Positive psychology in health care: defining key stakeholders and their roles.

Lifestyle-related diseases have common risk factors: physical inactivity, poor diet, inadequate sleep, high stress, substance use, and social isolation. Evidence is mounting for the benefits of incorporating effective methods that promote healthy lifestyle habits into routine health care treatments. Research has established that healthy habits foster psychological and physiological health and that emotional well-being is central to achieving total well-being. The Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine aims to raise awareness about strategies for prioritizing emotional well-being. The Committee advocates for collaborative translational research to adapt the positive psychology and behavioral medicine evidence base into methodologies that address emotional well-being in nonmental health care settings. Another aim is to promote health system changes that integrate evidence-based positive-psychology interventions into health maintenance and treatment plans. Also, the Committee seeks to ameliorate health provider burnout through the application of positive psychology methods for providers' personal health. The American College of Lifestyle Medicine and Dell Medical School held an inaugural Summit on Happiness Science in Health Care in May 2018. The Summit participants recommended research, policy, and practice innovations to promote total well-being via lifestyle changes that bolster emotional well-being. These recommendations urge stakeholder collaboration to facilitate translational research for health care settings and to standardize terms, measures, and clinical approaches for implementing positive psychology interventions. Sample aims of joint collaboration include developing evidence-based, practical, low-cost behavioral and emotional assessment and monitoring tools; grants to encourage dissemination of pilot initiatives; medical record dashboards with emotional well-being and related aspects of mental health as vital signs; clinical best practices for health care teams; and automated behavioral programs to extend clinician time. However, a few simple steps for prioritizing emotional well-being can be implemented by stakeholders in the near-term.

Depressive rumination in an analysand after a traumatic treatment.

The author attempts to understand the underpinnings of a ruminative depression that occurred in a patient after a troubled first analysis. Negative therapeutic reaction is often assumed to be the result of a patient's unconscious guilt or masochism and thus an intrapsychic phenomenon, but the author asserts that iatrogenic phenomena in the form of persistent misunderstandings and enactments that remain unanalyzed contribute to a destructive treatment experience. The analysand may relive the failed treatment again and again in his or her mind in an attempt to resolve it. The author asserts that a traumatic treatment experience can foster depressive rumination.

What's in a name: what analyst and patient call each other.

Awkward moments often arise between patient and analyst involving the question, "What do we call each other?" The manner in which the dyad address each other contains material central to the patient's inner life. Names, like dreams, deserve a privileged status as providing a royal road into the paradoxical analytic relationship and the unconscious conflicts that feed it. Whether an analyst addresses the patient formally, informally, or not at all, awareness of the issues surrounding names is important.

Silent thoughts, spoken wishes: when candidate experience of the supervisor converges with patient fantasies.

How and why a candidate's private experience of two supervisors emerged in patients' fantasies about them is explored. Four issues are examined in light of two control cases: (1) Patients divide, rather than split, the transference between supervisor and candidate, experiencing both ambivalently. (2) Even a patient with no knowledge of the supervisor's identity may have a fantasy of the supervisor that is congruent with the candidate's experience of the supervisor. (3) When new professional traits emerge in the candidate as he or she identifies with his or her mentor, the patient may attribute them to the invisible person in the room--the supervisor; the patient may intuit and be influenced by the candidate's feelings about the supervisor as well. (4) A patient's fantasies about the supervisor may reflect parallel process in reverse, whereby the patient discerns what is going on between supervisor and candidate through his or her treatment, just as the supervisor reads what is going on between patient and candidate through the candidate's reporting of the treatment. Because the trio is the truth of the training case, it seems fitting and empowering to acknowledge and analyze the role of the supervisor in the patient's mind.