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The psychiatric consultation has not been adequately exploited as a therapeutic device. Although, the original abstinent model for psychodynamic psychotherapy has become more flexible, passive listening with interventions to elicit diagnostic 'data' remains the prevailing mode in psychiatric consultation. In this paper I develop the idea of the consultation as an active (Viederman, M., 2002) that engages the patient emotionally for therapeutic effect.

A psychiatric case involving a 19-year-old African American female high school student with developmental problems complicated by illness and maternal loss is presented. The girl had been afflicted with systemic lupus erythematosus since she was 10 years old. By age 15 she had developed renal failure, as well as other complications, as a result of the disease. In the same year, she had also lost her mother. The course of her treatment is described, and the transcript of an actual psychiatric session as well a discussion of her case are presented.

A 41-year-old woman was examined for her complex partial seizure disorder. The woman has had medication-resistant epilepsy since she was 12, recurrent depressive and psychotic symptoms, and a borderline IQ. It was found that the patient suffers from complex partial seizures of temporal lobe origin. She also exhibited mood disorder, psychotic disorder, personality change, and borderline intellectual functioning. Such patients must be treated with neuroleptics, mood-stabilizing agents, and antiepileptic medications, as well as psychosocial and psychotherapy support.

A new required psychiatry course for first-year medical students linked the urgent need for acquired immune deficiency syndrome (AIDS) education with the traditional goal of teaching the biopsychosocial model of illness. The course, “Human Behavior in Disease: AIDS as Paradigm,” used HIV/AIDS to demonstrate principles of all life-threatening diseases. Formal evaluations of the course’s impact indicated that it significantly reduced students’ prejudices and increased positive attitudes regarding AIDS patients. The students’ ratings of the course indicated that the AIDS paradigm was understood and valued. Our experience suggests that preclinical psychiatry courses can play an important role in the medical educational response to AIDS, while, at the same time, achieving their traditional curricular goals.

The purpose of this case report is to describe the evolution of a psychosocial plan of management for an “uncooperative” patient on the inpatient nephrology unit at The New York Hospital. The edited transcript of the weekly multidisciplinary Psychosocial Conference on this unit is presented in order to detail this evolution. The conference was attended by nurses, social workers, psychiatrists, a psychology intern and the patient's primary physician, who all had input into formulating the plan and joint responsibility in effecting it. A brief discussion follows the transcript.

In this paper, the author emphasizes the practical importance for the internist of determining the underlying content of the patient's fantasies about his illness and its treatment. These fantasies are often the cause of the anxiety and depression that accompanies physical illness and may be quite divorced from the reality of the situation. When the particular fantasies are elicited, the physician will be in a position often to directly reassure the patient about unrealistic concerns. By communicating his understanding, the physician increases the power of the patient's bond to him and is in a position to substantially alleviate emotional distress that stems from physical illness.

This paper elaborates an aspect of the therapeutic experience of analysis that pertains to the examination of the past as it influences a patient's view of his self-worth and relationship to the world. It is complementary to the usual view of psychoanalytic process that involves analysis of transference resistance, revelation of transference, and the discovery of its genetic roots. I propose an additional therapeutic aspect of the reexperience of the past in which the changed representation of patient as child is validated by a new object, the analyst, who is experienced as a benevolent witness to the past and as a benevolent presence in the past, thereby consolidating the change and influencing the patient's adult self-representation. This therapeutic effect is more likely to be of significance in patients who have experienced parental loss or significant deprivation in childhood. Segments of the analysis of a patient illustrate this point. The patient described "listening to himself with compassion for the child he had been" and being listened to by me in the same way. He became thereby "tolerant and empathetic with the child he had been." The more general implications of this as a vehicle for change in psychoanalysis are discussed. Of ancillary interest was the patient's research into his past and ultimately his actualization of a family romance fantasy with a particular ironic twist."It is never too late to have a happy childhood" (button worn by patient on his fortieth birthday).

This paper focuses on the real relationship with the analyst in the psychoanalytic situation as an aspect of the therapeutic process that leads to change. The role of free association, clarification, and interpretation of the transference are taken for granted as major activities of the analyst, and the real relationship with him is seen as a complementary but important ingredient for change, In particular, his emotional availability determines the climate of analysis. The concepts of neutrality, anonymity, and abstinence, though of importance as guideposts in the conduct of an analysis, have conceptual limitations that not infrequently bind the analyst in a stance that is not useful for the progress of the analysis. On occasion, confirmation by the analyst of the verily of an experience in the patient's early life facilitates the analytic process. This occurs particularly in situations of early trauma, but at times may include chronically traumatic early life experiences. An important motivating force in analysis is the patient's unconscious wish to find the ideal parent absent in early life experience, a wish that is experienced and ultimately analyzed. This is to be distinguished from a defensive idealized transference. Psychoanalytic developmental psychology contributes to our understanding of how the real person of the analyst, his emotional availability, his responsiveness at particular times, his attitude toward action and progressive change in the patient, affect the therapeutic process that leads to change.

René Magritte was profoundly influenced in his painterly style and in the content of many of his paintings by his mother's suicide when he was fourteen. This paper explores the influence of this traumatic event on his work. My thesis is that the nighttime suicide of Magritte's mother by drowning: (1) had a profound impact on the form and style of his paintings; (2) his paintings represented an effort, mostly successful, to contain and master through intellectual control with isolation of affect the trauma of this experience, which must at the time have evoked helplessness and despair; (3) the contents of a series of his paintings directly reconstruct the traumatic experience under control and in the service of mastery; and (4) there are paintings, mostly painted at the time he clearly developed his own style (1926-1930), that reveal a breakthrough of projected primitive aggressive impulses and unconscious representations of the aggressive mother. In these latter paintings, both form and content are dramatically different from the main corpus of Magritte's work.