A family system perspective on custody and adoption

This paper will define the conceptual models of an internalized family image and an external psychological family as derived from psychoanalytic and family therapy studies, and relate these models to several issues impinging on custody, adoption, and foster care. Several suggestions based on these models and illustrated by clinical material will be presented which, if applied by families, and mental health, social, and legal authorities, can facilitate the creation of a psychological family, or at least an ambiance imbued with the concepts of a psychological family, for use in the construction of a family image by unrooted children.Dr. Sonne is Clinical Professor of Psychiatry and Human Behavior, Jefferson Medical College; Visiting Clinical Professor of Psychiatry, Hahnemann Medical College; Emeritus Director Clinical School, Family Institute of Philadelphia; Senior Attending, Institute of the Pennsylvania Hospital.     

Transference and the idea of God

While many factors influence the course of therapy, based on empirical evidence a strong case can be made for the importance of religious beliefs influencing the process of transference. During a ten-year period of private psychiatric practice, the senior author saw 353 patients suffering from anxiety and neurotic depression. The form of treatment was individual, dynamic, psychoanalytically oriented psychotherapy with occasional use of psychotropic drugs. Forty percent of the patients who were seen were Catholic; forty percent were Protestant; and twenty percent were Jewish.Protestants, Catholics, and Jews bring differing conceptions of God to the transference phenomenon in individual psychotherapy. Basing findings on extensive clinical evidence, this study seeks to explain why this occurs, and the need for the psychotherapist to be aware of religious factors that influence the course of psychotherapy.He is Associate Clinical Professor of Psychiatry at the Medical College of Wisconsin in Milwaukee and Associate Professor at the Institute of Psychology of the Pontifical Gregorial University in Rome, Italy.     

Ministers’ Perceptions of Depression: A Model to Understand and Improve Care

While depression is a significant worldwide health problem, fewer than half of individuals seek care. Faith-based communities may play an important role in improving the knowledge of and linkage to depression care. Focus groups of Caucasian and African-American clergy were conducted to explore these issues. Using a grounded theory approach five themes emerged, including explanatory models of depression, barriers and facilitators to care, and recommendations for involving religious communities. A model of depression care pathways was constructed that integrates secular and spiritual approaches. The findings highlight the need for targeted interventions to build trust between clergy and mental health professionals. Teresa L. Kramer, Ph.D., is Chief Psychologist and Associate Professor of Psychiatry in the College of Medicine, University of Arkansas for Medical Sciences in Little Rock. She has conducted research in child, adolescent and adult mental health assessment, outcomes, and quality of care. Her current research on adolescent depression is funded through a Research Career Development Award from the National Institute of Mental Health. She is currently developing faith-based programs to educate ministers and their congregations about depression-related illness. Dean Blevins, Ph.D., teaches in the Department of Psychiatry, College of Medicine, at the university and is associated with the Center for Mental Health & Outcomes Research, Central Arkansas Veterans Healthcare System, and the South Central Mental Illness, Research, and Clinical Center in Little Rock. Terri L. Miller, Ph.D., also teaches in the Department of Psychiatry. Martha Phillips, Ph.D., is at the Department of Human Services in Little Rock. Vanessa Davis and Billy Burris are employed at the Division of Behavioral Health Services, also in Little Rock.     

Irrational beliefs and the anxiety disorders

This study investigated the levels of irrationality reported by a clinical sample of anxiety disorder patients, including simple and social phobics, panic disorder patients, agoraphobics, and obssessive compulsive patients. The levels of irrationality were compared between these groups and a group of normal control subjects, using the Rational Behavior Inventory (RBI). Agoraphobic patients were significantly less rational than control subjects on six of the RBI's subfactors and the total score of the Inventory. Patients in all diagnostic categories except simple phobia were significantly different from control subjects on the projected misfortune subfactor, and patients in all categories except simple phobia and panic disorder were significantly different from controls on the total RBI score. There were only four instances where patients in anxiety disorder categories significantly differed from each other in levels of irrationality. The implications of these findings, methodological limitations, and directions for future research are discussed.Joseph A. Himle, ACSW is a Clinical Social Worker at the Anxiety Disorders Program, Department of Psychiatry, University of Michigan. David P. Himle, Ph.D. is an Associate Professor of Social Work at the University of Michigan. Bruce A. Thyer, Ph.D. is an Associate Professor of Social Work, University of Georgia and Faculty Fellow at the University Affiliated Program. He is also an Associate Clinical Professor at the Department of Psychiatry and Health Behavior, Medical College of Georgia.     

