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PubMed1976

Change in a schizophrenic adolescent as a result of a series of rage-reduction treatments.

A 15-year-old schizophrenic girl with many autistic features was observed to have minimal gains from verbal (individual and family) psychotherapy. A course of six rage-reduction sessions was carried out. Effects of the treatment was assessed by daily ratings made by attendants in the ward setting and by a recreation therapist. Both short term and long term effects were assessed. Short term improvement was noted in the ward ratings on dimensions assessed: eye contact when requested; eye contact, spontaneous; speech quality; expression of feelings; interaction with peers; frequency of autistic behaviors; and interaction with adults. In recreation therapy (using fewer observations), short term improvements were noted in all except two of the dimensions: eye contact, spontaneous; and interaction with peers. Long term (pretreatment vs. post-treatment) gains were evident in the ward ratings on all areas except expression of feelings. In the recreation therapy setting, only frequency of autistic behavior showed a stable improvement. The therapist working with the patient also noticed more global changes, and suggested that rating such dimensions as depth of self-disclosure and willingness to confront important issues in verbal psychotherapy would also show interesting results. Methodological weaknesses of the study are mentioned, and guidelines for future work on this problem are suggested.

Adolescent↗
PubMedDate not supplied

A meta-analytic study of predictors for loneliness during adolescence.

BACKGROUND: Extensive research has been completed to investigate loneliness in adolescents over the past several decades; identification of key predictors for loneliness was needed using meta-analytic techniques. OBJECTIVES: To identify predictors for loneliness in adolescents through a comprehensive review of the literature and to use quantitative meta-analysis to determine the magnitude of the relationships between each predictor and loneliness. METHODS: The literature reviewed included 242 studies published or unpublished between 1980 and 2004, of which 95 met the inclusion criteria. Eleven key predictors for loneliness were identified in the 95 studies. A meta-analysis was conducted on each of the 11 predictors in relation to loneliness. RESULTS: Four predictors (gender, depression, shyness, and self-esteem) had large effect sizes, four predictors (social support, social anxiety, maternal expressiveness, and paternal expressiveness) had large medium to medium effect sizes, two predictors (stress and self-disclosure) had low effect sizes, and one predictor (age) had a very low effect size. DISCUSSION: Theories of loneliness served as a framework for interpreting the findings of the meta-analysis. The most powerful predictors can be used in intervention studies aimed at reducing loneliness in adolescents.

Adolescent↗
PubMed2005

Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men.

OBJECTIVES: We sought to identify the determinants of sexual transmission risk behavior by HIV-positive individuals. We examined social cognitive theory (SCT) variables, which have been found to mediate the effectiveness of HIV risk reduction interventions. We also sought to identify contextual influences that might contribute to initial levels of SCT factors such as self-efficacy. METHOD: In the present study, a series of social cognitive variables and a number of factors hypothesized to influence self-efficacy were assessed among participants at baseline in the Seropositive Urban Men's Intervention Trial. Variables tested for their effects on self-efficacy included hedonistic and self-evaluative outcome expectancies, sexual compulsivity, a history of childhood sexual abuse, drug use, and race. Models predicting condom use during anal sex with partners of HIV-negative or unknown status were tested separately for main partners and for non-main partners. RESULTS: Self-efficacy was associated with condom use in both analyses. Contextual influences on condom use with main partners were fewer and operated mostly via effects on self-efficacy. Influences on condom use with non-main partners exerted both direct effects on condom use and effects mediated by self-efficacy. Drug use was predictive of condom use with non-main, but not main, partners. DISCUSSION: The present results support the approach of addressing both standard SCT factors, and when possible contextual factors in interventions for HIV-positive men.

Adult↗
PubMed2000

Subjectivity and unconsciousness.

Concepts of the unconscious were crucial to both Jung's and Freud's thinking. Psychoanalytic and analytical psychological views of the unconscious are compared and contrasted, and both are critically reviewed. It is suggested that we need to revise our conceptualization so as to take better account of the role of the analyst's expectations and inferences, and therefore of his or her subjectivity, whenever he or she makes a clinical judgement that unconscious mental processes are in operation. Some technical implications of a revised definition of unconsciousness are considered, especially indications for self-disclosure by an analyst of his or her own experience of events within the treatment.

Adult↗
PubMed2000

20-Item Toronto Alexithymia Scale: do difficulties describing feelings assess proneness to shame instead of difficulties symbolizing emotions?

A hallmark of alexithymia is the difficulty putting emotional states into words which has to be differentiated from problems to communicate emotion to others. Shame proneness is a personality trait that is expected to be closely related to a reduced emotional self-disclosure in social interactions. The present investigation was conducted to examine construct validity of the Difficulties Describing Feelings scale of the 20-Item Toronto Alexithymia Scale (TAS-20). The TAS-20 was administered to 68 subjects (30 psychiatric inpatients and 38 normals) along with the Levels of Emotional Awareness Scale (LEAS), a direct measure of the ability to express feelings verbally, and the Shame-Guilt-Scale. Difficulties Describing Feelings was associated with shame assessing scales but not with guilt assessing scales or the LEAS. Thus, in view of our data one should be cautious in interpreting scores from the TAS-20 scale Difficulties Describing Feelings as indices of a difficulty to symbolize one's emotions. Instead, this TAS-20 scale seems to evaluate aspects of social shame.

