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Obsessive-compulsive disorder (OCD) is considered one of the most difficult disorders to treat due to the diversity of its symptomatology, the difficulties of establishing and maintaining a relationship with patients and their rather rigid functioning. Freud made basic findings that described the nature of the disease, however in psychoanalysis there has been no truly novel theoretic approach to OCD ever since Freud's seminal work. In this present theoretically study, I am examining OCD-symptoms primarily through object relations theory focusing on one group of certain key theoreticians and their followers. My summary of psychoanalytic literature on OCD is based on the works of Freud, Ferenczi and Klein. As a second step, from an object relational point of view, beside paranoid-schizoid and depressive, I am postulating a third position under the name obsessive position, what we can assume as a specific constellations of object relations with anxieties, defence mechanism and patterns of thinking. The specific characteristics of this position are discussed in the study. I am making a clear distinction between the obsessive ego-state and the realistic ego-state and discuss the differences between the two states. Through the introduction of the obsessive ego-state I am suggesting the definition of OCD as a disorder of personality organization and ego-organization. In the study, I therefore, argue for the application of a modified psychoanalytic methodology in the case of OCD-patients. I am offering a glimpse into this technique through a segment from a session of psychoanalytic therapy with an OCD-patient., Author(s): Katalin Csigó [sup.1] Author Affiliations: (1) National Institute of Mental Health, Neurology and Neurosurgery, , Budapest, Hungary Introduction Obsessive-compulsive disorder (OCD) ranks among the most difficult psychiatric conditions to [...]

We are eager to call attention to Jacques Lacan's reconsideration of the mirror stage in Seminar X: Anxiety, recently published in English for the first time. In Seminar X, Lacan [...]

This article aims at presenting a cross-cultural examination of uncle-niece incest through the theoretical scope of feminist psychoanalysis in literary studies. The paper is thus centered on two novels: Woman at Point Zero (1975) by Nawal El Saadawi and Uncle Vampire (1993) by Cynthia Grant. The main contribution in this article is to highlight the cultural differences found in eastern and western literary studies in relation to escaping or ending incest. The cultural differences are addressed in relation to parental assistance and institutional assistance. The article is thus structured around the exploration of two main research questions: 'What is the role of parents in helping a victim of uncle-niece incest to end her abusive experience?' and 'what is the role of official institutions in assisting a victim of uncle-niece incest to terminate her abusive experience?'. A central concern to the researcher in this article is to voice the victims' 'particular' struggle and efforts to escape the incestuous relationship in which she is trapped., Author(s): Reem B. Atiyat (corresponding author) [1]; Khaled Sarayreh [1]; Sameer Rimawi [1] Introduction With a few notable exceptions, incest avoidance appears to be common to virtually all societies. Even [...]

INTRODUCTION In 2000, Anne Carson got a phone call out of the blue from her estranged brother Michael. This was the first time they had spoken in years, and Carson [...]

Voxel-based morphometry (VBM) studies have demonstrated that grey matter abnormalities are involved in the pathophysiology of late-life depression (LLD), but the findings are inconsistent and have not been quantitatively reviewed. The aim of the present study was to conduct a meta-analysis that integrated the reported VBM studies, to determine consistent grey matter alterations in individuals with LLD. Methods: A systematic search was conducted to identify VBM studies that compared patients with LLD and healthy controls. We performed a meta-analysis using the effect size signed differential mapping method to quantitatively estimate regional grey matter abnormalities in patients with LLD. Results: We included 9 studies with 11 data sets comprising 292 patients with LLD and 278 healthy controls in our meta-analysis. The pooled and subgroup meta- analyses showed robust grey matter reductions in the right lentiform nucleus extending into the parahippocampus, the hippocampus and the amygdala, the bilateral medial frontal gyrus and the right subcallosal gyrus as well as a grey matter increase in the right lingual gyrus. Meta-regression analyses showed that mean age and the percentage of female patients with LLD were not significantly related to grey matter changes. Limitations: The analysis techniques, patient characteristics and clinical variables of the studies included were heterogeneous, and most participants were medicated. Conclusion: The present meta-analysis is, to our knowledge, the first to overcome previous inconsistencies in the VBM studies of LLD and provide robust evidence for grey matter alterations within fronto- striatal-limbic networks, thereby implicating them in the pathophysiology of LLD. The mean age and the percentage of female patients with LLD did not appear to have a measurable impact on grey matter changes, although we cannot rule out the contributory effects of medication., Introduction Late-life depression (LLD) is a common and disabling disorder, which is typically defined as depression in individuals older than 60 years. Estimates of the prevalence of clinically relevant depressive [...]

