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Self-injury concept formation: nursing diagnosis development.

Self-inflicted injury, an increasingly common phenomenon in psychiatric settings, often is seen in borderline clients who scratch or burn themselves repeatedly. Their dysfunctional behavioral patterns present special challenges to the psychiatric/mental health nurse who seeks to interrupt such destructive means of coping. Aside from the difficult task of assisting these individuals to deal with their feelings in a constructive way, the psychiatric nurse often struggles with difficult countertransference feelings. The authors review a historical perspective of self-injury behaviors, define the phenomenon through the procedure of concept analysis, propose the creation of a new nursing diagnosis, and outline interventions appropriate for these clients.

Humans↗

Group therapy for partners of combat veterans with post-traumatic stress disorder.

TOPIC: An 18-month group-therapy experience with women partners of combat veterans with post-traumatic stress disorder (PTSD). PURPOSE: To describe the application of group process and feminist theory to the planning and development of a group of women partners of veterans with PTSD. SOURCE: The authors' clinical work. CONCLUSIONS: Using group psychotherapy theory and feminist theory, the group content and process involved the themes of rescuing, dissociation, and individuation. The exploration of transference and countertransference were useful in facilitating individual as well as process.

Adult↗

A multidisciplinary course to teach staff to conduct psychodynamic group psychotherapy for assaultive men.

TOPIC: A course in leading psychodynamic psychotherapy groups for assaultive men. PURPOSE: To teach multidisciplinary staff members to lead these groups, using both didactic and experiential learning. SOURCE: The author's own experience. CONCLUSIONS: Multidisciplinary staff members learned about the process of leading psychotherapy groups for assaultive men by attending lectures and observing the author lead a group over a 6-month period. The author's openness about her own thoughts, feelings, fantasies, and countertransference allowed students to explore their own reactions and to empathize with the patients, observing that they were not so different from them.

Curriculum↗

The challenge of ritualistic child abuse.

Survivors of ritual abuse have endured physical and psychosexual trauma typically compounded by mind-altering drugs. Some abused children have never known a trustworthy adult to protect them from harm. Children often cope with the anxiety and terror of abuse through psychological defenses such as denial, self-hypnosis, and dissociation, but more extreme responses such as self-mutilation or multiple personalities may occur. Reports of ritual abuse of children are so shocking and bizarre that professionals initially respond with confusion and disbelief (Cozolino, 1989). Nurses need to assess clues and detect symbols of abuse in drawings or flashbacks, to build trust, and to monitor their attitudes and countertransference. Nurses are in a critical position to detect and begin healing wounds of ritual abuse.

Adolescent↗

Treating the suicidal patient. Basic principles.

Successful psychotherapy with suicidal patients requires an emotionally full, active engagement from the therapist with his patient. Emphasis is on the real relationship, not the transference, and the therapist must be available to the patient as a sturdy, reliable object with whom to identify. The therapist's attitude must be loving, not neutral; the alliance is built upon the therapist's devotion to the patient's growth and the development of the attributes necessary for successful autonomous adult functioning. Patients require emotional containment and support, assistance in modulating painful affect, validation, education, help with reality testing, and kindly limit setting. Countertransference reactions must be expected and kept in check, so that the therapist does not get in the patient's way as he tries to build up the faulty mental structures that got him into trouble in the first place.

Humans↗

Divorce counseling: a community service for families in the midst of divorce.

A conceptual framework for the development of child-centered, preventive clinical services for divorcing families is presented. The structure and components of an intervention service--including treatment strategies, successful interventions, failures, therapist role, transference and countertransference responses, and professional dilemmas--are discussed.

Adolescent↗

Psychoanalysis and brief psychotherapy: some new considerations on the psychotherapeutic process.

This introductory paper describes the technique of brief analytic psychotherapy as has been developed in Lausanne. The author has tried to demonstrate that a single modification of the setting in comparison with psychoanalysis stresses the importance of the 'hic et nunc' in the therapeutic relationship. If this phenomenon becomes apparent to the therapist and is adequately interpreted, a natural associative process can develop where the analysis of transference and countertransference takes a primordial place. This process is comparable to psychoanalysis as far as certain transference movements are concerned, but the working mechanisms are different.

Female↗

Psychotherapy training in an isolated setting.

This paper describes the setting up of a training programme in psychodynamic psychotherapy in Perth, 'the most isolated city in the world'. Previous attempts to do so have petered out after a short period of time. It had certainly never been possible to develop a training programme. Initially a study group of interested health professionals was formed in 1984 which met to study certain texts at fortnightly meetings and participated in workshops conducted by the supervisors who visited from Sydney, 3,400 km away. At the end of that year the study group was changed into the Association for Psychodynamic Psychotherapy of Western Australia. The foundation members were also the first training group. The training programme consisted of fortnightly meetings concerned with intragroup issues, administrative matters and with the didactic programme: this consisted of seminars being conducted as part of a training programme in Sydney which were recorded on videotape and flown to Perth. As the 3-year training progressed we also added additional topics of our own. On the alternative fortnight the members split into small groups for peer supervision of audiotape recordings of sessions with the patient being supervised. In addition there were supervision workshops conducted by the visiting supervisors from Sydney. The paper also discusses the logistical problems of conducting such a training as well as transference and countertransference issues that arose within the group of trainees as well as with the supervisors who were so far away.

Curriculum↗

A violence clinic: three years' experience.

