Inquiry Systems as Coping Mechanisms

First and foremost, Inquiry Systems or ISs are major models for the production and authentication of credible knowledge in which, along with Ethics, we put our basic trust to guide our lives. However, at the same time, ISs also serve as fundamental coping mechanisms to alleviate the intense anxiety that accompanies the immense uncertainty associated with less than perfect knowledge, especially in today’s problematic and highly uncertain world.

Background Experiences, Developmental Perspectives

Over the course of our lifetimes, narratives build on one another and gain depth. Erik Erikson's Eight Stages of Psychosocial Development provide a blueprint for helping us understand the world and stories we tell to describe it. A typical college student's life encompasses the first five stages from infancy (basic trust vs. mistrust) to late adolescence (identity vs. confusion). The lives of the interviewees are examined through this psychosocial lens with a focus on the development of their diversity stories, and early interactions and milestones set the stage for their four-year college experience.

Remote or close? Notes on working psychoanalytically by videoconference

In a time of forced physical distancing due to the Covid-19 virus, psychotherapy has moved online, disrupting what some feel is essential to the process. For the individual therapy couple the author describes in this article, the teletherapy platform provided a frame in which deeper, earlier feelings came to light, not only in the new, initially unwanted therapy space, but between the patient and his wife outside it. One session, especially, made it apparent that one person's need for affect-attunement conflicted with the other's need for recognition of difference or separateness — arousing feelings of mutual betrayal of basic trust and rage between husband and wife. These were witnessed by the therapist who was able to work with what was taking place as an enactment of old trauma, unconsciously contributed to, but eventually reparative for both parties. Several sessions are presented before and after that pivotal one in which technical problems were collaboratively overcome by the therapeutic couple, providing useful metaphors for familiar, but previously insurmountable obstacles between the marital couple, as well as freeing up verbal and non-verbal affective expression and reflection in the virtual, but increasingly intimate consulting room.

Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme

ObjectivesTrust plays an important role in workplace-based postgraduate medical education programmes. Trainers must trust their trainees for granting them greater independence. Trainees must trust their trainer for a safe learning environment. As trainers’ and trainees’ trust in each other plays an important role in trainee learning and development, the authors aimed to explore the development of the mutual trust relationship between trainers and trainees.SettingThis study was performed in a general practice training department in the Netherlands.ParticipantsAll trainers and trainees of the general practice training department were invited to participate. Fifteen trainers and 34 trainees, voluntarily participated in focus group discussions.Outcome measuresThe authors aimed to gain insight in the factors involved in the development of the mutual trust relationship between trainers and trainees, in order to be able to create a model for the development of a mutual trust relationship between trainers and trainees. The risk-based view of trust was adopted as leading conceptual framework.ResultsIn the first stage of trust development, trainers and trainees develop basic trust in each other. Basic trust forms the foundation of the trust relationship. In the second stage, trainers develop trust in trainees taking into account trainees’ working and learning performance, and the context in which the work is performed. Trainees trust their trainer based on the trainer’savailability and accessibility and the personal relationship between the trainee and their trainer. Trainee self-confidence modifies the development of a trust relationship.ConclusionThe development of a mutual trust relationship between trainers and trainees is a complex process that involves various stages, goals, factors and interactive aspects. As the mutual trust relationship influences the learning environment for trainees, greater emphasis on the mutual trust relationship may improve learning outcomes. Further research may explore the effect of long-term and short-term educational relationships on the trust relationship between trainers and trainees.

T192. BINSWANGER’S THREE FORMS OF FAILED EXISTENCE AND ITS RELEVANCE FOR CONTEMPORARY PSYCHIATRY

Background Social impairment is a hallmark feature of schizophrenia spectrum disorders and the subject of much research attention. In contemporary psychiatry the principal way of understanding and examining these difficulties is closely linked to the concept of social cognition, but while this approach has yielded valuable results it has still left the bulk of the variance of social functioning unaccounted for. By zooming out from subpersonal constructs and engaging with first hand experiences of lived through sociality, the phenomenological tradition offers a complementary viewpoint. One prominent proponent hereof is Ludwig Binswanger, but unfortunately much of his pivotal work is only accessible in the original German. It is the purpose of this presentation to introduce some of his central but largely overlooked insights to a wider audience and to highlight their relevance for current research and clinical practice. Methods A reading of Binswanger’s magnum opus Drei Formen missglückten Daseins of which only a fraction has previously been presented to an Anglophone readership. Results To Binswanger, schizophrenic existence is, at its very core, marked by a breakdown of natural experience understood as the unreflective and unobtrusive processes which usually afford us a sense of harmony with ourselves, others, and the material world. In its place schizophrenic autism may transpire and be traced in three forms of existential failure: extravagance (“Verstiegenheit”), perverseness (“Verschrobenheit”), and manneristic behavior (“Maniertheit”). These are not mere defects or plain symptoms, but represent modified modes of being in the world, which all testify to a breakdown of the intersubjective dimension. In extravagance a certain disproportion between basic features of human existence eschews the existential “order of preference”, which usually affords us a basic trust in being, a tacit feeling of ontological security, and the possibility of true community with others. Perverseness, then, denotes a replacement of pragmatic prudence and seamless adjustment to the world and others with withdrawal, resistance, and certain private concepts, principles or rules. Finally, manneristic behavior, deeply rooted in a loss of basic trust, represents an inauthentic mode of being in which the self may be defeated in an effort to appropriate some foreign model of existence. Discussion From Binswanger’s descriptions of these modified modes of existence three key insights emerge, which all challenge fundamental, if often tacitly held, assumptions in current psychiatric research and clinical practice: 1) Intersubjective difficulties are not simple symptoms or add-ons that may or may not be present, but constitutive features of the schizophrenic Gestalt. 2) Intersubjective difficulties in schizophrenia spectrum disorders cannot be reduced to the dysfunction of one or more modular psychological constructs or to mere sequelae of specific symptoms and signs. Rather, they reflect a fundamentally and globally altered structure of subjectivity. 3) Schizophrenic autism and intersubjective difficulties cannot be sufficiently understood in purely behavioral terms as a tendency to withdraw or isolate oneself or as an insufficient stock of knowledge. Autism is neither a neatly demarcated symptom or sign nor a simple defect but transpires through the various clinical manifestations. It is perhaps best understood as a disruption of the basic prereflective attunement with the shared-social world. If taken seriously, these realizations might be helpful in developing novel and complementary ways of understanding and engaging with schizophrenia spectrum patients’ oftentimes altered existential styles.

