Psychiatry-Interpersonal and Biological Processes最新文献

{"title":"A Naturalistic Study of Time to Recovery in Adults with Treatment-refractory Disorders.","authors":"J Christopher Perry,&nbsp;J Christopher Fowler","doi":"10.1080/00332747.2021.1907869","DOIUrl":"https://doi.org/10.1080/00332747.2021.1907869","url":null,"abstract":"<p><p><i>Objectives</i>: Individuals with treatment-refractory disorders have high comorbidity. There is little information on whether recovery is possible and how long it might require. We focused on the individual's recovery using a broad measure of psychopathology, regardless of the variety of disorders present.<i>Methods</i>: We recruited 226 adults [mean age 31.0, SD = 10.3; 75.2% female] entering residential treatment for treatment-refractory disorders to delineate their course and outcome. Individuals received periodic Longitudinal Interval Follow-along Evaluation interviews for symptoms and functioning variables for up to 14 years. Periodic psychodynamic and relationship vignette interviews were rated with the Psychodynamic Conflict Rating Scales (PCRS) for a subgroup of 54 subjects. Outcome variables included modeled rates of change, final scores, time to recovery, and time to attaining healthy adaptive functioning, using Kaplan-Meier estimates from time-to-event analyses.<i>Results</i>: Recovery of PCRS Pathological Functioning occurred in 12 (22%) of 54 subjects rated: median time-to-recovery = 11.63 years (CI: 9.64- upper number not calculable). Eight (14.81%) subjects also developed healthy adaptive functioning, with the time-to-attainment for the first quartile at 10.95 years (CI: 7.87 - upper bound not calculable). Recovery from psychopathology was significantly associated with a median percentage recovered in the domains of symptoms (64.29%), functioning (87.50%), and psychodynamic functioning (50%). Although attaining healthy adaptive functioning was less common, it was highly associated with already achieving recovery from dynamic psychopathology, [OR = 57.40, CI 5.80 - 567.83, <i>p</i> = .0001].<i>Conclusions</i>: These results provided convergent validation of recovery in psychodynamic psychopathology. Some recovered individuals also attained healthy adaptive functioning, which took somewhat longer.</p>","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 3","pages":"260-275"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2021.1907869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39274331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empathy in Psychotherapy: What Is It and What Else Do We Need?","authors":"Edward K Silberman","doi":"10.1080/00332747.2021.1958566","DOIUrl":"https://doi.org/10.1080/00332747.2021.1958566","url":null,"abstract":"In their 1949 paper, “The Empathic Responses” (Cottrell & Dymond, 1949) the authors call attention to empathy as a neglected concept in psychiatry and highlight the work of Harry Stack Sullivan as seminal to understanding its proper place. Empathy has long had a checkered career in psychiatry and psychotherapy, having been looked upon as largely irrelevant in some schools (Havens, 1973) and centrally essential in others (Rogers, 1957). Psychiatry’s struggles with empathy begin with the difficulty of agreeing about the meaning of the concept (Batson, 2009). A dictionary definition of empathy as “The ability to understand and share the feelings of another” (Oxford Languages) provides as good a general orientation as any to the term. This essay attempts to clarify some of the complexities of empathy in psychotherapy, leaving aside its more general social, philosophical, and moral implications. For more general discussions, an excellent review by Elliott et al. (2011) deals with research on empathy in psychotherapy and one by Steuber (2018) with philosophical and social aspects of empathy. EMPATHIC UNDERSTANDING","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 3","pages":"214-219"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39555804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Internalization of a Representation of the Therapist as an Element in Psychotherapeutic Gain.","authors":"Milton Viederman","doi":"10.1080/00332747.2020.1843325","DOIUrl":"https://doi.org/10.1080/00332747.2020.1843325","url":null,"abstract":"<p><p>This paper illustrates the beneficial effect of a positive benevolent transference in the development of an internalized representation of the therapist/analyst in a variety of patients in psychodynamic treatments ranging from consultation to psychoanalysis itself. This is described in patient presentations. In those who have had substantial early nurturant life experience and now find themselves in a dysphoric state due to crisis, the effect lies in the transference reactivation of these positive object relations that relieve their distress. In those who have been deprived of such early experience, the positive transference may emerge during the intensive work of psychoanalysis and may lead to the internalization of a new positive object representation of the analyst generated in the transference that persists after termination of treatment. In both of these situations, the patient discovers a sense of greater harmony with self and the world. The special conditions that permit and facilitate this process are described since this does not occur in all psychodynamic interventions.