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Though he has a few good friends from high school, he feels that their acceptance, like his family's is exceptional. That is the psychotherapy. A concrete example is the remoralization of a depressed and defeated patient. The patient could be Alice Alcott, William Steele, Howie Harris, Rudolph Kristiva, Antigone articlet, or another of the patients whose stories I have told: sick persons who are viewed by their caregivers as problem patients. The objective differs. It might be significant reduction in disability; The mini-ethnography and the life history will suggest the specific aims and the means, so that the form taken by remoralization will differ. With one patient, say Antigone articlet, the emphasis of care may be on catharsis; For Alice Alcott emotional support takes the form of existential empathy, as it did for Gordon Stuart in his final days (article 9). Other patients, like William Steele, require a sociotherapeutic approach in which the practitioner works to help them break out of vicious local social cycles that amplify distress. Gus Echeverra failed to respond to intensive psychoanalytically oriented psychotherapy focused on his severe personality disorder, and it is unlikely that cases as serious as his could be treated by the medical practitioner; You might want to lay your arms by your side, but this puts a bit of strain on the shoulders for some folks. We don't want strain - this isn't supposed to be punishment. Some other comfortable positions for your hands are on your groin (where your legs join your body), on your belly, or on your chest (left hand will be over your heart). Well, those are the basic positions. I bet you'll find at least one that works well for you. And consider changing things up occasionally - it keeps life interesting. Music hath charms to soothe a savage breast. We live in a busy world, and more and more people are exploring meditation to relax and calm their busy minds. But what if you're unsure of your ability to sit in silence?

Ahhh, that's probably why music was invented! It is not close relationships that bother Harold, but rather his entry into any new social group, his interaction with a new bank teller, a new waitress, a new postman. They all stare at him, and the old feeling of shame returns. Harold told me that if a blemish can be hidden by clothing then its effects can be limited, but when a blemish is as visibly disfiguring as his there is nothing that can be done. Harold holds his mole responsible for what he takes to be great constraints on his life: he could not work in a setting where there were new faces to confront; He has undergone behavioral therapy with a psychologist to reduce his sensitivity to the blemish, but without success. Harold recognizes that his is a problem that can be mastered by a more confident, less morbidly sensitive approach to others; Rather, each new situation makes him feel discreditable, calling into question a fragile self-identity. I am marked for life. I look in the mirror and I feel ashamed. I stare at myself, too, like everyone else. But for most patients and families, the required steps are not nearly so difficult. The chief sources of therapeutic efficacy are the development of a successful therapeutic relationship and the rhetorical use of the practitioner's personality and communicative skills to empower the patient and persuade him toward more successful coping. The care of the chronically ill, moreover, need not be overly solemn or gloomy: there is ample place for wit and humor, a sense of irony and paradox. Almost all patients with serious chronic illness can benefit from grief work to help them mourn their losses, which as we have seen play such a large role in care. Learning how to assist in grieving and authorizing patients' right to grieve actively in care are things anyone who treats the chronically ill should master. Short-term psychotherapeutic models of grief therapy, such as that of Horowitz et al. For those practitioners who are themselves uncomfortable with undertaking this specific psychotherapeutic task, timely referral to appropriately trained grief counselors might be a useful alternative. But for the practitioner who wishes to be a healer with the chronically ill, working through grief is a skill that he should acquire and practice. The practitioner might devote five or six weekly sessions for the purpose of grieving losses.

He can block out thirty to forty minutes for each session. Music can help you have a more successful meditation, but knowing exactly which music to choose and how to use music to meditate can sometimes be a challenge. Keep reading if you're interested in trying music for your practice. What to Look For The right music can help you relax into a deep state of peace, although not everybody finds the same sorts of music relaxing. Most important is that you choose music that encourages you to unwind and let go of any worries you might have. Some general guidelines: You'll want to remain positive through your meditation, or you won't get the full benefit package. There are loads of CDs designed specifically for meditation, or try a slow track from a Classical, New Age or Indigenous Music album. Use Music to Enhance Your Experience Before you turn the music on, you may want to spend a few minutes silently preparing for your meditation session. It has ruined my life. Horacio Grippa Horacio Grippa is a thirty-two-year-old homosexual teacher with AIDS. When I interviewed him, in early 1985, he was about to leave the hospital, his disease in partial remission but his life in disarray. When it became known that he was suffering from AIDS, he was dismissed from his job. Later his landlady ordered him to vacate his apartment. Finally, his parents told him that he could not come home. He was in a lawsuit with his private medical insurance company, and he was not sure that the company would pay his hospital bill. Deeply depressed, he had been referred for psychiatric help.

Grippa was angry about the way he was being treated. He must select suitable patients who are experiencing significant demoralization and solicit their informed consent. In the first session, he assists the patient to recognize and express major personal losses due to his chronic illness. During the second and third sessions, he encourages the patient to talk about these losses and to describe for each the emotional experience of that loss: that is, he helps the patient to grieve. These sessions also allow the physician to work with his patient to express other emotional responses (such as anger or fear) that may interfere with grieving. The fourth session can be devoted to complete the grieving by guiding the patient to grieve for his own death or for other anticipated losses of profound significance. The final one or two sessions are arranged to move beyond grief to restitution. Termination of this series of sessions should emphasize reattachment of the patient to the ongoing patient-doctor relationship, to intimate personal ties, and to his own lived experience. A long-term relationship allows the practitioner to monitor the outcome of such intervention and, from time to time, when he feels it may be useful, to revisit the work of grieving. It is the experience of many therapists that therapy may have its effect after the therapeutic process has ended, when the patient has sufficient time to synthesize new insights and initiate change on his own. Thus the general practitioner may see remoralization occur well after such sessions have ended. Find somewhere comfortable to sit or lie down and take the time to empty your mind by focusing on your breathing. Take long, slow breaths and count down from fifty in your mind. It may help to visualize going down a long stairway and counting each step. Take as long as you need to really let go. When you're ready, turn on your music and return to your comfortable position. Then close your eyes and focus all your attention on the music. Nothing else exists but the beautiful sounds that you hear. You should get a feeling that the music is washing over you and helping to empty your mind. It could take a little bit of practice to reach this feeling, but that's completely normal.

You'll know when you're there. The nurses are scared of me; Even the priest doesn't seem too anxious to shake my hand. What the hell is this? I'm not a leper. Do they want to lock me up and shoot me? I've got no family, no friends. Where do I go? What do I do? God, this is horrible! Is He punishing me? Patients should achieve, as a result of therapy, a degree of distance from their former emotional state. They should feel that they have experienced a significant catharsis. But whatever new relationship they work out with their illness cannot be prescribed, and will be as different as their situations and personalities. This kind of grief work, in my experience, is an effective means of remoralizing many patients. It can also be of use to remoralize the practitioner, or at least to rekindle his enthusiasm for treating the patient. And often that is all that is needed to keep him from giving up, to enable him thereby to sustain the often fragile hope of patient and family. I am sure that there are different and equally useful ways to conduct the grief work (see Osterweis et al. Again, I would emphasize how important it is for the patient and practitioner to undertake the experience together. The means is not what counts.