The past remains essential - and inescapable. A quarter-century after the publication of his classic account of man's attitudes to his past, David Lowenthal revisits how we celebrate, expunge, contest and domesticate the past to serve present needs. He shows how nostalgia and heritage now pervade every facet of public and popular culture. History embraces nature and the cosmos as well as humanity. The past is seen and touched and tasted and smelt as well as heard and read about. Empathy, re-enactment, memory and commemoration overwhelm traditional history. A unified past once certified by experts and reliant on written texts has become a fragmented, contested history forged by us all. New insights into history and memory, bias and objectivity, artefacts and monuments, identity and authenticity, and remorse and contrition, make this book once again the essential guide to the past that we inherit, reshape and bequeath to the future.

https://www.tandfonline.com/doi/pdf/10.1080/2325548X.2017.1315261

The Past Is a Foreign Country - Revisited

Medical Education 2012: 46: 357-365 Context  Current debate in medical education focuses on the nature of 'competency-based medical education' (CBME) and whether or not it should be adopted. Many medical schools claim to run 'competency-based' curricula, but the structure of their programmes can differ radically. A review of the existing CBME literature reveals that little attention has been paid to defining the concept of competence. A straightforward examination of what is meant by the term 'competence' is noticeably missing from the literature, despite its impact on medical training. Objectives  This paper aims to illustrate the varying conceptions of 'competence' by comparing and contrasting definitions provided in the health sciences education literature and discussing their respective impacts on medical education. Methods  A systematic review of recent publications in medical education journals published in English and French was conducted to extract definitions of competence or, if definitions were not explicitly stated, to derive the authors' implicit conception of competence. A sample of 14 definitions from articles in the health sciences education field was studied using thematic analysis. Results  There is agreement that competence is composed of knowledge, skills and other components. Although agreement about the nature of these other components is lacking, attitudes and values are suggested to be essential ingredients of competence. Furthermore, a clear divergence in conceptions of how a competent person utilises these components is apparent. One view specifies that competence involves selecting components according to specific situations, as required. A second view places greater emphasis on the synergy that results from the use of a combination of components in a given situation. Conclusions  These conceptual distinctions have many implications for the way CBME is implemented. A conception of competence as the selection of components may lead to a greater emphasis, in a training setting, on the mastery of each component separately. A conception of competence as the use of a combination of components leads to greater emphasis on the synergy that results as they are deployed in clinical situations.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2923.2011.04183.x

Varying conceptions of competence: an analysis of how health sciences educators define competence.

We propose an integrative theory of love and hate intended to help resolve problems and inconsistencies that have emerged from previous conceptualizations. We suggest that love is a motive based on the valuing of the other and is associated with the goal of preserving or promoting the other's well-being. Likewise, hate is a motive based on devaluing the other and is associated with the goal of diminishing or destroying the other's well-being. We further suggest that intense, powerful emotions may serve as eliciting experiences for different types of love and hate, and we discuss how benefiting or harming the other can be either an instrumental or an ultimate goal for the various forms of love and hate. Finally, we discuss some ways in which our theory can promote new directions in the future study of love and hate.

Let me count the ways: An integrative theory of love and hate

This paper argues for a preventative approach to ethical violations through developing and maintaining ethical awareness in training and in the group life of each society. Rather than teaching ethics as a theoretical subject, a method is proposed that encourages direct personal confrontation with ethical dilemmas through the consideration of key examples, in the Talmudic manner. This develops ethical ‘muscles’ and allows candidates to explore the dilemmas of what Primo Levi called the ‘grey zone’ where the boundaries between good and bad are unclear. Several illustrations of such ethical dilemmas are described, as used in workshops that the author has run in several societies and developing groups. In this way, ethical awareness becomes part of the group life of the society so that analysts become an ethical resource for each other.

Translations of Abstract

Cet article defend une approche preventive des manquements ethiques par le developpement et le maintien de la conscience ethique tout au long de la formation et dans la vie de groupe de chaque societe. Plutot que d'enseigner l'ethique comme une matiere theorique, la methode ici proposee incite a la confrontation personnelle directe aux dilemmes ethiques a travers la consideration d'exemples-cles a la maniere talmudique. Ceci developpe les « muscles »ethiques et permet aux etudiants d'explorer les dilemmes de ce que Primo Levi nomma la « zone grise », cette zone ou les frontieres entre le bien et le mal cessent d'etre claires.



