THE LAST FARTHING

ABSTRACT Forgiveness is powerfully enjoined within the Christian tradition, but how feasible is forgiveness and what are the consequences of non‐forgiveness? This paper explores these questions by considering the therapeutic experiences of three people for whom forgiveness was an issue. Their struggles suggest that part of the process of forgiveness may be working towards a ‘third position’, within ourselves, which transcends the instinct to portray our relationship with the person who has hurt us in terms of absolute goodness or badness, innocence or guilt. The significance of the ‘third position’ is that it provides a way of ‘seeing’ ourselves as we were at the time of the outrage, and the person who hurt us as they were at that time, and of continuing to live with both, while not being controlled by either. This understanding of forgiveness is then set alongside the experiences of two people who showed a remarkable capacity to use this ‘third position’; and also the author's experience, as priest and therapist, of hearing confessions which have arisen out of therapeutic work.     

THE USE OF VIDEO IN PSYCHOTHERAPY SUPERVISION

This article provides a rationale for the increased use of video recording psychotherapy sessions in clinical supervision and training, including psychodynamic and psychoanalytic training. Social and cognitive psychology research on memory shows that it is limited in a number of ways and, because of this, supervision that solely depends on second‐hand reporting of session events in supervision can be equally limited. Additionally, second‐hand reporting and audiotapes of session material are often not able to adequately shed light on the nonverbal behaviour exhibited by the patient and therapist. Video recording allows a supervisor to view the session material as it happened during the session so as to provide more effective supervision and psychotherapy training. Examples are given from face‐to‐face once‐weekly work, in a training clinic which uses non‐mandatory video recording. Concerns about confidentiality and ethics are discussed, along with potential objections to video recording.     

THE LAST RESORT: SOME NOTES ON THE SUICIDE OF A PATIENT

ABSTRACT Working with severely disturbed patients is one of the most challenging and difficult areas for the psychotherapist in private practice. Not only is there an ever present risk of a psychotic episode but, worse, the patient may threaten or actually commit suicide. The following gives an account of one such patient. Describing the typical ambience of the sessions, it tracks the developing realization for the therapist of the patient's involvement with the psychiatric system, and the consequent ethical dilemmas, which remained unresolved. Finally, it considers from the therapist's point of view what factors may have led to the patient's suicide.     

SOME THOUGHTS ON SUPERVISION

The practice of supervision is increasingly seen today as a pedagogic activity in which knowledge and skills are transmitted from one party to another. Debates around supervision, however, have historically been concerned with a number of other issues, most notably transference and countertransference. We examine the central arguments of these debates in the psychoanalytic tradition, and discuss some of the theoretical and clinical consequences that follow from them. Taking unconscious dynamics into account forces us to recognize that supervision cannot be seen as a ‘neutral’ exercise of accumulating knowledge, but rather confronts both supervisee and supervisor with significant questions about their own position and self-image.     

RACE AND COMMUNITY PRACTICE: REFLECTIONS FROM THE SUPERVISION OF PROFESSIONAL TRAINING

Given South Africa's unique history of colonization and racial segregation, understanding and working with issues of race and racialization have been of paramount importance in South African critical community psychology. This article considers how race has emerged in the supervision of community work with master's students in a community psychology practicum. Using an autoethnographic approach, we document our reflections as two community psychology supervisors to discuss the dilemmas experienced in dealing with race in community psychology supervision. We engage with notions of Whiteness and Blackness, intersections of race and language, and race and crime, and document specific issues that emerge in the supervision for Black and White supervisors. In conclusion, we highlight the importance for supervisors to adopt a critical stance that utilizes reflexivity as a tool for the supervision of community work to help students to reflect on issues of race and racism as part of their community engagement.     

ASSESSMENT IN SUPERVISION: AN ANALYTIC PERSPECTIVE

abstract    The art and science of assessment in supervision are considered in relation to all the dimensions of the supervisory matrix. Issues relating to assessing the patient and the supervisee are considered along with the interactive dynamics between patient and supervisee and supervisee and supervisor that influence this process. The paper considers criteria that the supervisee can utilize in relation to the assessment of the patient and the supervisee and includes issues relating to supervisee development. The complex process of assessment in supervision is also considered in relation to the many interactive layers and conscious and unconscious processes inherent within supervision.     

GROUP SUPERVISION OF INDIVIDUAL CASES IN THE TRAINING OF COUNSELLORS AND PSYCHOTHERAPISTS: TOWARDS A GROUP‐ANALYTIC MODEL?

ABSTRACT The process through which individual psychodynamic practitioners learn how to learn from practice is central to their future professional development and second only to having had a 'good enough' experience of personal therapy. To facilitate this learning process many trainees, particularly those working within organizations, might be offered the opportunity to join a supervision group. The aim of this article is to explore some group dynamic issues that might enable greater understanding of this learning opportunity. Literature from the general field of professional education will be integrated with more specific psychodynamic and group-analytic psychotherapy sources. Implications for the place of analytically informed cooperative inquiry groups in continuing professional development will also be briefly discussed.     

