Comparing Bion's Container-Contained Relationship with Aspects of Containment in the Collective Unconscious

The psychodynamic therapist is both aware of and open to phenomena arising in their relationship with the patient. This paper compares two different phenomena and expands on how processing these phenomena aids the therapeutic pair: Bion's container-contained relationship and Jung's concept of the collective unconscious, which could be thought of as containing the therapeutic relationship. The two concepts will be described and elucidated using a clinical example of a therapist's dream from the collective unconscious following sudden termination in therapy. This supports a synthesis of the two concepts in a developmental context and within the wider scholarship of both thinkers. Finally, their relationships to embodied processes will be explored. Copyright © 2022 BPF and John Wiley & Sons Ltd.

COMBINING IMPLEMENTATION SCIENCE AND HUMANCENTERED DESIGN TO EXAMINE USABILITY OF A DEPRESSION SCREENING SHARED DECISION-MAKING TOOL AMONG CORONARY HEART DISEASE PATIENTS

BACKGROUND: Only 30% of coronary heart disease (CHD) patients are screened and treated for depression, far below general population rates. Utilizing a theoretical framework based on the Behavior Change Wheel integrated with patient-centered design processes, we conducted a second round of postcoronavirus disease 2019 (COVID-19) beta-phase testing of a web-based, electronic shared decision-making (eSDM) tool for depression screening and follow-up in patients with CHD. METHODS: We recruited English-speaking patients who had internal medicine or cardiology clinic appointments from October 2020-January 2021. All participants were aged ≥21 years with CHD and a diagnosis of and/or positive screen for depression by the patient health questionnaire (PHQ)-2 and/or -8. Think aloud usability sessions with participants verbalizing their thoughts on the eSDM tool were conducted remotely. Sessions lasted approximately one hour. Pre-and post-session questionnaires assessed comfort, ease-of-use of the tool, and perceived barriers to success, and included the Decisional Conflict Scale (DCS) and System Usability Scale (SUS). Think aloud and survey feedback were analyzed for recurring themes. RESULTS: Four patients participated before we reached saturation (25% aged > 65;75% male;75% White). The average SUS score was 77.00 (C, or “Good” on the scale). Three of four participants found the tool easy to use and straightforward, and none expressed confusion/difficulty utilizing the tool. Only 25% felt the tool alone was sufficient to make informed treatment decisions (pre-post decisional conflict increased from 21.3 to 27.5). Postsession, we observed lower perceived barriers to treatment related to access/ coordination (75% vs. 50%), stigma/motivation/efficacy (100% vs. 75%) but not in cost of treatment (50% vs. 50%) or time/travel (50% vs 50%). Three of four participants found the tool's video depicting a patient's depression treatment journey after experiencing a heart attack helpful but two found it retraumatizing. Finally, all participants indicated they would spend time reading about cardiac wellness topics at the end of the tool. CONCLUSIONS: Using an innovative theory-based approach to usability testing, we found high acceptability and usability of our eSDM tool but highlighted several features that will need to be optimized to improve postCOVID-19 adoption rates (e.g., traumatization considerations and increased decisional support). Our study adds further evidence to concerns that selfadministered eSDM tools may be insufficient without provider and clinician level intervention components. Enhancing a tool's features may improve its usefulness to patients, ultimately improving patient and provider adoption.

IMPLEMENTATION OF A SHARED READING CAMPAIGN IN THE NICU: A QUALITY INITIATIVE STUDY

Purpose of Study Language exposure is essential for speech and language development in newborns. NICU infants by virtue of their prolonged hospitalizations or multiple complications are more likely exposed to less language. Based on a low rate of reading measured in our NICU, this initiative was designed to target this deficiency. Methods Used A family reading survey used for two-week old infants at home (modified from Before and After Books and Reading Survey and the Stony Brook Family Reading Survey) was adapted for inpatients. The survey, consisting of 22 questions, was given to caretakers of infants in the NICU at >7 days to 2 months' time period. The R.E.A.D. (Read to, Enjoy, And Develop) Your Baby program was developed to promote shared reading and educate parents about the importance of language. The campaign consists of giving baby books to families with an infant in the NICU >7 days and bi-weekly for chronically hospitalized infants. Books were made available by the Reach Out and Read Program and by acquisition using a regional grant fund. Using historical cohorts, the survey was given to parents before and after instituting the R.E.A.D. Your Baby program. Comparisons of proportions of parents reporting reading or verbalizing activity was analyzed using N-1 two proportion test. Summary of Results The initial survey was conducted with 50 families in 2019;the post-intervention survey collection is still ongoing and currently 12 families have participated. Demographic data of caretakers are included in Table 1. One item asked parents to name three favorite activities to do with your baby in the NICU by free text-25.2% (37/150) responses centered about language (talking, singing, or reading) in the pre-phase;41.7% (15/36) provided language responses (p=0.024) in the post-intervention phase. Reading represented 5.3% (8/150) of responses in the pre-phase, whereas it represented 13.9% (5/36) of the responses in the post-phase, p=0.00001. A multiple-choice question later asked do you read to your baby in the NICU? in which 22% (11/50) of parents answered yes in the pre-phase;91.7% (11/12) respondents answered yes in the post-phase, p=0.00000. Conclusions Shared reading was occurring for a minority of infants in our urban-setting NICU before the R.E.A.D. Your Baby campaign. Initially we had aimed to improve the reading rate to 50%. Already in the early stages of surveying postintervention, a remarkable increase has been observed. One confounding factor may be a long interval of time between pre- and post-intervention (which was mostly due to the Covid-19 pandemic);another factor may be higher number of parents with education beyond high school in the post-phase. Beyond exposing infants to language in the NICU, additional benefits of reading together likely include promoting parentinfant bonding, providing parental stress coping techniques, and priming for continued reading at home. (Table Presented).

Integrating pocus education with critical care in the era of distance learning

Learning Objectives: Teach the use of POCUS in critically ill patients with respect to image acquisition, image interpretation, and clinical decision-making in the setting of distance learning. : Introduction: Point-of-care ultrasound (POCUS) is integral to Emergency Medicine Residency training and often a fundamental component of a senior medical student EM rotation. The Covid-19 pandemic has dramatically limited in-person instruction and necessitated innovative methods of ultrasound education. Using video-conferencing software, we created a novel simulation experience that integrates POCUS into the core EM content delivery of a virtual EM sub-internship. Curricular Design: Following a brief didactic session, a group of 20 sub-interns was divided into 5 “breakout rooms,” each with 1 resident facilitator. The students then progressed through 4 critical care cases in slide format. For each case, students were able to choose from a variety of diagnostic and therapeutic options, and when the students selected POCUS, they then chose both the order and anatomic region of the scans. Images of normal and abnormal findings were provided in GIF format as they pertained to the given case. After verbalizing and interpreting the findings, students could then perform additional scans or interventions until the patient was stabilized. Following the initial session, some ambiguity was added to the vignettes to increase the number of scans typically performed prior to intervening. Impact/Effectiveness: Based on post-session feedback, students felt this approach was highly effective in helping interpret POCUS images and apply the information to a clinical scenario. Mean Likert scale feedback on organization, applicability to clinical practice, and effectiveness was 4.92 out of 5 for each of the categories based on 25 total responses. Written feedback revealed students would have preferred less didactic time and more time with cases. Qualitatively, this feedback did not notably differ from similar in-person sessions held previously. Similar approaches could be used to teach these skills to providers of all levels from the next room or a location across the world.