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An approach to supervision of students on fieldwork.

This paper describes a method for supervision of occupational therapy students on clinical affiliation. The approach is based on the assumption that students behave in ways that are consistent with Levels 3 through 4 of Jane Loevinger's stages of personality development. The most effective supervisory approach for students at each level of behavior is described. The model assumes that the level of student can be matched with a supervisory approach to result in a more satisfying experience for both student and supervisor.

Humans↗

First step: report on a pilot course for personal and professional development.

OBJECTIVE: To describe a pilot course in personal and professional development, entitled 'Becoming a doctor: the first step' and our suggestions for what might be incorporated into future courses. SETTING AND CONTEXT: Leeds Medical School begins a new curriculum in September 1999 with a proportion of the first 3 years being devoted to a new module on personal and professional development. This module will include courses involving communication skills, ethics, working in groups and early patient contact through community visits. Some of these topics were piloted in a short course for first-year medical students in 1998. LEARNING METHODS: The course ran for 9 weeks and was largely experiential. The group facilitators came from diverse health and social care backgrounds. A variety of learning methods were used, concentrating on self-reflection, discussion, community visits and information gathering. EVIDENCE FOR EFFECTIVENESS: The views of both facilitators and students were analysed. Students particularly appreciated the community visits and group work. The facilitators were positive about the course overall while suggesting improvements, including their own involvement in future development of the course. CONCLUSIONS: The pilot course has helped us to focus on objectives for the new curriculum and to plan the new course. In particular there is a need for more attention to be given to the involvement of facilitators in course development.

Community Medicine↗

[Male adolescence, hatred for foreigners and the self-repair function exemplified by juvenile right extremist skinheads].

Restructuring the personality, developing a new we-feeling, coping with drive thrusts and ego-syntonically reorganizing infantile conflicts are key developmental functions during adolescence. Some characteristics of male adolescence explain why especially male teen-agers are susceptible to joining right-wing extremist groups ready to use violence. The surroundings of right-wing extremist violence offers specific stabilizations which support the adolescent configuration of the enlarged self but as the same time they also lead to deformations of the personality. Establishing a greater self by ideology, self reparative transformation of self hatred to xenophobia, masking the personality and the regression of sexual desire to the desire of violence are consequences of processes of adaption and assimilation as described in cases of serious inner or outer threats.

Adolescent↗

Course and prognosis of childhood schizophrenia.

Follow-up data on 57 schizophrenic patients, including 25 boys and 32 girls between the ages of 7 and 13, is reported. Average length of follow-up was 15 years. Symptoms found in children under 10 and in prepubertal cases are described. Cases with acute, relapsing episodes occurred more often than chronic cases, but before age 11 acute cases were less frequent. Twenty percent of the patients recovered completely, 30% reached a relatively good social adjustment, and 50% had moderate or poor remission. Family incidence of psychiatric disorders had no influence on prognosis, nor did unfavorable family environment. Premorbid personality development was, however, found to be of prognostic value. Prodromal episodes occurred in 55% of the cases, and 65% of the patients were preoccupied by death. Additional follow-up findings are presented, and problems of diagnosis are discussed.

Adolescent↗

Genital herpes: the psychological consequences.

This study investigated the psychological consequences of genital herpes among 42 men and women. The impact of the disease was assessed relative to five life-areas: sexual functioning, interpersonal relationships, emotional responses, self-concept, and work or school performance. The impact of genital herpes can be best understood when placed in the context of the ethical issues raised by the disease, the individual sufferer's personal development, psychodynamics and self-concept, and the meaning which genital herpes has come to have in society. It was found that for some individuals this illness produces psychological reactions of sufficient severity to warrant psychotherapeutic intervention.

Achievement↗

[Adjustment problems of students in first year of university studies (author's transl)].

First year university students constitute a high risk of adolescents. The student, old adolescent and young adult, must face many adjustment problems while his personality development is not yet accomplished. He obtains the status of intellectual worker and must integrate in the university community life, but is in a dependency situation. It is thus necessary that the university takes preventive measures concerning various risks, in assuring the students both welcome and advanced information.

Adolescent↗

[Transsexualism and transvestism].

The author examines the genetic and the psychodynamic points of view of transexualism and transvestitism, on the basis of literature and of his clinical experience. While the genesis of the syndromes still remain obscure, in spite of new psychodynamic hypothesis, it is now possible to understand the inner world of the parents better than ever before. The author is able to show by means of his own cases that on the basis of the syndrome is a personality development which is centered in the struggle of self-identity and which does not correspond to our definitions of neurosis or of psychopathy but, rather can assume, at least in some patients, very realistic traits of solving an objective problem of sexual identity.

Adult↗

[An adolescent patient with functional cardiovascular syndrome--treatment with short-term psychotherapy].

