TECHNICAL APPLICATIONS OF A CONCEPT OF MULTIPLE REALITY.
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Concept Formation↗
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Results for “Psychotherapy, Multiple”
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[Multiple personalities. Looking for my lost self].
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Dissociative Identity Disorder↗
Looking for answers: understanding multiple personality disorder.
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Diagnosis, Differential↗
Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis.
OBJECTIVES: To examine the relationship between patient-reported depression and adherence to therapy with interferon beta-1b (IFN beta-1b) and to test the hypothesis that treatment of depression is associated with improved adherence. DESIGN: Patients with multiple sclerosis were followed up 6 months after initiating therapy with IFN beta-1b. SETTING: A university outpatient multiple sclerosis center, an academic group practice, and a health maintenance organization. PATIENTS: Eighty-five patients with clinically evident multiple sclerosis taking IFN beta-1b. MAIN OUTCOME MEASURE: Follow-up questionnaire. RESULTS: Thirty-five (41%) of the 85 patients reported new or increased depression within 6 months of initiating therapy with IFN beta-1b. Patients experiencing symptoms of depression were more likely to discontinue therapy. Among the patients reporting new or increased depression, 86% who received psychotherapy or antidepressant medication and 38% of the patients who received no therapy for depression continued the IFN beta-1b therapy (P = .003). Although psychotherapy was used as a treatment option more frequently in university and academic group practice-based multiple sclerosis clinics than in the health maintenance organization (P = .02), the treatment adherence patterns were similar across sites. CONCLUSIONS: These findings support previous findings that patients report increased depression after initiating therapy with IFN beta-1b. Although the source of this depression is unclear, these findings suggest that treating patient-reported depression increases adherence to treatment.
Adjuvants, Immunologic↗
[On the necessity of improving the supply network for chronic alcoholics with multiple impairments].
OBJECTIVES: Description of care offers for chronic multiple handicapped dependents on alcohol in the service area of the clinic for psychiatry and psychotherapy of the district of Heidenheim and comparison with the situation on the supra-regional and national level ("Länder und Bund"). The present study aims at drawing attention to potential deficiencies as well as analysing the needs of the target group in order to suggest measures for improvement. METHODS: Using a multi-perspective qualitative approach, the authors conducted interviews with experts from 15 institutions, services and associations of the area in question as well as semi-structured interviews with 16 patients undergoing qualified detoxification treatment. In addition, 14 patients being part of a group trying to prevent relapse into alcohol were interviewed to achieve triangulation. RESULTS: With regard to the group of chronic alcoholics with multiple impairements care offers are deficient by reason of insufficient communication within the network of existing institutions, a lack that was also stated by studies carried out on a supra-regional and national level. There is no multi-professional office for coordination and cooperation, whose primary aim should be remedial measures will regard to the lack of home- and day-care treatment e.g. in hospital. Moreover, an inadequate situation as to organizing a patient's day and his leisure activities can be stated. CONCLUSIONS: A case-management-model should be implemented into existing care structures. Patients in need of additional support ought to be given the possibility of day-care treatment. In this context the development of topic-centered qualification- and training programs is required, especially in the field of medical care. In the long run it will be necessary to realize a meeting place for dependents, run both by professionals and volunteers.
Alcoholism↗
Multiple personality disorder as perpetrator of child abuse.
An eighteen-month-old Alaskan girl suffered transient coma with multiple superficial contusions when injured by her multiple personality disturbed caretaker. The relative disinterest in multiple personality disorder as a psychiatric diagnosis among American trained practitioners is reflected in the great difficulty encountered by child protection workers while seeking psychotherapy for this disturbed family. The public health nurse, pediatrician, and social workers of the child protection team were unsuccessful in attempting to secure psychiatric therapy for this child batterer. Multiple factors, other than psychiatric community disinterest in multiple personality disorders, influenced these unsuccessful attempts. Legal process delays, strongly punitive community attitudes, tired and nearly "burned out" child protection workers, and conflicting psychological and psychiatric consultant opinions are described. A brief review of multiple personality disorder traits is given with emphasis on the common childhood exposure to abuse and violence among reported multiple personality subjects. Despite the obvious hope by the eighteen-month-old child's parents for effective help to reconstitute her family, the multiple factors described show institutional neglect and abuse which has made such recovery impossible to date. A plea is made to all persons involved with child abuse and neglect to more accurately diagnose and treat multiple personality disorders in abusive parents.
