Spirituality and Religion in Antiretroviral Therapy (ART) in Kwazulu-natal,South Africa: A Longitudinal Study

This study assesses the effects of spirituality and religion in health outcomes of patients on ART in KwaZulu-Natal, South Africa. Participants were 735 patients who attended three HIV clinics for ART over a period of 20 months as follows: 519 after 6 months on antiretroviral therapy (ART), 557 after 12 and 499 after 20 months on ART. They completed the Duke Religion Index each visit. Factors associated with spirituality/religiousness included fewer mental health problems (lower depressive symptoms, lower alcohol use), CD4 cell counts, adherence to ART, better certain health related quality of life outcomes (physical, psychological and environmental), social support and internalized HIV/AIDS stigma. Further research could examine the feasibility of including spirituality and religion in the assessment and providing support interventions for HIV patients.     

Managing Hypochondriasis in Elderly Clients

The present paper provides a diagnostic and treatment overview of geriatric hypochondriasis. It is suggested that our current definition of hypochondriasis may be inadequate in describing the complexity of the disorder and its varied manifestations in the general population and especially in our geriatric population. Attempts by researchers to provide greater diagnostic clarity are reviewed, including the concepts of hypochondriasis as a discrete disorder (primary hypochondriasis) and hypochondriasis as part of a comorbid mix of disorders (secondary hypochondriasis). Diagnostic features of geriatric hypochondriasis are discussed, including comorbidity, prevalence, the relationship of medical illness to hypochondriacal symptomatology, and etiology. Treatment considerations which are reviewed include: the importance of respect for the defenses of the client, the importance of venting and expressions of feeling by the client, the creation of a psychological atmosphere of professional and interpersonal support, and reattribution training. It is suggested that hypochondriasis is a social “communication” and that comorbidity itself may be the key to unlocking the unspoken “messages” of hypochondriacal older adults.     

An Investigation of Genetic Counselors' Discussions of Genetic Discrimination with Cancer Risk Patients

Twenty-five genetic counselors who see familial cancer risk patients were interviewed about their definitions of genetic discrimination, perceptions of patient risk for discrimination, frequency and type of discrimination experienced by their patients, sources of information about discrimination, and what they tell patients about genetic discrimination. There was variability in participant definitions and content of discussions of genetic discrimination. Although 82% regarded risk to be low to theoretical, 40% reported possible instances of genetic discrimination, including insurance companies requiring results to cover procedures, denial of life/health insurance, social discrimination, and employment discrimination. Ninety-six percent of the sample reported always or almost always discussing genetic discrimination, and one or more of the following: insurance discrimination risks, protective legislation, no known cases positively documenting discrimination, strategies to avoid discrimination, and uncertainty of protective measures. The majority use current literature and research as information sources. Practice, policy, and research implications are discussed.     

Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender

The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff members and patients rated their self-images using the Structural Analysis of Social Behavior (SASB). Male staff seemed less influenced by the patient, with their feelings relating mainly to aspects of their own self-image, while the feelings of the female staff were more related to the patient's self-image. The patient's diagnosis was less important for a staff member's feelings than that member's self-image. Generally, the relation between feelings and self-image was stronger for negative feelings. The results point to the importance of understanding more about the influence of staff members' self-structure on their negative feelings toward their patients and how this relates to both the staff member's and patient's gender.     

Psychotherapists' dreams about their patients

Abstract This study examines therapists’ dreams about their patients from the Jungian and the relational perspectives. Few clinical and empirical references to this subject are to be found in the literature. In the present study 31 dreams were collected from 22 therapists. Dreams were collected using anonymous self‐report inventory. The research focused on three theoretical research questions: 1. What themes appear in the manifest content of therapists’ dreams about their patients? 2. What contributions are made by Jungian interpretation of therapists’ dreams about their patients? 3. To what extent are masochistic contents present in the manifest content of therapists’ dreams about their patients? The first question was addressed using categorical content analysis of a) themes common to different dreams and b) pre‐determined themes for all dreams. The third research question was addressed using Beck's (1967) ‘Masochistic Dream’ measure. Results: Among the themes common to different dreams were: therapist‐patient role reversal; therapist and/or patient attends and remains in meeting, departs/doesn’t depart; cancellation of therapy session; sexuality between therapist and patient; aggression; presence vs. absence; non‐verbal relationship and communication; time; driving vs. stopping. With regard to pre‐determined themes it was found that in 20 of the 31 dreams, the therapist had a negative experience and was characterized as vulnerable. Likewise it was found that 26 out of 31 dreams took place in either a) a street, a road, a route, a corridor; b) en route to somewhere; c) a therapy room and/or building; d) a house. With regard to the contribution of Jungian interpretations of the dreams it was found that 17 of the dreams had diagnostic and prognostic elements, 4 of which were initial dreams, 9 of them were compensatory dreams and in 14 it was found that the patient represents the shadow of the therapist. With regard to the third question it was found that 18 of the 31 dreams met Beck's (1967) criteria for masochistic dreams. The theoretical discussion examines the findings from a Jungian perspective, with an emphasis on also understanding the dream in terms of its expression of relational aspects of the therapist‐patient relationship. The findings affirm the presence of the ‘wounded healer’ archetypes in therapists’ dreams about their patients. The results of the study indicate that therapists’ dreams about their patients can be a valuable tool for deepening understanding of the therapeutic relationship and process.     

The Angry Patient: Case and Session Presentation

Responding to patients who become angry at the therapist is difficult for many clinicians. In the case and session presented, the patient is not only angry, but devalues the therapist by not paying while asking for more frequent sessions. The therapist loses it, states she is angry, and remains insistent on the patient keeping his bills paid or reducing the frequency of sessions. The therapist is conflicted over confronting the patient with what she believes has to change in order for his symptoms to diminish—the irrational beliefs, life style, and sense of entitlement related to the personality disorder of this patient, but likely to drive him away from treatment. The therapist engages in a risky confrontation and remains unclear about the eventual benefit of this response.     

REDUCING WANDERING BY PERSONS WITH DEMENTIA USING DIFFERENTIAL REINFORCEMENT

Wandering behavior of 4 geriatric patients with dementia residing in a long-term care facility was assessed using direct behavioral observations. The consequences identified during the observations as maintaining wandering for each patient were then applied for the absence of wandering using differential reinforcement of other behavior (DRO). The effectiveness of the DRO procedure was evaluated using an ABAB design. Results indicated significant reductions in wandering during treatment.     

Sensitivity to Levels of Importance in the Logical Memory Subtest

The performance of Alzheimer's disease (AD) and neuropsychiatric patients was examined using the Logical Memory (LM) subtest of the WMS-R, utilizing a levels of importance methodology described by Haut et al. (1990). Although patient groups were matched for dementia severity, we found the expected differences between groups in terms of absolute level of performance. There was considerable variability, however, in the AD patients' performance. AD patients' recall and sensitivity to levels of importance depended on the story (Anna or Robert), and when the passages were recalled (immediate or delayed recalls). Results suggested that AD patients were able to utilize semantic information in their immediate recall, though this was dependent on individual story characteristics. AD patient's delayed recall was essentially absent. Thus, no conclusions could be drawn with respect to the level of importance factor. NP patient's recall performance was similar to patterns observed in other clinical samples for both immediate and delayed memory.