Reply to the ‘Comment on “Negative effective Li transference numbers in Li salt/ionic liquid mixtures: does Li drift in the “Wrong” direction?”’ by K. R. Harris,Phys. Chem. Chem. Phys., 2018,20, DOI: 10.1039/C8CP02595A

Irrespective of the choice of an internal or external reference frame, Li+cations may have negative transference numbers.

El consentimiento esclarecido: aportes del campo “Psi” a la clínica actual / The elucidated Consent: Contributions from the “Psy” Domain to the Current Clinical Practice

ABSTRACTThis work tries to show how autonomy principle can turn ethos of health agent and, with it, of contemporary practices. This principle leave aside paternalistic moral. In that, “professional criterion” decides information to know and it leads to autonomous moral of reasonable person where individuals play an active role in made of social order. However, “autonomy” should be understood in a broader sense than a Kantian one. It shouldn´t be already focused on “autonomous person”, this level deeper and last, but on more peripheral level of “choices” and “autonomous actions”, considering subject competence according to minimum, medium and maximum levels (Drane). If paternalistic model is based on “deterministic and causal logic”, autonomy model is attached to the “probabilistic and statistical logic”. With that, it´s proposed now a “rational decision theory” that learns us how decide in “uncertainty” situations, but without arriving at certainty. Rational decision is the most probable one and nobody can ask more. In that way, the matter of informed consent is opened to new perspectives, which have to make a change not only in logic of health team, but also in logic of patients and of social groups. Lastly, psychodynamic psychology has helped to humanize dyadic relationships where the unconscious plays an important role such as those linking patient to therapist, client to professional and subject to researcher. Thus, the application to them of psychoanalytic mechanisms such as transference and countertransference can illuminate their nature and help to resolve any negative transference that may be obstructing their dialogical space.RESUMENSe intenta mostrar cómo el principio de autonomía puede transformar el ethos de los agentes de salud y con ello las prácticas contemporáneas. Este principio deja de lado una moral paternalista donde el “criterio profesional” decide la información a conocer y da paso a una moral autónoma de la persona razonable donde los individuos juegan un rol activo en la puesta del orden social. Pero la “autonomía”, debe entenderse en un sentido más amplio que el kantiano y no centrado ya en la “persona autónoma”, ese nivel más profundo y último, sino en el más periférico de las “elecciones” o “acciones autónomas”, considerando la competencia del sujeto de acuerdo a sus niveles mínimo, mediano y máximo (Drane). Si el modelo paternalista se basa en un “lógica determinista y causalista”, el modelo de la autonomía se adscribe a una “lógica de la probabilidad y estadística”. Con ello se postula ahora una “teoría de la decisión racional”, que nos enseña a cómo decidir en situaciones de “incertidumbre”, aunque sin llegar a la certeza. La decisión racional es la más probable y nadie puede exigir más. De este modo, la cuestión del consentimiento infor-mado se abre a nuevas perspectivas, que deberá producir un cambio no sólo en la lógica de los equipos de salud, sino también en la de los mismos pacientes y en los conjuntos sociales. Finalmente, los aportes del campo «Psi» han contri-buido a humanizar la relación terapeuta-paciente, profesional–usuario, investigador-investigado, en la medida que se plantea en ella también la dimensión inconsciente. Precisamente la noción de transferencia y contra-transferencia postulada por el psicoanálisis, posibilita evaluar la incidencia de estos vínculos y permiten disolver las transferencias negativas que pueden obstaculizar este espacio dialógico.

Beginning and end of treatment of patients who dropped out of psychoanalytic psychotherapy

Introduction: Even though it is expected that patients and therapist will agree on when to terminate psychotherapy, quite often patients discontinue treatment on their own. This study aims to better understand dropout in psychoanalytic psychotherapy (PP). Method: Baseline and post-treatment interviews were conducted with six adult women classified by their therapists as dropout patients at a PP outpatient clinic. Results were analyzed using Bardin's content analysis. Results: Content analysis generated five categories (reasons for treatment, goals, readiness to change, previous treatment, transference) for the baseline interviews and three categories (change process, results, interruption) for post-treatment interviews. Unclear treatment goals, low readiness to change, early signs of negative transference and resistance, and absence of recognition of their own participation in problems emerged in baseline interviews. In most cases, the patient's evaluation of the therapeutic relationship was not determinant of dropout. Therapeutic gains, dissatisfaction, and resistance during the psychotherapeutic process seemed to be associated with noncompliance. Conclusions: Decisions to initiate, continue, or quit PP depend on multiple factors, such as initial goals, readiness to change, insight capacity, awareness of personal problems, resistance, and transference. However, these factors should be considered in view of the methodological limitations of this study. Further investigation of PP dropout is still necessary.