While many diffusion tensor imaging (DTI) investigations have noted disruptions to white matter integrity in individuals with chronic psychotic disorders, fewer studies have been conducted in young people at the early stages of disease onset. Using whole tract reconstruction techniques, the aim of this study was to identify the white matter pathology associated with the common clinical symptoms and executive function impairments observed in young people with psychosis. Methods: We obtained MRI scans from young people with psychosis and healthy controls. Eighteen major white matter tracts were reconstructed to determine group differences in fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) and then were subsequently correlated with symptomatology and neurocognitive performance. Results: Our study included 42 young people with psychosis (mean age 23 yr) and 45 healthy controls (mean age 25 yr). Compared with the control group, the psychosis group had reduced FA and AD in the left inferior longitudinal fasciculus (ILF) and forceps major indicative of axonal disorganization, reduction and/or loss. These changes were associated with worse overall psychiatric symptom severity, increases in positive and negative symptoms, and worse current levels of depression. The psychosis group also showed FA reductions in the left superior longitudinal fasciculus that were associated with impaired neurocognitive performance in attention and semantic fluency. Limitations: Our analysis grouped 4 subcategories of psychosis together, and a larger follow-up study comparing affective and nonaffective psychoses is warranted. Conclusion: Our findings suggest that impaired axonal coherence in the left ILF and forceps major underpin psychiatric symptoms in young people in the early stages of psychosis., Introduction While many diffusion tensor imaging (DTI) investigations have noted disruptions to white matter integrity in individuals with chronic psychotic disorders, (1) fewer studies have been conducted in young people [...]

Background: Recent evidence has revealed abnormal functional connectivity between the frontal and parietal brain regions during working memory processing in patients with schizophrenia and first-episode psychosis. However, it still remains unclear whether abnormal frontoparietal connectivity during working memory processing is already evident in the psychosis high-risk state and whether the connection strengths are related to psychopathological outcomes. Methods: Healthy controls and antipsychotic-naive individuals with an at-risk mental state (ARMS) performed an n-back working memory task while undergoing functional magnetic resonance imaging. Effective connectivity between frontal and parietal brain regions during working memory processing were characterized using dynamic causal modelling. Results: Our study included 19 controls and 27 individuals with an ARMS. In individuals with an ARMS, we found significantly lower task performances and reduced activity in the right superior parietal lobule and middle frontal gyrus than in controls. Furthermore, the working memory-induced modulation of the connectivity from the right middle frontal gyrus to the right superior parietal lobule was significantly reduced in individuals with an ARMS, while the extent of this connectivity was negatively related to the Brief Psychiatric Rating Scale total score. Limitations: The modest sample size precludes a meaningful subgroup analysis for participants with a later transition to psychosis. Conclusion: This study demonstrates that abnormal frontoparietal connectivity during working memory processing is already evident in individuals with an ARMS and is related to psychiatric symptoms. Thus, our results provide further insight into the pathophysiological mechanisms of the psychosis high-risk state by linking functional brain imaging, computational modelling and psychopathology., Introduction A key challenge in research on the early detection of psychosis is to find robust neural markers to characterize the brain mechanisms underlying the onset of psychosis. A fundamental [...]

