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PubMed2002

Suspicion, resistance, tokenism and mutiny: problematic dynamics relevant to the implementation of clinical supervision in nursing.

In this paper I will discuss some of the more common pitfalls inherent in attempts to introduce clinical supervision to hospital wards or community teams. I will consider pre-existing relationships and how these may, if unexamined and unaccounted for, result in clinical supervision becoming less than optimally effective. Drawing upon the theory of Transactional Analysis, in particular the concept of 'psychological distance', I consider four possible interpersonal dynamics and examine how these may impact upon the implementation of clinical supervision. These problematic dynamics can result in undue resistance, suspicion, tokenism or interpersonal difficulties. Finally, I will consider ways in which the aforementioned problems may be addressed and their effects minimized through the use of co-operative contracting.

Clinical Competence↗
PubMed1977

Dimensions of family therapy.

This article is a description of different approaches to therapy with a family orientation. There are general categories of family therpay which had their origins in individual therapy, such as the approaches based upon psychodynamic theory, those derived from experiential procedures, and the behavioral approaches. There are also family therapies which have not developed from individual therapy, such as the extended family system approach and the communication school of family therapy. The different therapy approaches are described within a set of dimensions which characterize most therapy. Such dimensions include whether the past or present is emphasized, whether the therapist uses interpretation or directives, whether the approach is in terms of growth or specific problems, whether hierarchy is a concern, and whether the unit is an individual, two people, three people, or a wider network. Illustrations of the different family therapy approaches are given in terms of the kinds of information that would interest the therapist of each school and the kinds of actions he or she would take to bring about change.

Behavior Therapy↗
PubMed1978

Disengagement versus engagement - a need for greater expectations.

An attempt is made to clarify some existing perspectives of successful aging. The environmental milieu of the aged is laden with potent and pervasive implications about successful adaptation. Considerable exploration is required to facilitate a realistic focus upon various theoretical contributions already presented. The influence of stresses and adaptive energy depletions preceding the senescent state is discussed in an effort to facilitate knowledgeable assimilation of the potential impact of the socioeconomic milieu upon the aged. It is the author's contention that the elderly person, upon retirement, presents an adaptive energy reserve highly personalized in its ability to accommodate to change, and especially dependent upon the nature, number and intensity of environmental stressors to adapt, successfully or unsuccessfully, to senescence. Various environmental stressors are identified (e.g., changes in social opportunities and expectations which create new needs and constrict the realm of emotional and vocational influence, thus reducing opportunities and diminishing self-esteem). Heavy emphasis is placed upon role theory, interaction ritual, and transactional analysis. These concepts are extended to the institutional setting - an environment which serves only to magnify mechanisms occurring throghout the social system while adding its own unique dimension to the stressors confronting the elderly.

Adaptation, Psychological↗
PubMed1981

J.L. Moreno: An unrecognized pioneer of family therapy.

J.L. Moreno's fundamental and pioneering contributions to be development of group therapy, encounter, transactional analysis, and especially psychodrama are well known. However, most family therapists seem unacquainted with the fact that from his earliest writings in 1923 J.L. Moreno developed an interactional view of psychotherapy that in 1973 already resulted in formulations of a true systems orientation and very concrete ideas about marital therapy, family therapy, and network therapy. He probably is the first (1937!) therapist that actually involved a husband's lover in conjoint marital therapy. His general theoretical formulations about the pathology of interpersonal relations as well as his practical suggestions for the therapy of the interpersonal relations seem to be insufficiently known to workers and researchers in the field of family therapy.

Family Therapy↗
PubMed1994

Sequences of emotional distress expressed by clients and acknowledged by therapists: are they associated more with some therapists than others?

When clients come to psychotherapy they are distressed, this distress usually being expressed in the form of anxiety, hostility, depression and helplessness. This study explored the sequences of emotional distress expressed by clients and acknowledged by therapists, and examined their associations with other factors. The transcripts of five therapists (two single sessions each) were content-analysed: they used personal construct, client centered, rational-emotive, Gestalt and transactional analysis therapy. Log-linear analyses of appropriate contingency table cell frequencies were conducted to test associations between identified sequences and the two variables of therapist and timing of completion of the sequence. Therapist-client sequences of Anxiety-Anxiety, Anxiety-Hostility and Helplessness-Hostility were found to be associated more with the personal construct and client centred therapists than with the rational-emotive therapist. Client-therapist sequences of Anxiety-Anxiety, Helplessness-Anxiety and Helplessness-Helplessness were more often found with the client centred therapist than the other therapists. For most of these sequences timing had an effect, yet timing rarely interacted with the therapist variable. The findings are discussed in terms of their relevance to the theoretical positions represented, the shortcomings of the research and the value of this methodology in studies linking therapy process with outcome.

