The severe depression of a patient critically ill with myasthenia gravis necessitated psychiatric intervention. Over a period of two years three different approaches were utilized by three therapists: 1) intensive psychotherapy, 2) limited supportive psychotherapy, and 3) therapy based on the therapist's presentation of himself as an all-powerful healing figure. Improvement occurred in phase one, severe regression in phase two and marked improvement and death in phase three. Transference and countertransference factors were of critical importance in each phase.
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References
1.
RooseLJ: The dying patient. Int J Psycho-anal50:385–95, 1969.
2.
FeifelH: The function of attitudes towards death, Death and Dying: Attitudes of Patient and Doctor. GAP Symposium, No 11, 1965.
3.
HackettTPWeismanAD: Psychiatric management of operative syndromes: I. The therapeutic consultation and the effect of non-interpretive intervention. Psychosom Med22:267–82, 1960.
4.
HackettTPWeismanAD: Psychiatric management of operative syndromes: II. Psychodynamic factors in formulation and management. Psychosom Med22:356–72, 1960.
5.
LeShanLLeShanE: Psychotherapy and the patient with a limited life span. Psychiatry24:318–23, 1961.
6.
McKegneyFP: Problem of the dying patient. N Y St J Med65:2356–66, 1965.
7.
PayneE: The physician and his patient who is dying, Psychodynamic Studies on Aging. Edited by LevinSKahanaR.New York, International Universities Press, 1967, pp 140–41.
8.
WeinshelE: Severe regressive states during psychoanalysis (scientific proceeding panel report). J Amer Psychoanal Ass14:538–68, 1966.
9.
GreensonR: Technique and Practice of Psychoanalysis. New York, International Universities Press, 1967, pp 325–55.
10.
StoneL: The Psychoanalytic Situation. New York, International Universities Press, 1961, pp 27, 36, 129.
11.
BradleyMHollenderM: Psychological problems of patients with myasthenia gravis. J Nerv Ment Dis122:178–84, 1955.
12.
MeyerE: Training in Psychosomatic Medicine: Some Observations on the Hospital Environment. Adv Psychosom Med, vol 4. Basel/New York, Karger, 1964, pp 47–57.
13.
LeowaldH: On the therapeutic action of psychoanalysis. Int J Psycho-anal41:16–23, 1960.
NachtS: Technical remarks on the handling of the transference neurosis. Int J Psycho-anal38:196–203, 1957.
16.
BurtonA: The adoration of the patient and its disillusionment. Amer J Psychoanal29:194–204, 1969.
17.
NachtS: Interference between transference and countertransference, Drives, Affect and Behavior, vol 2. Edited by SchurM.New York, International Universities Press, 1965, pp 315–22.
18.
FriedlanderK: On the “longing to die.”Int J Psycho-anal21:416–26, 1940.