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Medium 9781782201632

Chapter Seven - Sex as an SOS: Group Analytic Perspectives

Alan Corbett Karnac Books ePub

Like Freud before him, Foulkes, one of the founders of group analysis, viewed intellectual ability as a prerequisite for entry into a group. He specified that the candidate for group analysis should have a level of intelligence that was “not below average—preferably high” (1964, p. 44) while also privileging the “potential social value of (the) individual”. Much has, thankfully, changed in the intervening decades, with group therapy being demonstrated as effective with people with intellectual disabilities for a wide range of emotional issues (Rose, West & Clifford, 2000; Stoddart, Burke & Temple, 2002; Beail, 2003), with its reach extending to patients with autism and other complex diagnoses (Ãvila & de Macedo, 2012). Group analytic approaches with forensic disability patients, while attracting less research attention than other approaches, do, however, have a growing evidence base (Xenitidis, Barnes & White, 2005) and may be seen to occupy an expanding place in the range of treatment options open. In this chapter I wish to examine not just the core treatment group itself, its content, processes, and boundaries, but also the environmental factors that need to be addressed if the group is not only to survive, but to be born in the first place.

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Medium 9781782201632

CHAPTER FIVE The disability transference: transference and countertransference issues

Alan Corbett Karnac Books PDF

CHAPTER FIVE

The disability transference: transference and countertransference issues

T

he narrative of forensic disability psychotherapy is largely constructed in the “here and now” experience of the countertransference relationship. Through an intersubjective exchange of feelings, thoughts, and memories a jointly authored narrative emerges that is guided as much by affect as cognition. The countertransference becomes the repository for those elements of the patient’s unconscious he cannot bear to keep hold of, providing the therapist with projected aspects of the forensic patient’s self and allowing an insight into those aspects of their perversion that can rarely be put into words. Through this process the countertransference becomes an invaluable tool with which the patient’s internal landscape can be mapped and navigated. In this chapter I wish to examine various theoretical concepts relating to transference and countertransference in forensic disability therapy. Through examining some clinical vignettes in which failures to work through problematic transference issues have resulted in breakdowns in therapeutic functioning, I will outline the notion of the disability transference, a way of conceptualising the various countertransference implications of working with patients with disabilities.

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Medium 9781855753723

CHAPTER FIVE: Rehabilitation issues: remove children or keep them with their parents?

Roger Kennedy Karnac Books ePub

General points

Deciding whether or not a child should be removed from their parents, or deciding that an attempt should be made to return them once they have been removed, can be one of the most difficult and complex decisions facing the professionals working with children and families. For this reason, assessment of such families should usually be undertaken within a multi-disciplinary team, where different views can contribute to the clinical picture and extensive discussion of issues can take place. A single jointly instructed expert can have a role in looking at a complex situation as an outsider. They may be able to look at the papers and give some guidelines about how to proceed and the potential prospects for rehabilitation. Or they may see the parents as a preliminary to a more extensive assessment, either to rule out the possibility of rehabilitation if the parents are, for example, devoid of insight, or, on the contrary, display a willingness and ability to be assessed fully. But it is difficult to give a final view about the prospects for rehabilitation without a comprehensive multi-disciplinary assessment.

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Medium 9781855753228

8. Assessing Adolescents: Finding a Space to Think

Emanuela Quagliata Karnac Books ePub

Margot Waddell

Exploring adolescent difficulties with a view to possible therapeutic treatment involves attempting to engage a troubled, and often confused, individual in beginning to think; to think in a very specific and probably unfamiliar way. Beginning to think can itself be a frightening process. It necessitates learning about oneself.’… they all hate learning’, says the psychoanalyst in Bion’s final Memoir ‘it makes them develop swell up’ (1979, p. 8), pregnant, that is, with a new idea, a new birth/thought in the mind.

It is often at adolescence that the issue of different kinds of learning and thinking, and their implications for development, take on some kind of clarity. The emotional ferment stirred up by puberty and its complex aftermath is one which adolescents find themselves alarmingly, and often unexpectedly, caught up in. Inner conflicts and anxieties are aroused which many seek to avoid, if at all possible. Some seem to stop thinking independently altogether, and submerge themselves either in the shared mentality of group-life, and/or in activities which are literally mindless — such as drug, alcohol or substance abuse. At me other extreme, some may try to rely on intelligence itself as a defence against facing and thinking about turbulent and often contradictory feelings as a way of avoiding intimacy and evading engagement with ‘the agitation of inexperience’ (Copley, 1993, p. 57).

