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Biomedical subjects

R P Kluft

Publications and source records attributed to R P Kluft.

At least 19 recordsLinked to original sources
PubMed1992

Enhancing the hospital treatment of dissociative disorder patients by developing nursing expertise in the application of hypnotic techniques without formal trance induction.

Many symptoms suffered by dissociative disorder patients are unresponsive or incompletely responsive to medications. This poses a unique challenge to the staff of specialized dissociative disorder units, in which many such patients who require hospital care suffer serious distress that may not respond predictably to the pharmacological interventions that are available. However, the majority of their symptoms are dissociative in nature, and dissociative disorder patients generally are quite hypnotizable. Anticipating the need for nonpsychopharmacological interventions that we could use in the absence of the treating psychiatrist, we taught the unit's nursing and social work staff to rely on the inherent trance-proneness of these patients to utilize hypnotic techniques without the formal induction of hypnosis. Their implementation facilitated crisis resolution, led to a greater sense of safety on the part of the patients, enhanced the staff's sense of mastery, and minimized the need for emergency sedation and restraints.

Dissociative Disorders↗
PubMed1992

The use of hypnosis with dissociative disorders.

The dissociative disorders are characterized by difficulties in the integration of memory and/or identity. Typically this is manifested by amnesia and either the development of alternate identities or an estrangement from one's own identity. Spontaneous and self-generated dissociative states and phenomena sharing much in common with those that can be induced with hypnosis are thought to play a major role in their development, symptomatology, and perpetuation. Medical heterohypnosis offers a powerful tool to reestablish a functional continuity of memory and identity in many such cases. The application of hypnotic interventions in the treatment of such conditions will be discussed, explored, and illustrated with clinical vignettes.

Adaptation, Psychological↗
PubMed1991

Clinical presentations of multiple personality disorder.

It is hoped that this discussion of MPD will discourage stereotypic thinking about this condition and encourage the inclusion of MPD in virtually all differential diagnoses. The major thrust of what has been learned about the natural history of MPD is that most patients with this condition spend most of their lives not manifesting their MPD in classic manner. The typical presentation of MPD is the tip of a rather large iceberg. Covert and other nonclassic presentations are much more characteristic. An appreciation of this will help the clinician approach the diagnosis of MPD with a heightened sensitivity to the possibility of encountering it within his or her practice.

Adult↗
PubMed1991

Hospital treatment of multiple personality disorder. An overview.

MPD patients are not rare. They frequently need hospital treatment. This brief and necessarily incomplete communication has attempted to share what is generally known and accepted with regard to their inpatient care. Such knowledge, however, even though it represents the current state of the art, is, like all state-of-the art knowledge, preliminary with regard to what remains to be discovered and developed. It is anticipated that within the next decade the increasing recognition of such patients will result in their becoming commonplace within most psychiatric hospital settings, drawing the attention of more and more hospitals and psychiatrists alike to the study of their care. At that point, the concentrated attention and endeavors of large numbers of skilled mental health professionals and administrators will, in all likelihood, bring fresh insights and offer new approaches that will enrich and perhaps supplant the observations and advices offered in this contribution.

Combined Modality Therapy↗
PubMed1989

Playing for time: temporizing techniques in the treatment of multiple personality disorder.

The treatment of multiple personality disorder (MPD) is often a prolonged and grueling enterprise, which imposes taxing demands upon the therapist and the patient alike. It becomes quite important to pace the therapy, lest the already beleaguered patient become both acutely and chronically overwhelmed. The majority of the extant literature on the use of hypnosis for the treatment of MPD addresses the processes of accessing the alters, abreacting traumata, arranging reconciliations among the alters, and facilitating integration. This communication discusses the necessity of titrating the amount of discomfort the patient must endure against the patient's resources and capacity to achieve mastery and self-efficacy. Several hypnotherapeutic techniques for offering respite and temporary asylum are explained and illustrated: alter substitution, the provision of sanctuary, distancing maneuvers, bypassing time, bypassing affect and/or memory, attenuating affect and/or memory retrieval, and rearranging the configuration of the alters by bartering or "shuffling the deck."

Affect↗
PubMed1989

Treating the patient who has been sexually exploited by a previous therapist.

