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Biomedical subjects

H E Book

Publications and source records attributed to H E Book.

14 recordsLinked to original sources
PubMed1995

The "erotic transference": some technical and countertransferential difficulties.

This paper highlights dynamics that may interfere with the therapist's identifying and addressing the erotic transference: (1) deficient training; (2) theoretical orientations that devalue the transference while espousing a "real" relationship including self-disclosure; (3) countertransference responses to the erotic transference; and (4) clinical errors of focusing on the manifest erotic transference while overlooking significant but latent pre-oedipal, oedipal, aggressive, or selfobject issues. Inattention to these dynamics may render the therapist vulnerable to sexual acting out with his patient.

Adult↗
PubMed1991

Is empathy cost efficient?

In an attempt to constrain rising health-care costs, third-party payers are currently encouraging psychiatrists and other physicians to focus on the financial aspects of their treatment approaches. This paper has attempted to address the impact of this cost-efficient attitude on our empathy and by tracking the evolution of our health-care-delivery system since the turn of the century. I have described three overlapping phases: the humanist, the scientific, and the current corporate phase, and emphasized the importance or trivialization of an empathic practice-style associated with each stage. I have warned how the corporate delivery system, with its focus on cost constraints, may inhibit our capacity to be empathic by stimulating self-serving concerns about the corporation's monetary welfare and our own financial well-being. This unempathic stance may result in treatment being driven by financial factors that override clinically driven needs of the patient. At its extreme, this approach may render psychiatrists vulnerable for viewing patients as bad objects that deprive financially, and for countertransferentially retaliating against them through "warehousing" and abandonment.

Adult↗
PubMed1988

Empathy: misconceptions and misuses in psychotherapy.

The frequent misconceptions and misuses of empathy that occur during psychotherapy are related to confusion about the definition of empathy, misunderstanding of the difference between the process of empathy and the therapist's response of being empathic, countertransference exploitation of empathy to act out the therapist's needs, the therapist's unawareness of the "layering" phenomenon, and overlooking the patient's level of self-other differentiation. These misuses result in the patient's feeling misunderstood and damaged, with a subsequent weakening of the therapeutic alliance and, at times, a breakdown in self-other differentiation. Once identified, misuses should be addressed and explored in psychotherapy to offset disruptions in treatment.

Acting Out↗
PubMed1987

The resident's countertransference: approaching an avoided topic.

The resident's countertransference to his/her patient may offer essential information about certain denied processes within that patient. It may also signal the existence of countertherapeutic scotomas within the resident. This paper offers a clinically based approach for directly identifying, exploring, and utilizing the information emerging from the resident's countertransference. This approach focuses on the "only or never" phenomenon, the parallel process, and introspective curiosity as modes of identifying the existence of countertransference responses. It highlights the importance of confrontation and clarification to explore the meaning of these responses in the context of that particular resident with his/her particular patient.

Adult↗
PubMed1987

Some psychodynamics of non-compliance.

With up to 50% of psychiatric patients refusing medication at some time during therapy, non-compliance can become a major treatment difficulty. This problem is compounded by the countertransference responses evoked within the therapists, and their tendency to react solely with information and exhortation rather than attempting to view non-compliance psychodynamically. When exploring with empathic concern, a number of common dynamic issues can be seen as playing a major role in drug refusal. Commonly at work are issues relating to projection, denial, identification, and transference difficulties that emerge in a relationship where a therapist offers a patient a pill.

Adult↗
PubMed1986

Soft clinical research on an inpatient unit: effect of findings on treatment.

This paper describes the value of identifying and processing intuitive hunches and impressionistic ideas that arose amongst psychiatrist/clinicians on an inpatient unit. Through semistructured meetings, these hunches generated psychodynamic formulations and therapeutic approaches that were integrated into already existing models of treatment to yield a better understanding of, and a more tailored approach to, the borderline patient and his/her impact on staff.

Borderline Personality Disorder↗
PubMed1983

Psychotherapy and the inpatient unit: a unique learning experience.

This paper describes the advantages of an inpatient setting for the teaching and learning of psychotherapy. Contributions to this process derive from the continuous and intense expressions of conscious and unconscious dynamics, transferences, and object relationships by the patients, the obligation on residents to therapeutically engage in a relatively exposed way with all the patients under their care, the availability and familiarity of the staff supervisors who participate in assessments and decisions regarding patient management and psychotherapy, and the collaborative work of all the other team members. Conditions of the setting which make this possible are the strong psychodynamic orientation of all the staff, the resident's role as manager and psychotherapist, the staff psychiatrist's role as supervisor and team leader, and the completely open communication among all the treating personnel.

Humans↗
PubMed1983

The characterologically difficult patient: a hospital treatment model.

A treatment model for the hospitalized borderline patient has evolved from the long-term, intensive treatment of these patients in a psychodynamically oriented setting. Four stages are identified and described. Each has a therapeutic goal and strategy, and repeatedly observable patient responses and staff counter-responses. Although patients vary in the lengths of time in each stage and there is much back and forth between stages, the regularity with which this pattern occurs greatly increases the capacity of the treating personnel to understand and guide the treatment process. The model clarifies perplexing, discouraging, or stale-mating affects and behaviours in the patients, and misleading counter-therapeutic affects and behaviours in the staff. Further, it can predict certain features and, to some extent, probable outcome in any particular course of treatment.

Acting Out↗
PubMed1981

The teaching and learning of psychotherapy in a general hospital.

A general teaching hospital provides an excellent setting for the teaching of psychiatric residents. The Canadian model for a teaching network, including general and specialty hospitals, allows for special interests to develop within given hospitals. A department of psychiatry which chooses the teaching of psychotherapy as a special interest is examined. The teaching occurs in all areas of the department (ambulatory, inpatient, consultation-liaison) and is backed up by appropriate seminars. Individual supervision provides the backbone of the teaching program. The special interest exists within a department which must answer all of the psychiatric needs of a general hospital population. From the university point of view, the network is strengthened by the existence of various areas of concentrated interest within various component units of the network.

Ambulatory Care↗
PubMed1979

Negative responses of the borderline to inpatient treatment.

The intense therapeutic encirclement maneuvers possible in long-term inpatient therapy of the borderline patient frequently stimulate emotional flooding and intense negative therapeutic reactions. Such reactions have understandable precipitants: a mixture of therapeutic goals, treatment methods, and defensive structures of the patient best conceptualized within an object-relations model.

Adult↗
PubMed1978

Staff countertransference to borderline patients on an inpatient unit.

Borderline patients evoke unique countertransference responses among members of the treatment team: pejorative behavior, undue optimism, and pessimistic nihilism to these patients, along with difficulties in limit-setting, and fragmentation of the treatment team are common. Frequent meetings and open communication within the treatment team are recommended in order to minimize the splitting that is central to these countertransference constellations.

Acting Out↗