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PubMed1975

The use of hypnosis in the treatment of a case of multiple personality.

The literature regarding the use of hypnosis in the therapy of multiple personality is reviewed. Cautions of other authors are noted which intend to protect the patient from further "splitting" of the personalities involved. A case of a 25-year-old woman is described in which, several months after leaving therapy abruptly, a second personality appeared and prompted her re-entry into treatment. Hypnosis was employed several weeks after restarting therapy on four separate occasions. Therapeutic outcome was favorable with coalescence of the personality into a new whole. A rationale for the use of hypnosis in this case is presented.

Adult↗
PubMed1990

The empathic process and its mediators. A heuristic model.

Clinical empathy research has been plagued with conceptual and methodological difficulties. This paper describes a model of the empathic process that enables clinicians, teachers, and researchers to examine specific components of the model and to determine the influence of particular mediators on the empathic process. Empathy is conceptualized as a three-phase time-sequenced process rather than as a multidimensional or multicomponent phenomenon. Stripped of detail, the empathic process reveals an inducement phase, a matching phase, and a participatory-helping phase. By examining these phases, it becomes possible to distinguish empathy from closely related concepts such as sympathy. Each of the phases reveals numerous mediating variables that influence the outcome of the phase, i.e., whether the process of empathy continues or an alternate terminal point is reached. Many of these mediators are derived from existing conceptual and empirical work on empathy. Particular attention is paid to situational or contextual mediators of empathy. Contextual mediators have only recently been acknowledged as an important variable in the empathic process. For clinicians, identification of contextual variables that may be responsive to intervention is a critical step in the modification of the clinical environment. We would suggest that clinical empathy research is largely the study of these mediating influences and should be recognized as such.

Countertransference↗
PubMed1993

Nonlinear analysis of autonomic responses in a therapist during psychotherapy.

An experienced, analytically trained psychotherapist was physiologically monitored while conducting a 28-session exploratory psychotherapy with a patient suffering a pathological grief reaction. The therapist's autonomic responses, as manifested by perturbations in heart rate, were subjected to nonlinear dynamical analysis, yielding a series of characteristic "trajectories" representing the flow of these responses in time. We report interrater reliability and present descriptive statistics resulting from classifying these trajectories into four types. Interesting but preliminary clinical correlates of these autonomic trajectories were obtained by having the therapist review videotaped excerpts of the sessions and complete a self-report questionnaire. In conjunction with a previous report focusing on autonomic responses in the patient, this study further demonstrates the application of nonlinear dynamical methods to investigations of psychophysiology in the setting of psychotherapy, and perhaps in dyadic interactions more generally.

Adult↗
PubMed1998

The influence of patient diagnosis and self-image on clinicians' feelings.

This paper presents an analysis of the relations between the patients' psychiatric diagnoses, their self-image, and the staffs feelings toward the patients. At 17 treatment units for severely disturbed psychiatric patients, the staff rated their feelings toward the patients on a feeling checklist twice a year for 5 years. The patients were diagnosed on DSM-III-R (axis I and II) and rated their self-image on a self-rating instrument, the Structural Analysis of Social Behavior. First, comparisons between reactions toward patients with different axis I diagnoses, toward patients with different axis II diagnoses, and toward patients with either axis I or axis II diagnoses were made with one-way ANOVAs. No significant differences were found in any of these comparisons. The amount of variance in feelings explained by these groupings was between 2% and 4% (mean = 3%) for axis I, between 3% and 14% (mean = 8%) for axis II, and between 4% and 17% (mean = 9%) for the combined comparison. Differences between axis II diagnoses had the largest influence on the staffs feeling reactions. Second, comparisons between the influence of the patients' diagnoses and of their self-image on the therapists' feelings were made by way of blockwise multiple regression analyses. The results showed that the patient's self-image was more important in influencing the staffs feelings than the diagnosis but that diagnosis and self-image were virtually independent in this respect.

Adolescent↗
PubMed2000

Associations between staff feelings toward patients and treatment outcome at psychiatric treatment homes.

This paper presents, as part of a national Swedish research project, a study of associations between staff feelings toward patients and treatment outcome at 23 small psychiatric inpatient units. The outcome was measured with a composite scale based on structured interviews. Staff feelings were reported on a feeling checklist. Few and scattered correlations were found between staff feelings and treatment outcome when the whole group of patients was analyzed together. More meaningful patterns were found when data for psychotic and borderline patients were analyzed separately. For psychotic patients, positive outcome was associated with low levels of negative feelings throughout treatment. For borderline patients, positive outcome was associated with negative feelings at the beginning of treatment, followed by strong positive feelings in the later part. Staff feelings were more strongly associated with outcome for borderline patients than for psychotic patients. Patients with different structural diagnoses need different kinds of staff "feeling milieus."

Adolescent↗
PubMed2004

Outreach to the homeless: craft, science, and future implications.

Outreach is a treatment modality for engaging underserved populations in health care. Nowhere is outreach more relevant than in delivering services to homeless persons with mental illness. Programs providing outreach to homeless people have been in existence for at least two decades and a craft has developed naturalistically. However, there has been insufficient formal examination of factors that influence the effectiveness of outreach and how it is actually performed. The authors present an in-depth examination of issues related to outreach to the homeless. They review different outreach modalities, the role of the individual clinician, and the art of teamwork. They also discuss external issues such as financing, access to housing, interactions with other professions, and working conditions. The authors conclude with a brief discussion concerning the application of outreach to populations other than homeless individuals with psychiatric disorders and suggest future directions for improving our understanding of this important modality.

Adult↗
PubMed2004

Disclosure of a diagnosis of borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) is a common psychiatric disorder with a prevalence of 1%-2% in the general population. BPD also has the potential to cause significant distress in the lives of patients with BPD and their families. The diagnosis of BPD, however, is often withheld from patients. The purpose of this article is to explore the history of diagnostic disclosure in medicine and psychiatry and then discuss reasons why clinicians may or may not disclose the diagnosis of BPD. METHODS: The authors review medical literature about diagnostic disclosure and other issues that may affect the decision to disclose a diagnosis of BPD. RESULTS: The authors discuss the historical precedents for diagnostic disclosure and reasons a clinician may not disclose the diagnosis of BPD to a patient: questions regarding the validity of BPD as a diagnosis, worries about the stigma of the diagnosis being harmful to the patient, and transference/countertransference issues common in the treatment of patients with BPD. The authors cite factors promoting disclosure, such as the ideal of patient autonomy, possibilities for psychoeducation and collaboration with the patient toward more specific and effective therapies, and the increasing availability of diagnostic information available to patients from sources other than their clinicians. CONCLUSIONS: There are compelling reasons to make the diagnosis the subject of open examination and discussion between clinician and patient, and reasons to believe that disclosure would serve to advance the patient in his or her recovery.

Borderline Personality Disorder↗
PubMed1998

The case of Marcello: transference and the unfolding of the analytical relationship.

The analytical process of a male patient is herein described, the main focus being on the phase when the transference develops and transference projections are modified, leading to a transformation of the personality, which was previously characterized by severe obsessional defences. The specific aim of the discussion is to evaluate when and what to interpret, in relation to the importance of the transferential patterns and with regard to the role of the analyst as a container.

Adult↗