Countertransference in the treatment of the borderline personality.

The emotional pressure and transferences of patients to their physicians and other caregivers are natural, inevitable occurrences that are not restricted to therapeutic situations in which one is using a dynamic approach. Transferences are present in all relationships but are scrutinized in intensive dynamic psychotherapy. This article presents clinical examples that illustrate the intense pressures, often near-psychotic, exerted by certain borderline patients, which are unconsciously targeted to force a specific type of response from the therapist.

Surgical reconstruction of a congenital foot deformity: hallux varus with brachymetatarsia of the first metatarsal.

A literature review of the etiologies and treatments of both hallux varus and brachymetatarsia is presented. An unusual case report of a young girl with bilateral congenital hallux varus and brachymetatarsia of the first metatarsal is then discussed. A detailed account of the surgical correction consisting of autogenous bone grafts from adjacent metatarsals proved to demonstrate excellent biomechanical and cosmetic results.

Exploring psychiatric prescribing practices: the relationship between the role of the provider and the appropriateness of prescribing.

The prescribing habits of psychiatrists and neurologists in a large, urban Veterans Administration medical center were surveyed. It was determined that these physicians prescribed a large amount of nonpsychotropic medication, and the rationale for this practice was explored and is presented. Patient expectations in this population derived from certain established sociocultural biases toward the medical profession appeared to significantly influence prescribing practices. Such prescribing behavior suggests that the psychiatrist in this setting is often required to assume the role of primary care provider as part of a larger patient therapist relationship.

Treatment of traumatic war neurosis with phenelzine.

Traumatic war neurosis may become a chronic, debilitating condition that resists treatment interventions. Five patients with traumatic war neurosis had favorable therapeutic responses to phenelzine sulfate. These patients did not respond to multiple previous therapeutic trials with antipsychotics, tricyclic antidepressants, and psychotherapy with or without medication. With phenelzine, the patients felt calmer and stopped having nightmares and flashbacks of traumatic war material. Startle reactions and aggressive, violent outbursts also ceased.

Impact of the threatening patient on ward communications.

Patients and staff may have difficulty facing the realities of a dangerous situation on an inpatient service. The authors describe how, in response to the presence of a potentially violent patient, distorted patient communications in group settings may be reinforced by staff avoidance patterns. Appropriate therapeutic interventions are often delayed until staff members overcome their resistance to acknowledging the signals that frightened patients send. The authors discuss strategies to circumvent and overcome these problems.

Implications of increased dosage of neuroleptic medications during psychotherapy.

Unrecognized emotional reactions on the part of the psychiatric trainee may result in the inappropriate use of medications. To illustrate the possibility that increases in medication dosages may be related to the psychiatric clinician's lack of control, the authors present three clinical examples and discuss the concept of countertransference. A model of supervision is described in which the supervisor, trainee, and patient meet to correct these therapeutic distortions and reduce the amount of medication required.