Psychodynamic Psychiatry最新文献

For health care professionals, especially psychiatrists, retirement is not a narrowly defined process. Retirement only means the end of a specific work-related job. It is closely related to aging although the impact of aging on the body and mind varies. In recent decades, there has been growing focus on healthy aging, which is associated with continued professional activity. This article summarizes retirement-related personal experiences described by four psychiatrists who are clinicians and academicians from diverse backgrounds. Three of us have technically retired from our previously titled specific jobs, but all remain markedly active as psychiatrists. Each has a sense of purpose, continues to be productive, and maintains close, positive connections with colleagues and community. The fourth and youngest of us is at least a decade away from retirement and plans to continue life's thrilling journey delightedly. Our experiences exemplify how retirement does not require a health care professional to abandon other vital aspects of their lifelong professional activity and identity, such as learning, helping, serving, caring, reading, writing, teaching, discussing, and understanding. Psychodynamic and positive orientations in particular lead to a strong belief in the need to be an active and compassionate member of the community who helps promote one's own as well as others' well-being. The so-called retirement provides a psychiatrist with the opportunity to ponder, deepen, and savor the adventure of living within the context of an exceptionally broad range of experience with the human condition.

Dissociative identity disorder is a complex condition associated with severe trauma and disrupted attachment. This case report describes a young woman initially diagnosed with borderline personality disorder and major depressive disorder, later rediagnosed with comorbid dissociative identity disorder. This report details her treatment course with psychodynamic psychotherapy complemented by secondary strategies such as breathing and relaxation exercises. Prognostic implications are discussed, emphasizing how a diagnosis of dissociative identity disorder reshaped her treatment plan. The authors explore the psychodynamics of dissociation and its relational foundations, incorporating perspectives from Chefetz alongside other contributions to the understanding of dissociative identity disorder.

Transference-focused psychotherapy (TFP) is a modified form of psychoanalytic psychotherapy grounded in object relations theory. It was developed to treat borderline personality disorder but has been used with a broader range of personality pathology. Notable adaptations include establishing an explicit treatment contract; a grounding in the domains of work, intimacy, and creativity rather than strict free association; a more formalized structure for training and supervising therapists; and a staged approach to interpretation that focuses sequentially on the elucidation of dominant object relations dyads, role reversals, and in later stages insight into dyadic layering and unconscious motivations. This article suggests that, whereas the existing literature on transference-focused group psychotherapy (TFP-G) emphasizes the use of group-as-a-whole interpretations, the clinical application of TFP principles in group psychotherapy for personality pathology could draw from TFP's approach to interpretation in individual therapy to elaborate a range of interventions that could be deployed according to patient needs and abilities. This flexible approach could remain compatible with the object relations model of borderline personality organization elucidated by Kernberg, while drawing upon the strategies, techniques, and tactics of individual TFP to equip group therapists with a broader array of tools than have been proposed thus far. Doing so would improve the model's ease of application, enhance flexibility, and mitigate potential drawbacks of group approaches emphasizing whole-group interpretations. Such adaptations could be useful to TFP-G therapists per se and group therapists with an integrative approach.

In this brief clinical review, I examine misophonia as a relational phenomenon rather than just a sensory or neurological problem. I highlight the primacy of sensory reception in early development. Psychodynamic formulations of misophonia describe it as a manifestation of disgust, fear of mental contamination, and interpersonal violence. I offer a brief literature review, and reconceptualize misophonia as a disruption of intimacy through perceived relational violence and breach of relational boundaries. I encourage clinicians and researchers to reimagine misophonia as symbolic of unspoken conflicts that interfere with intimacy and attunement, with implications for psychoanalytic psychotherapeutic work.

Psychoanalysts resist working with sexual issues in multiple ways. A strategy for modifying one's counterresistance is described, including collecting information about sexuality and gender identity, focusing on the patient's stated aims and wishes, and examining one's biases based on life experiences. Some notable examples of counterresistance in psychoanalytic history are described.

