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Key to psychodynamic and psychoanalytic work is an observing ego and the capacity to reflect on conscious and unconscious dynamics. Supervision frequently requires us to think the unthinkable and consider and reflect on material that might be shame inducing or provoke anxiety. However, this requires the ego to allow unconscious thoughts and feelings to surface and not be inhibited by the superego. The superego affects us in many ways. It sometimes acts as a censor determining what can be consciously thought in order to manage anxiety and inhibit unwanted thoughts and affects entering consciousness. It can persecute us with shoulds and oughts but it can also protect through consideration of what is appropriate and ethical. In this paper I explore the impact of the superego on supervisory and clinical work in terms of being a censor, a persecutor and protector. The paper interweaves theory with clinical examples and examines how the superego can inhibit the exploration of clinical material and the development of a reflective and psychodynamic understanding of the client's internal world. In addition I consider how the superego is a factor that ensures good practice and that the work of the clinician is fit for purpose. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress and impaired antioxidant capacity in diabetes are associated with diabetic nephropathy. Metformin, as an adjunct to insulin could decrease oxidative stress and may therefore improve renal function in type 1 diabetes (T1D). Objectives: To investigate the effects of metformin as adds-on therapy to insulin on renal dysfunction in T1D. Materials and Methods: Male Sprague-Dawley rats (230-250 g) were divided into 5 groups (n =7). Rats in groups A and B were orally treated with 3.0 mL/kg body weight (BW) of distilled water, while those in groups C and D were treated with insulin (4.0 U/kg BW bid) or oral metformin (250 mg/kg BW), respectively. Group E rats were similarly treated with both metformin and insulin. Groups B-E were rendered diabetic by intraperitoneal injections of 65 mg/kg BW of streptozotocin. Fasting blood glucose concentrations and glucose tolerance tests were done. The animals were sacrificed by halothane overdose after 56 days, blood taken by cardiac puncture and kidneys excised and stored at -80°C for further analysis. Results: Untreated diabetic rats exhibited significant weight loss, increased polydipsia and polyuria, impaired glucose tolerance, electrolyte retention, reduced creatinine clearance and urea excretion and increased oxidative stress compared to controls, respectively. However, these were reversed by treatment with metformin and insulin. Conclusions: Metformin does not improve glycemic control in TID but exerts renoprotective effects by reducing oxidative stress in the presence of insulin. Metformin should therefore be considered for adjunct therapy with insulin in TID. [ABSTRACT FROM AUTHOR]