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PubMed1999

Multiple-case depth research: bringing experience-near closer.

The term "experience-near" has become associated with a variety of alternatives to mainstream clinical research. These alternatives converge on one basic methodological goal-faithfulness to clinical phenomena as lived. This article presents one approach to lived clinical phenomena that I term multiple-case depth research or MCDR. MCDR is a novel and highly sensitive methodology that combines both in-depth case investigation with experiential therapeutic principles. To illustrate the power of MCDR, I present a hypothetical process and outcome study involving three client cohorts (those who undergo respectively cognitive-behavioral therapy, intersubjective psychoanalytic therapy, and existential-humanistic therapy). I detail the structure of this hypothetical study, the steps by which it proceeds, and the yield that it portends. I conclude that, if conducted properly, MCDR can provide rich, valid, and unprecedented insight into effective psychotherapy.

Cognitive Behavioral Therapy↗
PubMed1980

Purpose in life, depression, and locus of control.

Parallel to Frankl's theory of the search for meaning, which posits the separateness but intertwining of the psychological and existential realms, the Purpose In Life Test (PIL) has been found to have a low to moderate relationship with most conceptually related psychological measures. Extending separate correlational studies of the PIL with depression and locus of control, the current study inspected the relationship of individual PIL items to groups formed according to Zung Self-Rating Depression Scale and Rotter Internal-External Locus Of Control scores. One-hundred thirty-four Ss were split into four groups: Depressed external, depressed internals, nondepressed externals, and nondepressed internals. Although ungrouped correlational analysis of PIL items revealed only seven significant relationships with depression and two with locus of control, multiple discriminate analysis was successful in correctly classifying depressed externals about three-fourths of the time, and the overall "hit rate" for the four groups was above 60%. In addition to further validating the interaction of purpose in life with related psychological and social expectancy variables, results indicated a compounding effect between depression and external perception of reinforcement control with PIL scores in general, and two items (#4, 12) in particular, which appear to reflect the experience of current congruent involvement between the individual and his world.

Adult↗
PubMed2002

Mind's response to the body's betrayal: Gestalt/Existential therapy for clients with chronic or life-threatening illnesses.

In the literature on chronic or life-threatening illness, there is an overriding emphasis on clients' psychological coping styles and how they relate to psychological functioning. By contrast, in our approach, we look at the subjective mind/body experiences that clients have of their illness and how their lives are impacted by their illness. As psychotherapists, we address their existential distress, pain, body experience, thoughts, and feelings, as well as their efforts to cope or find meaning in their illness. We summarize Gestalt/Existential therapy for chronic illness, illustrate the approach with three case-vignettes, and stress the importance of attending to each client's unique responses to illness.

Adaptation, Psychological↗
PubMed1998

Sanctification of "the accursed". Drinking habits of the French existentialists in the 1940s (a case study).

The chapter deals with the drinking habits of the French existentialists during and after World War II (roughly from 1943 to 1948). It attempts to show that the phenomenon cannot be understood separately from their lifestyle as a whole, which in this case (as I claim) is primarily manifested through a certain (mythical) structure of meanings related to the category of the sacred. Jean-Paul Sartre's position as the leading intellectual figure of the time is also to be seen as a result of his ambiguous reputation as a "prophet" and a "criminal" in the yellow press. What is involved is a single mythical structure, where "decadent" life is precisely one aspect of sanctification. On the other hand, Sartre's "bohemian lifestyle" and his desire to break bourgeois habits can be seen as a variant of the bourgeois myth of the artistic lifestyle created in the 19th century. From this angle, existentialism can in a certain sense be considered the last hybrid expression of the "transgressive" myth of rebellion which this sort of lifestyle had crystallized.

Alcohol Drinking↗
PubMed1989

The physician in the technological age.