Plusieurs illustrations de ces dilemmes ethiques, tels qu'ils sont presentes par l'auteur au cours d'ateliers, dans diverses societes et groupes en constitution, sont ici decrits. Ainsi, la conscience ethique devient-elle partie integrante de la vie de groupe de la societe et les analystes deviennent les uns pour les autres une ressource ethique.



Der Autor setzt sich fur eine praventive Herangehensweise in Bezug auf unethisches Verhalten ein, in dem das ethische Bewusstsein in der Ausbildung und im Gruppenleben in jeder Gesellschaft entwickelt und aufrechterhalten wird. Statt Ethik als theoretisches Fach zu unterrichten, wird eine Methode gefordert, die zu einer direkten personlichen Konfrontation mit ethischen Dilemmata ermutigt. Dies geschieht in talmudischer Art und Weise durch das Nachdenken uber grundsatzliche Beispiele. Hierdurch werden ethische ‘Muskeln’ entwickelt, die den Auszubildenden erlauben, Dilemmata zu erforschen, die Primo Levi als ‘graue Zone’ beschrieben hat, in der die Grenzen zwischen Gut und Bose unklar sind. Zahlreiche Beispiele fur solche ethischen Dilemmata werden beschrieben, wie sie der Autor in zahlreichen Workshops in verschiedenen Gesellschaften und Gesellschaften in Entwicklung angewendet hat. So wird ethisches Bewusstsein ein Teil des Gruppenlebens der Gesellschaften, so dass Analytiker / Analytikerinnen eine ethische Hilfsquelle fureinander werden konnen.



Questo lavoro propone un approccio preventivo alle violazioni etiche attraverso lo sviluppo e il mantenimento di una coscienza etica durante il training e nella vita di gruppo delle societa. Piu che insegnare l'etica come un argomento teorico, viene proposto un metodo che incoraggi confronti personali diretti con dilemmi etici attraverso l'esame di esempi chiave, alla maniera del Talmud. Cio sviluppa ‘muscolatura etica' e permette ai candidati di esaminare i dilemmi di cio che Primo Levi chiamo la ‘zona grigia' dove i legami tra bene e male non sono chiari. Vengono descritti molti esempi di tali dilemmi etici, come si e fatto nei workshops che l'autore ha condotto in varie societa e nei gruppi emergenti. In questo modo la coscienza etica diviene parte della vita di gruppo della societa cosi che gli analisti possono essere una risorsa etica l'uno per l'altro.



Este trabajo defiende una aproximacion preventivacontar las violaciones etica mediante el desarrollo y mantenimiento de una conciencia etica durante todo el entrenamiento y en la vida grupal de cada sociedad. Mas que la ensenanza de la etica como sujeto teorico se promociona un metodo que estimule la confrontacion directa y personal con conflictos eticos por medio de la discusion de ejemplos claves a la manera Talmudica. Esto desarrolla unos ‘musculos’eticos y permite que los candidatos examinen los dilemas de aquello que Primo Levi llamo‘La Zona Gris’ donde los limites del bien y el mal no son claros. Se describen algunas ilustraciones de tales dilemas eticos, tal como son usadas por el autor en seminarios realizados en diferentes sociedades y grupos en desarrollo. Asi la conciencia etica pasa a formar parte de la vida grupal de la sociedad de tal manera que los analistas se transforman en un recurso etico para cada uno.

Stimulating ethical awareness during training.

We expand on Rempel and Burris’ (Pers Relat 12:297–313, 2005) conceptualization of hate in light of recent theory and research suggesting that emotions and motives represent two distinct but interconnected systems. Prototypical emotional states generate a quick response when there is little time to react, but, with more processing time, the “emotivational” trajectory inherent in the emotion will influence behavioral responses. With still more time, conscious motivational deliberation will further refine response options. Although directly relevant research is limited, neurological, survey, prototype, and experimental data all support a motivational conceptualization of hate in which the core goal is the desire to harm a target. In close relationships, the desire to harm (i.e., the hate process) can be impulsive (emotivational) or deliberate, fleeting or prolonged, infrequent or recurring, modest or intense, suppressed or expressed, a means to some other end or an end in itself, and labeled or not labeled as “hate.” We discuss how the interaction of these various components can significantly influence the impact of the hate experience within intimate relationships. Finally, we suggest a number of strategies to reduce hate that are focused on decreasing the motivational desire to harm.