Anxiety↗
PubMed1979

Psychosomatic medicine and cybernetics.

In our daily psychosomatic medicine clinics, we have adopted four principles from Wiener's cybernetics and von Bertalanffy's general system theory. We use the polygraphic method for the diagnosis of psychosomatic disease (black box principle). For the control of psychosomatic symptoms, we use the biofeedback method (feedback principle). We use systematic desensitization to relieve social stresses which cause psychosomatic disease (open and closed system principle). And lastly, transactional analysis, which corresponds to the information and energy principle.

Biofeedback, Psychology↗
PubMed1984

Current therapies and the ancient East.

Current therapies, their theories and techniques ebb and flow in popularity, but there is a residue of basic principles and practices which remain. Much of this useful residue has been present in ancient Eastern religions and philosophies. This article compares the content of several current theories of individual, group, and family therapies to seed ideas in ancient Taoist, Zen, Confucian, yoga, and Buddhist source materials. Gestalt, existential, psychoanalytic, transactional analysis, cognitive-behavioral and family therapy concepts are traced to these ancient precursors. Illustrative examples are presented such as satori (flash of insight), koans (insight riddles), parables, yanas (exercises), rituals, and written teachings. The article concludes with the Four Noble Truths and the 8-fold path of Buddhism, given 2500 years ago but very timely to contemporary problems of life adjustment and a useful guide to counseling and therapy.

Buddhism↗
PubMed1994

Quantitative assessment of stressors and stress reaction: a review.

To survey methods for assessing stress and to examine the relationship of stress to health and the factors of lifestyle, we reviewed the literature on stressors and stress reactions. Firstly, we reviewed the representative methods for assessing stressors. Secondly, self-report questionnaires based on a theoretical model of occupational stressors were surveyed and factors in work stress were listed. Then, we reviewed stress reactions including physiological, psychological and behavioral reactions. Finally, we examined the relationship of perceived stress measured by a single question to mental health status determined by the General Health Questionnaire (GHQ-28), lifestyles and personality based on the Egogram in Transactional Analysis. It is suggested that we need to assess subjective aspects as well as using objective indices such as data from physical examinations, to evaluate the level of stress and to promote mental health.

Adult↗
PubMed2001

[Listener education].

Listener education has usually been conducted as primary prevention in occupational medicine. We report on the present state of listener education in which the training focuses on active listening (AL). AL means the way of listening to a person in the person-centered attitude (PCA) that is based on Rogers' three conditions, i.e. empathy, unconditional positive regard, and congruence. Although the need of this kind of training has been widely described, there is a paucity of academic literature on this subject. This review deals with listener education by dividing it into two types; one is listener education in a narrow sense that consistently depends on the three conditions, and the other is listener education in a broad sense that combines other methods that have different orientations from Rogers' theory. As an example of the former, Ikemi et al. reported the importance of the PCA, and studies conducted by Kubota et al., Mishima et al., and Miyagi dealt with the actual training. As an example of the later, Morisaki and Hamaguchi et al. illustrated their training including other methods such as transactional analysis in their studies. Finally, we point out not only that future research needs to focus on the assessment of listener education, but also that AL needs to be understood from the standpoint of developing workers' competency.

Communication↗
PubMed1979

Therapeutic communities, old and new.

The author attempts to clarify two largely different uses of term, Therapeutic Community (TC). By "old" TC he describes a movement which originated in psychiatry in the United Kingdom at the end of World War II. This was an attempt to establish a democratic system in hospitals where the domination of the doctors was replaced by open communication of content and feeling, information sharing, shared decision making, and problem solving shared as far as possible with all patients and staff. Daily meetings of all patients and staff formed the nucleus of this process. In recent years developments in the areas of systems theory, learning theory, and organization development have contributed to a better understanding of social organization and change. The "new" TCs derive from the more recent developments in the treatment of substance abuse. Central to this movement is Synanon and its many modification which use the clients' peer group to solve their own problems, largely eliminating mental health professionals. Linked with these "new" TCs is the development of Asklepieion units in prisons, which use Synanon "games" along with transactional analysis. An attempt is made to distinguish the methodologies used in TCs, "old" and "new".

Alcoholics Anonymous↗
PubMed2002

Behavioural awareness, interaction and counselling education in audiological rehabilitation: development of methods and application in a pilot study.

