Faculty Bibliography

Background: Ineffective medication management contributes to repeated hospitalization and death among patients with chronic heart failure (CHF). The meaning ascribed to medications and the influence of expectations on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, nonadherent patients with CHF. Methods and results: Patients (n=265) with CHF were screened for adherence to prescribed medication using the Morisky Medication Adherence Scale (MMAS). Patients (MMAS score <6; n=44) participated in semi-structured interviews, analyzed using qualitative content analysis. The overarching theme ?unmet expectations? comprised two subthemes: ?working to be heard? by professionals and ?resignation? to both illness and medications. Patients' expectations were challenged by the amount of unanticipated work required to communicate with providers in general, specifically regarding medications, as well as feelings of resignation regarding the medication regimen. Conclusions: These findings suggest that unmet expectations, of both providers and medications, contribute to poor medication management. Improved listening and communication by providers to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation, and improve patients' ability to effectively manage medications

Although the literature has stressed that the training analysis should be identical to a nontraining 'therapeutic analysis,' it was hypothesized that differences do exist between the two, particularly with respect to educational aims. Candidates at the Columbia University Center for Psychoanalytic Training and Research were sent anonymous questionnaires and asked to identify aims they felt were being achieved in the training analysis and to identify certain types of interventions that their training analyst made. Most candidates reported that widely accepted goals of the training analysis, such as promoting understanding of countertransference reactions, were being met in their analysis. Many also endorsed didactic and educational goals. Almost all reported using their analyst's technique to some degree as a model for their own. Most notably, a significant minority of candidates reported that their analyst made interventions that appeared to have a primarily didactic, supervisory, or mentoring purpose. The implications of these findings for an understanding of the role of the personal analysis in psychoanalytic education are discussed

Although the training analysis is considered by many to be the most important element of a candidate's analytic training, its aim remains unclear. Some think of the training analysis as being a strictly therapeutic tool, while others assign it a more frankly educational role. This paper reviews the literature on this topic from Freud to the present, discusses the problems that lack of clarity about the aim of the training analysis generates for psychoanalytic education, and proposes future research in this area