Alaska↗
Antidepressant pharmacotherapy of depression associated with multiple sclerosis.
In a double-blind clinical trial involving 28 patients with multiple sclerosis and major depressive disorder, 14 patients were randomly assigned to a 5-week trial of desipramine and individual psychotherapy and 14 to placebo plus psychotherapy. Clinical judgments indicated that patients treated with desipramine improved significantly more than the placebo group. This was confirmed by scores on the Hamilton Rating Scale for Depression but not by Beck Depression Inventory scores. Side effects limited desipramine dosage in half of the treated patients. The authors conclude that desipramine has a modest beneficial effect in serious depression associated with multiple sclerosis but that side effects may be more of a limiting factor than in patients without medical or neurologic disease.
Adult↗
[Disseminated encephalomyelitis--a mask for conversion neurosis?].
A female patient, aged 24 years, with a case history of 9 years duration, 4 admissions to a neurological and 3 to a psychiatric ward was first diagnosed as multiple sclerosis. Diagnosis was based on neurological symptoms, whereas repeated laboratory values, electrophysiological measurements, CT and MRI scans were equivocal. Nevertheless this initial diagnosis profoundly influenced the further course of the illness: the patient ending up with an invalidity-pension. At that period she was admitted for her first psychiatric hospitalization after attempted suicide. Extensive investigations led to revision of the former diagnosis and Adlerian psychotherapy effected a remission of practically all neurological symptoms, so that the woman could be reintegrated socially and in her profession. Differential-diagnosis of multiple sclerosis is revised and the necessity of extensive, also psychodynamic, case-investigation is stressed, as is the need of consequent psychotherapy effected by a medical therapist.
Adult↗
Voices of the self in psychotherapy: a qualitative analysis.
Approaches that view the self as constituted by socio-cultural processes and as plural, consisting of a multiplicity of states, positions, functions, etc., have flourished in the last decades. This paper explores the multi-voiced nature of the self, drawing upon Lacan's theory of subjectivity and Bakhtin's concept of dialogism. Subjectivity is seen as constituted through language as expressed in the speech of the subject's important early others. The psychoanalytic concept of transference, understood as a semiotic process of enacting early interpersonal patterns in the subject's present relations, provides a link between the unfolding of subjectivity in the present and its historical continuity. The articulation of subjectivity is discussed through a micro-analysis of extracts from sessions of a long-term psychoanalytic psychotherapy. The analysis demonstrates the enactment of transferential dialogical positions at the beginning of the therapy and traces their recognition by the client through the gradual development of increasingly reflexive subject positions towards the end of therapy. It is argued that the aim of therapy should be the facilitation of a complex subjectivity, whereby the different subject positions can be fluently articulated within an overall reflexive frame.
Ego↗
Voices of the self in psychotherapy: A qualitative analysis.
Approaches that view the self as constituted by socio-cultural processes and as plural, consisting of a multiplicity of states, positions, functions, etc., have flourished in the last decades. This paper explores the multi-voiced nature of the self, drawing upon Lacan's theory of subjectivity and Bakhtin's concept of dialogism. Subjectivity is seen as constituted through language as expressed in the speech of the subject's important early others. The psychoanalytic concept of transference, understood as a semiotic process of enacting early interpersonal patterns in the subject's present relations, provides a link between the unfolding of subjectivity in the present and its historical continuity. The articulation of subjectivity is discussed through a micro-analysis of extracts from sessions of a long-term psychoanalytic psychotherapy. The analysis demonstrates the enactment of transferential dialogical positions at the beginning of the therapy and traces their recognition by the client through the gradual development of increasingly reflexive subject positions towards the end of therapy. It is argued that the aim of therapy should be the facilitation of a complex subjectivity, whereby the different subject positions can be fluently articulated within an overall reflexive frame.
