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PubMed1979

Libidinal cathexis and emotional growth in the analytical treatment of psychosomatic patients.

The paper deals with a form of analytical therapy in psychosomatics, which was developed and applied for many years in a model research ward. The therapeutic arrangement, or setting, was designed to make provision for all 3 elements of a person's make-up - his environment, his mind and his body. At the heart of the model is the therapeutic team, which offers the patient empathatic 'holding' and encourages his emotional growth. The members of the team have learned to offer themselves to the patient as a unit with a common inner attitude towards him. This means that they must first have worked out a unified approach, a hermeneutic structure, with which to understand him. Against the background of a special genetic conception of a mother's function for her child, the ward was turned into a setting that confronts the patient, in psychodramatized form, with a specific form of 'physical ambience'. In coming to grips with the team's physical, sensual presence, the patient is stimulated into developing a transference relationship to the empathizing, maternal father-figure, the 'père maternel'. In this way he can break loose from his clinging dependency on an 'omnipotent object', his dyadic partner, and, through internalizing the therapist both in his female and his male aspects, create a libidinal object in his inner world.

Cathexis↗
PubMed1998

Relationship between empathic family attitude and relapse in schizophrenia: a 2-year followup prospective study.

Empathy plays a central role in social relationships, and lack of empathy has been suggested as part of expressed emotion in the relatives of patients with schizophrenia. The aim of this research is to measure empathy in the relatives of schizophrenia patients and to establish the relationship between lack of empathy and relapse. Eighty schizophrenia patients were followed up in a 2-year prospective cohort study. Relatives' empathy, defined as the ability to perceive the patient's mood state, was measured at the beginning of the study with a questionnaire given after a 10-minute interaction between the patient and his or her relative. Several other attitudinal, clinical, and social variables were also measured. A significant relationship was found between poor empathic attitude and relapse. Lack of treatment compliance, negative symptoms, unemployment, and poor premorbid adjustment were also associated with relapse. In a multivariate analysis, the association between poor empathic attitude and relapse was maintained. Statistical control of the relatives' critical attitude showed that each kind of attitude predicts relapse independently.

Adolescent↗
PubMed2006

Meaning-making in the aftermath of sudden infant death syndrome.

The reconstruction of meaning in the aftermath of sudden infant death syndrome (SIDS) is part of the grieving process but has to date been poorly understood. Earlier theorists including Freud, Bowlby and Kübler-Ross provided a foundation for what occurs during this time using stage theories. More recent researchers, often using qualitative techniques, have provided a more complex and expanded view that enhances our knowledge of meaning reconstruction following infant loss. This overview of representative contemporary authors compares and contrasts them with the longstanding models that are being supplanted within the emerging field of thanatology. Understanding parental reactions within this new framework can help healthcare professionals in dealing with those affected by SIDS and provide a more empathic and sensitive approach to individual differences. Parents' own accounts of their post-SIDS experience are consistent with these newer theories. Comprehending how parents cope and reconstruct their lives is an important element in providing appropriate psychological support services.

Adaptation, Psychological↗
PubMed1990

Psychological autopsies: methods and ethics.

Essential knowledge on suicide is derived from studies that include interviews with survivors. In this paper, we discuss methodological and ethical issues pertaining to the interview method known as "psychological autopsy"; the discussion is based on our application of the method to three studies of suicides in Sweden and on a review of other investigations. Interviewing a survivor is a delicate matter, and the integrity of the deceased, the integrity and health of the informant, and the psychological strain on the interviewer must all be taken into consideration. The interviewer should have clinical experience in order to be prepared to deal with interviewees in grief. Contact by telephone, followed by an introductory letter, provides an opportunity to meet survivors in an empathic manner and has a low rejection rate. A 2- to 6-month interval between suicide and interview is recommended. The survivor's reactions to the interview should be evaluated in order to expand the empirical base for ethical considerations. Studies on the validity and reliability of the method are necessary.

Adaptation, Psychological↗
PubMed1978

Negative treatment responses in psychiatry.

