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Biomedical subjects

R I Simon

Publications and source records attributed to R I Simon.

32 records · Page 2Linked to original sources
PubMed1993

The psychological and legal aftermath of false arrest and imprisonment.

False arrest and imprisonment can be an extraordinarily stressful psychological trauma. This is clearly demonstrated in the evaluation of forensic cases alleging false arrest and imprisonment, a review of the recent forensic psychiatric literature and reported legal cases. A clinical vignette is presented that illustrates the psychological trauma and sequelae associated with false arrest and imprisonment. Psychiatric treatment of these individuals is discussed. A number of these cases are litigated.

Criminal Law↗
PubMed1992

Treatment boundary violations: clinical, ethical, and legal considerations.

The observance of treatment boundaries maintains the integrity of the therapist-patient relationship. It is the therapist's professional duty to establish appropriate treatment boundaries. Basic boundary guidelines are reviewed. The principles underlying these boundary guidelines are explored. A clinical vignette describing the sexual exploitation of a patient by her therapist dramatically illustrates progressive boundary violations. Boundary violations involving money are particularly common. Double agent roles also are likely to lead to the establishment of dissonant treatment boundaries with patients. The clinical, ethical, and legal issues surrounding the maintenance of treatment boundaries are discussed.

Ethics, Professional↗
PubMed1992

Assessing boundary violations in psychotherapy: survey results with the Exploitation Index.

The usefulness of the Exploitation Index (Epstein & Simon, 1990) was evaluated in a survey of psychiatrists. Forty-three percent of the respondents indicated that at least one item alerted them to behavior they thought could have been counterproductive to treatment. Twenty-nine percent found that they were stimulated to make specific changes in future treatment practice. On average, female respondents endorsed fewer boundary violations than males.

Ethics, Professional↗
PubMed1990

The Exploitation Index: an early warning indicator of boundary violations in psychotherapy.

Exploitive behavior by therapists is highly disruptive in psychotherapy because it violates the sense of trust derived from a coherent treatment boundary. Such behavior may be difficult to detect because it is often associated with self-deception. The compensatory need to feel "special," a state of mind often associated with exploitiveness, suggests that narcissistic mechanisms play a significant role. The authors present an "Exploitation Index" (EI), a self-assessment questionnaire for therapists that is designed to serve as an early warning indicator of boundary violations.

Ethics, Medical↗
PubMed1989

Silent suicide in the elderly.

The suicide rate in the United States rises consistently with age. Silent suicide is defined as the intention, often masked, to kill oneself by nonviolent means through self-starvation or noncompliance with essential medical treatment. Silent suicide frequently goes unrecognized because of undiagnosed depression and the interjection of the personal belief systems of health-care providers and family members. Elderly individuals committing silent suicide are often thought to be making rational end of life decisions. However, the elderly committing silent suicide must be distinguished from terminally ill patients who refuse further treatment in order not to prolong the act of dying. The clinical/legal issues surrounding silent suicide will be discussed.

Aged↗
PubMed1987

After the terrorist incident: psychotherapeutic treatment of former hostages.

With the ever-increasing number of terrorist incidents involving the taking of hostages, therapists are called upon to treat those victims who develop psychological sequelae to their hostage experience. The subsequent psychological symptoms and characteristic attitudes that develop in many former hostages requires special modifications in treatment techniques and goals.

Adaptation, Psychological↗
PubMedDate not supplied

Between the chair and the door: boundary issues in the therapeutic "transition zone".

Empirical and consultative experience reveals that damaging boundary violations begin insidiously and are progressive. During the segment of the therapy session that occurs "between the chair and the door," patients and therapists are more vulnerable to committing boundary excursions and violations. We suggest that inchoate boundary violations with a potential for damaging progression usually first appear within this interval. This part of the session can be scrutinized for early warning of boundary violations and studied for its instructive value in risk management and prevention of sexual misconduct.

Humans↗
PubMedDate not supplied

Clinical risk management of the rapid-cycling bipolar patient.

Important clinical-legal issues surround the management of patients with rapid-cycling bipolar disorder (RCBD). An increased risk of liability exposure may exist for improper diagnosis and treatment, lack of informed consent, inadequate assessment of the risk of violence toward self and others, and failure to monitor the patient. Practice guidelines may facilitate defensive practices by psychiatrists, which can increase the risk of liability. Clinical risk management combines professional expertise and knowledge of the patient with an understanding of the legal issues governing clinical practice to provide good care to patients and only secondarily to limit legal liability. A working understanding of the legal issues surrounding patient care in general and the RCBD patient in particular should provide more comfort and wider latitude in helping these difficult-to-treat patients.

Bipolar Disorder↗
PubMedDate not supplied

Chronic posttraumatic stress disorder: a review and checklist of factors influencing prognosis.

Mental health clinicians are often asked to evaluate prognosis in individuals with posttraumatic stress disorder (PTSD) in clinical, administrative, and legal contexts. Although chronicity of PTSD has been addressed in a number of trauma studies, the data have not been integrated into a coherent approach to the assessment of prognosis. In this paper, the peer-reviewed PTSD literature is surveyed to assist clinicians in making informed prognostic evaluations of the course of PTSD in adults. Potential risk factors, grouped into 11 categories (PTSD stressors, PTSD symptoms, current comorbidity, lifetime comorbidity, childhood separation and abuse, demographics, life stressors, family history, support, treatment, and functional impairment), are reviewed. Knowledge of these risk factors, and of factors associated with chronic PTSD, is helpful in assessing the potential for or degree of chronicity present at the initial evaluation of the patient, as well as in measuring treatment response during the course of therapy. Early identification and the appropriate treatment and management of remediable risk and associated factors may help prevent the development of chronic PTSD. Longitudinally assessing the response of treatable risk factors should provide an additional means for evaluating prognosis. A PTSD Prognostic Checklist, which rates risk and associated factors in each category, is proposed. Validity and reliability have not yet been established for this instrument. It is hoped that clinicians will use and conduct research on it as an initial step toward advancing its scientific utility.

Adult↗