PubMed Health⌕ Search

Biomedical subjects

John T Maltsberger

Publications and source records attributed to John T Maltsberger.

17 recordsLinked to original sources
PubMed2006

Psychoanalytic perspectives on the treatment of an acute suicidal crisis.

The psychoanalytic understanding of suicide has greatly expanded in the past 30 years, and the older therapeutic approach has been modified. Although the turning of murder on the self inferred by Freud 90 years ago remains a cornerstone, current practice concentrates on the identification of a precipitating event, the escalation of intolerable painful affect that the patient cannot moderate, the self-perception of helplessness, the evolution of hopelessness as a secondary affect, increasing fantasies of suicide as a means of escape, and ego regression (self-deconstruction), leading progressively to suicide. Recent clinical research, advances in the study of cognition, and neurobiological studies have contributed to the reorientation and enrichment of the psychoanalytic perspective on suicide. The treatment of a university student who had fallen into a suicide crisis is discussed from the psychoanalytic point of view, and evidence for the efficacy of this treatment is reviewed.

Adult↗
PubMed2006

Assessing and engaging suicidal teenagers in psychoanalytic psychotherapy: a case consultation.

Assessing and engaging suicidal adolescents in psychoanalytic psychotherapy is filled with complexity and stress, but offers a potential for lasting suicide prevention. This study provides a detailed account of the initial psychotherapy sessions with a suicidal teenager, drawing extensively on the comprehensive notes taken by the therapist. Four discussants were invited to provide their perspectives as to how they would assess the main factors in the case and from this to provide a brief commentary for their own perspectives. This study concludes with a discussion of the differences and commonalities between the various contributions.

Adolescent↗
PubMed2006

Problems in psychotherapy with suicidal patients.

OBJECTIVE: The authors studied recurrent problems in psychotherapy with suicidal patients by examining the cases of patients who died by suicide while receiving open-ended psychotherapy and medication. METHOD: Therapists for 36 patients who died by suicide while in treatment filled out clinical, medication, and psychological questionnaires and wrote detailed case narratives. They then presented their cases at an all-day workshop, and critical problems were identified in the cases. RESULTS: Six recurrent problem areas were identified: poor communication with another therapist involved in the case, permitting patients or relatives to control the therapy, avoidance of issues related to sexuality, ineffective or coercive actions resulting from the therapist's anxieties about a patient's potential suicide, not recognizing the meaning of the patient's communications, and untreated or undertreated symptoms. CONCLUSIONS: These cases illuminate common problems therapists face in working with suicidal patients and highlight an unmet need for education of psychiatrists and other mental health professionals who work with this population.

Adult↗
PubMed2004

Factors contributing to therapists' distress after the suicide of a patient.

OBJECTIVE: Factors contributing to therapists' severe distress after the suicide of a patient were investigated. METHOD: Therapists for 34 patients who died by suicide completed a semistructured questionnaire about their reactions, wrote case narratives, and participated in a workshop. RESULTS: Thirteen of the 34 therapists were severely distressed. Four factors were identified as sources of severe distress: failure to hospitalize an imminently suicidal patient who then died, a treatment decision the therapist felt contributed to the suicide, negative reactions from the therapist's institution, and fear of a lawsuit by the patient's relatives. Although one emotion was sometimes dominant in the therapist's response to the suicide, severely distressed therapists, compared to others, reported a significantly larger number of intense emotional states. CONCLUSIONS: Over one-third of therapists who experienced a patient's suicide were found to suffer severe distress, pointing to the need for further study of the long-term effects of patient suicide on professional practice.

Adult↗
PubMed2004

The descent into suicide.

Suicidal breakdown requires attention both to attack upon the self (ego) as aggressive forces are unleashed against it by the superego, but also to the phases of self-breakup (ego regression) that follow. Less attention has been directed to ego-regression in suicide than to superego-directed assault on the ego in the psychoanalytic literature; this paper directs attention to the phenomena of ego failure and disarticulation of the self-representation. Clinical study of suicidal patients shows four aspects of suicidal collapse as ego loosens: affective flooding, desperate maneuvering to counter the resulting mental emergency, loss of control as the self begins to disintegrate, and grandiose magical scheming for mental survival as the self-representation splits up and body jettison becomes plausible. These phenomena are discussed theoretically in terms of failed affect regulation, ego helplessness, narcissistic surrender, breakdown of the representational world, and loss of reality testing.

Aggression↗
PubMed2004

Desperation and other affective states in suicidal patients.

Data collected from 26 therapists who were treating patients when they died by suicide were used to identify intense affective states in such patients preceding the suicide. Eleven therapists provided comparable data on 26 patients they had treated who were seriously depressed but not suicidal. Although the two groups had similar numbers diagnosed with MDD, the suicide patients showed a significantly higher total number of intense affects in addition to depression. The acute affective state most associated with a suicide crisis was desperation. Hopelessness, rage, abandonment, self-hatred, and anxiety were also significantly more frequently evidenced in the suicide patients.

Acute Disease↗
PubMed2003

Determination of precipitating events in the suicide of psychiatric patients.

Data from therapists who were treating patients when they killed themselves were used to provide information about precipitating events that was missing from accounts obtained from suicide victims' relatives and friends. Among 26 patient suicides studied, the therapists identified a precipitating event in 25 cases; in 19 of these, supporting evidence linked the identified event to the suicide. A schema was developed that identifies nine types of evidence provided by therapists in determining that an event precipitated the suicide. Use of the schema is likely to improve accurate identification of events that precipitate patient suicides, and distinguish them from unrelated coterminous events or suicide risk factors.

Adolescent↗
PubMed2002

Discovering the truth in attempted suicide.

The findings of an international workshop on improving clinical interactions between mental health workers and suicidal patients are reported. Expert clinician-researchers identified common contemporary problems in interviews of suicide attempters. Various videotaped interviews of suicide attempters were critically discussed in relation to expert experience and the existing literature in this area. The working group agreed that current mental health practice often does not take into account the subjective experience of patients attempting suicide, and that contemporary clinical assessments of suicidal behavior are more clinician-centered than patient-centered. The group concluded that clinicians should strive for a shared understanding of the patient's suicidality; and that interviewers should be more aware of the suicidal patient's inner experience of mental pain and loss of self-respect. Collaborative and narrative approaches to the suicidal patient are more promising, enhancing the clinician's ability to empathize and help the patient begin to reestablish a sense of mastery, thereby strengthening the clinical alliance.

Adult↗