Unheard Voices: Experiences of Families Living with HIV/AIDS in India*

This study was aimed at understanding the impact of HIV on the family system in the Indian context. A sample of 20 families caring for a relative living with HIV/AIDS (PLWHAs) was recruited from a HIV counseling clinic at the National Institute for Mental Health and Neuro Sciences and a respite home for PLWHAs in Bangalore City in southern India. Qualitative data were collected from these families using a semi-structured interview guide and recorded in the form of narratives. Analysis of these data revealed the following themes: Stigma and discrimination; disclosure; changes in family functioning; financial difficulties; fears of the family; and helplessness. Each theme was presented in detail and implications for intervention to help these families and their PLWHAs discussed. V.A.S. Krishna, PhD, MPE, Fogarty Funded Post Doctoral Fellow, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63108 (krishnavas@epi.wustl.edu). Ranbir S. Bhatti, PhD, Professor of Family Therapy, Montfort College, Bangalore, Former Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (ranbirbhatti@yahoo.com). Prabha S. Chandra, MD, Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India 560029 (prabhachandra@rediffmail.com). Srilatha Juvva, PhD, Reader, Department of Family and Child Welfare, Tata Institute of Social Sciences (TISS), Mumbai, India 400088 (juvvas@tiss.edu). *The authors would like to thank all the PLWHAs and their family members for volunteering to be part of this study. Post-doctoral Fellowship support for Dr. V.A.S. Krishna from Fogarty Grant—TW05811 (LB Cottler, PI).     

Modified group therapy for psychotic and depressed patients

This paper describes a group treatment program for chronically ill patients which has been found to be more economical than traditional modalities of treatment of such patients and to minimize transference and countertransference problems. Technical guidelines and the theoretical rationale are discussed, as are the therapeutic factors in such a group. Case vignettes are given to illustrate both the group process and the individual patient's use of the group.The authors are deeply grateful to the residents of the department who, as cotherapists, shared in the planning and work of the coffee lounge groups. Invaluable to us also were the interest and ideas of Dr. Donald Miller who served as a consultant to this project.This is a revised version of a paper presented at Grand Rounds, Montefiore Hospital and Medical Center, Bronx, N.Y. in September, 1975.Miss Emery is, and Mrs. Levitan was, a social worker at Montefiore Hospital and Medical Center, Bronx, N.Y. Mrs. Levitan was formerly Principal Associate in Psychiatry (Social Work), Albert Einstein College of Medicine. Dr. Gadlin is Director of the Group Therapy Training Program at Montefiore Hospital and Medical Center, and Assistant Professor, Albert Einstein College of Medicine.     

II. Symposium für Empirische Forschung in der Forensischen Psychiatrie, Psychologie und Psychotherapie am 25. und 26. Oktober 2012 in Hamburg

The Second Symposium for Empirical Research in Forensic Psychiatry, Psychology and Psychotherapy was held on 25th–26th of October 2012 in Hamburg. The symposium offers young scientists in the field the opportunity to present their research studies. In total 15 papers were presented at the symposium which will be briefly described in this article. The following four topics were discussed:

1. Innovative measurement tools for violent and sexual offenders,
2. Risk assessment tools for violent and sexual offenders,
3. Physiological and neuropsychological assessment of violent and sexual offenders,
4. Treatment approaches for violent and sexual offenders.

The conference is organized annually either by the University Medical Center Hamburg-Eppendorf (Institute for Sex Research and Forensic Psychiatry), the Saarland University Medical Center (Institute for Forensic Psychology and Psychiatry) or the Asklepios Medical Center Göttingen (Ludwig-Meyer-Institute for Forensic Psychiatry and Psychotherapy). The best three research presentations are honoured with the Ludwig Meyer Award of the Asklepios Psychiatry Niedersachsen GmbH, the Eberhard Schorsch Award of the German Society for Sex Research and the Hermann Witter Award of the Southwest German Academy of Forensic Psychiatry. The proceedings of the conference are expected to be published in autumn 2013 by the Wissenschaftliche Verlagsgesellschaft Berlin.     

Reflections on using group therapy as a treatment modality—Why,how, for whom,and when: A guide to clinicians,supervisors, and instructors

This paper emphasizes the potential of group forces for benefit or harm in group therapy as well as human development. Clinical, experimental-historical, and experiential evidence is cited in order to assess methods for harnessing group forces effectively. Ways in which group therapy is particularly valuable for enabling individuals to develop interpersonal skills, resist group pressure, improve communicative skills, deal with problems of inferiority and pessimism, be responsive to feedback, deal with resistance and transference, and manage problems in the working through phase of therapy are focused on. Another emphasis is on how group therapy technique differs from, supplements, and improves on the effectiveness of individual therapy alone. Crucial problems of patient selection and placement are explored, as is the idea that doing group therapy helps the therapist deal with countertransference problems and increases overall effectiveness and personal growth.Dr. Fenster is Professor of Psychology and was founding Chairman of the Psychology Department at John Jay College of Criminal Justice. This paper was written while he was on sabbatical leave and serving as Coordinator of Group Therapy in the Psychiatry Department at Brookdale Hospital Medical Center.     