PSYCHOTHERAPY SUPERVISION FACE-TO-FACE AND BY VIDEO CONFERENCING: A COMPARATIVE STUDY

ABSTRACT A shortage in qualified psychotherapy supervisors in rural Norway motivated a study evaluating the quality of the supervision process when supervisors and trainees communicated by interactive audiovisual videoconferencing (VC). Six trainee and supervisor pairs participated in five alternating VC based and face-to-face sessions. The pairs had previously established a good face-to-face relationship. Self-report data of the quality of communication, the alliance and disturbing elements in the supervision sessions were collected from specially designed questionnaires completed after each session. Independent ratings of the videotaped sessions and qualitative interviews conducted at the end of the study were also conducted. The only significant difference between the two conditions was that trainees scored higher on disturbing factors under VC conditions. Recommendations for use of VC are provided in light of the findings.     

AN AUTOPSY STUDY OF LUNG CANCER IN UNIVERSITY OF TOKYO FOR THE LAST 27 YEARS, FROM 1958 TO 1984, WITH SPECIAL REFERENCE TO THE CHARACTERISTICS OF LUNG CANCER IN JAPAN

Four hundred and sixty-five male and 159 female consecutive autopsy cases of lung cancer, autopsied over the 27 years from 1958 to 1984, were analysed and were compared with other materials and mortality statistics, including statistics from other countries. Malignant tumor autopsy cases are gradually increasing and now comprise more than 60% of total autopsy cases. The percentage of lung cancer cases among all autopsy cases was 7% in males and 4% in females. The percentage of lung cancer in autopsies of patients with malignancies was about 13% for males and 9% for females. The most frequent fatal malignant tumors were gastric cancer, lung cancer, and leukemia. The relative incidence of gastric cancer was decreasing, while that of lung cancer was increasing. In the distribution of the histological types of lung cancer, adenocarcinomas were the most frequent types in both sexes. As has been noted in mortality statistics, we noticed a gradual shift in the peak age of lung cancer autopsy cases towards older patients. During the period under study, the peak shifted from patients in their sixties to patient in their seventies; this was true for most of the major histological types in both sexes. The male/ female ratio of all lung cancer cases was 2.9, which was much lower than the ratio found in the United States and Europe, and very similar to the ratio of the mortality rates in Japan and other Asian countries. It was pointed out that the male/female ratios by age-group in each country is a very good reflection of the histological distribution.     

Latex allergosorbent test (LAST): a new immunoassay for specific IgE with latex particles

We describe a two-step latex (Lx) agglutination assay for the titration of specific anti-Dermatophagoides pteronyssinus IgE. The samples are first incubated with allergen-coated Lx of 2.3 microns diameter. Bound IgE is digested by pepsin and then titrated by its agglutinating activity on 0.8 micron Lx particles coated with antihuman Fc epsilon rabbit F(ab')2. This latex allergosorbent test detects 100 pg of specific IgE per milliliter and does not depend on the concentration of total IgE. Owing to a tenfold increase in the allergosorbent surface, no competition with the binding of specific anti-D. pteronyssinus IgG is observed. Pepsin digestion eliminates potential interferences caused by autoantibodies against IgE. A good correlation (r = 0.92) is found with Phadebas RAST on a series of 91 samples. The latex allergosorbent test does not make use of radioisotopes and can be performed in less than 6 hours.     

LIBERATION‐FOCUSED COMMUNITY OUTREACH: A QUALITATIVE EXPLORATION OF PEER GROUP SUPERVISION DURING DISASTER RESPONSE

While it is clear that community outreach and disaster response must include cultural and social justice competence, there is a dearth of knowledge regarding the process by which this can occur. Guided by liberation psychology, this qualitative study examined the peer group supervision process of psychologists and counselors providing outreach to Haitian communities in Florida after the 2010 earthquake in Haiti. The findings suggest that peer supervision generated a cyclical process in which the practitioners focused on both content and process themes that were salient to the community outreach. During supervision, practitioners used content information on the community's culture, strengths, and sociopolitical issues to conceptualize the community's experiences and needs. This content informed the outreach process, including the practitioners’ roles and the ways in which they connected and developed respectful relationships with the community. Ongoing peer supervision appeared to facilitate a liberation‐focused community outreach and increase consciousness among the practitioners.     

A ‘GOOD SPACE’ CANNOT LAST FOREVER: PERCEIVED MECHANISMS EXPLAINING THE ROLE OF SOCIAL SUPPORT AS A HEALTH‐PROMOTING RESOURCE FOR CAREGIVERS IN HIV‐ENDEMIC SOUTH AFRICA

Despite a large body of evidence on the general “health‐promoting” effects of social support, a lot less is understood about the processes mediating these effects. This analysis aimed to explore perceived mechanisms explaining the direct relationship between more social support and better mental health observed in a previous survey of primary caregivers of children living in an HIV‐endemic, poor, urban community in South Africa (n = 1198). We conducted in‐depth qualitative interviews with 24 caregivers who had participated in the survey. Findings of the thematic analysis point to psychological and behavioral processes, including factors associated with resilience; positive social control; perceived support availability; personal development and knowledge; and the maintenance of personal relationships to secure support for stressful times. Future research should explore the longer term benefits of human and social capital, deriving from social relations, for resilience and health, and how these may be shaped by cultural norms and worldviews.