Training issues in the treatment of severely disturbed patients. 1985

L Giustra

When beginning psychotherapists undertake the treatment of severely disturbed patients, we see a confluence of factors involving both patients and therapist which predispose to the development of predictable countertransferential responses. These have a strong impact on patient treatment as well as therapist training. Patients may bring to this process their difficulty establishing a working alliance, use of primitive ego defenses, and ambivalence about closeness. Therapists may bring their identification with patients, lack of professional identity, and limited development of introspective capacity. Supervisors, therefore, need to maintain an awareness of the unique needs of inexperienced therapists, and pay careful attention to the parallel process as a reflection of the therapist's identification with patient, facilitate a teaching-learning alliance which meets the student's needs both for praise from and emulation of a powerful therapeutic role model, grant permission for countertransferential feelings, and finally acknowledge joint responsibility between patient and therapist for such responses.

UI MeSH Term Description Entries
D007397 Internship, Nonmedical Advanced programs of training to meet certain professional requirements in fields other than medicine or dentistry, e.g., pharmacology, nutrition, nursing, etc. Residency, Nonmedical,Internship, Non-Medical,Internships, Non-Medical,Internships, Nonmedical,Non-Medical Internship,Non-Medical Internships,Nonmedical Internship,Nonmedical Internships,Nonmedical Residencies,Nonmedical Residency,Residencies, Non-Medical,Residencies, Nonmedical,Residency, Non-Medical,Internship, Non Medical,Internships, Non Medical,Non Medical Internship,Non Medical Internships,Non-Medical Residencies,Non-Medical Residency,Residencies, Non Medical,Residency, Non Medical
D009289 Narcissism A psychoanalytic term meaning self-love. Narcissisms
D011369 Professional-Patient Relations Interactions between health personnel and patients. Contacting Clients,Pharmacist-Patient Relations,Professional Patient Relationship,Client, Contacting,Clients, Contacting,Contacting Client,Pharmacist Patient Relations,Pharmacist-Patient Relation,Professional Patient Relations,Professional Patient Relationships,Professional-Patient Relation,Relation, Pharmacist-Patient,Relation, Professional-Patient,Relations, Pharmacist-Patient,Relations, Professional-Patient,Relationship, Professional Patient,Relationships, Professional Patient
D011613 Psychotherapy A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. Psychotherapies
D011618 Psychotic Disorders Disorders in which there is a loss of ego boundaries or a gross impairment in reality testing with delusions or prominent hallucinations. (From DSM-IV, 1994) Psychoses,Psychosis, Brief Reactive,Schizoaffective Disorder,Schizophreniform Disorders,Psychosis,Brief Reactive Psychoses,Brief Reactive Psychosis,Disorder, Psychotic,Disorder, Schizoaffective,Disorder, Schizophreniform,Disorders, Psychotic,Disorders, Schizoaffective,Disorders, Schizophreniform,Psychoses, Brief Reactive,Psychotic Disorder,Reactive Psychoses, Brief,Reactive Psychosis, Brief,Schizoaffective Disorders,Schizophreniform Disorder
D001883 Borderline Personality Disorder A personality disorder marked by a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. (DSM-IV) Personality Disorder, Borderline,Disorder, Borderline Personality,Borderline Personality Disorders,Disorders, Borderline Personality,Personality Disorders, Borderline
D003379 Countertransference Conscious or unconscious emotional reaction of the therapist to the patient which may interfere with treatment. (APA, Thesaurus of Psychological Index Terms, 8th ed.) Countertransference, Psychology
D003674 Defense Mechanisms Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. Mechanisms, Defense
D004532 Ego The conscious portion of the personality structure which serves to mediate between the demands of the primitive instinctual drives, (the id), of internalized parental and social prohibitions or the conscience, (the superego), and of reality. Self,Egos
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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