NON-DIRECTIVE PSYCHOTHERAPY

Psychotherapy is a word to describe an age-old process. It would be better not to speak of psychotherapy, but of psychotherapies. Specialists are not the only ones who act as psychotherapists, since every human being fills this role at one time or another. Besides this, no two persons follow an identical approach. Finally, all therapists change technique constantly. The kinds of psychotherapy must therefore approach infinity.Some physicians appear to assume that only one type of psychotherapy may claim a scientific basis. Although Freud first put psychotherapy on a scientific path, there is no reason to say that Freud must be the last in this field.Over the past few years a new trend has started in psychotherapy which deserves close study. This new trend challenges some old beliefs and gives a new tool to help patients of some types. It is called non-directive or client-centered psychotherapy. This therapy does not try to solve the patient''s problems for him, but rather establishes the conditions under which a patient can work out his own salvation.Each year non-directive psychotherapy grows in importance. Much can be learned from the method.     

Donor Conception Disclosure: Directive or Non-Directive Counselling?

It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.     

Une approache pratique des résistances psychologiques aux traitements par injections intracaverneuses (I.I.C.)

Intra-cavernous injection of vasoactive substances has dramatically modified the medical approach of erectile dysfunction. There are psychological and ethical difficulties to this therapeutic procedure, and it is likely that they do contribute to the high drop out rate encountered with this method. According to our clinical experience, we suggest several attitudes in order to facilitate patient's and partner's acceptance:

? There is no opposition between psychotherapy and intra-cavernous injection, they may be regarded as complementary.

? It is advisable to find means to reduce the fear induced by self injection, by reassuring the patient, and making the act easier by choosing the most simple injection material. The pharmacological action must be explained, as well as the side effects.

? Pharmacologically induced erection is often described as artificial, although intra-cavernous injection of vasoactive substances is a symptomatic treatment just as many other symptomatic treatments. It compensates a functional insufficiency, restoring a physiological state very close to normal as far as erection is concerned, but has no effect on sexual excitation, glans intumescence and the development of the ejaculatory climax reflex. The sexuel relation's erotization lays only within the couple, and remains entirely apart from any iatrogenic effect.

? Should the treatment remain secret? Inta-cavernous injection must not systematically be performed withtout the partner knowing about it, although the act should remain discrete and intimate.

One should not encounter psychic or ethical difficulties in erectile dysfunction treatment with intra-cavernous injection of vasoactive substances, provided that it has been properly prescribed, well explained, and that it is part of a psychotherapy. It is doubtless that many refusals or therapy withdrawals are caused by poor or lack of technical initiation, on one hand, and by not taking into account the psychic and ethical aspects of the method, on the other hand.     

The Executive and Neurosis

Executives are prone to overwork, to need to achieve and to need to compete. The dynamics responsible for this pattern were also the dynamics of the breakdown in 16 executives with neurosis. Overcompensation for inferiority feelings, often originating in low socioeconomic childhood background, and ambivalence to the father with repression of hostility were prominent, the main ego mechanisms of defence being repression and denial. The patients often attempted to turn psychotherapy into discussions and had difficulty in accepting a non-directive approach.     

THE PSYCHOTHERAPEUTIC APPROACH TO EMOTIONAL PROBLEMS

Physicians are confronted with more and more psychological problems in their daily practice. Not only must a physician be able to recognize the problems, he must also be prepared to treat a certain number of them. Some of the patients will improve just because of a good relationship with the physician. Others will require more definitive, yet comparatively simple, psychotherapy. On the other hand, some patients with clear-cut emotional problems are best treated by the physician''s traditional medical approach rather than by some type of “formal” psychotherapy. In some circumstances psychotherapeutic efforts may be damaging.     

Constructions dans l’analyse: le transfert comme construction d’un espace porteur et comme reconstruction

The author argues that Binswanger’s daseinsanalyse is far from contradicting what Freud established in the field of analytical therapy. On the contrary, it enriches psychotherapy by making explicit what it is capable of constructing. This paper focuses on the transferential aspect of this construction. Übertragung, or transference, calls upon the world of the patient, its emotional space inhabited by the patient’s body and the bodies of others. This world, along with its underlying dramatics, not only requires recognition, but also carriage (Tragung) to the analyst’s side, at least if the analyst is to succeed in revealing the unconscious part of this world to foster its transformation rather than repetitions of the mechanisms that freeze it. The author reflects on the “gestation” and “carriage” metaphors to show how therapeutically effective the “carrier-experienced space” can be.     