The authors describe a clinical facility established for the neuropsychiatric treatment of individuals with a variety of psychopathological disorders where the common management problem is one of aggressive behavior. The authors present case vignettes to illustrate the clinic's consultation with mental health workers about the management of violent patients, countertransference problems, ward problems, the role of organic factors, medication, and prediction of violence. They urge that the subject of violence be included in the psychiatrist's training.

Female↗

The poor rich: the children of the super-rich.

Because they have little parental contact, many children of the very rich lack self-esteem and clear role models, resulting in shallow values and pathological narcissism. Low self-awareness and the absence of great suffering work against therapeutic progress, as do the efforts of the parents, who may feel threatened, and countertransference feelings of envy or anger by middle-class therapists. A supportive psychotherapeutic relationship is the most likely means of developing trust and self-discipline in these patients.

Female↗

Psychoanalytic teaching in medical education.

The author sent a questionnaire to directors of medical student education in psychiatry to determine the role of psychoanalytic concepts in medical education. Practically all of the 66 respondents indicated that psychodynamic theory had been incorporated into major required courses. More than half considered the concepts of defense mechanism countertransference, transference, and dynamic unconscious necessary to general education. The author concludes that psychoanalytic principles will continue to provide a unique view into illness behavior and the doctor-patient relationship.

Attitude of Health Personnel↗

On psychotherapy of patients with problems of hostility.

Psychotherapy often involves the person's recognition of the hostility, the role of reaction formation to hurtful situations and relationships, and transferential expression--and for the therapist, countertransference. Generally, underlying hostility is the wish to be free of it, granted the difficulty of some paranoid patients. Ambulatory therapy may be inadequate, and other resources, including hospitalization, may be required. The ethical issue of social responsibility transcending the obligation of confidentiality may arise.

Adult↗

Childhood parent loss: developmental impact and adult psychopathology.

A large number of cases in analytically oriented psychotherapy and psychoanalysis were studied to determine the developmental consequences of parent loss by death or continuous separation in childhood. The cumulative evidence from this data is that the meaning, impact, and consequences of parent loss on emotional development are determined both by the phase-sensitive issues impacted, as well as the unique interpretation by the child of the fantasied cause and effect of the loss event. Specific issues arising in treatment as a derivative of earlier parent loss are presented as they relate to developmental diagnosis, therapeutic alliance, transference, countertransference, mourning, and termination.

Adolescent↗

Psychoanalytic and cognitive therapies: a comparison of theory and tactics.

The theory and tactics of psychoanalytic and cognitive therapies for depression are explored. Tactics developed from either theoretical base are often similar, though described in different terms. Analytic therapies, being derivative from psychoanalysis, are broader in the possibilities prescribed, and therefore less rigorous in the application of several active techniques. In part because of this, there are differences between analytic and cognitive therapies in session structure, in history taking, in dealing with transference and countertransference, and with paranoid patients. A paradigm is offered regarding the reasons for success or limited success with either method.

Cognition↗

Psychotherapy with the substance-dependent physician: pitfalls and strategies.

Psychotherapy with substance-dependent physicians presents special problems. Accurate assessment and effective response is rendered difficult due to underrepresentation or denial by the patient and countertransference impediments to recognition and limit setting by the therapist. Case examples illustrate problems, pitfalls, and therapeutic strategies.

Adult↗

Developing the story in psychotherapy.

Psychotherapeutic work entails many paradoxes. Emphasizing the patient's imagery and deemphasizing theory enhances understanding at the manifest level, the level of hidden themes, and the level of transference-countertransference patterns. A useful therapeutic model embraces dilemma, promotes toleration of puzzlement, and views the therapist as editor of the patient's developing novel.

Adult↗

Older psychiatrists and their psychotherapy practice.

Interviews with 15 elderly practicing psychiatrists found them cheerful, optimistic and enjoying doing psychotherapy. Most practiced as they had been trained originally, saw outpatients primarily--though fewer and less frequently--than they had earlier in their careers. They experienced fewer transference and countertransference difficulties; and were neither more advice-giving nor self-disclosing than earlier in their careers. All had suffered numerous traumatic events, including ill health and death of spouses, but managed to keep that information out of the therapeutic relationship. Their primary professional concern was maintaining their practices; their major personal concern was the possibility of disability.

Aged↗

Patient-therapist codocumentation: implications of jointly authored progress notes for psychotherapy practice, research, training, supervision, and risk management.

This paper describes patient-therapist codocumentation, a method of creating and using jointly authored treatment-progress notes. Codocumentation has five basic elements: (1) Patient and therapist agree to share responsibility for documentation of treatment. (2) During the last several minutes of each session, the patient records, by dictation, his or her views about the important issues covered, while the therapist listens. (3) The therapist can then dictate his or her comments, in the presence of the patient. (4) The notes are transcribed from tape-recorded to written form between sessions. (5) The typed transcriptions are available for joint review by patient and therapist during subsequent sessions. Sharing responsibility for documentation of treatment using this method promotes bidirectional feedback between patient and therapist. Several examples illustrate how jointly authored progress notes can help in the management of countertransference, as well as transference components of common problems in psychotherapy. The implications of patient-therapist codocumentation for psychotherapy research, training and supervision, and risk management are potentially significant. Further experience is necessary to refine the indications for, and limitations of, patient-therapist codocumentation.

Attitude of Health Personnel↗