Selfobject intervention in brief treatment with patients inappropriate for traditional brief psychotherapy models

This article discusses brief psychodynamic intervention with patients who are likely not to benefit from a primarily verbal, insight-oriented or explorational treatment. The major models of brief psychodynamic psychotherapy and their range of effective applicability are discussed. The function of selfobjects throughout the life-cycle are explored. Interventions designed around these selfobject functions are presented for patients unlikely to benefit from a more traditional approach. These interventions are developed through a thorough assessment of the patient's difficulties and include the setting of time limits for treatment (i.e. both within sessions and for the treatment as a whole). Interventions specifically directed toward reestablishing effective selfobject functioning in the mirroring, idealizing and twinship/alterego spheres are also presented. Vignettes are used to illustrate such interventions.     

Health concerns as a deterrent to seasonal migration of elderly Canadians

Each year, thousands of older Canadians seasonally migrate to warmer climates to spend the coldest winter months. Generally in good health, these older Canadians face the possibility of becoming ill during their long stays outside the country. This paper investigates health incidents and health concerns of 2046 Canadians aged 65 and older who spent part of the 1985–6 winter in Florida. Respondents had completed a mailed questionnaire sent to subscribers to a weekly newspaper targeted at the Canadian audience.Forty-six percent reported a health problem that bothered them now, and 14% said they had experienced a medical emergency requiring doctor or hospital care on this trip to Florida. Another 41% reported having had such a medical emergency on a previous trip. Although most respondents were habitual seasonal visitors to Florida, 5% said they had anticipated they would not return next year because of a health condition.     

Low Probability Accidents

Experts frequently differ on their estimates of risk associated with accidents that have a low probability of occurrence. Those who stand to benefit from siting a new facility often perceive it as acceptably safe, using expert opinion to defend their argument. Potential losers find data to suggest that the new technology is too hazardous. This paper contrasts the role of risk assessments of low probability events in siting Liquified Natural Gas (LNG) terminals in the United States and the Federal Republic of Germany. In both cases the decision process was a rather lengthy one due to conflicts between interested stakeholders. The paper discusses the potential of compensation and insurance as policy tools for facilitating negotiation. Four criteria for improving the siting process in any country are also outlined.     

Integration of Daniel Stern's developmental theory into a model of couples therapy

Therapists commonly use a combination of techniques derived from psychodynamic, cognitive and systemic approaches in their attempts to treat the resistant patterns brought into therapy by couples. In this paper we utilize Dan Stern's concept of RIGS (Representations of Interactions that have been Generalized) to generate an integrative model of conjoint therapy. The model presented here presents a framework within which these modalities can be effectively integrated.     

Cultural sensitivity treatment and research issues with black adolescent drug users

Adolescent drug abuse is one of the nations' leading social problems. Secondary intervention programs have rarely designed treatments to address specific issues pertinent to the black adolescent drug user. Among these special issues is cultural sensitivity in clinical practice and research. A review of the research literature revealed no empirical work that has been conducted in the area of cultural sensitivity as it relates to black male adolescent substance abusers.The author proposes methodological considerations as applied to four phases of treatment: assessment, planning intervention, implementation, and termination and gives suggestions for how culturally sensitive therapeutic intervention can be conducted with chemically dependent adolescent black males.     

The uninterpreted rage: Protecting the therapeutic alliance in the treatment of borderline patients

After reviewing differing approaches to the treatment of the borderline patient, this paper describes the treatment of a patient whose negative transferences are not interpreted by the therapist; rather, the focus is on maintaining the therapeutic alliance via the awareness of the kinship selfobject function of the therapist and merger with the idealized selfobject.There is no end unless the bottom of the trough has been reached, unless the thing feared has been experienced. (Winnicott in Casement, 1991, pp. 129–130). As a matter of fact in these cases it is of decisive importance for the psychotherapist to remain clearly differentiated from the core of psychopathology—if he cannot achieve this separation and becomes drawn into the patient's delusions, he loses his tie to the healthy remainder of the patient's psyche and thus his therapeutic leverage. The maintenance of a realistic, friendly relationship with the psychotherapist is thus of crucial importance in the treatment of the psychoses and borderline states ... (Kohut, 1971, p. 30).     

Justifying conclusions in naturalistic evaluations: A critical perspective

This article examines the assumptions underlying the naturalistic perspective for evaluation that deal with justifying evaluative claims and conclusions. The author argues that ultimately these assumptions are inadequate and provides an alternative perspective for use in evaluation research and practice. The alternative, critical evaluation, is presented as attending to demands for empirical, practical, and normative adequacy in generating evaluative explanation and critique.     

What Are Strategies to Advance Policies Supporting Family Caregivers? Promising Approaches From a Statewide Task Force

Family caregivers are the cornerstone of the long-term supports and services infrastructure in the United States, yet they often contend with many challenges related to this role. Public policy has been slow to change, leaving many caregivers vulnerable to health and economic consequences. Using models of policy making, we identify barriers to advancing policies that support family caregivers and overcome policy drift. We draw on discussions from the California Task Force on Family Caregiving as it prepares state policy recommendations. Identified strategies include identification of caregivers in health care and workplace settings to promote political consciousness raising, collecting and reporting on data that frame caregiving as a policy problem, borrowing policies and language from overlapping fields to emulate their policy successes, and presenting supportive caregiver policies as solutions to other policy problems. By presenting specific strategic approaches to advance caregiving policies, we provide tools to address the growing gap between caregiver needs and policy responses.