Psychothérapie des cas difficiles. Perspectives phénoménologiques

The author provides a brief overview of clinical anthropology. To achieve better understanding of clinical anthropology, it is very important to grasp its close relationship with the development of phenomenology, most notably existential analysis. This paper mainly references L. Binswanger, S. Freud, V. von Weizsäcker and J. Schotte, arguing that the anthropological perspective is up to date in the psychotherapy of difficult cases. Four fields of application and a clinical case of a psychotic patient’s replacement of medications by psychotherapy after 30 years of use show how the anthropological perspective can create a new way of looking at pathology, help achieve a better relationship with the patient and revitalise the representation of what we call a clinical fact.     

Savants rêveurs et rêveurs savants: Freud lecteur de la science française des rêves

This paper sets out to place The Interpretation of Dreams within an historical context. It argues that it is impossible to have complete confidence in Freud’s words when, in his letters to Wilhelm Fliess, he characterized himself as a mere discoverer. In reality, Freud also felt he belonged to a learned community of dream specialists, whom I call “dreaming scientists” and “scientific dreamers”. Here, I offer, as example, a portrait of Freud as a reader of two French authors, Alfred Maury, and, indirectly, Léon Hervey de Saint-Denys. I analyze how Freud positioned himself as Maury’s successor and sometimes experienced dreams like Hervey de Saint-Denys. The premise of this work is that we must set aside Freud if we want to venture into the learned dream culture peculiar to the 19th century. Only afterwards can we return to Freud and place him in this context as a creative heir.     

The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons

Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: −0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.     

Evolution of viral structure

Viruses vastly outnumber their host cells and must present a huge selective pressure. It is also becoming evident that only a small percent of the eukaryotic genome codes for molecules involved in cellular structures and functions, and that much of the remainder may have a viral origin. Viruses clearly play a central role in the biosphere, but how is this viral world organized? Classification was originally based on virus morphology and the particular host infected, but now there is an increasing trend to rely on sequence information. The type of genome (e.g., RNA or DNA, single- or double-stranded) provides fundamental classification criteria, while sequence comparisons can provide fine mapping for closely related viruses. However, it is currently very difficult to identify long-range evolutionary relationships. We present here a different approach, based on the idea that each virus has an innate "self." When the structures and functions characteristic of this "self" are identified, then they uncover relationships beyond those accessible from sequence information alone. The new approach is illustrated by sketching some possible viral lineages. We propose that urviruses were present before the division of cellular life into its current domains, and that the viral world has lineages that can be traced back to the root of the universal tree of life.     

The definitions of information and meaning two possible boundaries between physics and biology.

The standard approach to the definition of the physical quantities has not produced satisfactory results with the concepts of information and meaning. In the case of information we have at least two unrelated definitions, while in the case of meaning we have no definition at all. Here it is shown that both information and meaning can be defined by operative procedures, but it is also pointed out that we need to recognize them as a new type of natural entities. They are not quantities (neither fundamental nor derived) because they cannot be measured, and they are not qualities because are not subjective features. Here it is proposed to call them nominable entities, i.e., entities which can be specified only by naming their components in their natural order. If the genetic code is not a linguistic metaphor but a reality, we must conclude that information and meaning are real natural entities, and now we must also conclude that they are not equivalent to the quantities and qualities of our present theoretical framework. This gives us two options. One is to extend the definition of physics and say that the list of its fundamental entities must include information and meaning. The other is to say that physics is the science of quantities only, and in this case information and meaning become the exclusive province of biology. The boundary between physics and biology, in short, is a matter of convention, but the existence of information and meaning is not. We can decide to study them in the framework of an extended physics or in a purely biological framework, but we cannot avoid studying them for what they are, i.e., as fundamental components of the fabric of Nature.     

