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A psychodynamic model of supportive therapy is described. The therapist by communicating his awareness of the experience of the patient shares it in a limited way and becomes a presence in the patient's life, thereby muting the experience of loneliness associated with internal conflict or crisis. In this respect, the aim is to 'be with the patient' rather than to 'act on the patient.' Techniques to accomplish this engagement are outlined. The positive transference that develops under these circumstances does not obviate the possibility of the use of interpretation that may lead to substantive change. The model is illustrated by case examples.

This paper illustrates the beneficial effect of a positive benevolent transference in the development of an internalized representation of the therapist/analyst in a variety of patients in psychodynamic treatments ranging from consultation to psychoanalysis itself. This is described in patient presentations. In those who have had substantial early nurturant life experience and now find themselves in a dysphoric state due to crisis, the effect lies in the transference reactivation of these positive object relations that relieve their distress. In those who have been deprived of such early experience, the positive transference may emerge during the intensive work of psychoanalysis and may lead to the internalization of a new positive object representation of the analyst generated in the transference that persists after termination of treatment. In both of these situations, the patient discovers a sense of greater harmony with self and the world. The special conditions that permit and facilitate this process are described since this does not occur in all psychodynamic interventions. [ABSTRACT FROM AUTHOR]

AM, an eighty-year-old woman, is brought by ambulance to the emergency room after an apparent suicide attempt. She was discovered by her neighbors, who have tried to look after her [...]

This paper presents a case for the active, dynamic engagement of patients during consultations. Observations and hypotheses about the patient’s predominant conflicts are used to formulate interventions early in the consultation process that are designed to convey meanings that make the patient’s experience comprehensible to him. This includes attention to his personality and his world view. The activity of the consultant in appropriately communicating aspects of these formulations to the patient is designed to facilitate the process of self-revelation and to permit a co-construction with the patient of a perspective on aspects of his life experience and his current problems. Active, dynamic engagement leads to the development of a bond between consultant and patient that facilitates the implementation of a treatment plan. Numerous case descriptions are included to illustrate this active approach as applied in different contexts. [Copyright &y& Elsevier]

Presents letters submitted by readers on medical topics. Marital stress and coronary heart disease; Training in psychiatric consultation; Linezolid and reversible myelosuppression; Methylmercury and neurodevelopment.

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. [ABSTRACT FROM PUBLISHER]