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PubMed2004

Issues in psychotherapy with terminally ill patients.

Psychotherapy with the terminally ill poses special challenges for clinicians and in return offers unique rewards. As a time limited therapy, acceptance, rather than change is a primary goal; yet, patients can be strongly motivated to change. Patients may need to struggle with how to disengage while also maintaining connection. Unique transference and countertransference issues arise. The psychological tasks of dying include grieving, saying goodbye, constructing a meaningful context to one's life, and letting go. The therapist can serve as a companion and guide to the dying person as she or he negotiates these tasks. Through the use of a case example, these issues are explored from the perspectives of patient and therapist. The therapist must address the following issues: attending to physical suffering, differentiating between grieving and depression, addressing fears, facilitating the life review, and assisting in decision making. A dying patient's need to leave a legacy, complete relationships, grapple with spiritual and religious issues, and attend to his or her family, are often important themes. Therapists must work productively with denial, maintain flexible yet appropriate boundaries, grapple with their own anxiety about death, and grieve the loss of their patients. Psychotherapy with dying patients can help reduce their psychological pain, relieving psychosocial distress and providing opportunities for personal growth in the last stage of life. Such work is often draining yet immensely rewarding for the patient and therapist alike.

Aged↗
PubMed2002

From the Balint method toward profession-related supervision.

This paper focuses on Michael Balint's special application of psychoanalysis, originally conceived as a training of doctors. Then the attempt is made to discover indirectly, since Balint never described his method in context, what he thought mattered in terms of method. Besides Balint's own contributions, those of his own staff are also consulted as well as the cultural background of the Tavistock Clinic and the Tavistock Institute. Then the further developments of the Balint method in the German-speaking world are presented. At the center are the special features of the method: (a) the atmosphere, (b) the narrator's contribution, (c) listening and reactions of the members of the group, (d) the unconscious enactments in transference and countertransference and the mirror-phenomena, respectively. Furthermore, the respective central points of reference are discussed from the viewpoint of communication science: (a) case, (b) group, and (c) institution. In conclusion and based on these foundations, the characteristics of the application of the Balint method in the form of a particular profession-related supervision are presented.

Humans↗
PubMed2005

Intervention strategies for treating traumatized siblings on a pediatric inpatient unit.

This article examines the course of treatment for 2 traumatized siblings in an acute inpatient child psychiatric unit following severe physical abuse by their mother. In treating these 2 boys, the authors used intervention strategies that can be applied to the treatment of other traumatized siblings in institutional settings. Issues of self-worth, survivor guilt, and conflictual sibling dynamics are illustrated as they relate to the treatment. In addition, transference-countertransference dynamics are examined.

Child↗
PubMed1999

Identifying and reducing risk factors related to trainee-client sexual misconduct.

Sexual misconduct involving therapists-in-training and their clients is addressed. Personal and situational factors that may constitute risk factors for the development of inappropriate sexual activity between trainees and their clients are identified. Although there may be certain characteristics that put particular students at risk for such involvement, the authors believe this risk is more strongly related to systemic, programmatic, and pedagogic characteristics of the environments in which students train. Examples include, respectively, the decline of concern over transference and countertransference, failure to include education about client-therapist sexual attraction and the consequences of sexual misconduct in graduate psychology curricula, and the reluctance of supervisors to deal straightforwardly with trainees' sexual feelings. Suggestions for reducing risks for client-therapist sexual misconduct are directed toward these situational factors.

Ethics, Professional↗
PubMed1997

Death, poetry, psychotherapy and clinical supervision (the contribution of psychodynamic psychotherapy to palliative care nursing).

This paper explores one facet of a therapeutic relationship with a woman suffering from inoperable cervical cancer. The psychotherapy sessions were conducted in both hospital and the family home and continued on a weekly basis until final termination immediately prior to the woman's death. Through a "suspense structure' case study narrative, the writer, a nurse psychotherapist, describes the way in which the humanities, art and poetry can provide a means through which to understand seemingly incomprehensible feelings related to reviewing past events as a preparation for death. While no explicit critique is made of the twin psychoanalytical concepts of transference and countertransference, the occurrence is woven into the text. The essential nature of clinical supervision is illustrated in context. The author proposes that engagement in a therapeutic relationship with a dying person presents the worker with parallel struggles manifesting in elementary feelings which require discernment. The central recommendation of this paper is that the rich symbolic language and metaphors, redolent in art and poetry, be harnessed as a potent therapeutic tool. Throughout the discussion, the terms counselling and psychotherapy are used interchangeably.

Death↗
PubMedDate not supplied

Borderline personality disorder and the chronic headache patient: review and management recommendations.

