Elegiac Poetry: A Pastoral Resource with Complicated Grief

This essay argues that elegiac poetry, the poetry of mourning, may be a resource for pastoral care with complicated grief. It builds on Freuds distinction between mourning (normal grief) and melancholia (complicated grief), particularly as appropriated by French literary critic and psychoanalyst Julia Kristeva. It makes the case for elegy as a locus for externalizing a lost object which, in complicated grief, has been internalized as part of the bereaved persons self and which is not only grieved but also treated ambivalently if it is not hated. Drawing on the suffering God motif in Christian theologies of the cross, theological reflections supplement psychological arguments.     

Families Leaving Family Therapy After One or Two Sessions: A Multiple Descriptive Case Study

A multiple case study design was used to discover something of the experiences of families, therapists, and members of the reflecting team of the first and or second session of family therapy in an attempt to answer questions regarding why families drop out after only one or two sessions. It was found that the families attending these sessions found them to be ineffective in assisting them to re-author the stories of their lives. There many reasons for this being the case.     

From neurotic guilt to existential guilt as grief: the road to interiority, agency, and compassion through mourning. part I

This study proposes through a case illustration that psychoanalytic patients who can process both aggression and loss through a mourning process are able to free themselves from pathological self attack when the object relations work of attachment, psychic holding, and separation transpires. In the case of Helen discussed here, transformation through a “developmental mourning process” results in the evolution of powerful psychological capacities for interiority, self agency, and interpersonal compassion. This developmental mourning process is endowed with the assimilation and psychic fantasy symbolization of aggression.Susan Kavaler-Adler, Ph.D., ABPP, is Founder and Executive Director, Training Analyst, Faculty Member, and Supervisor at the Object Relations Institute for Psychotherapy and Psychoanalysis, New York.     

From Neurotic Guilt to Existential Guilt as Grief: The Road to Interiority, Agency, and Compassion Through Mourning. Part II

This study is a continuation of an article that was published in the previous issue of The American Journal of Psychoanalysis (Volume 66, Number 3, September 2006). The case of Helen is illustrated in terms of the analysand’s developmental mourning, countertransference, interiority, antilibidinal ego, and transformation of aggression into self-agency.Susan Kavaler-Adler, Ph.D., ABPP, is Founder and Executive Director, Training Analyst, Faculty Member, and Supervisor at the Object Relations Institute for Psychotherapy and Psychoanalysis, New York.     

A Professor's Experience With Loss: An Autobiographical Case Study

The purpose of this article is to present an autobiographical case study chronicling a psychology professor's experience with grief and the loss of her father during the early stages of her academic career. The article highlights the obstacles faced in dealing with anticipatory grief but also demonstrates how clinicians and researchers may use adverse life circumstances to develop research and applied programs centered around their experiences. Rooted in Viktor Frankl's work on logotherapy, the author demonstrates how traumatic experiences can help psychologists find meaning and purpose in their work. Directions for future research focusing on larger scale populations are addressed.     

Mapping grief: A study in practice using a quantitative and qualitative approach to exploring and addressing the range of responses to loss

The Adult Attitude to Grief (AAG) scale was devised for an earlier study (Machin, 2001) to test the validity of a concept of loss, which proposed that grief reactions fall broadly into three categories — ‘overwhelmed’, ‘balanced’ and ‘controlled’. There was statistical support for the proposed differences but the AAG scale, more importantly, provided insight into the diverse reactions taking place in individual bereaved respondents. This paper describes a second study undertaken to examine the clinical usefulness of the AAG scale with clients receiving help within the Psychological Services Operating Unit of the North Staffordshire Combined Healthcare (NHS) Trust. The scale has been used both in its original form with bereaved clients and in a modified form with clients having distress symptoms associated with other losses, such as relationship breakdown or the onset of chronic illness. The use of the AAG scale in this clinical setting suggests that, both as an assessment tool and as a cue for therapeutic dialogue, it provides a promising way of mapping the general and particular characteristics of response to loss in individual clients. Consideration is also given to varying therapeutic approaches needed to help clients regain the equilibrium disturbed by their grief.     

A Case Study of a Consultation Using the Two-Circles Method With a Junior High School Teacher1

To resolve various problems in schools, a “school as a team” approach for teachers to cooperate with other professionals as well as other teachers has been introduced in Japan. Consultations are one method school counselors use to support teachers as a team. This study examines a consultation case using the two-circles method based on narrative therapy and discusses the possibilities and challenges when using this method in Japan. Using a case study analysis, the author found that the two-circles method contributed positively to the consultation by externalizing the problem, gathering local knowledge, visualizing the participants' narratives, and applying scaffolding to develop the consultee's story. The results suggest that this method could be useful for achieving the “school as a team” approach because it combines teachers' narratives to resolve problems in schools.     