Adult↗
PubMed2004

Measuring youth outcomes from alcohol and drug treatment.

AIMS: This report examines adolescent alcohol and drug treatment outcome research from a process-oriented, developmental perspective. A dynamic developmental model is proposed in which adolescent treatment outcome research incorporate considerations relevant to changes occurring typically during this stage of life as well as developmental distinctions pertinent to the early onset of abuse and dependence. METHOD: Findings from our developmentally focused longitudinal research of adolescent treatment participants and the extant literature on adolescent treatment outcome are reviewed. Conceptual, research design and measurement recommendations are presented from this double developmental perspective of addiction. FINDINGS: Techniques for engaging youth in the research process, managing confidentiality and facilitating self-disclosure are described. Developmental considerations in the type and timing of outcome assessments, measurement content, predictor domains and data analytical approaches are discussed. Predictors and process measures for adolescent alcohol treatment outcome study are suggested based on current findings. CONCLUSIONS: Inclusion of developmental considerations may enhance the utility of adolescent treatment outcome research.

Adolescent↗
PubMed2006

Exploring community nurses' perceptions of life review in palliative care.

AIMS AND OBJECTIVES: This exploratory study aimed to identify community nurses' understanding of life review as a therapeutic intervention for younger people requiring palliative care. The objectives set out to: (i) Describe the participants' understanding of reminiscence and life review (ii) Detail their current ideas regarding a structured approach to using life review in the community setting. (iii) Outline their understanding of the possible advantages and limitations of life review in relation to palliative care. (iv) Identify future training requirements. BACKGROUND: The literature review illustrated how the eighth developmental stage of Erikson's theory, ego-integrity vs. despair, is a 'crisis' often faced by older people entering the final stage of life. Life review is considered a useful therapeutic intervention in the resolution of this crisis. Younger terminally ill people in the palliative stage of an illness may face the same final crises due to their reduced lifespan. Therefore, this study explored the benefits and limitations of life review as an intervention in palliative care. METHOD: The study used a purposive sample of community nurses responsible for delivering generic and specialist palliative care. A qualitative method of data collection in the form of three focus group interviews was used. Subsequent data were manually analysed, categorized and coded with associations between the themes identified. RESULTS: The findings suggested that community nurses have limited knowledge pertaining to the use of life review and tend to confuse the intervention with reminiscence. Furthermore, they believed that life review could potentially cause harm to practitioners engaged in listening to another person's life story. However, the participants concur that with appropriate training they would find life review a useful intervention to use in palliative care. CONCLUSIONS: The results led to the identification of a number of key recommendations: Community nurses require specific education in the technicalities of life review and additional interpersonal skills training. The need for formalized support through clinical supervision is also recognized and discussed. Finally, suggestions are offered regarding the need to generate wider evidence and how, possibly, to integrate life review into existing palliative care services. RELEVANCE TO CLINICAL PRACTICE: This study has demonstrated that community nurses are keen to extend the support offered to younger terminally ill people who are in the palliative stage of their illness. Despite having limited knowledge of life the main components and underpinning theory pertaining to life review participants could appreciate the potential of life review as a therapeutic intervention in palliative care and were keen to learn more about its use and gain the necessary knowledge and skills.

Adult↗
PubMed1993

Behavioural sciences and the real world: report of a community interview scheme for medical students.

A community interview scheme was designed to provide preclinical medical students with an opportunity to investigate the role of social and psychological variables in patient care and gain insight into interpersonal aspects of the interview process. Evaluation of the scheme showed that students and community interviewees found their participation valuable. Eighty per cent of interviewees were willing to take part in the scheme in the following year. The strongest predictor of willingness to participate was interviewees' rating of the extent to which they had enjoyed the experience. Students valued the opportunity to meet 'real people', to explore social and psychological determinants of health and illness and to develop communication skills. A significant positive change in perceived interviewing competence was observed. It is suggested that the scheme might be further developed by using feedback from interviewees to provide students with evidence of both their own skill development and the benefits of self-disclosure to the patients involved.

Behavioral Sciences↗
PubMed1998

Maryborough skin health survey: prevalence and sources of advice for skin conditions.

A computer-assisted telephone interview survey was carried out in the City of Maryborough to determine the prevalence and sources of advice for self-reported skin conditions. Of the 443 adults contacted, 416 (94%) agreed to participate in the study. One hundred and fourteen people (27%) reported having one or more skin conditions over the past 2 weeks, which included eczema/dermatitis 25.5% (range, 18.1-32.8%; 95% CI), warts 16.1% (9.8-22.4%), acne 16.2% (9.6-22.7%), cold sores 13.1% (7.3-18.9%) and tinea 11.2% (5.9-16.5%). Medical practitioners were the most common source of advice for 49% of skin conditions, followed by family and friends or self-prescribed (25%). Advice from a pharmacist was sought for 19% of skin conditions. Logistic regression analysis showed that those people who reported a moderate to severe inflammatory skin condition, such as dermatitis, urticaria or psoriasis, were most likely to seek advice from their medical practitioner. The type and severity of skin condition were factors which determined where a person sought advice on diagnosis and management.

