Assault on the therapist.

The authors conducted a questionnaire survey among psychotherapists in psychiatry, psychology and social work to determine how many patients posed a threat to others or to the therapist and how many actually assaulted the therapist. They found that 9.2% of all patients seen by 101 therapists in one year presented a threat to others, 1.9% posed a physical threat to the therapist, and .63% actually assaulted the therapist. The authors conclude that attacks on a therapist are infrequent but almost inevitable and suggest the development of techniques for coping with assaultive patients that therapists can use in crisis situations.

Separation anxiety in panic disorder.

OBJECTIVE: A number of researchers have provided evidence that separation anxiety is an important antecedent or current affect in panic disorder. The objective of this pilot study was to test this hypothesis by comparing dreams, screen memories, and life situations of panic disorder patients with those of comparison patients. METHOD: A recent dream with associations, screen memories with associations, and life situations at onset of symptoms were recorded verbatim during semistructured interviews with 20 patients with DSM-III-R panic disorder and 20 comparison subjects upon referral to a private outpatient practice. A judge blind to the diagnoses rated each of the dreams, screen memories, and life situations separately on each of the 10 Gottschalk-Gleser Content Analysis Scales, thereby measuring manifest and latent death, mutilation, separation, guilt, and shame anxiety and overt and covert hostility in each group. RESULTS: mean separation anxiety scores were significantly higher in both the dreams and screen memories of the panic disorder patients than in the comparison patients. Mean scores for covert hostility directed outward were significantly higher in the dreams of the panic disorder patients than in the comparison patients. CONCLUSIONS: The hypothesis that separation anxiety is a prevalent affective undercurrent in the dreams and screen memories of panic disorder patients was supported. Significantly higher covert hostility in the panic disorder patients' dreams may support Bowlby's observation that people with high separation anxiety tend to disavow their anger.

Empathy and outcome in brief focal dynamic therapy.

In an attempt to test the hypothesis that therapist empathy is an important variable in successful dynamic therapy, the authors collected outcome measures and empathy ratings in the brief focal dynamic therapy of 59 patients. There was no significant agreement among patients, therapists, and clinical supervisors when they used the same scale to rate therapist empathy for the same sessions. Only the patients' ratings correlated significantly with some of the outcome measures, and they added modest but statistically significant predictive variance on multiple regression analysis. The authors discuss the implications of these findings for the traditional mode of supervision of dynamic therapy.

Therapist envy.

The vicissitudes of envy comprise some of the most powerful relationships between people. Originally viewed as a character trait, envy is now viewed as occurring in two-person interpersonal interactions. The therapeutic situation is therefore an ideal context in which to examine envy on the part of both therapist and patient. Envy is an intense affect, inhibiting effective behavior, and it may damage the therapeutic relationship in ways not easily recognized by therapist and patient.

Impact of psychosocial factors on the conduct of combined drug and psychotherapy research.

The effect of attitudes of therapists, patients and researchers on the conduct and outcome of combined drug and psychotherapy research was examined in a brief crisis-oriented psychotherapy clinic. Seventy-seven consecutive patients were given one of two anti-anxiety drugs or a placebo in conjunction with the typical psychoanalytically-oriented treatment used in the clinic. The therapists' attitudes favouring psychotherapy over drug therapy (and psychotherapy research) were clearly conveyed to the patients. Indicative of this are the following: (a) 82 per cent of the patients dropped out of drug taking, although a similar percentage remained in treatment; (b) only a third of the patients perceived it as being important to their therapists that they should take medication; (c) 87 per cent of the patients were rated as improved; and 75 per cent of patients completing forms considered that most or all of their improvement was attributable to talking. The research team, made up of members of the same department who therefore had similar values as the therapists, diligently collected outcome data, but ignored its responsibility to enforce drug-relation portions of the protocol. Overall, patients remained in therapy, improved and participated in completing forms, so that only the research goals of combined therapy were thwarted, while traditional clinic service and training goals proceeded as usual.