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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_180"
                     title="APsaA: Connecting Online with Patients in China"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18016?impressionId=1265773785257"
                     
      &lt;p&gt;NEW YORK  --  As some analysts become comfortable with the notion of &quot;the chair,&quot; instead of &quot;the couch,&quot; others are welcoming yet another setting: the computer screen.&lt;/p&gt;
&lt;p&gt;Though it may be controversial among the conservative clinicians, researchers have been using a popular online video chat program known as Skype to reach faraway patients, particularly those in China.&lt;/p&gt;
&lt;p&gt;Ubaldo Leli, MD, an analyst in private practice in New York City, is vice president of the China American Psychoanalytic Alliance (CAPA), an organization that treats patients and trains mental health professionals in China.&lt;/p&gt;
&lt;p&gt;At a session at the American Psychoanalytic Association meeting here, Leli said he conducted his first Skype analysis with a Chinese patient in 2004.&lt;/p&gt;
&lt;p&gt;&quot;When I did my first Skype analysis, I had many doubts,&quot; he said. &quot;Will the analytic process develop? Will there be language differences? Cultural differences?&quot;&lt;/p&gt;
&lt;p&gt;He soon began to feel that the Skype analysis was &quot;similar to any type of analysis.&quot;&lt;/p&gt;
&lt;p&gt;He recalled one Chinese patient who was seated on his own couch in his own living room, with his computer (and hence, Leli on video chat) behind him, as in a typical analytic setting.&lt;/p&gt;
&lt;p&gt;&quot;He was talking, and then he stopped, and I asked him why he stopped,&quot; Leli recalled. &quot;He replied that he sensed a change in my breathing and thought I wanted to say something.&quot;&lt;/p&gt;
&lt;p&gt;The popular Skype software (available at skype.com) is a free download that allows users to make free voice or video calls (if both sides are equipped with Web cameras) anywhere in the world. The company also provides low-cost long distance calls between Skype users and standard local phone customers. Other programs provide many of the same features.&lt;/p&gt;
&lt;p&gt;Although Skype can create a sense of connectedness, Elise Snyder, MD, an analyst from New Haven, Conn., and president of CAPA, said it &quot;simultaneously provides intimacy and distance.&quot; Patient and analyst are in separate spaces, and are often divided by many hours  --  about 13 with Chinese patients.&lt;/p&gt;
&lt;p&gt;And it introduces issues of language and culture that are not typically present in analysis. Snyder said these are &quot;not insurmountable, but they are present.&quot;&lt;/p&gt;
&lt;p&gt;Lana Fishkin, MD, who is on the board of directors of CAPA, said from a cultural standpoint, sex is often a troublesome issue in remote sessions. While discussion of sex is a usual component of analysis in America, it&apos;s rarely mentioned among Chinese patients.&lt;/p&gt;
&lt;p&gt;During analysis, Fishkin said she&apos;s &quot;hesitant to point out that it&apos;s absent, because I&apos;m not sure what it means in Chinese culture.&quot;&lt;/p&gt;
&lt;p&gt;She also called attention to differences within the Chinese culture itself.&lt;/p&gt;
&lt;p&gt;&quot;There have been huge changes over just one generation in China that both we and they have to deal with,&quot; she said.&lt;/p&gt;
&lt;p&gt;Ralph Fishkin, DO, who is also on CAPA&apos;s board, said language issues can be tricky as well.&lt;/p&gt;
&lt;p&gt;&quot;You have to pay more attention to the word the person uses and what exactly they mean by it,&quot; he said. &quot;You have to ask yourself if you&apos;re precisely understanding their feelings.&quot;&lt;/p&gt;
&lt;p&gt;He added that the process of analysis itself is different in the context of Skype: &quot;You&apos;re in your room, they&apos;re in their room. It&apos;s like making a house call at the same time the patient is coming to your office.&quot;&lt;/p&gt;
&lt;p&gt;Some audience members at the session pointed out that there&apos;s no data on the subjective impact of the &quot;space&quot; that patient and the analyst are in. They also questioned the analyst&apos;s ability to maintain perfect eye contact with the patient, as well as the potential to pick up on other body language that would be perceived during an in-person session.&lt;/p&gt;
&lt;p&gt;Yet one of CAPA&apos;s goals is to train Chinese analysts so patients there can have one-on-one interaction.&lt;/p&gt;
&lt;p&gt;Snyder said next year&apos;s class has 100 applicants, among whom 40 or 50 will be accepted to the program.&lt;/p&gt;
