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In 1962 the outpatient department of the division of psychiatry at the Boston
University School of Medicine had too few professional therapists to provide
for a growing list of patients awaiting assignment. Because the outpatient
department was staffed by psychiatry residents at the time, the problem
became mine as director of psychiatric education.
Not unexpectedly, a review disclosed that a significant number of
patients were being seen regularly over long periods of time, even for years.

Since they were being treated by residents who rotated from one psychiatric
service to another every six months their treatment was interrupted twice a
year. An examination of the records of some of these long-term patients
revealed that, although they apparently related well to their new therapists,
they tended to reexamine with each therapist much of what had already been
discussed. Further, we noted that these patients did not appear to react
strongly to the loss of the previous therapist; thus, we wondered whether
transference to the institution and to the outpatient department had become
more significant than transference to the therapist. It would seem that
patients could go on forever, having their dependent needs well gratified—
although their best interests would not be served. Patients awaiting
treatment remained at a disadvantage.

This book provides the reader with the most creative and most effective approaches in regard to the treatment of the basic psychopathological disorders that a psychotherapist is likely to encounter written by outstanding therapeutic practitioners. Each chapter is the sum and integration of the therapist’s understanding of the essence of psychotherapeutic practice, the nature of the disorder under consideration and what he has learned over long years of experience working with patients of the particular type that he is discussing, as well as what he is as a person. (659 pp.)

ORIGINS AND DEVELOPMENT
Early in the 1970s, my colleagues and I conducted clinical investigations
of persons who were struggling to master recent stressful events. At the time,
there was no diagnosis of posttraumatic stress disorder (PTSD) in the official
nomenclature, DSM II. Yet in our clinical observations we found that intrusive
and repetitive thought, especially unbidden images, was a distinctive symptomatic response to stress, and often occurred in conjunction with its apparent opposite, phases of ideational denial and emotional numbing related to the potentially traumatic experiences.

In a series of experimental studies we found that most people’s subjective experience of intrusive thought increased after they experienced stress-inducing perceptions. Those experiments consisted of showing different types of subjects different types of films in laboratory settings with varied demand characteristics.
In field studies, my colleagues and I also focused on a variety of persons who had recently undergone major life events. This led to the development of questionnaires that were specific to the subjective experiences that may increase after stress, such as found in the intrusion and avoidance measures on the Impact of Event Scale and in
clinicians’ equivalent rating scales, such as the Stress Response Rating Scale
(Horowitz, Wilner & Alvarez, 1979; Weiss, Horowitz & Wilner, 1984).

The pleasures and pains, the gratifications and frustrations of
parenthood are existential components in the adult life of humans. In spite of
the ubiquity of its problems, the psychology of parenthood has not been
studied systematically. Science progresses slowly. Generations of scientists
labor arduously to build the foundation for an insight that a genius
formulated long years before. I refer here to a statement of Darwin: “The
feeling of pleasure from society is probably an extension of the parental or
filial affections, since the social instinct seems to be developed by the young

remaining for a long time with their parents” (p. 6). It is obvious that Darwin, the naturalist, arrived at this insight from innumerable, seemingly unrelated observations.
Today the verity of this generalization appears evident to students of behavior, whether the objects of observation are human, subhuman mammalians, or the lower levels of the evolutionary scale.

Author: Lynn P. Rehm, Ph.D.
In 1928 Ivanov-Smolensky, a physician working in Pavlov’s labs, reported on
his observations of a dog that appeared depressed consequent to its inability to
make extremely fine discriminations in a classical conditioning task. The paper
had little impact on the field of depression psychopathology and only in the past
20 years has there been a concerted effort to apply learning models to the
phenomena of depression. During this recent period a number of new theories
have developed. They have led to the generation of a great deal of research data

on the psychopathology of depression and to the development of many new therapeutic approaches to treatment. The theories themselves have been influenced by these developments and revised theories have evolved from earlier forms.

Supportive psychotherapy is widely practiced and may in fact be the treatment provided to most psychiatric patients. In the early years of psychoanalysis, it was generally assumed that anyone who studied psychoanalysis could automatically do psychotherapy. Since the 1950s it has been recognized that psychotherapy should be systematically taught as a modality apart from analysis and that it should be conceptualized on its own terms, not as a lesser form of analysis. However, supportive psychotherapy has seldom been taught.

It seems to be assumed that if one masters psychodynamic therapy, one is able to do supportive therapy, which has generally been seen as a therapy that requires less skill and is appropriate primarily for patients who are less intelligent, less well motivated, or less interesting (Winston, Pinsker, & McCullough, 1986).
The consequence of this assumption has been that supportive psychotherapy is often conducted with the objectives and techniques of expressive therapy as the model. Paul Dewald (1971) described expressive therapy and supportive therapy as the poles of the continuum of dynamic psychotherapies.
Most patients receive a therapy that incorporates both supportive and expressive elements.