BACKGROUND: Physicians and psychologists who treat headache not infrequently encounter patients with borderline personality disorder (BPD). BPD patients frequently suffer from headache, and often pose special problems in treatment. Few guidelines exist for the management of the BPD headache patient. OBJECTIVES: To provide an overview of current concepts on BPD, including comorbidity, psychopathophysiology, and treatment. To provide an explicit framework for managing borderline behavior in patients with chronic headache. METHODS: A literature review combined with clinical observations from the tertiary treatment of intractable headache in outpatient and inpatient settings. RESULTS: BPD is found in almost 2% of the general population, with increased prevalence in patients with comorbid psychopathology and substance abuse. Severe headaches and migraine appear to be more prevalent in patients with BPD than the general population. A reported history of abuse is common, but must be interpreted with caution. Recent research has found reduced hippocampal volume in women patients with BPD; hypometabolism in the premotor, prefrontal, and anterior cingulate cortex, as well as the thalamic, caudate, and lenticular nuclei; and serotonergic dysfunction. Opioid medications may have an adverse influence on certain clinical features of BPD. Some patients show at least short-term improvement in dissociative behavior when given opioid antagonists. Treatment should combine appropriate pharmacotherapy with ongoing psychotherapy. Early identification of BPD is likely to improve the course of treatment. Treatment often requires explicit contracts, consistent limit-setting, confrontation, and communication between different treating professionals to avoid "splitting." The recognition and management of the doctor's own countertransference is important to successful management. Noncompliant patients may need to be terminated from treatment. CONCLUSIONS: Specific management guidelines and the use of explicit treatment contracts can help sustain patients in treatment, reduce the risk of medication abuse, and minimize distress in the treating professional. Headaches and other symptoms in patients with BPD can be successfully managed over the course of a long-term relationship with clearly defined limits.

Borderline Personality Disorder↗
PubMed1991

Contemporary psychoanalysis and homosexuality.

In this paper, I contrast older, traditional, psychoanalytic ideas about homosexuality, with those put forth at a panel on homosexuality at the American Psychoanalytic Association in 1983 (and subsequently). I focus particularly on relationships between cross-gender behavior during childhood and adulthood homosexuality; sexual orientation and personality functioning; determinants and intrapsychic consequences of homophobia, countertransference issues in working psychoanalytically with gay and bisexual patients; the sexual orientation of the analyst (i.e. should gay patients be treated only by gay analysts?). Changing psychoanalytic ideas about sexual orientation reflect the increasingly widespread recognition by psychoanalysts of the necessity to integrate psychoanalytic theory with advances in neurobiology, particularly neuroendocrinology.

Female↗
PubMedDate not supplied

[Premature termination--a multifactoral phenomenon].

Twelve drop out cases in psychodynamic short term therapies according to the focus of cyclic maladaptive pattern by Strupp and Binder (CMP 1984) are reviewed regarding initial diagnostics, tape-recorded therapy sessions, and supervision records. Predictors of premature termination of therapy such as initially rated patients' therapy motivation, narcissistic personality traits, but also characteristics of interpersonal behavior of both patient and therapist are examined and discussed. Particularly important are the therapeutic alliance and narcissistic patients' difficulties to relate personally to their therapists instead of enacting projective dynamics of idealization and devaluation. Therapists frequently tend to respond to them by subconscious display of hostile countertransference. Four patterns of dynamics of therapy drop outs are described.

Adult↗
PubMed1993

Etienne Félix d'Hénin de Cuvillers: a founder of hypnosis.

Etienne Félix d'Hénin de Cuvillers (1755-1841) was one of the few followers of Mesmer who continued to study, practice, and refine animal magnetism after its eclipse resulting from the 1784 publication of the essentially negative investigatory reports of the French commissions. He differed from Mesmer in that he denied the existence of a magnetic fluid, emphasized the role of mental processes in mesmerism and in general behavior, and anticipated the much later psychodynamic constructs of transference and countertransference. In addition, he used and publicized a system of scientific nomenclature based upon the "hypn-" prefix for which Braid has usually, but inaccurately, been given credit for originating.

France↗
PubMed1992

Psychodrama: group psychotherapy through role playing.

The theory and the therapeutic procedure of classical psychodrama are described along with brief illustrations. Classical psychodrama and sociodrama stemmed from role theory, enactments, "tele," the reciprocity of choices, and the theory of spontaneity-robopathy and creativity. The discussion focuses on key concepts such as the therapeutic team, the structure of the session, transference and reality, countertransference, the here-and-now and the encounter, the group-as-a-whole, resistance and difficult clients, and affect and cognition. Also described are the neoclassical approaches of psychodrama, action methods, and clinical role playing, and the significance of the concept of behavioral simulation in group psychotherapy.

Adult↗
PubMed1994

Group psychotherapy with inner-city grandmothers raising their grandchildren.

