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PubMed1997

The candidate and the patient: some transferential and counter-transferential aspects of the reality of apprenticeship.

This paper examines the impact of apprenticeship on the analytic process. It describes how the reality of the apprenticeship appears in or even intrudes into the transference-counter-transference dialogue. The clinical examples illustrate the use of candidate-analyst's reality as a defence. In the authors' opinion, the realistic aspects of the apprenticeship should be analysed as a part of the transference and counter-transference. The candidate is in a narcissistically vulnerable position between the analysand and the institute, and therefore prone to a Talion-like response and to displacement of aggression. An appropriate working through of apprenticeship difficulties should take place in a double dialectical process between candidate and analysand, and between candidate and institute representatives.

Countertransference↗
PubMed1997

The meaning of the symbolic function in psychoanalytic psychotherapy: clinical theory and psychotherapeutic applications.

This study presents the clinical theory and psychotherapeutic applications of symbolic function in psychoanalytic psychotherapy. The three modes of symbolic function (indexical, iconic and conventional symbolic) form the representations of the self and the object and further the unconscious fantasy, which includes the affective bond between these representations. During his/her development the child absorbs from the mother a new ego capacity (by means of identification), which I call the reflective-integration capacity. Then, the ego of the child has two crucial functions: the fantasy world adopted through the symbolic function and the reflective-integrative capacity. In psychoanalytic psychotherapy our aim is to study the fantasy world of the patient by means of the reflective-integrative capacity, or if this capacity is missing or weak, to promote its development. During psychoanalytic psychotherapy a shared area of reflection-integration is formed, in which the healing changes occur. These healing changes include mainly the formation, consolidation and enrichment of the symbolic function of the patient. The consolidation of symbolic function and the capacity to move within the different modes of symbolic function occur in the area of psychology in which there are incapabilities and/or conflicts (e.g. separation anxiety) in the patient. Clinical case material is presented to illustrate these phenomena.

Adult↗
PubMed1999

Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges.

Food refusal occurs for a variety of reasons. It may be used as a political tool, as a method of exercising control over others, at either the individual, family or societal level, or as a method of self-harm, and occasionally it indicates possible mental illness. This article examines the motivation behind hunger strikes in prisoners. It describes the psychiatrist's role in assessment and management of prisoners by referring to case examples. The paper discusses the assessment of an individual's competence to commit suicide by starvation, legal restraints to intervention, practical difficulties and associated ethical dilemmas. Anecdotal evidence suggests that most prisoners who refuse food are motivated by the desire to achieve an end rather than killing themselves, and that hunger-strike secondary to mental illness is uncommon. Although rarely required, the psychiatrist may have an important contribution to make in the management of practical and ethical difficulties.

Communication↗
PubMed1995

Dealing with the difficult patient.

Dealing with difficult patients can represent a significant burden in the life of doctors. It is more productive, however, to view this burden as a product of the interaction between doctor and patient, for which both have a responsibility, rather than attributing any problems encountered to shortcomings of the patient alone. There is a significant risk in such situations of potentially harmful over-medicalisation. It behoves doctors, therefore, to try to prevent such problems becoming established, or make some attempt to rectify matters if they have already become so. Much is known about the factors that contribute to successful and unsuccessful clinical transactions. The awareness of what doctors bring both as professionals and as individual people to this interaction, will count as much as the practical clinical efforts made towards helping patients.

Attitude of Health Personnel↗
PubMed1975

Some dynamic and transactional aspects of family theraphy with psychotic patients.

The application of family therapy to families with psychotic patients involves both technical and theoretic observations and underpinnings. The implications of these for the understanding of certain family dynamics and the use of family therapy in general are investigated. The rhythm of real participation and observation on the therapist's part and the utilization of co-therapists is contrasted with a more authoritarian, 'director' model of intervention. Tendencies in these families towards frozenness and immobility, as well as splitting and chaos, must be counteracted, and are reflected in interactions and transactions between co-therapists. The importance of unravelling these patterns and aiding therapists in the framework of a specially designed, ongoing supervisory seminary is stressed.