I share my personal journey toward retirement, grappling with feelings of loss, relevance, and legacy, and finding renewed purpose through teaching yoga and learning kirtan. I review core findings about happiness from the Harvard Study of Adult Development, emphasizing that meaningful social connections are central to a good life and healthy aging. Despite having moments of self-doubt and inevitable experiences of loss, I highlight the lasting impact of even small acts of human connection, underscoring the profound importance of social relationships and shared humanity in giving life meaning.

Clinicians working with patients with primary or co-occurring personality disorder diagnoses are often confused about how to work most effectively with patients' families. While there are a variety of well-described interventions for working with families of patients with borderline personality disorder, these options are often unavailable or unaffordable. The goal of this article is to outline a set of simple, commonsense interventions for generalist providers informed by two evidence-based treatments for patients with borderline personality organization or other moderate to severe personality disorder presentations, transference-focused psychotherapy (TFP), and good psychiatric management for borderline personality disorder. Clinicians can benefit from familiarity with the guidance for working with families outlined in these modalities, even if they are not motivated to offer either of these two treatments themselves. The combination of TFP and good psychiatric management elements offers a clear and helpful road map for useful interventions in what can be thorny and complicated situations.

This article aims to give the reader an overview of the concept of omnipotent responsibility guilt, which, according to control-mastery theory (CMT), is the emotional manifestation of a set of pathogenic beliefs that make people believe that if they put their needs in the foreground and do not try to satisfy the needs of their important others, their significant others will suffer. These pathogenic beliefs were generally developed to adapt to early traumatic and adverse experiences, that is, experiences that disrupted the patient's sense of safety in acute, systematic, or chronic ways. In the case of people with omnipotent-responsibility-related pathogenic beliefs, among these experiences, we find parents with physical or psychological problems, parents who were victims of accidents, parents who were separated or were mourning some loss and wanted their children to take care of them, and situations where parents reversed their roles with their children. Omnipotent responsibility guilt correlates with different forms of psychopathology, such as depression, obsessive-compulsive disorders, and anxiety disorders, and with several transdiagnostic features, such as worry and low self-esteem. We describe some clinical exemplifications to show how, according to the CMT, patients with pathogenic beliefs supporting omnipotent responsibility guilt can try to become aware and disprove these pathogenic beliefs and master their traumas in psychotherapy, and how therapists can help them have the corrective emotional experiences they need to get better.

Positive and transcultural psychotherapy is a humanistic and psychodynamic approach that integrates positive psychology principles with culturally sensitive and analytic methods. Rooted in both existential and psychodynamic traditions, positive and transcultural psychotherapy emphasizes the strengths and capacities of individuals across diverse cultural contexts. This study investigated the effectiveness of a structured, 24-session group psychotherapy program grounded in the principles of positive and transcultural psychotherapy. Employing a quantitative experimental design, the study involved two experimental groups and one control group assessed at different time intervals. Outcome measures included life satisfaction, positive and negative affect, depressive symptoms, and psychological distress related to current mental health concerns. Nonparametric analyses (Kruskal-Wallis and Mann-Whitney U tests) were conducted to assess group differences. Findings demonstrated statistically significant improvements in the experimental groups compared to the control group, particularly in posttest scores on negative affect, depression, and psychological discomfort. These results were consistent across both experimental groups. The study provides evidence for the efficacy of positive group psychotherapy within a transcultural framework. The significant reductions in depressive symptoms and emotional distress underscore the clinical value of incorporating strength-based, culturally informed group interventions into psychodynamic practice.

Racial inequities within both heart transplantation and psychotherapy access have been well documented. In this report, we describe the case of a patient from a racially/ethnically minoritized background awaiting heart transplantation for whom panic attacks significantly impacted his quality of life and presented a barrier to transplantation. This case illustrates the novel utilization of time-limited psychodynamic psychotherapy exploring racialized health care dynamics as a precipitant to psychological symptoms. We highlight how racialized treatment experiences can contribute to symptoms of panic directly and indirectly. The case emphasizes the importance of discussions about race, ethnicity, and culture within a therapeutic treatment relationship. We also recommend the use of time-limited psychodynamic psychotherapy as an effective mental health treatment in a medically complex transplant population.