</p>","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 1","pages":"46-56"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2020.1843325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38322779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five Principles in Context: We Have Been Blind to Ecological Principles and Politics.","authors":"Stevan E Hobfoll","doi":"10.1080/00332747.2021.2005421","DOIUrl":"https://doi.org/10.1080/00332747.2021.2005421","url":null,"abstract":"In our 2007 article, Hobfoll, Watson and colleagues advanced a theoretical overview of the empirical evidence supporting immediate and mid-term mass trauma intervention in our paper, ‘Five essential elements of immediate and mid-term mass trauma intervention’ (Hobfoll et al., 2007). Perhaps because the evidence of anything resembling clinical trials was nearly non-existent, the authors chose another direction of logic. Specifically, we identified five essential elements that studies had found critical in predicting favorable outcomes in situations of mass casualty ranging from war, to terrorist attack, to mass shootings, and disasters. There was strong support for interventions to promote (1) a sense of safety, (2) calming, (3) a sense of selfand community efficacy, (4) connectedness, and (5) hope as naturalistic studies found these to be tied to more positive outcomes including lower levels of PTSD and depression, lower levels of physical, post-traumtic distress, traumatic growth, and functional adjustment. Further, these associations were tied to better outcomes on the individual, familial, and community levels of analyses. The impact of the five principles, as they have become known, has been remarkable. At the date of this writing, the paper has been cited 1319 times, according to Google Scholar (6-21-21). Perhaps more to the point of its importance, the five principles were used as a framework during the COVID-19 pandemic by hundreds of websites, including government authorities, NGOs, and psychosocial support organizations around the world. These included, guiding managing the stress related to the COVID-19 pandemic on the national level by the National Center for PTSD (2020), the Indian Council of Medical Research for patients and families with COVID-19 (2021) and New Zealand Red Cross (2020), as exemplars; supporting the well-being of the school community (National Educational Psychological Services, 2020), supporting children and adolescents during the COVID-19 Pandemic (Brymer, 2020) returning to school (Moore, 2020; Oxfordshire Schools, 2021), support for medical staff (Nadler et al., 2020). Literally, thousands of websites were informed by and credited the five principles as foundational in their strategy to COVID-19. At this juncture, rather than reveling in the clear success and contribution of the five principles paper, it is time to step back and assess where we were less successful, and where we might more humbly admit we have","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 4","pages":"347-350"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39935936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Principles of Psychological First Aid: Core Elements of Disaster Care, COVID-19 Pandemic Care and Supportive Psychotherapy.","authors":"Robert J Ursano","doi":"10.1080/00332747.2021.2005379","DOIUrl":"https://doi.org/10.1080/00332747.2021.2005379","url":null,"abstract":"Psychological care in times of disaster has changed substantially in the past 20 years. In acute care, Psychological First Aid (PFA), published by Hobfoll et al. in 2007 in PSYCHIATRY, now forms the core of early postdisaster response. These same principles are fundamental to nearly all supportive psychotherapy. Importantly now, during the COVID-19 pandemic, PFA is the core of mental health-care delivery for individuals, organizations, and communities. Recognizing the importance of PFA in the present and future, we are republishing the article, “Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence.” (Hobfoll et al., 2007) and updating it with commentaries by Stevan Hobfoll and many of the coauthors of the original article and other leaders in the field of disaster and crisis mental health care. Many of the eleven commentaries are written through the lens of the COVID-19 pandemic. The original paper outlined the five key principles that came to be known as Psychological First Aid (PFA): 1) establishing and promoting a sense of safety; 2) calming; 3) connectedness; 4) a sense of self and community efficacy (the belief and skills to enable “I/ we can do it”); and 5) hope/optimism. Today, the principles of PFA are widely implemented in