What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

Sado-masochism as a defense against merging: Six case studies

This paper reports on several patients who use sado-masochism as a defense against an unconscious wish for and fear of merging. The sado-masochism can be expressed as a sexual perversion or in a difficult ungratifying interpersonal relationship. These relationships have some of the quality of addictions in that the patients have a compulsive need to continue them and find it extremely difficult to leave them. Therapy must focus on helping the patient become more separate, rather than on other problems which may also be present. Initially, the therapist needs to take an educational stance in regard to the process the patient must complete, rather than the more traditional analytic stance.     

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.     

Profile of Rural College Reach-Out Students

This study focuses on the personality profile and career aspirations of rural, underachieving seventh-grade students from low socioeconomic families who were selected to participate in a college reach-out program. Implications for career counseling and educational planning are discussed.     

A Career Counseling Diagnostic Model: How to Assess and Counsel Career-Concerned Clients

This article provides a practical and proven diagnostic system that can be used by career counselors to assess and counsel their clients.     

Paternal empathy in the transference/countertransference relationship

This paper explores the process of paternal empathy within the context of the transference and countertransference relationship. The masculine and feminine elements of paternal responsiveness are described with implications for therapeutic resonance and mirroring. Case material illustrates the author's thesis.     

How much can people really change?

The basic purpose of pastoral counseling, and counseling in general, is to help people change. Therefore, it's critically important to understand the nature of change and to have realistic expectations with respect to how much people can change. To expect too little change can lead to underachievement and despair, whereas to expect too much change can cause needless frustration and an abiding sense of failure. This article discusses behavioral change, its potential and its limits, from the point of view of genetic potential and offers some specific pastoral implications.