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doi: 10.1080/02668739900700021pmid: N/A
SUMMARY In the management of patients who are violent or antisocial in their behaviour, attention to safety is a priority. Physical interventions which are required to provide safety have the effect of altering the dynamics between patients and nurses, with forces towards regression in both. The nurses have to stay alert to potential danger so that they can intervene quickly when necessary. This can alter their responses to patients towards a parental approach, one which has been recognised as a problem in institutions. In regression, the patients have the opportunity for affectionate relationships otherwise denied. Unless a space for reflection is available, many patients who could otherwise benefit from psychological intervention are trapped in regression. This space is provided by the work of the multidisciplinary team. An interpretative intervention is described, one in which the patients were alerted to a potential external reality of a concerned object. The patients' responses showed a capacity for psychological mindedness which had been obscured by behaviour. In a setting with limited resources, a psychoanalytically informed approach proved to have major therapeutic impact.
doi: 10.1080/02668739900700031pmid: N/A
SUMMARY This paper presents a model of integrative treatment for serious mental disorders based on the identification of specific needs and characteristics of the patient by means of a psychoanalytic approach. The treatment includes different types of bio-psycho-social techniques, both therapeutic and rehabilitative, which are utilised according to specific selection criteria. The authors describe the most important features of the conceptual framework and illustrate its clinical application through a case-study example.
doi: 10.1080/02668739900700041pmid: N/A
SUMMARY This paper makes a contribution to the understanding of some different forms of resistance to change found in severe mental disorders, whose treatment is often marked by exhausting phases of ‘illusion’ and ‘disappointment’. A conceptual framework is provided, both for the evaluation of the problem and for a multiple approach to treatment based on an integrative conceptual model, and is illustrated through the presentation and discussion of case-study examples.
doi: 10.1080/02668739900700051pmid: N/A
SUMMARY Using illustrative clinical material, drug-addiction is shown to be characterised by repeated sadistic attacks on internal objects perceived by the addict to be dead or dying. Damaged internal objects appear resuscitated in order that they might be repaired, though the result is a continuation of a self-destructive attack. This compulsive cycle of repetitive attack and attempt at repair is compared with the punishment cycle in the Greek myth of Prometheus. Particular attention is paid to the attack on Prometheus's liver. It is proposed that the process of repairing the liver might be considered in terms of a need for detoxification of noxious internal objects. It is proposed that the toxic mentation of addiction might be thought of as a specific object-relations syndrome.
doi: 10.1080/02668739900700061pmid: N/A
SUMMARY In this paper, the author describes aspects of his work as a psychoanalytical psychotherapist in a hospital for diseases of the colon and rectum. After reviewing some of the earlier psychoanalytic literature (Freud and Abraham), and more recent theoretical contributions, two cases are described in some detail, which help give a flavour to some of the work. The paper concludes with caveats about the internal and external working environment, which will facilitate or hinder working in particular medical settings.
doi: 10.1080/02668739900700071pmid: N/A
SUMMARY This paper outlines the context for the emergence and development of a family support service at the Anna Freud Centre. Its main aim is that of helping us think about the therapeutic space to which family support work belongs. Drawing on a range of case material, it describes a flexible and somewhat open-ended model of practice that is emerging in our work and which seems well suited to this particular area of practice. Inter-agency communication and service integration are also seen as integral to this work, and the paper argues that, in this way, professionals can mirror to families in difficulty a holding capacity which has been damaged or disrupted for the family, and which impedes their capacity to address their difficulties.
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