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Results for “Reality Therapy”

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PubMed1984

Families of borderline patients: literal-minded parents, borderline parents, and parental protectiveness.

While borderline personality disorder is a well-established psychiatric diagnosis, less is known about family functioning and interactional patterns in subjects with the disorder. The authors describe interactional patterns in families of borderline children where one parent has a severe personality disorder and the other fails to protect the child adequately against the effects of that psychopathology. Two types of parents are described: the literal-minded parent and the borderline parent. The literal-minded parent resembles an alexithymic patient, lacking the ability to empathically understand and respond to the child's feelings and needs. The borderline parent uses the child as the target of projections and reality distortions. Therapy should mobilize the active protective functions of the healthier parent.

Adult↗
PubMed1985

The defense process in posttraumatic stress disorders.

The authors discuss the role of the subjective determinants in the premorbid personality and in the symptom-formation of patients who develop posttraumatic stress disorders. Such factors are assessed through a careful evaluation of the defense mechanisms. It is suggested that psychotherapists focus their attention on the dynamics of such mechanisms and shape their interventions accordingly.

Adaptation, Psychological↗
PubMed2006

Innovations: child and adolescent psychiatry: measuring outcomes of real-world youth psychotherapy: whom to ask and what to ask?

To illustrate complexities in outcomes measurement for youths receiving community-based mental health services, this column presents data on 112 youths in publicly funded, usual-care psychotherapy. Youths and their parents separately completed standard measures of outcomes in three domains--symptoms, functioning, and family environment--at baseline and at six months. The results indicate minimal agreement between youths and parents on individual outcome domains and almost no overlap for each informant (youth and parent) across multiple domains. These findings are especially relevant because service providers are increasingly required to demonstrate treatment effectiveness and monitor youths' progress. The results highlight the complexities in measuring the impact of care and indicate the need to develop more feasible methods to measure multidimensional outcomes.

Adolescent↗
PubMed1982

"Developmental lag" in the evolution of technique for psychoanalysis of neurotic conflict.

The practice of psychoanalysis of neurotic conflict has not--to the extent that might be expected--evolved a consistent use in technique of available knowledge of the ego's mechanisms of defense. This is primarily related to a general resistance that can usefully be regarded as a "developmental lag." The evidence for this, particularly in Freud's writings, is reviewed as are the observations of others who have made note of this phenomenon. Some of the reasons that have contributed to this resistance among analysts are discussed.

Conflict, Psychological↗
PubMed1989

Pains and gains: a study of forced terminations.

The forced termination of psychoanalysis, such as occurs when the analyst makes a geographic move, uniquely disrupts the analytic setting. This paper recounts the author's experience of terminating a full-time private practice of psychoanalysis and psychoanalytic therapy for such a move. The limited literature on the subject is reviewed with a focus on the use of technical variation in the forced termination situation. The author delineates three areas of interaction with patients where technical variation proved in her experience to be of value: dealing with countertransference and counter-reaction, providing information about the move, and the consideration and process of referral for continued therapy. As opposed to what would be predicted from a classical psychoanalytic perspective, the use of such technical maneuvers seemed to facilitate rather than impede analytic work. These variations in technique served at crucial times to maintain the analytic alliance, to preserve the patient's capacity to recognize and make use of transference, and to provide avenues for resolving past traumas in the transference and the actual loss of the analyst. The concept of the analyst as a new or useable object is proposed as providing a theoretical framework for understanding these observations.

Adaptation, Psychological↗
PubMed1993

What is sublimated in sublimation?

Sublimation has always been an elusive idea in psychoanalytic thought. This is because psychoanalysis is most systematic as a clinical psychology, while sublimation signifies an obverse of neurosogenesis. Nevertheless, the idea of sublimation remains a concern of psychoanalysis inasmuch as sublimation entails a version of socialization and cultural experience that answers to various principles of psychoanalytic theory. For reasons developed here, the creation and experience of art figure prominently in reflections on sublimation. Clinical material from the analyses of several artists is presented to demonstrate how neurosis takes a toll of sublimation and how sublimation takes a toll of the analytic process. Sublimatory experiences are then reconstructed from the devices of art. Two achievements of sublimation are especially noted: reduction of the ordinary instrumental functions of affects, and heightened consciousness of endopsychic processes.

