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PubMedDate not supplied

A controlled study into the (cognitive) effects of exposure treatment on trauma therapists.

Several researchers have reported on therapists' symptoms as a result of trauma treatment, such as disruptions in cognitive schemata and symptoms resembling PTSD-symptoms. Thus far, however, no studies compared the symptoms of trauma therapists and non-trauma therapists. In the present study, both trauma therapists (n = 20) and non-trauma therapists (n = 19) were included. During semi-structured interviews, both therapist groups reported negative and positive effects of their work with patients on their personal and professional functioning. Trauma therapists reported more often changes of cognitions due to trauma work. Results from questionnaires, however, showed that compared with norm-standards and compared with non-trauma therapists, trauma therapists did not show enhanced psychopathology nor distorted cognitive schemata. It is concluded that although exposure treatments with trauma patients are associated with therapists' distress, therapists seem able to cope with it in a healthy way.

Adaptation, Psychological↗
PubMed1988

"Don't tell us--show us": the use of role play in the teaching of psychoanalytic theory.

The psychological concepts associated with psychoanalysis are sometimes considered to be precious and somewhat irrelevant by professionals working with disturbed adolescents. Discussions (at a theoretical level) of these ideas may not highlight their usefulness in clinical situations. This paper describes the use of active role play techniques in a staff training group designed to teach about the "Inner World of the Adolescent". The fundamental features of "transference" and "counter-transference" were brought alive during these groups, and several other theoretical contributions of modern psychoanalysis were demonstrated within the setting of a training session. These groups were not intended to train "therapists", but to support and improve existing styles of work with adolescents.

Adolescent↗
PubMed1999

Therapist-patient sex. From boundary violations to sexual misconduct.

It is the therapist's ethical, professional, and legal duty to establish and maintain treatment boundaries consistent with the provision of good clinical care. The therapist must guard against progressive boundary violations that are damaging to patient care and that may also lead to sexual exploitation of the patient.

Adult↗
PubMed1997

Psychotherapeutic approaches to aggressive and violent patients.

Behavioral and cognitive-behavioral strategies and a broad range of group, family, couples, and milieu treatment approaches have been developed for the psychotherapy of aggressive and violent patients. These methods have been carried out in diverse settings ranging from hospitals and prisons to individual outpatient practices and have been applied across diverse populations including adults with mental retardation, dementia, and brain injury; children with attention deficit and conduct disorders and autism; recurrent violent offenders with antisocial personality disorder; and individuals with chronic psychotic disorders, mood disorders, or medical illnesses such as hypertension. Bridging these different strategies are the underlying principles of psychotherapy with aggressive and violent patients. These include ensuring the safety of clinician, patient, and potential victims as the foremost concern; developing a finely detailed assessment of aggressive and violent acts and of the antecedents, assumptions, and consequences that are attached to them; formulating well-defined goals and striving for clear communication to achieve consistency in the pursuit of these goals between therapist and patient, and among therapist and other clinicians, staff, and relevant family members or agencies; specifying ahead of time well-considered outcome measures to be used to gauge the effectiveness of treatment; and maintaining a healthy vigilance for countertransferential and similar reactions and a willingness to use consultation as an integral part of treatment.

Aggression↗
PubMed2003

Vicarious traumatization: implications for the mental health of health workers?

It has been suggested that a unique feature of some mental heath practitioners' work is exposure through their role as therapists to clients' descriptions of and reactions to trauma, and that these experiences may actually indirectly cause distress and traumatization to the therapist. This proposed phenomenon has been termed "vicarious traumatization" (VT) and is the focus of the current review. The concept of VT, together with other related concepts such as "burnout," "compassion fatigue," "secondary traumatic stress" (STS), and "work stress" are appraised. Psychological mechanisms that might be theoretically involved in VT are considered. The measurement of VT is reviewed alongside the limited research evidence supporting its existence. Factors such as direct trauma exposure and the personal attributes of mental health workers, which have been suggested to be associated with VT, are also assessed. It is concluded that the evidence to support the existence of VT is meager and inconsistent. Future research needs to be directed at distinguishing VT from other sources of distress arising within the workplace. Finally, the organizational relevance of VT and its possible implications for the management of mental health workers are critically appraised.

Affect↗
PubMed1998

Workshops to support the bereavement process.

