The Interpersonal Theory of Psychiatry by Harry Stack Sullivan

Charismatic relationships occur frequently in treatment of substance abusers because patients are regressed and have temporary needs for inspiration and guidance. The therapist who assesses patients' needs for charisma in the pregroup evaluation can avoid the twin pitfalls of placing patients in groups with insufficient or excessive charismatic leadership. Too little charismatic leadership is ineffective; patients remain regressed and the group does not come together. Too much charismatic leadership stifles patients' growth. As patients develop control over their addictive behavior, the need for charisma diminishes. A sensitive leader can recognize this from changes in patients' attitudes toward their addictions and from indicators of autonomy in the group process. The leader can then accept the need for adjustments in leadership style to avoid hindering patients' growth.     

Coping strategies and quality of life in women with advanced breast cancer and their family caregivers

Abstract

This study examines the effects of personal resources of both heart patients and their close social partners on patients' coping and quality of life. Generalized personal resources (self-efficacy beliefs, dispositional optimism, self-regulation competence) and outcomes were assessed by questionnaire 1–3 days before surgery (n = 122) and again six months later (n= 50). Outcome variables were coping styles, social resources (social support and social integration), emotional states, and further measures of quality of life. Patients' personal resources were dominant in the prediction of most of the outcomes. Partners' resources were uniquely related to social support, social integration, and quality of life as perceived by the patients. Further, partners' personality resources predicted changes in patients' loneliness and energy levels during the six-month interval.     

Alcohol dependency,recovery, and social words

The influence of social support to recovery is a well‐known phenomenon. We supposed that examining relapsed and recovered alcohol‐dependent patients' autobiography vocabularies we could detect special differences. First, we examined group of relapsed patients treated in hospital at least twice within a year (n = 30). We chose for at least 2 year abstinent persons into the second group (n = 20). We compared their autobiographies by the Atlas.ti 5.0 content analyzing software and detected higher frequency of social words referring to social connections and social activity in the recovered patients' groups. The chi‐square test showed significant difference (p = 0.000155 < 0.01) between the frequency of social words of the two groups. We could estimate the spontaneous indicators of their social support via the content analysis.     

Spouses' responses to the dietary nonadherence of their partners managing diabetes

The association between patients' dietary nonadherence and spouses' involvement in patients' diabetes diet was examined, with spouses' anxiety about nonadherence considered as a mediator of this association. Daily diary data from 128 older adult patients with type 2 diabetes and their spouses were analyzed using multilevel models. Results revealed that on days when patients reported less adherence to their diabetes diet than usual, spouses reported greater anxiety about patients' diabetes management, which, in turn, was related to greater spousal persuasion and pressure the same day. The association between patients' nonadherence and diet‐related support on the same day was not mediated, however, through spouses' anxiety. The findings contribute to an understanding of spouses' responses to patients' nonadherence to their diabetes regimen.     

Accuracy and Bias in Perceptions of Spouses' Life‐Sustaining Medical Treatment Preferences1

This research investigated accuracy, projection bias, and base‐rate utilization in spouses' perceptions of end‐stage renal disease patients' preferences for life‐sustaining medical treatment in hypothetical conditions of declining health. Multilevel models revealed that spouses' perceptions were largely biased, determined by their own preferences for the patients' treatment (projection bias) and by typical treatment preferences (base‐rate utilization). Both biases, however, served as indirect routes to a modest degree of accuracy. Moreover, spouses who overestimated patients' preferences for life‐sustaining treatment and who perceived patients' preferences as consistent with their own reported higher levels of marital adjustment than did those who were less biased. Results suggest that spouses' biases in judgments of patients' treatment preferences may promote accuracy and marital adjustment functionally.     

Physicians' nonverbal rapport building and patients' talk about the subjective component of illness

Physicians' nonverbal communication has sometimes been found to be associated with patients' affective satisfaction. Too little attention has been given, however, to the impact of these caregiver behaviors on patients' self‐disclosure. This paper examines the relationship between physicians' nonverbal rapport building and patients' disclosure of information related to the subjective component of illness. Twelve third‐year residents at a large teaching hospital were videotaped during interactions with patients (N = 34). These physicians' nonverbal communication behaviors were coded in the introduction and diagnosis segments of the interactions. Patients' verbal communication behaviors related to disclosure of information about the subjective component of their illnesses were coded across the same segments. Correlation analysis revealed significant relationships between physicians' use of some types of nonverbal behaviors and patients' subjective disclosure, as well as physicians' avoidance of negative facial behaviors and patients' disclosure about life beyond symptoms and structural barriers to wellness. Implications for understanding the role of physicians' nonverbal communication on health care outcomes are considered.     

