Therapist anger in group psychotherapy.

Countertransference anger serves as a defense against the experience of shame, which occurs when therapists fail to live up to jointly created idealized expectations. The author describes ways of changing these expectations in order to reduce the transference-countertransference resonance, which is based on narcissistic needs. The author distinguishes countertransference anger (which should not be disclosed to group members) from realistic therapist anger, which has therapeutic value. Realistic anger can be used as a therapeutic tool to dispel distortions, provide an interpersonal connection, help members trust the reality of the situation, and provide a balance of good and bad between the members and therapists.

Resolving shame in group psychotherapy.

This article addresses shame and the defenses against shame in group psychotherapy. The experience of shame involves the activation of devalued and devaluing introjects, either of which can be externalized through projection or projective identification resulting in the manifestation of contempt and envy. This article will examine ways to identify, understand, and manage these defenses in order to help resolve shame. The resolution of shame involves experiencing and verbalizing the profound sense of inadequacy associated with shame without resorting to splitting or receiving the anticipated rejection and condemnation from self and others.

Self-disclosure and coping styles in men with cardiovascular reactivity.

The purpose of this study was to investigate self-disclosure, emotion-focused, and problem-focused coping styles among men with borderline hypertension and two groups of normotensive men differentiated by parental hypertension. Because blood pressure reactivity may discriminate between hypertensive and normotensive men, subjects in these three groups were categorized as high or low cardiovascular reactors based on their blood pressure response to a mental arithmetic task. Self-disclosure and coping styles were investigated in relation to status effects within the doctor-patient relationship. Men with exaggerated blood pressure reactivity were less self-disclosive and used fewer emotion-focused coping strategies than men with no blood pressure reactivity. Normotensives with a history of parental hypertension were less self-disclosive than normotensives without a history of parental hypertension.

Developing object constancy in group psychotherapy.

This article describes a therapeutic approach that fosters the development of object constancy in group psychotherapy. By managing group boundaries, instilling an analytic attitude of self-reflective curiosity, and fostering shared group experiences, the therapist helps to create an environment in which individuals can develop a constant sense of themselves and relate to others as separate and distinct persons.

Postvasectomy semen analysis: why patients don't follow-up.

Semen analysis following elective vasectomy is necessary to confirm that the procedure was successful. However, many patients fail to follow postoperative instructions to obtain semen analysis. One hundred forty-one patients who had undergone vasectomy at the Family Practice Center of the Medical College of Ohio were surveyed to assess reasons for a poor rate of follow-up after vasectomy. Only 26 percent of respondents had returned two or more semen samples following surgery. Forty-five percent had not returned any samples. The inconvenience and embarrassment of having to bring semen specimens to the laboratory were identified as factors that can affect patient adherence to instructions. Respondents who had not returned any semen specimens were more likely to answer that their spouse would not be very upset if the vasectomy failed and pregnancy resulted. Our survey results identify issues for improving patient care following vasectomy. These include patient education and postoperative protocols.

PIP: This survey of the 141 post-operative vasectomy patients at the Family Practice Center of the Medical College of Ohio resulted in suggestions for modifying postoperative patient care protocol and patient education. The concern centered on the poor response rate for post operative semen analysis, where 29% returned 1 specimen, 26% returned 2 or more samples following surgery, and 45% had not returned any samples. Patient education was repetitions with the 1st verbal instructions preoperative, the 2nd verbal instructions postoperative, and a typewritten instruction sheet postoperative; additional reinforcement was given at the 1 week followup visit. Masturbation, condom, or withdrawal were recommended method of collection. 2 sterile containers were provided and the request made for a 1st collection after 12 ejaculations and a 2nd 2 or more weeks after the first. The requirement was for 2 specimens completely sperm free. The results of the questionnaire analyzed with Pearson chi-square for nominal or ordinal data and the 2 tailed remembered all 3 methods of collection; remembering was not related to whether the specimen was returned. Of those returning specimens, 70% masturbated, 20% used condoms, and 17% withdrew. 99% knew the reason for collection. Convenience was an important factor. 68% found daytime drop off inconvenient and 77% agreed that refrigeration and a next day dropoff was better. 50% were embarrassed to bring the specimen in. 59% felt that a failure in vasectomy with pregnancy was upsetting. Those not returning specimens had wives less concerned about the failure of vasectomy. 69% had mutual agreement about the vasectomy decision. 58% did not return due to inconvenience, 38% embarrassment, 29% confidence in sterility, 17% forgot, 4% afraid of repeat surgery. Recommended protocol is for a 1st aspermic specimen or a fresh specimen that shows only few, nonmotile sperm turned in in a brown bag provided along with a separate handout on semen collection and joint signatures. Motility checks should be made monthly if sperm persist. Ambivalence about future pregnancy means reevaluation of suitability of couple for vasectomy.

Blood pressure norms for healthy young adults: relation to sex, age, and reported parental hypertension.

Blood pressure norms are presented for 1,522 white, healthy, nonsmoking, normotensive 18 to 22-year-old men and women as a function of age and parental hypertension. Age effects were observed for diastolic blood pressure among males only. Parental hypertension was related to higher systolic and diastolic blood pressure among young women, and women with two hypertensive parents had higher systolic blood pressure than women with one hypertensive parent. The use of oral contraceptives is likely to have affected these results. Directions for future research are given.