The role of the leader in managing the preoedipal patient in the group setting

Preoedipal patients present a special problem in group treatment. This is because their difficulties arose largely before they learned to use words. Such patients are prone to act rather than talk. They do not respond well to interpretation. They must be approached and influenced through feelings. We can utilize the group to provide them with maturational experiences, helping them reach a more adult level of mental functioning so that our usual technical interventions can be brought into play. The paper discusses methods for enhancing this process, including reflection, emotional communication, using reconstruction to close developmental gaps, and immunization.     

A.G.P.A. News

Clinical observations regarding themes and roles that are characteristic of short-term, psychoanalytically oriented therapy groups for loss patients are presented. They reflect aspects of both the therapy and the patients. Themes refer to the content of a recurrent conflict in the group. They include trust, survivor guilt, mortality, and termination. Roles refer to a set of patient behaviors that represent a shared conflict. They include the apparition, monk, professor, professional nurturer, emotional conductor, and cruise director. Challenges that the themes and roles present to the therapist and clinical guidelines for addressing them are offered. Awareness of characteristic themes and roles and possible therapist responses are regarded as important parts of the preparation and training of therapists who plan to conduct short-term loss groups.     

The divine dreams of a sample of South African children: the gateway to their spirituality

As part of a research project on religion, spirituality and education, the authors attended to the role that children's divine dreams could play in religious education (RE). They contend that such dreams can indeed be used by RE teachers as the gateway to understanding the spirituality of their learners. They defend their claim by firstly developing a conceptual‐theoretical framework with respect to religion, spirituality and children's divine dreams, and then presenting the results of an explorative quantitative‐qualitative investigation in three schools. They find their claim to have been vindicated, and suggest that although RE teachers should not necessarily teach divine dreams per se, they should, nevertheless, explore the possibility that (at least some of) the contents of children's divine dreams may be useful for the purpose of teaching them RE from religion itself, rather than teaching them only about religion.     

Living on a Slippery Slope

Our actions, individually and collectively, inevitably affect others, ourselves, and our institutions. They shape the people we become and the kind of world we inhabit. Sometimes those consequences are positive, a giant leap for moral humankind. Other times they are morally regressive. This propensity of current actions to shape the future is morally important. But slippery slope arguments are a poor way to capture it. That is not to say we can never develop cogent slippery slope arguments. Nonetheless, given their most common usage, it would be prudent to avoid them in moral and political debate. They are often fallacious and have often been used for ill. They are normally used to defend the moral status quo. Even when they are cogent, we can always find an alternate way to capture their insights. Finally, by accepting that the moral roads on which we travel are slippery, we become better able to successfully navigate them.     

Family relations,mental health and adherence to nutritional guidelines in patients facing dialysis initiation

This study investigated the effect of family relations on patients’ adjustment to dialysis. The two main aims were to develop a family typology, and to explore the influence of family profile on the patient's anxiety, depression and adherence to nutritional guidelines. The sample consisted of 120 patients (mean age 63 years; 67.5% of men). They completed several measures 1, 6 and 12 months after dialysis initiation. The scales used were the Family Relationship Index and the Hospital Anxiety and Depression Scale. Perceived adherence to nutritional guidelines was assessed using two visual analogical scales. Results showed that family relations remained stable over time. Cluster analysis yielded three family profiles, which were named conflict, communicative and supportive families. Patients belonging to conflict families perceived themselves as less adhering to nutritional guidelines. For these patients, anxiety and depressive moods increased significantly over time, whereas mental health remained stable over time for communicative and supportive families. This research underlines that family relations are essential in global consideration of the care of patients treated by dialysis. Conflict families seem especially at risk. They should be identified early to help them adapt to this stressful treatment.     

The Organization of a Mental Hospital on the Basis of Group Participation

Group treatment of the chronically mentally ill has often been a fruitless and exasperating experience. The intense emotional responses of group leaders in working with this chronic population reinforces a spiral of repetitive failures. An attempt to intervene in this chronic spiral will be presented by the author's experience in leading a training group of mental health workers who, in turn, lead groups of chronic patients. In particular, the effects of projective identification on various holding environments will be examined by using the methodology of object relations. Understanding and utilizing countertransference responses of the training leader illuminate the unconscious aims of chronic patients to perpetuate their internal and interpersonal lives by their effect on the group leaders who work with them and on each other. This understanding can lead to interventions that have more constructive outcomes.     