Creativity↗
PubMed1994

The uses of the past and the actualization of a family romance.

This paper elaborates an aspect of the therapeutic experience of analysis that pertains to the examination of the past as it influences a patient's view of his self-worth and relationship to the world. It is complementary to the usual view of psychoanalytic process that involves analysis of transference resistance, revelation of transference, and the discovery of its genetic roots. I propose an additional therapeutic aspect of the reexperience of the past in which the changed representation of patient as child is validated by a new object, the analyst, who is experienced as a benevolent witness to the past and as a benevolent presence in the past, thereby consolidating the change and influencing the patient's adult self-representation. This therapeutic effect is more likely to be of significance in patients who have experienced parental loss or significant deprivation in childhood. Segments of the analysis of a patient illustrate this point. The patient described "listening to himself with compassion for the child he had been" and being listened to by me in the same way. He became thereby "tolerant and empathetic with the child he had been." The more general implications of this as a vehicle for change in psychoanalysis are discussed. Of ancillary interest was the patient's research into his past and ultimately his actualization of a family romance fantasy with a particular ironic twist.

Adult↗
PubMed1993

Reality orientation, validation and the reality of the disoriented old old.

Approaches of disoriented elderly people can be distinguished in two main perceptions, Reality Orientation and Validation. Reality Orientation appeals to still existing functions and helps people to get oriented toward the reality. Validation goes with people into their inner world, where feelings dominate and facts are no longer important. In this article both approaches are explicated. Further, it is stated that measuring the effects of Reality Orientation or Validation have the same pitfalls, such as lack of adequate scales, unclear definitions of the behaviour and symptoms of patients involved, and the risk of measuring a Hawthorne effect. The author states that Validation meets the demands of disoriented people better than Reality Orientation. She argues to think in-depth about the aims of psychogeriatric care, in order to define what effects should be pursued and measured. Nursing diagnoses should be used instead of medical diagnoses.

Aged↗
PubMed1981

Reality orientation and dementia: a controlled trial of two approaches.

Classroom Reality Orientation was investigated with a sample of dements drawn from a psychogeriatric hospital and an old people's home. Treatment effects were examined on a range of cognitive and behavioural measures, and compared with the effects of a specific behaviourally directed orientation training in the ward. Class RO improved cognitive functioning but not behaviour, irrespective of degree of dementia. Highly significant behavioural change was demonstrated for ward behaviour orientation training and this technique is not only cheaper but has potential in managing dements.

Aged↗
PubMed1982

Reality orientation: a critical appraisal.

Reality orientation is now extensively used with psychogeriatric patients. The evidence for its effectiveness is reviewed and the underlying philosophy and assumptions are critically examined. Whilst reality orientation does appear to have some effect, the benefits are small and restricted in range. It can be argued that it is not directed at the most appropriate therapeutic goals. Reality orientation should be seen as the starting point for the development of more effective intervention techniques for use with this client population and not as an end in itself.

Aged↗
PubMed1999

The performance of a fluoroscopic electronic portal imaging device modified for portability.

Advances in external beam therapy technology have made routine, efficient conformal therapy a reality. With it comes the increasing need for online treatment verification, which is only achievable at present through the use of electronic portal imaging devices (EPIDs). For a large radiotherapy centre, the provision of one EPID per treatment machine proves extremely expensive. This paper details modifications to the design of a commercial fluoroscopic EPID (the SRI-100) to produce a portable system, capable of providing quick, high quality imaging on more than one treatment machine. We describe the necessary hardware and software changes made to the system, as well as the variety of mechanical and quality control checks performed for testing the stability and quality of the imaging. The modified system has been found to be both electronically and mechanically robust, with associated image quality, scaling, distortion and movement similar to other EPIDs in the department. Although the modification was designed specifically to allow for the acquisition of images from multiple treatment machines, it may also enable the operation of the EPID for other uses such as total body irradiation (TBI) treatment verification and a further range of quality control procedures on the linear accelerator itself.

Ambulatory Care↗