Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Emotional Distress. Show all posts
Showing posts with label Emotional Distress. Show all posts

Sunday, May 12, 2019

Looking at the Mueller report from a mental health perspective

 Bandy X. Lee, Leonard L. Glass and Edwin B. Fisher
The Boston Globe
Updated May 9, 2019

Here is an excerpt:

These episodes demonstrate not only a lack of control over emotions but preoccupation with threats to the self. There is no room for consideration of national plans or policies, or his own role in bringing about his predicament and how he might change, but instead a singular focus on how he is a victim of circumstance and his familiar whining about unfairness.

This mindset can easily turn into rage reactions; it is commonly found in violent offenders in the criminal justice system, who perpetually consider themselves victims under attack, even as they perpetrate violence against others, often without provocation. In this manner, a “victim mentality” and paranoia are symptoms that carry a high risk of violence.

“We noted, among other things, that the president stated on more than 30 occasions that he ‘does not recall’ or ‘remember’ or have an ‘independent recollection’ of information called for by the questions. Other answers were ‘incomplete or imprecise.’ ” (Vol. II, p. C-1)

This response is from a president who, in public rallies, rarely lacks certainty, no matter how false his assertions and claims that he has “the world’s greatest memory” and “one of the great memories of all time.” His lack of recall is particularly meaningful in the context of his unprecedented mendacity, which alone is dangerous and divisive for the country. Whether he truly does not remember or is totally fabricating, either is pathological and highly dangerous in someone who has command over the largest military in the world and over thousands of nuclear weapons.

The Mueller report details numerous lies by the president, perhaps most clearly regarding his handling of the disclosure of the meeting at Trump Tower (Vol II, p. 98ff). First he denied knowing about the meeting, then described it as only about adoption, then denied crafting his son’s response, and then, in his formal response to Mueller, conceded that it was he who dictated the press release. Lying per se is not especially remarkable. Coupled with the other characteristics noted here, however, lying becomes a part of a pervasive, compelling, reflexive pattern of distraught gut reactions for handling challenges by misleading, manipulating, and blocking others’ access to the truth. Rather than being seen as bona fide alternatives, challenges are perceived as personal threats and responded to in a dangerous, no-holds-barred manner.

The info is here.

Wednesday, January 24, 2018

Top 10 lies doctors tell themselves

Pamela Wible
www.idealmedicalcare.org
Originally published December 27, 2017

Here is an excerpt:

Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.

Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.

The interview is here.

Thursday, May 28, 2015

Tarasoff's catch-22.

By Stephen R. Huey
The American Psychologist
2015 Apr;70(3):284-5. doi: 10.1037/a0039064

Abstract

Comments on the article by D. N. Bersoff (see record 2014-28692-002). Bersoff poses a much-needed challenge to the rationale of laws based on Tarasoff v. Regents of the University of California (1976), which exist in most states and require therapists to warn the intended victim, police, and/or others when a patient voices serious threats of violence. If Tarasoff-related laws were ever to be modified, research support would be required. To begin with, what is the experience of other countries that happen to address this issue differently and of the seven states that, according to Bersoff, have not adopted Tarasoff-related requirements? Another question is whether patients who are unwilling to invite the consequences of therapist disclosure ever reveal reportable intentions to their therapists anyway-say, by mistake or impulse-thus making current law marginally useful? Rules that undercut sacrosanct confidentiality create a catch-22 in which the indisputable ethical necessity of informed consent has an unintended consequence- namely, therapy is preceded by informed consent but precluded by it.

The entire article is here.

Tuesday, November 4, 2014

Doctors Tell All—and It’s Bad

By Meghan O'Rourke
The Atlantic
Originally published October 14, 2014

Here is an excerpt:

But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.

The entire article is here.

