Patients’ Perceptions of Risky Developments During Psychotherapy

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.     

Negotiating control: Patients’ experiences of unsuccessful weight-loss surgery

Interviews were carried out with 10 men and women who had undergone weight-loss surgery (WLS) up to 10 years ago and felt that it had failed. Seven had had a further successful procedure. Data were analysed using Interpretative Phenomenological Analysis. Weight regain following surgery was explained in terms of either the mechanics of the operation or with participants describing ways to ‘cheat’ as food continued to be used for emotional regulation. Everyone spoke of how surgery neglected their mind. Following the second successful surgery, participants described changes in both their eating behaviour and cognitions emphasising how their mind had been brought ‘in gear’ through the investment of two invasive procedures. Transcending all accounts was the mind/body relationship and the issue of control with attributions for both failed and successful surgery shifting from the self to the surgical mechanism as the participants negotiated the pathway between self-blame and responsibility and utilised conflicting frameworks in which the mind and body were either divided or united. Whereas failed surgery is characterised by a battle for control, successful surgery involves handing control over to their restricted stomachs or considering WLS as a tool to be worked with.     

Narcissism,Mania, and Analysts’ Envy of Patients

It is not uncommon for analysts to feel envy toward patients who have achieved significant rewards or acclaim for their work. Highly successful individuals in all fields often display both narcissistic and manic qualities. Analysts all too often destructively exaggerate these qualities into the realm of the diagnosed pathological as one way of dealing with this envy.     

Patients’ Pregnancies During Treatment: The Influence of the Analyst’s Psychology

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense—that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient’s expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30–45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients’ personality structure. Was the analyst’s psychology a common factor? The paper presents three quite different case examples and examines whether and how the author’s developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind “anonymity” and “neutrality,” as well as momentary countertransferences, to the real-life effects that we have in our treatments.     

Review of Ordering Don’t Resuscitate in Iranian Dying Patients

Making decision on not to resuscitate is a confusing, conflicting and complex issue and depends on each country’s culture and customs. Therefore, each country needs to take action in accordance with its cultural, ethical, religious and legal contexts to develop guidelines in this regard. Since the majority of Iran’s people are Muslims, and in Islam, the human life is considered sacred, based on the values of the community, an Iranian Islamic agenda needs to be developed not taking measures about resuscitation of dying patients. It is necessary to develop an Iranian Islamic guidelines package in order to don’t resuscitate in dying patients.     

Patients’ illness schemata of hypertension: The role of beliefs for the choice of treatment

It has long been believed that adult somatic complaints are associated with early family dysfunction. Yet, few studies have examined this hypothesis in community samples, where medically unexplained symptom complaints are estimated to be very common. Given the potential population-wide impact of subthreshold symptom complaints as well as questions about the extent to which findings with patient populations generalize to broader samples of community adults, the present study examines the influence of distal family factors on current adult somatic complaints relative to demographic and other psychosocial predictors. Results based on multiple linear regression analysis indicated that, after controlling for the other variables, family-of-origin functioning did not predict adult somatic complaints. However, self-reported symptoms of current depressed mood and low internal locus of control were significantly linked to somatic complaints (p?=0.001). These results lend support to questions about the generalizability of findings based on psychiatric groups to broader community samples, highlight the robust relationship between contemporaneous attributions of lower internal control, depressed mood, and somatic complaints, and suggest that early family environment may not be the most important focus of attention for health professionals providing care to adults in the community.     

Psychologists’ Evaluation of Bariatric Surgery Candidates Influenced by Patients’ Attachment Representations and Symptoms of Depression and Anxiety

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists’ evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult attachment and levels of depression and anxiety. Psychologists rated patients’ suitability for bariatric surgery using the Cleveland Clinic Behavioural Rating System (CCBRS), unaware of the results of the completed questionnaires. Attachment anxiety (OR = 2.50, p = .01) and attachment avoidance (OR = 3.13, p = .001) were found to be associated with less positive evaluations on the CCBRS by the psychologists, and symptoms of depression and anxiety mediated this association. This study strongly supports the notion that patients’ attachment representations influence a psychologist’s evaluation in an indirect way by influencing the symptoms of depression and anxiety patients report during an assessment interview. The clinical implications of these findings are discussed.     

