Suicidal ideation and somatic symptoms of patients with mind/body distress in a Japanese psychosomatic clinic

To examine associations of suicidal ideation with somatic symptoms, 863 outpatients were studied in a psychosomatic clinic in Japan. All subjects were diagnosed according to the third and fourth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R and DSM-IV). They completed the Cornell Medical Index Questionnaire to assess suicidal ideation and 15 major somatic symptoms. Mood states were rated using the Profile of Mood States (POMS). In the study, 266 patients (31%) reported suicidal ideation. The age- and sex-adjusted odds ratios (typically in the range of 1.5 to 2.5) of somatic symptoms for suicide ideation showed significant differences (all ps < .05) for 13 of 15 symptoms. The total number of somatic symptoms predicted suicidal ideation (p < .05), controlling for the significant effects of sex, education, marital status, and the POMS Depression scale scores through multiple regression analysis. Evaluation of somatic symptoms might be important to assess suicidal ideation in a psychosomatic medicine population.     

Predictors of middle childhood psychosomatic problems: An emotion regulation approach

Development of the psychosomatic problems picky eating and headache and stomachache complaints in middle childhood was investigated from an emotion regulation perspective. The role of negative emotionality and family emotion regulatory factors (attachment to mother and parental perceived control) was studied. The sample (N=87) was a predominantly middleclass, community sample. The study was longitudinal, based on data from several data collections between child age 11 months and 9 years. The results showed that headache and stomachache complaints were mainly predicted by early negative emotionality, and picky eating by the family factors. More negative emotionality, insecure attachment and less perceived control were related to more psychosomatic problems in linear and interaction models. The findings were interpreted as showing that by considering emotion regulation, a fruitful perspective for understanding the development of psychosomatic problems could be elaborated. Copyright © 2004 John Wiley & Sons, Ltd.     

Psychotherapy with families of psychosomatic patients

Paradigmatic complexes in family psychotherapy have been indicating a revolutionary change and the creation of new paradigms for the past thirty years. Starting with the application of the general systems theory and the development of those concepts that have been emerging regarding psychosomatic illnesses we discuss the epistemological confusion created, the methodological problems and the dissociation between theory and practice. We suggest a double process of investigation of the family structure using a knowledge of the basic attitudes and the development of a psychotherapy programme within the family of the psychosomatic patient.     

Psychoticism and response to treatment in neurotic patients

A study is reported of neurotic patients at St. Bartholomew's Hospital, London, who were given the Eysenck Personality Questionnaire and who were rated by their doctors for prognosis and final assessment after treatment. The results indicated that those patients who had elevated psychoticism scores took longer to improve and that doctors rated them harder to treat at final assessment. It is suggested that early knowledge of patients with a poor prognosis, in the form of their Psychoticism score, might prove helpful to psychiatrists and psychologists, both for diagnosis and (primarily) for choice of appropriate treatment.     

Cognitive styles and behavior problems of clinic boys

Groups of hyperactive, learning-disabled, epileptic, and normal boys matched on age and intelligence were compared on measures of cognitive style and maternal reports of behavioral pathology. All clinical groups were more impulsive, more field dependent, and weaker automatizers than their nonclinic peers. Although the clinical groups were described by their mothers as showing more behavior problems than controls, hyperactive boys were seen as having more conduct problems, while learning-disabled boys were seen as immature.     

Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

An intervention program for adolescents with behavior problems

Adolescents with behavior problems (aged 12 to 14) attending a regular public high school were in need of an intervention program. The purpose was to enhance their personal and interpersonal functioning as well as to structure a stimulating learning environment. In order to improve their social, educational, and psychological functioning, program objectives were established to help students develop the ability to listen to one another, respect others as well as their opinions, become aware of their own emotions and those of their peers, and recognize and minimize derogatory remarks toward one another. To attain these objectives, relaxation sessions, magic circle activities, art sessions, future planning groups, and decision-making groups were used. Meetings with teachers enabled them to examine and improve their attitudes and relationship with students. Upon completion of the program, the adolescents manifested less disruptive classroom behavior, increased their class participation, and displayed a more positive attitude toward school. The achievement of these behavioral changes indicates that a psychologically oriented intervention program is a feasible addition to a conventional curriculum. Teachers learned the basic skills of program formation, implementation, and evaluation, and most importantly, revitalized their attitude toward troubled students and their profession.     

An intervention strategy for children with developmental problems

In a program for primary grade children with developmental and perceptual difficulties, children met daily with a specially trained teacher in their own school to form a consistent meaningful group while they continued as members of their regular classes. To combat the destructive negative self-image of such children, the teacher and group stressed acceptance, openness, informalitym and success. This, plus the program's esteem in the eyes of the child, seemed to affect the child's sense of his own worth. Continual in-service training and sharing of teacher experiences were stressed. The teachers' facility for relating to the child was considered to be more relevant than the technique utilized.     