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Medium 9781607320739

CHAPTER TWO Caring and the Nursing Administrator

Jan J. Nyberg University Press of Colorado ePub

One of the foundational concepts for this book is that of caring. Caring is referred to throughout our society—it helps advertise hamburger, weight-loss systems, flowers, and clothing. Lots of commercials say “we care,” but just what does that mean? We talk about caring about people—our moms, our children, our spouses, and our friends. There has been a lot written on caring. As we review the literature, we will focus on a couple of non-nurse writers and then several nurse authors.

Noddings (1984) wrote about caring as a feminine ethic. She was an educator, so she focused on the teacher-student relationship. She viewed caring as an extension of “natural caring” like a mother cares for a child. She wrote that it is our duty to maintain a preparedness to care that, for her, focuses on the welfare, protection, or enhancement of the one cared for. To care is to feel with another and involves the commitment of energy to the other. Caring is receiving the other unto oneself and sensing with and understanding the other. Noddings believes that caring and nurturing are traits more highly developed in women, who define their very reality in terms of caring relationships. She believes that this caring is a form of ethics, and that it is important—if not essential—to the future of our society.

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Medium 9781780644394

21 Current Approach to Optimal Use and Dosing of Vancomycin in Adult Patients

LaPlante. K. CABI PDF

21

Current Approach to Optimal Use and Dosing of Vancomycin in Adult

Patients

Joseph J. Carreno1, Dmitriy Martirosov,2 and Thomas P.

Lodise1*

1

Albany College of Pharmacy and Health Sciences, Albany, New York, US;

Henry Ford Hospital, Detroit, Michigan, US

2

Introduction

Despite its approval nearly 60 years ago, vancomycin remains a mainstay in therapy for invasive infections due to Gram-positive bacteria (Rybak et al., 2009; Liu et al., 2011). In the US alone, it is estimated that clinicians administer over 100 million days of vancomycin therapy a year (Kirst et al.,

1998). The high rate of vancomycin use is related to the growing prevalence of infections due to methicillin-resistant Staphylococcus aureus

(MRSA). In the past, MRSA was confined to critical care unit settings (Moran et  al., 2005, 2006,

2012), but now it is the most common S. aureus antibiotic susceptibility phenotype across all healthcare settings, including general hospital patient wards, skilled nursing homes and facilities, and dialysis centers (Capitano et  al., 2003; NNIS

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Medium 9781780644394

7 Colonization and Its Importance for the Emergence of Clinical Resistance

LaPlante. K. CABI PDF

7

Colonization and Its Importance for the Emergence of Clinical

Resistance

Curtis J. Donskey*

Case Western Reserve University and Louis Stokes Cleveland Veterans Affairs

Medical Center, Cleveland, Ohio, US

Introduction

Selective pressure exerted by antimicrobials plays a central role in the emergence and dissemination of antimicrobial-resistant pathogens. Systemic antimicrobials exert selective pressure not only on infecting microorganisms, but also on the normal microbiota of the host (e.g., the gastrointestinal tract, genitourinary tract, upper respiratory tract, and skin). Although a minority of those acquiring colonization with resistant pathogens develop infection, colonized individuals serve as a major reservoir for transmission. The intestinal tract is a particularly important source for the dissemination of resistant pathogens, including Enterococcus spp., Gram-negative bacilli,

Clostridium difficile, Candida spp., and Staphylococcus aureus (Vollaard and Clasener, 1994; Cole et  al.,

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Medium 9781780646824

17: Climate Change and Population Movements

Webber, R. CABI PDF

Climate Change and

Population Movements

17

We live in a changing world, and the dual processes of climate change and urbanization will bring us into greater conflict with disease. The change in climate due to global warming will be from an increase in temperature and from changes in weather patterns, with more storms and flooding.

One of the largest weather systems is the El Niño southern oscillation, which can reverse or become severely disrupted, bringing heavy rain and flooding when no rain is normally expected and drought conditions during the rainy season. Countries in South America, South-east Asia and

Oceania are mostly affected, but some disruption is felt all over the world.

In the northern hemisphere, the occurrence of revolving tropical storms – cyclones, typhoons or hurricanes, depending on where in the world they occur – appear to be increasing in frequency and ferocity, bringing disruption and damage, leading to an increase in diseases that flourish in such conditions, such as diarrhoeal infections.

