RT Book, Section A1 Nash, James L. A1 Lomax, James W. A2 Ebert, Michael H. A2 Loosen, Peter T. A2 Nurcombe, Barry A2 Leckman, James F. SR Print(0) ID 3282230 T1 Chapter 11. Psychodynamic and Social Interventions T2 CURRENT Diagnosis & Treatment: Psychiatry, 2e YR 2008 FD 2008 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-142292-5 LK accessmedicine.mhmedical.com/content.aspx?aid=3282230 RD 2024/03/28 AB Many medical and perhaps most psychiatric conditions cannot be eradicated totally. The affected individual must often learn to manage a protracted or chronic condition. The scope of medical, surgical, and psychiatric intervention is therefore appropriately not limited to acute pathologic states in which a definitive therapy is applied and the person is restored to perfect function. Humans are subject to a multitude of adverse influences, both external and internal. Whether these adverse influences are from bad luck, bad genes, bad environment, or simply the effects of aging, suffering is inherent in the human condition, and the individual must learn to manage personal suffering. It is appropriate that physicians provide others with assistance in the management of suffering. Analogously, psychotherapy often is focused on modifying the patient's overall pattern of adaptation to life (personality). As Cloninger and others (1993) note, personality is best considered as an interactive combination of factors that are gene-based and relatively immutable with factors stemming from the nonshared environment. While the expressive psychotherapies may make some modifications in character as defined, there is very little that a psychological intervention can do to alter the gene-based expressions, which are conceptualized as “temperament” (novelty seeking, harm avoidance, reward dependence, and persistence). Thus, the psychotherapist must help the person accommodate to the more gene-based temperaments so that they are expressed in ways that create less havoc or irritation for the person's relational world.