Did the serial position functions observed in certain semantic memory tasks (e.g., remembering the order of books or films) arise because they really tapped episodic memory? To address this issue, participants were asked to make 'remember-know' judgments as they reconstructed the release order of the 7 Harry Potter books and 2 sets of movies. For both classes of stimuli, the 'remember' and 'know' serial position functions were indistinguishable, and all showed the characteristic L/-shape with marked primacy and recency effects. These results are inconsistent with a multiple memory systems view, which predicts recency effects only for 'remember' responses and no recency effects for 'know' responses. However, the data were consistent with a general memory principle account: the relative distinctiveness principle. According to this view, performance on both episodic and semantic memory tasks arises from the same type of processing: Items that are more separated from their close neighbors in psychological space at the time of recall will be better remembered., When people recall a list of items in an episodic memory task, they recall the first few items well (the primacy effect) and the last few items well (the recency [...]

The Aberrant Behavior Checklist (ABC) is a widely used measure in autism spectrum disorder (ASD) treatment studies. We conducted confirmatory and exploratory factor analyses of the ABC in 1,893 children evaluated as part of the Autism Treatment Network. The root mean square error of approximation was .086 for the standard item assignment, and in exploratory factor analysis, the large majority of items continued to load on the originally assigned factors. Correlations between the ABC subscales and multiple external variables including the Child Behavior Checklist and demographic variables supported the convergent and divergent validity of the ABC as a measure of behavior problems in ASD. Finally, we examined the impact of participant characteristics on subscale scores and present normative data. Keywords Autism spectrum disorder * Aberrant Behavior Checklist * Factor analysis * Irritability * Rating scales * Assessment, Introduction The Aberrant Behavior Checklist (ABC; Aman et al. 1985) was developed for assessing treatment effects in people with developmental disabilities. Since its introduction, the ABC has been used in [...]

HAVE YOU EVER WONDERED IF YOU MIGHT HAVE Multiple Personality Disorder (now called Dissociative Identity Disorder) or any of the other Dissociative Disorders? Ever wonder if you're dissociating or have [...]

Background: Bipolar disorder is a common psychiatric mood disorder that is defined by recurrent episodes of abnormally elevatedmood and depression. Progressive structural brain changes in individuals with bipolar disorder have been suggested to be associated with defects in the secretion of neurotrophic factors. We sought to assess how the regulated secretory pathway in the brain is affected inpatients with bipolar disorder by measuring chromogranin B and secretogranin II, which are 2 cerebrospinal fluid (CSF) biological markers for this process. Methods: We measured the concentrations of chromogranin B (peptide 439-451) and secretogranin II (peptide 154-165) in the CSF of patients with well-defined bipolar disorder and healthy controls. The lifetime severity of bipolar disorder was rated using the Clinical Global Impression (CGI) scale. Results: We included 126 patients with bipolar disorder and 71 healthy controls in our analysis. Concentrations of secretogranin II were significantly lower in patients with bipolar disorder type I than in healthy controls. The reduction was most pronounced in patients with high CGI scores (i.e., severe disease). Limitations: The cross-sectional design of the current study limits the ability to pinpoint the causalities behind the observed associations. Conclusion: This study shows that the CSF marker secretogranin II has the potential to act as a biological marker for severe forms of bipolar disorder. Our findings indicate that patients with bipolar disorder possess defects in the regulatory secretory pathway, which may be of relevance to the progressive structural brain changes seen in those with severe forms of the disease., Introduction Bipolar disorder is a common psychiatric mood disorder that is defined by recurrent episodes of abnormally elevated mood and depression. (1,2) Although the neurobiology of bipolar disorder is mainly [...]

