Toward a Telic Vision of Human Beings: A Dialogue with Joseph F. Rychlak

Over the past 25 years, Joseph F. Rychlak has developed a unique approach to theory, research, and practice in counseling that he refers to as “rigorous humanism.” His conceptualization of human action is radically different from the mainstream understanding of human beings in scientific theory and research. His position is quite compatible, however, with the views of most practicing counselors. Rychlak's proposals have been instrumental in developing a modified view of science, upon which a research-based understanding of counseling practice can be constructed.     

George Gazda: Steps Ahead of the Group

Dr. George Gazda has been and remains a pioneer in the counseling profession. During the past several decades, he has been instrumental in several movements and has influenced the direction of the field of counseling. His leadership in bringing group counseling to the respected status it holds today is a remarkable feat. The development of the comprehensive and practical “Life Skills Model” has influenced the way many counselors work with clients. In this brief interview, he talks of the significant people in his professional development, and some of the many people he has touched speak to his caring and commitment to his chosen profession. This short synopsis of Dr. Gazda's career hardly does justice to his many contributions. He is indeed a remarkable professional and person. The counseling profession, in may ways, owes him considerable credit for where we are today and for where we may strive in the future. His dreams provide a true vision for the rest of us.     

Status der psychosomatischen Forschung im deutschsprachigen Bereich

Psychosomatic medicine aims at exploring the relationships between biological, psychological and social factors in onset, maintenance and treatment of psychosomatic disorders. The present article describes current topics and methodological approaches in the field of psychosomatic research. A bibliometric analysis of two German journals in 2009 and 2010 was conducted, yielding 43 articles dealing with different aspects of psychosomatic medicine: chronic illness, somatoform disorders and pain, trauma-related disorders, borderline personality disorder and attention deficit hyperactivity disorder. The results show that psychosomatic research covers a variety of topics with different research designs. However, there is still a paucity of controlled studies in the field.     

Personality and Health in the 1980s: Psychosomatic Medicine Revisited?

This special issue is a sign of a resurgence of interest in the role of personality in health not seen since the 1940s and early 1950s when the promises of the psychosomatic approach to health and illness appeared to be the greatest. This new look at personality and health represented by contributions to this special issue attempts to address the limitations of earlier work in psychosomatic medicine by making more explicit efforts to define personality variables precisely, to distinguish these variables from conceptually related psychological constructs, and to embed them in a body of theory and empirical research. This new work also attempts to remedy methodological limitations of earlier work by placing greater emphasis on prospective research and highlighting distinctions between symptom reports, illness behavior, and actual illness. However, the new work and earlier work in psychosomatic medicine share certain working assumptions, for example, a primary emphasis on the relatively direct impact of personality on disease onset, an assumption that personality variables operate in interaction with stressful events, and a frequent emphasis on general susceptibility to disease. Moreover, this new work frequently risks the same methodological pitfalls that limited scientific progress in psychosomatic medicine. We argue that the rapid rise and decline of psychosomatic medicine is most likely to be repeated in research on personality and health in the 1980s if reasonable criteria for considering personality variables a risk factor for disease are not precisely defined, disease endpoints (the dependent variable) are not assessed precisely, personality variables of interest (the independent variable) are not empirically distinguished from other related psychological variables, and complex relationships among risk factors are not taken into account. It is emphasized that models drawn from personality research cannot be transferred unchanged to the health arena without risking false inferences about the role of personality in health.     

The Counselor and the Curriculum

The counselor is involved in the curriculum structure of high school because of the amount of time he spends in educational planning with students. His record of participation in curriculum change has been poor. Educational counseling has consisted of adjusting the student to the curriculum that exists, rather than working for curriculum change that can benefit all levels of students. Curriculum resources should be thought of in a broad sense of not only formal courses and units but also extracurricular activities both in and out of school. The counselor is stationed at the crossroads of student and community needs. What is he doing to help integrate these needs through continual curriculum revision?     

