Belief, hope and faith

A case of hysteria is presented in order to create a frame of reference for the author's approach to the concepts of hope, belief and faith. A difference between hope as a 'sad passion' (which is here called regressive hope) and hope as a principle of mental functioning is established. The concept of hope will at fi rst always be based on beliefs-either beliefs organised in the paranoid-schizoid position (called here fragmented and delusional beliefs)-or those organised from the depressive position (complex systems of beliefs, which end up being dogmatic); the latter typically occur in neurotics. It is suggested here that there is another possibility for hope, which is based on faith. The meaning of faith is considered here externally to the religious sense. The solid establishment of hope as a principle-based on faith-can be viewed as responsible for the opening up of creative potentials and as one of the main aims of analysis. Such an aim, however, requires the establishment of a deep relationship, both in theory and in clinical practice, between the Kleinian question of the depressive position and the Freudian question of the Oedipus complex.     

Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder

Individuals diagnosed with borderline personality disorder (BPD) are notoriously difficult to engage in treatment. The purpose of this paper is to highlight therapeutic strategies that are likely to facilitate early alliance in therapy with individuals diagnosed with BPD. The seven strategies include, collaborative assessment, the use of contracts, motivational interviewing, linking treatment targets to client goals, commitment strategies, validation, and the use of metaphors. Clinical vignettes are presented to elucidate the concepts described and demonstrate their use in clinical practice.     

Children At-Risk for Borderline Personality Disorder

Adult patients who have been diagnosed with borderline personality disorder (BPD) have provided valuable information about events and family dynamics that are frequently associated with BPD. Clinicians who work with children are frequently aware of family or individual characteristics that may put a child at risk for developing BPD. Such situations frequently involve attachment issues with the child's caregivers and can include sexual abuse, divorce, alcoholism/substance use, illness/ death, and neglect. Child characteristics such as learning difficulties and temperament may also predict BPD. Yet, many children are resilient and seemingly unaffected by these events or situations, especially when early intervention may prevent development of BPD.     

The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder

The authors describe a new cognitive-behavioral systems-based group treatment for outpatients diagnosed with borderline personality disorder (BPD). The program is identified by the acronym STEPPS, which stands for Systems Training for Emotional Predictability and Problem Solving. The STEPPS program was developed to address the cognitive distortions and behavioral dyscontrol typical of clients with BPD, and combines this with skills training and a systems component. The latter involves clients with BPD and those in their system including family members, significant others, and health care professionals. The program is fully manualized, and involves 20 two-hour weekly group meetings; specific goals (or lessons) are identified for each session. Preliminary data from the US and the Netherlands have shown that the group achieves high levels of acceptance from clients and therapists and that the model may be effective in helping to relieve the symptoms associated with BPD. Work is now underway to confirm the effectiveness of the model through a randomized controlled trial.     

道德失范：社会安全的腐蚀剂

本文认为 ,我国进入社会转型加速期以来 ,较为普遍的道德失范现象正以自己特有的方式影响着社会的良性运行与协调发展 ,一定程度上正威胁着社会安全。克服道德失范现象 ,应该从构筑社会精神、落实《公民道德建设实施纲要》、做好制度安排几个方面下功夫。     

Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder.

Cognitive behavioral treatment (CBT) has been shown to reduce risk for adverse reactions (e.g., rebound panic) following benzodiazepine taper for patients with panic disorder (PD). This study evaluated the effects of antidepressant discontinuation for patients with PD in the context of CBT. Patients with PD (n=21) on a stable dose of antidepressants completed a 12-week group CBT treatment and were randomly assigned to discontinue antidepressants during week 8 of the treatment. There were no statistically significant differences between groups at posttreatment or 6-month follow-up. Data indicate no apparent immediate or long-term adverse effects for antidepressant discontinuation for patients with PD receiving CBT.     

心内科处理心理障碍患者治疗方案的可行性分析

为了探讨在心内科治疗心理障碍患者的可行性,我们应用汉密尔顿量表评估400例到心内科就诊的患者,对诊断为焦虑或抑郁状态的患者分为两组（心内科干预组,心理科治疗组）,随访半年,观察焦虑或抑郁状态的缓解情况。结果显示,本研究共入选符合心理障碍诊断者71例,占就诊人数的17．75％。到心理科治疗患者30例,在心内科门诊治疗患者41例,半年随访评估,治疗有效率分别为16．7％和79．4％（16．7％vs79．4％,P〈0．05）。因此,在心内科门诊对就诊的心理障碍患者进行治疗,是一种可行的方案。     

惊恐障碍药物心理干预的临床动态研究

惊恐障碍（panic disorder,PD）是综合医院常见的一种急性焦虑障碍,严重地影响患者的精神心理健康、社会功能和生活质量,并造成医疗资源的极大浪费。本研究通过动态比较药物与药物加心理治疗的疗效,为更合理的对惊恐障碍进行临床干预提供了一定决策依据。     

从惊恐障碍看生物心理社会医学模式的必要性和紧迫性

归属于精神医学研究范畴的惊恐障碍患者反复就诊于综合医院内科,频繁使用急救医疗服务,是误诊率最高的疾病之一。本文探讨了惊恐障碍患者去综合医院就诊的必然性和误诊误治的原因及危害性,提出了综合医院医师掌握该病诊治方法,由生物医学模式向生物心理社会医学模式转变的必要性和紧迫性。     

‘Seeing beyond the battled body’ – An insight into selfhood and identity from women's accounts who self‐harm with a diagnosis of borderline personality disorder

Background: Self‐harm (self poisoning and self‐injury) is broadly characterised as any act intended to harm one's own body, without a conscious intent to die. Research indicates that when practitioners encounter self‐harm they often remain anxious, fearful, frustrated, and challenged about such individuals, principally because they are constrained to understand and respond to self‐harm almost exclusively within a problematised discourse (Walker, 2006). That is, a problem that must be diagnosed and contained. Women who self‐harm with a diagnosis of BPD are often portrayed as being risky, chaotic and their identity can be unstable. The aim of this study was to examine and explore the subjective experiences of women who self‐harm with a diagnosis of BPD. Participants: Four women who had a history of self‐harming behaviour with the diagnosis of BPD volunteered for the study. Method: Face‐to‐face, in‐depth narrative interviews were undertaken and were analysed within a framework which drew upon aspects of the ‘performance’ (Langellier, 1989; 2001) and ‘narrative thematic’ approaches (Reissman, 1993). Findings: Two of the participant's accounts illustrate how their self‐harming appeared to have affected their selfhood and sense of agency. They discuss how the external signs of self‐harm may take over their identity and how others communicate and interact with them. Despite the problematic nature of self‐harm implications for practice are highlighted which practitioners may draw upon in their work around self‐harm.