“Without being in psychoanalysis I would never have dared to become pregnant”: Psychoanalytical observations in a multidisciplinary study concerning a woman undergoing prenatal diagnostics

Psychological and cognitive factors involved in decision-making process of haemophilia carriers in reproductive choices

INTRODUCTION

Haemophilia carriers (HCs) face a multitude of psychological challenges, mainly linked to the possibility of having an affected child. Important reproductive decisions such as opting for pre-implantation genetic testing, or choosing prenatal diagnosis and then whether to continue or interrupt pregnancy in case of affected male fetus, have to be taken into consideration. Notwithstanding, the role of psychological characteristics on such decision-making process needs further investigation.

AIM

The aim of this study was to investigate whether HCs' beliefs and emotions about haemophilia and cognitive factors such as decision-making style, risk perception, coping strategies in response to stress, and need for cognitive closure might modulate HCs' reproductive decisions.

METHODS

Participants were interviewed about their beliefs and emotions on haemophilia and filled an on-line standardized questionnaire on cognitive variables. Sixty HCs participated in this study.

RESULTS

Results show that HCs with high distress for haemophilia given by negative childhood experiences for one or more family member illness and by high concern for their children's health, and with psychological traits characterized by logical (versus emotional) reasoning, active coping style and high need for certainty, tend to choose diagnostic prenatal tests over routine pregnancy analysis.

CONCLUSION

This study highlighted the influence of negative early-life experience with haemophilia and of several cognitive factors in HCs choice of prenatal test.

Qualitative multi-centered study: Trustworthiness of the three-level model (3-LM) Part 1

The 3-Level Model (3-LM) is proposed as a guide or heuristic for observing and describing patient change. Used since 2011 in the context of the International Psychoanalytic Association (IPA), its trustworthiness as a model still needs to be studied. OBJECTIVES AND METHODS: This study aimed to assess the trustworthiness of the 3-LM by comparing the output of three groups of IPA-certified analysts (Europe, North America and South America). The comparison was made using process and outcome measures as analytical tools. This objective was divided into specific objectives presented in two articles. Each group belonged to a different geographical region of the IPA. They all worked on the same clinical case and their output was analysed using the same structured qualitative methodology. To analyse levels 1 and 3 of the model, the Consensual Qualitative Research (CQR) method was used. For level 2, the Operationalised Psychodynamic Diagnosis (OPD-2) was used. RESULTS AND DISCUSSION: There was a predominance of convergence between each of the groups for each of the levels analysed, with some points of divergence. The implications of these results for the trustworthiness of the model, clinical practice, training and research in psychoanalysis are discussed.

European principles of care for women and girls with inherited bleeding disorders

INTRODUCTION

Despite increasing awareness of issues faced by women and girls with inherited BDs (WGBD), standards of care are lacking, with disparities in diagnosis and treatment for WGBD across Europe. We aimed to develop practical principles of care (PoC) to promote standardization of care for WGBD within European Haemophilia Treatment and Comprehensive Care Centres (HTC/CCCs).

METHODS

The co-creation process, supported by the European Association for Haemophilia and Allied Disorders, consisted of four multidisciplinary meetings with health care providers (HCPs) experienced in WGBD care, and European Haemophilia Consortium representatives, combined with broad patient and HCP consultations in the European haemophilia community. Relevant medical societies outside Europe were contacted for confirmation.

RESULTS

We developed ten PoC for WGBD, stressing the importance and benefits of a centralized, multidisciplinary, comprehensive, family-centred approach to support and manage WGBD during all life stages. These PoC emphasise the right to equitable access and quality of care for all people with BDs, irrespective of gender. Multiple medical societies outside Europe also confirmed their support for endorsement.

CONCLUSIONS

Ten PoC for WGBD evolved from an iterative process among stakeholders, supported by relevant medical societies worldwide. These PoC can serve as a benchmark for diagnosis and comprehensive multidisciplinary management of WGBD, and improve awareness of their unique challenges. They offer a framework to guide HTC/CCCs in providing equitable care for all WGBD, both in their own services and in other healthcare settings. Implementation of these principles aims to positively impact the health, wellbeing and quality of life for WGBD.