Patients who have experienced sexual exploitation by a previous therapist constitute an increasingly recognized clinical population. Although some of these patients were transiently overwhelmed or mildly disturbed when exploited, the majority were severely symptomatic and the victims of incest or other previous abuse. Many demonstrate a constellation of four factors that predisposes them to revictimization or the sitting duck syndrome: severe symptoms, idiosyncratic dynamics, atypical socialization that discourages self-care, and cognitive difficulties. The experience of such exploitation is not benign, although the sequelae vary considerably. The treatment of such patients is facilitated by arranging the therapy in a way that maximizes safety and clear communication. The importance of hearing the patient' own reconstructions, pacing the treatment to the patient's tolerance, and respecting the patient's agenda cannot be overemphasized. A cluster of issues that appear central to the treatment of such patients includes addressing their helplessness, their ambivalence about the exploitive therapist, their difficulties with trust, their guilt, their depression and pressures toward self-harm, their confusion over sexuality, their post-traumatic and dissociative features, their severe symptoms and the diagnostic confusion this involves, and the countertransference pressures upon the therapist.

Ethics, Medical↗
PubMed1988

The postunification treatment of multiple personality disorder: first findings.

The treatment issues encountered in the unified multiple personality disorder (MPD) patient have received little attention in the literature to date. This study reviews the therapy records of 91 such patients and identifies seven recurrent areas of concern: (1) coping with the psychophysiologic changes associated with unification, (2) coping with the psychologic changes associated with unification, (3) working through, (4) abandoning autohypnotic evasions, (5) modifying adaptive and coping mechanisms, (6) interpersonal adjustments, (7) and major life changes. Some therapeutic approaches are indicated.

Adaptation, Psychological↗
PubMed1987

The parental fitness of mothers with multiple personality disorder: a preliminary study.

Recent studies show that nearly all individuals who develop multiple personality disorder (MPD) were abused as children. The majority of identified MPD patients are women in the age range associated with child-rearing responsibilities. A review of the parenting patterns of 75 mothers with MPD yielded findings suggesting that 38.7% were competent or exceptional mothers, 16% were grossly abusive to the extent of injuring, molesting, or placing their children at risk, and 45.3% were compromised or impaired as parents. The compromised/impaired mothers were a mixed group, including psychologically abusive individuals and those whose symptoms interfered with parenting despite their best efforts. Clinical illustrations are offered.

Child↗
PubMed1987

First-rank symptoms as a diagnostic clue to multiple personality disorder.

Thirty patients with multiple personality disorder had one or more of Schneider's 11 first-rank symptoms at initial assessment (mean = 3.6; range = 1-8). The author describes these symptom categories, eight of which were noted in the patients he interviewed, and illustrates them from the patients' case material. He suggests that inquiry about first-rank symptom phenomena may be a valuable diagnostic clue to the presence of multiple personality disorder.

Delusions↗
PubMed1987

An update on multiple personality disorder.

Within the last decade, multiple personality disorder has been diagnosed, treated, and studied with increasing frequency. A growing body of literature suggests that this condition is not a rarity but that its manifestations, often coexisting with or obscured by other phenomena, frequently go unrecognized for years within the mental health care delivery system. The author reviews recent advances in the understanding of the etiology, diagnosis, and treatment of multiple personality disorder. The thrust of the contemporary literature is that it is a difficult-to-diagnose condition that usually follows severe child abuse, that it is most parsimoniously understood as a chronic dissociative posttraumatic stress disorder, and that it has an excellent prognosis when intensive and prolonged psychotherapy with an experienced clinician is available.

Child↗
PubMed1987

Unsuspected multiple personality disorder: an uncommon source of protracted resistance, interruption, and failure in psychoanalysis.

Multiple personality disorder (MPD) is being recognized with increasing frequency. A great imitator, it may be encountered among patients who appear to have a wide range of other diagnoses, and have been in treatment for years without the presence of MPD being discovered. Nine of 241 MPD patients interviewed by the author, 3.7%, had been accepted for psychoanalysis. In only one case had the diagnosis been appreciated by the analyst prior to his accepting the patient for analytic treatment. Four patients were profoundly resistant and or inaccessible to analysis for protracted periods. In one of these cases the diagnosis became clear and successful analysis was concluded, but three analyses ended unsuccessfully with the diagnosis still unknown. Two patients' analyses were interrupted due to abrupt regressive events initially perceived to indicate severe ego weakness incompatible with sustaining an analytic process, but later appreciated as signs of MPD. In three cases it appeared that the patients' being accepted for analysis triggered the emergence of the dissociative process, and either the patient or the analyst decided to pursue a different form of therapy. Unsuspected MPD appears to account for a small percentage of stalemates, failures, interruptions, and early flights from analysis.

Adult↗
PubMed1986

High-functioning multiple personality patients. Three cases.

This article describes the circumstances of the diagnosis of three of a group of 12 high-functioning multiple personality disorder patients. All had performed major social and professional activities with consistent competence, and all appeared to be neurotic patients suitable for classical psychoanalysis. All 12 had been misdiagnosed on at least three occasions before the correct diagnosis was made. Aspects of the difficulties encountered in assessing these patients are discussed and guidelines for the preservation of their high level of function during the treatment process are offered.

Achievement↗