The process of learning psychotherapy involves narcissistic dangers--there may be injuries to self-esteem and self-image, especially when working with certain kinds of disturbed and hostile patients. Some patients will unconsciously recreate, in the transference, representations of early damaging experiences with parents, but now reversed with the therapist as the victim. It is vital for the trainee to be helped to understand these powerful interactional pressures. There are aspects of the professional culture and ideals of clinical psychologists (and possibly of some psychiatrists and social workers as well) which may make them particularly vulnerable in work with the hostile patient. It is argued that the function of supervision is not to teach a technique directly, but to create a 'space for thinking'--a kind of thinking which is more akin to maternal reverie, as described by Bion, than problem solving.

Some of the data are consistent with memories being of iatrogenic origin, but other data clearly point to the need for additional explanations.

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Posttraumatic stress disorder (PTSD) is a common condition among veterans and is often regarded as treatment-resistant. Emotional Freedom Techniques (EFT) combines brief exposure therapy with acupressure and has demonstrated efficacy for PTSD in other trials and meta-analyses. This study recruited 58 veterans who scored 50 or greater on the military PTSD checklist (PCL-M), indicating clinical symptom levels. Participants were randomized into a Treatment As Usual (TAU) wait-list group (n = 26) and an experimental group (n = 32), which received six one-hour EFT sessions in addition to TAU. The mean pretreatment PCL-M score of participants was 66 ± 7.4, with no significant difference between groups. The EFT group demonstrated a significant reduction in PCL-M score from 65 ± 8.1 to 34 ± 10.3 (p < 0.001), while subjects in the TAU group showed no significant change. The TAU group was then treated with EFT and groups were combined for analysis using linear mixed effects modeling. In the combined EFT group, posttreatment PCL-M scores declined to a mean of 34 (-52%, p < 0.001). Participant gains were maintained at three and six-month follow-up, with mean six-month PCL-M scores of 34 (p < 0.001). Psychological conditions such as anxiety and depression also declined significantly, as did physiological markers of insomnia and pain. An effect size of Cohen's d = 3.44 indicates a large treatment effect. These results replicate those obtained in an earlier investigation, and indicate that EFT is an evidence-based practice that is highly effective at reducing symptom severity in veterans with PTSD.

The role of self-esteem in the aetiology of depressive disorders is not limited to negative self-evaluations. A broader concept, embracing the experience of the self, is necessary. A developmental model of self-esteem regulation is proposed, derived in part from Mahler's work on separation-individuation in infants and Kohut's work on narcissism. A concept of a 'fragile self' is formulated and developed; the depressive state is seen as protecting this fragile self. The model provides a coherent account of individual differences in proneness to depression (in interaction with environmental factors) which is useful to psychotherapists, yet open to empirical test and research use. The model is discussed in relation to psychological research on depression and implications for clinical practice are outlined.