Powerful disagreements about the helping relationship are often expressed by clinical worsening of the patient and by defensive reactions of the doctor. Typical presenting patterns are the patient who wants "more" from his doctor, or who feels the doctor expects "too much" of him. Resolution of these relationship issues depends on empathic understanding and clarification of the patient's feelings plus small, symbolic, nonverbal gratifications of the patient's felt needs. After resolution of the relationship impasse, specific therapies are more likely to be effective.

Attitude of Health Personnel↗
PubMed1997

Minding the close relationship.

In this theoretical analysis, we argue that a process referred to as minding is essential for a couple to feel mutually close and satisfied in a close relationship over a long period Minding represents a package of mutual self-disclosure, other forms of goal-oriented behavior aimed at facilitating the relationship, and attributions about self's and other's motivations, intentions, and Mort in the relationship. Self-disclosure and attribution activities in minding are aimed at getting to know the other, trying to understand the other's motivations and deeper disposition as they pertain to the relationship, and showing respect and acceptance for knowledge gained about other. We link the concept of minding to other major ideas and literatures about how couples achieve closeness: self-disclosure and social penetration, intimacy, empathy and empathic accuracy, and love and self-expansion. We argue that the minding process articulated here has not previously been delineated and that it is a useful composite notion about essential steps in bonding among humans. We also argue that the minding concept stretches our understanding of the interface of attribution and close relationships. We present research possibilities and implications and consider possible alternative positions and counter arguments about the merits of the minding idea for close relationship satisfaction.

Journal Article↗
PubMed1989

Diagnostic interviewing with children: the use and reliability of the diagnostic coding form.

There have been few attempts to standardize assessment methods in Child Psychiatry. This paper describes a semi-structured approach to diagnostic interviewing of the child. Thirty-four children six to 13 years of age, and their parents, were interviewed two weeks apart by two different psychiatrists. A diagnostic coding form consisting of 29 clinical symptom items, eight summary items, and nine positive health ratings was used. Three diagnostic items were also included: "severity of clinical condition," "probability of disorder," and "adjustment status." Twelve of the Time 2 interviews with the child and parent were videotaped and rated by three different psychiatrists. Results indicated that summary items had higher reliability than individual symptom items and the three diagnostic items had the highest reliability, suggesting reliability is better for broad classes of behaviour. Interrater reliability was higher for the face-to-face rating than videotaped ratings. This suggests first that face-to-face interviews are reasonably stable over a two week period and second, since videotaped ratings had lowest reliability on items that depended on inferences about the child's feedlings, an important source of variance in assessment may be the clinician's ability to empathize with the child and draw inferences about internal feeling-states. It was concluded that this interview schedule can be a part of routine clinical practice. It ensures a reasonably standard, yet flexible and reliable approach to diagnostic interviewing.

Adaptation, Psychological↗
PubMed1985

Wives' reactions to learning that their husbands are bisexual.

Interviews with 33 women, plus data from 70 more, explored wives' reactions to being informed by their husbands that their husbands were bisexual, the consequences of disclosure, and the factors determining those reactions and consequences. Findings suggest that wives struggled less with the homosexuality itself than with problems of isolation, stigma, loss, cognitive confusion and dissonance, and lack of knowledgeable, empathic support or help in problem solving. Moreover, faulty assumptions about "disclosure" seem to have led to serious misconceptions about the wives, on the part of husbands, researchers, and therapists alike. These misconceptions and the "realities" are discussed.

Adult↗
PubMed1989

Making society's groups more therapeutic.

This paper represents the author's Presidential Address to the American Group Psychotherapy Association, delivered at the annual meeting on February 11, 1988, in New York. The author poses a challenge: What can we teach society about how to make our groups more healing and productive? He suggests certain guidelines relating to effective communication, empathic understanding, willingness to assume responsibility, and, most importantly, recognition that groups exist for the individuals who comprise them. For groups to function well, individuals must play their role and sacrifice themselves for the good of the whole; yet for groups to function well, the needs of the individual must never be lost.

