Musings on the "Seasoned Therapist".

This is a brief essay offering the personal reflections and musings of a therapist in her ninth decade.

Comprehensive perinatal safety initiative to reduce adverse obstetric events.

A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.

Anniversary reactions in the therapy group.

From Freud onward, the psychoanalytic literature has offered many references to the idea and significance of past time-specific neuroses and to the subterranean lingering of so-called anniversary emotions. Group therapy is particularly effective in surfacing hidden anniversary reactions that often block the course of treatment. Strikingly, groups can perceive buried associations to long past calendar dates such as traumatic birth and death days, holidays, and past seasonal emotionally-laden responses that patients do not consciously recall or dare articulate. This heightened sensitivity to obscured commemorative syndromes can result from the group interactive process. As such the therapy group can aid in surfacing hidden ghosts far more rapidly than individual therapy might achieve. In this paper illustrations of these anniversary reactions arising in groups are presented and the facilitating effects of group process in identifying and resolving these specific resistances are described.

Psychopathic characters on the stage of Stephen Sondheim.

Many of the characters in Stephen Sondheim's musical theater are burdened with a character pathology which results in their inability to establish intimate relationships. Drawing on Freud's "Psychopathic characters on the stage" and psychoanalytic theory, this article suggests that developmental, biological, and environmental factors from Sondheim's childhood contribute to his characters' social and interpersonal alienation. Sondheim's art is a partially successful attempt to re-assert connections and repair narcissistic injuries, introjecting the absent mother as part of the superego. The resistance to dramatizing character pathology through biography is both an expression of society's postmodern fragmentation and resistance to Oedipal drama.