Separation, termination process and long-term outcome in psychotherapy with severely disturbed patients.
ABSTRACT Long-term consequences of working through of intratherapeutic separations were studied in combined psychotherapy and milieu therapy with severely disturbed adult patients. Seven of the 10 cases were consistent with the hypothesis about the significance of therapeutic work with separation for the longitudinal outcome. Inability to mourn was connected with less emotional and functional improvement. Besides the therapist's contribution in the middle phase, the patients' different ways of dealing with the trauma of termination were decisive.
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ABSTRACT: Most of the literature on countertransference in clinical social work practice is based on assumptions that the relationship between the client and practitioner is structured and formal. These assumptions do not apply in community-based case management practice, where the social worker and client interact in a variety of settings and circumstances. Additionally, the complex problems of clients who have serious mental illnesses may evoke a range of conscious and unconscious reactions from social workers that must be acknowledged for appropriate intervention to occur. In this paper key principles for the supervisor's recognition and management of countertransference are presented and discussed. Case illustrations are included.The Clinical Supervisor 01/2002; 21(2):129-144. DOI:10.1300/J001v21n02_09
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ABSTRACT: Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.Issues in Mental Health Nursing 04/2009; 30(3):151-8. DOI:10.1080/01612840802557246
Article: The Process of Termination.[Show abstract] [Hide abstract]
ABSTRACT: The primary focus in this chapter is on the process of those terminations that arise "as a natural organic outcome of the treatment process itself" (Loewald, 1988, p. 155) in open-ended, psychodynamically oriented therapy. The discussion applies to open-ended therapies in both individual and group formats. These terminations can be contrasted with endings associated with preestablished time limits in brief therapy approaches, terminations characterized as temporary interruptions in the ongoing supportive treatment of more chronic patients, or endings due to extraneous factors. Implications for practice based on the general psychotherapy are generalized to these other therapy approaches in the manner discussed in chapter 2. This chapter is divided into three major sections. The sections follow the late phases of an open-ended therapy. The first section considers issues associated with the ending of the working phase, with a focus on the therapist's preparation for termination. The second section addresses the pretermination phase, the relatively brief period associated with emergence of the termination criteria. The third section considers the termination phase proper. The text of the discussion implies that the boundaries between these phases are distinct. In practice, however, the boundaries will not be as readily evident unless made explicit by the patient or therapist. The exception is the setting of the actual date of the last session that marks the move from the pretermination phase to the termination phase proper. (PsycINFO Database Record (c) 2012 APA, all rights reserved)