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PubMed1998

Psychotherapy with cancer patients.

Cancer is associated with significant psychosocial morbidity. Although psychodynamic psychotherapy is a valuable intervention for some cancer patients, this modality has been underutilized because psychotherapy with medically ill patients has been linked historically to work with patients who have psychosomatic illnesses. Psychotherapy with patients who have cancer has unique features, such as the prominence of illness-related issues during the initial phase of treatment, the mixture of supportive and interpretive therapy, focused goals, and special issues pertaining to the transference/countertransference field. Understanding of those special issues will improve psychiatrists' ability to use long-term psychotherapy as an effective psychosocial intervention for patients with cancer.

Countertransference↗
PubMed1999

The fate of the unconscious in future psychotherapy.

It is important in these changing times to reconsider the psychoanalytic conception of the unconscious and the phantasmal mental life that occupies it--so that we can recalibrate our clinical work with it. It is the foundation of all our endeavors. Recent developments in neurobiology, combined with a more pragmatic intersubjective approach in psychoanalysis and psychotherapy, have marginalized the status of the unconscious in the eyes of many mental health professionals. Moreover, considerations of realistic childhood traumata and neglect are being more and more counterposed to the traditional concept of the infantile neurosis. What is at stake is a dismissal of a concept that is still of enormous importance, yet one that has been too little understood. What is required is a dual-track conception in which an interplay can be seen to be taking place between the unconscious, neurobiology, and trauma in the intrasubjective as well as in the intersubjective matrix.

Adult↗
PubMed1999

Impasse or pseudo-impasse in the psychotherapy of an inhibited writer.

This paper describes the interactions of a patient and her therapist in the course of psychoanalytic psychotherapy, during which there occurred two significant impasse enactments. At first sight, each resembled a classical impasse. On further review of the case, the interactions took on a different texture that we have described as a pseudo-impasse in the course of the therapy. The enactments took the form of an abrupt cessation of the therapy in which the patient terminated and then later returned, thereby giving a more intense rhythm to the therapy. The patient, described as a sexually inhibited novelist with symptoms of panic and anxiety, said at the outset that she was never able to express strong feelings for fear of criticism. Central issues included a number of conflicts: the manner of referral in which her friend (who was also a friend of the therapist) was instrumental; the grief for her dead mother and her lost sister; and overt conflict with her critical father. These conflicts became re-enacted within the interactions between herself and her therapist. The stages of therapy could best be described as at first wishing her therapist to be her "sin eater," and, subsequently, her idealized, loving, nonjudgemental parent. We understand the pseudo-impasses to represent psychotherapeutically framed developmental steps.

Acting Out↗
PubMed1999

Coming of age: the adolescent in psychotherapy.

Psychotherapy clients in their adolescence are receptive to self-exploration. When given the opportunity to reduce external distractions and directives, these young individuals are serious seekers of emotional well-being. They also seek quality and genuine interpersonal relationships. Gentle guidance within a safe container encourages adolescents to explore their inner world.

Adolescent↗
PubMed2000

Cancer and the experience of meaning: a group psychotherapy program for people with cancer.

Cancer illness affects people in many ways, physical, financial, and existential. In this paper, we describe a proposed group intervention for individuals with advanced disease who want help finding a sense of meaning at this critical juncture in their lives. This intervention has a brief, semi-structured format, and is informed by the work of Viktor Frankl, empirical findings in the area of meaning and trauma, and the empirical findings of other group interventions for cancer patients. Individual sessions focus on different aspects of meaning, including responsibility to others, creativity, transcendence, and ascertaining one's values and priorities. Having goals on which to focus and feeling like part of a larger whole are critically important to the ability to find meaning and cope with terminal illness. Such goals may be generated by a number of sources, including connectedness with others, or a sense of the temporal continuity of one's own life despite the disruption posed by severe illness. Didactic discussions and experiential exercises help to facilitate exploration of these various elements in group members' lives. The finite structure of the intervention may also highlight these issues, as people who are faced with similar issues work together in a limited time frame in order to accomplish the goals they set out for themselves.

Attitude to Health↗
PubMed2001

Agitation therapy for antisocial and psychopathic personalities: an outline.

In this paper, a hypothetical model of agitation therapy for some categories of antisocial and psychopathic patients/offenders is presented. Agitation therapy is mainly meant for very problematic and aggressive individuals who do not (or hardly) respond (in some periods) to any other type of psychotherapy, neurofeedback, and/or psychopharmacotherapy. The author makes an attempt to develop an adequate model of agitation therapy that makes optimal use of learning moments in controlled conflict situations. During agitation therapy the aggressive antisocial or psychopathic individual will be exposed to external agitation of other patients in a controlled manner in order to increase his/her self-knowledge; awareness of his or her intolerable behavior and limitations; sublimation of aggression/anger; the willingness (and insight in the necessity) to change; feelings of responsibility and emotional, social and moral development. Agitation therapy is not intended to be an isolated form of psychotherapy, but it may be rather often successful in combination with other types of psychotherapy, neurofeedback, and/or psychopharmacotherapy.

Acting Out↗
PubMed2003

When we give more: reflections on intangible gifts from therapist to patient.