Media reviews

Abstract

Dr. H. James Lurie, reviewer of the videotape “Sybil's Plight” is Clinical Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, in Seattle. His expertise in the development of training and educational audio-visual materials, as well as his long teaching experience with both primary care physicians and family therapists, makes his assessment especially valuable. The importance of family concepts in the treatment and management of patients and families who must cope with chronically disabling medical illnesses has reached a new level of concern, and has resulted in renewed interest in the fields of consultation-liaison and family medicine.

—I.A.

Sibyl's Plight, black and white videotape, Library, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213.     

In-depth continuing education for clergy in mental health: Ten years of a large scale program

This paper describes an interdenominational continuing education program for parish clergy in the mental health dimension of pastoral work. The program is in its eleventh year and has reached a significant proportion of the clergy, representing a wide range of religious, ethnic, and socio-economic groups, within a large urban community. The format utilizes case-oriented, small group discussion focused on the clergy's own pastoral work. It emphasizes preventive educational activities along with the development of basic counseling and mental health skills. Ongoing evaluation indicates that the program constitutes an effective, economical, and flexible tool for continuing education with clergy.Dr. Wasman is Assistant Professor of Psychology, Dr. Corradi is Assistant Professor of Psychiatry, and Dr. Clemens is Assistant Clinical Professor of Psychiatry in the Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, 44106. This work has been supported in part by the National Institute of Mental Health Grant MH11929 and by grants from the Cleveland Foundation, The Grant Foundation, Inc., and The Cuyahoga County Board of Mental Health and Retardation. The authors wish to thank Dr. Milton Matz, the current Director of the Pastoral Psychology Service-Institute, Case Western Reserve University, for his advice and cooperation in preparing this article.     

Behavioral family therapy symposium

Abstract

The Albert Einstein College of Medicine/Montefiore Medical Center (AECOM/MMC) Department of Psychiatry and the Gralnick Foundation/ High Point Hospital jointly sponsored the Second Annual Einstein Symposium on November 7, 1985 commemorating the centennial year of Yeshiva University. The symposium, focusing on Behavioral Family Therapy, opened with the presentation of the Einstein Award for Research in Psychiatry to B. F. Skinner by Herman van Praag, Chairman of the Department of Psychiatry. After Skinner's discussion of the role of emotions in behavior analysis, several nationally renowned clinical researchers in the field of behavioral family therapy presented findings of their recent work.     

Inpatient cognitive therapy: Detours,potholes, and roadblocks along the routes of progress

Developing innovative treatment approaches for psychiatric inpatient settings is an emerging area of interest. This paper delineates the detours and circuitous paths treatment with difficult patients often takes. Differences between typical outpatient and inpatient care are described and the obstacles to cognitive therapy that inpatients present are discussed. The role of case conceptualization is emphasized as a way to promote increased effectiveness. Finally, methods for maximizing therapeutic opportunities with inpatients are suggested.Robert D. Friedberg, Ph.D. is a staff psychologist on the Cognitive Therapy Unit at Mesa Vista Hospital and is an adjunct faculty member at the California School of Professional Psychology.Raymond A. Fidaleo, M.D. is the Clinical Director of the Cognitive Therapy Unit at Mesa Vista Hospital. He is also the Medical Director of the Cognitive Therapy Institute as well as an Associate Professor of Psychiatry at the University of California-San Diego School of Medicine. Dr. Fidaleo engages in private practice in San Diego, CA.Michele M. Mikules, M.A. is a predoctoral psychology intern with the United States Navy at Balboa Hospital, San Diego, CA.     

Identity: recent findings and clinical implications

After a review of foundational contributions to the concept of identity, including Erikson's, the author discusses the research methods and findings of the Personality Disorders Institute of the Joan and Sanford I. Weill Medical College of Cornell University regarding the concepts of normal identity and identity diffusion, toward an elucidation of the psychopathology of personality disorders--their etiology, diagnosis, and treatment. The application of an object relations theory model to analyze the development of identity clarifies the relationship of individual identity with the social and cultural frame that influences identity formation and may amplify the effects of pathological identity development. Detailed excerpts are presented from a diagnostic structural interview at the Personality Disorders Institute.     

Book review

Abstract

Chronic Illness: From Experience to Policy, edited by S. Kay Toombs, David Barnard, and Ronald A. Carson. Bloomington, IN: Indiana University Press. 1995. 221 pp. ISBN 0-253-36011-0. $27.95 hardback. Reviewed by Lee Combrinck-Graham.

S. Kay Toombs is Assistant Professor of Philosophy at Baylor University and author of The Meaning of Illness.

David Barnard is Professor and Chairman of the Department of Humanities at Pennsylvania State University College of Medicine. He is coauthor of Nourishing the Humanistic in Medicine: Interactions with the Social Sciences.

