Sändor Ferenczi

Abstract

This essay will explore the early contributions of Sändor Ferenczi and their relationship to current psychodynamic perspectives on short-term treatment. Ferenczi'S development of the “active technique” and his later collaboration with Otto Rank influenced the works of Alexander and French, and the later writings of Malan, Davanloo, Sifneos, and Mann. Ferenczi'S emphasis on here-and-now transference interpretations and the importance of the patient'S emotional experience in treatment have proven to be enduring contributions to contemporary psychoanalytic practice.     

The Hepatitis C treatment experience: Patients’ perceptions of the facilitators of and barriers to uptake,adherence and completion

Objective: This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program.

Design: Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC).

Main outcome measures: To explore patients’ perceived barriers and facilitators of Hepatitis C treatment adherence and completion.

Results: Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment – fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication – patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion – social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion – these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system.

Conclusion: To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients’ social, practical, and emotional support needs and adaptive coping strategies.     

Physical Abuse and Childhood Disability

SUMMARY

Several authors have hypothesized that children with disabilities are at increased risk for physical abuse. Such a finding would be consistent with current ecological models, which posit that certain child characteristics (e.g., behavior problems) in combination with other risk factors can lead to abuse. The paucity of research in this area makes it difficult to draw firm conclusions at this time. However, the few studies conducted suggest that child characteristics play a minor role in the etiology of abuse. Despite the lack of evidence indicating that children with disabilities are at significantly greater risk for abuse than their nondisabled peers, the presence of a disability raises some unique issues in the identification, assessment, and treatment of special needs children. This article reviews the literature linking abuse and disability as a risk factor. In addition, impediments encountered in the assessment and treatment of abused children with disabilities and their families are discussed and guidelines for practice are presented.     

Cognitive Processing Therapy for Incarcerated Adolescents with PTSD

Summary

Despite increased recognition of trauma's association with conduct disorders, trauma treatment for the conduct-disordered population has been neglected. This study evaluated the effect of short-term, cognitive processing therapy (CPT) treatment on self-reported symptoms of trauma, such as anxiety, depression, intrusion, avoidance, and numbing. After treatment, the CPT group showed significant declines in these symptoms, while the wait-list control group did not.     

Relational treatment of a borderline analysand

Abstract

This paper, in case material, examines the role of the analyst is co-creating the sado-masochistic enactments so common in the transference/countertransference with borderline analysands. Emphasis is placed on how to resolve the enactments so that a new paradigm is created based on trust and cooperation.     

Dialectical Behavior Therapy in the Treatment of Abusive Behavior

Summary

Research suggests that a subset of men who abuse their partners have characteristics associated with borderline personality disorder (BPD). Dialectical Behavior Therapy (DBT) has shown promise as a treatment for BPD, and thus may be useful for these men. This paper describes how DBT principles might be applied to address the problem of partner abuse, including discussion of why one might expect DBT to be a helpful treatment model for this population, and how implementation of the model might be designed.     

The effects of actors vocal exercises for relaxation on fluency: A preliminary study

PurposeTo determine the efficacy of treatment based on Kristin Linklater’s technique for vocal preparation for performance for use with people who stutter.MethodA protocol for a treatment for stuttering involving breathing exercises, relaxation techniques, and focus on awareness was designed by the first author from Linklater’s published exercises in her book Freeing the Natural Voice (2006). Four adults who stutter participated in a 12-week, single-case reversal design study. Treatment efficacy was determined by baseline and post-treatment measures on the OASES, self-report naturalness, tension and severity scale, and percentage of stuttering-like disfluency (SLD). Qualitative measures included a daily tension and practice log, a program completion questionnaire, and accounts from the clinicians administering the treatment protocol.ResultsThree of four participants scored lower on the OASES post-treatment, suggesting that the impact of stuttering on their daily lives had decreased. All four experienced a reduction in the number of SLD counted throughout treatment sessions compared to baseline data.ConclusionA treatment for stuttering based on Linklater’s work including regulation of breathing, relaxation, and awareness of breath may be effective in improving fluency and decreasing the impact of stuttering and warrants further study.     

Does Depression Affect Clinical Practice?