Internet Versus Group Cognitive-Behavioral Treatment of Distress Associated With Tinnitus: A Randomized Controlled Trial

Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT), and the treatment can be delivered in different ways. The most recent format is Internet-based self-help. The aim of this study was to compare this treatment (n = 26) with standard group-based CBT (n = 25) in a randomized controlled trial. Outcomes on self-report inventories measuring tinnitus distress were evaluated immediately after and 1 year after treatment. Results showed that both groups had improved, and there were few differences between them. The effect size for the Internet treatment was d = 0.73 (95% CI = 0.16–1.30) and for the group treatment was d = 0.64 (95% CI = 0.07–1.21). The Internet treatment consumed less therapist time and was 1.7 times as cost-effective as the group treatment. At pretreatment patients rated the Internet treatment as less credible than the group treatment. In conclusion, Internet treatment for tinnitus distress merits further investigation, as the outcomes achieved are promising.     

Can negative attitudes toward patients with borderline personality disorder be changed? The effect of attending a STEPPS workshop

We sought to determine whether negative attitudes toward patients with borderline personality disorder (BPD) can be modified through education. Mental health clinicians attended a 1-day workshop on the Systems Training for Emotional Predictability and Problem Solving (STEPPS) group treatment program for BPD. A questionnaire to assess attitudes towards BPD was given to 271 clinicians before and after the workshop. Following the workshop, clinicians endorsed having significantly greater empathy toward patients with BPD, and having greater awareness of the distress and low self-esteem associated with the disorder. Significant improvement was seen in the clinicians' attitudes toward patients with BPD and their desire to work with them. Clinicians were significantly less likely to express dislike for BPD patients. They also reported feeling more competent in their ability to treat these patients. The study offers preliminary evidence that negative attitudes toward patients with BPD can be modified through education.     

Interaction Process Differences between Groups of Paranoid Schizophrenic and Depressed Patients

Group psychoanalytic treatment has special value for helping people form intimate attachments, in particular, for enabling them to resolve lifelong unconscious resistances to closeness. The group serves both as an amphitheater and as an agent for change.

As group therapists, we may break the task down into three stages. First, we bring the character resistances into play; second, we resolve the fears underlying them; and third, we empower our patients to develop mature ways of expressing intimacy.

Our task requires that we establish a contract with our patients so as to study any breach as a possible resistance to intimacy with other members. We study these resistances, which are expressed in words and attitudes. Beneath such resistances lie various fears, which we bring to the surface. As our patients resolve these fears, they begin to act toward each other as they did toward significant figures in their formative years. We work with these vestigial modes of relating, and help our patients turn them into mature modes of expression.     

Problems in Integrating Traditional Group Therapies with New Group Forms

The authors describe a range of critical issues that are common within homogeneously composed groups for patients suffering from Acquired Immunodeficiency Syndrome (AIDS) and AIDS Related Complex (ARC). They examine the need for these patients to understand their physical symptomatology, to reconsider life's priorities, and to confront their ethical and moral dilemmas. The authors also highlight special affects, unique group atmosphere and process, and the nature of the group contract that is essential for these patients.     

Examining patience as a psycho-religious construct in Iranian patients with cardiovascular diseases: a pilot study

The current study aimed to compare patience and its components in cardiovascular patients (CVPs) with healthy individuals. Ninety-one patients with cardiovascular diseases (CVDs) referring to the clinic of Imam Reza in the city of Shiraz in Iran, and 91 healthy individuals were recruited by convenience sampling method. They completed demographics questionnaire and the Patience Scale. The data were analysed by sets of analysis of covariance. Results showed significant difference between CVPs and healthy participants on patience (M?=?85.92, SD?=?12.69 vs. M?=?90.45, SD?=?11.33); patients had less patience mean than their healthy peers (F?=?9.423, η²?=?.050, p?=?.002). The results also indicated that cardiac patients had significantly lower scores on patience components of transcendence, persistence, and delay than the healthy group (all p’s?p?>?.05). According to the results of the present study, it can be inferred that less patience may play a key role in vulnerability to physical illnesses such as CVDs.     

Simultaneous Group and Insulin Therapy

Abstract

The concept of focus can provide a meaningful bridge between theory and practice. The authors’ aim in this paper is to demonstrate that for theory to be clinically useful, it should provide a sense of focus and organization for clinical work. They illustrate how their particular use of a self–psychological/intersubjective model leads to an emphasis on what they refer to as “sustained empathic focus.” The authors’ choice of concepts leads them consistently to stress the patient’s subjective experience and emerging vulnerability.     

