How to make a daily clinical practice with various restrictions more psychotherapeutic is a very important challenge for clinicians. From my clinical experience, considering quality of life of patients, supporting natural recovery from an illness and doing non-invasive practice are the important basic attitudes. Based on these attitudes, I picked up ten practical points that I care during my daily clinical practice. Through daily clinical practice, continuous challenge to offer better psychotherapy is desired.

Seven factors in regard to motivation for marriage have been discussed; namely love, identity completion, procreation, sexuality, feeling of security and escapism, social and parental pressure, and unconscious needs. Next, we discuss the disappointment when each married individual does not receive what he/she is hoping for from his/her partner and the setbacks when the children in such a marriage reach adolescence. Finally, as a component of handling families with adolescent children, we discuss how to counsel parents who have realized that their children are experiencing difficulty in some area.

As a basic concept, all medical treatments are based on therapeutic relationships. However, in psychiatric clinical practice, as we are dealing with patients who have difficulties in maintaining stable collaborative relationships due to their psychopathology, we need to be especially cautious about this point. For this reason, construction and maintenance of therapeutic relationship are important factors of psychiatrists’ expertise, though those aspects have not been valued rightly in the training of psychiatrists in Japan. As a psychoanalyst who is also continuing psychiatric practice, I would like to give an overview first, of how psychoanalysis is focusing on therapeutic relationship itself as the target of treatment, and then would like assert that the knowledge that psychoanalysis has been cultivating for a long time has the possibilities of providing useful perspectives towards good relationships in the psychiatric practice. In particular, those perspectives include 1) becoming conscious about the setting, 2) understanding the patient by using one’s own mind, 3) touching upon the patient’s feelings by verbal communication and 4) perceiving the patient as a person with his/her own unique history.

Cognitive behavioral therapy (CBT) is a form of psychotherapy that improves dysfunctional cognition and enhances the ability to manage problems in daily life. Not only CBT techniques, such as behavior activation, cognitive restructuring, and problem solving but also case formulation and therapeutic relationship are important in CBT, which is useful for psychiatrists who works at a general hospital.

Purpose: Depression during pregnancy can have clearly harmful effects on both mothers and children. It is necessary to examine the factors associated with depressive symptoms in order to better understand pregnant women, which could then lead to improvements in obstetrics and general hospital psychiatry. Because previous studies have examined women in late pregnancy, the present study examined relevant factors of depressive symptoms in mid-pregnancy. Methods: Pregnant women between 12-23 weeks’ gestation and aged ≥ 20 years were recruited at Tokyo Medical University Hospital from April 2014 to September 2014. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Results: Among 369 eligible pregnant women, 72 participated in the study. In multivariate logistic regression analysis, depressive symptoms were significantly associated with psychiatric history and unplanned pregnancy. Conclusion: Depressive symptoms during mid-pregnancy were associated with psychiatric history and unplanned pregnancy among pregnant women who visited a university hospital. We recommend that multiparas as well as primiparas be asked about unplanned pregnancy in clinical settings. Due to some major limitations, further studies are needed to replicate our findings.

Introduction: Living-donor liver transplant (LDLT) donors have been reported to experience various psychological problems. A number of case reports have investigated the relationship between the physical status of recipients and the psychological and physical perceptions of donors. The aim of this study is to statistically clarify this phenomenon. Methods: In this cross-sectional study, 167 persons who underwent a pediatric LDLT donor operation from 1 to 10 years ago were surveyed with Short Form-36 (SF-36), a self-administered evaluation scale for quality of life. Information about recipient outcomes was gathered for the 117 participants from whom valid responses were received, and the presence of any relationships were investigated. Results: The donor was the recipient’s mother in 50.4% of cases and the recipient’s father in 46.2% of cases. In 76.9% of cases, the recipient progressed favorably; in 19.7% of cases, postoperative complications occurred; and in 3.4% of cases, the recipient died. The mean scores for all of the eight sub-items of SF-36 (physical-functioning, role-physical, bodily-pain, general-health-perception, vitality, social-functioning, role-emotional, and mental-health) were all better than national averages. However, general-health-perception, a scale for physical health, was lower in cases where the recipient developed postoperative complications, and mental-health was lower for cases where the recipient died (p < 0.05, Steel-Dwass method). Conclusions: The results suggested that donors experience the recipient’s poor physical condition as their own (the ‘Siamese-twin’ effect). Furthermore, it seems that psychosomatic problems may develop in response to poor outcomes in recipients, indicating the necessity of offering mental support.