The Non-Disclosing Patient: A Clinician's Guide 3030486133, 9783030486136

Table of contents :
Contents
Introduction
Is DND Insignificant?
The Nature of Deception
Suppression of Diagnostic Uncertainty
Syndromal Diagnosis
Good News/Bad News and the Tendency to Withdraw
Human Tendency to Withdraw
Conclusion
Reference
Part I: DND in the Clinical Encounter
Chapter 1: A Personal Encounter with Deceit
A Question of Relevance
Chapter 2: Deception in the Psychiatric Interview
Fact Collection and “Templating”
Assessment Goes Awry
Psychotherapeutic Literature
Therapeutic Repulsion
References
Chapter 3: Types of Interviews, Types of Listening
The Fact-Based Interview
The Meaning-Focused Interview
Beyond Facts: The Transactional Interview
Stratified Listening
Level I: The Subjective Narrative
Level II: The Emotional Narrative
Level III: Omissions and Distortions
Level IV: (Formulation-Guided) Listening
“Hard” and “Soft” DND
Conclusion
Reference
Chapter 4: Therapeutic and Anti-therapeutic Relationships
The Therapeutic Relationship
Therapeutic Relationship and Behavioral Therapy
References
Chapter 5: Engaging Deceit
Four Principles of Engaging Deception and Non-Disclosure (DND)
Interviewing Charlie
Charlie as Storyteller
References
Chapter 6: Deceit and Its Meaning
Application of the Transactional Interview
Transactional Encounters
Objections to Psychodynamic Principles
Absence of Treatment Frame
Failure of Neutrality
Imbalance of Power
Anxiety
Part II: Personality Functioning and DND
Chapter 7: Neurobiology of Deception
Executive Function and Deception
Deception Detection Techniques
Polygraph
Thermal Imaging
Electroencephalogram (EEG)
Neuroimaging of Deception
Functional Magnetic Resonance Imaging (fMRI)
Connectivity Studies
Neurochemistry of Deception
Attention
Memory
Inhibitory Modulation
Deception and Role of Genetics
Conclusion
References
Chapter 8: Shared Consciousness and the Emergence of Mind
The Capacity to Conceal
Types of Deception: Concealment, Falsification, and Dissociation
Nondisclosure and the “Moral High Ground”
Engaging Deceit
Proposition One: DND Manifests as Hopelessness
Proposition Two: DND Is a Window
Attributes of Deception
Taxonomy of Deception: Nondisclosure and Concealment
Self-Deception
DND and Psychopathology
Clinical Example
Social Deception and “White Lies”
Pragmatic Lies
Deception in the Setting of Psychopathology
Affect Containment
Shame and Guilt
Paranoia and Psychopathy
Dissociation and Disorganization
Type IX: Predatory Deception
“Multiple Function”
Qualities of DND
Active Falsification
Dissociation and Self-Deception
“Soft” Versus “Hard” DND
Dissociation, Disorganization, and Nondisclosure
The Patient as Storyteller
References
Chapter 9: Personality Disorders, Psychopathy, and Deceit
A Psychoanalytic Perspective on Personality
Structural Model
Defense Model
Motivational and Early Fragmentation Model
Fragmentation Model “Borderline Personality Organization”
Differentiation of “Borderline Personality Organization” from DSM
“Defensive” and “Malignant Narcissism” Models of DND
Morality, Self-Esteem, and Descent into Primitive Masochism
Discussion of the Linda Case
“Structural” Problems or “Nonspecific Ego Weakness”
“Defensive” Problems
Case Studies in Psychopathy
Case 1: Johnny
Case 2: David
Case 3: Lisa
Case 4: Leon
Case 5: Carla
Discussion
References
Part III: Assessing DND in a “Gated” Simulated Patient
Chapter 10: “Biggie” Assessing a Deceptive Patient in a “Gated” Simulated Patient Interview
Introduction
A Simplified Process
Good Patients/Bad Patients
Different Challenges
Higher Goals for Interview
Role of Simulated Scenario—Positive Reports
Cautionary Views of Simulated Patient (SP) Exercises
WMC SP Scenario Goals
The “Biggie” Scenario
Development of the WMC Simulated Patient Program
Method
Scenario Design
Actors and Interview Setting
Interview Cohort
Measures
Results
Covariance of Interviewing Competencies
Discussion
Conclusion
Appendix I Definitions of Selected Terms
Therapeutic Relationship
Response to Breakthrough Affect
Rapport
Empathy
Negative Case Examples
Confrontation
Natural Conversational Style
Hope
Appendix II: Correlation by Training Year
Appendix: III—Biggie Scenario Documents
Background Information for Standardized Patient
Introduction
Appearance + Behavior
History of Present Illness
Past Psychiatric History
Social History
Family History
Critical Information
Chapter 11: Aggression in the Simulated Case Scenario: Karl Moehller
Problems with the “Karl Moehller” Scenario
Interview with Dr. Choudhury—Transcript
Transcript
Doing a “Dorothy” (i.e., Ignoring Subject’s Aggression)
Bobbleheading
Pheromones
Perfection
Domestic Violence
The Door
Longitudinal History
Templating
Founding Fathers
Conclusion
Good Intentions, Frustrated
Appendix IV: The “Karl Moehller” Simulation Scenario—Design and Supportive Documents
Goals of the Interview
Presenting Problem
Karl’s Background
Sandy
Other Background Information
Interview Scenario
Interview Process
Examples of Karl’s Dialogue
If Confronted with the Fact that the Incident Occurred as Jenna Was Getting Ready for School
If Questioned About Removing the Door
Asked About the Bruises on Jenna’s Arms
LEVEL TWO Behavior During the Interview
LEVEL THREE Behavior During the Interview
LEVEL 4
References
Conclusion
Index