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PubMed2002

Hope and despair: making sense of politics in the twenty-first century.

As his life degenerates into accelerating cycles of chaos in the film 'Clockwork', the headmaster, played by John Cleese, expresses his existential response to the latest crisis in his life: 'It's not the despair, I can cope with the despair. It's the hope I can't stand.' Politics as hope has fallen out of favour. Whether from cynicism, pessimism or realism--or a combination of all three--the standing of politics, let alone politicians, is at a very low ebb. This reality provides the opportunity to assess both causes and consequences by asking: how do we make sense of politics? The following discussion considers this vital question under four headings: context, participation, issues and goals.

Cultural Diversity↗
PubMed1994

House calls: a support group for individuals with AIDS in a community residential setting.

The author describes a support group led by two psychiatrists for individuals with AIDS set in the participants' residence, the AIDS Community Residence Association (ACRA) House. Similar to other AIDS groups described in the literature, the residents spoke of existential fears such as losing their physical beauty or intellect. In contrast to the intimate and familial atmosphere of many other AIDS groups, the members' strong sense of invasion by the facilitators and their ongoing ambivalence were striking. This reaction toward the group and the co-leaders appeared to be metaphorically related to the "invasion" of illness and health care workers into their lives. As members better tolerated and expressed these thoughts and feelings, a greater intimacy and sense of "family" emerged.

Acquired Immunodeficiency Syndrome↗
PubMed1993

A Persian Gulf War support group: process, viability, and flexibility.

Observations of a Persian Gulf War support group suggest that the support group is a viable approach to ameliorating the stress of war among those personally affected. Cohesiveness developed readily, and facilitated a social support network. Therapeutic factors are compared with previous support group literature, and existential issues appear to be involved in groups addressing an uncontrollable stressor and/or the possibility of death. The volatility of the stressor produced variations in group character (supportive psychotherapy versus support versus self-help), necessitating a flexible leadership role. Observations are offered toward clarifying the nature of support groups in general.

Group Processes↗
PubMed1998

The rationale and foundations of group psychotherapy for women with metastatic breast cancer.

Group psychotherapy has become an important modality of intervention in contemporary psychooncology. This article reviews and describes the rationale and foundations for group psychotherapy for women with metastatic breast cancer. It emerges from a replication study of an earlier study performed by Spiegel (Spiegel, Bloom, Kraemer & Gottheil, 1989), which demonstrated that participation in structured group psychotherapy resulted in improved psychosocial adjustment and a significant survival effect on women with metastatic breast cancer. Other intervention studies, psychosocial effects of psychosocial interventions, as well as psychosocial variables associated with the course of illness, are described. The contribution of existential considerations in psychotherapy is also articulated as a component of the group-supportive expressive intervention. Clinical illustrations, emerging from ongoing treatment groups, are used to demonstrate theoretical concepts.

Adaptation, Psychological↗
PubMed2002

Family functioning and psychological well-being, school adjustment, and problem behavior in chinese adolescents with and without economic disadvantage.

Using an indigenously developed measure of family functioning, the author examined the association between family functioning and adolescent adjustment in 1,519 Chinese adolescents. Results showed that family functioning was significantly related to measures of adolescent psychological well-being (existential well-being, life satisfaction, self-esteem, sense of mastery, general psychiatric morbidity), school adjustment (perceived academic performance, satisfaction with academic performance, and school conduct), and problem behavior (delinquent and substance abuse behavior). Family functioning was generally more strongly related to measures of adolescent adjustment for adolescents with economic disadvantage than for adolescents without economic disadvantage.

Achievement↗
PubMed1992

Meaning in life and psychological well-being: an empirical study using the Chinese version of the Purpose in Life questionnaire.

The Chinese version of the Purpose in Life questionnaire (C-PIL) was administered to 2,150 Chinese secondary school students, along with other instruments assessing psychiatric symptoms and positive mental health. Total C-PIL and its two subscales, Quality of Existence (QEXIST) and Purpose of Existence (PEXIST), correlated significantly with all measures of psychological well-being. Relative to PEXIST scores, QEXIST scores were found to be more predictive of psychological well-being. Subjects with different existential status (defined by high vs. low levels of QEXIST and PEXIST) were associated with different degrees of psychological well-being. The concept of meaning in life, as indexed by the C-PIL, and the hypothesis that life meaning is related to psychological well-being require further elaboration and refinement.

Adaptation, Psychological↗
PubMed1993

Levels of trauma: a multidimensional approach to the treatment of PTSD.