It is frequently overlooked that today’s conception of a cause is only one
of several used earlier in history. In particular, based upon Aristotle’s theory
of knowledge, one could once speak of at least four causes. The first he called
the material cause. In describing a chair we can say that we know it is a chair
because like most chairs it is made of wood, or metal, or the like. Another
cause of the chair is the fact that it was assembled by someone or something
(a machine). This Aristotle termed the efficient cause. Chairs also meet our
blueprint conceptions of what chairs “look like”. This usage Aristotle termed the formal cause.

Finally Aristotle noted that there is often a purpose in events, a “that for the sake of which” something like a chair is made to come about. The “sake” for which a chair is constructed might be termed “utility” in eating, writing, and so forth. Of course, the chair docs not itself decide to “come about.” It is the human being who obtained the wood (material cause) and made it (efficient cause) into a chair matching his physical requirements (formal cause) so that he might live more comfortably (final cause) who may be said to have a purpose or an intention.

Goals of IPT with Depression
A goal of IPT is to relieve acute depressive symptoms by helping the patient
to become more effective in dealing with those current interpersonal problems
that are associated with the onset of symptoms. Symptom relief begins with
educating the patient about depression—its nature, course, and prognosis, and the
various treatment alternatives. Following a complete diagnostic evaluation, the
patient is told that the vague and uncomfortable symptoms are part of a known
syndrome that has been well described, is understood, is relatively common,
responds to a variety of treatments, and has a good prognosis.

Psychopharmacological approaches may be used in conjunction with IPT to alleviate symptoms more rapidly.

Professor of Philosophy at Loyola University in Chicago and taught at the Seabury Theological Seminary in Evanston, IL.
Dr. Chessick has received numerous awards such as “teacher of the year,” and the Sigmund Freud Award from the American Society of Psychoanalytic Physicians (where he served as President), and is known as a national and international lecturer on topics of psychoanalysis, psychodynamic psychotherapy, and philosophy. He has published 17 books and over 300 papers in various professional journals and over 200 book reviews in these journals. He is on the editorial board of several of them.

Short-term therapy generally has three goals: modifying or removing the symptom complaint for which help is being sought, which is the immediate objective, producing some corrective influence on the individual’s general adjustment, and initiating essential alterations in the personality structure.
With the properly conducted treatment we may anticipate substantial or complete symptom relief as well as some modification for the better of behavioral coping.
However, we may scarcely have broken ground on the third goal of personality reconstruction. We may hope, nevertheless, that the experience of treatment will have set into motion a process following therapy that over a long-term period will result in true character permutations.

That such changes do occur has been demonstrated in follow-up studies of patients who have received appropriate professional help over a brief span. Though not anticipated, significant and lasting changes in the self-image and the quality of interpersonal relationships have been noted.

The psychodynamic understanding of the personality and its disorders rests
heavily upon the study of the life cycle. The commonalities and similarities in
the course of all lives make possible the generalizations and abstractions
necessary for the scientific study of the personality. Although no two persons
are identical and no life stories are the same, the basic themes are limited and
it is the variations upon them that are infinite and inexhaustible. Behind their
individual uniqueness all persons are born with physical endowments that
are essentially alike and with similar biological needs that must be met.

Comments from Reviews:

“The best textbook of psychotherapy in existence today.” “Shows Wolberg’s extensive experience and enormous empathy.” “Deals with every conceivable question” “The most remarkably comprehensive discussions of what to do in psychotherapy.” “The range of topics covered is truly astounding.” “Stands in the forefront of the field” “Astonishing” “This is a very important book to be read and enjoyed by all clinicians.” “Replete with clinical dialogue.” (2639 pages)


Publisher: International Psychotherapy Institute

This book grew out of a long-standing interest in the self, its conceptual
elucidations and its experiential reality. Originally that interest was philosophical and theoretical, being a topic I pursued many years ago in the philosophy department of
McGill University; more recently, it has had a more directly “practical” import for me in my clinical practice as a psychoanalyst and psychotherapist. I have learned much about the vicissitudes of the self, its psychopathology, and the amelioration of that
psychopathology from my patients. I am grateful to them. I have also had the opportunity to teach a course on “Theories of the Self’ to students young and old at the New School for Social Research.

My classes, with their mutually enriching mix of traditional undergraduates, adult students, and older students from the New School’s Institute for Retired Professionals, have provided a forum for multigenerational, intellectually stimulating, intense and deeply felt discussions of the self that lluminated the questions raised in this book. My students have taught me a great deal and I am in their debt.
Jerome David Levin

Publisher: International Psychotherapy Institute