(Jeff_L) #1


Angela Hodgson-Teall

2 The phrase hovering attention was used by Paula
Heinman (1949), a student of Melanie Klein, to
describe the positive clinical use of empathy in a
psychoanalytic setting.

3 A term first used by Melanie Klein (1959)

4 My good Lysander/I swear to thee by Cupid’s
strongest bow/By his best arrow with the gold-
en head/By the simplicity of Venus’ doves/By
that which knitteth souls and prospers lovers/
And by that fire which burned the Carthage

5 For more information about empathy the fol-
lowing is very useful: Decety, J., Ickes, W Eds
The Social Neuroscience of Empathy, MIT Press,
Cambridge, Massachusetts. My personal take on
it uses a more psychoanalytic framework and is
rooted in the description of the first clinical use
of counter-transference by Paula Heinman at the
1949 Psycho-Analytic conference, Zurich

6 My research degree definition is in tune with
Gerlinde Gabriel who talks about the hand and
the tool (Gabriel’s introduction to ‘The Body of
Drawing’ at the South Bank Centre 1993). “For
the hand holding the pencil which makes the line
of drawing is also a form which cups itself into a
container, suggesting a structure, a “body” which
begins to be the inside and outside of what is the
material condition of sculpture”.

7 For my very first event in autumn 2008 in the
hospital where I work I asked participants to se-
lect an animal that captured their interest, their
own pet or an animal that fascinated them for
some reason, one that they could identify with
and would feel “at home with” in some way. I pro-
vided a selection of color photographs pictures of
animals, varying from Aardvark to Zebra, to help
them visualize. I played notes to them, on a cello,
as some of them drew.

8 The best and most reliable form of research in
medical circles is considered to be the double-
blind, placebo-controlled study. A treatment is
said to be proven effective if it has been exam-
ined in properly designed and sufficiently large
studies. In these experiments, one group of sub-

jects receives the “real thing”—the substance or
activity being tested. The other half receives a
placebo, designed to appear, as much as possible,
like the real thing. Individuals in both groups do
not know whether they are getting the real treat-
ment or placebo (they are “blind”). Furthermore,
the researchers administering placebo and real
treatment are also kept in the dark about which
group is receiving which treatment (making it a
“double-blind” experiment). This is important
as it prevents the researchers from unintention-
ally tipping off the study participants, or uncon-
sciously biasing their evaluation of the results.
(Health Library 2011


Carefully gaze at the abdomen from a slight
distance, checking movement with respiration,
flank distension, the presence of abnormal pul-
sations, visible peristalsis, and visible masses.
Warm your hands by rubbing together (if it’s a
cold day) and ask permission to examine the pa-
tient’s abdomen. Tap gently to check for a fluid
wave or shifting dullness. Take out your stetho-
scope, warm the end and listen for bowel sounds,
presence or absence, type and pitch. Listen again
for bruits & venous hums. Palpate lightly to elicit
local tenderness use one-handed technique.
Deeper palpation may be better with two-hand
technique (one hand on top of the other). Per-
form orderly palpation of four quadrants. Re-
laxation techniques to relax abdominal muscles
may be needed. Start in a non-tender quadrant
and check for guarding, rebound tenderness.

To palpate the spleen begin in the right lower
quadrant and follow the path of splenic en-
largement. Begin with superficial one-handed
palpation for an edge or splenic fullness. Move
to bimanual palpation technique (patient su-
pine) with left hand attempting to move the
area below the left rib forwards and push the
spleen outward. The spleen will be felt during
inspiration; the fingers should move forward
during inspiration to feel the tip of spleen as it
comes down. If you still cannot feel it but sus-
pect that it may be enlarged ask the patient
to turn onto the right side, rolling slightly for-
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