Irradiating the environment: Radiological impacts in life cycle assessment

One of the main shortcomings of Life Cycle Assessment (LCA) when applied to the Nuclear Fuel Cycle, is that there is currently no recognised procedure to deal with radionuclide emissions in the Impact Assessment stage. A framework which considers both human and environmental impacts is required and a methodology which is compatible with the other impact assessment approaches in LCA must be developed. It is important that the discussion is not only restricted to concepts, but that a working methodology is developed which can be readily applied by LCA practitioners. A provisional method is available for assessing radiological impacts on human health, but no consideration has been given to potential effects on the environment. A methodology is proposed in this paper which assesses irradiation of the environment using Environmental Increments (EI) as the quality standard. This approach is based on the same principles as for the Ecotoxicity classification group, and it represents a working methodology which can be continuously improved as knowledge in the area increases.     

Freud’s Lamarckism’ and the Politics of Racial Science

This article re-contextualizes Sigmund Freud’s interest in the idea of the inheritance of acquired characteristics in terms of the socio-political connotations of Lamarckism and Darwinism in the 1930s and 1950s. Many scholars have speculated as to why Freud continued to insist on a supposedly outmoded theory of evolution in the 1930s even as he was aware that it was no longer tenable. While Freud’s initial interest in the inheritance of phylogenetic memory was not necessarily politically motivated, his refusal to abandon this theory in the 1930s must be understood in terms of wider debates, especially regarding the position of the Jewish people in Germany and Austria. Freud became uneasy about the inheritance of memory not because it was scientifically disproven, but because it had become politically charged and suspiciously regarded by the Nazis as Bolshevik and Jewish. Where Freud seemed to use the idea of inherited memory as a way of universalizing his theory beyond the individual cultural milieu of his mostly Jewish patients, such a notion of universal science itself became politically charged and identified as particularly Jewish. The vexed and speculative interpretations of Freud’s Lamarckism are situated as part of a larger post-War cultural reaction against Communism on the one hand (particularly in the 1950s when Lamarckism was associated with the failures of Lysenko), and on the other hand, against any scientific concepts of race in the wake of World War II.     

Depolarization of the Client's Moral Position as a Method of Psychological Consultation

In an earlier article we attempted to construct a universal psychotherapeutic theory. On the basis of an analysis of the works of Freud (1923), Carl Rogers (1965), and V. Frankel (1990), we distinguished some universal principles in explaining the mechanisms of formation of neurotic symptoms and formulated, in a more general way, the principal goal of psychotherapy of neuroses (Kapustin, 1993). We also showed that these principles can be used to explain the mechanisms of a broader range of clients' problems in psychological consultation (Kapustin, 1994). We regarded the purpose of a psychological consultation for this range of problems as a somewhat universal one, independent of the content of the problems or of the symptoms accompanying their mental disorders. Further development of our theory will inevitably require the development of a technique of consultation that fits the language and the concepts of the given theory.     

Analysis of information content for biological sequences.

Decomposing a biological sequence into modular domains is a basic prerequisite to identify functional units in biological molecules. The commonly used segmentation procedures usually have two steps. First, collect and align a set of sequences that are homologous to the target sequence. Then, parse this multiple alignment into several blocks and identify the functionally important ones by using a semi-automatic method, which combines manual analysis and expert knowledge. In this paper, we present a novel exploratory approach to parsing and analyzing such kinds of multiple alignments. It is based on a type of analysis-of-variance (ANOVA) decomposition of the sequence information content. Unlike the traditional change-point method, this approach takes into account not only the composition biases but also the overdispersion effects among the blocks. The new approach is tested on the families of ribosomal proteins and has a promising performance. It is shown that the new approach provides a better way for judging some important residues in these proteins. This allows one to find some subsets of residues, which are critical to these proteins.     

