Mary-Joan Gerson

A collaborative health care model for the treatment of irritable bowel syndrome.

BACKGROUND & AIMS There have been few reports of successful treatment of chronically symptomatic patients with irritable bowel syndrome. We performed a preliminary single center study to evaluate a new collaborative treatment model that used both gastroenterologist and psychologist working together, compared to medical treatment or psychological treatment alone. A second goal was to determine the sample size that would be necessary to definitively demonstrate efficacy of such a collaborative treatment program. METHODS Forty-one patients with irritable bowel syndrome, seen in a tertiary setting, were randomly assigned to the 3 treatment groups. The research design was weighted toward collaborative treatment, which consisted of 3 biweekly visits. A series of questionnaires, including a 2-week daily diary as well as measures of quality of life, anxiety, depression, and relationships, were administered before treatment, after treatment, and again 3 months later. At termination of the study, patients completed a global assessment scale. RESULTS Sixteen patients completed the collaborative program, 8 completed medical treatment directed at gastrointestinal function, and 6 completed psychological therapy. Eleven patients dropped out of the study; 2 had organic disease. Intent to treat and per protocol analyses showed that global self-assessment improved significantly at long-term follow-up in the collaborative treatment group (P<0.0002). Abdominal pain, diarrhea, and constipation also improved significantly in the collaborative treatment group (P<0.001). Collaborative treatment was statistically superior to medical treatment alone (P<0.05). The psychological treatment group had 50% improvement in global score. There was no significant improvement in the medically treated group. CONCLUSIONS We have demonstrated that short-term treatment with gastroenterologist and psychologist working together is more effective than medical treatment in relieving symptoms in patients with chronic irritable bowel syndrome. Attributes of a collaborative approach are discussed. These pilot data suggest that collaborative treatment programs should be explored in further studies, and they show the importance of dealing with both mind and body in these patients.

THE PROSPECT OF PARENTHOOD FOR WOMEN AND MEN

This study, which involved older subjects of both sexes (113 women, 75 men) and variables drawn from a psychodynamic perspective, is an extension of an earlier investigation that explored parenthood motivation in young women. Though feminism was not significantly related to motivation for older subjects of either sex, in both investigations psychological variables accounted for greater variance in female motivation than did demographic variables. The uniquely significant psychological variables in this investigation were narcissism, self-esteem, and memories of fathers love. However, demographic variables alone accounted for differences in male motivation. Perceived importance of having a child to the fulfillment of life values was studied as well, with self-esteem, judged effect on ones own parents, and age as instrumental variables for women, and religious background, socioeconomic status, age, and marital status as key correlates for men.

Group Hypnotherapy for Irritable Bowel Syndrome With Long-Term Follow-Up

Abstract This study tested whether group gut-focused hypnotherapy would improve irritable bowel syndrome (IBS). Several possible outcome predictors were also studied. Before treatment, 75 patients completed a Symptom Severity Scale, a Mind–Body attribution questionnaire, and a Quality of Relationship Inventory (QRI). The symptom scale was completed posttreatment, 3, 6, and 12 months later. There was significant symptom reduction at each data point (p < .001). Sixty percent had a reduction of more than 50 points, indicative of clinical improvement. Initial severity score (p = .0004) and QRI conflict (p = .057) were directly correlated with a response to hypnotherapy, while attribution of symptoms to mind (emotional) causation was inversely correlated (p = .0056). The authors conclude that group hypnotherapy is effective in patients with IBS.

Psychosomatics and psychoanalytic theory: The psychology of ulcerative colitis and Crohn's disease.

From the beginning, psychoanalysts have grappled with the phenomenon of psychosomatic illness. Freud’s (1923/1961) early statement that “the ego is first and foremost a bodily ego” (p. 26) has been expanded and instantiated in numerous clinical and theoretical illustrations of mind and body interactions. Ulcerative colitis, involving inflammation of the lining of the large intestine, is a psychoanalytic exemplar, one of a paradigmatic group of disorders, including peptic ulcer, hypertension, asthma, rheumatoid arthritis, eczema, and anorexia nervosa (Alexander, 1950). A syndrome medically very similar to ulcerative colitis, Crohn’s disease, was identified 40 years later. Their symptomatic pictures are very similar,

Feminism and the wish for a child

The present study investigated the relationship between feminism and the intensity of the wish for a child, as well as the costs and benefits of having children in a sample of 184 female undergraduates. Feminism was negatively related to motivation for motherhood, and the perceived costs of child raising rather than perceived benefits accounted for this finding. Perceptions of mothers—not fathers—level of nurturance and happiness of childhood seemed to influence eagerness to assume the role of mother in profeminist women.

The importance of relationships in patients with irritable bowel syndrome: a review.

Chronic illnesses such as irritable bowel syndrome are not experienced by patients in isolation. They live in a context of relationships, including spouses and partners, other family members, friends and business associates. Those relationships can have an effect, both positive and negative, on the course of illness and may also be affected by the experience of living with a chronic illness like IBS. We review the general literature regarding the effect of relationship factors on chronic illness followed by a focus on IBS symptomatology. We then discuss the challenges experienced by partners of IBS patients, followed by the effects of spousal violence, the particular relationship of mothers with IBS and their children, the effects of social support, and the importance of family dynamics and IBS. The final segment includes conclusions and recommendations. The topic, relationships and IBS, may have a significant effect on the lives of IBS patients and deserves more attention than it has received.

A cross‐cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome

Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment. Aims: In this cross‐cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity.

Cyberspace Betrayal: Attachment in an Era of Virtual Connection

Electronic technology has yielded new forms of relationship bonding as well as unique aspects of betrayal and ruptures in attachment. Four key characteristics of betrayal that differentiate online from offline experience will be identified. The inherent ambiguities in defining online sexual infidelity will point to a need to professionally define the parameters of internet betrayal in light of the ever expanding electronic revolution.

The Justice of Intimacy

Abstract I find that the process of couples therapy is marked by frequent judgments and accusations regarding “fairness” and “justice,” reflecting our cultural belief in the principle of the golden rule. Personification of self as autonomous, emphasized by Sullivan and underlined by a particularly American emphasis on individual independence, reinforces the couples salient emphasis on responsibility and moral behavior. However, a preoccupation with “fairness” often masks anxiety about the extent to which we are vulnerable to need and influence in intimate relationships, and to profound difficulties in connecting to another. A therapist can help expand the couples relationship discourse, while recognizing the complexity of value implications in moving beyond the frame of the golden rule. This expansion is viewed through the lens of psychoanalytic, systemic, and attachment theory. I illustrate my thinking with a brief clinical vignette.

The Analyst and the Significant Other: Two's Company, Three's a Crowd: Commentary on Paper by Carla Leone

My response to Carla Leones paper focuses on how psychoanalysts perceive the significant others of their patients is an attempt to both endorse raising this important question and to augment our thinking about it. Leone identifies the dynamic backdrop for the tendency of individual therapists to unquestionably accept their patients representation of the significant other. From an interpersonal-relational and family systemic perspective, I raise other dynamic possibilities regarding transference and countertransference, the self as co-constructed with the significant other, introduce the importance of attachment theory, and suggest creative ways to keep a balanced view of the partner who is not known to the analyst except through the patients representation.