The Use of Hermeneutics in the Criminological Interpretation of Forensic Documents: A Case Study

This study explored the use of hermeneutics to retrospectively construct a criminological assessment. The data are archival records on a convicted woman (Mrs B: not real name) for the murder of her husband. The data are analyzed using a Ricoeurian narrative identity analysis framework. The results indicate that Mrs B has a history of violent behaviour and is manipulative and does not accept responsibility for her behaviour, suggesting that hermeneutic inquiry is appropriate for criminology assessments.     

Preliminary Findings from a Qualitative Study of Trauma Survivors in Treatment: Changes in Personal Narratives

This article seeks to document the characteristics and themes of later trauma recovery using a grounded theory analysis of interviews with trauma survivors enrolled in outpatient treatment. Little research exists that speaks to patients’ own accounts of the process of trauma recovery. Such accounts might elucidate how psychotherapy helps survivors make and remake meaning of their lives, their experience of traumatic events, and the resources they might call on in psychotherapy to secure recovery. This study examined narrative material gathered in a series of interviews with trauma survivors (n?=?14) who had been in treatment for an average of 8 months and could be described as in a later phase of the recovery process. Two significant themes emerged from the analysis: (a) greater coherence to the trauma narrative, and (b) the emergence of a more reflective and observational stance with respect to one's history. Implications for trauma-informed therapy are discussed.     

Conceptualising Decadent Technology: A Case Study of Path Dependence in Radiotherapy

Abstract

Large-scale investments in health technologies often have limited evidence for effectiveness when first introduced. Nevertheless, professional and public discourses often present the advantages of such investments, with unknown risks, as necessary and entailing significant improvement. Such discourses are evident with the introduction of the Linac Adapted Conebeam Imager (LACI), introduced to improve the accuracy of radiotherapy treatments. From one perspective, the introduction of such technologies can be considered to be decadent since there is limited, if any, evidence of improvement of current standards and procedures, yet they are promoted as the latest and best technologies for solving societal problems. Connecting the concepts of decadence to those of path dependence, through the case of the LACI, enables the exploration of the ‘technical interrelatedness’ of technological changes. Building on the concept of path dependence, it is possible to demonstrate how introducing a closely related technology does not only become a low-risk course of action. Rather change is demanded (but not determined) as well as potential alternative systems being obscured. With decadent technologies, any future changes are not only dependent upon past introductions; but also they create a need for future changes. Such a view demonstrates how these technologies may not necessarily offer any improvements, but rather contribute to the creation of ongoing demand for unproven technologies. As a result they may encourage the introduction of increasingly complex technologies.     

Family Dynamics and AIDS Phobia: A Case Study

The author introduces and defines AIDS phobia. He illustrates the hypochondria type of AIDS phobia from a combined individual, couple, and family treatment perspective. He describes the treatment process and outcome after an effective countertransference-based intervention, connects the individual manifestations of the index patient's illness to the family dynamics, and concludes with an analysis of the multigenerational contributions to the individual's psychopathology.     

Irrational Beliefs and Basic Assumptions in Bereaved University Students: A Comparison Study

Several authors have argued that the loss of a loved one triggers changes in people's beliefs and assumptions, and that these changes play a role in emotional problems after bereavement. The present study was an attempt to investigate these hypotheses. Thirty students who had been confronted with the death of a parent or sibling, on average nearly 3 years ago, were compared with 30 nonbereaved matched control subjects on different measures assessing basic assumptions and irrational beliefs as defined in REBT. In line with the notion that bereavement has an impact on people's basic assumptions, results showed that bereaved students had a less positive view of the meaningfulness of the world and the worthiness of the self than their nonbereaved counterparts. Also, in accord with the notion that the tendency to think irrationally is likely to increase after a stressful life event, the bereaved were found to have higher levels of irrational thinking. Furthermore, it was found that the degree to which bereaved individuals endorsed general as well as bereavement-specific irrational beliefs was significantly associated with the intensity of symptoms of traumatic grief. Conversely, none of the basic assumptions was associated with traumatic grief. Beliefs reflecting low frustration tolerance explained most variance in traumatic grief. Clinical and theoretical implications of these findings are discussed.     

