Systemic-Oriented Psychological Counselling for Caregivers of People with Severe Brain Injury: Reflections on a Clinical Case

Severe brain injuries can have dramatic consequences on family life, often changing rules and routines and fostering intense and prolonged caregiving duties. People affected by the injuries have to face relevant restrictions in their activities and a loss of independence. Thus, primary caregivers are often involved in their assistance, which can entail the help for self-care, movements and many activities of daily living. Furthermore, cognitive and behavioural symptoms can complicate communication, disrupt previous relationships and put an additional strain on all family members. Indeed, caregiving relationships take place in wider familial and societal contexts and are obviously influenced by previous characteristic of such relationships, as they were before the onset of the pathological condition. Therefore, a thorough examination of typical emotions, feelings and thoughts that can emerge during caregiving must be paralleled by an ecological and developmental perspective, in order to appraise the complexity of these cases and provide effective interventions. The present work aims to address such topics taking inspiration from a clinical case.     

Reflections on Freud's Dora Case After 48 Years

I revisit Freud's case of Dora from the vantage point of current literary and psychoanalytic perspectives. Mahony (this issue) argues that Freud's understanding of Dora is unconvincing to the modern reader because Dora is a victim of trauma rather than sexual repression. I extend Mahony's ideas in terms of the development of psychoanalytic ideas, place Freud's view in the context of my psychoanalytic education in the mid-20th century, and suggest that modern contributions to trauma theory and memory further support the thesis that Dora was a victim of trauma rather than of conflicted libidinal desires.     

Clinical Study Reflections: Another View

Federal regulations are the minimum requirements for conducting clinical studies. Some innovation would improve the situation of many involved in these studies, including: study subjects, those who monitor studies, and clinical investigators as well as Institutional Review Boards. Respecting patient and whistle-blower input; appreciating research staff contributions; and implementing a systems and partnership approach would foster quality and advance clinical research.     

Using Disguised Clinical Case Material

When, why, and how clinicians decide to write about clients are ethical concerns. There are risks and potential clinical ramifications as well as responsibilities for how these decisions are made. On the basis of 141 interviews with psychoanalysts who have published in 3 major national and international psychoanalytic journals, the author explores decisions about whether to only disguise the client's material or whether, in addition, to ask consent outlines and some of the clinical consequences. The author concludes that clinicians need to individualize their decision making based on the particular client and the nature of the therapeutic relationship and offers ways to go about making these judgments.     

Reflections for Clinical Pastoral Education Students in Psychiatric Settings

This article focuses on Donald Capps’s books on mental illness. In doing so I highlight three key insights from Capps that I have applied in my own ministry with persons with mental illness in various psychiatric hospitals. These insights, together with my own experience as a chaplain, lead to three practical lessons for clinical pastoral education students in psychiatric settings. I provide some context for my interest in mental illness and my friendship with Capps, as well as some background regarding how Capps’s writings on mental illness fit with certain broader themes in his own work as a pastoral theologian. This essay is personal throughout.     

Raging better: Reflections on the Myisha Cherry's The Case for Rage

Myisha Cherry's The Case for Rage is a significant addition to the growing body of analytic philosophy that succeeds in not just engaging but shaping and even creating new forms of public discourse. It does so while remaining an exemplar for what good analytic philosophy should look like: filled with systematic and clear distinctions that illuminate rather than obfuscate real and concrete lived phenomena. I offer two challenges to Cherry's typology of rage: first, I rehabilitate two of variations she takes to be morally and politically problematic, and, second, I argue that the freedom to feel, express, and act on Lordean rage proper should be more limited than Cherry allows. I then raise a set of questions about the aesthetics of persuasive anger. Finally, I highlight two striking insights in Cherry's rich argument.     

Facilitating 'Perspectival Reciprocity' in Medication: Some Reflections on a Failed Case

Mediation services arise in contexts where the notions of community cohesion, relationship integrity and social order are valued over their opposites (disorder, dissent, conflict etc). Yet it is not at all clear whether and how the mediation of conflict works to re-establish harmony or consensus. Indeed it is not at all clear that mediation is always effective or just. It has even been suggested that some conflicts (e.g. work-place, commercial and sexual assault) are either not resolved or not resolved justly by mediation. On the other hand, advocates maintain that mediation can bring resolution and repair to ongoing relationships, promote community harmony, and empower people to be self-determining in the construction and maintenance of their resolutions. Whether mediation is adjudged positively or not, all mediation is instantiated in, indeed performed through, talk. In this paper I examine mediations from an Australian mediation program, and use Conversation Analysis to expose the practical methods by which mediators achieve consensus between disputants. I then examine a case in which mediation has failed to produce the sought-after consensus, and explore one way of understanding the failure of mediation in that case.     

