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      Empathy in Psychoanalysis and Medical Education - what can we learn from each other?

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          Abstract

          Background

          Several research areas, including medical education (ME), focus on empathy as an important topic in interpersonal relationships. This focus is central to the use of communication skills related to empathy and even more crucial to provide information in a way that makes patients feel more involved in the treatment process. Psychoanalysis (PA) provides its initial concept of empathy based on affective aspects including findings from neuroscience and brain research. Enhancing cooperation between ME and PA can help to integrate both aspects of empathy into a longitudinal training program.

          Discussion

          The condition of psychoanalytic empathy definitions is the understanding of unconscious processes. It is important to primarily attend especially the dominant affects towards the patient before interpreting his or her behaviour, since in explaining the emerging affects, the analyst has to empathize with the patient to understand the (unconscious) reasons for its behaviour. A strong consideration of nonverbal communication, clinical perceptions, intuitive interaction, contagion-like processes and their implementation and empowerment in medical and therapeutic curricula is one way of beneficially using interdisciplinary approaches to yield empathy in clinical interaction.

          Conclusion

          Established methods of PA, like training of containment, reflective functioning, affective holding and giving meaningful interpretations in accordance with countertransferential and transferential aspects may help to put a focus on the clinican-patient-interaction and the preservation of the physicians’ (mental) health. In consequence of the discussion of various training methods that take the theoretical and practical concepts of empathy into account, we aim for an implementation of the named methods in the medical curricula.

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          Most cited references32

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          Research in clinical reasoning: past history and current trends.

          Research in clinical reasoning has been conducted for over 30 years. Throughout this time there have been a number of identifiable trends in methodology and theory. This paper identifies three broad research traditions, ordered chronologically, are: (a) attempts to understand reasoning as a general skill--the "clinical reasoning" process; (b) research based on probes of memory--reasoning related to the amount of knowledge and memory; and (c) research related to different kinds of mental representations--semantic qualifiers, scripts, schemas and exemplars. Several broad themes emerge from this review. First, there is little evidence that reasoning can be characterised in terms of general process variables. Secondly, it is evident that expertise is associated, not with a single basic representation but with multiple coordinated representations in memory, from causal mechanisms to prior examples. Different representations may be utilised in different circumstances, but little is known about the characteristics of a particular situation that led to a change in strategy. It becomes evident that expertise lies in the availability of multiple representations of knowledge. Perhaps the most critical aspect of learning is not the acquisition of a particular strategy or skill, nor is it the availability of a particular kind of knowledge. Rather, the critical element may be deliberate practice with multiple examples which, on the hand, facilitates the availability of concepts and conceptual knowledge (i.e. transfer) and, on the other hand, adds to a storehouse of already solved problems.
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            Empathy: Conceptualization, measurement, and relation to prosocial behavior

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              Cross-Species Affective Neuroscience Decoding of the Primal Affective Experiences of Humans and Related Animals

              Background The issue of whether other animals have internally felt experiences has vexed animal behavioral science since its inception. Although most investigators remain agnostic on such contentious issues, there is now abundant experimental evidence indicating that all mammals have negatively and positively-valenced emotional networks concentrated in homologous brain regions that mediate affective experiences when animals are emotionally aroused. That is what the neuroscientific evidence indicates. Principal Findings The relevant lines of evidence are as follows: 1) It is easy to elicit powerful unconditioned emotional responses using localized electrical stimulation of the brain (ESB); these effects are concentrated in ancient subcortical brain regions. Seven types of emotional arousals have been described; using a special capitalized nomenclature for such primary process emotional systems, they are SEEKING, RAGE, FEAR, LUST, CARE, PANIC/GRIEF and PLAY. 2) These brain circuits are situated in homologous subcortical brain regions in all vertebrates tested. Thus, if one activates FEAR arousal circuits in rats, cats or primates, all exhibit similar fear responses. 3) All primary-process emotional-instinctual urges, even ones as complex as social PLAY, remain intact after radical neo-decortication early in life; thus, the neocortex is not essential for the generation of primary-process emotionality. 4) Using diverse measures, one can demonstrate that animals like and dislike ESB of brain regions that evoke unconditioned instinctual emotional behaviors: Such ESBs can serve as ‘rewards’ and ‘punishments’ in diverse approach and escape/avoidance learning tasks. 5) Comparable ESB of human brains yield comparable affective experiences. Thus, robust evidence indicates that raw primary-process (i.e., instinctual, unconditioned) emotional behaviors and feelings emanate from homologous brain functions in all mammals (see Appendix S1), which are regulated by higher brain regions. Such findings suggest nested-hierarchies of BrainMind affective processing, with primal emotional functions being foundational for secondary-process learning and memory mechanisms, which interface with tertiary-process cognitive-thoughtful functions of the BrainMind.
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                Author and article information

                Contributors
                +43-1-40400-30700 , henriette.loeffler-stastka@meduniwien.ac.at
                felicitas.datz@meduniwien.ac.at
                karoline.parth@meduniwien.ac.at
                Ingrid.Preusche@vetmeduni.ac.at
                xenia.bukowski@gmail.com
                charles.seidman@emory.edu
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                2 May 2017
                2 May 2017
                2017
                : 17
                : 74
                Affiliations
                [1 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, Department for Psychoanalysis und Psychotherapy and University Program for Psychotherapy Research, , Medical University of Vienna, ; Währingerstraße 18-20, 1090 Vienna, Austria
                [2 ]ISNI 0000 0000 9259 8492, GRID grid.22937.3d, , Medical University of Vienna, Teaching Center, Postgraduate Program, ; Vienna, Austria
                [3 ]University of Veterinary Medicine, Teaching Center, Vienna, Austria
                [4 ]ISNI 0000 0004 0431 1180, GRID grid.461709.d, , International Psychoanalytic University, ; Berlin, Germany
                [5 ]ISNI 0000 0001 0941 6502, GRID grid.189967.8, , Emory University, ; Atlanta, USA
                Article
                907
                10.1186/s12909-017-0907-2
                5414377
                28464865
                9e7515e3-85f3-4c98-ae06-812c2c0baff5
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 November 2015
                : 1 April 2017
                Funding
                Funded by: Medizinisch-Wissenschaftlicher Fonds des Bürgermeisters der Bundeshauptstadt Wien
                Award ID: Project-Nr: 14077
                Award Recipient :
                Categories
                Debate
                Custom metadata
                © The Author(s) 2017

                Education
                empathy,psychoanalysis,medical education,medical curricula,training,nonverbal communication
                Education
                empathy, psychoanalysis, medical education, medical curricula, training, nonverbal communication

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