This paper presents a case of 14 year old boy with psychogenic heart complaints after the divorce of his parents. Additionally we diagnosed a depressive and dependent personality and neurotic defence mechanisms presenting as somatisation. Psychotherapy was suggestive and supportive and involved imaginative and creative elements as utilized in day dream techniques. This proved to be a sufficient short time therapy and resulted in rapid improvement of the distressing heart pain. The boy was helped to reorganize his life and enabled to adapt sufficiently. This case shows a positive outcome of a multimodal, symptom focused, short time psychotherapy as being sufficient in the treatment of a child with somatisation disorder, due to the high flexibility of the developing personality.

Adolescent↗

[Predisposition for violence in adolescence].

Uncontrolled aggressiveness, violence, and reckless behavior make up the contents of many myths of the 'real man'. For youths with unfavourable developmental conditions these myths are especially important. Two types of adolescents, willing use violence, with antisocial personality developments are illuminated with the help of psychoanalytic models of understanding; the borderline disorder on a low structure level and the mimicry development with its 'false' structure development, which often leads to a wrong diagnosis. With specific interactions with youths of both types in an inpatient setting, developmental processes are described which then often lead to the use of violence if effective interventions are not used enough. In closing pedagogic, social-therapeutic and psychotherapeutic strategies for dealing with such adolescents are discussed.

Adolescent↗

Basic concepts in family therapy: a differential comparison with individual treatment.

The author presents basic differences between the approaches of family therapy and of the individual therapies on three dimensions: personality development, symptom formation, and the approach to producing therapeutic change. Family therapy bases its view of these factors in psychotherapy on the idea that they are determined by the family's functioning as an interderdependent transactional unit; the individual therapies base their views of these factors on the idea that they are determined by the dynamic intrapsychic functioning of the individual alone.

Family Therapy↗

Identity and individuality in the nouveau-religious patient: theoretical and clinical aspects.

Revitalized interest in the clinical complexities of psychotherapy with religious patients (for example, Bradford 1984; Lovinger 1984; Spero 1985a; Stern 1985) has drawn attention to the need for perspectives on religious personality development that account for healthy and adaptational aspects as well as psychopathological aspects of particular forms and levels of religious beliefs, enabling more creative, enriching psychotherapy. This search represents movement beyond the significance of infantile wish-fulfillment aspects of religiosity toward the broader domain of ego functioning and quality of object relations. Rizzuto (1976, 1979) and McDargh (1983) emphasize qualitative similarities between interpersonal object representations and God representations. Elkind (1971), using a Piagetian model, views religious beliefs and rituals as forms of constructive adaptation to normal cognitive needs for conservation, representation, symbols of relation, and comprehension. Meissner (1984) highlights the role of God concepts as transitional phenomena. In earlier papers, I have demonstrated the relationship between patients' use of religious themes and legends, quality of psychosexual and object relational achievements, and the consolidation of religious identity (Spero 1982a,b, 1986a,b). Throughout the preceding there is unequivocal recognition that religious development recapitulates many important aspects of healthy psychological development, and that in the case of pathological or dysfunctional religiosity something has gone wrong in an otherwise normal process. There is need to understand and if necessary distinguish between the development of religious belief in individuals whose ideological commitment is relatively constant from earliest childhood and its development in those who adopt or modify religious belief in later life, in conjunction with the many technical implications for psychotherapy. Clinical experience has taught that the process of religious change in later life represents a significant psychosocial crisis, requiring certain important psychological tasks in order to achieve successful resolution. In some instances, generally when there are preexisting difficulties or psychiatric disorders, the process of ideological change, either at the onset or during subsequent stages, takes on psychopathological momentum and quality. Clinicians who intervene at this juncture are confronted with patients whose primary complaints include malfunction in their religious lives or misuse of religious metaphor or behavior enmeshed with mild to serious personality disorder.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Black adolescent pregnancy: prevention and management.

In New York State, today and every day, 180 teenagers become pregnant. However, pregnancy in adolescents is not just a technical or demographic issue. It has cultural and practical dimensions. Nationally, unmarried black teenagers are five times more likely to give birth than white teenagers. In other words, one in every five nonwhite babies has a teenager for a mother! This has long-term societal consequences incalculable dimensions; and black leaders are increasingly concerned. It is recognized that sex-role socialization is an important component of personality development. Yet, few researchers have examined the unique situation of black girls in a society which denigrates both the female and the black role. As pluralistic as our society may be, and no matter how relevant cultural and subcultural values may be, it is an incontrovertible fact that, by exceedingly early childbearing, poor teenagers who are black immeasurably increase their inherent disadvantages to pursue education and acquire marketable skills, not to mention attractive jobs. On the other hand, more women in upper socio-economic categories are characteristically delaying, childbearing, and even marriage, into their thirties. The immediate and long-range consequences of unplanned teenage pregnancies are many. These include poverty, stress, suboptimal environment, nutritional inadequacy, and frequently, late or no prenatal care. Negative outcomes include low birthweight, prematurity, child abuse and development disability. There are, in addition, many delayed effects. Therefore, physicians and other health professionals must ensure that wanted pregnancies yield a healthy child. Young women and young men must be convinced that early childbearing will foreclose chances of a better socio-economic future for themselves and their progeny.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Feeling states during adolescence.

