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Biomedical subjects

P Chodoff

Publications and source records attributed to P Chodoff.

At least 19 recordsLinked to original sources
PubMed2000

The changing role of dynamic psychotherapy in psychiatric practice.

The author reviews the range of accepted indications for dynamic psychotherapy when he first began practice after World War II and describes factors that have played a role in the current undervaluing of this treatment approach. He attributes much of the change to research that has produced a different understanding of many of the conditions treated by psychiatrists and has placed greater emphasis on their medical and biological aspects than on their psychological aspects. He also attributes many alterations in current practice to the change from a two-party to a three-party reimbursement system for psychiatric services. On the basis of his practice, the author illustrates his belief that dynamic therapy continues to have a role in today's psychiatric practice. He describes one category of patients in particular-those who seek treatment for "problems of living"-who can be helped by dynamic psychotherapy. The author makes a case for freeing dynamic therapy from the need to rely exclusively on the criteria of the medical model for its legitimacy.

Forecasting↗
PubMed1998

Medical necessity and psychotherapy.

Managed care and, specifically, the need to conform to medical necessity requirements have had a dramatic effect on medical and psychiatric practice, especially on psychotherapy. The author describes the progression of the concept of medical necessity from a simple accounting of services reimbursable by insurance companies to an ambiguous term without definitional consensus. He describes its relationship to the medical model and discusses the incongruity between medical necessity and certain aspects of psychotherapy. He proposes a broader concept--health necessity--based on an evaluation on the merits of the advantages, disadvantages, and costs of medical and psychiatric services.

Humans↗
PubMed1996

Ethical dimensions of psychotherapy: a personal perspective.

A substantial increase in the interest devoted to ethical issues has been a defining feature of my 50 years in psychotherapeutic practice. Reasons include a shift from a paternalistic to a contractual model of the doctor-patient relationship, increased litigiousness, and greater emphasis on the business rather than professional aspects of practice. Many ethical violations stem from misuse of therapist power in the psychotherapeutic relationship. One of the most egregious of these is overt sexual acting out between therapist and patient, a dereliction now viewed much more sternly, largely because of the rise of the women's movement. Therapist power can also be misused for purposes of psychopathological gratification, such as to dominate patients or impose values, and by emphasizing financial rewards over patient needs. A sea change I have observed has been the gradual replacement of a two-party by a three-party system of payment for psychotherapy. Among its most serious consequences in the ethical domain has been the weakening of the therapist's guarantee of absolute confidentiality to the patient. Managed care has further compounded the ethical dilemma by imposing a need to choose between the interests of patients and the organizations from which therapists receive remuneration. In their efforts to ensure parity coverage for psychotherapy, therapists need to respond to certain questions about their claims that their work promotes both individual welfare and the common good. Questions include the professional qualifications for skillful practice of psychotherapy, the evidence for its efficacy, the delimitation of the conditions properly treated by psychotherapy, and the extent to which these conditions fall within the medical model and thus satisfy the criterion of medical necessity. I conclude that, in spite of the efforts needed to maintain ethical standards, the "ethical revolution" that I have witnessed has enhanced the integrity and value of psychotherapy, both for its practitioners and for the public that they serve.

Child↗
PubMed1987

Effects of the new economic climate on psychotherapeutic practice.

Psychotherapy, especially the intensive variety, has been put under considerable adverse pressure by changes in the economics of medicine and psychiatry. The dominance of third-party rather than out-of-pocket payment for services raises questions about the "medicality," and thus the eligibility for coverage, of some disorders treated with psychotherapy. Trends toward the "industrialization" of psychiatry threaten to curtail the independent, fee-for-service conditions that may be necessary for psychotherapeutic practice. Efforts to reassert the medicality of psychotherapeutic psychiatry are essential, even though this will be difficult to accomplish and may have some limiting effects on coverage.

Diagnosis-Related Groups↗
PubMed1987

Fear of AIDS.