The historical course of professional interest in psychological trauma in the 20th century parallels the cycle of intrusion and denial characteristic of traumatized individuals, in which periods of recognition and concern alternate with times of forgetfulness and neglect (Glass et al. 1966; Ingraham et al. 1986). The inclusion of the diagnostic category of posttraumatic stress disorder (PTSD) in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III-1980) inescapably confronted the mental health community with the problem of psychic trauma and catalyzed the quest for a deeper understanding of the disorder. This has led to a variety of explanatory models from such distant fields as neurobiology (Krystal et al. 1989; Pitman 1989; van der Kolk et al. 1985), psychophysiology (Kolb 1987), learning theory (Keane et al. 1985), psychoanalysis (Krystal 1978; Laufer 1988), cognitive psychology (Janoff Bulman 1985), and existential-humanistic philosophy (Lifton 1988).

Adaptation, Psychological↗
PubMed2000

The use of narcissism as a motivational structure to resolve the problem of personal significance: implications for treatment of narcissism.

Shaw's article discusses universal existential despair and how we reorganize by a narcissistic motivational structure, which informs clinicians when working with less constructive or adaptable narcissistic motivational structures. Generally, within the self devaluing perceptions and behavior of despair are the seeds of an enlivening life force that the clinician can promote within a relational context. The relational psychotherapeutic experience transforms the rigid, maladaptive, self-defeating attempts motivated in dealing with various forms of despair into a more flexible, adaptable, organizing, and enlivening expression of the self.

Adolescent↗
PubMedDate not supplied

Sex-role reversal and clinical judgment of mental health.

The separation between nonconformist lifestyles and mental disorders plays a central role in behavioral therapeutic orientations, where emphasis is put on the client's definition of the problem, and in existential and humanistic orientations, which encourage the development of the client's individuality. In the present study, 621 psychotherapists and students intending to practice psychotherapy ranked the mental state of a male client suffering from social phobia related to examination situations. Half of the subjects received a case history of a law intern (married to a teacher), suffering from social phobia related to the oral bar. The other half received a case history of a student in a teachers' college (married to a lawyer) suffering from social phobia related to being tested in teaching a class. The mental state of the latter has been perceived as significantly more severe than that of the former. This difference in perception was not related to the subject's sex, professional experience, and the frequency of a similar client in their practice. Results are discussed in the context of the liberal political attitudes and the secular orientation of the subjects.

Adult↗
PubMedDate not supplied

Extramarital sexual affairs.

In this essay, sexual acting out is subdivided into four forms in order to better define their separate meanings to the unfaithful spouse, the partner, and the therapist: affairs, just-sex, making-do sex, imaginary partner sex. The conventional justifications for considering any sexual acting out a form of psychopathology are presented. These justifications are more compelling in some forms of acting out than others. Love affairs, the major subject of this paper, can also be understood as an existential choice that arises within a large array of social and psychological situations. The conscious experience of the betrayed and betrayer is explored. Guidelines for the therapist's role in dealing with individuals and couples involved in these lifechanging experiences are offered.

Extramarital Relations↗
PubMedDate not supplied

Recovery from intimate partner violence: a difficult journey.

In this existential-phenomenological investigation 15 women were interviewed about their experience of recovering from intimate partner violence (IPV). The purpose of the study was to examine the healing process from IPV from the perspective of those who have experienced it. Transcribed interviews were analyzed using a hermeneutic process. The thematic structure of a woman's journey is comprised of three distinct but connected phases of her life: the abusive past, the struggles of freeing herself physically and emotionally from the abuse/past, and finally the healing/growth that occurs as a woman releases herself from the bitterness and anger of the past. Most of the women in this study were able to experience the peace and healing that occurs with recovery, although a few remained emotionally stuck and unable to free themselves from the past. Thus, there are two stories that are told in this study. The first story is about a journey of recovery. Sadly, the second story is about nonrecovery.

Adult↗
PubMed2004

Lived experiences of being a father of an adult child with schizophrenia.

The aim of this study is to analyze and describe lived experiences of being a father of an adult child with schizophrenia. Interpretations of interviews with seven Swedish fathers of sons or daughters with schizophrenia revealed a pattern of gradually changing existential consequences. After an initial period of shock when receiving the diagnosis, a long struggle to regain control follows. The findings are presented in a structure based on eight different aspects of this struggle, which seems to be characterized by a balance between grieving and adaptation. An important conclusion is that the fathers' life-world must be attended to in professional family interventions.

Adaptation, Psychological↗
PubMedDate not supplied

Spiritual experiences of parents and caregivers who have children with disabilities or special needs.

