RESUMO
The authors report a series of flashbacks of a combat patient's experience 18 years earlier. The flashback episodes occurred immediately after the patient's humiliating job loss. The man had no symptoms of delayed stress and no history of drug or alcohol abuse. The wartime memory served an obvious screening function by diminishing the impact of the patient's narcissistic injury just preceding the onset of the flashback sequence. The flashbacks also screened childhood and adolescent conflicts activated by the job loss.
Assuntos
Distúrbios de Guerra/psicologia , Rememoração Mental , Adulto , Distúrbios de Guerra/terapia , Hospitalização , Humanos , Masculino , Estresse Psicológico/complicações , DesempregoRESUMO
A clinical investigation of nightmares enhanced the psychotherapy of many hospitalized borderline patients. Early familial trauma, prominent in the latent content of the nightmares, predisposed these patients to adult dysfunction or to a maladaptive response to subsequent trauma. The hospital ward's emphasis on intergenerational family therapy and the well-integrated holding environment helped offset distress in patients resulting from the upsurgence of conflictual material latent in their nightmares, whether or not they were posttraumatic. The authors present illustrative cases.
Assuntos
Transtorno da Personalidade Borderline/psicologia , Sonhos , Hospitalização , Interpretação Psicanalítica , Terapia Psicanalítica/métodos , Adulto , Transtorno da Personalidade Borderline/terapia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A psychiatric inpatient unit with expertise in family treatment has developed an integrated effort to provide a one to three month treatment program for hospitalized borderline patients. Treatment goals are more ambitious than those obtainable by simple crisis intervention. Appreciation of staff splitting is enhanced by an intergenerational family systems approach. Early and sustained focus on splitting is aided by the use of a 15 minute educational tape and a weekly therapy group required for all nonpsychotic patients and recommended for their families. Cases illustrating the family perspective and a group therapy session are presented in detail. The therapy group, run by an interdisciplinary team (the authors) requires active staff initiative and confrontation to avoid responsibility-evading patient coalitions. Diagnostic considerations and impact of the program on patients and on staff are discussed.
