Biomedical subjects
Publications and source records attributed to M F Hoyt.
Questioning various implications of the conventional term countertransference, the author proffers the idea of client-inspired therapist contributions and gives several clinical examples.
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Innovation, collaboration, and efficiency are the hallmarks of good HMO therapy. The essential characteristics of effective therapy in managed care settings are described. A series of guidelines is presented for promoting clinician identification with HMO values. Emphasis is placed on the importance of a total quality management approach that enhances the development of a cooperative, competency-based culture. Selecting, educating, and rewarding clinicians for ¿doing the right thing¿ is vital if we are to meet the challenge and mandate of providing high-quality, professional mental health services.
Group psychotherapy is often the treatment of choice with appropriate patients, because of its clinical utility and efficacy as well as possible cost-effectiveness. Common elements of short-term group therapy are reviewed, and different forms of group therapy practiced within the HMO context are discussed. Attention is also called to the value of group therapy for providing cost-sensitive treatment to more chronically impaired psychiatric patients who may require extended supportive care. The relationship between various health care delivery structures (staff/group versus IPA/PPO models) and the provision of group treatments is emphasized, as is the importance of developing a group therapy program as part of a comprehensive mental health service.
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Psychotherapists' and an independent observer's ratings of the "good" to "poor" quality of therapy sessions were correlated with their ratings of various therapist actions. As predicted, significant positive correlations were obtained between the goodness ratings and the emphasis given by therapists to actions encouraging patients' expression of thoughts and feelings and the exploration of their reactions. For a number of other actions, however, therapists and the independent observer disagreed about whether emphasis of the actions correlated with "good" or "poor" sessions. Some possible causes and implications of these differences are discussed.
Remorse involves a sense of guilty and shameful condemnation having sources in both the Self and Other. In addition to providing punishment for real or imagined wrongdoing, remorse may function to preserve a relationship with the harmed Other, who is kept alive and intact as an internalized judge. As painful as the feelings of remorse are, they may be sought or clung to as a defense against having to give up the Other, who, via incorporative processes, may be unconsciously experienced as part of the self. Painful memories and affects may serve to ward off the feelings of abject emptiness that would otherwise be experienced, especially with persons whose sense of self is highly dependent on a stable relationship with an Other. After a brief review of the etymology of the term "remorse" ("to bite again") and some of its cultural manifestations, the defensive, relationship-maintaining function of remorse was further illustrated with a case vignette.
The authors interviewed 10 therapists and supervisors who had clinical experience in working with deaf patients. The responses centered on issues related to the necessity of visual rather than auditory communication, problems of diagnosis and assessment, therapist and patient expectations, special strengths of deaf patients, involvement of third parties, and modification of therapeutic technique. The authors emphasize that additional resources and research are necessary for clinicians to meet the needs of this large but still underserved population.
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Experienced clinicians' ratings of the "good" to "poor" quality of 46 therapy sessions were correlated with their ratings of various therapist and patient actions. As predicted, significant positive correlations were obtained between the goodness ratings and the emphasis given by therapists and patients to actions involving emotional expression and to explorations of the patients' thoughts and feelings pertaining to their self-concepts and their relationships with therapists and significant others.
The importance of primal-scene experience is suggested by the wide range of attention it has received, with a multitude of derivative phenomena being attributed to its influence. Emphasis has been on possible psychiatric problems, and almost all available reports are clinical and anecdotal. The classical psychoanalytic view has been that such stimulation, be it through actual witnessing or fantasy, results (especially in children) in experience of anxiety, intense eroticization, and sadomasochistic confusions about sexuality. It is suggested here that issues of affectional love and fears of aloneness and feelings of vulnerability may often be the focus of primal-scene reactions. A wide range of evidence has been presented here to support the view that primal-scene experience per se is not necessarily deleterious, and that traumatic or pathogenic effects usually occur only within a context of general brutality or disturbed family relationships. In contradistinction, some emphasis here has been placed on possible positive effects of primal-scene experience. There is a clear need for further study, especially among nonpsychiatrically selected persons, for understanding to be advanced regarding the vicissitudes of both normal and pathological primal-scene experience.
Data are reported from detailed semistructured interviews with 25 males and 25 females, 18-30 years of age. Special attention is given to age and reactions at time of initial awareness of parents' sexual relationship and at time of any possible primal-scene witnessing, beliefs about parents' present sex lives, and interviewees' own ideas of how their parents' sexual attitudes and relationship may have influenced them. Particularly interesting are data indicating that primal-scene experiences, including actual witnessing, do not necessarily result in pathological consequences for psychosexual functioning or satisfaction. The importance of family-relationship patterns as determinants of reactions to primal-scene experience is emphasized.
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The authors conducted a systematic psychodynamic investigation directed explicitly toward the bereavement reactions of people who have lost a parent during their adult life. They conducted a single in-depth interview of 14 people with a mean age of 32.4 years who had experienced the death of a parent in the last 3--20 months. The authors present clinical data illustrating several themes, including the importance of the last meeting with the parent, the experience of grief and aggression, coping resources, and growth-oriented aspects of the bereavement process. They also make a number of suggestions regarding clinical practice and further research.
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Theoretical and clinical anecdotal studies have assigned considerable significance to the witnessing of and fantasizing about parental sexuality for a person's later understanding and behavior, especially with regard to sexuality and male-female relations. Little is known, however, about the psychology of primal-scene experience, especially if one seeks any systematic or formal data. Even such basic facts as the incidence of recalled primal-scene exposure or fantasy are unavailable, as are any normative data regarding the reactions that may be provoked by such experience. In this study, 345 college student respondents completed questionnaires stating their age and reactions at the time of their initial awareness of their parents' sexual relationship, any actual primal-scene observations, and their ideas and reactions to the idea of their parents' present sexual lives.
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