Converted patients and clinic patients as control cases: a comparison with implications for psychoanalytic training

All twenty-eight respondents to a recent poll of the thirty institutes affiliated with the American Psychoanalytic Association reported that they now accept cases converted from psychotherapy to psychoanalysis as control cases. This study was designed to compare converted cases to clinic cases systematically with respect to patient characteristics, treatment, and the educational experience of the treating candidate. The study followed twenty-four candidates entering analytic training between 1992 and 1995, who treated thirty-four clinic cases and forty-three converted cases between February 1993 and July 2000. Clinic and converted patients were comparable with regard to demographics, prior treatment histories, structural diagnoses, and Axis I diagnoses. In addition, the two groups of cases were indistinguishable with respect to the rate at which candidates received credit toward graduation requirements. Candidates treating converted cases earned approximately dollars 7,600 per patient per year, compared to candidates treating clinic cases, who earned nothing. Eighty-four percent of converted patients diagnosed with a mood disorder by the treating candidate were on medication, in contrast to only 20% of clinic patients with the same diagnosis. Similar differences were seen in the case of anxiety disorders. Given the prevalence of affective and anxiety disorders in control cases and the availability of a variety of medications and psychotherapies with documented efficacy in treating these disorders, candidates should be trained to discuss treatment options with patients who present with Axis I disorders.     

Challenges in treating patients with psychosomatic disorders: some patterns of resistance

The treatment of people suffering from psychosomatic disorders poses important clinical challenges to psychoanalytic practice, including early abandonment, difficulties in engagement and superficial involvement in the treatment. The lack of systematic research on the subject suggests that a better understanding of the resistances and dynamics involved in such episodes is needed. Using supervision group to study treatments and inspired by action-research paradigm, this paper presents the results of an 18-month mixed-method qualitative clinical research on treating 22 cases. Thematic analysis revealed a frequent pattern of resistance to experience emotions that presented in two states: failure of repression (thin-skin) and massive repression (thick-skin). Narcissistic dynamics in the therapeutic relationship taking the form of ‘resistance to transference’ and a tendency to action were evident in both presentations. Symmetric and complementary counter-transference reactions, which compromised treatment, were also identified. Some technical implications are highlighted, such as the need to focus in the recovery of the patient's actual emotional experience and to understand such experience in the context of the ‘here and now’ of the therapeutic encounter. These findings suggest the need for a flexible approach to therapeutic work that moves between an ‘intrapsychic’ and a ‘relational’ focus.     

Existential and psychopathological evaluation of group psychotherapy of neurotic and psychotic patients

General problems in researching group psychotherapy are reviewed, especially for those with similar theoretical and methodological approaches. The sample consisted of 100 subjects, 26 of whom were neurotic and 24 of whom were psychotic. They were treated in small groups, headed by the author (the experimental group). An equal number and the same categories of patient attended control psychiatric sessions (the control group). All subjects were tested twice. With three instruments: the semantic differential (with twelve existential categories, five general therapy, and three ego psychology categories), the Kotchen test, and MMPI (midiform). A discriminative analysis of tests and the repeated test data, statistically significant, revealed experiential changes in existential categories, such as "Freedom," "Sex," and "Love" amongst psychotics; and in the case of both psychotic and neurotic patients, treated in groups and compared with the controls, such categories as "Understanding among people." With the help of MMPI, a statistically significant reduction of hysteria in neurotic subjects was established, as well as the preventive effects of group psychotherapy regarding the emergence of psychopathy in psychotic patients. Correlation calculations indicated a greater discrimination in the perception of changes using existential categories in the experiencing of psychotic and depressive patients. Finally, the results obtained are discussed from the viewpoints of clinical experience, results obtained in similar research studies, and unanswered questions resulting from such research.     

Internalization of the therapeutic process: differences between borderline and neurotic patients

Intersession process in psychotherapy refers to the thoughts, memories, and feelings about each other and about their therapy sessions that participants experience during the intervals between sessions. This study compared the intersession process experienced by patients who had been diagnosed with severe borderline personality disorders (BPD) with others who had not. A total of 76 patients with neurotic disturbances and 20 patients with BPD were treated in a therapeutic day clinic and completed the Intersession Experience Questionnaire (IEQ) before sessions of individual psychotherapy and the Session Questionnaire (Stundenbogen) after those sessions. Comparison of the two groups on these measures of intersession process and postsession outcome showed markedly different patterns in patients' evaluations and internalizations of in-session therapeutic experiences: most prominently, that BPD patients internalize therapy sessions with much more negative and contradictory emotions.