Complementarity in relationships of couples affected by HIV

Psychological interventions with patients with HIV infection may affect the stability of the patient's relationship with others. Two clinical cases are described to illustrate this. Both the impact of AIDS on patients and their relationships, and the impact of psychological interventions on the index patient and others, should always be considered when HIV-infected patients are referred to psychiatrists and other mental health care workers.     

Prolonged Exposure Therapy for a Vietnam Veteran With PTSD and Early-Stage Dementia

Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article describes the successful coordination of care and application of PE in the assessment and treatment of a Vietnam veteran with comorbid PTSD and early-stage dementia. Measures related to the patient's cognitive and psychological functioning were obtained before, during, and after treatment. PE was associated with significant declines in PTSD and depression symptoms. Moreover, the patient's cognitive functioning was made clearer in the absence of severe psychiatric symptoms. Factors contributing to the patient's positive response are discussed.     

Interpersonal Psychoanalysis: The Selected Papers of Clara M. Thompson Edited by Maurice Green

The aging process presents a challenge to the narcissism of the individual due to physical, social, and psychological changes and losses. There is a danger that mental health professionals may add to narcissistic trauma by underestimating the elderly patient's potential for change. An older adults group established on a short-term psychiatric unit is presented. Therapeutic principles and strategies are discussed which are aimed at helping the aged patients make restitution for losses and regain self-esteem through renewed engagement with their environment. The importance of cohesion and inclusion in the group is examined, with attention given to the particular needs and conflicts experienced by the older adult population. The use of techniques to promote the experience of mastery is also discussed.     

Timing of Early Maternal Mental Health and Child Cortisol Regulation

Maternal mental health problems can negatively impact children's physiological stress regulation. Yet, little is known of their long‐term effects, especially related to the timing of maternal symptoms. We examined how maternal mental health problems during pregnancy versus in the early postpartum period predict children's cortisol levels and diurnal patterns at 10–12 years. Participants were a selection (N = 102) of an original sample of 805 Finnish families, who were followed from the second trimester of pregnancy (T1) to child's age of 2 months (T2) and 12 months (T3), and again at child's age of 10–12 years (T4). Based on the timing of psychological distress and depressive symptoms (T1–T3), the mothers could be assigned to three distinct mental health trajectory groups: mothers with prenatal mental health problems (n = 15), mothers with early postpartum mental health problems (n = 15) and mothers without mental health problems (n = 72). Children's cortisol (T4) was measured by saliva samples through five within‐1‐day assessments. The results show that maternal prenatal mental health problems predicted a relatively steep increase of child cortisol from awakening to 1 h later, indicating an intensified cortisol awakening response (CAR). Mothers' early postpartum mental health problems instead predicted a reduced CAR. Both maternal prenatal and postnatal mental health problems thus predicted children's later stress regulation, but in unique ways. We discuss the specific roles of direct biochemical effects during pregnancy and postpartum mother–infant interaction quality as modifiers of the hypothalamic–pituitary–adrenal system. Copyright © 2015 John Wiley & Sons, Ltd.     

Can functional emotion regulation protect children's mental health from war trauma? A Palestinian study

Effective emotion regulation (ER) is expected to protect mental health in traumatic stress. We first analysed the protective (moderator) function of different ER strategies and the associations between ER and mental health. Second, we tested gender differences in the protective function of ER and the associations between ER strategies and mental health. Participants were 482 Palestinian children (girls 49.4%; 10–13 years, M = 11.29, SD = .68) whose ER was assessed by the Emotion Regulation Questionnaire and mental health by post‐traumatic stress (Children's Impact Event Scale), depressive, and psychological distress (Strengths and Difficulties Questionnaire) symptoms, and by psychosocial well‐being (Mental Health Continuum‐Short Form). War trauma involved 42 events. Results showed, first, that none of the ER strategies could protect a child's mental health from negative impact of war trauma, but self‐focused ER was associated with low depressive symptoms, and other‐facilitated ER with high psychological well‐being. However, controlling of emotions formed a comprehensive risk for children's mental health. Second, gender differences were found in the protective role of ER, as self‐focused and distractive ER formed a vulnerability among boys. The results are discussed in the context of emotional and regulative demands of war and life‐threat.     

Hope and Burden among Latino Families of Adults with Schizophrenia

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family member's increased hope for the patient's future would be associated with decreased family burden beyond effects explained by the patient's length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patient's future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.     