Translator's summary and notes: Karl Jaspers (1883-1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today. Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every medical person, the researcher contests with the physician and the technician with the humanist. Jaspers therefore opposes all modern tendencies that regard men as abstractions. As a creative existentialist influenced by Kierkegaard, Nietzsche, and Husserl, he reasons that clinical medicine should always treat patients as irreducable individuals, and his thinking on psychotherapy argues for a realm of interiority, freedom, intelligibility, and existential communication that transcends the reach of the causal thinking of natural science. This essay, written in 1959, reflects Jaspers' lifelong preoccupation with the philosophical meaning of medicine (he received his MD degree in 1909) and the totality of the human person. It should significantly enhance our own comprehension of medical power, dangers, reasoning, and accomplishments.

Communication↗
PubMed1993

The importance of a holistic concept of health for health care. Examples from the clinic.

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed.

Adult↗
PubMed1994

Towards authentic conversations. Authenticity in the patient-professional relationship.

The purpose of this paper is to evaluate the significance of the existential notion of authenticity for medical ethics. This is done by analyzing authenticity and examining its implications for the patient-professional relationship and for ethical decision-making in medical situations. It is argued that while authenticity implies important demand for individual responsibility, which has therapeutic significance, it perpetuates ideas which are antithetical both to authentic interaction between patients and professionals and to fruitful deliberation of moral dilemmas. In order to counteract these consequences, an alternative idea of authenticity is introduced. According to this idea, authenticity is not regarded primarily as individual sovereignty, but as an ability to participate in a dialogue in which the subjectivity of both partners is respected. Such practice, based on mutual trust and responsibility, would enhance common decision-making and overcome the alienation between patients and professionals.

Communication↗
PubMed2002

Creating a language for 'spiritual pain' through research: a beginning.

The findings presented in this discussion seek to make a contribution to fostering an appreciation of the importance of research on spirituality, a previously neglected dimension of health care. Qualitative research methodology based on open-ended interviews with 12 survivors of haematological malignancies was used. The interviews were transcribed verbatim and thematically analysed using the NUD*IST computer package. The preliminary findings from the study indicate a need for the development of a new language for articulating spirituality. The present discussion is an introductory attempt to begin to explore the notion of, and language for, the idea of 'spiritual pain'. The findings indicate that individuals need a strong sense of meaning-making and connection with life to be able to deal with the demands of aggressive, invasive treatments. Such a connection can be threatened by a break with the normal or expected relationships and satisfaction with life through physical, identity, relational and existential challenges and losses. When the disconnection is acutely painful (a subjective phenomenon depending on the individual) it then is experienced as spiritual pain, creating a void that challenges the individual's ability to derive any meaning from their existence. This study is seen as preliminary work, the first step in a series of articles aimed at beginning to develop, through research, a language of spiritual care.

Adult↗
PubMed1982

A new model of integrating Occidental and Oriental approaches.

In the Western countries, dynamically oriented psychoanalysis, behaviour modification based on learning principles and existential, humanistic psychology have been widely used as treatment modalities for neuroses and psychosomatic disorders. Autogenic therapy for relaxation and self-control has been utilized. In the Orient, Yoga, Zen, Acupuncture and Fasting Therapy have been applied to various neuroses and psychosomatic conditions. These unique Oriental approaches, in general, induce an altered state of consciousness in the subjects, and the characterized by the heightening of self-normalization and the restoration of homeostasis. Morita therapy aims at accepting reality as it is and at promoting constructive ego function, and is effective for suitable cases. The above-mentioned Western approaches, which are rather psychosomatic, and the Oriental approaches, which are rather somatopsychic, are considered to be complementary within the framework of a holistic and integrative therapeutic model.

Autogenic Training↗
PubMed1982

Incidents of reality: sources of ontological stress and concern.

This study provided initial data on the hierarchical order among various existential-ontological stresses; compared these stresses to Spielberger Trait vs State anxiety; and, examined these stresses with respect to Eysenck's extraversion and neuroticism dimensions as well as Eysenck's social favorability response bias. Death in the immediate family emerged as the highest ranked items on the 69 open-ended item scale. Data on 139 males, 244 females, plus 4 individuals without recorded gender (median age approx. 29.5 years) indicated little overlap as well as little difference between State and Trait anxiety measures. Approximately one-eighth of the correlations between the Incidents of Reality items and both the Eysenck and Spielberger scales were statistically significant though all were of slight magnitude. Data were further compared for correspondence to the Holmes-Rahe Social Readjustment Rating Scale. For the nine items judged as common, the Spearman rank-order correlation (rho = 0.867) indicated support for the cross-reliability of the two scales. Overall, stress to ontological issues is both positive and negative in direction. A number of points based on these findings are discussed with reference to various conceptions in ontology.