Background: Psychopathy is a severe personality disorder that has been linked to impaired behavioural adaptation during reinforcement learning. Recent electrophysiological studies have suggested that psychopathy is related to impairments in intentionally using information relevant for adapting behaviour, whereas these impairments remain absent for behaviour relying on automatic use of information. We sought to investigate whether previously found impairments in response reversal in individuals with psychopathy also follow this dichotomy. We expected response reversal to be intact when the automatic use of information was facilitated. In contrast, we expected impaired response reversal when intentional use of information was required. Methods: We included offenders with psychopathy and matched healthy controls in 2 experiments with a probabilistic cued go/no-go reaction time task. The task implicated the learning and reversal of 2 predictive contingencies. In experiment 1, participants were not informed about the inclusion of a learning component, thus making cue-dependent learning automatic/incidental. In experiment 2, the instructions required participants to actively monitor and learn predictive relationships, giving learning a controlled/intentional nature. Results: While there were no significant group differences in acquisition learning in either experiment, the results revealed impaired response reversal in offenders with psychopathy when controlled learning was facilitated. Interestingly, this impairment was absent when automatic learning was predominant. Limitations: Possible limitations are the use of a nonforensic control group and of self-report measures for drug use. Conclusion: Response reversal deficits in individuals with psychopathy are modulated by the context provided by the instructions, according to the distinction between automatic and controlled processing in these individuals., Introduction Our ability to learn associations between events with rewarding or punishing outcomes plays an important role in guiding our behaviour. (1) Of equal importance is our capacity to successfully [...]

This essay describes paradoxes and contradictions in treatments of masculine psychology in men, masculine women, and female-to-male transgendered persons. Using object-relations psychoanalysis, Nancy Chodorow explained the complementary and opposing psychologies in men and in women, emphasizing competitive and inhibited aspects of masculine psychology. Similar psychological theories are still being advanced today as applicable to most men and women. However, some contemporary, gender scholars reject psychoanalysis as not only outmoded, biased, and sexist, but also as intrinsically inapplicable to gender variant people. They may resist all psychological theories on the grounds that such theories inevitably pathologize their subjects, with the paradoxical results that transgendered subjects, in particular, are accorded no psychological interiority at all and that all descriptions of the non-normative are considered pathologizing. Even more paradoxically, theorists of female masculinity like Judith Halberstam and scholars of transgender studies, including Henry Rubin, Sally Hines, and Bobby Noble, imply that people born female may make better men than people born male. Along with therapists of transgender clients, transgender studies scholars claim that gender is innate and biological in origin, yet they seek to facilitate gender transition through social changes, including new technologies and new queer ideologies. Although generally decking essentialist prescriptions for human behavior, moreover, these scholars may conclude that they are ethically bound to essentialist explanations of gender. Keyterms: transgender; psychoanalysis, female masculinity, queer theory, FtM, gender ethics, The fields of masculinity and gender studies have advanced significantly in the past few decades as new empirical data complement theories of gender and sexuality and encourage their revision. However, [...]

The goal of this article is to illustrate the interaction between trauma, attachment, and spirituality, and to demonstrate how to address this interaction in long-term attachment-based psychoanalysis. Toward that end, [...]

Subjects completed a baseline stimulus matching procedure designed to produce two symmetrical stimulus relations; A1-B1 and A2--B2. Using A1, B, and two novel stimuli, subjects were then trained to produce a common key-press response for two stimuli and a second key-press response for two further stimuli across two blocks of response training. During one block, the reinforcement contingencies were consistent with baseline relations (i.e., A1 and B1 shared a response function), whereas during the other block they were not. Thirteen of 18 subjects who completed the procedure showed a response class acquisition rate differential across the two test blocks in the predicted direction. It is suggested that this procedure may serve as a behavior analytic alternative to popular implicit tests. It provides a nonrelative measure of stimulus association strength and may display superior procedural implicitness over other tests. Key words: FAST, Function Acquisition Speed Test, Implicit Association Test, Implicit Relational Assessment Procedure, implicit cognition, There has been considerable recent interest in developing behavior analytic 'implicit' tests for assessing histories of relational responding and stimulus relations generally. This interest can be traced to the finding [...]