Abstract

While recent autobiographical accounts of women psychotherapists with depressive illnesses have provided vivid and compelling portraits of therapists' experiences in therapy (e.g., Jamison, 1995; Manning, 1995), further research is needed to clarify the impact that depression and its treatment have upon both collegial relationships and clinical practice. A subset of the membership of the Association for Women in Psychology (AWP) was surveyed concerning therapists' experiences with depression and its treatment. Of 220 respondents, 76% reported some form of depressive illness. Eighty-five percent of respondents indicated that they participated in personal therapy. When evaluating their clinical work, respondents reported both positive and negative consequences resulting from their depression. While some respondents noted improvement in collegial relationships, many felt judged and avoided.     

Cross‐Cultural Examination of the Tripartite Model in Adults

Abstract

Operant conditioning was applied to a total of 32 female anorexia nervosa patients in order to restore their normal weight. A comparative study was carried out on two groups of 16 patients each, who were treated with two different therapeutic procedures. The group having informational feedback, more flexible contacts with their family and a special psychomotor program (Group B), achieved a greater rate of weight gain compared to the other group (Group A), with an average of 1.75 versus 1.30 per week. The differences in weight evolution and problems during treatment are discussed. The fact that the study only is a short-term one concerning a limited aspect of the treatment of anorexia nervosa, and also the need for further follow-up research is strongly emphasized.     

Body and meaning

Abstract

This paper discusses the very important but disregarded theme of somatization. Somatizers comprise a wide-ranging group of patients, who normally choose to consult doctors rather than psychoanalysts for treatment. We present two clinical reports of somatizing patients in which the psychoanalyst played a considerable role in the study and treatment of their problems. The subjects were not only totally relieved of their physical symptoms, but also dramatically changed their psychic lives.     

Dialectical behavior therapy: current status, recent developments, and future directions

Dialectical behavior therapy (DBT) was developed as a treatment for parasuicidal women with borderline personality disorder and has been adapted for several other populations. This article describes standard DBT and several adaptations of it and reviews outcome studies with borderline patients in outpatient, inpatient, and crisis intervention settings, borderline patients with substance use disorders, suicidal adolescents, patients with eating disorders, inmates in correctional settings, depressed elders, and adults with attention-deficit/hyperactivity disorder. This treatment outcome review is followed by discussion of predictors of change in DBT, possible mechanisms of change, and current developments in theory, practice, and research.     

Towards modern post-coma care based on neuroscientific evidence

BackgroundUnderstanding the mechanisms underlying human consciousness is pivotal to improve the prognostication and treatment of severely brain-injured patients. Consciousness remains an elusive concept and the identification of its neural correlates is an active subject of research, however recent neuroscientific advances have allowed scientists to better characterize disorders of consciousness. These breakthroughs question the historical nomenclature and our current management of post-comatose patients.MethodThis review examines the contribution of consciousness neurosciences to the current clinical management of severe brain injury. It investigates the major impact of consciousness disorders on healthcare systems, the scientific frameworks employed to identify their neural correlates and how evidence-based data from neuroimaging research have reshaped the landscape of post-coma care in recent years.ResultsOur increased ability to detect behavioral and neurophysiological signatures of consciousness has led to significant changes in taxonomy and clinical practice. We advocate for a multimodal framework for the management of severely brain-injured patients based on precision medicine and evidence-based decisions, integrating epidemiology, health economics and neuroethics.ConclusionsMajor progress in brain imaging and clinical assessment have opened the door to a new era of post-coma care based on standardized neuroscientific evidence. We highlight its implications in clinical applications and call for improved collaborations between researchers and clinicians to better translate findings to the bedside.     

Introduction

Abstract

Managed health care policy has created dramatic changes in current clinical practice, and all too frequently, impacts the overall treatment plan. Clinicians making referrals for emergency hospitalizations can no longer rely on an in-patient, safe, holding environment. Rather the hospital's relationship and stance with managed care insurance providers determines the length of the hospitalization and the case management plan for patients, instead of the patient's need.     

