In defense of strategic therapy

The practice of strategic therapy has raised a number of critical issues and has stimulated criticism of various sorts. Among the criticisms leveled at strategic therapy are that it involves the taking of too many risks, that it is deceptive, that it is controlling and manipulative, that it is disrespectful, and that it is superficial and narrow. Each of these five major areas of concern is discussed and addressed with case examples to illustrate a rationale and justification for the use of these less conventional methods.     

The child sexual abuse victim: Assessment and treatment issues and solutions

Particular attention is given in this paper to the assessment process with child sexual abuse victims and recommendations are made regarding practical issues both in the assessment and the treatment phases of therapeutic work with child victims.     

Using psychodynamic concepts in strategic family therapy: A suicidal adolescent case

This paper describes the treatment of a suicidal adolescent with strategic family therapy. The cotherapists conceptualized the case psychoanalytically and systemically. They propose that their understanding of psychodynamics enhanced their ability to tailor their interventions to the family's unique style and capacities. Rather than dismiss psychodynamic concepts as irrelevant to strategic family therapy, they maintain that an appreciation of individual members' ego strengths, defenses, affects, and unacknowledged impulses leads to the construction of more effective metaphors and a set of interventions more isomorphic to family patterns.     

Physicians and obligatory social activism

This essay examines the claim that physicians have a special obligation to engage in social and political activism. Four ethical paradigms are considered. Two paradigms, the preventive medicine and the social medicine models, embody a limited professional obligation to advocate the priority of health in society; the justification for a more aggressive stance is limited by the failings of paternalism. The radical model and the heroic model speak to issues of personal virtue rather than professional obligation; they are not strictly comparable.     

The unforgivable humiliation: A Dilemma in couples' treatment

Therapists sometimes encounter cases of intense marital discord in which the disaffected spouse seems unable to specify the reason for his or her discontent except in the vaguest, most general terms. Such cases may be extraordinarily difficult to treat, as the disaffected partner may seem impervious to any attempt at negotiation, to the point of dissolution of the marriage. The reason for the disaffected spouse's intransigence may seem unclear to the other spouse, to the therapist, and even to herself/himself. We hypothesize an explanation for this phenomenon in terms of the disaffected partner's experience of having suffered humiliation at the hands of the other spouse and offer a plan for treatment, citing case materials.     

Illegality 1988

The author presents how the Holocaust appears symbolically in an obsessive-compulsive neurosis in 1988 in Budapest, through the therapy of a 16-year-old boy and his family. The behavior therapy that was first applied made the symptoms even more serious, supposedly because the index patient interpreted it as pursuit. The hypothesis supposed the appearance of the Holocaust in the third generation—as a family myth—and intervention based on this hypothesis brought an end to the neurotic symptoms. The knowledge of historical processes is very important in psychotherapeutic treatment.I would like to acknowledge my debt and my appreciation to Valeria Kiss, occupational therapist, Central National Institute, Budapest, who has had a major role in creating therapy, as co-therapist. I would like to thank Beata Susansky and Gareth Dewar for helping in translation and Andras Posman for helping with the figures of the genogram.     

The conflict cycle in the case of an adolescent in crisis

This is an extension of a previous paper describing a conflict cycle in families and therapy consisting of four steps: (1) the dispute; (2) blaming; (3) shame, guilt, or denial; and (4) reparation, reconciliation, or retaliation. The focus is on a single case of a 15-year-old male with a gender identity disorder in addition to a conduct disorder. He is an adopted child living in a small community in the southern United States. Conflict is illustrated from several perspectives in a single interview with the family and over the length of contact over a nine-month period: (1) between the adolescent and parents, (2) between the adolescent and community, (3) between the parents, and (4) between the Good Self and the Bad Self of the adolescent. The thesis is that the conflict cycle is an organizing principle helpful to therapists working with families to make assessments and plan interventions.This paper is an expanded and edited version of a presentation by the senior author in San Diego, California, on November 12, 1988, at the Western States Conference of the American Society of Adolescent Psychiatry.     

Suicide and Suicidal Attempts in the United States: Costs and Policy Implications

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under‐reporting increased the total cost to $93.5 billion or $298 per capita, 2.1–2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit–cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients.     

Toward a psychology of courage: Implications for the change (healing) process

Courage is a virtue which has been held in highest regard by all societies. In an age in which courage and its companions, human dignity and commitment, seem sadly lacking, it is imperative that we reacquaint ourselves with the implications of these attributes. In this paper we demonstrate the integral relationship between courage and intimacy and the importance of the concept of therapeutic caring to their development. We also introduce the theory of the double in which the self, in the act of intimacy, seeks to come together with its contradictory and disavowed attributes. These concepts are related to a psychotherapeutic paradigm in which we examine the requirements courage, intimacy, and caring impose upon practitioner and client.Paper presented at the 25th winter meeting of The American Academy of Psychoanalysis, New York City, December, 1981.