In conventional audiological rehabilitation, the hearing therapist interacts with the hearing-impaired person and with significant others. In order to strengthen the personality and self-confidence of the hearing-impaired individual, a different strategy was designed and implemented whereby the pedagogic interaction was directed only towards the hearing-impaired individual, who in turn worked as a tutor/aid/counsellor to the communication partner. On the basis of an interactive communication model, new methods for rehabilitation of subjects with moderate hearing impairment were developed and evaluated in a pilot study on 13 men with noise-induced hearing loss. A course programme was developed with three main active components: (1) increased insight and knowledge; (2) education as counsellors with the ability to focus on the problems of the communication partner; and (3) motivation to change through group discussion and reflexive conversation. Increased insight and knowledge were obtained through test and training experiences in a sound environmental chamber, tutorials and discussions. The pedagogic training focused on helping the hearing-impaired subjects to become able communication counsellors in relation to their interlocutors. An act-react, offensive-defensive paradigm was used in conjunction with transactional analysis. Results of the pilot study were evaluated using questionnaires, interviews and a method of dialogue analysis. The results were evaluated for the hearing-impaired and the partner and in recordings of conversations in the home environment. There were clearly positive cognitive and emotional effects seen in the inquiries and interviews. The observations from the dialogue analysis indicated only small effects, with the exception of the two individuals with the most pronounced functional impairment, for whom dialogue was improved after the course. It was concluded that these new methods could contribute new possibilities in rehabilitation programmes, emphasizing the shared responsibility for communication and the unique competence and abilities of the hearing-impaired person.

Awareness↗
PubMed2006

[The impacts of a community health practitioner's ego state, and interpersonal attitude on depression].

PURPOSE: Community health practitioners (CHP) in Korea have a responsibility for delivering primary health care to remote or isolated communities. The aim of this paper is to analyze CHPs' level of depression and impacts of their Ego state and interpersonal attitude in transactional analysis on depression. This paper gives fundamental data for developing a the program for mental health promotion of CHPs. METHOD: The subjects of this study consisted of 459 Korean CHP who were conveniently selected from the target population. The data was collected through interviews using self-administered questionnaires, including the Korean Ego gram and life position inventory and depression scale. RESULTS: The CHP's Ego gram showed the N type with the top point of NP. The type of interpersonal attitude was I'M OK - YOU'RE OK (I+U++). The level of depression was 35.4, normal range. There was a significant difference in depression according to the duration of the career. There was a significant negative correlation among NP, A, FC ego states, interpersonal OK and depression, and a significant positive correlation between interpersonal Not-OK and depression. The NP, A, FC ego states and interpersonal Not-OK were significant predictors (47.1%) of depression. CONCLUSION: This study showed that a program for CHPs to should include increasing the function of ego states and positive interpersonal attitude.

Adult↗
PubMed1992

Traumatic brain injury crisis intervention and family therapy--management and outcome. Brain Injury Treatment and Research Group.

This article presents a model for crisis intervention and family therapy after traumatic brain injury. Our program, firmly rooted in object-relations theory and transactional analysis, included patients and family members (significant others) living within 100 miles from the University Hospital of Umeå. The effects of the interventions were gauged at one and two years after the trauma are presented in terms of agreement/disagreement between the patient and the significant other concerning inter- and intrapersonal relationships as well as through a short case presentation. As a conclusion of our study a point is made to expand the scope of intervention to include also other segments of the social network of the patient.

Adult↗
PubMed1998

[Informed consent in psychosomatic medicine].

Obtaining informed consent perfectly is very difficult from the view of psychosomatic medicine. Medical education regarding informed consent is generally of a low level. However as it is important to defend patients' human rights, we must educate them as to the precise meaning of both "informed" and "consent". In this report I have tried to demonstrate that both the education of medical students and their social consciousness are very important. I examined students' opinions regarding the care of a sudden case of hysterectomy (Porro's emergent operation). The following students were involved: 1st year medical students (N = 73), 4th year (N = 85) and 6th year (N = 119), and 3rd year nursing students (N = 42) and midwife students (N = 27). I examined their answers by transactional analysis. The answers of the 1st year medical students reflecting the view of the child ego state were significantly greater than those of the other students (P < 0.01). But following my lecture the answers of the same 1st year students altered to reflect the view of the adult ego more (P < 0.05). We opened "the key center of psychosomatic women's health in Japan" in our clinic two years ago. Since then we have talked every month to people in general about various women's diseases, and also discussed various problems of the doctor-patient relationships during these talks. I feel that public awareness concerning informed consent has increased gradually recently in Japan.

Adult↗
PubMed1984

Analysis of reference transactions using packaged computer programs.

Motivated by a continuing education class attended by the authors on the measurement of reference desk activities, the reference department at Scott Memorial Library initiated a project to gather data on reference desk transactions and to analyze the data by using packaged computer programs. The programs utilized for the project were SPSS (Statistical Package for the Social Sciences) and SAS (Statistical Analysis System). The planning, implementation and development of the project are described.

Computers↗