Storytelling Is the Representation of Differences

This chapter examines the dialogue between Jochen Rack and Alexander Kluge wherein they talk about Kluge's book Chronik der Gefühle (Chronicle of Feelings, 2000). The book tells the story of a century, featuring all the moments that changed the contours of the world, which happened within Kluge's lifetime. Kluge understands these historical events as expressions of emotional states. He argues that feelings do not play a significant enough role in the way history is currently told. Rack and Kluge then discusses the concept of basic trust, which Kluge claims exists in both human beings and animals. They also consider Homer's Odyssey and the thesis that Odysseus has to kill his feelings in order to emancipate himself from the forces of myth. Ultimately, the examples of stories that Rack and Kluge discussed show that there are different, conflicting layers of emotions. Indeed, according to Kluge, storytelling is the representation of differences.

When is it appropriate to withhold a trust deed from a beneficiary? Disclosure of trust documents in the New Zealand Supreme Court

Disputes over beneficiaries’ access to trust documents are increasingly common, particularly as a prelude to hostile litigation. This article examines one of the latest offerings on this subject, Erceg v Erceg [2017] NZSC 28, in which the New Zealand Supreme Court refused to permit a discretionary beneficiary access to trust deeds. The extreme facts of Erceg demonstrate the importance of courts and trustees retaining a discretion to refuse disclosure of even basic trust documents. The decision also clarifies several points of principle about the court’s supervisory jurisdiction, and gives detailed consideration to the factors the court should take into account.

Remediating Child Attachment Insecurity: Evaluating the Basic Trust Intervention in Adoptive Families

Purpose: This study evaluated the video-feedback intervention Basic Trust in families with internationally adoptive children aged 2–12 years. The intervention aims to reduce child attachment insecurity and behavior problems by enhancing mothers’ and fathers’ sensitivity and mind-mindedness (parents’ capacity to hold in mind the mind of their child). Method: Fifty-three adoptive families participated in a pretest, posttest, and 6-month follow-up assessment. Questionnaires on parenting stress, child attachment insecurity, and behavior problems were administered. Parents’ sensitivity was assessed from free-play observations at home, and mind-mindedness was measured with a describe-your-child interview. Results: Parents reported less child behavior problems, insecure and disorganized attachment, and parenting stress at posttest and follow-up. Parents’ mind-mindedness increased from pre- to post-test but not from pretest to follow-up. Parents’ sensitivity showed an improvement at follow-up. Conclusions: Future studies should investigate whether the present study’s positive results can be replicated under conditions of strict experimental control.

Beyond the angers of populism: a psychosocial inquiry

This article offers a model of psychosocial inquiry in an analysis of the sources of the passionate desire for the UK to leave the EU. It proceeds from separate consideration of the ‘monocular’ modes of both societally- and psychologically-focussed approaches, towards bringing them together in a more ‘binocular’ vision. Firstly, familiar societal explanations are considered, in the perceived losses of material security, of national sovereignty and of indigenous community. It is noted that this level of explanation cannot account for the variations amongst Leave-supporting individuals in the intensity of their anger with the ‘establishment’. Secondly, a depth-psychological approach is explored, noting the contribution of theories of ‘othering’ and focussing on how pro-Brexit anger can be understood as a narcissistic rage against the ‘otherness’ of authority, as represented both by Parliament and the British elites, and by European institutions. Thirdly, a psychosocial ‘binocularity’ is outlined, in which societally-generated anxieties can be seen to interact with the intra-psychic vector of the narcissistic defence. That defence in turn can be seen to have become more prominent in late-modern societies due to cultural changes which have impacted adversely on the capacity for basic trust, so in historical context the psychic dimension folds back into the societal.