Clinical significance of serum phenytoin level]

Phenytoin serum concentrations in 115 epileptics treated on an inpatient basis showed, in two groups, only relatively weak correlation with the dosage used. The range of variation was assigned a factor of 16. For individual patients there was observed a correlation between the dosage in mg/kg and the corresponding phenytoin serum concentration. The level of phenytoin serum concentration was not found to be related to the frequency of attacks. The effective phenytoin serum level showed interindividual differences and can be low as well as relatively high. Resulting from this is the need for determining, from the determination of serum concentrations, the effective serum concentration for each individual patient.     

Resistance revisited

It was a coincidence that I was asked to talk about resistance at Ground Rounds at the University of Texas, Department of Psychiatry, on the tenth anniversary of mailing the first version of Death of Resistance to a journal in 1979. Although the paper was subsequently rejected 17 times and revised six times, it was eventually published inFamily Process (de Shazer, 1984). I still insist that the concept of resistance was a bad idea for therapists to have in their heads.This paper was presented April 14, 1989, at Ground Rounds, University of Texas, Southwest Medical Center, Department of Psychiatry, Dallas, Texas.     

Restructuring revisited

The Gestalt psychologists proposed that restructuring ( Umstrukturierung ) is an essential process in thinking. This concept has not been integrated into the information processing theory of problem solving. As a preparation for such an integration, the Gestalt writings about restructuring in problem solving are summarized in a set of principles. Critical scrutiny shows that some Gestalt principles are overstated; others have very weak empirical support. But the psychological reality of restructuring is not in doubt, in spite of the recent criticism by Weisberg and Alba (1982 a ). A unified theory of thinking should interpret restructuring in information processing terms, and explain the relation between restructuring and search.     

Reduction revisited

Abstract

This is a first tentative examination of the possibility of reinstating reduction as a valid candidate for presenting relations between mental and physical properties. Classical Nagelian reduction is undoubtedly contaminated in many ways, but here I investigate the possibility of adapting to problems concerning mental properties an alternative defmition for theory reduction in philosophy of science. The defmition I offer is formulated with the aid of non-monotonic logic, which I suspect might be a very interesting realm for testing notions concerning localized mental-physical reduction. The reason for this is that non-monotonic reasoning by defmition is about appeals made not only to explicit observations, but also to an implicit selection of background knowledge containing heuristic information. The flexibility of this defmition and the fact that it is not absolute, i.e. that the relation of reduction may be retracted or allowed to shift without fuss, add at least an interesting alternative factor to current materialist debates.     

Countertransference revisited

A female patient of mine recounts her week. I listen with interest, waiting for her to arrive at particular conclusions. She has suffered a great deal and still does, but prefers not to dwell on it. My interest turns into patience as she continues to talk but circumvents her discontent. She is adroit at avoidance, but easily offended when I point such things out. "I'd better wait" I think. I grow more aware that I must encourage her digressions. I feel frustrated. Getting further and further away, she skirts the issue with supple grace, then strays off into tangentiality. I forget her point and lose my focus, then get down on myself. The opportunity is soon gone. I glance at the clock as her monologue drones on into banality. I grow more uninterested and distant. There is a subtle irritation to her voice; a whiney indecisive ring begins to pervade my consciousness. I home in on her mouth with aversion, watching apprehensively as this disgusting hole flaps tirelessly but says nothing. It looks carnivorous, voracious. Now she is unattractive, something I have noticed before. I forget who my next patient is. I think about the meal I will prepare for my wife this evening, then glance at the time once more. Then I am struck: Why am I looking at the clock? So soon? The session has just begun. I catch myself. What is going on in me, between us? I am detached, but why? Is she too feeling unattuned, disconnected? I am failing my patient. What is her experience of me? I lamentingly confess that I do not feel I have been listening to her, and wonder what has gone wrong between us. I ask her if she has noticed. We talk about our feelings, our impact on one another, why we had lost our sense of connection, what it means to us. I instantly feel more involved, rejuvenated, and she continues, this time with me present. Her mouth is no longer odious, but sincere and articulate. She is attractive and tender; I suddenly feel empathy and warmth toward her. We are now very close. I am moved. Time flies, the session is soon over; we do not want it to end.     

Eclecticism revisited

Eclecticism as a counseling point of view has experienced a history of contempt and skepticism mixed with sporadic enthusiasm. A viewpoint described here as emerging eclecticism has promise as a counseling position for the practitioner faced with the needs to be comprehensive, flexible, and open in his theory and method. The emerging eclectic is a skilled observer in the scientific behavioral tradition; he knows the history of counseling theory and contemporary views; he is aware of his unique style and counseling setting. From these he forges his own comprehensive evolving view of behavior change.     

Restructuring revisited

The central concept of the information processing theory of problem solving is search. In contrast, the central concept of the Gestalt theory of problem solving is restructuring. Both concepts express important aspects of human thinking. A theory is presented which interprets restructuring and the related concept of insight in information processing terms. It is hypothesised that restructuring is a change in mental representation which affects the applicability of problem solving operators. Insight is hypothesized to occur when restructuring of the search space brings the goal state within the horizon of mental look-ahead.