Group Processes↗
PubMed1995

[Accepting and understanding patients. A study of experiences and behavior of nurses in psychologically demanding nursing situations].

Accepting and understanding patients: a study of how the nursing staff behave in and experience psychologically demanding situations in nursing This text summarizes a study which is the result of a dissertation written at the end of the Training for Experts in Nursing. The author focuses on two questions. Firstly: What are the implications for the nursing staff of treating patients in an accepting and understanding manner, especially in difficult situations on a long-term basis? Secondly: In what way are they influenced in their behaviour? In the first part of her study she investigates the personal experience of the nursing staff, whereas in the second part she is concerned with the influence and the conditions of their place of work. She concludes that the success of empathic nursing depends primarily on the staff themselves--driven by their motives--but also on the conditions of their place of work.

Attitude of Health Personnel↗
PubMed1995

Client and worker satisfaction in a child protection agency.

Client and staff satisfaction with the workings of a multidisciplinary child protection agency were investigated using interviews and standard questionnaires. The goal was to discover the nature and strength of the helping relationship between service-recipients and providers. Current clients (N = 24) expressed a great deal of satisfaction with the staff and services. The agency staff (N = 21, with 11 employed at least half-time to work directly with families) were relatively satisfied with their jobs, and showed little evidence of the burnout which has been recognized as a risk for child protection workers. They were able to relate empathically to clients and felt enthusiasm for the work. Taking account of possible bias in both sets of answers, there is still evidence that the agency is succeeding in creating a necessary precondition for therapeutic change: the development of accepting and positive worker-client relationships.

Adult↗
PubMed2006

Group morality and intergroup relations: cross-cultural and experimental evidence.

An observational, cross-cultural study and an experimental study assessed behaviors indicative of a moral code that condones, and even values, hostility toward outgroups. The cross-cultural study, which used data from the Standard Cross-Cultural Sample (Murdock & White, 1969), found that for preindustrial societies, as loyalty to the ingroup increased the tendency to value outgroup violence more than ingroup violence increased, as did the tendencies to engage in more external than internal warfare, and enjoy war. The experimental study found that relative to guilt-prone group members who were instructed to remain objective, guilt-prone group members who were instructed to be empathic with their ingroup were more competitive in an intergroup interaction. The findings from these studies suggest that group morality is associated with intergroup conflict.

Adult↗
PubMed2005

The impact of an ICU liaison nurse: a case study of ward nurses' perceptions.

AIMS AND OBJECTIVES: To provide a description of ward nurses perceptions of the intensive care unit liaison nurse role. BACKGROUND: Critical care outreach services have become commonplace over recent years. In Australia, the intensive care unit liaison nurse, developed at a local level by healthcare providers, has emerged as a way of improving the continuity of care offered to this patient group. As a relatively new development in critical care services, evaluation of this role has been limited, particularly in relation to the perceptions of ward nurses who receive patients on discharge from intensive care unit. DESIGN: Case study of one Australian hospital that utilizes an intensive care unit liaison nurse. METHODS: Ten ward nurses were purposefully selected for their representativeness of the population and for their experience with the intensive care unit liaison nurse role. Each of these nurses participated in semi-structured in-depth interviews. Thematic analysis was used to analyse the data. FINDINGS: Three major themes emerged from the interviews, highlighting role behaviours, contextual demands and outcomes associated with the intensive care unit liaison nurse role. The role behaviours of the liaison nurse included the professional characteristics of the individual and the primacy of clinical liaison as a role descriptor. Contextual demands were environmental characteristics relevant to providing patient, family and staff support. Outcomes of the role were perceived to include environmental preparation and education. CONCLUSIONS: This qualitative study has presented an overview of ward nurses perceptions of the intensive care unit liaison nurse role within one Australian hospital, illustrating the educative and empathic support that the liaison nurse role can provide to ward nurses. RELEVANCE TO CLINICAL PRACTICE: Collaboration with ward nurses in developing specialist roles such as the intensive care unit liaison nurse is essential in ensuring improvements in patient and family care across the continuum.

Adult↗
PubMed2000

Rediscovering fire: small interventions, large effects.

