Edward Charles

Life Events and the Occurrence of Cancer in Children

&NA; Over a two‐year period the families of twenty‐five children with cancer and of a comparison group of children brought to a general pediatric clinic were studied by means of the Holmes‐Rahe Life Schedule of Recent Events and by personal interviews. Results obtained by use of the Holmes‐Rahe questionnaire revealed significant differences between the patient and control groups. Histories obtained from families in both groups also revealed that in the cancer group certain important life events were found to have occurred with greater frequency in the year prior to the onset of the disease. The relevance of these findings to previous work done in the field and to some current theories concerning the relationship of genetic, viral, endocrine, and psychological factors in the development of cancer are discussed.

Emotional Factors in Juvenile Diabetes Mellitus: a Study of the Early Life Experiences of Eight Diabetic Children

&NA; The developmental history of eight diabetic children was compared with that of their nondiabetic siblings. On the basis of data obtained through interviews with the children and their families, as well as a chart review, we advance the hypothesis that an as yet unspecified metabolic “pre‐diabetic” pathophysiological condition may be reflected in disturbances of appetite, satiation and weight regulation appearing early in life in those children who may later develop clinical diabetes mellitus. We further hypothesize that these dysfunctions are accompanied by a disturbance in important psychological developmental processes, compounding the liability a physiologically susceptible individual suffers. The results are discussed in terms of previous psychosomatic research.

Theory and practice in psychotherapy: some contradictions in expressed belief and reported practice.

Anecdotal reports from psychotherapists frequently suggest that theoretical guidelines are not readily adhered to in actual practice. Previous studies have found marked differences in viewpoint on many aspects of technique and practice among even relatively homogeneous groups of psychotherapists. In order to explore further the discrepancies between specific theoretical issues in psychotherapy and their practical clinical applications, the authors surveyed a large group of experienced, practicing psychodynamic psychotherapists. A comprehensive questionnaire addressing theoretical issues such as transference, countertransference, and goals of therapy was constructed. In all there were 70 items and respondents were requested to rate each item in terms of psychotherapy “as you practice it.” Numerous discrepancies between theoretical belief and clinical practice were found. Almost all of the 81 respondents agreed that the therapist should not impose his value system on the patient, yet half of the group viewed the therapists encouragement of the enrichment of the patients social life and encouragement of educational and vocational pursuits as an important aspect of the therapy. A significant number agreed that giving suggestions and advice to the patient may be harmful, but an equal number felt that the therapist should encourage more adaptive modes of behavior including sexual intimacy in the patients outside life. Marked disagreements were found over issues of dependency, controlling the patients outside behavior, and the development of countertransference feelings. Analysis of the data by age revealed that older therapists allowed themselves to be more liberal in their attitudes to such issues as the development of dependency by the patient, the promotion of the enrichment of the patients social life and the development of countertransference than younger therapists. This study confirmed the presence of striking discrepancies between theoretical belief and clinical practice in dynamic psychotherapy. In particular, the incongruities in the data indicate that therapists may prefer a value-free therapy as an ideal, but invariably bring their personal values into the treatment situation.

Age factors in patient-therapist relationship

This paper reports on the effects of therapist and patient age as factors in the evaluation and treatment of adult psychiatric outpatients. Therapist ratings and patient self-ratings are contrasted in three age groups. Rating scales include symptomatology, motivation, insight, and prognosis. In addition, a chart review follow-up of 68 patients includes disposition and drop-out. The data suggest that older patients are perceived as sicker, but less treatable than younger patients or patients of the same age group as the therapist. Residents express a strong preference for treating younger patients, but more readily develop a treatment relationship with same age patients. Both older and younger patients were significantly less likely to remain in treatment. Age of therapist and patient as a significant, frequent unrecognized factor in psychotherapeutic intervention is discussed and modifications in psychiatric training programs are suggested.

Social stresses of medical students: A couples group approach

In recent years, undergraduate education has undergone significant changes. Among these have been increased flexibility of curricula, independent study programs, and earlier clinical experience (Bennett, 1973; Banks & Vastyan, 1973). Medical schools in particular have attempted to broaden clinical training by introducing seminars in medical ethics and human sexuality. As part of this trend, many studies have indicted the usefulness of small groups to help medical students improve communication skills (Derbyshire & Hunt, 1970), improve the doctor-patient relationship (Pollack & Manning, 1967), and deal with issues of sexuality (Woods & Natterson, 1967). In addition, sensitivity training and T-groups have been found to be valuable adjuncts to learning (Flach, 1971; Yalom & Moos, 1965; Seguin, 1965). Indeed, in all areas of education in the country today, experiential approaches have been introduced to improve motivation and depth of Learning. While these developments have been occurring in medical curricula, the field of mental health has also experienced rapid change. The last two decades have seen the emergence of group psychotherapy, family therapy, and community mental health, growing from what at first appeared to be fringe movements within

A multiple entry system for psychiatric clinics

The authors studied the characteristics of 100 patients who applied for psychiatric treatment at the clinic of the Bronx Municipal Hospital Center and did not keep their initial appointment. This group was compared with a matched group of 100 patients who kept their initial appointments. Eighty-two of the “no show” group responded to a mail and telephone inquiry. The characteristics of particular subgroups were identified in relation to the percentage of appointments kept. Among the most significant factors were the male-female distribution, and the source of referral.The hypothesis is advanced that a single entry system for admission to psychiatric clinics, using an appointment or “walk-in” approach, does not promote easy entrance for many in need of treatment. Certain systems of entry into a clinic are suitable for particular subgroups, but not for others. The findings are discussed in relation to other studies of pre-intake clinic dropout.