Adolescent suicide: perspectives on a clinical quandary.
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Biomedical subjects
Publications and source records attributed to C R Keith.
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As the dental students of the Class of 2000 entered the Comprehensive Care Clinic at the University of Colorado School of Dentistry in the spring of their second year (spring of 1998), a different, competency-based set of clinical expectations was communicated to them. These students were presented a list of "Recommended Core Experiences" and told that the "requirements" for completion of the Comprehensive Care Program were 1) successful performance on all departmental competency examinations, and 2) timely completion of the comprehensive dental treatment appropriate to each assigned patient. This study examined the number of procedures completed during the six semesters in the Comprehensive Care Clinic for the Class of 2000, as compared to the clinical activity for the Class of 1999 during the same stage of their career. The overall mean number of clinical procedures performed per student was 7 percent greater for the students in the Class of 2000 than for those in the Class of 1999. These results suggest that numerical requirements are not necessary to ensure dental student productivity and that, in fact, students can complete more clinical procedures in a comprehensive care clinical environment without numerical requirements.
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I have described paradoxical naughtiness due to guilt which occurs in some child patients during therapy and, if undetected and not interpreted, can escalate to destructive proportions. A clear conceptualization of the superego developmental line is crucial since it provides a framework for understanding the shifting superego transferences as played out by the child. The prohibitive and the loving superego transferences in turn provide the specific material for interpretations that lead to new identifications with the therapist's benign superego and at times eventual understanding of the child's internalization and distortion of parental superego functions from the past.
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