post-disaster interventions. The principles of PFA can be easily taught and applied by a range of disaster workers and community members. PFA has been adopted for delivery in diverse settings for direct victims and for “first responders.” First responders in the COVID-19 pandemic include our health-care delivery teams from physicians and nurses to those who keep the hospitals’ communities running by working in the cafeteria, in housekeeping, and in communication systems; and those who keep our communities together, spanning from food delivery to schools. The principles of PFA have been applied in many settings including hospital ICUs, acute care facilities (emergency departments), nursing homes, respite centers for first responders, crisis hotlines, family reception and assistance centers, homes, businesses, schools, evacuation centers, and other community settings. What do we learn from these commentaries that adds to PFA? First, the COVID-19 pandemic highlights the changes over time and across geography – and the need to respond as new “hot spots of crisis and trauma” emerge. Similarly, the COVID-19 pandemic has brought attention to new groups to consider for care – such as long-term care facilities, ICUs, schools, and meat packing plants. The important and complex role of information and misinformation is now clearer as we see the challenges in the ability to manage","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 4","pages":"309-310"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39935941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"P\" in Parenting is for Positive: A Conversation with Matthew R. Sanders, Ph.D.","authors":"Stephen J Cozza","doi":"10.1080/00332747.2021.1924567","DOIUrl":"https://doi.org/10.1080/00332747.2021.1924567","url":null,"abstract":"In her 1947 paper, The Role of the Parent in Psychotherapy with Children, Hilde Bruch outlined the challenges experienced by psychiatrists when dealing with parents of children being treated in psychotherapy. “[The] problem of how to handle the parent has been recognized as a serious difficulty since psychotherapy was first extended to the treatment of children.” Bruch described the shift in thinking that was taking place at that time. Although parents were seen less as willful contributors to the problems of their children and more as adults within the lives of children who were affected by their own psychopathology, the prevailing sentiment was that engaging parents within the context of a child’s treatment would contaminate the work and strangle any opportunity for therapeutic success. As a result, parents were often referred to their own separate, individual treatments in order to better address the problems that were believed to be compromising the lives of their children. In her paper, Bruch described her attempts to directly address parental issues in the context of treating their children. Her descriptions of the challenges she encountered are remarkably familiar 75 years later. She described the shame that parents carry for their children’s problems, the competitiveness they might have with the psychiatrist working with their children, and most relevant to today given contemporary parents’ access to multiple sources of information on the Internet, the challenges of dealing with the parent who comes armed with information about “modern psychology.” At the time that Bruch wrote her paper, psychotherapeutic work with parents was often done grudgingly by therapists who treated children. Parents were generally assumed to be unable to be instructed how best to help their children because challenges to their parenting were seen as stemming from their own psychological and personality conflicts. Over time, there has been a shift in clinicians’ thinking that more accurately acknowledges the positive effects parenting can have on the healthy development of children. Parenting practices that are empathetic and supportive, and that foster a sense of safety and optimism in children have been shown to result in healthy child development (Collins et al., 2000), as they promote self-regulatory skills and the capacity to be resilient in the face of adversities (Odgers et al., 2012). Positive parenting is described as authoritative, rather than autocratic, and employs empathic discipline and clear and effective communication with children. Positive parenting is currently recognized as one of the most critical components to child health and wellbeing across the","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 2","pages":"121-126"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2021.1924567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39209067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Therapeutic Alliance in Children and Parents.","authors":"Amy M Ursano","doi":"10.1080/00332747.2021.1932393","DOIUrl":"https://doi.org/10.1080/00332747.2021.1932393","url":null,"abstract":"Hilde Bruch, the German-born American pediatrician, psychiatrist, and psychoanalyst, was born in 1904, the third