Amelioration of transference resistance: substitute therapists in milieu group psychotherapy.

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.

A reconsideration of power in psychiatric administration.

The management literature of the past few decades was imbued with a humanistic, behavioral science orientation in which the formal use of power was down-played. But with the changing economic climate has come a reappraisal of concepts of power and leadership, and more than ever the clinician-executive must recognize his responsibility for the constructive use of power. The authors review definitions and classifications of power from the management literature and psychoanalytic theory related to the use of power in groups. They present a model, analogous to the doctor-patient relationship, for the use of power by the clinician-executive in both stable and unstable organizations.

The drug addict as chronic patient.

From the above discussion, it is clear that the chronic drug addict is in need of a careful diagnostic work-up, a team approach, a highly sophisticated model of illness, and treatment targeted to his or her special needs. . Given the high prevalence and social costs of addictions, it is obvious that increased support for training and research, prevention, and treatment is needed within psychiatry and medicine.

Involutional melancholia revisited.

In this study, 31 patients with involutional-onset major depression had significantly more somatization and hypochondriasis and less loss of libido, guilt, suicidal intent, and family history of depression than 60 patients with an earlier onset. Regardless of age at onset, patients over age 50 had more agitation, initial insomnia, and hypochondriasis than those under 50. These findings suggest that clinical characteristics of patients with unipolar endogenous depression may be influenced by age at both onset and time of current episode. Although there is insufficient evidence to view involutional melancholia as a separate clinical entity, further research into the genetic and biochemical basis of late-onset depression is warranted.