Adolescence is characterized by a wide variety of feeling states with certain stages in adolescence being associated with particularly strong affects, a result of the normative developmental process. Affective psychopathology during the adolescent years, particularly in the disorders of depression and mania/hypomania, is characterized by abnormalities in the quality and quantity of affective patterns and additionally by the appearance of feeling states, which may be historically uncharacteristic for the teen (i.e., out of keeping with his previous longitudinal pattern of personality development). Clinicians faced with assessing disturbances in feeling states during the adolescent years must carefully distinguish fluctuating developmental problems from clinical syndromes. A longitudinal assessment period is usually necessary before this distinction can be made with some certainty. The prescription of treatment, be it psychologic, biologic, or systems based, should await the completion of a careful clinical assessment prior to its institution.

Adolescent↗

Adolescent children of Vietnam combat veteran fathers: a population at risk.

This exploratory study compared 28 adolescent children of Vietnam combat veterans with 28 adolescents whose fathers were not in Vietnam on multiple variables related to (1) social and personal adjustment, (2) attitudes toward parents, and (3) personality development. The majority of outcomes were not significantly different. The children of combat veterans, however, showed poorer attitudes toward school; more negative attitudes toward their fathers; elevated scores of depression, tension, apprehension, and anxiety; lowered scores on creativity; and their mothers rated their behaviors as more problematic. Interactions with gender were not significantly different.

Adolescent↗

Identity disturbances in drug addicts.

Identity disturbances in a heterogeneous group of drug addicts (n = 30) were studied. Hirvas' scale of identity, which is based on Erikson's epigenetic theory of personality development was used. An equal number of normal individuals formed the control group. The identity confusion was studied in three dimensions: intrapersonal, interpersonal, and capacity for objective self-appraisal. Among the addicts a significantly high degree of identity disturbances was found in these three dimensions regarding areas of time perspective, sexual identity, leadership polarisation and ideological polarisation. The possible interrelationship between these disturbances and addictive behaviour is discussed.

Adult↗

The impact of incest on identity formation in women.

In conclusion, the purpose of this paper was to elucidate some of the long-term impacts of the incest trauma on women. This includes its impact on identity formation. The process of idealization and the creation of an idealized image as a defensive and adaptive strategy to cope with overwhelming trauma was highlighted. This initially successful coping mechanism later causes problems in limiting the individual's self-perception and restricting her relationships with others. This is frequently manifested in problems that the adult survivor presents in regard to interpersonal relationships, as well as revictimization and an inhibition in identifying and expressing certain aspects of herself. The goal of treatment is therefore twofold. I am in agreement with Alpert (1991), van der Kolk (1987), and others who stress the importance of the validation and integration of the trauma and related affects through the recovery and reliving of past memories. Additionally, an analysis of the character structure that the person developed to cope with overwhelming and damaging experiences is essential. The achievement of a more cohesive, integrated sense of self for an adult survivor of incest can only be accomplished through the working through of past traumas and the understanding of its effect on identity development and character structure. This aspect of the treatment process was best expressed by one of my patients, who said, "the first part of my analysis dealt with remembering and reliving what happened to me, the second part is dealing with who I had to become and not become as a result of it." She later added that she felt the second part is even more difficult and challenging.

Adolescent↗

Theoretical developments in the psychology of aging.

This article presents a summary overview of the most distinctive psychological theories of aging since World War II. Theoretical developments are broadly classified into three periods, respectively: The Classical period ('40s-'70s), represented by Developmental Tasks/Activity Theory, Psychosocial Theory of Personality Development, Counterpart Theory, Disengagement/Activity Theory, Personality Theory of Age and Aging, and Cognitive Theory of Personality and Aging; the Modern period ('70s-'90s), which includes theories on Life-span Development and Aging, Reduced Processing Resources, Personality and Aging, Behavioral Genetics and Aging; and the New period ('80s-'90s), represented by Gerotranscendence and Gerodynamics/Branching Theory. The overview ends with an outlook on psychogerontological theorizing.

Aged↗

Remembering your parents: reflections on the retrospective method.

In the present paper, I critique the use of the retrospective method when it is used as a proxy for actual longitudinal data on personality development. Studies on the constructive nature of memory cast strong doubts about the meaning of retrospective data. There are good reasons, both theoretical and empirical, to distrust the accuracy of such recall concerning parenting, whether recalled by parents, children, or siblings. Instead of using the method as a shortcut to developmental data, studies examining individual differences in accuracy and distortion and the factors that moderate them may inform us of the various meanings of retrospective data.

Humans↗