Ronald A. Carson is Professor and Director of the Institute for the Medical Humanities at the University of Texas in Galveston. He is coeditor of Medical Humanities Reviews.

Lee Combrinck-Graham is a Child and Adolescent Psychiatrist, Behavioral Health Medical Director of Oxford Health Plans, and Editor of Children in Family Contexts and Children in Families at Risk. She is the author of Giant Steps: Therapeutic Innovations in Child Mental Health.     

Women who lead

Summary This essay reviews aspects of historical and cultural changes that now permit women increasing opportunities to lead both women and men. Women assuming leadership responsibilities undergo psychic reorganization, reworking their personal histories and their modes of interaction. The author challenges women who inhibit their leadership potential to scrutinize their attitudes and to consider the implications for the next generation of women. Presented at the American Academy of Psychoanalysis Seminar Series: Clinical Advances in Dynamic Psychotherapy, October 30, 1994, New York University Medical Center Chestnut Lodge Hospital in Rockville, MD. She teaches at the Washington Psychoanalytic Institute, Walter Reed Army Hospital, the Uniformed Services University of the Health Sciences and the Washington School of Psychiatry. She coordinates a Washington School of Psychiatry study group with Maurine Kelly, Ph.D., and Tybe Diamond, LCSW, “Women’s Contributions to Psychoanalysis,” where many of the ideas in this paper were discussed.     

Behavior modification and human rights: A legacy of Edward Stanton Sulzer, 1930-1970

Edward Stanton Sulzer was born in New York City on June 4, 1930. He attended school in Laureltown, N.Y., until the age of 15, when, after two years of high school, he was admitted into the University of Chicago. Leaving prematurely due to his mother's death, he returned to New York to work in film production. Sulzer completed his undergraduate work at the City College of New York, studying film production and psychology. In 1953 he entered the doctoral program in clinical psychology at Teachers College, Columbia. Spending two years in the Army during his graduate training, his work was completed in 1958. He then joined the faculty of the Upstate Medical School of the State University of New York, Department of Psychiatry, moving on two years later to the Psychiatry Department at the University of Minnesota. In 1965 Sulzer moved to assume the directorship of the Behavior Modification Program, in the Rehabilitation Institute at Southern Illinois University, where he remained until his death on February 28, 1970.In observance of the 10th anniversary of the death of Edward Stanton Sulzer, these reminiscences are presented. They describe how an individual psychologist could affect the professional and personal lives of many. Edward Sulzer is described in terms of the environment that shaped his values, how they affected the actions of his students and clients, and how they are reflected in current social policy. The account leads to a conclusion that the actions of single individuals may influence the course of human events.     

The rationing of health care: A doctor's dilemma

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital—Cornell Medical Center in March 1991.The Rev. Curtis W. Hart, M.Div. is Director of Pastoral Care and Education at the New York Hospital—Cornell Medical Center.The Rev. Paul Conner, O.P., is Associate Professor and Director of the Master's Program in Public Health Care Ethics at New York Medical College. Larry Rasmussen, Th.D., is Reinhold Niebuhr Professor of Social Ethics at Union Theological Seminary in New York. Dr. Harlan J. Wechsler is Rabbi of Congregation Or Zarua and Visiting Professor of Philosophy at Jewish Theological Seminary in New York.     

A look at social support patterns

The issue of how to provide support for patients with a life-threatening illness continues to be a problem for pastors and chaplains. The authors discuss the significance and reasons for looking at the present day social support patterns as an unnatural problem. Unless the unnatural nature of support in the modern medical setting is understood pastors and chaplains can miss the target on answering the question of how to provide support. The authors conclude the article by addressing this question from the position of reserving the unnatural nature of providing support.Dr. Bergen is Professor of Psychiatry, Dartmouth Medical School, Hanover, NH 03755. Dr. Nelson is affiliated with the Chaplain Service, Veterans Administration Center, White River Junction, VT 05001 and Assistant Professor of Clinical Psychiatry, Dartmouth Medical School.     

The suicidal risk in severe personality disorders: differential diagnosis and treatment.

This article describes the clinical approach to patients with severe personality disorders who present suicidal intention and behavior, developed at the Personality Disorders Institute of the Department of Psychiatry at Cornell University Medical College and the Westchester Division of the New York Presbyterian Hospital. It describes the diagnostic evaluation of patients' suicidal potential, personality disorder, and the presence or absence of a spectrum of regressive illness. The analysis of the combined features in these three symptomatic domains determines alternative strategies of psychotherapeutic and psychopharmacological interventions. Within these strategies, transference-focused psychotherapy is described as a specific psychodynamic psychotherapy geared to treat characterologically based suicidal and parasuicidal tendencies in the context of the treatment of the patient's personality disorder.