“Test-Tube Baby” procedures: Stress and judgements under uncertainty

Patients participating in an in vim fertilisation with embryo transfer (IVF and ET) programme face uncertainty at each stage of the procedure. Research on heuristics and on stress lead to predictions about behaviour in situations of uncertainty. It was predicted that IVF and ET participants would overestimate the likelihood of success, due to publicity the process has received, and would underestimate the likelihood of an earlier, less publicised. stage in the procedure. Both predictions were confirmed in a total of 70 participants (26 women at out-patient clines, 23 of their partners and 21 surgical in-patients). All the men and all but one woman overestimated the likelihood of becoming pregnant and having a baby. and most of the surgical patients underestimated the likelihood of egg recovery. Estimates were not related to patients' confidence about their information, confirming previous evidence about confidence in inaccurate judgements based on heuristics. Data on patients' distress as indicated by mood rating show high anxiety at points of uncertainty and Pailure, as found in other studies of stress. While the couples shared their inaccurate judgements. they did not necessarily share their distress. The results are discussed in terms of patients' decision making. coping strategies and the implications for doctor-patient communication.     

Freud's view of hysteria in light of modern trauma research

Freud's earliest notion of the aetiology of hysterical symptoms was based on his hypothesis on the importance of trauma dissociation, upon which he began to construct his first theory of neurosis. Soon, his conception of trauma narrowed to apply only to sexual trauma, and later only to childhood experiences of sexual abuse by the father. He substituted these earliest variations on a theory of neurosis with the libido theory due to his discovery of infantile sexuality, the poor treatment results he had with hysteric patients, the frequency of hysteria symptoms, the difficulties he had in distinguishing between his patients' internal and external realities and the ambiguous nature of the reasons behind the patients' problems, presumably due to repression. Recent trauma research, however, has rediscovered trauma dissociation, which is separate from repression. This has led to a new theoretical understanding of trauma-originated dynamics and the development of corresponding treatment interventions. In this paper, the author analyzes the development of Freud's conceptions of hysteria in the social-clinical cultural context of his period, as well as the reasons which led Freud to abandon the notion that trauma dissociation was an underlying cause of hysteria symptoms.     

Books Received

The physical and mental consequences of the Holocaust combined with difficult present events and the problems of old age can have devastating effects on survivors. Our clinic has recently introduced a psychodynamic-supportive group therapy model for elderly Holocaust, survivors. The model includes specific integrative interventions, which are based on Horowitz's model, of mourning and coping with stress and the leaders' clinical experience. The aim of the group is to improve the patients' homeostasis and enhance their ego functions and adaptation to inner and outer worlds. The theory and working model, are described.     

Voices from the Inaudible: The Patients Speak by Theodor Reik

Fifty-one inpatients, hospitalized on average for 21 days, were studied by means of discharge debriefing interviews. An unstructured, mandatory, and functionally heterogeneous psychotherapy group was compared with a structured, voluntary, and functionally homogeneous psychotherapy group. Statistical analysis of the patients' valuation of the group psychotherapy experiences and of their rankings of traditional group psychotherapy curative factors were performed. Results demonstrated that group psychotherapy was a highly valued component of the overall inpatient treatment. Structural modifications aimed at increasing the here and now, and interpersonal focus of the group meetings, such as the use of patient agendas and group rehashes, significantly affected the patients' group experiences. A comparison of both types of inpatient groups with an outpatient group psychotherapy sample suggests certain guidelines for the goal setting and conduct of inpatient group psychotherapy, recognizing the specific and heterogeneous needs and capacities of the patients treated.     

From tarasoff to hopper: The evolution of the therapist's duty to protect third parties

The duty of therapists to protect third parties has gained national attention following the analyses of the California Supreme Court in Tarasoff v. Regents of the University of California in 1974 and in 1976. The assassination attempt by John Hinckley, Jr., has spawned yet another “duty to protect” case (Hopper v. Brady). Utilizing the issues involved in Hopper, this paper discusses the psychotherapists' duty to protect from harm the patients' potential victims. Following an analysis of Hopper, Tarasoff is extensively reviewed. The evolution of Tarasoff within California and other jurisdictions is traced. Finally, an appraisal of the current status of the therapists' duty to protect as applied to Hopper and future cases is presented.     

Community as Outsider Witness: Utilising Community Members in the Reconstitution of Problem-Saturated Identities

This study explored community members' ability to enlist discourses affirming of psychiatric patients' quest for generative identities. The participants were members of the public who attended an exhibition of psychiatric patients' artwork (n = 7, age range 18–55). A Foucauldian discourse analysis was used to analyse the research interviews. Results revealed that the majority of community members used dominant cultural discourses to speak about psychiatric patient-artists. These discourses conferred a problem-saturated identity on to psychiatric patients. We conclude that community members can be recruited as outsider witnesses to support psychiatric patients' search for generative identities, provided community members resist discourses that produce problem-saturated identity conclusions.     

