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Biomedical subjects

M R Lansky

Publications and source records attributed to M R Lansky.

15 recordsLinked to original sources
PubMed1991

The transformation of affect in posttraumatic nightmares.

The author questions the classical psychoanalytic assumptions that anxiety in posttraumatic nightmares arises from the same conflict represented in the manifest content of the nightmare, that such nightmares have no latent content, and that the day residue is insignificant. Such assumptions obscure the function of these nightmares, in which the dreamwork transforms shame into fear. Case material from two patients highlights the instigating role of posttraumatic dissociative states and shame in the day residue of posttraumatic nightmare sufferers. The author also emphasizes that conflict in the latent dream thoughts differs from that represented in the manifest content.

Adult↗
PubMed1991

Flashback as screen memory.

The authors report a series of flashbacks of a combat patient's experience 18 years earlier. The flashback episodes occurred immediately after the patient's humiliating job loss. The man had no symptoms of delayed stress and no history of drug or alcohol abuse. The wartime memory served an obvious screening function by diminishing the impact of the patient's narcissistic injury just preceding the onset of the flashback sequence. The flashbacks also screened childhood and adolescent conflicts activated by the job loss.

Adult↗
PubMed1990

Exploration of nightmares in hospital treatment of borderline patients.

A clinical investigation of nightmares enhanced the psychotherapy of many hospitalized borderline patients. Early familial trauma, prominent in the latent content of the nightmares, predisposed these patients to adult dysfunction or to a maladaptive response to subsequent trauma. The hospital ward's emphasis on intergenerational family therapy and the well-integrated holding environment helped offset distress in patients resulting from the upsurgence of conflictual material latent in their nightmares, whether or not they were posttraumatic. The authors present illustrative cases.

Adult↗
PubMed1989

Post-traumatic nightmares and the family.

The authors conducted a systematic investigation of nightmares in consecutive admissions to an inpatient unit at a Veteran Administration hospital for a six-month period. Fifteen of the 41 nightmare sufferers identified their nightmares as post-traumatic. Examination of the nightmares in the light of family histories revealed that familial dysfunction from many points in the nightmare sufferers' life histories found clear-cut representation in the nightmare scenario. In this sample, post-traumatic nightmares dealt not only with the identified trauma, but also with a lifelong continuum of family stresses for which the traumatic scene served as a screen.

Adult↗
PubMed1989

The subacute hospital treatment of the borderline patient: III. Management of suicidal crisis by family intervention.

A family approach to suicidal crises in hospitalized borderline patients is described. The approach is aimed not only at the acute crises, but at the likelihood that repetitive, panic-inducing suicidal episodes provoke shame-producing over-regulation in the short run or exhaustion of support systems (family and treatment team) in the long run. An emergency family session with a hospitalized patient in acute suicidal crisis is presented. Subacute hospital treatment must respond to these crises mindful of long-term as well as acute risks. Subacute hospitalization allows for family intervention to buttress support systems for the long term task of caring for the suicidal borderline patient.

Adult↗
PubMed1988

The subacute hospital treatment of the borderline patient. II: An integrated focus on splitting.

A psychiatric inpatient unit with expertise in family treatment has developed an integrated effort to provide a one to three month treatment program for hospitalized borderline patients. Treatment goals are more ambitious than those obtainable by simple crisis intervention. Appreciation of staff splitting is enhanced by an intergenerational family systems approach. Early and sustained focus on splitting is aided by the use of a 15 minute educational tape and a weekly therapy group required for all nonpsychotic patients and recommended for their families. Cases illustrating the family perspective and a group therapy session are presented in detail. The therapy group, run by an interdisciplinary team (the authors) requires active staff initiative and confrontation to avoid responsibility-evading patient coalitions. Diagnostic considerations and impact of the program on patients and on staff are discussed.

Adult↗
PubMed1988

The subacute hospital treatment of the borderline patient--I: An educational component.

Failure to begin the hospital treatment of the "borderline" patient with a formulation of the problems requiring hospitalization is an indication of a lack of integration in the staff's view of the patient's pathology. This failure may dovetail with a basic lack of integration in the patient's personality and recapitulate similar confusion and inconsistency within that patient's family. A 15-minute educational tape about "borderline" illness has been used to enhance integration and formulation of problems by staff and patients in a hospital setting in which stay is limited to one or two months. The program is described, and the taped programs included. "Self-regulatory disorder" is preferred to "borderline personality disorder." After one year's experience with the program, the staff has been better able to formulate difficulties in clinical discussions with patients and their families. The staff has noted a clearcut reduction of disruptive impulsive action in this population of hospitalized nonpsychotic patients.

Borderline Personality Disorder↗
PubMed1986

Right on the money: disability forms and the hospitalized borderline patient.

Handling of the hospitalized borderline patient's request for disability compensation reflects the therapists's success or failure in keeping a sustained focus on splitting. This focus is crucial to the subacute hospital treatment of borderline psychopathology. Overprotectiveness or withholding of appropriate support results from countertransference reactions. Splitting is reinforced rather than minimized if the therapist fails to focus both on the damaged and overwhelmed aspect of the personality (how the patient feels) and on the irresponsible and manipulative aspect (what the patient does). The therapist who fails to respond to the disparate aspects in an integrated way risks acting out key aspects of the clinical picture to the detriment of successful subacute hospital treatment. The therapist's awareness of typical patterns of splitting can be enhanced by considering the patient's developmental history; current familial and vocational relations (or lack of them); and the patient's relation to the hospital staff.

Adult↗
PubMed1975

Difficulties in brief conjoint treatment of sexual dysfunction.

The authors offered conjoint treatment of sexual dysfunction to an unselected population in a military hospital for one year. Of the 10 couples who requested treatment, 7 were treated by techniques outlined by Masters and Johnson. The couples who completed the treatment exercises improved, and neurotic interactions, presumably resulting from the symptoms, often disappeared. The couples who avoided the exercises had interactional patterns dominated by projection and blame, sadomasochism, and depressive features; typically their marital difficulties were aggravated by the treatment.

Adult↗
PubMedDate not supplied

Preoccupation as a mode of pathologic distance regulation.

This paper describes a defensive pattern, pathologic preoccupation, that is used to hide emotional absence under a mask of rationalization, in regard to loyalties outside the family. Observations and clinical data drawn from both individuals and families are used. The emphasis is on preoccupation as a transpersonal process of defense and on the resistances to treatment that result. The patient's struggle with the past against identification derives from representations of the family of origin in which the same-sex parent figures as an object of contempt or shame. Pathologic distance regulation must be understood through the manifest defensive operation of narcissistically vulnerable persons, that is, by the nature of binding and unbinding that occurs among real people, not just in fantasy.

Adult↗