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Document Typology: Book
Methodology addressed by the publication:Narrative medicine
Title of document: On Learning from the Patient
Name of author(s): Patrick Casement
Name of publisher: Tavistock Publications Ltd
Language of the publication: English
Language of the review: English
Patient is concerned with the potential for psychoanalytic thinking to become self-perpetuating. Patrick Casement explores afresh the dynamics of the helping relationship - learning to recognize how patients offer cues to the therapeutic experience that they are unconsciously in search of. Using many telling clinical examples, he illustrates how, through trial identification, he has learned to monitor the implications of his own contributions to a session from the viewpoint of the patient. He thus shows how, with the aid of this internal supervision, many initial failures to respond appropriately can be remedied and even used to the benefit of the therapeutic work. By learning to distinguish better what helps the therapeutic process from what hinders it, ways are discovered whereby the circularity of pre-conception can more effectively be avoided by those who aim to understand the unconscious of others. From this lively examination of key clinical issues, the author comes to see psychoanalytic therapy as a process of re-discovering theory - and developing a technique that is more specifically related to the individual patient.The dynamics illustrated here, particularly the processes of interactive communication and containment, occur in any helping relationship and are applicable throughout the caring professions. Patrick Casement's unusually frank presentation of his own work, aided by his lucid and non-technical language, allows wide scope for readers to form their own ideas about the approach to technique he describes. This book, together with its sequel Further Learning from the Patient , will be invaluable to trainee and practising analysts or therapists, and those teaching in related professions.
Reviewer's comments on the document:
Research studies on cognitive function in MS have demonstrated that as many as 50 to 66 percent of people will experience some cognitive changes over the course of the disease. Even though the severity of these changes can vary from mild to quite severe, the majority of these changes are in the mild-to-moderate range.
It's important to familiarize yourself with the kinds of changes that can occur because:
Cognitive changes can occur at any time, and their severity doesn't appear to correlate with either length of time since diagnosis or the level of a person's physical disability. For example, a person with significant physical limitations, who has had MS for some time, can be totally free of cognitive symptoms, while a person with a recent diagnosis and few physical symptoms can have significant cognitive impairment.
Even relatively mild symptoms can have a pretty big impact on various activities of daily living. For instance, people with MS are more likely to leave the workforce because of cognitive symptoms and fatigue than because of mobility problems! Early departure from the workforce is a critical issue for people with MS, but it can often be avoided with adequate symptom management.
Cognitive fatigue can interfere with your ability to get things done. Research has shown that people with MS who are concentrating very hard on a cognitively strenuous task can experience a kind of mental fatigue that feels like acute "brain drain." Fortunately a brief rest from the task will generally help you get back on track.
Cognitive changes tend to progress slowly over time. Even though MS relapses can include a sudden worsening of cognitive symptoms as well as physical ones, which tend to improve as a relapse ends, problems with thinking and memory don't generally disappear completely.
The sooner these kinds of cognitive problems are identified, the easier it is to develop effective strategies to manage them. Small problems are always easier to work around than bigger ones. When you're able to put your finger on a problem with thinking or memory early on, you can find ways to compensate for it before the problem begins to interfere significantly with your daily life.
Like the physical symptoms that can occur in MS, the cognitive changes are highly variable from one person to another. One person may experience a lot of problems while another person experiences none or very few. In other words, no two people experience the same changes in exactly the same way.
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