Countertransference↗
PubMed1975

A concept of analytical treatment for patients with psychosomatic disorders. Report on the psychosomatic phenomenon and its consequence for therapy.

With the Paris school the author holds the view that the 'pensée opératoire' is pathognomic for the psychosomatic patient. This archaic, 'automatistisch-mechanistisch' thinking is a consequence of defects in the sphere of the physiological pre-ego. Certain typical findings, such as reduplication and mechanized object relations are seen as correlates of disturbances in the patient's early identification processes. Analytical therapy must thus aim at shifting the all but inaccessible psychosomatic phenomenon into a historical perspective. The psychological event can set in only when the patient has discovered the connexion between his somatic reaction patterns and the emotions he is beginning to feel for the security-giving therapist. An account of the development of the treatment of one patient (Birgit) illustrates the author's concept of analytical therapy in psychosomatics. The 'facilitating environment' helped the patient Birgit to differentiate herself from her dual object and thus to be able to cathect the level of the triangular relationship. The concept of the model ward led on to the development of an ambulatory method of therapy, 'relaxation analytique', which is based on investigations into the concept of the holding function. 'Taking care' of the patient is function of the therapist's own inner attitude, of his being prepared to do everything to encourage the therapeutic regression. The correlate of this attitude, on the side of the patient, is the sense of security which is an essential condition for the 'new beginning' to set in.

Adult↗
PubMed1983

Different models in the approach to the doctor-patient relationship.

In the last years the doctor-patient relationship has been the subject of many studies. However, the framework in which this relationship is approached is not always specified. The doctor-patient relationship is a specific form of interpersonal relationship. But this does not exclude that different models, formulated in the approach to interpersonal relationships in general, can also be applied to the doctor-patient relationship: the communication model, the socio-cultural model, the model of medical transference and the model of human encounter. According to a given model, specific expectations of patient and doctor emerge and their interaction processes are formulated in specific concepts. The choice of a given model should be determined by the characteristics of a given medical situation and/or the objectives pursued.

Communication↗
PubMed1985

Latent thematic concordancy in psychotherapy sessions.

In a single case study of a psychoanalytically oriented treatment, the associative distance between patient and therapist concerning the subject of the session was rated. This distance was operationalized by the so-called 'latent thematic concordancy' (LCON) and measured after each session. With the aid of a modified form of the 'therapy session check sheet' (TSCS) of Graff and Luborsky, a constellation of low manifest and low positive transference together with high resistance was isolated which was linked with low LCON with a high prediction rate. This transference constellation resembles the resistance against transference as described by Gill. It seems to be related to a great distance between the associations of patient and therapist concerning the subject of therapy sessions.

Adult↗
PubMed1986

Soft clinical research on an inpatient unit: effect of findings on treatment.

This paper describes the value of identifying and processing intuitive hunches and impressionistic ideas that arose amongst psychiatrist/clinicians on an inpatient unit. Through semistructured meetings, these hunches generated psychodynamic formulations and therapeutic approaches that were integrated into already existing models of treatment to yield a better understanding of, and a more tailored approach to, the borderline patient and his/her impact on staff.

Borderline Personality Disorder↗
PubMed1989

Study of the patients' difficulties in ending brief psychoanalytic psychotherapy.

Brief psychotherapy implies a limitation of the time needed, which should meet both the patient's acceptance and the therapist's awareness. However, some patients have difficulties in ending therapy. The material of this study consists of 27 patients. Of these patients, 5 dropped out in the termination phase, while for another 8 it became apparent a little before or after the final phase that psychotherapy would have to be continued. The results of the statistical analysis--factor analysis and analysis of variance for the investigation of therapists' difficulties, and discriminant analysis to assess differences concerning the suitability of patients for brief psychotherapy--showed that: (1) the less a therapist feels self-confident, the more likely his/her patient is to break off therapy at the termination point, and (2) the suitability score, determined during evaluation, emerges as the main differentiating parameter of the three groups (dropouts, continuers, completers).

Countertransference↗