&lt;p&gt;She noted that the &quot;community interested in analysis is small in China,&quot; which can create ethical dilemmas. Shanghai may have 22 million inhabitants, but psychoanalysts will be familiar with everyone in their community, including patients.&lt;/p&gt;
&lt;p&gt;&quot;It does raise ethical issues in confidentiality,&quot; she said.&lt;/p&gt;
&lt;p&gt;Psychoanalysis via Skype can also help analysts keep in touch with patients who used to come to in-person sessions but have since moved away  --  although there are no data on how many currently practice this type of remote analysis.&lt;/p&gt;
&lt;p&gt;&quot;Skype is only the beginning,&quot; Leli said. &quot;There are all sorts of new technological developments that will modify the way we think about the analytic frame.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_179"
                     title="APsaA: Do We Need the Past to Imagine the Future?"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18012?impressionId=1265773785257"
                     
      &lt;p&gt;NEW YORK  --  Imagining future events depends on much of the same cognitive and neural machinery as remembering past events, researchers said here.&lt;/p&gt;
&lt;p&gt;In several brain imaging studies, similar areas of the hippocampus were activated when patients recalled past events or imagined future ones, Daniel L. Schacter, PhD, of Harvard University, said during a plenary session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;Memory can be thought of as a tool used by the brain to allow us to generate predictions and simulations of upcoming events,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter and colleagues have conducted several studies involving the link between memory and imagining future events. They&apos;ve found that in remembering past events, patients&apos; brains don&apos;t just replay the scenario the way a computer pulls up a file.&lt;/p&gt;
&lt;p&gt;&quot;We don&apos;t need to preserve every detail,&quot; he said. &quot;We&apos;re good at preserving the gist and meaning, and that serves us pretty well.&quot;&lt;/p&gt;
&lt;p&gt;In imagining future events, those remembered details tend to be recombined into a novel event.&lt;/p&gt;
&lt;p&gt;&quot;We link bits and pieces of information from different sources,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter began wondering why humans may have this type of memory system rather than a literal one, and it led him to conduct several brain imaging studies.&lt;/p&gt;
&lt;p&gt;In their earliest work, Schacter and his colleagues were &quot;struck by the similarity we saw&quot; in the brain regions that became active when patients remembered past events or dreamed up possible future scenarios. The hippocampus was especially active.&lt;/p&gt;
&lt;p&gt;Schacter devised that the remembered details are not stored in one place, but are are reactivated during retrieval and reintegrated by the hippocampus into a coherent event.&lt;/p&gt;
&lt;p&gt;Yet the researchers noticed that a couple of regions activated selectively when patients imagined the future  --  particularly the anterior hippocampus.&lt;/p&gt;
&lt;p&gt;That region may play a role in &quot;active recombining that&apos;s critical to imagining one&apos;s future,&quot; he said.&lt;/p&gt;
&lt;p&gt;Based on their findings, the researchers formed the Constructive Episodic Simulation Hypothesis, which essentially states that imagining the future requires a system that can flexibly combine details from past events into novel scenarios.&lt;/p&gt;
&lt;p&gt;One caveat: although this theorized system is well-suited to simulate future events, it runs the risk of misrecombination that can result in memory errors, such as false recognition.&lt;/p&gt;
&lt;p&gt;Schacter questioned whether the findings &quot;tell us something new about the hippocampus, or do we already know this because the hippocampus is involved in encoding information and memory? And maybe future simulation is just piggybacking on the role of the hippocampus in encoding.&quot;&lt;/p&gt;
&lt;p&gt;Either way, he said, the process is &quot;crucial for adaptive functioning.&quot;&lt;/p&gt;
&lt;p&gt;Henry F. Smith, MD, a psychiatrist in private practice in Cambridge, Mass., said that the &quot;simulation of future events may be what the brain does when we&apos;re not perceiving the present  --  we call it daydreaming.&quot;&lt;/p&gt;
&lt;p&gt;&quot;But,&quot; he added, &quot;if the memory of the past and the simulation of the future use the same brain system, maybe that&apos;s the reason [memories] get all jumbled up.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_177"
