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2 results

  • Chapter 6 - The Goals of Psychodynamic Psychotherapy

  • from Part 2: - The Model of Psychodynamic Psychotherapy into Practice
  • Adam Polnay, The State Hospital, Carstairs and Royal Edinburgh Hospital, Edinburgh, Rhiannon Pugh, Victoria Barker, East London NHS Foundation Trust, London, David Bell, British Psychoanalytic Society, Allan Beveridge, Royal College of Psychiatrists, London, Adam Burley, Rivers Centre, Edinburgh, Allyson Lumsden, NHS Greater Glasgow and Clyde, C. Susan Mizen, Devon and Exeter NHS Foundation Trust, Exeter, Lauren Wilson, Royal Edinburgh Hospital, Edinburgh
  • Foreword by Nancy McWilliams
  • Book:
    Cambridge Guide to Psychodynamic Psychotherapy
    Published online:
    25 August 2023
    Print publication:
    10 August 2023, pp 89-97

  • Summary

    This chapter commences with a brief description of the complexities conceptualising goals in psychodynamic psychotherapy as they differ across different schools. In addition, some goals are inferred rather than being explicit. Nonetheless, the author goes on to delineate goals which are relevant to early, middle, and end stages of a course of psychodynamic therapy. These include promotion of a positive alliance, a description of ‘common factors’ in therapy, and also some relevant technical goals. Final stage goals consist of management of the ending and enabling the ability to mourn the lost good object of the therapist. An alternative framework to conceptualising goals is presented in terms of symptom relief, life adjustment, personality change, and use of relevant procedures as being necessary. Clinical vignettes are used to illustrate these concepts. Finally, there is a brief section on current contributions from neuroscience specifically related to psychodynamic psychotherapy.

  • Palliative care during the final week of life of older people in nursing homes: A register-based study

  • Jonas Smedbäck, Joakim Öhlén, Kristofer Årestedt, Anette Alvariza, Carl-Johan Fürst, Cecilia Håkanson
  • Journal:
    Palliative & Supportive Care / Volume 15 / Issue 4 / August 2017
    Published online by Cambridge University Press:
    04 January 2017, pp. 417-424
  • Objective:

    Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes.

    Method:

    Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics.

    Results:

    The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place.

    Significance of results:

    There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.