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PubMed1993

Multiple personality disorder and iatrogenesis: the cautionary tale of Anna O.

An examination of Breuer's treatment of Anna O. illustrates some of the controversies surrounding the recent rise of case reports of multiple personality disorder. Anna O., the first patient of the cathartic method, psychoanalysis, and dynamic psychiatry, fits current criteria for multiple personality disorder. Breuer's treatment, however, may have contributed to her states of absence; the timing, type, and intensity of Breuer's interventions make it possible that he unwittingly encouraged and amplified Anna's dissociations, reified her ego fragments, and then explained Anna's symptoms with the pseudomemories and confabulations recovered from Anna while she was hypnotized. A review of Breuer's treatment highlights some of the controversial aspects of multiple personality disorder, specifically its possible vulnerability to iatrogenesis via suggestion and unconscious collusion and other factors. The current stance of some multiple personality disorder enthusiasts, opaque to their participation in interactions that may lead to certain patient productions, resembles the older psychoanalytic stance exemplified by the early Breuer and Freud. The dialectic of the therapist as a neutral observer versus as an influential participant continues to be a focus of controversy, both within psychoanalysis and psychotherapy and in the understandings of the etiology and treatment of multiple personality disorder.

Catharsis↗
PubMed1993

[What is therapeutic in psychotherapy? An empirical evaluation of assumptions of the "Generic model of psychotherapy"].

What is effectively therapeutic about psychotherapy? The generic of psychotherapy provides an empirically valid conceptual representation of psychotherapy process and outcome relationships that begins to answer this question. The aim of this study is an empirical investigation of patterns of process and outcome relationships. The data come from 18 single therapies (9 very successful and 9 less successful therapies) of the Bernese Comparative Treatment Study (Grawe, Caspar & Ambühl, 1990). First the variables of the generic model of psychotherapy are operationalized by different process and outcome measures. The statistical method of stepwise multiple hierarchical regression serves to prove a number of assumed relationships of the generic model. The findings reported here demonstrate the utility of the generic model for guiding exploratory psychotherapy research that aims to identify emerging patterns of relationships between process and outcome.

Humans↗
PubMed2000

Outcomes in a referral cohort of patients with anxiety disorders.

This study describes 6- and 12-month outcomes in a referral cohort with anxiety disorders and identifies treatment and prognostic factors related to these outcomes. Patients were recruited at three general hospital clinics, two psychologist-run clinics, and one psychiatric hospital clinic. Outcomes included severity of symptoms, physical and mental health status, and subjective global change in problem severity. Of 254 patients eligible for follow-up, 165 (65.0%) completed a follow-up questionnaire. Methods of treatment included consultation with return to the primary care physician (38.2%); or continued treatment at the clinic, with medications (16.4%), psychotherapy (22.4%), or both (23.0%). Both severity of symptoms and mental health status improved but remained abnormal at follow-up. In multiple logistic regression, subjective global improvement was related to a diagnosis of panic disorder only, treatment with psychotherapy, and type of referral. Change over time in symptom severity was related to clinic type, and change over time in mental health was related to clinic type and duration of previous treatment.

Adult↗
PubMed2001

The rejection of natural science approaches to psychotherapy: language and the world.

Many postmodernists appeal to theses about the relationship between language and reality as one basis for rejecting natural science approaches to psychotherapy. The theses include one or more of the following: (a) There are multiple worlds rather than just one, (b) worlds are constructed rather than discovered, and (c) worlds are not independent of mind and language. I refer to the conjunction of these three propositions as the multiple worlds-constructionist view. After examining the most systematic defense of the multiple worlds-constructionist view. I conclude that it fails, and that each component of the view is false.

Humans↗
PubMed1980

Psychic structure, psychic illness and psychotherapy in Plato and Freud.

Freud was familiar with the platonic writings and made multiple references of Plato's work claiming significant similarities with his own. This paper is an attempt to examine, in some detail, the existing similarities and differences between the two psychological systems. Parallels are striking, but these are, more, agreements in principle only. Fundamental divergences emerge, and these relate to different conceptions of the 'hidden knowledge' within the psyche, and of the nature of 'reality'. The two systems reflect different traditions and responded, historically, to different ideological climates.

Ego↗
PubMed1999

Self-structure and self-transformation in group psychotherapy.

This article first outlines a theory of self-structure as a hierarchically organized multiplicity of versions of self. It then describes self-transformation as a two-part process: (Part 1) the articulation and strengthening of individual self-boundaries, and (Part 2) the reclaiming of split-off, denied, or projected aspects of self. Clinically, both parts are products of the communicative interaction among members, the therapist, and the group as a whole. A parallel conception of group development posits that the group, as an object and as a social system, also needs to: (a) articulate and strengthen its boundaries so that it may (b) contain the sustained interdependent, sometimes conflictual, interactivity among members that is essential to the self-reclaiming process.

Humans↗
PubMed1990

Psychotherapeutic approach to the management of the severely injured patient.

In this modern day and age, severe injury has become the dire consequence of an ever-increasing number of motor vehicle, industrial and mining accidents as well as sport-, military- and terror-related incidents that occur. The management of the severely injured patient is mostly directed on an exclusively physical level. Often, very little attention is afforded to the psychosocial factors that prevail following physical trauma. The author describes and discusses how holistic multidisciplinary intervention within the medical milieu facilitates a more psychotherapeutic approach to the management of severely injured patients. This approach facilitates physical recovery and increases the rate of readjustment and reintegration into society, of those who have sustained severe injury.

Adaptation, Psychological↗
PubMedDate not supplied

[Psychological care to polytraumatized patients].

