Counter-transference

Of even greater importance, the success of any therapy, including pharmacotherapy, depends on the relationship between patient and therapist. The nature and quality of the interaction between the clinician and the patient, flavored by both of their cultural backgrounds, values, attitudes, and expectations, serve as the backdrop against which drugs work, or fail to work. Attention to and successful management of transference and counter-transference are key to the success of not only psychotherapy, but also pharmacotherapy. The importance of culture in this respect cannot be disregarded. 

The ordinary problems of transference, counter-transference, and projection produce so many complications in psychotherapy that few practitioners would want to risk augmenting this predicament. 

The fluxes are now converged to an accuracy of less than 1%. One further iteration will give only marginal improvement (N = 8.0858 X 10 N2 = 4.3442 X 10" mol/m s). The four iterations required here is fairly typical of problems involving equimolar counter transfer N, = 0. 

As the contaminant concentration in a system increases, what happens to the assumption of equimolar counter transfer ... 

Counter-transference is transference from the physician to the patient... 

The bracketed term above is an exact definition for the individual mass transfer coefficient corresponding to the steady-state situation of one component diffusing through a non-diffusing second component. The two most frequently encountered situations involve equimolar counter transfer and the transfer of one component through another non-diffusing component. Theodore and Ricci provide additional details. 

You ve probably had lots of communication skills teaching, but may not have come across the ideas of transference and counter-transference. These are the invisible collection of thoughts, memories and feelings, which travel between you and your patient in an interview, affecting how you get on with each other. It helps to think about the vibe or emotional atmosphere you e q)erience from a patient, remembering that you give off a vibe yourself. 

Yours comes from your past experiences and what you feel when you relate to them (counter-transference). 

Transference and counter-transference affect the interview, whether they creep about stealthily or ricochet around the room like fireworks. You ll probably remember patients who hated or became particularly attached to you (transference). Likewise, there will have been some you... 

Be aware of your counter-transference (p78) to Karen, e.g. irritation, helplessness. Notice whether you re taking up a role , e.g. disapproving parent. 

Notice staff counter-transference (p78-79) including splitting. 

Discuss Karen s presentation with the team ( ward psychologist), e.g. inward rounds or staff support group. Recognising transference/counter-transference will help you understand Karen s behaviour, and stop you exacerbating it. 

Don t panic This happens a lot. Consider the role of counter-transference Ben has successfully displaced his anxiety onto you - but has communicated for a reason. If risks seem immediate (e.g. about to hang himself), try calling back immediately (e.g. dial 1471 to get his number) and find out more, including ... 

Pipette a volume V, cm of the active solution (with a safety pipette) into a 25 cm beaker. Heat nearly to boiling on a water bath and add V2 cm of 0.4 M iron complex solution dropwise and with stirring. Allow the suspension to settle and filter under suction through GF/F paper in a filter assembly, Fig. 18.2, collecting the filtrate in a clean dry receiver. Pipette 9 cm of the filtrate (safety pipette) into a liquid G-M counter. Transfer it to the lead castle and count for an adequate time (>60 min) setting the H.V.of the counter at 420 V. 

Figure Bl.10.2. Schematic diagram of a counting experiment. The detector intercepts signals from the source. The output of the detector is amplified by a preamplifier and then shaped and amplified friitlier by an amplifier. The discriminator has variable lower and upper level tliresholds. If a signal from the amplifier exceeds tlie lower tlireshold while remaming below the upper tlireshold, a pulse is produced that can be registered by a preprogrammed counter. The contents of the counter can be periodically transferred to an online storage device for fiirther processing and analysis. The pulse shapes produced by each of the devices are shown schematically above tlieni.

Figure Bl.28.8. Equivalent circuit for a tliree-electrode electrochemical cell. WE, CE and RE represent the working, counter and reference electrodes is the solution resistance, the uncompensated resistance, R the charge-transfer resistance, R the resistance of the reference electrode, the double-layer capacitance and the parasitic loss to tire ground.

The situation in figure C2.8.5(b) is different in that, in addition to the mechanism in figure C2.8.5(a), reduction of the redox species can occur at the counter-electrode. Thus, electron transfer tlirough the layer may not be needed, as film growth can occur with OH species present in the electrolyte involving a (field-aided) deprotonation of the film. The driving force is provided by the applied voltage, AU. 

Fig. 14. The H.E. IS blow-and-blow machine (85). The gob is deUvered into a blank mold, setded with compressed air, and then preformed with a counter-blow. The parison or preform is then inverted and transferred into the blow mold where it is finished by blowing.

Fields of Application One of the major advantages of the gravity-bed technique is that it lends itself well to true intimate counter-current contacting of solids and gases. This provides for efficient heat transfer and mass transfer. Gravity-bed contacting also permits the use of the sohd as a heat-transfer medium, as in pebble heaters. 

Theoretical Transfer Model Transfer from single droplets is theoretically well defined for the gas side. For a droplet moving counter to a gas, interfacial area is (in consistent units)... 

Although two fluids may transfer heat in either counter-current or cocurrent flow, the relative direction of the two fluids influences the value of the LMTD, and thus, the area required to transfer a given amount of... 

L the shell-side fluid makes one pass from inlet to outlet. With a longitudinal baffle, and with the nozzles placed 180° around the shell, the shell-side fluid would be forced to enter at the left, flow to the right to get around the baffle, and flow to the left to reach the exit nozzle. This would be required to approximate true counter-current flow, which was assumed in the heat transfer equations of Chapter 2. 

In the basic heat transfer equation it is necessary to use the log mean temperature difference. In Equation 2-4 it was assumed that the two fluids are flowing counter-current to each other. Depending upon the configuration of the exchanger, this may not be true. That is, the way in which the fluid flows through the exchanger affects LMTD. The correction factor is a function of the number of tube passes and the number of shell passes. 

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