Freud,His Illness,and Ourselves

The history of Freud's illness shows that he tried to avoid confrontation with it, and to treat it as unimportant. In his personal letters, the ill body remains outside-as another person, "Konrad," not he himself-and it is not taken into account. Particularly in Freud's correspondence with Ferenczi, we realize to what extent certain phenomena, especially depressive ones, he considered somatic, with a tendency to dismiss them, and this despite important occasional insights, such as about the role played by hate in psychosomatic illnesses. In the post-Freudian development, these topics have been more and more integrated in the dialogue, in the discourse between the analyst and the analysand.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

Pa/enser bien le corps: Cognitive and Curative Language in Montaigne’s <Emphasis Type="Italic">Essais</Emphasis>

Montaigne’s writings on medicine and the body have always been seen as part of a larger project about knowing ourselves. Responding to medical developments that seemed to privilege the anatomical body over the mind or the emotions, Montaigne defended the humoral link between mind and body. His essays make use of word play, puns, and anecdotes based on his own experience and reports from antiquity to counter what he perceived to be an increasingly one-sided approach to medicine. The result is a witty but nuanced argument for a more balanced outlook to what is now known as psychosomatic medicine.     

Psychosomatische Frauenheilkunde

The psychosomatic perspective offers the adequate method in face of the particularities of gynaecologic tasks and the expectations of women. Every patient comes not only with her illness as an acute and pressing issue into the treatment situation, but brings with her the sum of her previous experiences about her own body and about the medical institutions. The more conscious the doctor-patient-relationship, the less the risk of violations of personal limits which could trigger interpersonal conflicts and problems. The gynaecologist accompanies the normal bodily development, too. So she/he is an advisor in various life-periods as adolescence, pregnancy and childbirth or the menopause and senium. This very special relationship between doctor and patient offered the ground for integrating psychosomatics into gynaecological practice. The theoretical basis of psychosomatic gynaecology includes several models which can be applied to the one or the other illness. We assume a complex, multifactorial and interdependent event where biological, organic, psychodynamic and sociological factors are interacting. From historical and feminist perspective interesting developments can be traced about "what makes women ill". Psychosomatic symptoms may be seen as disturbances of interpersonal relationships on the background of the indidvidual life history and they may be understood as socially co-determinated. For the theory of psychosomatic gynaecology this means, that the bodily, social and psychic differences between women and men should be considered and theoretically reflected. In the future, specific strains of women as expressed in psychosomatic-gynaecological symptoms need further investigation.     

Courtland Lee: A Global Advocate for Counseling

Courtland Lee is exemplary in his accomplishments nationally and internationally. His academic achievements are notable in multicultural counseling and social justice. His leadership in counseling has been outstanding with his having served as president of the American Counseling Association, the Association for Multicultural Counseling and Development, and the International Association for Counselling. In this interview, Lee describes his development as a person, a counselor, and a counselor educator.     

Counselor values—Client freedom

A framework for an approach to counseling which respects the freedom of clients and yet leaves them open to the consideration of different value systems is presented. The framework is based upon values shared by many counselors and a stage model of counseling compatible with different theoretical approaches. It is hoped that consciousness of shared values and continuing dialogue will lead to a greater commonality of values.Michael J. O'Brien is Professor of Psychology at Loyola University of Chicago. He is active in the undergraduate Applied Psychology Program where there is a dual emphasis on theory and practice. For eleven years he was director of the M.A. program in Counseling Psychology for religious workers. (It is now a part of the Institute of Pastoral Studies at Loyola.) His thinking on values has developed through the realization of the central part values in counseling. This article strives to synthesize devergent approaches to the question of values.     

Obsessive-Compulsive Disorder: The Process of Parental Adaptation and Implications for Genetic Counseling

Obsessive-compulsive disorder (OCD) has primarily pediatric onset and well-documented unique impacts on family functioning. Limited research has assessed the understanding that parents of children with OCD have of the etiology of the condition, and there are no data regarding potential applications of genetic counseling for this population. We recruited 13 parents of 13 children diagnosed with OCD from the OCD Registry at British Columbia Children’s Hospital, and conducted qualitative semi-structured telephone interviews to explore participants’ experiences with their child’s OCD, causal attributions of OCD, and perceptions of two genetic counseling vignettes. Interviews were audio-recorded, transcribed, and analyzed using elements of grounded theory qualitative methodology. Analysis revealed key components and contextual elements of the process through which parents adapt to their child’s OCD. This adaptation process involved conceptualizing the meaning of OCD, navigating its impact on family dynamics, and developing effective illness management strategies. Adaptation took place against a backdrop of stigmatization and was shaped by participants’ family history of mental illness and their child’s specific manifestations of OCD. Parents perceived genetic counseling, as described in the vignettes, as being empowering, alleviating guilt and blame, and positively impacting treatment orientation. These data provide insight into the process of parental adaptation to pediatric OCD, and suggest that genetic counseling services for families affected by OCD may help facilitate adaptation to this illness.     