of seven children. Originally planning to be a mathematician, she was convinced by her uncle, who sponsored her education after her father’s death, that medicine was a more practical career choice for a Jewish woman at the time. Receiving her medical degree from the University of Freiberg in 1929, Bruch completed research and training in pediatrics. Ultimately, the rise of antisemitism led Bruch to leave Germany for England in 1933 and then shortly thereafter for the United States. After obtaining her pediatric license in 1935, she sought further study in psychiatry at Johns Hopkins and underwent psychoanalytic training with Henry Stack Sullivan and Frieda FrommReichmann. Hilde Bruch helped rescue her mother and many of her siblings from Nazi Germany, but many of her relatives died there. In 1946, Dr. Bruch adopted her then 13-year -old orphaned nephew. Teaching at Columbia University and later Baylor College of Medicine, Bruch published in the areas of schizophrenia, psychotherapy training, and obesity. She was widely known for her work on eating disorders and obesity. Growing up, Bruch was known as das Dicka – the fat one. In her work with obese children, Bruch “demonstrated that some children . . . were obese because their mothers had overfed and overprotected them.” (Silverthorne & Fulgham, 1997) Her assertion that childhood obesity can have psychological underpinnings ran counter to the medical model of the time. Known as an independent thinker and proliferative writer, Hilde Bruch received many awards for her clinical and written contributions to American psychiatry. Originally printed in Psychiatry, in 1947, Bruch’s “The Role of Parent in Psychotherapy with Children” offers a remarkably enduring perspective on the challenges and rewards of working with parents and children in therapy. Bruch’s writing traces the history of this challenge in child therapy as well as various models of management. She explores many components of the therapeutic or working alliance – the evolution of roles, expectations and attitudes of the parent and clinician – along their shared journey in the treatment of the child. In general, for a patient to trust and work closely with a clinician, it is essential that there be a reality-based relationship outside the conflicted ones for which the patient is seeking help (Friedman, 1969; Rawn, 1991) This working alliance includes both cognitive and affective components. “The working alliance is positively associated with patient adherence, satisfaction, and improved patient","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 2","pages":"127-130"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2021.1932393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39209072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate and Severe Fragility: An ISTDP Webinar.","authors":"Janet R Merkel","doi":"10.1080/00332747.2021.1890973","DOIUrl":"https://doi.org/10.1080/00332747.2021.1890973","url":null,"abstract":"On July 18, 2020 Jon Frederickson (2020) presented a webinar on Moderate and Severe Fragility to the Intensive Shortterm Dynamic Therapy (ISTDP) community. The day preceded the up-coming publication (December 15) of his new book Co-Creating Safety: Healing the Fragile Patient. Frederickson presented a patient who was very fragile at the beginning of therapy and was on several anti-psychotic medications. The patient had years of previous therapies. During the trial therapy, the patient did not have a psychotic level of character structure but rather was very fragile. Patients with fragile character structure have trouble tolerating the anxiety that mixed feelings generate and so they rely on primitive defenses such as splitting, projection and projective identification. Because the patient was assessed as a fragile patient, Frederickson began what is known in Intensive Short-term Dynamic Therapy (ISTDP) as a graded approach. This approach uses techniques such as pressure to feeling, that is, raising the unconscious to consciousness, while regulating anxiety. The graded approach applies these techniques in a careful and gradual way so that that patient can build ego capacity while not being overwhelmed with anxiety. “Since fragile patients have such a low level of anxiety regulation and affect tolerance, we must tailor our techniques to their capacity” (Frederickson, 2013, p. 124). Patients with fragile character structure need a way of working that helps build inner self awareness and capacity so that the patient does not use splitting and prjection as means to ward off complex mixed feelings. In fragile patients the process of splitting and projection work together to ward off mixed feelings of love and rage. As mixed feelings arise, anxiety rises usually in the form of cognitive/perceptual disruption such as dissociation, confusion, visual blurring, dizziness, or ringing in the ears. Splitting works to separate the feelings of love and rage with the patient embracing the love and rejecting the feeling of rage. Then the disavowed