The image schema and innate archetypes: theoretical and clinical implications

Based in contemporary neuroscience, Jean Knox's 2004 JAP paper ‘From archetypes to reflective function’ honed her position on image schemas, thereby introducing a model for archetypes which sees them as ‘reliably repeated early developmental achievements’ and not as genetically inherited, innate psychic structures. The image schema model is used to illustrate how the analyst worked with a patient who began life as an unwanted pregnancy, was adopted at birth and as an adult experienced profound synchronicities, paranormal/telepathic phenomena and visions. The classical approach to such phenomena would see the intense affectivity arising out of a ruptured symbiotic mother‐infant relationship constellating certain archetypes which set up the patient's visions. This view is contrasted with Knox's model which sees the archetype an sich as a developmentally produced image schema underpinning the emergence of later imagery. The patient's visions can then be understood to arise from his psychoid body memory related to his traumatic conception and birth. The contemporary neuroscience which supports this view is outlined and a subsequent image schema explanation is presented. Clinically, the case material suggests that a pre‐birth perspective needs to be explored in all analytic work. Other implications of Knox's image schema model are summarized.     

Combining Patient Utility with Health Status Assessment to Improve Medical Decision Making

Physicians often use health status assessment tools to evaluate a patient's condition, then apply established guidelines to determine the most medically effective treatment. Yet additional criteria, such as the appropriateness of the treatment given the particular patient's preferences and attitude toward risk, are also highly relevant to quality care. While such preferences could be addressed via patient utility functions, their use in actual practice is somewhat limited because elicitation is often considered too burdensome for patients, unreliable, or redundant given other measures. For a small group of real patients who have suffered a stroke, we measure both traditional health status and patient utility for the current state to determine whether limited, focused utility assessment is a practical means of obtaining additional and relevant patient information. We find that utility assessment is perceived as reasonable and useful by patients, even when quite ill, and that utilities and health status are not redundant. In fact, investigating apparent inconsistencies between patient utility and observed health status can alert the physician to patient concerns and criteria not captured by more traditional measures. We propose an approach to medical decision making that uses both measures to improve patient–physician communication.     

Attitudes toward seeking professional psychological help among Chinese students at a UK university

Aim: In this study we aimed to investigate whether Chinese international and British home students at a university in the United Kingdom differed in their attitudes towards seeking psychological help. Method: The total sample comprised 323 participants. Participants completed measures to assess their attitudes toward seeking professional psychological help (recognition of need for psychological help, stigma tolerance, interpersonal openness, confidence in mental health practitioners). Results: Chinese students reported significantly less interpersonal openness than that reported by British students. Contrary to prediction, however, no significant group differences were found on any of the other mental health attitudes (i.e. recognition of need for psychological help, confidence in mental health practitioners or stigma tolerance). Within‐group contrasts also showed that Chinese students reported lower scores on interpersonal openness than on stigma tolerance and confidence in mental health practitioners. In contrast, British participants reported less confidence in mental health practitioners and recognition of the need for psychological help than reported for stigma tolerance and interpersonal openness. Conclusion: The findings highlight the need for a greater understanding of students' cultural inclinations toward mental health issues and cultural attitudes that may hinder and/or facilitate students' access and engagement with psychological services in higher education institutions.     

Dynandcs in cancer caregiver's health over time: Gender-specific patterns and determinants

Abstract

This study exandned patterns and determinants of three dimensions of caregiver's health of newly diagnosed colorectal cancer patients, i.e. physical, mental and social functioning (N= 148). Physical functioning declined within a 6-month period in female caregivers, while no change was observed in male caregivers. For mental and social functioning, an improvement was observed in male and female caregivers. Change in physical functioning was associated with gender, age, income and initial level. Change in mental functioning was predicted by initial status and positive as well as negative caregiver experiences. Change in social functioning was mainly predicted by initial level and change in patient's dependency. Physical and mental functioning showed the least favorable patterns in female caregivers. The study shows that caregiving may lead to positive health consequences, and underlines the importance of making a distinction between male and female caregivers and of studying caregiver outcomes by using multidimensional assessments.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

The travails of Martin Orne: On privacy,public disclosure,and confidentiality in psychotherapy

The experiences of one psychotherapist have brought to the fore the entire issue of privacy and confidentiality and the responsibilities of mental health professionals. In a computer driven culture, where data about patients become subject to public scrutiny, how does the mental health professional practice, guided by the concept of confidentiality? Where does confidentiality begin and end? What about the patient's right to self-disclose? What about patient autonomy? In this paper, illustrated by one particular case where the rule of absolute confidentiality, an intrinsic part of the practice of psychotherapy, was questioned, our current confusion comes to the surface. The reader is urged to re-think the concept of confidentiality and patient self-disclosure.     