Effect of Partners’ Disgust Responses on Psychological Wellbeing in Cancer Patients

The aim of this study was to explore quantitatively the relationship between disgust responses in cancer patients and their partners, and in turn their relationship to patients’ psychological well-being. We recruited 50 participants with heterogeneous cancer diagnoses and their partners from cancer-related groups (e.g., charities). Patients completed questionnaires to determine levels of disgust propensity, disgust sensitivity, self-disgust, and symptoms of anxiety and depression. Disgust propensity and sensitivity were also assessed in their partners. Partners’ disgust sensitivity was significantly positively correlated with cancer patients’ self-disgust, disgust propensity, and depression. Path analyses suggested that patients’ self-disgust plays a role in mediating the effect of partners’ disgust sensitivity on patients’ psychological well-being. This study provides the first quantitative evidence that psychological well-being in cancer patients is contingent on their partners’ sensitivity to disgust, and that patients’ self-disgust plays a mediating role. Focusing therapeutically on disgust responses could well be beneficial to people with cancer.     

Patients’ health or company profits? The commercialisation of academic research

This paper is a personal account of the events associated with the author's work at the University of Toronto's Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author's academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good.     

Patients’ Expectations of Healthcare Chaplaincy: A Cross-Sectional Study in the German Part of Switzerland

Identifying patients’ expectations of and need for healthcare chaplaincy is important in terms of appropriate intervention. Therefore, a sample of 612 patients from 32 general hospitals and psychiatric clinics in the German part of Switzerland was surveyed about their expectations of chaplaincy service. A principal component factor analysis of participants’ ratings found that the survey items fell into three distinct categories. These were the need for (1) emotional support, (2) help to cope with illness/disease, and (3) religious/spiritual assistance. Among the expectations, the need for emotional support was rated most important, followed by help to cope and, lastly, religious/spiritual assistance. Gender, religious denomination, general religiosity, and subjective health status significantly influenced these expectations. The results showed that fulfilling patients’ expectations increases their overall satisfaction with, and the importance they accord to the chaplain’s visit, as well as their confidence in the chaplain.     

Lynch Syndrome Patients’ Views of and Preferences for Return of Results Following Whole Exome Sequencing

Whole exome sequencing (WES) uses next generation sequencing technology to provide information on nearly all functional, protein-coding regions in an individual’s genome. Due to the vast amount of information and incidental findings that can be generated from this technology, patient preferences must be investigated to help clinicians consent and return results to patients. Patients (n?=?19) who were previously clinically diagnosed with Lynch syndrome, but received uninformative negative Lynch syndrome genetic results through traditional molecular testing methods participated in semi-structured interviews after WES testing but before return of results to explore their views of WES and preferences for return of results. Analyses of interview results found that nearly all participants believed that the benefits of receiving all possible results generated from WES outweighed the undesirable effects. The majority of participants conveyed that relative to coping with a cancer diagnosis, information generated from WES would be manageable. Importantly, participants’ experience with Lynch syndrome influenced their notions of genetic determinism, tolerance for uncertain results, and family communication plans. Participants would prefer to receive WES results in person from a genetic counselor or medical geneticist so that an expert could help explain the meaning and implications of the potentially large quantity and range of complicated results. These results underscore the need to study various populations with regard to the clinical use of WES in order to effectively and empathetically communicate the possible implications of this new technology and return results.     

Why Analysts Need Their Patients’ Transferences

This lead article to the Special Issue of the American Journal of Psychoanalysis, celebrating Charles Rycroft's life and work, was originally published in 1993. It is republished here with the generous encouragement and permission of Rycroft's widow, Jenny Pearson. This article is part of many, written by Rycroft on the psychoanalytic process and the role of projective identification in psychoanalytic training relationships. Here, Rycroft continues his thoughts in his previous paper, “On Ablation of Parental Images” (I965–1973), on the illusion of having created oneself. In the process of ablation of one's parental images and a search for replacement of them, the psychoanalyst is vulnerable to enact grandiose phantasies to become the new omnipotent parent in the analytic relationship. An overemphasis on the role of the transference can contribute to such phantasies of both analysts and their patients, interfere with the healthy growth of candidates, and become a process in which candidates surrender their healthy judgements and individual voices. The challenge in psychoanalytic training relationships is to reach a state of independence of thought, while at the same time achieve an ability to recognize the immense debt all analysts have to their analysts, teachers and even patients.     