feeling of rage is projected outward which functions to lower anxiety. In fragile patients this process of splitting and projection is unconscious but consequently very disruptive in personal and professional relationships. The aim in therapy is to help the patient be able to observe, acknowledge and bear previously avoided feelings. As the patient is able to bear these mixed feelings, splitting and projection are no longer needed to lower anxiety. The patient experiences the relief of being able to embrace and accept all feelings. The workshop participants were able to witness the slow but steady progress of the therapy during a number of sessions with the patient. The technique of bracing was demonstrated. This is the application of a consistent mild pressure to feeling while watching for and regulating anxiety. In his 2015 book, Reaching Through Resistance, Allan Abbass introduced the concept of bracing which involves","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 1","pages":"99-100"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2021.1890973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25586796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Race and Racism and Its Impact on Professionals and Communities in the DMV.","authors":"Jonathan Lebolt","doi":"10.1080/00332747.2021.1889324","DOIUrl":"https://doi.org/10.1080/00332747.2021.1889324","url":null,"abstract":"","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 1","pages":"101-102"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2021.1889324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25586797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On Caring in Psychiatry.","authors":"Richard J Loewenstein","doi":"10.1080/00332747.2021.1889316","DOIUrl":"https://doi.org/10.1080/00332747.2021.1889316","url":null,"abstract":"Otto Allen Will, M.D. has a distinctive voice. When asked to write a commentary on his talk: “On Caring in Psychiatry”(Will, 1979), I found chapters he had written (Will, 1980, 1987), a long interview, actually a counterpoint to this talk (Thompson & Thompson, 1998) and a biographical history of Harry Stack Sullivan and Otto Allen Will, Jr. and their work and ideas (Cornett, 2017). Cornett’s descriptions of Will Jr. and his work, and his voice in talking with colleagues, trainees, patients and analysands fits this talk, and the style of Will Jr’s written work. Cornett (2017) reports that Will Jr. openly said that including autobiographical elements in his writings and lectures helped give him more of a sense of coherence about himself and his life. It is not simple or easy to write a “commentary” on Otto Will Jr.’s ideas. He travels many paths, then diverges in different directions in the forests of his words. Then, onto another path, that ties back to what he said some minutes before, and then sidelong to another one. Themes come forward, some are left hanging, some not to be fully connected, others connected again later. This piece is more symphonic and poetic than didactic. Otto Will’s voice is conversational and without jargon, but this is a serious, but not selfimportant, conversation. His style is one of openness about his own life, and about how he developed as a clinician. He has a basic optimism, but one that is tempered by realism about our world, the complexity of human life and love, and his awareness of the dangers, and particularly, the uncertainties the world presents. His descriptions of the chaotic and frightening political, social and climatological challenges could have been written today. Will Jr. reflects on his life and his life as a therapist, and what he learned about himself, people, the world, attachment, communication, connection, disconnection, failure of communication, loneliness, shame, sorrow, loss and grieving. He communicates his personal experience of the seemingly odd profession in which he has found himself or chosen to wander within: psychotherapist to what he calls “schizophrenia”. Thus, as Will works his way through his ideas about the nature of caring, let alone love, in the psychotherapeutic relationship, the basic underlying idea is that caring means seeing the patient as a whole, real person, with all the complexity that entails; and not romanticizing the patient, the therapist or the therapeutic relationship. As therapists, we tend to think about “caring” in terms of empathy, compassion and dedication to the patient's well-being; the word “love” worries us because of its association with romantic and sexual attachment, and, thus, violation of treatment boundaries. However, these words have many other meanings: one can care for one's shoes; one’s pets; take care to paint the door neatly;","PeriodicalId":49656,"journal":{"name":"Psychiatry-Interpersonal and Biological Processes","volume":"84 1","pages":"21-32"},"PeriodicalIF":2.4,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00332747.2021.1889316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25586801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}