Life Design Career Counselling with an Abandoned Adolescent: A Case Study

This article describes the value of life design counselling with an abandoned adolescent female. The participant was selected purposively from among a group of abandoned adolescent females who had expressed a need for career counselling. The life intervention comprised two 90-minute sessions per week over a period of a month. Life design data included collage, family constellation, life line, career style interview, asset map and life chapters. Following the intervention, the participant demonstrated career adaptability and an eagerness to take an active part in her evolving life story. Life design counselling has potential to meet the career counselling needs of children with neglect and abandonment experience.     

Facebook as a Site for Inter-religious Encounters: A Case Study from Finland

The aim of this article is to analyse the social networking site Facebook as a possible platform for inter-religious dialogue. Building on a case study—an attack on a Buddhist temple in Turku, Finland, and the consequent interaction that took place online immediately following the attack—the article investigates the strengths and limitations of social networking sites such as Facebook for encountering and connecting with religious others. The ethnographic material—consisting of both Internet material and interviews with concerned parties—is discussed in close connection with current research on religion, social media, and discussions online. Themes that are highlighted include stereotypes and superficiality as assumed aspects of online conversations, the role of power in dialogue—both offline and online, and symbolic communicative actions and social networking sites.     

现代医疗回归人文关怀的路径——以京东中美医院为例

愈演愈烈的医疗纠纷带来了诸多值得研究的现实课题,也引发了医疗机构的许多深层次思考。在现代医疗呼唤人文关怀回归的背景下,京东中美医院以文化为路径,进行了一系列的有益尝试。以实录的形式记录了京东中美医院人文关怀的点滴细节,以期探求细节背后的文化根源。介绍了京东中美医院“人本、仁爱、公益”的文化理念和极具特色的医院行为文化,在医院发展过程中,重视医院文化的建设和发展,是让现代医疗回归人文关怀的有效路径。     

Treatment of Prostitution Using Integrative Therapy Techniques: A Case Study

This case study examines a pattern we believe to be common among female prostitutes: a woman (Bonnie) who, like most prostitutes, is a survivor of childhood sexual abuse. Bonnie's prostitution is part of the unconscious repetition compulsion common in trauma victims; by prostituting herself, Bonnie re-creates the scenario of sexual abuse that occurred during her childhood, while maintaining an illusion of control over the situation. We maintain that an effective approach to treatment for Bonnie is integrative therapy, a type of psychological counseling designed to address the major aftereffects of sexual abuse: dissociation from the body and sexuality in general; a profound sense of powerlessness; critically low valuation of the self; and mistrust and fear of intimacy. Bonnie's story shows the dynamics of both prostitute behavior and integrative therapy, providing an example we believe to be applicable far beyond this case study.     

Cognitive Processing Therapy Delivered in 5 Days via Telehealth to a Gay Latino Adolescent: A Clinical Case Study

Cognitive Processing Therapy (CPT) has been thoroughly investigated as an efficacious treatment for posttraumatic stress disorder (PTSD). However, for many, the barriers to receiving treatment in the traditional weekly, in-person format prevent engagement. Recent evidence suggests alternative modalities, such as telehealth, and condensed administration of treatment protocols may reduce barriers, increasing treatment completion. This case study reports the treatment of a gay-identifying adolescent Latino male who received 10 sessions of CPT over the course of 5 consecutive days (CPT-5). The patient experienced significant reduction in PTSD symptoms over the course of treatment, dropping below the clinical threshold for PTSD diagnosis by the 10th session. Treatment gains were maintained, and continued, 6 weeks posttreatment. Further, the patient reported marked reduction in suicidality and substance use. In conclusion, the administration of CPT-5 via telehealth holds promise as an effective evidence-based treatment for adolescents with PTSD, including those holding multiple historically marginalized identities, though further investigation through clinical trials is warranted.     

An Occupational Therapist's Interdisciplinary Approach to a Geriatric Psychiatry Activity Group: A Case Study

Occupational therapy has long recognized the usefulness of activity groups to promote functional outcomes for clients in mental-health settings. An occupational therapist used an interdisciplinary approach (working with a psychiatric nurse practitioner and a manual arts therapist) to conduct a biweekly geriatric psychiatry activity group. A case study is presented to demonstrate the success and longevity of the interdisciplinary activity group. Each clinician contributed unique skills to provide occupation which provided positive outcomes for the clients. Practically, the employing of different disciplines allowed group coverage for each other in times of cost-containment and limited resources.