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Medium 9781855754324

Dependence

Jan Abram Karnac Books ePub

1   A journey through dependency

2   The fact of dependence

3   The fear of WOMAN

4   Relative dependence

5   De-adaptation and failing

6   The beginning of an intellectual understanding

7   Awareness—towards independence

T he reality of the infant's dependence on his environment determines his emotional development. Winnicott postulates three stages of dependency: “absolute dependence”, “relative dependence”, and “towards independence”. The infant's successful negotiation of the first two stages of dependency relies on a good-enough environmental provision from the very beginning. It is the establishment of these stages that will facilitate the stage of maturity—named “towards independence”.

1   A journey through dependency

Winnicott's acknowledgement of the “fact of the infant's dependence” really began from 1945 as he recognized “there's no such thing as an infant” (see Introduction), but he began theorizing the sequential stages of dependence during the 1960s in the following papers: “The Theory of the Parent–Infant Relationship” (1960c), “Providing for the Child in Health and Crisis” (1965x [1962]), and “From Dependence towards Independence in the Development of the Individual” (1965r [1963]).

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Medium 9781855753457

CHAPTER THREE: The psychological assessment

Elisabeth Cleve Karnac Books ePub

Here we go

Douglas goes through a comprehensive psychological assessment, which I conduct. My wish is to obtain a picture of his psychological and neuropsychiatric status as well as an idea of his intellectual capacities. I use tests that measure several different aspects of his personality. It is necessary to carry out a broad psychological survey in order to illuminate both Douglas’s strong and weak sides. He is tested with so-called projective personality tests, which elucidate unconscious psychological processes. They can provide hypotheses on how mild or severe his personality disorder is. He is also given an intelligence test, which measures his general aptitude. I also test him with neuropsychological tests, which can indicate whether he has brain dysfunctions.

An important part of the assessment consists of everything Margareta and Gunnar say about Douglas’s earlier and present life, how he functions psychically, his somatic condition, and how he behaves with other people. For children who have had such a difficult start in life as Douglas, it is especially important to know as much as possible about the infancy period. In Douglas’s case, there is a considerable amount of information on how deprived he was from the very start of his life.

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Medium 9781780647463

Appendix B: Formulary

Scott, D.E. CABI PDF

Appendix B: Formulary

Drug dosages were derived from several sources, including those listed in the Bibliography. Many have been used by the author at the Carolina Raptor Center.

Drug

Dosage

Acid citrate dextrose

(ACD)

0.15 ml/ml blood for transfusions

Activated charcoal

10–20 ml/kg PO

Adequan

5 mg/kg IM q7d × 4, then monthly as needed

Albon

(sulfadimethoxine 12.5%)

25–50 mg/kg PO SID × 3–5d

Allopurinol

For hyperuricemia/gout: 10 mg/kg PO BID

Toxic in RTHAs at 50 mg/kg

Aminophylline

4 mg/kg PO BID/QID. Prepare suspension with a compounding syrup

10 mg/kg IV/IM TID

May have diuretic effects but may not be an effective bronchodilator in birds

Ampicillin

150 mg/kg IM QID

Amoxicillin

150 mg/kg PO BID

Amoxicillin with clavulinic acid

125–150 mg/kg PO BID

Not metabolized by liver. Good for anaerobes and penetrates lungs well

Amphotericin B

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Medium 9781855755727

CHAPTER FOUR: Killing off the shadow: the role of projective identification in murderous acts

Ronald Doctor Karnac Books ePub

Maggie McAlister

“You have to get close to stab. You can't be stand-offish when you stab.”

Helen Zahavi, Dirty Weekend

“When they entered they found, hanging on the wall, a splendid portrait of their master as they had last seen him, in all the wonder of his exquisite youth and beauty. Lying on the floor was a dead man, in evening dress, with a knife in his heart. He was withered, wrinkled and loathsome of visage. It was not till they had examined the rings that they recognised who it was.”

Oscar Wilde, The Picture of Dorian Gray

Ihave chosen the above two quotes from fictional writing to introduce the theme that is to be the subject of this chapter: the use of projective identification in acts of murder. In Oscar Wilde's novel, the protagonist, Dorian Gray, is engaged in a supernatural, symbiotic relationship with a painted portrait of himself, which records all of his crimes and misdemeanours, including murder, while he remains in a state of perpetual youth and beauty, free from any physical signs of his split off secret life. In Jungian terms, this story could be seen to illustrate an attempt to deal with the “shadow”: those parts of one's personality which are unacceptable to the ego and projected externally. As Dorian degenerates deeper into dark and corrupt behaviour, his portrait, secretly hidden away in the attic, becomes more and more hideous, until Dorian, finally filled with horror and repulsion, decides to “destroy” it by stabbing a knife through its heart. It is only on “killing” the image that the true identities of the subject and portrait are reversed, and in the act of killing his shadow, Dorian kills himself.

