Psychotherapist-patient sexual contact after termination of treatment.
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Adult↗
Biomedical subjects
G O Gabbard
Publications and source records attributed to G O Gabbard.
Psychodynamic psychiatry in the "decade of the brain".
OBJECTIVE AND METHOD: To illustrate the continued relevance of psychodynamic thinking in the practice of contemporary psychiatry, the author reviews a number of studies that demonstrate the intimate connection between psychosocial and neurophysiological factors in the etiology and pathogenesis of psychiatric disorders. A survey of three specific anxiety disorders illustrates the complex interaction between mind and brain in these disorders. RESULTS: Research on both primates and humans suggests that psychological influences result in permanent alterations of a neurobiological nature. Similarly, psychological interventions in a treatment context may have a profound impact on neurophysiology. Clinical case examples demonstrate that "biologically based" disorders may be rich in unconscious meaning. Clinical understanding of the meaning of symptoms may be instrumental in ensuring patients' compliance with pharmacotherapy regimens and in the removal of other resistances to treatment. CONCLUSIONS: In contemporary psychiatry, a psychodynamic perspective must be preserved. Without it, meaning will be lost, and both diagnostic understanding and informed treatment planning will suffer as a result.
Adult↗
Obstacles to the dynamic understanding of therapist-patient sexual relations.
Several dynamic resistances appear to interfere with rational and empirically based discourse about therapist-patient sexual misconduct. These resistances include the lure of reductionism and a longing for simplicity; wishes for "political correctness"; gender bias; and confusion about the nature of the trauma in sexual misconduct. We conclude that (1) empirical study may produce unpleasant results; (2) "politically incorrect" models of misconduct merit study with care equal to "politically correct" ones; and (3) those reenactments we call transference-countertransference should be viewed in all their human complexity. Only then will our increased understanding of misconduct offer hope of prevention.
Ethics, Professional↗
The therapeutic relationship in psychiatric hospital treatment.
The therapeutic relationship between staff members and patients is a crucial healing ingredient of psychoanalytically informed hospital treatment. The author describes how this relationship facilitates each patient's repetition of early object relations, which are reenacted with staff members through splitting and projective identification. During regular meetings, staff members work together to understand and integrate the various projected parts of a patient's psyche, which are then reintrojected by the patient through both interpretive and noninterpretive aspects of the therapeutic relationship. The author concludes by describing the deleterious effects on this process of current economic and regulatory forces.
Adult↗
Psychodynamics of panic disorder and social phobia.
d psychological treatments of psychiatric disorders are often wrongly polarized. The related anxiety disorders, panic disorder and social phobia, illustrate the interdependence of biology and psychology. The author describes current psychodynamic understanding of the factors that contribute to the etiology and pathogenesis of these disorders. He concludes by stressing the value of integrated, psychodynamic treatment.
Behavior Therapy↗
A psychodynamic perspective on the clinical impact of insurance review.
The rise of managed care and concurrent utilization review has had a profound impact on the practice of inpatient psychiatry. Little has been written, however, on the clinical impact of the review process itself. The actions of insurance reviewers often result in their being incorporated into the psychopathology of individual patients and into the dynamics of families and institutional settings. The authors apply psychodynamic understanding to a series of case examples to illustrate how concurrent review may promote splitting, impede the patient's ability to separate from the hospital, and paradoxically reinforce the patient's illness. They also explore a number of typical responses of treatment staff and families to the review process. A case vignette demonstrating a sincere effort at mutual collaboration between payers and providers is also presented. This spirit of compromise is proposed as the solution that best serves patient care.
Adolescent↗
Homicidal maniacs and narcissistic parasites: stigmatization of mentally ill persons in the movies.
The portrayal of mentally ill persons in movies and television programs has an important and underestimated influence on public perceptions of their condition and care. Movie stereotypes that contribute to the stigmatization of mentally ill persons include the mental patient as rebellious free spirit, homicidal maniac, seductress, enlightened member of society, narcissistic parasite, and zoo specimen. The authors suggest that mental health professionals can fight this source of stigma by increasing their collaboration with patient advocacy groups in monitoring negative portrayals of mentally ill people, using public information campaigns such as Mental Illness Awareness Week to call attention to the process of stigmatization, and supporting accurate dramatic and documentary depictions of mental illness.
Attitude of Health Personnel↗
Technical approaches to transference hate in the analysis of borderline patients.
Transference hate presents a major obstacle to effective analytic work with borderline patients. In a subgroup of these patients, the analyst is hated relentlessly in a manner that seems unresponsive to interpretation. The persistent projective identification of hated aspects of the patient's internal world may erode the analyst's ability to maintain his analytic posture and lead to various forms of countertransference acting out. A prolonged period of containment is required for both patient and analyst before they are likely to converge in an 'analytic space' where interpretation will be effective.
Adult↗
Do we need theory?
In response to the question raised by Lindon in his paper, "Does Technique Require Theory?" the author replies in the affirmative, arguing that theory is inherently involved in the application of psychoanalytic treatment. In contrast to Lindon's view that theory must be downplayed in treatment, the author contends that this perspective is itself part of a theory--the intersubjective theory of self psychology. The author concludes that theory provides numerous benefits to therapists; indeed, Lindon's own account suggests the value of the sensitive use of theory.
Disruptive, Impulse Control, and Conduct Disorders↗
The creative process of the actor.
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Creativity↗
Stage fright.
Stage fright is a universal human experience that occurs with varying intensity in everyone who stands before an audience. The anxiety generated in this situation stems from the re-emergence of certain key developmental experiences. The dynamics involved are related both to genital and to pre-genital conflicts. Shame arises from conflicts around exhibitionism, from concerns over genital inadequacy, and from the fear of loss of control. Guilt is produced from the aggression inherent in self-display and from the fear of the destruction of one's rivals, along with the dread of retaliation. A major portion of the stage fright reaction is the reactivation of the crisis of separation-individuation, which generates separation anxiety connected to the fear that asserting oneself as a separate individual will result in withdrawal of love and admiration by maternal figures, i.e. the audience. The various developmental experiences are differentially weighted in each individual's stage fright reaction depending on the vicissitudes of his early childhood experience. Perhaps it is fortunate that few performers ever completely master stage fright, for an intangible sense of communion between the performer and his audience might well be lost as a by-product of the mastery.
Adolescent↗
The unwed pregnant teenager and her male relationship.
A group of 100 primiparas, 17 years of age and younger, were interviewed one to three days postpartum. From these interviews, the quality of the relationship between the patient and the father of the newborn child was scored in three categories. Contrary to popular opinion about illegitimacy, it was found that in the majority of cases a good, continuing relationship was maintained throughout the pregnancy, despite the fact that 97% of the patients were unmarried. Fully 84% of the fathers of the unborn children has ongoing contacts with the patients; 68% of the fathers reported that they liked the idea of having the baby, whereas only 9% disliked the pregnancies. The relationship scores were compared with the occurrence of complications in the patient's labor and delivery. Statistical analyses revealed that the relationship between the teenage obstetric patient and the father of her child was not associated with the occurrence of complications in the patient's labor and delivery. However, trends indicate a possible association between these two variables.
Adolescent↗
The psychodynamic perspective: a conversation with Glen O. Gabbard, MD. Interview by Norine J Kerr.
After providing a broad overview of Dr. Gabbard's recent book, Psychodynamic Psychiatry in Clinical Practice, the editor talks with him about a variety of topics, including hospital treatment of clients with dissociative disorders, sexual abuse, borderline and narcissistic clients, and the current status of relationships between psychiatrists and psychiatric mental health nurses.
Humans↗