Adult↗
PubMed2006

Effects of writing about emotions versus goals on psychological and physical health among third-year medical students.

A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the "best possible self" (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.

Adaptation, Psychological↗
PubMed1997

Communication types and sexual protective practices of college women.

Sexually transmitted disease, such as the fatal HIV disease, continues to threaten the health of young women. Adolescents have typically been inconsistent users of effective strategies that prevent the spread of disease during sexual activity. Communication practices related to disease-related sexual protection have received little attention as a variable separate from sexual protection. The purpose of this study was to explore the relationship among different types of interpersonal communication of young women and their new sexual partners and their implementation of disease-related sexual protection. A sample of 163 young women who had experienced sexual intercourse completed the Safe Sex Behavior Questionnaire. Interpersonal communication was explored using the general-information-seeking (getting to know a partner), sexual self-disclosure, and specific-disease risk-information-seeking scales. These scales were combined; factor analysis revealed three subscales closely related to the original scales. Findings suggest that young women who seek specific information about their new sexual partner's disease risk status are more likely to implement sexual protective practices. These findings provide guidance to nurses who work with adolescent women in advising on aspects of interpersonal relationships that need to be enhanced to protect one's health status.

Adolescent↗
PubMed1979

Drug usage and health characteristics in noninstitutional retired persons.

A study was made of total drug usage (prescription, over-the-counter, social), health characteristics, and life satisfaction in 55 noninstitutional retired men and women whose average age was 70 years. The sample was purposively selected on the basis of involvement in peer group interaction networks. Among those using drugs, the average number taken per person was 2.0 prescription, 1.8 over-the-counter, and 1.8 social (alcohol, caffeine, nicotine), for a total of 5.6 drugs. For men the average was 7.5, and for women 4.7 drugs. Although drug interaction hazards from prescription drugs alone appeared to be minimal, examination of total drug usage indicated potential interactive hazards. Despite the number of chronic illnesses and physical impairments (5 and 1 per person respectively) and the number of drugs ingested, the respondents usually expressed overall satisfaction with their life condition. A commonly expressed dissatisfaction (males 75 percent, females 35 percent) was with government officials. Respondents had confidence in both their physicians' diagnoses and the effectiveness of the drugs prescribed. The findings that women reported more chronic diseases and physical impairments, and were relatively more dissatisfied with their life condition than were men, may be associated with their greater acquiescence with self-disclosure.

Aged↗
PubMed1983

Brief, problem-focused group psychotherapy with adolescents.

Practical issues and treatment considerations in brief, problem-focused group therapy with adolescents are discussed, including selectivity factors, group composition, and leadership style. The need for therapists using this approach to engage actively in emotional exchange and self-disclosure is emphasized, and the varieties of interventions encompassed in this approach are illustrated by case vignettes.

Adolescent↗
PubMed1993

The concept of boundaries in clinical practice: theoretical and risk-management dimensions.

The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation. They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct. These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact. While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context. Heightened awareness of the concepts of boundaries, boundary crossings, and boundary violations will both improve patient care and contribute to effective risk management.

Female↗
PubMed1993

The bereaved therapist and her patients.

Discussions on the role of self-disclosure during times of personal crisis have been mostly confined to the theoretical. Little clinical material has been published. For the writer, this lack contributed further to the sense of loneliness following bereavement, and to uncertainty in terms of how to provide adequate information to patients while protecting herself at a time of great vulnerability. Using case vignettes, the impact of a therapist's bereavement on patients treated in an outpatient consultation-liaison service is explored. Four patients are described--one woman and two men with very serious physical conditions bringing their own frailty and death very near, and one woman with a psychophysiological condition as part of a borderline personality disorder. The impact of personal crisis is discussed, in an attempt to review how such a situation should be handled, and particularly whether and how patients should be informed.

Adaptation, Psychological↗
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↗
PubMed2003

Therapeutic boundary issues in working with childhood sexual-abuse survivors.

The article describes a study of therapists involved in treating survivors of childhood sexual abuse. The authors focus on what induces participants to change their usual therapeutic boundaries. Through qualitative research utilizing extensive interviews, written questionnaires, and a focus-group discussion, the authors gathered information from therapists related to situations that influence them to change their own boundaries. Emergent themes are discussed and the information is integrated with the authors' experience of supervision and psychotherapy. Concern for client safety is the commonly recurrent issue that pushes therapists to change their boundaries. Other intense feelings, such as resentment of the client, worry about the client's feelings, a wish to connect and imbue hope are also strong influences. Self-disclosure boundaries of the therapist are challenged by the wish to balance power within the relationship. Supervision provides an opportunity to examine what influences therapists to make subtle boundary shifts before they become harmful boundary crossings.

Child↗
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↗