Unexpected findings are often the spark for new discoveries and theories. A puzzle emerged from a series of unanticipated findings over 3 decades, indicating that for problem drinkers (a) relatively brief interventions can trigger significant change, (b) increasing the intensity of treatment does not consistently improve outcome, (c) therapist empathy can be a potent predictor of client change, and (d) a single empathic counseling session can substantially enhance the outcome of subsequent treatment. These phenomena are considered in light of other findings in the addictions-treatment-outcome literature. There is, at present, no cogent explanation for the efficacy of brief interventions. An ancient construct is explored as one possible factor in how some brief encounters may exert large effects in human change.

Alcoholism↗
PubMed1996

[The Brodsky & Brodsky risk factor model of schizophrenia--an empirical contribution].

In the year 1981 the Canadian psychologists Patricia & Marvin Brodsky published an article about a model integrating risk variables involved in the development of Schizophrenia which is very important but not very well known in the German speaking countries. This model which describes essentially the interaction of four risk variables, such as mental health of the mother, neonatal status, temperament and mothering style, shall be published for the interested reader on the one hand. On the other hand the consequences of the risk variable "mothering style" should be empirically examined in a retrospective study. With a standardized interview containing all essential variables of Brodsky's risk model 73 patients suffering in schizophrenia and being inpatient in the Rheinische Landesklinik Bonn were examined and the interview data were evaluated with regard to the contents in contrast to a control group of 26 healthy persons. With regard to the "schizophrenia spectrum" the portion of so called "superphrenics" (defined as "artistically and muscially gifted offspring with a schziophrenic mother" was not significantly increased in the schizophrenic sample (17.8% vs 7.7%) but the comparison of mothering style (empathic contingent vs. non-empathic and non-contingent) revealed a statistically significant difference between the groups. Finally the data of the risk variable "mothering style" are discussed in the light of the Brodsky-model and it is pointed at the special problems in reliable and valid opertionalisation and assessment of the risk variables.

Adult↗
PubMed1990

The Psychiatric Consultation Checklist: a structured form to improve the clarity of psychiatric consultation requests.

Medical specialty consultation is requested to obtain expert review of a patient's condition. The specialist usually receives a case synopsis with pertinent positives and negatives and a specific request for assistance. In contrast, the psychiatrist often gets a statement of diagnostic speculation (e.g., "depressed") with a request to "please evaluate." Classically, the psychiatric consultant begins with open-ended empathic questioning in an attempt to redefine the written consultation question. However, given the difficulty consultees have in forming questions, and increasing time limitations, a more structured approach to obtaining data might assist both the consultee (M.D. requesting assistance) and the consultant (psychiatrist). The Psychiatric Consultation Checklist (PCC) was devised to function as a paper "expert" questioning system to provide such assistance. In a pilot study, 10 administrations of the PCC took an average of 3.6 minutes. In comparison to consultations using standard forms, more data were supplied in several categories when the PCC was used, particularly regarding patient stressors, patient behaviors of concern, and consultee speculation on psychiatric diagnostic formulation. The PCC may be used in consultation research, for assessment and education of physicians in training (regarding psychiatric issues in the medical/surgical setting), and for general clinical consultation purposes.

Humans↗
PubMed2000

[Bullous dermatitis self-induced].

In three patients, two women aged 37 and 20 years and a man aged 46 years, a blistering skin condition was observed. Histopathological examination of the skin lesions revealed a blister level just beneath the stratum granulosum, which is proof of a friction blister. The patients were suffering from bullous dermatitis artefacta or bullous pathomimia. This is a psychiatric disorder characterised by rubbing skin blisters but denying self-infliction. Early diagnosis is important to prevent unnecessary drug therapy and chronic morbidity. The typical histology supports the doctor in his suspected diagnosis. A supportive and empathic dual disciplinary approach (by somatic physician and psychosocial worker) is recommended, avoiding direct confrontation with the self-inflicted nature of the lesions, and using the 'narrow escape' strategy, avoiding loss of face of the patient.

Adult↗