人格维度、自我和谐及行为抑制与心身症状的关系

研究旨在通过实证研究建立人格维度、自我和谐、行为抑制和心身症状之间关系的结构方程模型。对600余名被试问卷测量的相关、回归和结构方程模型分析表明,人格维度可以直接和/或通过行为抑制和自我和谐对心身症状有着正向或负向的预测作用,而且自我与经验的不和谐、行为抑制和心身症状本身都可以作为心理健康的指标,它们之间又存在密切的相互关系     

Comparison of Rorschach anatomy responses from psychosomatic out-patients and a matched group of psychiatric controls.

35 out-patient Ss with demonstrable psychosomatic symptoms were matched with 35 psychiatric out-patients with "milder" forms of psychopathology, i.e., neurosis, personality disorders and latent schizophrenia. The psychosomatic group showed significantly more anatomy responses on the Rorschach but there was much overlap, leading to the conclusion that anatomy does not directly reflect simply psychosomatic disturbances but, rather, is associated with psychodynamics which tend to underlie psychosomatic illnesses.     

Eine streitlustige psychoanalytische Psychosomatik und die gegenseitige Analyse von Ferenczi und Groddeck

This article is the third part of an originally unplanned trilogy caused by the internal logic of the research process on psychosomatic theories. On the background of Freud’s difficulties with the illness and disease theory the fragmentation of the field of psychosomatic medicine has been described and presented in the two previous parts as an attempt to explain its tortuous developmental course. In the first part of this current paper the author tries to understand both the ideas and sociopolitical forces that were involved in the historical development of psychosomatic medicine. The scope of the field as well as the models used oscillated greatly. Psychoanalysis has played an important role in this development even if the mainstream psychoanalysts showed relatively little interest. Psychosomatics also required therapeutic approaches that were foreign to the accustomed psychoanalytical setting. Occasionally the influence of various physiological models was strongly displayed (e.g. Selye’s stress model and the influence of the immune system). The deepening of the psychological understanding is nevertheless due to original marginal psychoanalytic thinkers, such as Ferenczi and Groddeck. Under the influence of Ferenczi the unconventional search was completed by Balint to some extent either through development of the psychotherapeutic technique or by the influence of listening to the doctors in their interaction with patients.     

The prostitutes' syndrome

When female patients, at critical periods in their lives, receive suggestions regarding promiscuous and unacceptable behavior, they may at a later time in life act upon these suggestions. However, involvement in promiscuous sexual behavior results in guilt, which will often be seen clinically in the form of depressive neuroses or psychosomatic illness. Several case histories are presented, and implications for treatment are discussed.M.D. is a psychiatrist in private practice in Memphis, Tennessee, maintaining an active inpatient and outpatient practice of psychotherapy.With Dr. Sexton, he maintains a private practice in Memphis.     

Mothers’ Perspectives on Their Child’s Mental Illness as Compared to Other Complex Disorders in Their Family: Insights to Inform Genetic Counseling Practice

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.     

Spiritual Wellness for Clients With HIV/AIDS: Review of Counseling Issues

The epidemic of HIV/AIDS has resulted in an increasing population of individuals in need of counseling services: persons living with AIDS, as well as family, friends, and caregivers. The relationship between HIV/AIDS clients' counseling and spiritual issues is demonstrated by a review of salient literature. Three broad themes are used: terminal illness issues such as post-death existence and existential meaning of life, religious disenfranchisement from society or families of origin, and multicultural spiritual and religious issues. Practical recommendations for counselors and research implications are included.     

Panic as a form of foreclosed experience

Following a discussion of panic states and their relationship to psychosomatic illness and related disorders, the author presents an extended clinical vignette in which he initially viewed the patient's intense anxiety as a manifestation of repressed conflict and, accordingly, used verbal interpretations as the principal mode of intervention. After this approach did not prove effective, the analyst began to make use of nonverbal interventions consistent with his emerging understanding of the patient's distress as a manifestation of the foreclosure (de M'Uzan 2003) and relegation to the body of undreamable experience (Bion 1962).