Get the Bigger Therapeutic Picture

The issue of self-disclosure in psychotherapy is one of complexity and some evolution.1-16 Most discussions about the practice refer to boundary questions because self-disclosure by the therapist to the patient is a boundary issue. Self-disclosure has, of course, a number of dimensions, including clinical, therapeutic, technical and-in some cases-legal or regulatory. Despite the rich and interesting clinical issues relating to self-disclosure (outlined in Gutheil and Brodsky1), the focus of this article is on the ethical aspects of self-disclosure.1,15,16 Of necessity, the discussion centers on the more exploratory forms of psychotherapy, such as dynamic therapy, rather than on behavioral therapies, co-counseling, substance abuse treatment, or pharmacological treatment.

Ethical Aspects of Self-Disclosure in Psychotherapy

Bioethicists often debate whether the rapid pace of medical science truly generates new ethical questions or whether what appear to be novel dilemmas are really ancient conflicts presented in modern terms and contexts.1 The valuable essays in this Special Report offer support for each position and, more important, provide clinical wisdom for mental health professionals struggling with ethical issues both profound and prosaic in a variety of practice settings.

Introduction: Ethical Dilemmas Old and New

Questions have also been raised about the extent of industry influence on the American Psychiatric Association’s diagnostic and treatment guidelines-namely, its DSM and Clinical Practice Guidelines.

Undue Pharmaceutical Influence on Psychiatric Practice

The health insurance reform bill Congress passed and President Obama signed has a number of small, psychiatric-targeted provisions, but their significance probably pales beside the first-time insuring of somewhere above 30 million Americans-some of whom will visit psychiatrists for the first time in their lives.

The Health Insurance Reform Bill and Psychiatry: A “Huge Step Forward”

A Psychiatrist’s Guitar

The recently posted draft of DSM5 makes a seemingly small suggestion that would profoundly affect how grief is handled by psychiatry.

DSM5 and the Medicalization of Grief: Two Perspectives

My “most important achievement to date” is that I’m capable of even the simplest forms of basic cognition. I can remember, perceive, speak, feel, think, solve, and-sometimes-pay attention.

Extraordinarily Ordinary

Perhaps one of the positive things to come out of the Kansas v Hendricks wave of sexually violent predator (SVP) commitment laws during the past decade is that our knowledge base on sex offenders has grown tremendously.

The Political Diagnosis: Psychiatry in the Service of the Law

While the Army considers what, if any, disciplinary actions to take against those who directed the medical training of MAJ Nidal Hasan-the accused Fort Hood shooter-one psychiatrist’s legal counsel faults the military for blaming a handful of officers for a broader institutional failing.

The Fort Hood Aftermath-Army Accountability Review and Psychiatrists

I can almost hear Albert Ellis saying “Amen” to the data I am about to share. To explain his reaction, I have to talk about war.

Memory Reconsolidation and What Albert Ellis Knew All Along

Nothing can replace talking with patients. This can take substantial amounts of time, but it is the only way to obtain as clear a view as possible about whether a patient is benefiting from treatment.

Guidelines for Prescribing Opioids for Chronic Pain

The White Ribbon  is an instant classic of European cinema. Filmed in black and white and set in a rural village in northern Germany circa 1912, it may remind you of early Bergman, Buñuel, and other great European filmmakers of the black-and-white era, but it is an homage to none of them.

The White Ribbon

This is the second installment of a new series in which clinically relevant research is briefly discussed and, perhaps more important, a few tips on how to read and interpret research studies are presented. Your feedback, suggestions, and questions are eagerly solicited at rajnish.mago@jefferson.edu.

Efficacy of Drugs in Bipolar Depression: What the Data Show

Oregon’s Governor Kulongoski has vetoed a bill that would have allowed psychologists to practice clinical medicine without adequate training-otherwise known by the euphemism of “prescribing.” The Governor’s rationale was precisely the one opponents of the bill, such as I, had advocated.

The Psychologist Prescribing Bill Is Dead-Long Live Science in the Public Interest!

Readers who know me well will not be surprised by my citing the Tao Te Ching-but some may be taken aback by my quoting football legend, Kurt Warner, who announced his retirement recently.1 Mr Warner had some wise things to say about leaving a job under your own steam, while you are still in good health-and preferably, before you are shown the door. As I prepare to step down from the editor in chief position at Psychiatric Times in June, I believe I can honestly claim that these conditions apply to my departure. The “hail and farewell!” is intended to encompass both my leave-taking from the helm and my greetings to the incoming editor in chief-my friend and colleague, James Knoll, MD.

Turning Over the Helm: Hail-and Farewell

The overall effectiveness of electroconvulsive therapy (ECT) is well known, but its speed of action is much less talked about. Here I review what is known about the time course of action of ECT in depression.

Speed of Response to ECT

In January of my third year of medical school while attempting to study for my medical licensing examination, I began a blog. (Any distraction from learning about the Krebs cycle was heartily welcomed!) Within a week, I had posted photos of my family members, criticized an episode of ER, and griped about my studies. A social addict, I was hooked on this self-disclosure.

Challenges Faced by Psychiatrists in the Internet Age

In his recent David Letterman–like Top 19 list of DSM5 issues, Allen Frances1 targeted a proposed revision of the DSM-IV diagnosis of Pedophilia, and 2 proposed new diagnoses: Hypersexual Disorder (HD) and Paraphilic Coercive Disorder. He protests the inclusion of pubescent teenagers in the definition of the proposed revision of Pedophilia (including the renaming of it as Pedohebephilic Disorder) and criticizes the quality of writing of these criteria.1 As the chair of the DSM5 Work Group responsible for those draft criteria, I need to address his poorly reasoned claims.

Psychiatric Times Vol 27 No 5