Adolescent↗
PubMed1994

Nurses' views of the coping of patients.

The findings of a study that explored the beliefs, assumptions and ideas nurses have about the coping of patients are presented. Interactive interviews with 26 nurses were used to elicit explanations of the meaning of coping and stories from their practice that illustrated coping. Analysis of the interview transcripts revealed three themes in the form of idioms or particular and different ways of talking about coping. Each idiom represented a different perspective or view of coping. The first idiom represented a view of coping as a rational, cognitive problem-solving response to illness. The nurses attributed, and thus valued, this view to science. In the second idiom the nurses spoke of coping as permeated with values that contrasted with the prior view of coping as a rational process. In the final idiom the nurses spoke of coping as courage--they told stories of patients who had faced existential situations with strength and will. The focus of this idiom was on issues of spirituality, struggle, personal meaning and acceptance. After each idiom is delineated and illustrated by data, the discussion is concentrated on the orientational and ontological metaphors that underlie them. Interpretation of the origin and construction of these different ways of talking about coping, and their underlying metaphorical meanings, is made in the context of cultural and subcultural influences.

Adaptation, Psychological↗
PubMed2006

Experience of siblings of children treated for cancer.

The aim was to obtain an understanding of the experience in everyday life of being a sibling when a brother or sister is receiving treatment for a cancer disease or has completed treatment. In order to illuminate the experience of the siblings themselves a phenomenological-hermeneutic method was used. Ten siblings were asked, in the form of a broad-based, open question, to tell about their experience of being the sibling of a brother or sister in this situation. There was an awareness of sibling-ship as a special relation since the brother or sister had got cancer. This feeling was very strong and close, and when needed the sibling admitted a protective and advocacy role. The siblings felt difficulties to always be loyal with the brother or sister needs and demands from other interests. They lived a new life and periods of ups and down following the condition of the brother or sister. Everyday life varied from joy to a life filled with worries and anxiety. Siblings experienced feelings of an existential nature, such as quality of life and death.

Activities of Daily Living↗
PubMed2006

Family members' experience of participation in the needs of assessment when their older next of kin becomes in need of public home help: a qualitative interview study.

BACKGROUND: The policy that older people should be able live in their own homes in spite of extensive care and social service needs means that close family members are increasingly involved in help provision. Ways must be found to facilitate their situation. Their participation in the needs assessment of their next of kin may be crucial. OBJECTIVES: The aim of the study was to illuminate close family members' experience of having an older next of kin becoming in need of public home help, their participation in the needs assessment procedure and the decisions about their next of kins' public home help. PARTICIPANTS: The sample was 27 close family members (mean age 63, range 42-93 years) chosen by their older needs-assessed next of kin. METHODS: An interview using a thematic interview guide formed an everyday dialogue jointly constructed by the interviewer and the interviewee. Thereafter an interpretative content analysis was conducted on the transcribed interviews. RESULTS: One overarching category was illuminated: "Feeling disconfirmed or confirmed in the needs assessment, when feeling pressed by the responsibility and struggling to balance the needs of the family." Four principal categories with sub-categories were derived: (1) Experiencing existential ruminations and the need to help. (2) Help giving and receiving as a difficult balance between needs. (3) Feeling overlooked or acknowledged as having an influence on the needs assessment. (4) Hopes about the home help being fulfilled or dashed. CONCLUSION: The findings imply that the main focus is on the help seeker, overlooking the contribution of family members representing and providing help. A more holistic needs assessment approach is required with a framework and working methods that involve and support the family as a whole.

Adaptation, Psychological↗
PubMed2004

The language of spirituality: an emerging taxonomy.