Wednesday, September 4, 2013

The Contribution of the Quality of Therapists' Personal Lives to the Development of the Working Alliance

By Helene A. Nissen-Lie, Odd E. Havik, Per A. Hoglend, Jon T. Monsen, and Michael Helge Ronnestad
Journal of Counseling Psychology. 2013 Aug 19

Abstract

Research suggests that the person of the psychotherapist is important for the process and outcome of psychotherapy, but little is known about the relationship between therapists' personal experiences and the quality of their therapeutic work. This study investigates 2 factors (Personal Satisfactions and Personal Burdens) reflecting therapists' quality of life that emerged from the self-reports of a large international sample of psychotherapists (N = 4,828) (Orlinsky & Rønnestad, 2004, 2005) using the Quality of Personal Life scales of the Development of Psychotherapists Common Core Questionnaire (Orlinsky et al., 1999). These factors were investigated as predictors of alliance levels and growth (using the Working Alliance Inventory) rated by both patients and therapists in a large (227 patients and 70 therapists) naturalistic outpatient psychotherapy study (Havik et al., 1995). The Personal Burdens scale was strongly and inversely related to the growth of the alliance as rated by the patients, but was unrelated to therapist-rated alliance. Conversely, the factor scale of therapists' Personal Satisfactions was clearly and positively associated with therapist-rated alliance growth, but was unrelated to the patients' ratings of the alliance. The findings suggest that the working alliance is influenced by therapists' quality of life, but in divergent ways when rated by patients or by therapists. It seems that patients are particularly sensitive to their therapists' private life experience of distress, which presumably is communicated through the therapists' in-session behaviors, whereas the therapists' judgments of alliance quality were positively biased by their own sense of personal well-being.

Introduction

The notion that the psychotherapist as an individual is important for psychotherapeutic outcomes stems in part from the well-known and frequently cited finding of meta-analyses that therapy outcome appears to be less related to the use of different therapy methods associated with established schools of therapy, and significantly related to differences between the individual psychotherapists providing the therapy (Benish, Imel, & Wampold, 2008; Blatt, Zuroff, Quinlan, & Pilkonis, 1996; Huppert et al., 2001; Kim, Wampold, & Bolt, 2006). Moreover, in efforts to identify the characteristics in therapists that promote treatment success or failure, the studies to date suggest that experience level, type of training, theoretical orientation, and so forth have limited value in distinguishing between more or less successful therapists (Beutler et al., 2004; Dunkle & Friedlander, 1996; Sandell et al., 2007; Skovholt & Jennings, 2004; Strupp & Hadley, 1977). Instead, therapists' interpersonal qualities appear to be more relevant, such as their facilitative interpersonal skills (Anderson, Ogles, Pattersen, Lambert, & Vermeersch, 2009); their ability to be affirmative, responsive, and empathic (Bohart, Elliott, Greenberg, & Watson, 2002; Najavits & Strupp, 1994); their ability to resist counteraggression when confronted with devaluation and rejections by patients (von der Lippe, Monsen, Ronnestad, & Eilertsen, 2008); and their interpersonal functioning in their personal lives (Dunkle & Friedlander, 1996; Hersoug, Hoglend, Havik, von der Lippe, & Monsen, 2009b). Hence, although therapists are professional helpers, it may be that their personal characteristics are more important than their professional qualifications in determining their therapeutic capabilities. This suggestion echoes the statements of Rosenzweig (1936), Strupp (1958), and Rogers (1957, 1961), who emphasized that studying the personal characteristics of psychotherapists is necessary in order to understand patient development in psychotherapy.

Thanks to Ken Pope for this information.

Thursday, November 8, 2012

Suit filed against Capitola psychologist for allegedly sexually abusing a child patient

By Jessica M. Pasko
The Santa Cruz Sentinel
Originally published October 23, 2012

A civil lawsuit has been filed against a Capitola psychologist who is facing criminal charges of sexual abuse against a child.

Dr. John William Visher was arrested last month at his La Selva Beach home after Capitola police investigated allegations that he committed lewd acts against an 8-year-old girl. The girl had been his patient and detectives believe the incidents occurred at Visher's former Bay Avenue office in 2009.

Last week, the girl's family filed a personal injury suit against Visher in the civil divisions of Santa Cruz County Court. It charges him with sexual harassment, professional negligence and intentional infliction of emotional distress, and seeks unspecified damages.

Visher pleaded not guilty on Oct. 9 to five felony charges that include lewd acts upon a child, sending obscene material and possession of material depicting a minor engaging in sexual conduct. He is due back in court Nov. 14.

The entire story is here.