Given This All, What is the Therapist’s Role?
Here are My Recommendations:
4. The art of therapy involves the therapist learning how
to move seamlessly back and forth between
empathizing with the patient’s narrative (their
illusive appraisal of reality) and proposing
alternative perspectives and areas of inquiry
(potential for disillusionment); how to do this
delicately so that learning is not traumatic!
5. This involves role flexibility, i.e, shifting between the
ordinary and the extraordinary, always being a “two”
and knowing when and how to reveal your two-
ness (C.K.)
17
18. Therapists in Training:
Problems of Exhibition and Inhibition
• Some novice therapists claim their “two-ness” too
aggressively: a problem of “exhibition” (too little
neutrality/poor tact/overly permissive role-playing).
• Others are reluctant to embody their two-ness and to
use it as Renik advises: a problem of inhibition (hyper-
neutrality/overly heightened tact; overly restricted
role-playing).
18
19. If the Extraordinary Can Be Entered Into….
• There will emerge “the gradual and nontraumatic
accumulation of knowledge facilitated by a ‘good
enough’ mother and the ‘holding environment’ she
provides” (#4).
• This is Winnicott’s notion of therapy being a
“transitional play space,” a safe arena of exploration in
which illusion/fantasy (what is dissociated) is gently
and delicately replaced by the reality of experience
(the therapist works to move the patient from
dissociation to a more realistic appraisal and
acceptance of experience). 19
20. Shame is Gradually Replaced by Regret
• Gradually increasing the patient’s (non-dissociated)
contact with experience alters shame-based defenses,
replacing them with regret (“learning/suffering”)
(theme of the film “Magnolia”).
• What patients most need is “location of the intuitions
about reality that have not received adequate
confirmation or support from others” (#4, p. 365).
• Shame is nothing more than the patient’s dissociated
intuitions about what actually happened that were
also avoided or denied by others.
20
21. An Essential Paradox
• Our patients need to suffer what they have dissociated and
not yet learned (the therapist detects dissociated material);
paradoxically, the therapist cures by helping the patient
suffer.
• For Freud, the goal of therapy is “determin[ing] the role
we play in our unhappiness and the role assigned to
fate” (Thompson, p. 149).**
• “… hysterical misery into common unhappiness” (Breuer &
Freud, 1893-1895/1955, p. 305).
21
22. Supervision as Suffering
• The supervisee avoids multiple contacts with
experience in therapeutic interactions with
patients (including traumatic identifications),
frequently colluding and dissociating.
• The supervisor is in conflict vis-à-vis the
supervisee: he wants her to learn but not to
suffer.
• This leads to an ongoing battle over staying in the
ordinary (Kubrick) vs. moving into the
extraordinary that exists throughout the course of
supervision.
22
23. Supervision as Suffering
• To the extent to which the supervisee can tolerate
holding/containing the supervisee, and does not
remain too rigidly attached to a role vis-à-vis the
supervisee, he will capitalize on extraordinary
moments as they emerge (not collude in
resistance or dissociate from them) and non-
traumatically offer them to the supervisee for
exploration.
• This involves enormous sensitivity to the
supervisee’s shame-based defenses.
23
24. Supervision as Suffering
• The supervisor will also be open to the
supervisee’s capacity to pick up on
dissociations emanating from the
supervisor, and not to respond defensively
when the supervisee raises them.
• All of this models “a way of being” (an
alternative view of therapeutic function) to
the supervisee she can then enact with her
patients.
24
25. Supervision as Suffering
• The two-ness of the supervisee is a reality the
supervisor can never deny – this will cause the
supervisor to exhibit when he would otherwise
prefer to inhibit, and vice versa.
• This teaches the supervisee that the supervisor is
able to suffer for the sake of her learning, just as
the supervisee must suffer for her patients.
25
26. References
• Aron, L. (1991). The patient’s experience of the
analyst’s subjectivity. Psychoanalytic Dialogues, 1, 29-
51.
• Bollas, C. (1989). Forces of Destiny: Psychoanalysis
and human idiom. London: Free Association Books.
• Chodorow, N. (1989). Feminism and psychoanalytic
theory. New Haven, CT: Yale University Press.
• Frankel, S. A. (2006). The clinical use of therapeutic
disjunctions. Psychoanalytic Psychology, 23, 56-71..
• Frosh, S. (2009). What does the other want? In C.
Flaskas & D. Pococh (Eds.), Systems and
psychoanalysis: Contemporary integrations in family
therapy (pp. 185-202). London: Karnac Books.
26
27. References
• Ghent, E. (1990). Masochism, submission, surrender.
Contemporary Psychoanalysis, 26, 108-136
• Gilhooley, D. (2005). Aspects of disintegration and
integration in patient speech. Modern Psychoanalysis,
30, 20-42.
• Gill, M.M. (1982). Analysis of transference I: Theory
and technique. New York: International Universities
Press.
• Hoffman, I. Z. (1983). The patient as interpreter of the
analyst’s experience. Contemporary Psychoanalysis,
19, 389-422.
• Levenson, E. (1972). The fallacy of understanding.
New York: Basic Books.
27
28. References
• McLaughlin, J.T. (1981). Transference, psychic reality,
and countertransference.
• Pizer, S. (1992). The negotiation of paradox in the
analytic process. Psychoanalytic Dialogues, 2, 215-
240.
• Pizer, S. (2003). When the crunch is a (k)not: A crimp
in relational dialogue. Psychoanalytic Dialogues, 13,
171-192.
• Renik, O. (1996). The perils of neutrality.
Psychoanalytic Quarterly, 65, 495-517.
• Renik, O. (1999). Getting real in analysis. Journal of
Analytical Psychology, 44, 167-187.
28
29. References
• Stern, D. B. (2010). Partners in thought. Working with
unformulated experience, dissociation, and enactment.
New York: Routledge.
• Stolorow, R.D., Brandchaft, B., & Atwood, G.E. (1987).
Psychoanalytic treatment: An intersubjective approach.
Hillsdale, NJ: The Analytic Press.
• Wolstein, B. (1983). The pluralism of perspectives on
countertransference. Contemporary Psychoanalysis, 19,
506-521.
• Wolstein, B. (1988). Introduction. In B. Wolstein (Ed.),
Essential papers on countertransference (pp. 1-15). New
York: New York University Press.
• Wolstein, B. (1994). The evolving newness of
interpersonal psychoanalysis: From the vantage point of
immediate experience. Contemporary Psychoanalysis,
30, 473-499. 29