Joint stimulus control occurs when responding is determined by the correspondence of elements of a complex sample and a complex comparison stimulus. In academic settings, joint stimulus control of behavior would be evidenced by the selection of an accurate description of a complex graph in which each element of a graph corresponded to particular sentences and phrases in the description. The current research describes a test that detected various degrees of joint stimulus control by different combinations of elements, ranging from complete joint control by all elements to a lack of joint control by any elements. Key words: joint stimulus control, complex sample stimuli, complex comparison stimuli, college-level content, statistical interaction, graph-text correspondences, In the natural environment, information is frequently presented in the form of stimuli that consist of many elements, or complex stimuli. For instance, a paragraph is a complex stimulus because [...]

Arguably, the defining feature of the counseling profession is an appreciation for human diversity. Early counseling movements emphasized individual diversity, while multiculturalism and social justice highlighted cultural diversity. The author [...]

As an analyst and an analysand, we explore reasons for not 'doing' psychoanalysis in the last third of life when our own experience became sufficiently intense to make self-exploration through pain undesirable. For the analyst, self-knowledge was inseparable from the therapeutic process: she discovered and created her selves in therapeutic relationships, which meant living in the pain of others. The analysand needed to know whether she could reinvent her life, after one of its lengthiest and most complex phases had ended. The analyst decided to turn away from a primary focus on the therapeutic other in order to commit herself to being alive with more pleasure. The analysand decided that she did not need to go back in order to move forward. For both, it was the formation of a new relationship in the last third of life that created the environment for mutual recognition and libratory self-discovery. KEYWORDS aging, psychoanalysis, psychotherapy, termination, transference

The construct of self-awareness is highly valued by the counseling profession. However, the foundational assumptions that support this construct have not been systemically examined and critiqued. The author provides an overview of self-awareness in light of humanistic, psychoanalytic, and postmodernist ideologies. The author concludes that the construct of self-awareness should be replaced by self-storying. Implications of self-storying for counseling practice are discussed., The counseling profession has a rich and diverse history. During the course of this history, various schools of thought have emerged, diverse realms of helping have been established, and the [...]

This essay explores the familiar German ideology according to which a revolution in thought would, in varying proportions, precede, succeed, accommodate, and generally upstage a political revolution whose defining feature was increasingly thought to be its founding violence: the slide from 1789 to 1793. Germany thus sets out to quarantine the political threat of revolution while siphoning off and absorbing the revolution's intensity and energy for thinking as such. The essay holds that this structure corresponds to the psychoanalytic logic of trauma: the dissolution of the event into a missed event, and the hypertrophic investment in the trivial, the non-event, the negligible remainder.

Through an examination of recent works by two anthropologists, a psychoanalyst, and a historian, I argue in this review essay that scholars gain analytic purchase into the workings of power, signification, and, ultimately, identity when we are aided by an ethnographic attentiveness to unconscious compulsions. Although psychoanalysis has been critiqued for its a historical and transcultural subject produced within authoritative institutional discourses, I suggest that, these critiques notwithstanding, renewed ethnographic reckoning with the unconscious proves valuable when examining cases of excessive identification. [psychoanalysis, power, identity, signification]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9272.2007.00640.x Byline: Mary E. Thomas (1) Keywords: psychoanalysis; qualitative methodology; subjectivity; unconscious Abstract: In this article I ask to what extent geographers can draw on psychoanalytic theory when examining interview data. I consider Freud's theory of the mind and its unconscious processes to ask how bringing the unconscious to bear on identity studies potentially impacts qualitative research on subjectivity and identification. Existing geographic debate on psychoanalytic theory and methods provides an organizing framework for my argument. Although the article advocates an ontology of the psychoanalytic subject, I suggest that researchers must avoid psychoanalyzing research subjects. This distinction limits the ways in which scholars can 'read' personal narratives for unconscious processes. Author Affiliation: (1)The Ohio State University Article History: Initial submission, January 2006; revised submission, May and November 2006; final acceptance, February 2007.

