Final oral test expansion 1

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READING Read the text and check the best option. (Total: 5 points - 0.5 each correct answer) The 'Rules' of Psychotherapy In a way, her instincts about my willingness to talk By Robin about myself were partially correct. I agree it's not a When Julia first appeared in my office, she was good idea to tell your patients about your personal approaching her 35th birthday. A hard-working life, but I'm not I believe exceptions can surgeon at a nearby hospital, Julia endured a grueling be made. Even if you're not a classical Freudian analyst, existence even in the best of times. Then a deep there are many good reasons for a therapist to adopt depression struck and she began to think about a posture of neutrality. Patients need to be free to take suicide. After much insistence, a colleague convinced the discussion anywhere, including uncomfortable or Julia to look for help. taboo If therapy were reciprocal, therapists might close off avenues of conversation that they From the start of therapy, Julia seemed determined might want to avoid. to protest what she called the "rules of therapy" especially the notion that would not disclose personal So I tended to be my usual "therapist self" with Julia: information about myself during her She'd attentive, open and, hoped, warm yet neutral and interrogate me all the time: "Don't you get bored closed when it came to my own life. But the more I listening to us mental patients?" "You're holding your kept from her, the harder she pressed me to open up. head in your hand do you have a headache?" "Do It was impossible not to wonder what lay behind her you have children? How many?" She didn't learn this rule from me. This "rule" There is a quotation from the psychiatrist D. W. originated, in fact, with Freud. In a 1912 paper, he Winnicott: "It appalls me to think how much deep advised doctors practicing psychoanalysis that the change I have prevented or delayed by my personal physician should not reveal anything to the patient, need to interpret." except what the patient was showing him, just like With Julia, I began to learn Winnicott's lesson. As a mirror. therapy continued with her, I heard how flat and In psychoanalysis, there is a reason for this rule. tinny I sounded whenever I tried to analyze what was Patients tend to re-enact with therapists the going on between us. When I became too clinical, relationships they had with their parents. This process our connection would wobble, and her alienation is called By paying careful attention became palpable. to this process as it plays out, right there in the In contrast, as I began, in the face of her challenges, office the therapist and patient can uncover and to let down my guard, our alliance grew stronger, and resolve childhood If a therapist interjects she became open to These interactions information about herself, she clouds the mirror and helped develop her capacity to observe herself in compromises the process. action. But I'm not a psychologist. I'm a psychiatrist, a medical I may have been a slow student, but eventually I doctor who treats mental illness not only with understood: I was the one who had to change. From psychotherapy, but also with medication And Julia then on, when she saw that look in my eyes, said yes, had a biological illness major depressive disorder I did have a migraine. We followed episodes of the TV that required in part a biological Freud's show "ER" together, and I told her where I was going rule was not necessarily central to my work with her. when left for vacation. Julia agreed to take antidepressant medication, which Many years have now passed. What's become of Julia? reduced her most immobilizing symptoms. Yet sitting Her life changed in many ways for the better. She still in my office she looked like a sad, lonely child. What has severe depression, for which there is yet no magic was the origin of her melancholy? Unless we could cure. But she has succeeded in training me to become better understand it, it would probably continue to a better doctor for her, and she continues to come to predispose her to severe depressive episodes. So we me for treatment. Though modern psychiatry can't embarked on more intensive psychotherapy, and Julia always cure every disease, I can at least help Julia do still persistently tried to get confidences from me. some of the heavy lifting. Why? Adapted from nytimes.com FINAL TEST TYPE A 3 CNA EXPANSION FINAL 3 02/03/15 17:30