Hate: Theory and Implications for Intimate Relationships

Implicit in Jung's alchemical metaphor of the vas bene clausum is the idea of an analytic frame with a space inside it for something vital, a relationship between two selves, to develop. For this to happen, analysts must respect their patients' rights to confidentiality. The paper explores the analyst's state of mind and the intrapsychic processes that are constellated when struggling with ethical dilemmas about issues of confidentiality in analytic work. The author suggests that at times when analysts consider breaking confidentiality, there is often a disturbing inner conflict between their moral principles (codes of ethics) and their internal personal ethical attitude. At these difficult moments, the mutuality of the work and the vas bene clausum can be significantly disrupted. The analyst tries to find a third position, a mental and emotional ethical space where the subjective and the objective, the ethical and the unethical can become more companionable bedfellows.

Confidentiality and paradox: the location of ethical space.

This paper seeks to illustrate the ambiguity of the affect of 'anger' which masks a number of subtly different emotions observable in clinical work. The author differentiates between anger, rage and hatred in terms of the dialectical relationship between ego and self and pays particular attention to why it is that for some patients, experiences of anger may be harnessed creatively into development, whereas for others, they remain self destructive. Using illustrations from work with two patients in analysis, the author describes how a persistent grievance originating in the earliest stages of life is linked with hatred and can lead to a defensive self structure. It is suggested that the clues to the presence of a grievance and to its potential transformation are likely to be observable first in the analyst's countertransference in the form of an all-embracing emotional strait jacket. Analysts' capacity to tolerate their own hatred is crucial to the transformation of a patient's grievance.

Under the volcano: varieties of anger and their transformation

Jung was mercurial in his attitudes to method and technique, leaving us a problematic legacy when it comes to evaluating the progress of trainees. Some would say that those of us involved with the assessment of candidates during their training continue to rely too heavily on intuition and subjective assessments. However good our admissions' procedures and the structures in place to review progress, the emotional and financial demands for trainees of embarking on an analytic training, the tendency for analytic institutes to remain opaque and slow to link up with the external world and the cliques within our profession make more objective assessments of progress and readiness to qualify at best haphazard and at worst inadequate. Some trainees have an immediate talent for analytic work; others develop their gifts more slowly; some never find this capacity. Working from a definition of analytic talent, the paper begins to map out a Jungian framework for assessing progress, emphasizing the significance of both character and competence and the developing relationship between them.

Evaluating progress in training: character or competence?

In this paper, I use illustrations from analytic work with one patient to suggest that we reconsider and extend the meaning which we give to the term 'psychosomatic'. It should include patients who come for analysis with severe anxieties about their bodies which may not necessarily take the form of an actual organic bodily illness. Using contemporary analytic thinking in this field, I have tried to look at what we mean by the term 'psychosomatic' and to make some attempt to differentiate it from the term 'hysteria'. Hysterical symptoms may sometimes mask earlier and more profound psychosomatic troubles, but may need to be analysed before the core split between psyche and soma may be approached. A useful way of bypassing difficult overlaps in diagnostic terminology when thinking about the way in which patients use the body in the consulting room, can be to make a distinction between body talk and body language. Body talk I have described as a primitive mode of communication which is a precursor to actual talking and which for some patients can come to be a substitute for talking, thinking and reflecting. When this happens, it suggests a very early fundamental rupture between body and mind where certain deintegration/reintegration experiences have inhibited growth and the body continues to function in an archetypal fashion. I hypothesize that body talk is a consequence of the kind of preverbal communication between mother and baby where there may have been a bad fit in terms of vitality affects. In later life, this can manifest itself in the form of 'body' or psychosomatic problems which cannot be put into words but are often recognizable through the quality of the interpersonal transference dynamics. Body language, on the other hand, is an essential and unique component in every patient's communication about him or herself. Our sense impressions of a patient can teach us much about the psychic meaning of body-based responses through observing with our eyes, our nose, as well as through our ears. Whilst we may all regress into body talk when under stress, body language may be said to be more integrated at all points with verbal communications and therefore it suggests some capacity to symbolize. In the transference/countertransference dynamics, there is less evidence of discomfort or dissonance between what the patient is 'saying' and what they seem to be 'doing', than there was in the earlier body talk.

Looking out and looking in: some reflections on 'body talk' in the consulting room.

This paper explores transference and countertransference dynamics in the supervisory relationship and their impact on the task of supervision. The development of analytic theory in relation to supervision is described and the value—and ambiguity—of the concepts of ‘mirroring’, ‘parallel process’ and ‘reflective process’ are discussed. The impact of organizational dynamics on the supervisory relationship is investigated in relation to four main unconscious forces: a) organizational defences, b) power and authority, c) accountability and responsibility, d) ethical concerns. Clinical situations which illustrate these issues are described and explored and used as a basis for examining the role of the supervisor's countertransference in supervision. The different framework of practice in supervision, as opposed to analysis, is described in terms of its focus, the supervisor's ways of responding and the dynamic process, and the concept of refracted countertransference is introduced and explained.