BACKGROUND: This paper explores the relationships that exist between the language used to describe spirituality within nursing and the appropriateness of constructing a universal definition acceptable to all individuals. 'Spirituality' is a term that is increasingly used in nursing but there may be problems about exactly what the term means and how it is interpreted and understood by both nurses and patients. AIM: The aim of the paper is to explore some of the commonly cited definitions to establish if the concept of spirituality could be termed 'universal'. METHOD: This paper presents a discussion, based upon a literature review, of the nursing and health care databases, combined with manual searches. The review demonstrates how the term spirituality is being constructed within nursing suggesting that there are numerous definitions each with several layers of meaning. FINDINGS: From the review the authors have developed 'a spiritual taxonomy' that may explain and accommodate the different layers of meaning found within nursing and health care definitions. At the extreme left there is a spirituality based on religious and theist ideals, while at the extreme right there is a spirituality based upon secular, humanistic, existential elements. A middle way is explained containing elements from both the left and right but not as fundamental or radical. CONCLUSION: The authors argue that because there are so many definitions with different layers of meanings, spirituality can imply different things depending upon an individual's personal interpretation or worldview. The results of the review suggest nursing is constructing a 'blanket' definition of spirituality, which has a broad, almost inexhaustible set of defining characteristics. If this approach continues then there is a danger that the word may become so broad in meaning that it loses any real significance.

Emotions↗
PubMed1987

Humanistic approaches to the understanding and treatment of anorexia nervosa.

Research and treatment approaches to anorexia nervosa are primarily based on behaviourist psychology. This review summarizes some attempts to understand the causes and consequent treatments of the condition from the viewpoints of psychoanalytically informed, family, existential and feminist psychology. These perspectives, which focus on the individual experience of the anorexic, leave many questions unanswered, but provide fresh frameworks from which to investigate and treat the condition.

Anorexia Nervosa↗
PubMed1999

The Heideggerian view of person: a perspective conducive to the therapeutic encounter.

The artistry of the therapist finds its origins in the therapist's authentic presencing of self and in the philosophical assumptions that constitute the therapist's perception of human beings. Based in existential phenomenology, Heidegger's view of person nurtures a conceptualization of individuals complimentary to the art of person-centered psychotherapy. Heideggerian hermeneutic phenomenology encourages ontological self-reflection and potentiates meaningful appreciation of one's "being-in-world." This study describes Heidegger's view of person as one that offers therapists and their patients an advantageous clinical orientation and an anesthetically comfortable realm from which the art of the therapeutic encounter can originate, be nurtured, and grow infinitely, thereby supporting patients' self-transcendence, self-love, and well being.

Existentialism↗
PubMed1996

Human association as a factor influencing wellness in homosexual men with human immunodeficiency virus disease.

In-depth interviews of 29 homosexual men with varying degrees of human immunodeficiency virus illness were conducted using grounded theory methodology. The study participants indicated that the need for intimacy and community were of paramount importance to living well and suggested that feeling connected to others was a synergistic process that promoted an existential/ spiritual understanding of one's self as being well. Clinical recommendations for nurses include the use of intimacy-building care strategies that are capable of helping clients construct meaning of their experience to enhance individual well-being.

Adult↗
PubMed1999

Reflective topical autobiography: an under utilised interpretive research method in nursing.

Reflective topical autobiography (an autobiographical method) belongs to the genre of testimonial research and is located within the postpositivist interpretive research paradigm. Despite the (reflective) topical autobiographical method enjoying a 'rebirth' in recent years and being utilised by a range of researchers in the human and literary disciplines, it remains largely unknown and under utilised in nursing research domains. In this article it is proposed that reflective topical autobiography is an important research method in its own right, and one which promises to make a substantive contribution to the overall project of advancing nursing inquiry and knowledge. This is particularly so where nursing research shares in the affirming projects of interpretive research generally and the relatively new sociology of the emotions in particular apropos: (i) increasing understanding of subjectivity and making subjective experiences more visible and intelligible, (ii) the search for meaning and increasing understanding of the commonality of existential human experience, and (iii) decentring the detached observer and his/her privileging the objectivist illusion in the hierarchy of research discourses, paving the way for the admission of multiple realities and interpretations of lived experience. In this article, a coherent reflective topical autobiographical research method is advanced for use in nursing education and research contexts.

Autobiographies as Topic↗