A patient-therapist's reaction to her therapist's serious illness

Article Abstract:

Because of the special, almost contractual nature of the psychotherapeutic process, any event which threatens the continuity of that bond requires analysis. In this case, a psychotherapist who was also a patient of a supervising psychotherapist describes her emotional and intellectual reactions to her therapist's heart attack and its aftermath. Careful attention was paid to her inner state during the time her therapist was away from their scheduled sessions; the observations are summarized in a personal review of her feelings and thoughts. Upon learning of the therapist's illness, denial was her foremost response, which was accompanied by concern and feelings of abandonment. Eventually, these feelings gave way to anger and fear of further loss, and a craving for specific information about her therapist's condition and plans. Compassion and concern were mixed with self-centered fear. Distancing and detachment predominated until the therapist returned from recuperation. Once her therapist had returned, he gave her full information about his health and his recent history, to reassure her of the continuity of their therapy and to allow questions and discussion about the experienced absence. On the basis of her own self-analysis, the author makes certain recommendations about how therapists should handle the problems caused by unexpected absence, especially health problems, which can be significantly emotionally charged. It is recommended that more specific information be made available during a protracted absence to confirm or correct previous information about an anticipated date of return. Depending upon the style of therapy and the nature of the patient, more or less information about the status of the therapist's health should be provided. It is concluded that the impact upon the psychotherapeutic process in such cases is unavoidable; the author learned from her own experience how important therapists can be to their patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Psychotherapists, Therapist-patient relations, Psychotherapist and patient

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Treatment alliance and the chronic schizophrenic

Article Abstract:

One of the difficulties in treating chronic schizophrenics using psychoanalytic techniques lies in communication. Therapists are comfortable using verbal abstraction and symbolization, but schizophrenics often cannot see the symbolic aspects of their own behavior, and thus cannot identify the distortions in their views of reality. Some sort of common ground must be developed, such that both therapist and patient can organize their communication around some object or topic that does not violate the patient's delusional belief system, but can eventually be used by the therapist to progress toward a more symbolic representation of the patient's understanding, and to help the patient learn to accept an alternate view of reality. To illustrate this method, a case is presented of a schizophrenic 34-year-old former journalist who had become a bag lady in New York City. The woman, who told of an elaborate plot against her by the CIA, felt it was important to 'get the record straight' in the event that she had to defend herself against CIA charges. The therapist, taking note of the woman's journalistic background, urged the woman to write a journal of their sessions. The notebook became something of a transitional object, in that it represented both the gradual development of trust in the therapist, and the increasing recognition of the patient's own nonpsychotic capacities. The authors suggest that finding or developing such an object with the schizophrenic is an important method of creating a sense of relatedness between therapist and patient. They also point out that it is important for the therapist to continue to maintain an understanding of the symbolic nature of the common object. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Schizophrenics

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Treating those who fail to take themselves seriously: pathological aspects of humor

Article Abstract:

In some cases, a response of humor and laughter by the patient in a psychotherapeutic context may have pathological aspects. By perceiving everything as amusing, the patient may trivialize the seriousness of the issues that need to be dealt with in therapy. Because of the nature of this behavior, therapists may often not give this problem the attention it deserves. To keep the therapeutic process on track, and to avoid the use of humor as a psychological defense by the patient, therapists should use a structured cognitive approach. Sensitivity to the patient's nonverbal expressive behavior and the correction of irrational thinking by the patient are key strategies for the therapist. Humor may be used as a defense mechanism, as a way of tempering anxiety, covering up hostility, or attenuating depression. Two case studies are presented which illustrate this behavior. Once the patients were made aware of their behavior and their network of beliefs began to change, their feelings were tempered by feelings of guilt and impotency. These feelings were ultimately replaced by a more fully integrated sense of humor and a serious hopefulness. It is stressed that the therapist must maintain a balance between letting the patient pathologically indulge in humor, and perhaps participating in this behavior himself, and recognizing laughter and humor as a frequently healthy expression of patient progress. (Consumer Summary produced by Reliance Medical Information, Inc.)

Wit and humor, Humor

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