Translations of Abstract

Cet article explore la dynamique du transfert et du contre-transfert dans la relation de supervision, ainsi que leur incidence sur la tâche de supervision. L'auteur presente les developpements de la theorie analytique sur cette question et analyse la valeur—et l'ambiguite—des concepts de «renvoi  en miroir», de «processus parallele» et de «processus reflechissant». L'effet des dynamiques structurelles sur la relation de supervision est examinea partir de quatre dynamiques inconscientes majeures: a) Les defenses structurelles, b) le pouvoir et l'autorite, c) la responsabilite, d) les preoccupations ethiques. Ces questions sont illustrees par des vignettes cliniques, envisagees et exposees de maniere a mettre en lumiere la place du contre-transfert du superviseur en seance. La difference de cadre d'exercice en supervision, par rapport a celui de l'analyse, est abordee en termes de focalisation, de modes de reponses du superviseur et de processus dynamique. Le concept de «contre-transfert refracte» est introduit et explique.



Die vorliegende Arbeit untersucht die Ubertragungs- und Gegenubertragungsdynamik innerhalb der Supervisionsbeziehung und ihren Einfluss auf die Supervision. Die Entwicklung der analytischen Theorie in bezug auf die Supervision wird beschrieben und der Wert sowie die Ambiguitat der Konzepte des ‘Spiegelns’, der ‘parallelen Prozesse’ und ‘reflektiven Prozesse’ werden diskutiert. Der Einfluss der organisatorischen Dynamik auf die Supervisionsbeziehung wird in ihrem Verhaltnis zu vier Hauptkraften des Unbewussten untersucht: a) organisatorische Abwehr, b) Macht und Autoritat, c) Verantwortlichkeit und Zustandigkeit, d) ethische Belange. Klinische Situationen, die diese Themen illustrieren, werden beschrieben und untersucht und als Grundlage benutzt, um die Rolle der Gegenubertragung des Supervisors/der Supervisorin in der Supervision zu erforschen. Der unterschiedliche Rahmen der Praxis der Supervision—der Gegensatz zur Analyse—wird beschrieben im Hinblick auf seinen Fokus, die Art und Weise der Reaktionen des Supervisors/der Supervisorin und den dynamischen Prozess. Das Konzept der gebrochenen (abgelenkten) Gegenubertragung wird vorgestellt und erlautert.



In questo lavoro si esaminano le dinamiche di transfert e controtransfert nella relazione di supervisione e il loro impatto sullo scopo della supervisione. Viene descritto lo sviluppo della teoria analitica in relazione alla supervisione e vengono discussi il valore—e l'ambivalenza—di concetti quali ‘rispecchiamento’, ‘processo parallelo’ e ‘processo riflessivo’. Viene esaminato l'impatto delle dinamiche organizzatrici sulla relazione di supervisione rispetto a 4 pricncipali forze inconsce: a) difese relative all'organizzazione, b) potere e autorita, c) affidabilita e responsabilita, d) qualita etiche. Vengono descritte situazioni cliniche che illustrano tali scopi e vengono analizzate e usate come base per esaminare il ruolo del controtransfert del supervisore nella supervisione. La differente struttura della prassi nella supervisoni, in quanto opposta a quella dell'analisi, viene descritta nei termini del suo focus, del modo di rispondere del supervisore e vengono introdotti e spiegati il processo dinamico e il concetto di controtransfert riflesso.



Este trabajo explora la dinamica de la transferencia y la contratransferencia en la relacion y su impacto en la meta de la supervision, Se describe el desarrollo de una teoria analitica en relacion a la supervision y se discute el valor—y la ambiguedad—de los conceptos de ‘espejo’, ‘procesos paralelos’ y ‘proceso reflexivo’. Se investiga el impacto de las dinamicas organizacionales en la relacion de supervision, en conexion a cuatro fuerzas inconscientes: a) defensas organizacionales, b) el poder y la autoridad, c) la confiabilidad y la responsabilidad, d) consideraciones eticas. Se describen y exploran y utilizan situaciones clinicas como base para examinar el papel de la contratransferncia del supervisor en la supervision. Se describen los diferentes marcos de la practica en la supervision, como opuestos al analisis, en terminos de focalizar las formas de respuesta del supervisor y el proceso dinamico, y se introduce y explica el terminos el concepto de contratransferencia refractaria.

The analyst's countertransference when supervising: friend or foe?

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