Functions of the Treatment Contract in TFP

The use of a verbal or written contract has been employed in many different modalities of treatment as a means of establishing the expectations and parameters of treatment. Traditionally, the contract is seen as serving a somewhat utilitarian purpose: setting up the practical conditions of treatment and providing a containing frame for the patient. Contracts, however, can extend to establishing agreed-upon goals of treatment, anticipating obstacles that may arise in the treatment and clarifying how they will be dealt with should they arise, and clearly defining the roles of the patient and therapist in a way that aids the exploratory process once the treatment has begun. Importantly, the mutually agreed-upon contract serves as a useful roadmap to keep the treatment focused and on track. In this article we will emphasize how the treatment contract can facilitate in-depth understanding of the patient's internal world, particularly when challenges to the contract are enacted by the patient. We will begin by briefly summarizing the functions of the contract and then focus on the key role of the treatment contract in furthering the exploratory process of the patient's dynamics as expressed in the transference/countertransference matrix.

Der Arzt im Konflikt zwischen Fehleroffenbarungspflicht und Selbstbelastungsfreiheit

For a long time, there was a diffuse body of opinion in the literature and case law regarding the physician's duty to disclose medical errors. With the entry into force of the Patients' Rights Act 2013, further discussion has become superfluous. In the course of the law reform, a corresponding right of the patient to information under the treatment contract was included in the German Civil Code. However, given the earlier controversy on this issue, it is hardly surprising that it is one of the most controversial provisions of the Patients' Rights Act. In addition to clarifying a number of legal uncertainties, the paper also provides a constitutional review of this provision as well as alternative incentives for dealing openly with medical negligence.

Managing the clinical encounter with patients with borderline personality disorder in a general psychiatry setting: key contributions from transference-focused psychotherapy

SUMMARYThis article describes how the core principles and techniques of transference-focused psychotherapy (TFP) can be used in general psychiatry to help in the management of patients with borderline personality disorder (or other moderate to severe personality disorders). It focuses on: knowledge – appreciating how an understanding of object relations assists the clinician in assessment and treatment; attitude – developing a stance to manage the confusing and negative feelings that may arise in both clinician and patient; and skills – describing how use of TFP techniques (technical neutrality, analysing the transference and countertransference, and judicious use of interpretation) helps the clinician to continue thinking in the fraught clinical encounter. The structural (including contemporary object relations) and structured approach in TFP are exemplified in clinical vignettes.LEARNING OBJECTIVESAfter reading this article you will be able to: •Apply an understanding of object relations theory to interactions with patients with Borderline Personality Disorder (BPD)•Describe the use of the treatment contract and technical neutrality•Understand and better manage the countertransference in working with patients with BPDDECLARATION OF INTERESTNone.

Session 5: Formulating the Problem Area

Chapter 9 of Family-based Interpersonal Psychotherapy (FB-IPT) for Depressed Preadolescents concludes the initial phase of family-based interpersonal therapy (FB-IPT). In this fifth session, the therapist presents the formulation of the problem area; elicits feedback from the preadolescent and parent; and makes sure that the therapist, preadolescent, and parent are all working from a common understanding of the child’s depression. The therapist introduces the treatment contract and clarifies how the problem area will be addressed in the middle phase of FB-IPT. This session concludes with a discussion of new communication skills and problem-solving strategies that will be introduced to both the preadolescent and the parent in ensuing sessions.

Beginning IPT

This chapter describes the tasks of the first few IPT sessions. The therapist’s tasks in the opening sessions are to review the depressive symptoms and make a diagnosis; explain depression as a medical illness and describe treatment options; evaluate the need for medication; review the patient’s “interpersonal inventory”; present a formulation, linking the patient’s illness to an interpersonal focus; make a treatment contract based on the formulation, and explain what to expect in treatment; define the framework and structure of treatment; and give the patient the “sick role.” After this, the work of IPT begins on the defined problem area. In these sessions the therapist focuses consistently on mood and interpersonal interaction. The therapist helps the patient to see the link between them, reinforces adaptive interpersonal functioning, and helps the patient to explore and gain comfort with new options where old strategies have not been working.