ABSTRACT Recently my writing has explored the position of the author, not only in relation to theoretical ideas, art objects, and architectural spaces but also to the site of writing [...]

C.R. Snyder and T.R. Elliott's forward-looking clinical training model (this issue, pp. 1033-1054) assumes that traditional clinical theories, particularly psychoanalytic theories, have little to offer the study of human strengths. Yet the psychoanalytic literature reveals many insights into the nature of strengths and weaknesses. This essay describes a three pronged habit of thinking that has led positive psychology advocates, including Snyder and Elliott, to underestimate the potential contribution of psychoanalytic models to our understanding of human strengths and to training models that stress their importance. Keywords: psychoanalysis: positive psychology; clinical psychology; graduate education

This paper was originally addressed to a convention of independent group members of the British Psychoanalytical Society who had gathered to consider whether common, theoretical and technical issues shape, or [...]

This article attempts to understand the problem in children who threaten to kill others using an interdisciplinary approach incorporating law enforcement, psychoanalysis of individual dynamics, and emperical research on conduct disordered adolescents. Results show that it distinguishes adolescents who make a threat from those who pose a threat. Some case vignettes are presented to illustrate the hypothesis.

Michael Balint regarded psychoanalysis as a relationship between two people as well as a technique. He identified the Oedipus complex, the concept of 'basic fault,' and creativity and insight as various stages in psychological maturity, with the libido taking different roles at each stage.

Physicians in the late 20th century must learn to cope with the impact of health insurance plans and the collapse of private medical practice. This is best accomplished when doctors focus on the individual as including a unique psychic universe and personality.

Research presented evaluates the effectiveness of a psychoanalytic method of dream interpretation called experiential focusing that motivates the dreamer to engage in beneficial psychological change. The method involves sharing the dream, understanding the factors that influence emotions and behaviors in the dream, and applying the insight gained to life.

Issues discussed concern how analysts address adult manifestations of child abuse trauma, focusing on the psychoanalytic theory that relates to shame, splitting, and unconscious conflict. Topics addressed include Freudian theory and the work of Sandor Ferenczi, as well as self-fragmentation and internalization of the aggressor as responses to trauma.

Issues discussed concern the influence of Sigmund Freud and Sandor Ferenczi on contemporary psychoanalytical thought, focusing on the relationship dynamics between the two pioneering psychoanalysts. Topics addressed include Ferenczi and Freud's clinical and theoretical dialogue, their personal friendship, and Ferenczi's changing beliefs throughout different stages of his life.

The concept of interiorization reveals Douglas H. Ingram's insight into the pyschoanalytic process and the therapist-patient relationship. Interiorization occurs when a patient is able to create a safe mental space in which to internalize the dialogue of the therapy session. The analyst should track the level of interiorization, making sure it is used for transformation and does not increase the patient's sense of unease and oppression.

An impasse in psychotherapy is characterized by the inability of the therapist and patient to communicate in a meaningful way. This situation requires consultation from a third party which can act from the position of Other, providing mutual recognition for patient and therapist and elucidating the transference-countertransference dynamics. The intervention of a consultant reinstates a triadic framework which contexualizes the conflict and allows the participants to reconcile directly.

Psychoanalysts resist teamwork because close relationships can create erotic drives and uncomfortably charged fantasies. The integration of such drives and fantasies into the psychoanalysts' personalities may create a freer and more effective clinician. The bonobo apes, for example, use sexuality to reduce conflict and their females are especially effective creating cooperative social bonds.

Psychoanalysts discover their professional potential when they explore the limits to which they can become emotionally involved with patients. Limits arise when therapeutic sessions activate personal issues in psychoanalysts, or when patients become uncomfortable with the session. The psychoanalyst's issues are resolved by working with another psychoanalyst and such resolution may lead to healthier, more clinically sound practices. The works of Sandor Ferenczi can be used as tools for this process.

