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.     

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.     

On self-disclosure: The vulnerable therapist

The therapist may stimulate the family's growth by sharing his personal experiences directly with them. This helps by providing the family with a model of a real (versus symbolic) person and encouraging them to respond in new and competent ways. As a result, the emotional commitment of the therapeutic system may deepen, while unconscious conflicts that have been causing impasses may surface and be resolved. The therapist hopes that his self-disclosure will benefit the therapy, but understands that there are risks involved. Specific guidelines can help in deciding when not to share, what kinds of problems can be revealed, and what attitudes best strengthen this endeavor. Self-disclosure is discussed here in an experiential frame-work. The author illustrates the above points with examples from his own personal clinical and supervisory experiences.The author would like to thank his wife, Linda Barth Garfield, MSS, without whose sustaining support this paper could not have been written, and his partner, Ellen Berman, MD, for her valuable comments and encouragement. The masculine pronoun is used in this paper for convenience, and because the author is often referring to himself.     

Symbolic experiential journeys: An introduction

This introductory article describes the origins of this special issue on Symbolic-Experiential Family Therapy. It goes on to elaborate the basic assumptions of Carl Whitaker's approach which emerge as unifying themes in the contributors' articles. It concludes with a tribute to Whitaker.The author wishes to acknowledge Linda Barth Garfield, MSS, and Ellen Berman, MD, for their helpful assistance and editorial comments in the development of this paper.     

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.     

Do women and men receive different care for sore throats?

Several studies have shown differences in the rates at which women and men receive treatment for several common medical problems, especially heart disease. The reason for these differences and the extent to which men and women receive different treatments for other problems is unclear. The purpose of the current study was to determine whether there are differences in the rates men and women receive antibiotic therapy for pharyngitis (sore throat), whether these differences are related to differences in disease severity or comorbidity across the sexes, and whether these differences could be due to prejudice against women by male clinicians. This was a retrospective analysis of data at two university student health services in Pennsylvania and Nebraska. Male clinicians did not prescribe antibiotics at significantly different rates for male and female patients, but female clinicians prescribed antibiotics more frequently for their male patients.The original data collection was supported in part by a grant from the National Library of Medicine, LM-04321.Presented in part at the Annual Meeting of the Society for Medical Decision Making, Portland, Oregon, October, 1992, and at the Third Primary Care Research Conference, Atlanta, Georgia, 1993.We thank Jane Kreisberg and Linda Rizjis for coordination of the collection of the original data, Linda Gray for help with data entry, and Cheryl Kull and Mary Martino for secretarial support. We are grateful to all the physicians who participated in the original study.     

Applying developmental previewing to the principles of family therapy

This paper discusses the application of principles of infant psychiatry to the diagnosis and treatment of multigenerational family conflict. Using a technique referred to as previewing, the therapist can focus on the interpersonal meaning that the infant's development precipitates in the family and determine how the parents' relationships with the infant replicate their relationships with their own families of origin. The therapist may then use these insights for overcoming conflict and for acclimating parents to new developmental skills in an optimal manner. Specific suggestions for how parents may promote more adaptive patterns of interaction with the infant using previewing are offered.