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At least 847 records · Page 47Linked to original sources
PubMed2005

Research advance directives: protection or obstacle?

OBJECTIVE: This study assessed how many adults completed a research advance directive and the preferences indicated on the completed forms. METHOD: The authors analyzed all 2,371 adults admitted as inpatients to the NIH Clinical Center from March 14 to Sept. 13, 2000. RESULTS: Overall, 11% of adult inpatients completed a research advance directive. Of those who specified preferences, 13% were not willing to participate in future research should they become unable to consent, 76% were willing to participate in research that might help them, 49% were willing to participate in research that would not help them and posed minimal risk, and 9% were willing to participate in research that would not help them and posed greater than minimal risk. CONCLUSIONS: Proposals to allow cognitively impaired adults to participate in research only with a formal advance directive could block important research. More flexible approaches should be considered to protect these individuals.

Adult↗
PubMed2005

Obstacles and opportunities in providing mental health services through a faith-based network in Los Angeles.

This study surveyed attitudes toward mental health services and barriers to providing these services within the agencies of QueensCare Health and Faith Partnership, a network of faith-based organizations, and parish nurses who provided health care in a low-income, ethnically diverse area of Los Angeles. Representatives from 42 organizations responded. Informal counseling was the most frequently provided service (57 percent); yet only 19 percent reported that counselors had at least a moderate amount of training. Although 69 percent felt that referrals to nonreligious counselors were appropriate, 50 percent were reluctant to collaborate with government agencies. Barriers to providing mental health services included limited professional training, reluctance to partner with government programs, and financial and staffing limitations.

Crisis Intervention↗
PubMed1992

Obstacles to the dynamic understanding of therapist-patient sexual relations.

Several dynamic resistances appear to interfere with rational and empirically based discourse about therapist-patient sexual misconduct. These resistances include the lure of reductionism and a longing for simplicity; wishes for "political correctness"; gender bias; and confusion about the nature of the trauma in sexual misconduct. We conclude that (1) empirical study may produce unpleasant results; (2) "politically incorrect" models of misconduct merit study with care equal to "politically correct" ones; and (3) those reenactments we call transference-countertransference should be viewed in all their human complexity. Only then will our increased understanding of misconduct offer hope of prevention.

Ethics, Professional↗
PubMed1995

Interactional obstacles to empathic relating in the psychotherapy of narcissistic disorders.

Psychotherapy with narcissistic patients exposes therapists to a set of interactional pressures which threaten to disrupt the desired therapeutic stance of empathic relatedness. The therapeutic relationship is a field of unconscious mutual influence in which therapists' own narcissistic vulnerabilities are threatened by narcissistic patients' characteristic interpersonal style. A typical constellation of countertransference feelings and reactions is aroused, characterized by a temporary or chronic state of narcissistic symmetry between patients and therapists. In this relational state both patients and therapists unconsciously defend their respectively tenuous sense of self-esteem from the perceived threat posed by the other, using similar defensive narcissistic strategies. Unless this interactional narcissistic symmetry is diffused a therapeutic impasse ensues, which may jeopardize the therapeutic alliance. This potential is exacerbated in the case of those therapists with characterological narcissistic features, as they unconsciously require constant affirmation from their patients in order to enhance their deficient self-esteem. Enduring, understanding, and adaptively processing narcissistic countertransference responses facilitates the resumption of the desired empathic stance, characterized by an optimal condition of narcissistic asymmetry between therapists and patients.

Adult↗
PubMed1984

Obstacles to reducing patient abuse in public institutions.

Although the abuse of patients in state mental health facilities compromises the patients' therapeutic environment and strongly affects public conceptions of such facilities, there is a lack of reliable research and data on patient abuse. Drawing on his five-year experience as chair of the New York State Commission on Quality of Care for the Mentally Disabled, the author discusses the problems that binder the reporting, investigation, and prevention of patient abuse in public facilities. He believes that the reporting of minor abusive conduct is precluded by the very working conditions that contribute to its occurrence, but that the reporting of major abusive conduct is precluded by powerful factors in the administrative and disciplinary structures of state institutions. After discussing the problems behind the reporting of patient abuse, the author suggests some preventive measures to decrease the incidence of abuse and to ensure its reporting when it occurs.

Attitude of Health Personnel↗
PubMed1993

Reducing obstacles to affiliation with alcoholics anonymous among veterans with PTSD and alcoholism.

Alcohol use is prevalent among Vietnam veterans who suffer from chronic combat-related posttraumatic stress disorder (PTSD). Although Alcoholics Anonymous (AA) is the mainstay of ambulatory alcoholism treatment, adherence to particular components of the AA philosophy may prove especially challenging for alcoholic Vietnam veterans with PTSD. The authors describe elements of AA's philosophy, such as "surrendering" to a "higher power," making amends to persons one has harmed, and sharing one's story publicly, that may be difficult for the Vietnam veteran with PTSD. The authors suggest that an important factor in the successful affiliation of these patients with AA is their capacity to separate their alcohol-related problems and treatment from their PTSD symptoms and treatment and to accommodate dual identities as both an alcoholic and a traumatized soldier. Preparing such patients for AA by reframing some of the 12 steps is recommended.

Alcoholics Anonymous↗
PubMed1989

Infantile sexuality, gender identity, and obstacles to oedipal progression.

Contrary to when it was first proposed, infantile sexuality nowadays is accepted as an important part of child development. However, Freud's views on masculine primacy and feminine inferiority are seen to be incomplete and inaccurate not only because they over-emphasize sexuality and sexual anatomy, but also because they neglect aggression, object relations, ego and superego functioning, and the sense of self. Infantile sexuality is therefore reconsidered within the broader perspective of gender identity. Within this broader perspective, normal and aberrant sexual development is discussed, and new ideas are offered about familiar concepts such as castration anxiety and penis envy.

Child↗