Sandor Ferenczi's relaxation principle proposes that when a psychoanalyst introduces empathy into therapeutic sessions, the patient will experience emotions necessary for healing. The psychoanalyst must be flexible enough to formulate an analysis while involving the patient in an emotionally reciprocal human relationship. Ferenczi pioneered these techniques, was successful with difficult patients, and was one of the geniuses of clinical and theoretical practice.

Sandor Ferenczi believed the empathetic powers of love helped cure patients' traumas when love was used as part of the psychoanalytic process. Sigmund Freud believed patients' internal disorders should be treated from a distance. Interpersonal dynamics as advocated by Ferenczi are becoming increasingly popular and are seen as a corrective measure to Freud's methods.

This article examines the relational conflict model developed by Stephen A. Mitchell. The main concepts of Mitchell's relational conflict model are discussed, particularly early patterns of connection to parental figures and the interactive treatment approach to understanding and changing those relational patterns. The model is contrasted with classical drive and developmental arrest theories in the psychodynamic treatment of psychopathology. We explain how Mitchell's model, in keeping with a social work perspective, takes into consideration the social, cultural, and environmental factors as well as the intrapsychic. We discuss how patterns of relating are reworked throughout the life course, and we explore the potential for individual agency in constructing new patterns of relating. We also highlight the social constructivist aspects of Mitchell's approach which are congruent with current contemporary trends in social work theory. A case vignette is presented to illustrate the viability of this model for clinical social work practice. KEY WORDS: relational conflict model; psychodynamic treatment; social constructivism.

Kernberg used the terminology 'Intersubjectivity and the Third Position' in the title of his paper indicating with the conjunction 'and' that the two concepts may be complementary, not contradictory. He found that the joining of the self-psychological and interpersonal culturalist approaches gave a new theoretical framework for intersubjectivity that precluded the analyst as outside observer.

The concept of providing reassurance in response to psychoanalysis patients' apprehensions has changed since Alexander Reid Martin's 'Reassurance in Therapy' was published in 1949. Analysis is now viewed as more of a dialogue between patient and analyst, with the two working together, instead of simply a therapist determining what lies behind a person's fears. Martin's insistence on a personal connection with the patient better reflects how solace is provided to patients presently, while his concept of the unity of the self seems outdated.

Encouraging and comforting patients takes place in every aspect of analytic therapy to assist patients in dealing with their anxieties. The four stages of reassurance presented by Douglas H. Ingram explain well how analysts and patients work together to overcome phobic anxiety through the telling of the patient's troubles and story, the analyst's determination of the problem, and the patient's acceptance of it. Ingram's perception of reassuring analysis reflects his personal understanding of psychoanalysis and his time period.

Psychoanalysts increasingly recognize their inability to maintain strict neutrality during the psychoanalytic process, and realize that their own expectations for their patients can serve a therapeutic purpose. An analyst's judgements, if managed correctly, can stimulate the analysis. Allowing the patients to retain their autonomy under such circumstances still remains a problem, however. Analysts can protect their patients' autonomy by keeping their interpretations as clinical and theoretical as possible, and by concentrating on the dynamics and variety of their patients' struggles.

The use of induced song recall in psychotherapy, referred to as song synthesis, often proves valuable in treatment because it represents an unconscious expression of creativity that neuropsychological research has shown reflects cooperation between the left and right hemispheres of the brain. The patient's song synthesis enables the therapist to monitor hemispheric integration, foster the patient's interpersonal relations by exchanging musical knowledge, and build rapport. The use of song synthesis also aids the identification and resolution of the patient's psychological conflicts.

Kenneth Winarick's paper, 'Visions of the Future: The Analyst's Expectations and Their Impact on the Analytic Process,' helps analysts remain aware of the impact their expressed judgments may have upon both patients and the analytic process. A psychoanalyst can express judgements that further the analytic process and foster therapeutic intent while still retaining a neutral stance. Analysts should avoid subjective expressions that arise from either their professional ambitions or their personal values. Analysts' expectations can lead to special difficulties when analyzing children and psychoanalysis students.