Behavioral Risk Assessment of the Guarded Suicidal Patient

Psychiatrists and other mental health professionals are trained to assess patients by direct observation and examination. Short inpatient length of stay, brief outpatient visits, emergency room evaluations, and other time‐limited clinical settings require rapid assessment of suicide risk. Recognition of behavioral suicide risk factors can assist in the early identification of the guarded suicidal patient, thus avoiding total reliance on the patient's reporting.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

Self psychology and projective identification—whither shall they meet? a reply to the editors (1995)

The concept of projective identification continues to be viewed as alien, even dangerous, by self psychologists. Six aspects of self‐psychology/intersubjectivity theory are explored in an attempt to understand the presumed incompatibility of self psychology and projective identification: 1) the empathic vantage point; 2) the focus on subjective reality; 3) the emphasis on the analyst's personal contribution; 4) the focus on selfobject experience; 5) the disruption—restoration process; and 6) the defining of transference and countertransference as “organizing activity.”; The self‐psychological/intersubjective concepts that come closest to describing the phenomenon of projective identification—that is, empathic immersion, affect resonance, and reciprocal mutual influence—fail to capture at least three of its essential elements 1) the patient's persistent, unconscious intent to communicate certain unformulated aspects of self through the other; 2) the analyst's sense of being “taken over”; by the patient's experience; and 3) the intensely visceral quality of the analyst's experience. It is argued that self psychology ignores this important form of patient communication to its own detriment and that the concept of projective identification needs to be reformulated in terms that are more experience near to self psychologists. It is suggested that there exists a normal, developmental need, a selfobject need, to communicate intolerable, unsymbolized affective experience through the other's experience—a need that remains more pervasive and intense in some of us than in others—and that the longed‐for selfobject response is to have one's communication received, contained, and given back in such a way that one knows the other has “gotten”; it from the inside out.     

The Caregivers' Attachment and Relationship Education Class: A New and Promising Group Therapy for Caregivers of Individuals with Parkinson's Disease

The authors examined whether a newly developed group therapy, based on principles of attachment theory and emotionally focused couples therapy, can potentially address the unique mental health and relationship difficulties in caregivers of individuals with Parkinson's disease. A comprehensive outreach effort, involving a review of 251 military veterans' medical records, yielded enrollment of seven spousal caregivers in the group therapy. At 1-month follow-up, caregivers who initially reported mild or greater levels of caregiver burden demonstrated statistically reliable declines in psychological distress, relationship distress, or both. Posttreatment surveys indicated positive perceptions in overall helpfulness of treatment goals, as well as positive changes in insight (e.g., greater understanding of the patient's attachment needs) and behaviors (e.g., greater social contact and self-care of the caregiver). Results are considered in the context of inadequate access to treatment for caregivers of spouses with Parkinson's disease or other major medical issues.     

诠释与转换：积极心理健康及其当代理解

积极心理健康是积极心理学理论系统的一个重要组成部分,也是积极心理学理论本身在心理健康领域的一种应用。积极心理健康以积极为核心观念,以人的积极品质为研究对象,注重人的个体差异的研究思路,引领和推动传统心理健康从关注人的消极品质转向人的积极潜力,从而使心理健康的主题既符合时代潮流又具有深厚的思想底蕴。     

The story of a ghost

SUMMARY

This paper is concerned with the relationship between psychotherapy and general psychiatry. This relationship is examined from historical, clinical and theoretical perspectives. Psychotherapy is an integral part of psychiatric practice imparting to it a means of participating in, as well as observing, the patient's subjective experiences. Mental illnesses, whatever their nature have fundamental elements in common. This common ground is most apparent when mental illnesses are conceptualised in psychological terms. Such an approach in no way undervalues the importance of the hereditary and somatic influences which contribute to the predisposition to mental illnesses. Viewed in this psychobiological way it is not difficult to discern what is common to neuroses, psychoses and disturbances of the personality. The clinical phenomena provide the basis for a developmental theory which portrays the essential unity of mental illnesses. The paper concludes with a discussion of why psychotherapy is being gradually divorced from clinical psychiatry. The dangers which this separation hold for the clinical tradition in psychiatry are emphasised.     

Elements of the Oedipus complex: A Kleinian account1

The author discusses and illustrates the place in current Kleinian practice of the analysis of the Oedipus complex. He outlines the development of the concept of the Oedipus complex by Freud and by Klein and later writers in the Kleinian tradition. Because the child's exclusion from his parents' sexual relationship represents such a fundamental aspect of reality for the child, analysis of the patient's responses to the oedipal situation constitutes the central task of analysis. Despite the Oedipus complex being in this way central, it is sometimes hard to discern because what is most visible are the patient's defensive responses to the oedipal situation. The emergence of meaning in analysis is often understood unconsciously as the product of the parental intercourse, represented by the work of the patient with the analyst, or of the analyst's or the patient's mind. The analysis of the patient's characteristic reactions to moments of meaningfulness in analysis is therefore an especially fruitful focus for the analysis of the Oedipus complex. The author illustrates these ideas by three clinical examples, from a 3½‐year‐old child, a borderline psychotic patient and a more neurotic patient.