Patients’ and Parents’ Perceptions of Appearance in Scoliosis Treated with a Brace: A Cross-Sectional Analysis

The perspective of trunk deformity is a matter of special concern for adolescent idiopathic scoliosis (AIS) patients. No research group has ever reported interviewing patients and their parents regarding differences in perception of body appearance in the course of Cheneau brace treatment. We aimed to investigate the level of agreement in the field of concerns and perceptions of spinal appearance in relation to brace- and scoliosis-related data between parents and female patients with AIS, treated with a Cheneau brace, by means of the Spinal Appearance Questionnaire-pl (SAQ-pl). In this cross-sectional study forty-one pairs of parents and female patients with AIS were asked to separately complete the Polish versions of the Spinal Appearance Questionnaire-pl patient form (SAQ-pl patient form) and the SAQ-pl parent form. Age of patients was 13.60 years SD 1.60 (range 10–17). Patients scored 2.70 (SD 0.60) and parents scored 2.70 SD 0.60 in the total score of the SAQ-pl. The study groups do not differ significantly in regards to the SAQ-pl results. The percentage of consistent answers on SAQ-pl items ranges from 34.10 % (item 20) to 78 % (item 8). Height, age and brace-wearing time per day, were significantly related to the differences in the patient-parent General perception of body shape (r _s  = ?0.51, r _s  = ?0.34, r _s  = 0.36, respectively). Parents and female patients with AIS have similar concerns and perceptions of spinal appearance. The discrepancies in General perception of spinal appearance between parents and AIS females decrease with age of patient. Parental emotional support may contribute to minimizing the risk factors of psychological impairment, especially in late adolescents with AIS.     

Patients’ Initial Doubts, Reservations and Objections to the ABC’s of REBT and their Application

This exploratory research set out to develop an initial framework and categorization scheme for understanding patients’ initial doubts, reservations and objections to the ABC’s of REBT and their application. 60 patients were asked to write down their doubts following a pre-therapy “Introduction to REBT” session. Subsequently, an emergent content analysis was carried out to identify main themes. The content analysis revealed five general categories, of which the two largest ones concerned theoretical doubts about the ABC model, and doubts about putting the ABC model into practice. Further sub-categorization revealed a variety of concerns that related to these categories. For example, a large proportion of doubts about putting the ABC model into practice were sub-categorized as concerning the perceived difficulty of doing so. In turn, this sub-category contained further sub-categories of difficulty-related beliefs.

Development of a Streamlined Work Flow for Handling Patients’ Genetic Testing Insurance Authorizations

Obtaining genetic testing insurance authorizations for patients is a complex, time-involved process often requiring genetic counselor (GC) and physician involvement. In an effort to mitigate this complexity and meet the increasing number of genetic testing insurance authorization requests, GCs formed a novel partnership with an industrial engineer (IE) and a patient services associate (PSA) to develop a streamlined work flow. Eight genetics clinics and five specialty clinics at the University of Michigan were surveyed to obtain benchmarking data. Tasks needed for genetic testing insurance authorization were outlined and time-saving work flow changes were introduced including 1) creation of an Excel password-protected shared database between GCs and PSAs, used for initiating insurance authorization requests, tracking and follow-up 2) instituting the PSAs sending GCs a pre-clinic email noting each patients’ genetic testing insurance coverage 3) inclusion of test medical necessity documentation in the clinic visit summary note instead of writing a separate insurance letter and 4) PSAs development of a manual with insurance providers and genetic testing laboratories information. These work flow changes made it more efficient to request and track genetic testing insurance authorizations for patients, enhanced GCs and PSAs communication, and reduced tasks done by clinicians.     

Patients’ Tests and Clinicians’ Emotions: A Clinical Illustration

Journal of Contemporary Psychotherapy - Psychotherapists can experience various kinds of emotions in response to their patients’ communications and behaviors over the course of therapy. These...     

Psychiatric Patients’ Evaluation of the Efficacy of Obeah vs. Western Medicine in Treating Their Mental Illness

This study sought to determine any potential benefits in psychiatric patients’ use of traditional medicine in their treatment. Participants were 51 Jamaican patients who self-reported on concurrent use of western and alternative medicine. They completed the Jamaican Healthcare Perception Questionnaire. Data were analysed using the chi-square test of differences between proportions. Findings indicated that 58.8% of patients incorporated traditional medicine in their treatment. These were less likely to agree with the diagnosis given by the formal practitioner and that his treatment was effective or to rate the quality of service of the formal practitioner as being satisfactory. Patients believed alternative medicine should be incorporated into the healthcare system.