When a bereaved person is in need of extra support during the bereavement process, at present four types of support can be distinguished: professional individual- and group counseling and non-professional individual- and group counseling. In this article another support facility is proposed: the workshop. It is indicated that the workshop can be considered as a valuable addition to the current counseling alternatives for bereavement and can possibly prevent more serious bereavement problems. After an explanation of bereavement counseling, the set-up of the workshop is described. Special attention is payed to the group dynamic aspects of the workshop.

Adult↗
PubMedDate not supplied

Self-disclosure. Reconciling psychoanalytic psychotherapy and alcoholics anonymous philosophy.

Therapists working in the addictions field and practicing from a psychoanalytic psychodynamic framework are often confronted with the patient's need to know, the demand for therapist self-disclosure. Consistent with Alcoholics Anonymous (AA) principles, many patients state that they cannot be helped unless the therapist is revealing of their personal background. This paper discusses the theoretical roots of therapist self-disclosure and the AA philosophy and offers suggestions for how the two might be reconciled.

Alcoholics Anonymous↗
PubMed1991

Group therapy with mothers of incest victims, Part II: Therapeutic strategies, recurrent themes, interventions, and outcomes.

Part II of this article continues the discussion of group process in a reality-based, ego-supportive therapeutic group for mothers of incest victims that was co-led for 2 years by the authors. Strategies are discussed that fostered development of a therapeutic group. Recurrent themes that emerged in the group are identified. Interventions that provided opportunities for corrective interpersonal experiences are described, as are therapeutic values and beneficial outcomes.

Adolescent↗
PubMed2002

Secondary traumatic stress and vicarious trauma: a validational study.

Vicarious trauma (VT) and secondary traumatic stress (STS) or compassion fatigue both describe effects of working with traumatized persons on therapists. Despite conceptual similarities, their emphases differ: cognitive schemas vs. posttraumatic symptoms and burnout, respectively. The TSI Belief Scale (TSI-BSL) measures VT; the Compassion Fatigue Self-Test (CFST) for Psychotherapists measures STS. Neither has substantial psychometric evidence yet, nor has their association been studied. Results for 99 sexual assault and domestic violence counselors show concurrent validity between TSI-BSL and CFST, moderate convergence with burnout but useful discrimination, and strong convergence with general distress, but adequate independent shared variance. Counselors with interpersonal trauma histories scored higher on CFST, but not TSI-BSL or burnout, consistent with the CFST's emphasis on trauma symptomatology.

Adult↗
PubMed1999

Treatment issues in the group psychotherapy of addicted physicians.

For the most part, physician-addict patients are affable, cooperative and tend to be bright, verbal and engaging. However, on a deeper level they experience significant internal obstacles to truly using treatment. The role of the healer adopted after years of training and work experience is not easily exchanged for the role of patient. Furthermore, the armour of defenses and character style that have been built up over a lifetime is resistant to modification. Additionally, most of these patients have not chosen to change. They have been ordered into treatment under considerable duress and are aware that retaining their hard-earned careers is dependent on their successful performance in treatment. Given all these difficulties it is striking that the vast majority of these patients gradually come to experience a genuine and meaningful connection to the group and the therapeutic process. They develop close relationships with their fellow group members and come to use them as a support system, even at times when the group is not in session. They report looking forward to group and missing it when it does not meet. In this context they begin to take risks by sharing on a deeper level and slowly bring to the group issues in their life other than addiction. Their devotion to group is reflected by the fact that when no longer mandated, many continue voluntarily and maintain that the experience is central to their recovery. One of the major reasons recovering physicians are able to make this connection is that behind their fear of interpersonal relationships is a tremendous wish to join with others. Many report profound relief at discovering they are not alone and are able to use group to address their deeply felt sense of shame. For many this is their first experience of such strong feelings of attachment and affiliation to a group of peers. Their prior professional experience did not routinely allow for such relationships and as Smith (1978) has observed, their experience has been characterized by extraordinary isolation even as compared to the general population of addicts. There are no communities of drug-using doctors and no romanticized antics shared amongst fellow addicted physicians. A doctor's addiction is at its core an activity of secrecy and solitude. This investment to group can only develop in an environment that feels fundamentally safe. It is the creation of such an environment that is the central task for the therapist working with addicted physicians. The patient must come to learn that he can say whatever is on his mind without being criticized, ridiculed or punished. To a large extent this is accomplished by highlighting the commonality between the group members which diminishes the sense of isolation and shame. In addition, the therapist must maintain an accepting and non-judgmental stance so that the patient is free to fully experience the ambivalence inherent in the decision to get sober.

Adult↗