Changes in Primary Process Thinking of a Prepsychotic Adolescent in Psychotherapy

The main goal of this study was to measure longitudinally change in thought processes and reality testing of a prepsychotic adolescent undergoing psychotherapy. The Holt scoring system for measuring primary process from Rorschach responses was the main measuring instrument. Four Rorschachs were administered over a period of three years. The results of the latter were compared with the clinical ratings of two psychiatrists. While clinical change in response to treatment was slight, there did appear to be a shift from primary to more secondary forms of formal thought processes as determined by the Rorschach.     

Gender Differences in Problem Solving: Expectancy and Problem Context

In this study, we investigated gender differences in problem solving as a function of problem context and expectations for success. Subjects were 90 women and 56 men from introductory psychology classes who were administered a set of mathematical problems varying in gender context under male-expectancy, female-expectancy, and neutral-expectancy conditions. No significant gender differences or interaction of gender with problem context were found. However, significant effects of problem context and expectancy were found. Both male and female subjects made higher scores on female-context problems and lower scores in the female-expectancy condition. When mathematics aptitude was used as a covariate, an interaction of gender with expectancy was found. Men in the female-expectancy condition made significantly lower scores than either men or women in the male-expectancy condition.     

the nature and frequency of medicare/medicaid fraud and neutralization techniques among speech,occupational, and physical therapists

ABSTRACT

The current study examines the nature and frequency of Medicare/Medicaid fraud and the techniques of neutralization utilized by a purposeful sample of speech, occupational, and physical therapists working within the context of hospitals, nursing homes, and with home health agencies, in a southern state. Participant observations, surveys, and in-depth interviews were utilized to obtain data for this study. We identified two main fraudulent practices, cutting sessions short while charging for the entire session and charging individual session rates for group therapy sessions. We also identified three techniques of neutralization utilized by the therapists in our study, including: (1) everyone else does it, (2) denial of responsibility, and (3) denial of injury. The implications of our findings are discussed.     

Cognición ambiental

Resumen

Esta investigación revisa el conocimiento espacial humano en los ambientes cotidianos y reales. Los estudios relativos a mapas cognitivos se organizan en cinco categorías empíricas: edad, familiaridad, sexo, clase-cultura y componentes físicos del ambiente. Se discuten las cuestiones metodológicas y conceptuales en los trabajos sobre el conocimiento ambiental, enfatizando los problemas con las metodologías que utilizan el dibujo de mapas cognitivos. En particular se observa una falta de integración entre la investigación cognitiva pertinente y los trabajos de la psicología ambiental sobre mapas cognitivos. Finalmente se discute la aplicación potencial de los trabajos de conocimiento ambiental a la arquitectura, el diseño urbanístico y la educación.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

MAKING ROOM FOR MADNESS IN MENTAL HEALTH: THE IMPORTANCE OF ANALYTICALLY‐INFORMED SUPERVISION OF NURSES AND OTHER MENTAL HEALTH PROFESSIONALS

In this paper, I discuss the importance of psychoanalytically informed supervision and training of nurses and other professionals in mental health settings. Using examples from supervision groups I will illustrate how a psychoanalytic approach to mental health can complement other ways of thinking about practice and management. Psychoanalysis provides a framework for understanding the relationship between the internal world of the patients, the therapeutic relationship and the social system. I will also argue that this understanding helps to develop and maintain therapeutic factors while reducing the risk of damaging behaviour and beliefs.     

Catch 22: the inflammatory nature of insight

I will describe a man I saw in psychoanalytic psychotherapy with a history of serious drug abuse and violent psychotic episodes. At the start of therapy my patient had little capacity to tolerate the anxiety, depression or the inevitable frustrations involved in facing reality. Over time and with the support of the therapy he was able to increase his capacity for self observation noticing the way he withdrew from the world of shared reality into psychotic states of mind in order to avoid painful feelings of rage, humiliation and shame. In the book ‘Catch 22?, Joseph Heller described the paradox of pilots who wish to claim insanity in order to avoid fatal flying missions, while the authorities maintain that in claiming insanity to avoid suicidal missions the individual demonstrates a sane awareness of the insanity of the missions! This insight is deemed to be evidence of the individual’s sanity and consequently their plea of insanity is denied. In this paper, I will show how Mr. A’s developing capacity for reflective functioning lead to a ‘Catch 22’ as the insight he needed as part of the process of recovery threatened to overwhelm him with depressing realities about the extent of his illness.