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Success or failure: psychotherapeutic considerations for women in conflict.

The authors describe conflicts experienced by women who request therapeutic intervention because of symptoms of depression, anxiety, marital discord, difficulty in asserting themselves, or inability to complete work that would lead to advancement. They discuss the developmentally based difficulties experienced by women in making career choices, advancing their careers, and facing midlife issues. The therapist who deals with such patients must be aware of reality-based factors and of his or her own values and attitudes as they influence choice of therapeutic approach.

Achievement↗

Anniversary reactions in therapists.

The authors provide three case examples of anniversary reactions in psychotherapists evoked in the course of treating patients. They note that psychotherapy has always been discussed in terms of time and phases, which lend themselves to periodicities and may provide the potential for anniversary phenomena. The authors recommend that therapists be aware of such phenomena; monitor their own losses, defenses, and dreams; and continue their own supervision. Possible positive aspects of identification of therapists' anniversary reactions are increased empathy with patients and help in completing unresolved therapeutic and personal issues.

Adult↗

Learning dynamic psychotherapy: a longitudinal study.

The authors investigated the evolution of psychotherapeutic skills over time in a group of psychiatric residents in their third year of training. A 29-item Supervisors Evaluation Scale measuring psychotherapy skills was developed. Each resident who began his or her clinical experience in conducting individual analytically oriented psychotherapy was rated by his or her supervisors on this scale toward the beginning of training and again 8 months later. Statistically significant changes were found for 7 of the skills measured. The authors feel that these may reflect those aspects of psychotherapy which the beginning therapist can readily learn with supervision and experience.

Attitude of Health Personnel↗

Treatment of divorcing fathers: social and psychotherapeutic considerations.

The author summarizes the psychotherapeutic issues most frequently encountered in his crisis treatment of 16 divorcing fathers for whom divorce was fundamentally a child-centered crisis. Fear and guilt over separation from children and wife, outrage and disappointment with the legal system, anxiety about the social and sexual readjustment to single life, and the need to develop strategies for continued child contact were most prevalent. The author's suggestions for the management of these issues include the therapist's familiarization with divorce as it affects and is influenced by intrapsychic, interpersonal, familial, and legal systems.

Adjustment Disorders↗

Psychiatric care for patients with self-inflicted gunshot wounds.

Self-inflicted gunshot wounds are the commonest form of suicide in this country. Seventeen individuals with such injuries were admitted to a trauma center over a 3-month period. Review of their records showed that psychiatric consultation was requested for only nine of the 13 patients who survived their wounds. Information on alcohol use was missing from half the case records and only six of the 13 survivors received psychiatric care after discharge. Use of guns in suicide attempts may evoke strong feelings in health care providers, resulting in omissions in history taking, evaluation, and follow-up.

Accidents↗

Psychotherapy of the narcissistic personality disorder patient: two contrasting approaches.

The differences in the theoretical and clinical approaches that Kernberg and Kohut have defined are used to discuss the psychodynamics and psychotherapy of the narcissistic personality disorder patient. Their contrasting contributions help clarify the nature of these patients' difficulties, the possibility that there is a spectrum of narcissistic disorders, the effect of existing theory and the personalities of clinicians-theoreticians on the collection of clinical data, and the effects of theoretical formulations on the psychotherapeutic process.

Attitude of Health Personnel↗

"Worse than death": psychodynamics of rape victims and the need for psychotherapy.

Victims of rape routinely are acknowledged to need counseling but not psychotherapy; if psychotherapy is provided, the major focus is on preexisting psychopathology. The author examines these assumptions and presents a different formulation based solely on an in-depth examination of the many levels of the trauma. Case material reveals the typical symptoms, conflicts, and defenses found in rape victims. The author makes recommendations for psychotherapeutic technique, especially in regard to difficulties in forming a therapeutic alliance.

Adolescent↗

Patient-therapist sex.

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Borderline Personality Disorder↗

Clarification of projective identification.

This paper clarifies the various current usages of the term "projective identification." The author presents a broad reference model of projective identification based on the work of Ogden. This model divides projective identification into three steps. Step 1 is the projection of a part of oneself onto an external object. Step 1a is the blurring of self and object representations. Step 2 is an interpersonal interaction in which the projector actively pressures the recipient to think, feel, and act in accordance with the projection. Step 3 is the reinternalization of the projection after it has been psychologically processed by the recipient. The different definitions of projective identification are shown to relate to exactly how the term "projection" is conceptualized (in step 1), to whether step 1a is deemed necessary, and to how many of the three steps are required for the definition of projective identification. The author reviews the work of Ogden, Kernberg, Meissner, Sandler, Malin and Grotstein, Porder, and Zinner et al. Six detailed case examples are provided from within and outside psychotherapy to illustrate all three steps of projective identification.

Countertransference↗