Psychodynamic Psychiatry最新文献

The request for hastened death by patients with psychiatric disorders poses a professional conundrum for psychiatrists. Issues of transference and countertransference loom large in such situations. Primitive defense mechanisms, particularly projective identification need to be addressed in understanding the request.

The impact of intense countertransference affects in working with patients experiencing complex trauma can have a critical effect on decisions about euthanasia, especially when such decisions are made solely on the grounds of a psychiatric condition. These countertransference dynamics become particularly significant in the context of the rising number of euthanasia requests by psychiatric patients in the Netherlands. We contend that for a subgroup of patients with complex trauma, attachment trauma, and personality disorders, the label "treatment-resistant" may be applied prematurely and incorrectly. This may occur when highly complex transference-countertransference dynamics are not properly assessed, and tertiary treatment options like intensive short-term dynamic psychotherapy (ISTDP) are not considered, particularly in cases of chronic and severe childhood trauma leading to an unconscious reservoir of murderous rage that is directed at the self. A long-term therapeutic relationship can activate unconscious transferences, leading to the reenactment of previous attachment trauma. We propose that assessments for euthanasia must include a psychological analysis of the unconscious transference, enactment, and countertransference involved. This article presents a hypothetical case example to illustrate how a patient labeled as "treatment-resistant" can be supported through a psychodynamic formulation and proposes further pathways for clinical decision-making.

This introduction to the special issue on mentalization-based treatment (MBT) with children, adolescents, and families highlights a range of conceptual and clinical contributions that illustrate the richness and usefulness of applying developmental and family systems perspectives to an MBT framework to alleviate the plight of young people and their parents.

This article reviews an approach to working with families that grounds in systemic thinking the framework of mentalization-based treatment. Employing a mentalizing stance, this approach aims to interrupt coercive, nonmentalizing cycles of interaction within the family system and replace them with mentalizing conversations in which epistemic trust and the shared social-emotional learning of the we-mode can be generated. The process thus promoted is a spiral of shared attention and co-mentalizing, constantly lost and then recovered, in which therapist and family members learn to hear, recognize, understand, and trust one another and repair the inevitable disruptions in mentalizing and trust that allow family members to experience a way of shared knowing- the we-mode-that they can apply to communicate and solve problems both within the family system and in the broader social systems in which the family is embedded.

Epistemic trust-trust in the relevance and utility of social learning-is central to helping processes between clients and workers in helping services. Yet, due to their experiences, clients may adaptively develop predispositions toward stances of epistemic mistrust or epistemic credulity. From an AMBIT (adaptive mentalization-based integrative treatment) perspective, this article argues that epistemic mistrust and credulity are both caused by social injustice and generate further social injustice. Helping services commonly respond in ways that fail to acknowledge this social injustice and, perversely, deliver further injustice still. Our primary focus is how these issues relate to work with clients, but we argue that they are present in work within AMBIT's other foci, too: in teams, multiagency networks, and learning. We conclude that workers and helping services have a moral duty to recognize and attend to the multiple social injustices associated with epistemic mistrust and credulity.

In this article we describe the structure and technique of mentalization-based therapy for adolescents (MBT-A), an evidence-based intervention that has shown effectiveness in helping young people with self-harm, borderline personality, and depression. We describe also the differences between MBT with adults and MBT-A, which primarily focuses on the developmental aspects of adolescence. The developmental trajectory of adolescence culminates in a coherent and consolidated sense of self. Mentalizing provides the main supporting socio-cognitive-emotional process for achieving a coherent sense of self and, consequently, authentic and rewarding intimacy, making its evolutionary relevance clear and underscoring the importance of scaffolding this critical process during adolescence, regardless of diagnosis or therapeutic modality. We further argue that mentalization is a central mechanism by which personality functioning is achieved. In our view, mentalizing can be seen as a cross-diagnostic feature common to all personality pathology and, arguably, all psychopathology. This broadens the relevance of MBT-A beyond its original remit of self-harm and borderline personality disorder and identifies the enhancement of mentalizing and epistemic trust as a common factor in all psychotherapies that support adolescents through a challenging but critical developmental period. As such, mentalizing can be viewed as the property of all good psychotherapy.

This article presents a mentalization-based treatment (MBT) framework for working with parents that fosters the emergence of mentalization in a context grounded in relational and developmental points of view. A basic premise of this framework is that mentalization and epistemic trust provide protective factors for parents during moments of family stress, promoting the parents' capacity to negotiate the developmental tasks of parenting, as these tasks interact with both their inner world and the external realities of an ethnically and racially diverse, gendered culture.

This article seeks to further specify how the mentalization-based approach may inform clinical intervention before the onset of psychosis, that is, during the stage of clinical high-risk for psychosis (CHR-P). We first review the concept of CHR-P, as well as the research evidence of the impact of early intervention. Next, we present evidence for the centrality of mentalizing as a process that may mitigate the risk for psychosis. We then review some of the key contributions in the psychoanalytical and phenomenological traditions concerning the centrality of core self disturbances in psychosis, and relate this to the alien self concept put forward in the mentalization framework. This leads us to expand on the structure of MBT for CHR-P, and to present a clinical vignette illustrating the process of epistemic trust at beginning of an intervention with a young person suffering from CHR-P. We summarize the links between core self disturbances, epistemic trust, and therapeutic communication in the context of CHR-P.