A specter is haunting our streets--the specter of AIDS, a remorseless and incurable disease whose nature, transmission and effects still contain elements of mystery. The fear of AIDS is pervasive. Most of us experience this fear as an uneasy but usually abstract awareness of its presence in the society. This awareness, however, may be jolted into something more concrete and immediate when we need to make or react to such decisions as whether our children should attend school with an AIDS victim or whether to require tests for the presence of AIDS antibodies (ELISA test) in food handlers and health workers. But populations at risk of infection with AIDS face a fear of a different quality. For hemophiliacs requiring the transfusion of blood products, for users of contaminated needles, even under certain circumstances for those who engage in heterosexual intercourse, infection with AIDS has to be a real issue. For homosexuals with an active sex life the fear is constant; ways must be found to come to terms with it. In this presentation I shall offer a series of vignettes illustrating reactions to the threat of AIDS that range from the distinctly maladaptive to the appropriately adaptive. I shall discuss some of the psychodynamic mechanisms operative in these cases and make general observations about the fear of AIDS in target populations.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Involuntary hospitalization of the mentally ill as a moral issue.

Conflict exists between medical model and civil liberties approaches to involuntary hospitalization for mental illness. The amassing and analysis of data will not resolve this conflict because the two sides view the problem from differing moral vantage points. Medical model adherents are influenced chiefly by utilitarian or consequentialist considerations, while the civil libertarians take more of a deontological or absolutist position. Opinions about such issues as hospitalization criteria of dangerousness versus medical necessity and the relative role of rights versus obligations and of autonomy versus paternalism can be seen largely to depend on such underlying value judgments. Neither side has a monopoly on truth or right in the question of involuntary hospitalization.

Attitude of Health Personnel↗
PubMed1983

Traumatic acute mitral regurgitation secondary to blunt chest trauma.

An 18-yr-old male involved in a motor vehicle accident developed acute traumatic mitral regurgitation with fulminant pulmonary edema and death. He had prominent V waves on his pulmonary arterial trace, a history of chest trauma, frothy pink pulmonary edema, and elevated pulmonary artery, wedge, and CVP. His ECG was normal and physical exam was negative for a typical murmur. He was on a ventilator and had copious secretions, making the diagnosis of a murmur difficult. A high index of suspicion is necessary when any patient is admitted with a history of chest trauma so that the diagnosis of a ruptured mitral valve is not missed.

Adolescent↗
PubMed1982

Assessment of psychotherapy: reflections of a practitioner.

Granting both the importance and the difficulty of assessing psychotherapy, I express my dissatisfaction with the relevance of large-scale controlled trials to the realities of outpatient clinical practice. I suggest that surveys of their psychotherapeutic experience by practitioners may have, at least, complementary value. It has been my impression that psychotherapy often is an effective modality for the symptoms and turmoil associated with emotional crises. It can also be effective in improving the life quality of patients with physical defects and disablement, with problems of aging, and with schizophrenia. For personality disorders and problems of living, psychotherapy has a good deal to offer if treatment goals are reasonable. I have been less favorably impressed with the efficacy of psychotherapy for symptomatic psychoneuroses and the sexual dysfunctions. I conclude with a discussion of the puzzling unpredictability of psychotherapy.

Adult↗
PubMed1982

The effects of a fluctuating Fio2 on metabolic measurements in mechanically ventilated patients.

The determination of minute oxygen consumption (VO2) for metabolic studies on patients using either the Beckman Metabolic Cart (MMC) or the Respiratory Monitoring System (RMS) requires a stable fractional inspired oxygen concentration (FIO2). Measurement of VO2 on mechanically ventilated patients using the Bourns BEAR 1 and the Engstrom 311 and 312 was unsuccessful due to FIO2 variations greater than the acceptable limits. The inspiratory and expiratory O2 and CO2 waveforms were studied using various methods of supplying source gas to the ventilators. A method using an external air/oxygen blender was found that provided a stable FIO2 for metabolic measurements for each of the ventilators tested.

Carbon Dioxide↗
PubMed1982

Hysteria and women.

Through the ages, hysteria has been considered to be a female disease. The author explores the historical record and concludes that the hysterical (histrionic) personality is a caricature of femininity. It develops under the influence of cultural forces, particularly male domination, and is not a natural attribute of women. He then inquires whether the concept of a distinct femininity is itself a stereotype or is based on inborn personality differences between the sexes. Citing current biological and ethological evidence, he favors the latter explanation. He suggests that the hypothesis of sex role distortion include not only the equation femininity-caricature-hysterical personality but also the cognate one, masculinity-caricature-"machoism."

Androgens↗