This article calls attention to the importance of the psychological assistance during the period of hospitalization and rehabilitation of polytraumatic patients. The authors comment on their experience with these patients giving special attention to the disorders resulting from corporal damages that will affect their professional and familiar lives. They emphasize the importance of a multiprofessional approach during the period of the rehabilitation process.

Critical Care↗
PubMed1998

[Value of psychotherapy in expert assessment of skin diseases. Recommendations and indications for additional psychotherapy evaluation in expert assessment from the viewpoint of dermatology].

Skin diseases, the psyche and psychological changes are often intertwined, especially in patients presenting for expert dermatologic opinion. In many cases an additional evaluation provided by psychotherapeutic medicine may be necessary. This resource may help with the diagnosis, explanation of the problem and estimation of the degree of disability. The different legal guidelines of the various evaluation boards must be considered. The role of psychotherapeutic evaluation is demonstrated through case examples. The evaluation of new possibly occupationally-related disorders such as multiple chemical sensitivity and mobbing is considered.

Adult↗
PubMed2001

An Economic Analysis of Psychotherapy for Borderline Personality Disorder Patients.

BACKGROUND: BPD is a serious mental illness in which psychotherapy has been shown to improve patient outcomes and reduce the use of health services. In most studies of psychotherapy, lower use of health services has been taken to imply lower health service costs. However, the costs of psychotherapy can offset any cost savings due to reduced use of other health services. AIMS OF THE STUDY: To estimate the net costs of health service use in a group of BPD patients receiving intensive psychotherapy. METHODS: Data on use of inpatient hospital, emergency hospital, ambulatory care, diagnostic tests and medications were collected for the twelve months before psychotherapy and the twelve months after the completion of treatment. Cost estimates were developed using standardised unit costs. RESULTS: There was a saving of approximately $670,000 in health service use over the thirty patients compared to a cost of $130,000 for psychotherapy, giving a net cost saving of $18,000 per patient. Most of this was due to reduced hospital admissions. Cost saving was higher in those patients who were high users of hospital services. Sensitivity analyses were performed; overall, the findings consistently show a reduction in the cost of health services used. DISCUSSION: The group studied consisted of 30 patients and comprised a before/after design. Therefore it does not overcome criticisms of other work in this area, that is of observational studies and small sample sizes. Nonetheless, the results were based on detailed costing of service use, using conservative assumptions and subject to sensitivity analysis. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The use of intensive psychotherapy in BPD patients who are high users of health services, particularly those who have had multiple hospital admissions, is probably warranted until more evidence is available. IMPLICATIONS FOR HEALTH POLICIES: There is little rigorous evidence on the effectiveness and cost-effectiveness of psychotherapy. BPD patients appear to generate high service costs so it is important to establish effective and cost-effective modes of treatment. IMPLICATIONS FOR FURTHER RESEARCH: Further research is warranted to establish accurate patterns of service use in BPD patients, and to identify those groups who will most benefit from intensive psychotherapy. erans.

Journal Article↗
PubMed1997

The treatment of chronic post-traumatic nightmares using psychodynamic-interpersonal psychotherapy: a single-case study.

This article presents a single-case experimental study of a woman suffering a traumatized reaction to a road traffic accident (RTA). In addition to meeting the DSM-IV (APA, 1994) criteria for the diagnosis of PTSD, the client suffered recurrent bizarre nightmares. The client reported at assessment, that each night her dreams were dominated by a terrifying hooded cloaked faceless figure. The central aim of the study therefore was to assess the efficacy of a psychodynamic-interpersonal (PI) style psychotherapy in the context of an unusual PTSD reaction. The methodology employed an A/B multiple baseline time series design, with six month follow-up. A and B represent a series of dream diary observations under two conditions: assessment/baseline (A) and treatment/intervention (B). Treatment consisted of a manualized psychodynamic-interpersonal (PI) psychotherapy to facilitate insight into the content and meaning of the nightmares. The intervention reduced the frequency and associated distress of the nightmares to zero. Follow-up at six months noted the long-term efficacy of the psychotherapy. The study is discussed with reference to the assimilation model of psychotherapeutic change.

Chronic Disease↗
PubMed1997

The use of metaphor by an artless first-time psychotherapist.

The experience in a psychiatric residency of being a psychotherapist for the first time can be overwhelming and anxiety-provoking. This paper examines a first psychotherapy case which utilizes a theory-distant approach based on the use of metaphor. Metaphorical theory is reviewed, and potential benefits and pitfalls of using metaphor are examined. An in-depth case study is done, focusing on the following six metaphors: Art as Psychotherapy; Psychotherapy as Art; The World Is a Trap; Mothers Are Martyrs; StepMothers Are Evil; and Artists Are Crazy. Each metaphor was utilized in multiple layers through the course of the therapy. Some of the current research in the use of metaphor in psychotherapy is reviewed. Through this approach, I was able to develop necessary psychotherapeutic skills without being overwhelmed by traditional theories such as Freudian, Object Relations or Self Psychology. I conclude that the use of metaphor with my first psychotherapy patient strengthened the therapeutic alliance, allowed an idiosyncratic language to develop in the therapy, structured recurrent themes, and permitted me to respect the patient's defenses.

Adolescent↗
PubMed2003

Harm reduction psychotherapy: extending the reach of traditional substance use treatment.

Harm reduction is a paradigm-shifting idea that has the potential to significantly improve the treatment of problem substance users. The essence of harm reduction is the recognition that treatment must start from the client's needs and personal goals and that all change that reduces the harms associated with substance use can be regarded as valuable. The paper presents harm reduction's rationale, principles, treatment implications, and application to psychotherapy. The author describes his model of Integrative Harm Reduction Psychotherapy, an approach that integrates a strategic skills-building focus with an exploration of the multiple meanings of substance use and the importance of the therapeutic alliance.

Harm Reduction↗