Spectral Houses, the Analyst’s Drawings: Postscript to the Dying Patient in Psychotherapy

This article is written in response to a timely request from the editors of ATOL to write for the 10thAnniversary edition. It was a very encouraging request inviting thoughts about the past 10 years and it came at a time when I was just completing the new edition of my bookThe Dying Patient in Psychotherapy.  In 2002 I published an account of my work in analysis with a dying man and now, in 2020, a new edition of this book is to be published by Routledge. Whilst planning the second edition I remembered that I had made some drawings during the process of the work with this patient. I searched them out and wrote a chapter based on them, with a view to publishing it in the book.  However my own pictures just did not seem to fit anywhere within the context of the book and so I discarded the chapter. At the point that I was thinking the chapter was redundant the request from the editors of ATOL came. So this article is based on that chapter. It is presented here as both, a postscript to the new edition of the book, and as a stand-alone article in celebration of ATOL.&nbsp

The Effect of Valence and Arousal on Spatial Attention

Conceptual metaphor theory suggests that to mentally represent abstract concepts we use metaphorical associations to map them onto more concrete constructs (Lakoff & Johnson, 1980; 1999). Using a choice reaction time (CRT) task, Meier and Robinson (2004) found that positively valenced words primed attention to higher areas in vertical space, while negatively valenced words primed attention to lower areas in vertical space, consistent with the good is up/bad is down conceptual metaphor. Meier and Robinson (2004; 2005) suggest this provides evidence that emotional words create an automatic and obligatory metaphor-congruent shift in spatial attention, driven by a Valence x Position interaction. However, other research shows that the arousal level, not just the valence of emotional words can affect reaction time (Robinson, Storbeck, Meier & Kirkeby, 2004). This means concluding that valence alone is driving the shift in attention is premature. Furthermore, Brookshire, Irvy and Casasanto (2010) dispute Meier and Robinson’s claim that the relationship between affect and metaphor is automatic, instead suggesting that affect-metaphor associations are optional and only accessed under certain contextual conditions. The purpose of this thesis was therefore two-fold. First, it aimed to explore whether valence, arousal, or an interaction between the two was responsible for driving the metaphor-consistent shift in spatial attention observed by Meier and Robinson (2004). Second, it aimed to progress the discussion about when affective stimuli, in the form of emotional words, automatically activate the good is up/bad is down conceptual metaphor. Three CRT experiments were conducted in which (a) emotional stimulus words were differentiated by arousal level as well as valence and (b) the evaluation of stimulus words’ affective tone (pleasant/unpleasant) was manipulated. A Valence x Position interaction in relation to the good is up but not bad is down conceptual metaphor was found when the valence of priming words was evaluated, suggesting valence, rather than arousal or a combination of both, is driving the affect-metaphor relationship. No evidence for the automatic activation of affect-metaphor associations was found when the word’s affective tone was not evaluated. These findings suggest that while driven by valence, affect-metaphor associations are not fully automatic and occur only under certain contextual conditions. The implications for our understanding of how emotion impacts spatial attention are discussed, suggesting metaphors enrich, rather than monopolise our mental representation of abstract, affective concepts

Three- and four-dimensional computed tomographic angiography and venography for imaging of the microvascular anatomy of perforator flaps

Two-dimensional (2D) contrast radiography utilising the intravascular injection of lead oxide or barium sulphate mixtures is the current gold-standard for investigating the vascular anatomy of surgical flaps. The vascular anatomies of surgical flaps, however, are three-dimensional (3D), and their evaluation is conceptually limited by evaluation in 2D. Static 3D computed tomographic (CT) angiography enables vascular anatomy to be evaluated in the coronal, axial, and sagittal plane, and dynamic fourdimensional (4D) CT angiography (CTA) allows the vascular filling of a surgical flap to be visualized over short time intervals in three dimensions. These methods are also capable of elucidating the vascular anatomy and perfusion of the integument in general. The tissues of the body are perfused by source arteries in 3D blocks. The perforating vessels that provide blood supply to the skin may be dissected from between or through the underlying muscle, and flaps based on these vessels are termed perforator flaps. These flaps have the advantages of reduced donor site morbidity due to preservation of the underlying muscle, versatility to accurately replace the components required at the recipient site, and freedom from orientation of the pedicle. Their development has followed our understanding of the blood supply from a source artery to the skin, which has been achieved due to landmark studies by Manchot, Salmon, Cormack and Lamberty, Taylor, and others. Many articles now attest to the safety and reliability of perforator flaps. The arterial and venous anatomies of the workhorse perforator flaps, which include the anterolateral thigh (LCFAP-v/), the thoracodorsal artery perforator (TAP), and deep inferior epigastric artery perforator (DIEAP) flaps, remain poorly understood, and better understanding may improve the reliability of these flaps, aid in optimal flap design with regards to the vascular anatomy, and may aid in the development of new perforator flapsTo elucidate the 3D and 4D arterial and venous anatomies and perfusion of perforator flaps, this thesis studied the vascular anatomies of the workhorse perforator regions in fresh adult cadavers acquired through the Willed Body Program at the University of Texas Southwestern Medical Center in Dallas using novel 3D imaging techniques. These regions included the thigh, the abdomen, and the back. The techniques consisted of cannulation of the vessels at the level of perforators and their accompanying venae comitantes, followed by either injection of a lead oxide or barium sulphate and gelatin mixture, or by iodinated CT contrast medium injected using a precision pump prior to acquisition of CT images and three-dimensional volume-rendered reconstructions. CT contrast medium has a viscosity similar to that of blood and enabled better physiological modelling of perforator flap perfusion than had been achievable previously.In conclusion this thesis studied novel techniques for acquiring both static and dynamic three-dimensional images of microvascular perforator flap anatomy using CTA and venography (CTV). The information gained has provided a better understanding of how perforator flaps and the integument in general are perfused

What is the theoretical ground on which art therapy stands?