癌症姑息治疗的临床意义和社会伦理思考

姑息医学作为医学学科之一,内容包括癌痛控制,处理缓解其他症状.癌症姑息治疗缓解了紧张的医患关系,有效的防止有限医疗资源的浪费及分配不公,同时姑息治疗给人们留下诸多社会伦理思考.如告知、癌痛控制等问题.如何将姑息治疗扩展到其他非恶性疾病面临着巨大挑战.     

Clinical Community Psychology: Reflections on the Decades Following Swampscott

The Swampscott report was foundational, but in some ways reflected divisions within community psychology that have continued into the present. Community psychologists trained in the 1970s and, especially, the 1980s confronted a period where the original focus of community mental health began to have less influence in the mental health field due to a variety of public policies, and the growth of third party payments as a significant source of health care funding. Programs that engaged communities and provided a base for prevention interventions were greatly curtailed because of changes in federal legislation and limited opportunities for state and local funding, although prevention interventions found growing interest from research funders. Clinical and community psychologists who trained in this period increasingly looked to a variety of areas outside of mental health. Consequently, the field of community psychology has become more applied and less academic, with increased attention to advocacy, theory, and global perspectives. The sweep of these changes and their implications for the future of the field are discussed here.     

癌症姑息治疗的临床意义和社会伦理思考

姑息医学作为医学学科之一,内容包括癌痛控制,处理缓解其他症状。癌症姑息治疗缓解了紧张的医患关系,有效的防止有限医疗资源的浪费及分配不公,同时姑息治疗给人们留下诸多社会伦理思考,如告知、癌痛控制等问题。如何将姑息治疗扩展到其他非恶性疾病面临着巨大挑战。     

Reflections on the Reflections

Pastoral Psychology -     

A Clinical Case of Generalized Anxiety Disorder

This article presents the clinical case of a 38-year-old man with generalized anxiety disorder (GAD). “William” reports longstanding excessive and uncontrollable worry about a number of daily life events, including minor matters, his family, their health, and work. In addition, he endorses chronic symptoms of restlessness and irritability, muscle tension, concentration difficulties, and sleep disturbance. In an attempt to cope with his worries, William engages in excessive information and reassurance seeking, particularly with respect to decision making, and he often double-checks even minor tasks. In addition, he engages in procrastination, and avoids spontaneous or unplanned events. Although William describes himself as a born worrier, his GAD symptoms became noticeably problematic over the last several years, subsequent to an increasing number of stressors. Comorbid conditions as well as predisposing and precipitating factors are described in addition to the specific symptom presentation.     

病例报告与临床科研思维

病例报告属于描述性研究方法,是通过记录非同寻常的临床现象,可能揭示新病种、特殊机制、新疗法等,为临床工作经验介绍、总结的初步形式。在医学科学探索的历程中,病例报告拥有特殊的地位和曾经的辉煌,目前仍是医学研究的一种重要体裁。"一个好的病例报告就是一个有教育意义的好故事",一个不同寻常的现象,可能是一个新的病种、一个特殊的机制或一种特殊的组织病变或生理功能紊乱所致。一篇好的病例报告为临床医生和科研工作者提供直接生动的第一手临床资料,能促进临床医生和医学生热爱临床工作,养成面对难题、独立思考、追根朔源、发现与解决问题的能力,值得重视。     

从典型案例分析临床心身症状问题

基于长期的肿瘤科临床见闻,笔者提出许多慢性病复杂的临床症状背后,可能存在心身互动机制;且研究已经明确,心身存在着共轭关系.因此,临床应具备心身相关思想,对慢性病及其症状,从人心身整体性做出考量;心身相关性症状的表现是错综且多样化的;对临床难以解释症状,主张从心身相关角度切入,常可帮助解开谜团;同时,处置时还应心身兼顾地进行干预;这样,既可反证诊断正确与否,又可帮助改善症状.