Collegiate Coaches' Perceptions of Their Goal-Setting Practices: A Qualitative Investigation

The purpose of the present investigation was to assess the perceptions of coaches regarding the process of goal setting using a qualitative methodology. Participants were 14 NCAA collegiate coaches from the American Midwest representing both team and individual sports. All participants were head coaches and were asked to respond to the interview questions in relation to their current head coaching position. Results revealed that coaches employed goal setting extensively for both individual and team goals in practice and competition. In addition, many interesting findings regarding the process of goal setting emerged including (a) coaches tended to set short-term goals although there were some nebulous longterm goals; (b) coaches only inconsistently wrote down their goals; (c) goals were both dictated by coaches and set in collaboration with players with a focus on collaboration; (d) the primary function of goals was to provide direction and focus; (e) goal commitment was related to enjoyment/fun; (f) process, performance, and outcome goals were set but coaches focused on performance and outcome goals; and (g) physical, psychological, and time barriers impeded goal attainment. These findings are discussed in relation to the current empirical/theoretical goal-setting literature and suggestions for best practice by sport psychology researchers are offered.     

Adherence,expectations and the placebo response: Why is good adherence to an inert treatment beneficial?

Objective: The current study sought to better understand why good adherence to a placebo treatment has been reliably associated with health benefits. We proposed a model where initial expectations shape adherence, which then influences subsequent expectations that affect placebo response. Design: Seventy-two participants were told that they were enrolling in a study of physical activity and memory, and were asked to increase their physical activity by 35% for two weeks (placebo treatment). Main outcome measures: Adherence to this physical activity target was measured by pedometer. Expectations and short-term memory (free recall) were assessed before and after physical activity. Results: Initial expectations predicted adherence to physical activity (r = .27, p < .03), but adherence did not predict subsequent expectations (r = .06, p = .60). Testing a multi-step meditational model revealed that initial expectations predicted better memory even after controlling for adherence, subsequent expectations, baseline memory and gender (c’ = 1.10, 95% CI = .46–1.74). Stronger expectations for memory improvement predicted better memory performance, but adherence and later expectations did not mediate this association. Conclusions: Good adherence to a placebo may reflect strong treatment expectations which may convey benefits by enhancing the non-specific effects of treatment.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

Time's wingèd chariot: Short-term psychotherapy in later life

Abstract

This paper is concerned with the appropriateness of short-term psychodynamic psychotherapy with older adults, a client group which has historically been neglected in psychotherapeutic practice. Drawing on the case study of a fourteen-session therapy with a woman in her seventies, it is argued that brief exploratory work can be of particular value to people nearing the end of their lives. The nearness of death gives a special urgency and motivation to the work and a time-limited therapeutic contract mirrors the reality of having only a short time left. Making psychotherapy available to older people also represents an important valuing and validation of their experience.     

Small Groups: Studies in Social Interactions Edited by A. Paul Hare,F. Borgatta,and Robert F. Bales

Abstract

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists’ group attachment styles and their assumptions and expectations of their patients’ attitudes about group psychotherapy. Seventy–six therapists completed the Smith, Murphy &; Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, &; Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

On the process of the psychoanalytic psychotherapy with the borderline depressive patient

Abstract

A certain subgroup of borderline patients often presents depressive symptomatology (either chronic or periodic) and an underlying borderline personality organization.

In this article, the effort is directed at elucidating the psychoanalytic psychotherapeutic process of these borderline depressives by presenting clinical fragments of several psychotherapeutic cases.

The process goes through periods of activation of the patient's depressive or primitive mental functioning, which also reflects on the therapist's countertransference.

The capacity of the therapist to tolerate and elaborate on his patient's projections, facilitates the development of the therapist-patient communication and plays a significant role in the therapeutic outcome itself.     

Noncompliance in hemodialysis patients as measured with the MBHI

Abstract

Fifteen patients beginning maintenance hemodialysis due to renal failure were administered the Millon Behavioral Health Inventory, the Family Environment Scale and Beck Depression Inventory at the outset of treatment. They were then followed regarding their compliance with fluid, diet and medication, using weight change and serum potassium and phosphorus levels. Statistically significant differences were found on independence/dependence conflicts and between patients showing at least moderate noncompliance with weight and/or phosphorus limitations. Significantly higher levels of depression were associated with consistently poorer compliance patterns.