Psychotherapy through the Group Process by Dorothy Stock Whitaker and Morton A. Lieberman

Ethics deals with right and wrong behavior. It can be used to check whether group therapists with their patients “abstain(s) from whatever is deleterious and mischievous,” an Hippocratic concern, and whether they safeguard their personhood, a Kantian requirement. Therapists' paternalism weakens the patients' moral agency and challenges their autonomy. Personal therapy lessens this tendency.

The group models Plato's and Socrates' ancient dialectic. Both see the end point, self-knowledge, as a virtue and seek it. Increased care of group members for each other is the modus operandi of treatment. This, with the therapist's clinical input, brings about patient wholeness. Reduction in the distorted treatment relationship returns autonomy to the patient. Group therapy is an ethical way to change patients psychologically. Gratuitously, they become more virtuous.     

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Emotion Beliefs and Cognitive Behavioural Therapy for Social Anxiety Disorder

Despite strong support for the efficacy of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), little is known about mechanisms of change in treatment. Within the context of a randomized controlled trial of CBT, this study examined patients' beliefs about the fixed versus malleable nature of anxiety—their ‘implicit theories’—as a key variable in CBT for SAD. Compared to waitlist (n = 29; 58% female), CBT (n = 24; 52% female) led to significantly lower levels of fixed beliefs about anxiety (M_baseline = 11.70 vs. M_Post = 7.08, d = 1.27). These implicit beliefs indirectly explained CBT-related changes in social anxiety symptoms (κ² = .28, [95% CI = 0.12, 0.46]). Implicit beliefs also uniquely predicted treatment outcomes when controlling for baseline social anxiety and other kinds of maladaptive beliefs (perceived social costs, perceived social self-efficacy, and maladaptive interpersonal beliefs). Finally, implicit beliefs continued to predict social anxiety symptoms at 12 months post-treatment. These findings suggest that changes in patients' beliefs about their emotions may play an important role in CBT for SAD.     

How to refer to ‘diabetes’? Language in online health advice

The adaptation of vocabulary between communication partners, i.e. the lexical entrainment phenomenon, is well documented. This study investigates whether the phenomenon can also be found in computer‐mediated communication between experts and laypersons. The respondents, who are medical experts (n = 46), answered to fictitious patients' queries on health problems. Language technicality within patients' queries was manipulated. One version contained certain concepts in everyday language, the other in technical language. Do experts adapt the vocabulary in their replies to that in the inquiry? Detailed analyses provide evidence that experts not only use the inquiry vocabulary, but also adapt the content of their answers to the technicality of the inquiry. Surprisingly, though queries differ in the use of vocabulary experts attributed very similar prior knowledge to the fictitious patient while providing them with very different replies. The results are discussed with respect to the implications for health counselling and for theoretical assumptions about adaptation in net‐based discourse. Copyright © 2005 John Wiley & Sons, Ltd.     

Babyface effects: A double‐edged sword in healthcare service evaluations

We examine how a doctor's baby‐like facial appearance affects people's perceptions and judgments before and after a medical fraud occurs. A 2 (face type: babyfaced vs maturefaced) × 2 (doctor's gender: male vs female) × 2 (doctor's specialty: internal medicine vs surgery) between‐subjects experiment was conducted. The results indicate that a babyfaced doctor fares better than a maturefaced doctor in terms of patients' expectations, satisfaction and intended loyalty. However, having baby‐like facial features may work against a doctor who is involved in a medical fraud. The severity of a medical fraud is perceived to be greater when it involves either a babyfaced female doctor of internal medicine or a babyfaced male surgeon. After the medical fraud, this altered perception of the fraud's severity leads to reduced patient loyalty. Service evaluations based on the doctor‐patient relationship show that the doctor's baby face is a double‐edged sword.     

Everyday Cognitive Functioning in Cardiac Patients: Relationships Between Self-report,Report of a Significant Other and Cognitive Test Performance

ABSTRACT

Candidates for cardiac bypass surgery often experience cognitive decline. Such decline is likely to affect their everyday cognitive functioning. The aim of the present study was to compare cardiac patients' ratings of their everyday cognitive functioning against significant others' ratings and selected neuropsychological tests. Sixty-nine patients completed a battery of standardised cognitive tests. Patients and significant others also completed the Everyday Function Questionnaire independently of each other. Patient and significant other ratings of patients' everyday cognitive difficulties were found to be similar. Despite the similarities in ratings of difficulties, some everyday cognitive tasks were attributed to different processes. Patients' and significant others' ratings were most closely associated with the neuropsychological test of visual memory. Tests of the patients' verbal memory and fluency were only related to significant others' ratings. Test scores of attention and planning were largely unrelated to ratings by either patients or their significant others.