Journal Article↗
[Empirical study of inpatients viewed from the individual psychotherapy].
There are very few empirical studies which address the effect of psychotherapy in inpatient settings. The author extracted 45 inpatient cases which could withstand detailed statistical analysis among patients who had been admitted to the psychiatric ward of the Tokai University Hospital between 1975 and 1981. Therapists of the cases were interviewed individually and the cases were evaluated retrospectively based on the criteria proposed by the study of Menninger Foundation. Significant statistical improvements were found on every items of evaluation. Furthermore, patients who had shown good interpersonal relationships and motivation at the time of admission showed positive conditions at the time of discharge. Factor analysis of therapeutic variables yielded five factors which delineated the following characteristics of the therapists: 1) having a psychoanalytic orientation, 2) viewing the improvement of symptoms as the goal of therapy, 3) utilizing one's experiences and skills, 4) utilizing a supportive approach, and 5) giving careful attention to the structuring of the psychotherapy sessions. As for the situational variables of the patients, factor analysis yielded only one factor, and multiple regression analysis revealed no significant therapeutic effects. Two types of multiple regression analysis were conducted to determine therapeutic effects and therapeutic variables, but no significant factors were found. Thus, the cases were classified into five groups according to interpersonal relationships factors and were analyzed according to "quantification method II" (Hayashi, C.). The following results were obtained: 1) the structuring of inpatient therapy should correspond with the patient's level of responsibility, 2) as for the structure of psychotherapy, the quality of improvement depended on the closeness to the psychoanalytic structure, i.e., the closer to the psychoanalytic structure, the higher the improvement, 3) the quality of improvement was poor when transference issues (in the sessions) were not brought up during the psychotherapy sessions, 4) the quality of improvement rose according to the degree that dreams and fantasies were dealt with, 5) hospital admission periods of 101 to 120 days showed the highest of improvement, 6) the frequency of sessions did not determine the quality of improvement, 7) the personality of therapist had strong effects when it worked in a negative way, and 8) the quality of improvement corresponded to the degree of the permissive atmosphere in the therapeutic relationship.
Adolescent↗
Pluralistic criteria for psychotherapy: an alternative to sectarianism, anarchy, and utopian integration.
A pluralist revolution has taken place in psychotherapy, discarding the assumptions that only one theory can be true and that there exists only one method for finding it. Rejecting the anarchistic attitude of "anything goes" as professionally nihilistic, we propose that in the present pluralistic era it is necessary to recognize a multiplicity of perspectives for determining the rightness of therapeutic constructs. A construct or intervention is right to the extent that it fits demands for coherence and pragmatic value from a variety of perspectives, such as the patient's, the clinical community's, the academic community's, and the general public's. Within the clinical and academic communities, the greater the variety of acceptance (by different schools, theories, and methodologies), the greater the construct's cumulative rightness. The difference between this variety rule and a majority one is made explicit. Coherence and pragmatic value are widely accepted criteria and they define the universe of rational discourse in psychotherapy. Adding to these the requirement of multiple acceptability is the necessary step for creating rational dialogue in the new pluralistic world.
Attitude of Health Personnel↗
A systems approach to behavioral neurobiology: integrating psychodynamics and neuroscience in a psychiatric curriculum.
