Consultation with the extended family. Primary process in clinical practice.

In this article, the authors have attempted to describe a method from their pattern of experiential family psychotherapy and to demonstrate its usefulness. Consultations with the extended family serve many purposes, but the one the authors highlight is the way they provide access to the unconscious components of the family. The extended family consultation interview is like an emotional hot tub that precipitates what the authors call a family group psychosis, an inherently therapeutic experience.

Munchausen syndrome by proxy.

Munchausen syndrome by proxy is the most difficult form of child abuse. It carries substantial morbidity and mortality. The diagnosis relies on appropriate suspicion and careful investigation. The psychological illness/need of the perpetrator is the main clinical feature. Early recognition and appropriate intervention prevent further abuse and criminal actions.

A follow-up study of the impact of family therapy in the pediatric office.

Fifteen families received family therapy from a pediatrician and nurse practitioner. Most families began therapy because of school problems or behavior problems with one of the children. There was serious marital discord in nine families that resulted in divorce in two of them. At least one year after the families began therapy, they were recalled for interviews by a psychologist who was unknown to them. Information was obtained during these interviews that indicates (1) pediatricians and nurse practitioners were accepted in their roles as therapists by 14 of the 15 families and (2) all families rated their family therapy experiences as useful.

The electric blanket syndrome. A metaphor for family dysfunction.

One pattern of dysfunctional family interaction is described as a syndrome. Four case histories are presented in which different family members take polar positions on various continua. In one instance the continuum is oral communication, with garrulousness on one side and silence on the other. Another continuum is family responsibility, where one member of the family takes total responsibility and another takes almost none. The symbolic continuum is an electric blanket with hot at one extreme and cold at the other. In all cases, family therapy was performed by a pediatrician. Guidelines are discussed for treatment and for appropriate consultation with mental-health professionals.

The case of Helen D.: a woman who learned to suffer.

Despite our earnest wish to be useful to patients, we sometimes fail. Part of the difficulty often has to do with the expectations that the patient brings to therapy. Another contribution to an impasse may be the psychiatrist's theoretical orientation. This review illustrates a playful distortion of the doctor-patient relationship so as to develop an alliance with a difficult patient. The involvement of part of her family in the long-term treatment facilitated her growth out of a biopsychosocial swamp.