A Family Physician in an Ultraorthodox Jewish Village

The ultraorthodox Jewish community of Kfar Habbad Village is a special minority community in the Israeli context, one with particular needs because of its special religious and social commitments. This paper gives a personal account of a family physician's work in treating this population. It emphasizes the unique role of the doctor in her ongoing interaction with the rabbis of the Village and the doctor's use of community resources in order to meet the special needs of the group.     

Issues in psychotherapeutic encounters of patients suspected of post-traumatic stress disorder malingering

The literature indicates on high rates of post-traumatic stress disorder (PTSD) malingering in various mental health settings but only few articles relate to therapeutic encounters with this population. The aim of this article is to present some of the difficulties that characterize psychotherapeutic encounters with patients suspected of PTSD malingering, and to examine the vicissitudes of significant elements of psychotherapy during these complex clinical situations. Some therapeutic interventions and indications that may help therapists to distinguish between patients with exaggerated symptomatology who suffer from true mental distress, and from full malingerers are also provided. It is argued that therapists and policy makers should relate to PTSD malingering more seriously due to the negative consequences of this phenomenon.     

The costs of caring: Gender identification increases threat following exposure to sexism

The current research examined whether group identification moderates the extent to which perceived ingroup discrimination is threatening, as indexed by physiological and self-report measures. Women read and gave a speech summarizing an article describing sexism as prevalent or rare. They then completed a distraction task and sat for a recovery period. Cardiovascular reactivity (CVR) was used to index threat experienced on an automatic level and self-reported anxiety was used to index threat experienced on a controlled level. Regardless of group identification, participants in the prevalent sexism (vs. rare sexism) condition exhibited a pattern of CVR consistent with threat during the speech and reported greater anxiety post-speech. During recovery, however, highly identified participants in the prevalent sexism condition exhibited a sustained threat pattern of CVR and reported higher anxiety post-recovery compared to low identifiers. High group identification may heighten the psychological and physiological burden of discrimination.     

Three stages of medical dialogue

The negative consequences of physicians' failure to establish and maintain personal relationships with patients are at the heart of the “humanistic crisis” in medicine. To resolve this crisis, a new model of doctor-patient interaction is proposed, based on the ideas of Martin Buber's philosophy of dialogue. This model shows how the physican may successfully combine the personal (I-Thou) and impersonal (I-It) aspects of medicine in three stages. These “Three Stages of Medical Dialogue” include:

1. An Initial Personal Meeting stage, which initiates the doctor-patient relationship and involves mutual confirmation;
2. An Examination stage, which requires a shift from a personal to an impersonal style of interaction;
3. An Integration Through Dialogue or “Healing Through Meeting’ Stage, which involves the integration of the impersonal medical data into the ongoing dialogue between doctor and patient, as a basis for shared decision-making.

The use of the model, as well as common failures of doctor-patient dialogue are discussed.     

When words lose their power: Shiatsu as a strategic tool in psychotherapy

A psychotherapist sometimes reaches the edge of his abilities, the point at which he/she realizes that for a certain client, words lose their power. The therapist may try a variety of psychological approaches, but with no effect, until he/she comes to feel that perhaps the patient simply cannot be helped. This article points the possibility that in certain cases, when psychotherapy is not bearing fruit, the psychotherapist can make use of additional tools to break through the barrier to treatment. These tools can include psychodrama, movement or dance therapy, and many other non- verbal techniques. The additional tool discussed here is Shiatsu (Acupressure), whose integration in certain cases was found to bring about the desired breakthrough, ultimately bringing the patient to the point at which talking was meaningful and effective again.     

Bereavement and Traumatic Bereavement: Working with the Two-Track Model of Bereavement

Bereavement following loss through death is a universal human experience, but how it is experienced and understood is mediated by many variables. In this article, we stress the importance of a bifocal approach to understanding, assessing and intervening following the loss of significant persons using the framework of the Two-Track Model of Bereavement. This model examines both biopsychosocial functioning as well as the nature of the ongoing relationship with the deceased and the death story in working with the bereaved. It is particularly suited to identify adaptive and maladaptive responses to loss and to optimally focus interventions where needed. Two case vignettes are presented to orient the discussion. Traumatic bereavements, a term indicating the interface between trauma and loss, increase the likelihood of complications following loss and these are considered. Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, symptomatic difficulties and complicated grief. In addition, there are forms of traumatic bereavement that arise due to subjective elements related to aspects of the psychological relationship to the deceased and the relational bond with him or her. Clinically, there is a need to identify and understand the various aspects of the traumas of bereavement and to intervene appropriately. Interventions based on the Two-Track Model of Bereavement will be described.