Despite the fact that faith has been described as a universal concern, and despite the realization that the presence of social supports is an essential element in successful coping, there has been no systematic examination of the quality of spiritual networks important to families impacted by childhood disability. There is also little understanding of how spirituality in children influences the lived experience of faith in the adults who care for them. Findings reported here come out of a larger existential phenomenology study that examined the lived experience of parents or caregivers who sought to obtain formal religious education for their children with special needs. Participants included 26 parents/caregivers representing 44 children with special needs and 15 different faith traditions. Narratives indicated that many clergy and members of faith communities either devalue or fail to recognize the spiritual lives of disabled children. This lack of recognition was associated with participant disillusionment or crises of faith and a sense of alienation from potential sources of emotional support. In contrast, those participants whose children were welcomed reported feeling sustaining support and strengthened faith. No parent or caregiver perceived nurses as having an awareness of or interest in spirituality within families of children who have special needs.

Adaptation, Psychological↗
PubMedDate not supplied

Female sexual assault: the impact on the male significant other.

In this existential-phenomenological investigation five men were interviewed about their experience of being a male significant other (MSO) of a female sexual assault victim. The purpose of the study was to understand the MSO's meaning of the rape and the emotional impact it had on him. The thematic structure of a man's response to having a female significant other sexually assaulted depicts an impact on his emotional life in four significant areas: (1) his immediate painful thoughts and feelings, (2) his relationship with the victim, (3) his world view on male attitudes, and (4) the long-term effects of the trauma. It is an experience that has left him feeling angry, helpless, and guilty, prompted him to self-inspection, and thus changed him forever.

Adaptation, Psychological↗
PubMedDate not supplied

Protective shield: a thematic analysis of the experience of having an adult sibling with insulin-dependent diabetes mellitus.

The purpose of this investigation was to describe the adult well sibling's experience of having grown up with a sibling who has insulin-dependent diabetes mellitus (IDDM). Using existential-phenomenological interview procedures, 14 participants were asked what it was like to have a chronically ill sibling. Analysis of participants' experiences was done using a hermeneutical approach. The thematic description of the experience of having lived with a chronically ill sibling with IDDM was divided into two interdependent and interrelated periods, the past and the present. The metaphor of a protective shield woven around the diabetic sibling by his or her family was taken from the words of a participant, and is seen by participants as occurring in the past and the present. The themes of the past provide the background for the themes of the present. Many of the themes of the past are moved forward to the present, but, because of the passage of time, are described differently by participants. Results of this study reinforce the fact that the stressors of chronic illness affect all family members, including the well siblings. It is imperative that nurses give care to the family, not just the designated patient. Nurses must be prepared to provide counseling, education, and anticipatory guidance to adults who have a sibling with a chronic illness.

Adaptation, Psychological↗
PubMedDate not supplied

Anger of African American women in the south.

In this existential-phenomenological investigation middle-class African American women (n = 9) in the Southern United States were interviewed about their experience of anger in daily life. The purpose of the study was to examine what African American women's anger is about, what it means, and how it is experienced. Transcribed interviews were analyzed using a hermeneutic process. The thematic structure of African American women's anger comprises three main elements that stand out as figural: power, control, and respect. These figural elements can be understood only when seen against the ground of a racist Southern culture that produces pervasive mistrust. These findings are of importance to clinicians, who cannot deliver culturally competent interventions to African American female clients without a clear understanding of the complexity and meaning of their anger experience.

Adult↗
PubMed2000

The doctor, the patient and the body.

Michael Balint has helped us realize that the clinical interaction is, above all, an inter-human interaction. However, the lived experience of the body -- the existential anatomy -- occupies but a very small space in the consciousness of medicine. Even the "psychosomatic body" is a theoretical construct favouring observation rather than understanding. The doctor shares the conditions of embodied life with his patients, and, in addition, has the opportunity to refine his sensitivity to the variations of bodily experience in his work with patients. Thus, a bodily empathic basis for clinical interaction is laid on which understanding and diagnosis may reinforce one another in a common endeavour.

Education, Medical, Continuing↗
PubMed2003

Action research on own practice. Methodological challenges.

OBJECTIVE: Using experiences from a study on clinical communication, the objective was to clarify the methodological challenges that general practitioners are faced with when researching their own practice. DESIGN: A case study of the methodological challenges of an action research project in which the researcher is both participating observer and observing participator. The material comprised notes and transcripts from audiotapes, and was investigated with a view to highlighting experiences that might facilitate the research process. SETTING: The practice of the author. SUBJECTS: 36 consultations with 16 patients during which the illness diary method was applied. RESULTS: The challenges of the project are presented as turning-point stories, i.e. stories demonstrating relations, perspective shifts and metapositions. Perspective shifts were established by introspection through dialogues with oneself, and by relation to helpers through dialogues with patients and supervisors. Reflexivity was promoted by combining pictures from different perspectives. CONCLUSION: It is possible and sensible to study oneself in interaction. The information gained from carefully designed research in one's own practice could be an underestimated source of valuable knowledge about the personal and existential aspects of clinical medicine.

Family Practice↗