                     title="APsaA: Top Psychoanalytic Journals Lack Rigorous Research (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18010?impressionId=1265773785257"
                     
      &lt;p&gt;NEW YORK  --  The top three psychoanalytic journals are short on original research on psychoanalysis, researchers said.&lt;/p&gt;
&lt;p&gt;Combined, the journals produced fewer than 10 original research articles annually over a seven-year period, Jane G. Tillman, PhD, of the Austen Riggs Center in Stockbridge, Mass., and colleagues reported in a poster session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s not very many in a scientific field,&quot; Tillman said.&lt;/p&gt;
&lt;p&gt;Calls for rigorous psychoanalytic research studies have become more common in the past decade, as an increasing number of analysts have committed to demonstrating the validity and efficacy of what they do.&lt;/p&gt;
&lt;p&gt;But the debate also goes to the heart of the discipline itself.&lt;/p&gt;
&lt;p&gt;Critics argue that because psychoanalysis attempts to explain everything, it&apos;s not falsifiable and can&apos;t state a null hypothesis; thus it&apos;s not a proper science.&lt;/p&gt;
&lt;p&gt;While some analysts say psychoanalysis is an hermeneutic discipline because of its reliance on the interpretation of texts, others argue that it is indeed a science and must demonstrate validity and efficacy via a solid methodology.&lt;/p&gt;
&lt;p&gt;To shed light on the debate, the researchers investigated whether there were significant differences in the number of research articles published in the three major psychoanalytic journals: the &lt;em&gt;International Journal of Psychoanalysis&lt;/em&gt;, the &lt;em&gt;Journal of the American Psychoanalytic Association&lt;/em&gt;, and &lt;em&gt;Psychoanalytic Psychology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;They also looked at the characteristics of research samples in the studies, as well as the predominant methodologies.&lt;/p&gt;
&lt;p&gt;Between 2001 and 2008, they found 76 original research articles, which yielded a mean of 9.5 total articles per year  --  only about three in each journal.&lt;/p&gt;
&lt;p&gt;There were no significant differences in the number of research articles published each year by all three journals.&lt;/p&gt;
&lt;p&gt;About 40% of studies used interviews for their data collection.&lt;/p&gt;
&lt;p&gt;The researchers said their survey &quot;raises questions about the status of psychoanalytic research&quot; in these journals.&lt;/p&gt;
&lt;p&gt;Tillman said the absence of serious methodological and research education at many psychoanalytic training institutes may play a role in the lack of research.&lt;/p&gt;
&lt;p&gt;&quot;It really cuts down on the interest,&quot; she said. Yet she also acknowledged that it&apos;s &quot;hard to reduce the complexity of psychoanalysis into well-defined variables.&quot;&lt;/p&gt;
&lt;p&gt;The researchers questioned whether the major psychoanalytic journals receive more submissions of research articles than they print but reject them because of poor quality or poor fit with the aims of the journal.&lt;/p&gt;
&lt;p&gt;Or perhaps psychoanalytic researchers tend to publish in journals that are not identified as specifically psychoanalytic in order to broaden their readership, they suggested.&lt;/p&gt;
&lt;p&gt;Tillman said further research is necessary to find out. Also, based on the high percentage of interviews used in data collection, developing &quot;clear methodologies for working with the interview data&quot; may help increase the rigor of studies.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_176"
                     title="APsaA: Away from the Couch and into the Community"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18009?impressionId=1265773785257"
                     
      &lt;p&gt;NEW YORK  --  Psychoanalysts should get out of their offices and engage their community more frequently, researchers said here.&lt;/p&gt;
&lt;p&gt;Harold Kudler, MD, of the VA in Durham, N.C., reported on four initiatives in his home state that got analysts involved in their communities at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;It all comes down to the idea that psychoanalysts need to get more involved in their communities, and by doing so, we make people more aware of what we do,&quot; Kudler said during a poster session.&lt;/p&gt;
&lt;p&gt;He noted that analysts are often portrayed as &quot;introspective denizens of their own quiet offices.&quot; But when they engage the larger community, both are enriched, he added.&lt;/p&gt;
