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Biomedical subjects

H E Book

Publications and source records attributed to H E Book.

9 recordsLinked to original sources
PubMed1991

Is empathy cost efficient?

In an attempt to constrain rising health-care costs, third-party payers are currently encouraging psychiatrists and other physicians to focus on the financial aspects of their treatment approaches. This paper has attempted to address the impact of this cost-efficient attitude on our empathy and by tracking the evolution of our health-care-delivery system since the turn of the century. I have described three overlapping phases: the humanist, the scientific, and the current corporate phase, and emphasized the importance or trivialization of an empathic practice-style associated with each stage. I have warned how the corporate delivery system, with its focus on cost constraints, may inhibit our capacity to be empathic by stimulating self-serving concerns about the corporation's monetary welfare and our own financial well-being. This unempathic stance may result in treatment being driven by financial factors that override clinically driven needs of the patient. At its extreme, this approach may render psychiatrists vulnerable for viewing patients as bad objects that deprive financially, and for countertransferentially retaliating against them through "warehousing" and abandonment.

Adult↗
PubMed1988

Empathy: misconceptions and misuses in psychotherapy.

The frequent misconceptions and misuses of empathy that occur during psychotherapy are related to confusion about the definition of empathy, misunderstanding of the difference between the process of empathy and the therapist's response of being empathic, countertransference exploitation of empathy to act out the therapist's needs, the therapist's unawareness of the "layering" phenomenon, and overlooking the patient's level of self-other differentiation. These misuses result in the patient's feeling misunderstood and damaged, with a subsequent weakening of the therapeutic alliance and, at times, a breakdown in self-other differentiation. Once identified, misuses should be addressed and explored in psychotherapy to offset disruptions in treatment.

Acting Out↗
PubMed1987

The resident's countertransference: approaching an avoided topic.

The resident's countertransference to his/her patient may offer essential information about certain denied processes within that patient. It may also signal the existence of countertherapeutic scotomas within the resident. This paper offers a clinically based approach for directly identifying, exploring, and utilizing the information emerging from the resident's countertransference. This approach focuses on the "only or never" phenomenon, the parallel process, and introspective curiosity as modes of identifying the existence of countertransference responses. It highlights the importance of confrontation and clarification to explore the meaning of these responses in the context of that particular resident with his/her particular patient.

Adult↗
PubMed1987

Some psychodynamics of non-compliance.

With up to 50% of psychiatric patients refusing medication at some time during therapy, non-compliance can become a major treatment difficulty. This problem is compounded by the countertransference responses evoked within the therapists, and their tendency to react solely with information and exhortation rather than attempting to view non-compliance psychodynamically. When exploring with empathic concern, a number of common dynamic issues can be seen as playing a major role in drug refusal. Commonly at work are issues relating to projection, denial, identification, and transference difficulties that emerge in a relationship where a therapist offers a patient a pill.

Adult↗
PubMed1986

Soft clinical research on an inpatient unit: effect of findings on treatment.

This paper describes the value of identifying and processing intuitive hunches and impressionistic ideas that arose amongst psychiatrist/clinicians on an inpatient unit. Through semistructured meetings, these hunches generated psychodynamic formulations and therapeutic approaches that were integrated into already existing models of treatment to yield a better understanding of, and a more tailored approach to, the borderline patient and his/her impact on staff.

Borderline Personality Disorder↗
PubMed1979

Negative responses of the borderline to inpatient treatment.

The intense therapeutic encirclement maneuvers possible in long-term inpatient therapy of the borderline patient frequently stimulate emotional flooding and intense negative therapeutic reactions. Such reactions have understandable precipitants: a mixture of therapeutic goals, treatment methods, and defensive structures of the patient best conceptualized within an object-relations model.

Adult↗
PubMed1978

Staff countertransference to borderline patients on an inpatient unit.

Borderline patients evoke unique countertransference responses among members of the treatment team: pejorative behavior, undue optimism, and pessimistic nihilism to these patients, along with difficulties in limit-setting, and fragmentation of the treatment team are common. Frequent meetings and open communication within the treatment team are recommended in order to minimize the splitting that is central to these countertransference constellations.

Acting Out↗