Download Author: Lidz, Theodore, M.D.
The Therapeutic Relationship
This chapter will move beyond the dynamics of personality development to consider some essential aspects of the therapeutic relationship. In particular, the transference relationships between patient and therapist and how they are critical to clinical work in all fields of medicine and form the core of psychotherapeutic activities will be discussed.
The Middle Years
The middle years start when persons achieve maturity, usually in their early thirties, having gained the skills, knowledge, and assurance needed to settle into their careers and family lives. They are caught up in the challenge of making the most of their abilities and opportunities. They soon move into the period most people consider the “prime of life,” the years between thirty-five and fifty-five, during which they reach the midlife transition or crisis—a period of stocktaking, and perhaps of reorientation, occurring around the age of forty—and become middle aged. Middle age is usually a period of fruition, but often a time of coming to terms with where one’s life is going. Then, as persons enter their mid-fifties, the efforts and creative capacities of most, though far from all, persons diminish as they tend to coast on previously gained skills and accomplishments until they reach old age, which is rather arbitrarily considered to start at about sixty-five.
Old Age
People have changed over the past several decades and now increasingly welcome retirement as an opportunity to live in leisure, and they accept and anticipate retirement as part of their life cycle. Whether retirement can be enjoyable—an autumn of deep but brilliant hues—depends greatly, as we shall consider later, upon income and health; whether it will be enjoyable depends greatly on the personality of the individual—and upon contingencies.
The Preschool Child
Sometime around the age of three, the child ceases to be a baby and becomes a preschool child. During the next two or three years the child passes through one of the most decisive phases of life’s journey that has been termed the oedipal transition.
Death
Death is part of the life cycle, an inevitable outcome of life that brings closure to a life story; and, because humans from early childhood are aware of their ultimate death, it influences their development and their way of life profoundly.
Childhood Integration
The closing of the oedipal period brings a consolidation of the child’s personality. The child now first achieves a fairly firm integration as an individual. Even though personality development is far from completed at five or six and many significant influences will still accrue before a firm integration and a stable identity are achieved, we must examine the paradox and the nature and extent of the organization that has occurred.
Life Patterns
Out of the multiplicity of factors that enter into the shaping of a life, resultant patterns of living and relating emerge.
The Juvenile
The entrance into school is symbolic of the crucial issues of the period. Children now move into the world beyond the home and must begin to find their places in it, and in so doing their self-concepts, value systems, and cognitive capacities change.
Personality Development and Physiological Functioning
We cannot understand human functioning without a clear appreciation of how emotions and physiology are inextricably interrelated, and how individuals’ personality development influences their body structure and can even determine what constitutes stress for them and creates strains on their physiological apparatus.
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