I am an Art Psychotherapist and a Jungian Psychoanalyst and, whilst my theoretical influences have developed from traditional Jungian views, his call to us to ”˜follow the image’ is still central in my thinking about art within analysis. I do not have time to discuss the details of this picture so I hope it will give you a feast for your eyes and for speculation (in every sense of the word) as I speak. (Speculate = conjecture Imagine]. This is what Jung did with alchemy; he speculated about these images, about their meaning and he imagined. He knew alchemy had been a physical art with spiritual resonance. The chemical reactions were thought to transform matter into gold - and Jung turned this into a metaphor for the analytic journey and for psychological transformation

Resurfacing Patella Using Pedicled Soleus Perforator Flap

Soft-tissue reconstruction in the knee area requires thin, pliable, and tough skin. To resurface the wound, many flaps are used, including free flaps, musculocutaneous flaps, axillary flaps, local flaps, and sometimes distant flaps. However, each flap has disadvantages. In this report, we present 2 cases of soft-tissue defects on the surface of the patella reconstructed with a pedicled soleus perforator flap, resulting in a successful outcome. Pedicled soleus perforator flaps enable the reconstruction of local soft-tissue defects of the patella without microvascular anastomoses and with minimal donor-site morbidity. We conclude that the pedicled soleus perforator flap is a favorable option for defect coverage around the knee, because of its fast and easy harvesting and very good esthetic results

Psychological Profiling of Hacking Potential

This paper investigates the psychological traits of individuals’ attraction to engaging in hacking behaviors (both ethical and illegal/unethical) upon entering the workforce. We examine the role of the Dark Triad, Opposition to Authority and Thrill-Seeking traits as regards the propensity of an individual to be interested in White Hat, Black Hat, and Grey Hat hacking. A new set of scales were developed to assist in the delineation of the three hat categories. We also developed a scale to measure each subject’s perception of the probability of being apprehended for violating privacy laws. Engaging in criminal activity involves a choice where there are consequences and opportunities, and individuals perceive them differently, but they can be deterred if there is a likelihood of punishment, and the punishment is severe. The results suggest that individuals that are White Hat, Grey Hat and Black Hat hackers score high on the Machiavellian and Psychopathy scales. We also found evidence that Grey Hatters oppose authority, Black Hatters score high on the thrill-seeking dimension and White Hatters, the good guys, tend to be Narcissists. Thrill-seeking was moderately important for White Hat hacking and Black hat hacking. Opposition to Authority was important for Grey Hat hacking. Narcissism was not statistically significant in any of the models. The probability of being apprehended had a negative effect on Grey Hat and Black Hat hacking. Several suggestions will be made on what organizations can do to address insider threats

Play and metaphor in clinical supervision: keeping creativity alive

This article explores the use of play and metaphor in clinical supervision. The intention is not to attempt to cover the whole area of play, or the use of metaphor in clinical supervision, but rather to highlight particular aspects of their respective roles in the service of learning about therapeutic work. The relevance of the arts - especially the visual arts - in relation to this is also discussed. A number of brief clinical vignettes are included by way of illustration. All names, and some identifying details, have been changed to preserve confidentiality. (C) 2010 Elsevier Inc. All rights reserved

Art therapy for people with psychosis:a narrative review of the literature

Art therapy enables individuals to use art to creatively express themselves and communicate differently with themselves, others, and their reality. The National Institute for Health and Clinical Excellence guidelines for psychosis and schizophrenia suggest that arts therapies, which include art therapy, are considered to improve negative symptoms of psychosis. We examined the effectiveness of art therapy for people with psychosis and explored whether art therapy is a meaningful and acceptable intervention in this Review. Seven electronic databases were searched for empirical papers that concerned the use of art therapy for adults with psychosis that were published from 2007 onwards. The search identified 18 papers. High-quality quantitative articles provided inconclusive evidence for the effectiveness of art therapy in adults with psychosis. However, high-quality qualitative articles indicated that therapists and clients considered art therapy to be a beneficial, meaningful, and acceptable intervention, although this conclusion was based on a small number of studies. In this Review, we discuss the theoretical, clinical, and methodological issues in light of the development of more robust research, which is needed to corroborate individuals' experiences and guide evidence-based practice

Distal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients

Management of Achilles tendon and heel area defects is a common challenge for the reconstructive surgeon due to the lack of soft tissue availability in that region. In this article, we present our experience in covering these defects by using the distal perforator propeller flaps based on the posterior tibial artery. Perforator flaps are based on cutaneous, small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to reach the skin. Their development has followed the understanding of the blood supply from a source artery to the skin. Six patients (five males and one female) underwent reconstruction by using the posterior tibial artery distal perforator flap for covering defects in the distal Achilles tendon region in patients with and without diabetes mellitus. Postoperative complications included a hypertrophic scar formation in one patient, partial marginal flap necrosis in another patient, and a wound infection in a third patient. All wounds were eventually healed by the last postoperative visit. In conclusion, perforator flaps based on the distal posterior tibial artery may be a reliable option for the coverage of small to moderate size defects of the Achilles tendon and heel area regions