A year-long psychotherapy group consisting of two co-therapists and eight grandmothers who were parenting their daughters' children is presented. Three models that correspond to the co-therapists' psychoanalytic developmental orientation were used to describe the group phases of development. A number of themes that emerged at different points in the group's life are delineated. They include: authority, control, sibling rivalry, the generation gap, dealing with schools, illness and mortality, isolation, defensiveness, anger, fear of going crazy, guilt, shame, separation, and abandonment. Transference and countertransference issues are also discussed.

Adolescent↗
PubMed1995

A therapy group for mothers with dissociative disorders.

This paper describes the evolution of a therapy group for mothers with dissociative disorders. Although the group is for survivors of childhood trauma, its focus is on the present dilemmas of child rearing rather than on past traumas. It uses mothering as a common bond to improve parenting and interpersonal skills and to propel forward each member's individual therapy. The article summarizes the relevant literature, provides a rationale for such a group, and discusses the issues of cotherapy, combined therapy, group process, transference, countertransference, and thematic material.

Adult↗
PubMed1996

Group therapy as an effective treatment modality for people of color.

The unique benefits for group therapy are examined with special emphasis on the treatment of blacks and Latinos. Because of racial prejudice, economic exploitation, and negative stereotypes, group forces have been especially detrimental to the personality development of people of color. The group therapist attempts to harness these powerful group forces and use them therapeutically, thus enabling people of color to relate better to others while retaining their own autonomy. Racial differences can intensely affect diagnosis, transference, countertransference, and the "real relationship." Distinctions between cultural and functional paranoia are particularly relevant in interracial groups. Implications for training group therapists are also explored.

Black or African American↗
PubMed1998

Staff support groups for high-stress medical environments.

Recent changes in health care delivery have added new demands to the already stressful work of medical staff, which makes the benefits of staff support groups all the more cogent. The author describes a conceptual approach to such groups and analyzes the systems issues that need to be understood to penetrate a complex institution successfully. Staff stressors are outlined along with the staff's psychological responses. Specific goals for support groups are considered and the profound technical differences between psychotherapy and support groups are delineated. The developmental stages of staff groups and their associated themes are described in tandem with practical guidelines about starting, maintaining, and terminating such groups. Special requirements of leadership style and related countertransference issues are reviewed.

Group Processes↗
PubMed1999

The missed session in psychodynamic group psychotherapy.

Missed sessions in group psychotherapy are often overlooked or not talked about, thus forfeiting an important therapeutic opportunity. Group members miss meetings for many different reasons, be they the result of real-life events or clinically driven occurrences. Missed sessions can have important emotional and metaphorical meanings for the missing member, the other group members, and the leader. Countertransference difficulties may interfere with optimal exploration of the many meanings of missed sessions. Five clinical examples illustrate meanings that may reside in the missed session. A cancellation policy that provides a framework for such exploration is recommended.

Appointments and Schedules↗
PubMed1999

Systems-centered supervision.

The systems-centered (SCT) approach to supervision frames the dynamics of both groups and individuals as isomorphic systems. In this chapter, the SCT supervisory experience, its goals, and its approach to transference and countertransference are addressed; the orientation of the seven questions that structure the SCT supervisory process are identified; and the thinking that is required to answer them is discussed. SCT supervisees locate their supervision issues in the context of the phases of system development; consider interventions as hypotheses that can be tested in the therapeutic context; and provide feedback to all parties about the validity of the theory of living human systems, the reliability of its systems-centered practice, and the accuracy of the therapist's hypotheses about the isomorphic dynamics of the systems of member, subgroup and group as a whole. Illustrations are taken from tape recordings of supervisory sessions.

Humans↗
PubMed1999

An experiential group model for psychotherapy supervision.

This article presents an experiential group model of supervision constructed for both group and individual therapy presentations, emphasizing concepts from object relations theory and group-as-a-whole dynamics. It focuses on intrapsychic, interpersonal, and systems processes, and stresses the group aspect of the supervisory process. Its central thesis is that material presented in a group supervisory setting stimulates conscious and unconscious parallel processes in group members. Through here-and-now responses, associations, and interactions among the supervisory members, countertransference issues that have eluded the presenter can make themselves known and be worked through on emotional as well as cognitive levels. Selected excerpts from supervisory sessions demonstrate various attributes and strengths of the model.

Humans↗
PubMed1990

Some issues affecting termination. The treatment of a high-risk adolescent.

This paper addresses some of the difficulties of termination in the psychoanalytic psychotherapy of a deprived, high-risk adolescent girl, who had two previous treatments. Some commonly referred to issues are explored: termination and the developmental process of adolescence; the relationship between termination, mourning, and internalization; the need for the resolution of the transference and careful monitoring of the countertransference; the importance of the transference resolution of the oedipus complex and related issues concerning preoedipal development and identification; and the consolidation of ego strength.

Adolescent↗