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Medium 9781607320982

CHAPTER SIX: APRAXIA

Christopher M. Filley University Press of Colorado ePub

Apraxia is an acquired disorder of skilled purposeful movement (Heilman and Rothi 2003; Greene 2005). As with aphasia and dysphasia, the term dyspraxia is sometimes used to denote less severe apraxia, but like aphasia, apraxia is far more commonly used for all degrees of severity. The theoretical importance of apraxia relates to the phenomenon of tool use, one of the key developments in human evolution that contributed to enhanced adaptation to the physical environment (Lewis 2006). In the clinical setting, apraxia can pose a significant impediment to patients with stroke and other brain lesions as they attempt to resume a normal life (Hanna-Pladdy, Heilman, and Foundas 2003). Diminished capacity to use tools such as pencils, forks, and toothbrushes in daily living may cause patients to experience a less favorable outcome in rehabilitation and potential lasting motor system disability. The term apraxia is often used as shorthand for ideomotor apraxia (see below), the most common and clinically important variety of the syndrome, but apraxia is best considered a generic designation for cognitive motor impairment. Thus apraxia represents a loss of motor skill qualitatively distinct from paresis much as aphasia is distinct from dysarthria. In clinical practice, an apraxic patient must be shown to have a disorder of skilled movement not caused by significant paresis, akinesia, ataxia, sensory loss, inattention, poor comprehension, or other cognitive impairment. Apraxia is commonly encountered with aphasia, but it is not simply an aspect of linguistic dysfunction; the concurrence of the two syndromes is more likely a result of the neuroanatomic proximity of the language and higher motor systems than a manifestation of a common underlying mechanism. Like aphasia, however, apraxia is typically caused by ischemic cerebrovascular disease. In essence, apraxia is a syndrome of higher motor dysfunction in the same way that agnosia (Chapter 7) represents higher sensory impairment.

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Medium 9781855755888

CHAPTER ELEVEN: Girls, boys, men, and women: the impact of sex hormone and environment on differences between the sexes

Susan Hart Karnac Books ePub

“One might speculate that the contribution of genetic influences, relative levels of estrogen and testosterone, or differences in interaction with the maternal caregiver based on gender expectations from the moment of birth could contribute to gender specific vulnerability”

(Scaer, 2001, p. 91)

For many thousands of years, people lived in relatively small hunter-gatherer societies, where the division of tasks between the sexes was clear, as, in fact, it continues to be in most modern societies. The men hunted the big game, which often required them to travel long distances, and they were responsible for defending the group against predators and enemies. Usually, the men produced the weapons. The women probably gathered food close to the dwelling, prepared the food, took care of clothing, and cared for the children. This specialization placed different evolutionary pressures on men and women. Men had to be able to navigate over long distances and tell different routes apart. They needed target-shooting skills for killing their prey. Women had to be able to navigate short distances and needed fine motor skills. They had to be able to direct their attention towards many things at the same time (multi-tasking) and had to master emotional communication and verbalization with their babies (Kimura, 1999a).

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Medium 9781855757301

CHAPTER FOUR: Play

Chris Scalzo Karnac Books ePub

Play

“Child analysis of whatever school is built around the child’s
playing.”

“… It is play that is universal, and belongs to health”

(Winnicott, 1971, pp. 39, 41)

Play is an activity viewed by Winnicott as a form of growth. A healthy, growing child will need to play, and Winnicott also claims within his book, Playing and Reality (1971), that in monitoring a child’s mental health and wellbeing, it is almost possible to disregard all other social dysfunctions if they are able to play creatively. His premise appears to be largely founded upon the importance of play as a facilitator and catalyst for the forming of relationships. He asserts that these relationships, with other people and the child’s world around them, fall into categories of being healthy or unhealthy. The emphasis that play makes on the health of these relationships is in communication, and Winnicott suggests psychotherapy is, in some ways, just a specialized and advanced form of communication through playing. The play, in this case, simply aids communication between the two parties.

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