Past and present in the therapeutic action: The persistent influence of the primary object

Psychoanalytic literature has focused on the influence of the primary object during early development, and the transference is described as a repetition of these early object experiences. Yet, personality is informed by past and present experiences with primary objects and others. Thus, limiting our understanding of the transference to past object experiences does not fully demonstrate the complexity of this phenomenon, nor does it allow for the ongoing influence that a primary object may have on the patient's life. Using contemporary psychoanalytic theory, this paper looks at the way that adult interactions with their primary object figures and the attunement of their therapists to these present experiences also influence the therapeutic action.     

Family engagement in the perinatal period and infant rights

The meaning of human rights for children is a contested issue; the notion of rights for unborn babies poses additional complexity. Drawing on data from a prospective case study of a specialist drug and alcohol obstetric provider and the statutory child protection service, this article discusses family engagement within a child-rights framework, and demonstrates how adherence to the "best interests" principle, in the absence of an appropriate service provision, excludes vulnerable mother/infant dyads from drawing on extended family support.     

Bodies on Display: Queer Biopolitics in Popular Culture

ABSTRACT

For this contribution to the special issue on “Mapping Queer Bioethics,” the author undertakes the curatorial spaces of the library, the museum, the textbook, and the public exhibition. With showcases such as natural history museums and the recent Bodyworlds traveling exhibit as touchstones, the author argues that distinctions between medical and popular visual culture in pedagogical contexts are porous, such that the study of sensational body types (queer, anatomically atypical, and otherwise) are couched in culturally problematic appreciations of the agency of certain bodies to speak for and/or about themselves. By extension, how and where certain bodies are viewed represent vital, bioethical dilemmas on the nature of corporeal viability.     

‘It is like being put through a blender’: inclusive research in practice in an Australian university

Abstract

How can university-based researchers committed to a position of solidarity with, and activism alongside, people with disabilities maintain such a stance in the metric-driven environment of the modern university? How can the academy ensure there is the opportunity for people with disabilities to contribute to production of the knowledge in which they have most at stake, in a wider environment where access to basic services for people with disabilities is precarious? In this article we draw on our experience as a team of university-based and community-based researchers with and without disabilities to reflect on these questions, using a framework of reflexive solidarity to consider practical strategies for strengthening the relationship between disability activism and the academy.     

An examination of pathways from childhood victimization to violence: the role of early aggression and problematic alcohol use

Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, we examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Structural equation models, including controls for race/ethnicity, socioeconomic status, parental alcoholism, and parental criminality, revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. Interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence.     

Outcomes from a homegrown HIV prevention program for extremely high-risk,substance-using men who have sex with men with multiple health disparities

ABSTRACT

From February 2010 through December 2014, 585 substance-using men who have sex with men (MSM) were enrolled into a “homegrown” risk reduction intervention. Participants evidenced significant iterative factor reductions in the odds of substance use including alcohol (AOR = 0.79) and marijuana (AOR = 0.78; both p ≤ 0.05) and marginally significant reductions in the odds of methamphetamine use (AOR = 0.83; p ≤ 0.07). Participants also evidenced significant reductions in sexual risks including the odds of reporting drug/alcohol use before or during sex (AOR = 0.80) and of condomless anal intercourse (AOR = 0.72; all significant at p ≤ 0.05). Results demonstrate that the homegrown intervention was effective at reducing HIV risk behaviors among high-risk MSM.     

Who Makes Decisions for Vulnerable Young People? Shifting Sands and Murky Waters

This paper discusses the existing guidance in Australian legislative and regulatory frameworks to inform the process of young people moving through varying stages of maturity towards independent decision-making. In the context of exploratory research to develop a stable online repository of personal documents for young people in out-of-home care, the researchers envisioned in-built, age-appropriate levels of decision-making authority, associated with what was stored, who had access, and who owned these records. They sought guidance to protect young people themselves and to support workers and other mentors. Little unqualified guidance emerged from the documentary search. Supporting any young people in the journey towards independent decision-making relies on individual judgements about the type of decision and risks involved, and the age, maturity, and experience of the young person. Above all, a supportive trusting relationship with an adult allows young people to learn through their own mistakes.

IMPLICATIONS

• Young people's competence in decision-making depends on a range of individual, familial, and social factors, and individualised guidance is necessary to support their participation.

• A supportive, trusting relationship with an adult provides the best environment for balancing vulnerable young peoples’ participation rights with their continuing needs for protection.

• The policy and practice challenge is to harness digital technologies without being distracted from the importance of relationship-based work.

     

Barriers to a healthy lifestyle post gestational-diabetes: An Australian qualitative study

Background

Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3–4 years previously.

Sex differences in psychological distress,behavioural and emotional problems,and substance use in young people in out‐of‐home care

The aim of the study was to examine sex differences in self‐reported psychological distress, behavioural and emotional problems, and substance use in young people living in out‐of‐home care (OoHC). One hundred seventy‐six young people aged 12–17 years (females 53.4%) in OoHC in metropolitan Melbourne, Australia, were interviewed. Participants completed self‐report measures: Kessler Psychological Distress Scale, Strengths and Difficulties Questionnaire, and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test—Youth Version. Girls had more OoHC placement instability over the past year compared with boys (p = .019). Compared with boys, the girls had significantly higher levels of distress (p < .001) (p = .007), were more likely to have self‐reported emotional symptoms (p < .001) and peer relationship problems (p = .043) and were more likely to use sedatives (p = .004). Girls had more psychological distress, behavioural disturbance, and sedative abuse; placement instability might contribute to these problems. Greater integration across OoHC, mental health, and substance use sectors is required. Girls in OoHC may benefit from interventions targeting problems with peer relationship and substance use and supporting prosocial behaviour; such targets may reduce distress and emotional symptoms and possibly prevent longer term problems.