Thought and the social community

The anti‐Cartesian idea that a person's thoughts are not entirely fixed by what goes on inside that person's head is suggested by Hegel, and echoed in Wittgenstein and Frege. An argument for the view has recently been given by Tyler Burge. This paper claims that Burge's data can be explained better by an individualistic theory. The basic idea is that an individual's thoughts are specified analogically, in ordinary discourse, through the model of a language. Though the modelling‐sentences are public, the thoughts of the individual are inner states whose identity does not depend upon those sentences. They have content naturally, whether or not content happens to be ascribed to them.     

Prima facie and seeming duties

Sir David Ross introduced prima facie duties, or acts with a tendency to be duties proper. He also spoke of general prima facie principles, wwhich attribute to acts having some feature the tendency to be a duty proper. Like Utilitarians from Mill to Hare, he saw a role for such principles in the epistemology of duty: in the process by means of which, in any given situation, a moral code can help us to find out what we ought to do.After formalizing general prima facie principles as universally quantified conditionals I will show how seeming duties can be detached from them. There will be examples involving lies, burnt offerings and the question of whether to have a napkin on your lap while eating asparagus. They will illustrate the defeasibility of this detachment, how it can lead into dilemmas, and how general prima facie principles are overridden by more specific ones.I've been lucky to discuss parts of this project with among others Jeff Horty, Paul McNamara, Alasdair MacIntyre, Wlodek Rabinowicz and Michael Slote. Thanks, too, to Henry Prakken and the reviewers for Studia Logica     

Evidence for a predication effect in deciding on the personal significance of abstract word meanings

Two experiments were conducted on college students (combinedN=240) to test for the effect of sentence predication on the independent judgement of word significance. Students judge which of two nouns was personally more significant to them. They also employed these nouns in a task which required them to place one word in the subject location and the other in the predicate location of an incomplete sentence. Administration order of these two experimental tasks was counterbalanced. Experiment I demonstrated that when the sentence-completion task is taken first-in which a predication is necessarily framed between the two nouns-the student will subsequently be more likely to judge the noun placed in the subject location of the sentence as more significant than its counterpart (p<.025). Experiment II provided a cross-validation of these findings and also demonstrated that the location of the more significant noun in the sentence can vary between subject and object location depending on whether the verb relation in the sentence unites the two nouns positively or negatively (p<.001).     

The Use of Humor with Chronic Schizophrenic Patients

The use of a humorous therapeutic approach combined with drug therapy in the treatment of chronic schizophrenia patients institutionalized for protracted periods of time led to positive changes in their symptoms. The majority of the patients responded well to humorous interpretations. The patients felt that they had the option of adopting the doctor's humorous manner. This approach appealed to them and raised self-esteem; they likewise gained confidence in their own ability to form judgments. They cooperated better with the doctor in issues pertaining to treatment. The fact that humor made an impact on the patients' cognition demonstrated that patients with disturbed thought processes could be influenced in ways which improved coping. The patients' condition was evaluated according to the BPRS scale, before the treatment, on a monthly basis during the treatment, and three months upon the completion of the experiment. In the course of the experiment, pharmacological treatment remained unchanged. On the average, a perceptible reduction in the BPRS value (p < .05) was detected as a result of humor therapy. Amusing representations of affective external stimuli were incorporated into the patients' cognition and, along with a newly gained awareness of the possibility of relating to them with humor, were retained long after the termination of the project.     

The Integration of Behavior,Vol. III by Thomas M. French

This article presents a model for understanding development within children's psychotherapy groups. It is proposed that two complementary cultures exist within children's groups, one, indigenous peer culture, strictly of the children's making and the other, therapeutic group culture, created by the therapist in collaboration with group members. The therapist is wise to approach indigenous peer culture as an ethnographer might a native culture, with an emphasis on observation and seeking understanding rather than on intervention. The therapist can use the indigenous peer culture to speak to the children in their own language and eventually to engage them in collaboratively building a meaning system that is uniquely designed to address their psychotherapeutic needs. The article defines these concepts, develops them theoretically, and illustrates them clinically.     

Quality of life in patients before and after kidney transplantation

Abstract

The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL.

Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22).

Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001).

Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL.

Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.