Since Freud's time, psychoanalytically oriented therapists have been wary of accepting gifts from patients, and have also been reluctant to give them to patients. This article first provides a literal definition of the word "gift," and then defines it within the context of the therapeutic relationship. It then reviews the literature on gifts and presents clinical examples describing five categories of offerings from therapist to patient, experienced by the patient as gifts, namely: 1. the gift of a transitional object; 2. the gift of self-disclosure; 3. the gift of time; 4. the gift of physical touch; and 5. the gift of developmental presence. Examples of therapists' considering but not offering gifts to patients are discussed and viewed from the perspective of whether they are requested by the patient, whether they arise from within the therapist, or whether they are offered in a context of reciprocation. Guidelines for how and when the therapist could attempt such interventions most safely are suggested, placing particular emphasis on counter-transferences.

Countertransference↗
PubMed2004

Psychotherapy with physically disabled patients.

With the last decades, health care interventions have been more productively attuned to actualizing the potential for optimal recuperation of every patient. Unique and important contributions of psychotherapy to this effort include: 1) A formulation which synthesizes an understanding of clinical behaviors, reality-based physical limitations and risks with an appreciation of the patient's mechanisms of defense, ego strengths and weaknesses, and transference expectations which impact the treatment process; 2) The utilization of individual psychotherapy (focused on "insight") in combination with supportive individual and group experiences. For children and adolescents struggling with age-appropriate physical-developmental and social issues or learning disabilities, psychoeducational approach for disabled youngsters has proven very beneficial. 3) Occasional crises occur which involve the spouse or relatives more than the index patient. Working to provide supportive Couple or Family System intervention is sometimes as essential as caring for the disabled individual. 4) Numerous Group Therapy approaches have proven efficacious. Treatment in a group setting is attractive to those who are concerned about cost-containment. Unfortunately, groups for disabled are often "didactic" and utilize a format that provides factual information about disabilities, medical procedures, and sometimes an intellectual discussion of "emotional answers" for certain types of problems or conditions. Groups that facilitate self-disclosure and emotional interactions among the members accomplish more meaningful results. In conclusion, we wish to emphasize the importance of developing rigorous scientific research in the area of disabilities which will match the excellence of clinical work already being done in the field. Gaining an accurate and more thorough understanding of the psychological reality of a disabled person's internal world may be a key to facilitating his or her self-esteem and optimal adaptive functioning.

Countertransference↗
PubMed1982

A suicide attempt by a seductive patient: what's the treatment plan?

For the past ten columns, we have been exploring questions of differential diagnosis and the ways to apply the Diagnostic and Statistical Manual of Mental Disorders, third edition, to the complexity of the clinical situation. We are now embarking on an even more uncharted and certainly more controversial area: differential therapeutics. In this column, to appear in alternate issues, we will learn how our guest experts would select treatment modalities for various clinical situations. We have the good fortune to lead off this new series with Toksoz B. Karasu, M.D., professor of psychiatry at Albert Einstein College of Medicine in the Bronx and director of psychiatry at the Bronx Municipal Medical Center, Dr. Karasu is the chairman of the American Psychiatric Association's commission on psychiatric therapies and has been deeply involved in studying how best to determine which treatments are most effective for which psychiatric disorders in which patients and circumstances.

Adult↗
PubMed1984

Preventing assaults on a psychiatric inpatient ward.

Although appropriate evaluation, management, and treatment of violence-prone patients will tend to reduce the incidence of aggressive acts on a psychiatric ward, such measures are not enough to prevent eruptions of violence. The author discusses several specific preventive steps that staff of psychiatric units can take to reduce the likelihood that assaults will occur: forming and maintaining a social norm against violence, recognizing and managing countertransferential reactions among both staff and patients, ensuring responsible involvement by psychiatrists during violent incidents, thoroughly assessing a patient's potential for assault, and paying prompt attention to the significance of an assault for the involved patient, other patients, and staff.

Aggression↗
PubMed1986

Posttraumatic stress disorder among black Vietnam veterans.

Because of racism in the military and racial and social upheaval in the United States during the Vietnam War years, as well as limited opportunities for blacks in the postwar period, black veterans of the Vietnam War often harbor conflicting feelings about their wartime experiences and have difficulty rationalizing brutality against the Vietnamese. As a result, black veterans suffer from posttraumatic stress disorder (PTSD) at a higher rate than white veterans. Diagnosis and treatment of PTSD in black veterans is complicated by the tendency to misdiagnose black patients, by the varied manifestations of PTSD, and by patients' frequent alcohol and drug abuse and medical, legal, personality, and vocational problems. The author presents his and others' recommendations about ways to treat black veterans with PTSD.

Adult↗
PubMed1986

Neuropsychiatric manifestations of AIDS-spectrum disorders.

Psychiatric symptoms among patients with acquired immune deficiency syndrome (AIDS) may be functional reactions to contracting a fatal and stigmatizing disease or may be secondary to malignancies and opportunistic infections in the central nervous system (CNS). More recent evidence indicates that HTLV-III, the virus that causes AIDS, directly infects the CNS and may cause psychiatric symptoms before signs of immunodeficiency, cognitive impairment, or neurological abnormalities emerge. AIDS-related organic mental syndromes may mimic functional disorders such as chronic mild depression and acute psychosis. Both of these common presentations are illustrated with detailed case reports, and diagnostic and management guidelines are provided.

Acquired Immunodeficiency Syndrome↗

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