&lt;p&gt;The impetus toward community involvement came when Kudler learned that only 45% of eligible patients seek treatment at VA hospitals. He wanted to branch out and raise awareness of the services his agency offered.&lt;/p&gt;
&lt;p&gt;The researchers&apos; first initiative was a concert to raise funds for a psychoanalytic preschool, the Lucy Daniels Center for Early Childhood. Kudler said the fundraiser sparked new levels of volunteerism within the center and generated &quot;a new base of support to build on for years to come.&quot;&lt;/p&gt;
&lt;p&gt;For the other three initiatives, the researchers reached out with the help of the North Carolina Psychoanalytic Foundation, focusing on children&apos;s and veterans&apos; issues.&lt;/p&gt;
&lt;p&gt;One project was a day-long program on bullying in a Durham, N.C., inner-city school, which Kudler said inspired involvement and sponsorship from across the community.&lt;/p&gt;
&lt;p&gt;The foundation also partnered with North Carolina state officials to create a training program for local providers regarding military issues. These included military culture, deployment stress, common effects on the veteran and on the family, recommended interventions, and appropriate resources.&lt;/p&gt;
&lt;p&gt;Finally, the organization appointed one member to serve as an adviser to a national multimedia children&apos;s program regarding military deployment issues.&lt;/p&gt;
&lt;p&gt;Kudler said he and his colleagues and the foundation are looking for other venues to integrate with their community. He said they are consulting with businesses, religious groups, and other organizations involved in community support.&lt;/p&gt;
&lt;p&gt;He emphasized that the &quot;psychoanalytic community is a vital part of the greater community. Their mutual health and their futures naturally intertwine.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_173"
                     title="APsaA: Patient&apos;s Suicide Less Stressful in Deed than in Thought (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18007?impressionId=1265773785257"
                     
      &lt;p&gt;NEW YORK  --  Analysts have greater distress when they imagine a patient committing suicide than they do when patients actually take their own lives, researchers say.&lt;/p&gt;
&lt;p&gt;The median distress score was significantly greater among analysts who merely imagined the situation, compared with those who&apos;d indeed been through it (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.001), Jane G. Tillman, PhD, of the Austen Riggs Center in Stockbridge, Mass., and colleagues reported at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;It says something about our ability to imagine our anxiety,&quot; she said. &quot;We may tend to overemphasize it.&quot;&lt;/p&gt;
&lt;p&gt;While no data on patient suicide have previously been reported, surveys have estimated that psychiatrists react dramatically to such an experience.&lt;/p&gt;
&lt;p&gt;The investigators also wanted to determine whether there were differences in the prevalence of patient suicide by clinician specialty or degree.&lt;/p&gt;
&lt;p&gt;To that end, they surveyed clinicians who attended the Consortium for Psychoanalytic Research meeting, using demographic data and a 16-item distress scale.&lt;/p&gt;
&lt;p&gt;The researchers collected a total of 73 usable questionnaires representing a 74% response rate. Over 60% of participants indicated their primary practice was in psychoanalysis or psychoanalytic psychotherapy.&lt;/p&gt;
&lt;p&gt;They found that 67% of responders had treated a patient who either attempted or completed suicide  --  and those incidents tended to occur earlier in their career.&lt;/p&gt;
&lt;p&gt;Participants reported an average of 16 years of post-graduate psychotherapy, while attempted or competed suicides occurred when they had accumulated an average of 5.7 years of experience.&lt;/p&gt;
&lt;p&gt;The researchers also found that patient suicide was significantly less prevalent among PhDs than among MDs or master&apos;s-level clinicians. The latter groups reported significantly more patient suicides, but the researchers add that&lt;strong&gt; &lt;/strong&gt;the findings do not support a widespread assumption that MDs have far more patients complete suicides than other clinicians.&lt;/p&gt;
&lt;p&gt;Finally, they found that clinicians who imagined a patient suicide reported significantly greater distress than those who actually had a patient attempt or complete suicide.&lt;/p&gt;
&lt;p&gt;Tillman said this could form the basis of a &quot;projective dynamic&quot; in clinicians that can adversely influence their response to colleagues whose patient commits suicide.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>