Scientific thinking styles: The different ways of thinking in psychoanalytic case studies

Historian and philosopher John Forrester argues that psychoanalysis is characterized by a style of scientific thinking and reasoning that he coins "thinking in cases". Since Freud, case studies have been used as a medium for sharing, demonstrating, discovering, expanding, consolidating and "thinking" psychoanalytic knowledge. In this paper, we seek to clarify and enrich Forrester's idea of thinking in cases. We first attend to issues around the lack of definition for thinking styles, and we propose a more detailed description for what might constitute a scientific thinking style. Second, we outline how thinking in cases differs from other kinds of thinking styles. In doing so, we argue that some of the criticisms directed at case studies are the result of a confusion between statistical and experimental thinking styles and thinking in cases. Finally, we propose that there is more than one way of thinking in cases. We distinguish between cases as exemplars for analytic generalization, cases as exemplars for analogical learning, and cases in the service of empirical generalization. By making these implicit thinking styles explicit, we seek to demonstrate the importance of case studies at all levels of psychoanalysis: clinical, research, training and teaching.

The experiences and attitudes of hemophilia carriers around pregnancy: A qualitative systematic review

BACKGROUND

Hemophilia carriers (HCs) face specific psychosocial challenges related to pregnancy, caused by their inherited bleeding disorder. Optimal support from healthcare providers can only be realized by exploring medical and psychological healthcare requirements.

OBJECTIVE

To review all published evidence on the experiences and attitudes of HCs regarding reproductive decision-making, prenatal diagnosis, pregnancy, childbirth, and puerperium to provide an accessible overview of this information for health care providers.

STUDY SELECTION

Cochrane library, PubMed/MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for original qualitative data. Two authors performed study selection, risk-of-bias assessment, data extraction, and data analysis through meta-summary. The extracted themes were discussed within the research team.

FINDINGS

Fifteen studies with an overall moderate quality were included. The following findings were identified: (a) Quality of life of family members with hemophilia influences reproductive decision-making; (b) Genetic counselling is generally considered useful; (c) The development of a specialized carrier clinic is considered valuable; (d) HCs describe prenatal diagnosis as beneficial yet psychosocially challenging; and (e) noninvasive prenatal diagnosis and preimplantation genetic diagnosis are predominantly considered beneficial. These findings are limited by the overall moderate quality of included studies and the possibly partly outdated results in the current era of hemophilia treatment.

CONCLUSIONS

Available qualitative literature on HCs around pregnancy focuses on genetic counselling and prenatal diagnosis. Future studies are needed on the experiences and needs of HCs through pregnancy and puerperium as well as in light of emerging hemophilia diagnosis and treatment options.

The Secret Life of Secrets: Deleterious Psychosomatic Effects on Patient and Analyst

The impact and complex nature of keeping secrets deserves greater scrutiny within psychoanalysis. While the capacity to keep a secret is a developmental achievement that furthers conscious choice and healthy boundary setting between self and others, an individual's need for privacy must be distinguished from untoward costs of collusion and concealment. Clinical case material shows that not all secrets are unconscious or multilayered, as assumed in most of the psychoanalytic literature. Nonetheless, in these cases deleterious effects to psyche and soma took root. These patients assumed that their secret was irreparably destructive to an essential object relationship; shame, guilt, narcissistic vulnerability, unconscious identification with an injured party, and developmental deficit were other factors found to undergird this mode of pathogenic dissembling. Two clinical examples also demonstrate that embodied countertransference reactions may herald the revelation of a secret in treatment that had been hidden, but in plain view. Secrets appear to exert their profound psychological and physical effects on patient and analyst by biological mechanisms that are as yet poorly understood but are readily observed in clinical practice. Psychoanalysts who keep in conscious awareness both the adaptive value and the potential costs of maintaining the confidences of others over the course of a career are better positioned to assist their patients and themselves in rendering essential self-care.