The relationship between DSM-III diagnosis and defense style was studied in a sample of 74 psychiatric patients. The subjects completed a self-administered questionnaire composed of 81 statements about behaviors, thoughts, and feelings, which were designed to reflect various unconscious defense mechanisms. Factor analysis yielded four defense styles ranging on a continuum from primitive to mature. Patients' defense styles were compared with their diagnoses on axes I, II, and IV of DSM-III. Significant relationships were found between defense style and only one diagnosis, major affective disorder. The fact that DSM-III diagnosis could not predict defense style suggests that diagnosis and defense style are two independent dimensions. If this can be confirmed by further, more adequate studies, a sixth axis reflecting psychodynamic formulation would provide additional information necessary for therapeutic planning.
Systematic knowledge about patient characteristics that predict the duration of long-term psychotherapy is largely absent. We examined predictors of attrition, retention, and duration of long-term dynamic psychotherapy to delineate the naturalistic history of psychotherapy, specifically focusing on childhood emotional neglect and abuse, adult diagnosis, personality, and functioning as predictors. Fifty-three adults with depressive, anxiety, and/or personality disorders (PDs) were offered at least 3 years of long-term dynamic psychotherapy. The median duration of therapy for the study group was 110 sessions (95% confidence interval [CI] 52-141). Nondynamic characteristics (including demographics; most Axis I diagnoses; depression, anxiety, and distress scores; social and global functioning; and the five personality factors) did not predict number of sessions. Dysthymic disorder, presence of any PD (particularly dependent PD [DPD]), emotional neglect in childhood, and higher adaptive defense style scores predicted a greater number of sessions, while obsessive-compulsive PD (OCPD) predicted fewer sessions. Emotional neglect, DPD, higher adaptive defenses, and OCPD were each unique predictors of duration. A session frequency less than 0.7 sessions per week (36 sessions per year) was associated with a three-fold higher risk for intrinsic attrition (relative risk = 3.04, 95% CI 1.10-8.44). Childhood emotional neglect as well as adult dependency may predispose patients to remain in therapy for longer durations, while some adaptive defenses may allow patients to contain the distressing affects that might otherwise lead to early termination. It remains to be seen whether longer durations of treatments are associated with respectively greater improvement, other things being equal, and whether these findings generalize to other types of treatment.
Olga is delighted when the Sawdust family move her inside their house for the winter. She has her own box in the corner of the dining room where she spends her days watching the comings and goings in the house. But when she decides to do a spot of decorating, things don't go according to plan ...More fun and mayhem from the outrageous Olga da Polga and all her garden friends.
is the famous bear from darkest Peru. This edition contains the first two stories about him, entitled A Bear Called Paddington and More About Paddington.