Death by suicide in the hospital. An analysis of 20 therapeutic failures.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The psychodynamic experience of the Vietnam trooper is described and emotionally evoked by the author, who is both a psychiatrist and a combat veteran of that war. It is shown how that experience continues to affect the lives of these men. The special implications of that experience for psychotherapy are then discussed.
Several clinical vignettes illustrate types of resistive children and adolescents: the shrugger, the silent child, the rose-colored-glass child, the mistrustful adolescent, the cheater and rule changer, the thrower. Several joining techniques are demonstrated such as hypervaluing, tutoring the therapist, ordering, and mirroring. Limited anxiety enhanced ego strength, and facilitated therapy result. Neal Miller's conflict model provides a theoretical framework for the approach.
Eighty patients, from four university-based psychiatric outpatient departments, were seen for four to six weeks by medical students. Eighty-two percent of the patients reported "some" to "marked" improvement. The four groups were studied to determine significant variables. A mutually positive attitude between patient and therapist appeared to be the only significant factor.
Supervision of the female psychotherapy neophyte is discussed in relation to sex role-exacerbated ambivalence toward the transition from classroom passive-dependency to self-reliance as a professional clinician. Supervisors are alerted to hostile-dependent strategies, such as seductive flattery, that serve immediate ego-protective needs but ultimately block the attainment of fuller professional functioning.
The paper describes the changes produced in the practice of dynamic psychotherapy when conducted within a circumscribed region. The authors discuss changes in anonymity, roles, and transference relationships for both therapist and patient. The paper demonstrates these effects on the therapist's professional training, his practice, and his family.
Individual supervision is a crucial element in the education of the psychiatric resident. Although the supervisory relationship is fully as complex as that between a patient and therapist, it is less frequently studied and far less well understood. After participating in a supervisory relationship for two years, the authors became aware of two important aspects of their relationship which were seriously interfering with the work of supervision. One was the fact of the dual role of the supervisor as teacher and evaluator. The second was the failure to deal openly with emotional issues between them. The authors' separate recollections of the experience are used to explicate the nature, opportunities and pitfalls of therapy supervision. Three levels of learning which occur in therapy supervision are examined. Particular attention is paid to the most neglected aspect of therapy supervision, namely ongoing examination of the emotional vicissitudes of the supervisory situation.
The uniqueness of the psychotherapeutic relationship requires the therapists to maintain a careful equilibrium between objectivity at the price of empathy and closeness at the expense of the necessary perspective. Crises in the course of long-term psychotherapy brings about a sudden, unexpected loss of such equilibrium. Uithout sufficient understanding of the crisis within the context of the therapeutic strategy and goals, the therapist might easily over- or underreact, to the detriment of the treatment. In this paper we suggest careful scrutiny and guidelines for dealing with those situations.