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Biomedical subjects

S H McDaniel

Publications and source records attributed to S H McDaniel.

18 recordsLinked to original sources
PubMed2002

Family issues in a psychoeducation group for women with a BRCA mutation.

Few services exist for women who test positive for BRCA1 and BRCA2 mutations despite the distress that they and their families may experience. We present one model of a time-limited family-oriented psychoeducation group to provide information and support for nine women who received positive test results. We report on five family-oriented themes that arose from the discussions: distress about possible transmission to children; family conflict about testing; concerns about disclosure; different coping styles and decision making; and underlying family conflict and unresolved grief. We also include recommendations from these women to enhance the services available to families by expanding assessment, and providing written literature and contact information. In addition, referrals for a psychoeducation group, community support group, or psychotherapy may be useful for individuals, couples and families who are considering genetic testing for BRCA mutations.

Adult↗
PubMed2000

Relational therapy in medical settings: working with somatizing patients and their families.

Psychotherapy for patients who present in a medical setting involves certain unique challenges, including the need to bridge the mind-body split. Somatizing patients, in particular, live at the interface of mind and body. Their physical symptoms may be biological markers as well as psychological metaphors and interpersonal communications. As such, it is important to assess and treat both patient and family, in collaboration with the healthcare team. We review three foundational principles for working with such families: biopsychosocial integration, development of a collaborative stance, and moving from "Either-Or" to "Both-And" thinking. An extended report of a patient with psychogenic seizures illustrates the use of nine treatment strategies: (1) Validate the reality of the problem, (2) involve the family, (3) work closely with the healthcare team, (4) enhance curiosity, (5) actively attend to somatic symptoms, (6) link the somatic and the psychological. (7) use physical interventions, (8) tolerate uncertainty and practice patience, and (9) terminate gently.

Adult↗
PubMed2000

Do physicians who diagnose more mental health disorders generate lower health care costs?

BACKGROUND: Underrecognition and undertreatment of mental health disorders in primary care have been associated with poor health outcomes and increased health care costs, but little is known about the impact of the diagnoses of mental health disorders on health care expenditures or outcomes. Our goal was to examine the relationships between the proportion of mental health diagnoses by primary care physicians and both health care expenditures and the risk of avoidable hospitalizations. METHODS: We used cross-sectional analyses of claims data from an independent practice association-style (IPA) managed care organization in Rochester, New York, in 1995. The sample was made up of the 457 primary care physicians in the IPA and the 243,000 adult patients assigned to their panels. We looked at total expenditures per panel member per year generated by each primary care physician and avoidable hospitalizations among their patients. RESULTS: After adjustment for case mix, physicians who recorded a greater proportion of mental health diagnoses generated significantly lower per panel member expenditures. For physicians in the highest quartile of recording mental health diagnoses, expenditures were 9% lower than those of physicians in the lowest quartile (95% confidence interval, 5% - 13%). There was a trend (P = .051) for patients of physicians in the highest quartile of recording mental health diagnoses to be at lower risk for an avoidable hospitalization than those of physicians in the lowest quartile. CONCLUSIONS: Primary care physicians with higher proportions of recorded mental health diagnoses generate significantly lower panel member costs, and their patients may be less likely to be admitted for avoidable hospitalization conditions.

Adult↗
PubMed1998

[Medical family therapy in children with chronic illness].

This article describes a medical family therapy approach to working with families of a child with a chronic medical illness. Medical family therapy combines the systemic paradigm of family therapy with the biopsychosocial paradigm of medicine to treat patients and families who are experiencing medical illness or disability. This article describes how family dynamics influence children's health and how children's health influences family dynamics. It then addresses special assessment issues, treatment issues, and collaboration issues for medical therapists when a child has a chronic illness.

Adaptation, Psychological↗
PubMed1991

The frog prince: tale and toxicology.

Bufotenin is a substance present in the skin of some common species of frogs, and its ingestion (such as would occur in licking or kissing a frog) can result in vivid hallucinations. This biological property offers an explanation for the portrayal of frogs in folklore as creatures of transformation, or as intermediaries with other worlds.

Animals↗
PubMed1991

Family-of-origin work and family therapy skills training: both-and.

Since the inception of field, theoreticians and teachers of family therapy have advocated for either problem-solving, skill-based training, or transgenerational training that emphasizes the therapist's own family-of-origin work. This article proposes an end to these polarized positions and argues for both-and, that is, a model of training that integrates the trainee's own family-of-origin work with live supervision and skills training. A family-of-origin curriculum designed for this purpose is described.

Clinical Competence↗
PubMed1987

Professional politics and the concepts of family therapy, family consultation, and systems consultation.

At a time when an increasing number of professionals are calling themselves "family therapists," many teachers and theorists in this field are troubled that the term "family therapy" no longer adequately characterizes the concepts or activities of the field. Recently, clinical, political, and economic circumstances have emerged that suggest the need for alternatives to the role of "family therapist." By adding the roles of family consultant and systems consultant, we can open up new options for ourselves and our clients. During initial contacts with families, agencies, and other professionals, we can heighten our therapeutic potential by proceeding with consultative stocktaking, not starting with therapy. Family consultation also can assist in redirecting therapy when a new problem or an impasse develops, in focusing on competency rather than on pathology, and in engaging constructively with families that have a physically or mentally ill member.

Adolescent↗
PubMed1985

A beginner's guide to the problem-oriented first family interview.

The large volume and diversity of family therapy resources can often confuse trainees who are in need of more abbreviated guidelines for managing their clinical responsibilities. This paper presents a structured outline of a problem-oriented first family interview for the family therapy supervisor and the beginning family therapist. We view the first interview as an integrated process including the important tasks preceding and following the initial family meeting. After the goals that shape the work of the first interview are described, a step-by-step guide to the twelve phases of the interview is presented: telephoning; forming hypotheses; the greeting; the social phase; identifying the problem; observing family patterns; defining goals; contracting; checklist; revising hypotheses; contacting the referral person; and gathering records. This approach to the first interview integrates a variety of structural and strategic procedures. The guide, intended for use in conjunction with close supervision, may serve as a foundation on which beginning therapists can build their unique styles.

Family↗
PubMed1983

Multiple theoretical approaches to supervision: choices in family therapy training.

The supervision techniques used in structural, strategic, family-of-origin, and experiential family therapy training are discussed and compared, with emphasis on the isomorphism between supervision and therapy in each school. The usefulness of each supervisory model is related to supervisees' needs at different levels of training. Recommendations are made about the sequence of family therapy training, including the utility of eclectic versus purist family therapy training programs for trainees at different levels of experience.

Family↗
PubMedDate not supplied

Using a family systems approach in a balint-style group: an innovative course for continuing medical education.

Primary care physicians provide access and continuity of care to difficult patients and their families. Optimal medical management may be jeopardized by the emotional responses of physicians caring for such patients. These responses may pose moral dilemmas for the physician, who may be reluctant to treat these patients. Even though physicians have the right to dismiss such patients, the ethos of primary care engenders a sense of obligation to provide access to care. Traditional continuing medical education (CME) overemphasizes content and avoids emotional issues common in problematic physician-patient relationships. This CME demonstration project for community based physicians addressed this issue through a longitudinal course which was learner-centered and process-oriented. This article reports the successes and difficulties in organizing this innovative course.

Curriculum↗