An Historical-Methodological Analysis of Psychotherapeutic Reliances

Each psychotherapeutic approach is determined not only by its technique and theory but also by its general philosophy. While this philosophy has many aspects (anthropological, epistemological, axiological, etc.), at its true core lies what the author calls a “psychotherapeutic reliance.” A reliance here is understood as a certain internal active process of the client (e.g., becoming aware, learning, experiencing), which the therapist hopes for and relies upon, believing that it is precisely what is responsible for achieving a psychotherapeutic effect. This article analyzes the history of psychotherapeutic reliances, endeavoring to understand the logic of their development. The author sees an important trend for future development in “synergetic psychotherapy,” which is based on Christian anthropology     

A decade of countering bioterrorism: incremental progress, fundamental failings

The fear and disruption caused by the 2001 anthrax attacks understandably led Americans to seek enhanced biodefenses. However, the path followed since those attacks has left the country inadequately prepared to face further risks from biological attacks. Why has security against these threats been only partially achieved? This article suggests that our responses over the past decade can be sorted into 4 levels in order of increasing difficulty. First, we rapidly appropriated funds, augmented personnel, and mandated reorganization of agencies. Though not easy to accomplish, these steps were easily conceptualized and, whatever their imperfections, could rather assuredly be achieved. A second level was more demanding, but also quite achievable. It involved the amplification of ongoing efforts. These efforts sometimes suffered as they scaled up, but, though they were qualified by delays and uncertainties, we can point to real achievements at this level. A third level was more difficult: It required evolving new strategies to deal with this largely unprecedented problem. In this regard, we have so far had only glimmers of possibility. At a fourth level, our performance and our prospects are worse still. At this level, our problems stem from resistances inherent in our country's cultural and political framework. This article identifies some of these problems and suggests, regrettably, that they are not likely to be resolved until change is catalyzed by further, and more dramatically traumatic, attacks or natural disasters. If this situational assessment is correct, what remedial strategies should we pursue? The article distinguishes 3 strategic approaches: an evolutionary one in which the U.S. continues advancing along its present path; a radical approach that attempts to address the fourth-level issues; and a third approach that prepares for punctuated evolution. This third approach accepts the improbability of level 4 change either by gradual evolution or by radical argument, but asserts that it is possible to lay the conceptual groundwork now for the radical changes that will be possible, even demanded, after a catastrophic incident. This approach, neglected at present, would be a valuable addition to our present efforts.     

« Sens et essence du monde et du moi onirique » dans <Emphasis Type="Italic">Rêve et Existence</Emphasis> de Ludwig Binswanger

This paper reflects on one of Ludwig Binswanger’s best-known essays, in an effort to clarify the mode of existence of the person within the oneiric world and, therefore, the manifestation mode of that world itself. The author argues that what matters most in the expression of that world is not that it consists of images, but that it is devoid of syntax. This makes it both global and perfective and explains why nothing in it is actually determined by the ego of the dreamer. Its space has no horizon, no perspective and no vantage point, and its temporality is in gestation (chronogenetics), with no concept of the separation of present, past and future. It is characterised by process and lacking in structure. In addition, it is strangely familiar, because it echoes the past in a way that indicates inevitable fate. While the dreaming ego is well folded into that world, its mode of existence remains impersonal; it doesn’t decide for itself, and it doesn’t confront what is coming. The strangeness encountered is not that of the Other, but that of the stranger the ego perceives within itself. Dreaming, therefore, offers the opportunity for human beings to experience existence when it is still undecided — Freud called it the id and Schelling Gemüt — in a place where the ego has not yet become a person. It is only in the waking world that people can integrate their still inchoative egos and give them a destination.     

General methodology for nonlinear modeling of neural systems with Poisson point-process inputs

This paper presents a general methodological framework for the practical modeling of neural systems with point-process inputs (sequences of action potentials or, more broadly, identical events) based on the Volterra and Wiener theories of functional expansions and system identification. The paper clarifies the distinctions between Volterra and Wiener kernels obtained from Poisson point-process inputs. It shows that only the Wiener kernels can be estimated via cross-correlation, but must be defined as zero along the diagonals. The Volterra kernels can be estimated far more accurately (and from shorter data-records) by use of the Laguerre expansion technique adapted to point-process inputs, and they are independent of the mean rate of stimulation (unlike their P-W counterparts that depend on it). The Volterra kernels can also be estimated for broadband point-process inputs that are not Poisson. Useful applications of this modeling approach include cases where we seek to determine (model) the transfer characteristics between one neuronal axon (a point-process 'input') and another axon (a point-process 'output') or some other measure of neuronal activity (a continuous 'output', such as population activity) with which a causal link exists.