[Musical experience in puberty].
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A psychological etiology or predisposition for cyclic vomiting syndrome (CVS) has long been suspected. Much of the psychiatric literature to date has blamed patients or their families for the problem or focused on psychoanalytic interpretation to account for the syndrome. Thirty-two patients with CVS were compared with 64 age- and sex-matched controls. The patients had a higher incidence of psychological symptoms and migraine. On the Achenbach Child Behavior Checklist patients had higher internalizing, somatic complaints, and anxiety/depression scores. CVS is a migraine variant, with attacks usually precipitated by stress and intercurrent infections. The psychological characteristics of patients with CVS probably contribute to their vulnerability.
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Bion's ideas may be extended to describe an emotional phenomenology of the analyst's subjectivity and a methodology which helps differentiate countertransference enactments from fuller emotional participation. Bion called the process of integrating and utilizing one's most basic and important emotions to make meaning, "passion." The analyst's primal feelings--of love, hate, and curiosity--serve as a central organizer of meaning in the analytic interaction. These feelings involve pain, and to the extent the analyst unconsciously decides to evade or foreclose the evolution of the feelings, such that they remain unintegrated in the thinking process, the analyst is liable to become mired in repetitive transference-countertransference experiences without establishing fresh meaning. A case example illustrates the relevance of "passion" to contemporary relational theory and practice.
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The nature of the fee arrangement has significant influence on the psychotherapeutic process even when there is no fee. Given the large number of psychiatrists who receive at least some part of their training in the public system, understanding the no-fee arrangement is vital to the psychodynamic training of future psychiatrists. Following a brief overview of the meaning of money and the fee arrangement, various scenarios are considered under the headings of "inadequacy" and "indebtedness. "Although similar dynamics may be present in other public and private settings, attention is given to the county training program, with the intent to assist psychiatry residents and supervisors in their awareness and understanding of the psychodynamics of psychotherapy without fee.
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