Mother-Blaming and Clinical Theory

No abstract available for this article.     

The effects of patient's frequency of attendance and etiology of symptoms,on the General Practitioners wellbeing

IntroductionThe presence of Medically Unexplained Symptoms and a high Frequency of Attendance negatively affects the General Practitioners’ (GP) wellbeing. Although, overlapping between both phenomena is partial, with a number of frequent attenders reporting medically unexplained symptoms during consultation, there is no evidence on how GP's well-being it is affected by the specific main effects of these factors and their interaction. Evidence is also scant on the psychological processes explaining the negative impact of attendance and the etiology of symptoms on GP's wellbeing.ObjectiveDrawing on the Job Demand-Control and the Conservation of Resource stress models, this paper tests the moderating effects of the GP’ perception of patient's attendance and etiology of symptoms on the relationship between patient's demands and feedback on the GP's wellbeing.MethodA total of 105 volunteer GPs self-reported on the study variables through an experience sampling methodology after 898 patients’ consultation. Patients attendance and etiology of symptoms were categorized according to the physician self-perception and an external criterion (organizational records).ResultsPerception of Patients Frequent Attendance and Medically Unexplained Symptoms were positively related to physician's Emotional Exhaustion. Contrary to expected the test of the moderation effects of patients characteristics on the relation between patient's demands and feedback and the GP's emotional exhaustion were stronger for normal attenders compared with frequent attenders. An ad hoc study shows this unexplained result is related to the GP's expectations on Frequent vs. normal attenders’ behaviors. No significant results were found when the external criterion of classification was used.ConclusionCombined analysis of Frequency of Attendance and Etiology of Symptoms lead to a better understanding of the GP's decreased wellbeing. Also, the perception of the strain level (demands/positive feedback levels) associated to the consultation with different types of patients contribute to explain the consequences for the GP's wellbeing, especially when GP's expectations on patient's behaviors are violated.     

Communion-orientation as an antidote for aggressive behaviour among high provocation sensitive individuals

The current study explored whether high provocation sensitive individuals would declare less anger and therefore fewer physical aggressive acts if they are high in communal values. Three samples, students, prisoners and psychotherapy patients, were compared for differences in occurrence of aggressive reactions and preassembly communion-orientation. Data was tested using Structural Equation Modelling (SEM).Among students, communion-orientation itself and in interaction with sensitivity to provocation had a diminishing effect on anger. Among prisoners and patients, there was no support for the notion that communion-orientation had an effect on anger. Among patients, the relationship between sensitivity to provocations and physical aggression was fully mediated by anger, but among prisoners a provoking situation was enough to lead to physical aggression.Although based on data from self-reports, possibly biased by impression management, results suggest that communion-orientation should be considered in research on aggression.     

Dissatisfied psychotherapy patients: A tentative conceptual model grounded in the participants' view

Usually, between 5% and 20% of psychotherapy patients are dissatisfied with their treatments. This naturalistic study explores seven clearly dissatisfied patients' view of the therapeutic process and outcome. Interviews at termination of psychoanalytic psychotherapy and at a 1.5-year follow-up were analysed to create a tentative conceptual model of patient dissatisfaction using grounded theory approach. At the core of the model is an experience of abandonment by a therapist felt to be insufficiently flexible, a therapy lacking intensity, and links missing between therapy and everyday life. Dissatisfied patients lacked confidence in their relationship with the therapist, described their therapists in negative terms and concluded that their therapies lacked direction. They wanted more response from the therapist. Paying greater attention to the patient's emerging dissatisfaction may prevent lasting disappointment, unnecessary continuation of fruitless treatment, and probably increase efficiency.     

Emotional and behavioural problems in children dealing with maternal breast cancer: a literature review

ABSTRACT

A significant number of breast cancer survivors are living with their minor children. In this review we investigated the impact of maternal breast cancer on children. A literature search conducted through PubMed, Scopus, Cochrane Library and CINAHL yielded 26 relevant studies, which documented a variety of effects. Evidence has been presented that dealing with maternal breast cancer can cause uncertainty, anxiety and depression in children, but may also lead to enhanced social and academic performance. The risk of problems in these children is reported to be associated with both low parental affective responsiveness and excessive parental involvement. Internalising child problems were shown to be linked with maternal depression and family dysfunction, and externalising problems with family dysfunction and communication problems. Some of these problems may be modified by interventions for supporting these families, which should be designed to include both parents and children, and also the healthcare personnel.