In the practice of medicine, an understanding of the biological functioning of organs and organ systems is the basis for theories of pathology and clinical practice. If psychoanalysis is to be accepted by the medical and psychiatric community, it must be based on a sophisticated understanding of the organ from which mental and emotional experiences emanate and use scientifically acceptable language. Each approach to psychotherapy has its own vocabulary for describing neuropsychological processes. Neurobiological vocabulary provides the various factions "neutral ground" upon which to carry on a multidisciplinary integrative dialogue. An understanding of behavioral neuroscience allows the therapist to look beyond the labels that spawn division and identify unifying biological principles that are described in a variety of ways in a multitude of theories. We contend that the neural network/representational approach to neurobiology views human mental experience as the result of multiple complex integrated systems, and is therefore holistic and antireductionistic in its perspective. Such a biologically informed psychotherapy facilitates integration of skill sets and flexibility in technique. With these principles in mind, the therapist can base his or her approach to the patient based on these principles rather than on devotion to one particular "school" or another. Because behavioral neuroscience supports many of the basic tenets of psychoanalytic theory, such an integrative psychotherapy would be psychodynamically informed. In this paper, we outline some of the ideas we present in our neuroscience course and how we relate biological concepts with some core principles of psychodynamics and psychotherapy.
Behavior Therapy↗
The context of transference interpretations in analytical group psychotherapy.
Transference interpretation varies with the underlying understanding of the concept of transference. We view the phenomena of transference in its multiple connections; its relationship to countertransference, its relationship to a particular kind of remembering that unfolds in sequence rather than in representation and its relationship to working through. The transference is expressed in the context of a "total situation" and in order to unfold, requires a time-space frame which variation will modify the nature of the transference available for interpretation. The analytical frame applied to a group situation creates an environment that promotes rapid and sometimes massive regression. We have introduced the notion of levels of transference to account for the state of self/object differentiation present in the group. This varies with the amount of regression, and depends on the severity of splitting, projection and projective identification. In terms of transferential objects available in the group, we recognize the analyst, other members and the group as a whole. The latter carries the more primitive transference and the underlying phantasy structure of the group transactions. We briefly described some possible errors in the interpretation of transference and their potential consequences.
Countertransference↗
Case study: feasibility of multisystemic therapy as a treatment for urban adolescents with poorly controlled type 1 diabetes.
OBJECTIVE: To determine the feasibility of using multisystemic therapy (MST), an intensive, home-based psychotherapy, to improve poor metabolic control among four adolescents with type 1 diabetes. METHOD: A multiple baseline, repeated measures design was used. Blood glucose readings were obtained every 2 weeks during a baseline period, a 7-month intervention, and a month-long postintervention period. Glycosylated hemoglobin (GHb) was measured at baseline and follow-up and was contrasted between two participants who received MST and two participants who did not receive the intervention. RESULTS: Intervention participants showed improvements in health status, as well as fewer hospitalizations and emergency room visits. CONCLUSIONS: Findings from this case study suggest that MST has the potential to improve treatment adherence and metabolic control among teens with poorly controlled type 1 diabetes.
Adolescent↗
Family therapy and chronic depression.
Individuals with chronic depression report significant problems in multiple areas of their family functioning, suggesting the importance of combining family therapy with psychotherapy and pharmacotherapy in the treatment of their depression. We describe a model of family functioning (the McMaster model) and therapy (the Problem-Centered Systems Therapy of the Family) and its application in the treatment of a young woman with chronic depression. The key elements of the family treatment are a comprehensive assessment of the family, a systematic progression through defined treatment stages, an open, collaborative stance with the family, and a focus on the family's responsibility for change. Family therapy can aid the amelioration of depressive symptoms and improve the ability of family members to deal more effectively with the depression as well as a wider range of problems.
Adult↗
[Psychiatric-psychotherapeutic management of trauma patients].
Psychiatric and psychotherapeutic treatment of victims of accidents is based on a concept of comprehensive medical diagnostic and therapy. This integrating approach is aiming at the emotional care for injured people, who already had mental disturbances before the accident or following the trauma. During 11 years as psychiatric and psychotherapeutic consultant at the Accident Hospital Lorenz Böhler in Vienna more than 2000 rounds where done. The necessary interventions during traumatologic treatment of stationary patients are demonstrated in an exemplary way.
Accidents↗
[Multiple chemical sensitivity (MCS) -- scientific and health policy aspects].
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Aged↗