Psychodynamic Psychiatry最新文献

For decades, diplomats and psychoanalysts have applied psychoanalytic theories to international relations. Their collaborations have led to the creation of Track II diplomacy, defined as unofficial meetings among people with access to policymakers. Track II diplomacy illuminates psychological barriers to negotiations by clarifying negotiators' defense mechanisms and communication styles. Track II diplomacy assumes a desire to negotiate, but differences in expectations among negotiating parties can interrupt negotiations. This Perspective suggests that conceptualizing interruptions through the psychoanalytic impasse can introduce novel ways to resume negotiations. I draw on experiences with India-Pakistan Track II diplomacy.

The meaning of being adopted is a process that needs to be reworked throughout the life cycle. Therapists ought to be familiar with the concerns that are pertinent to patients who are adopted but must be careful not to place adoption at the center of the therapy if this is not why patients are seeking help. The object relations of the adopted person will play an important role in therapy, given that the person has two sets of parents, one real and another that may exist only in fantasy. The most commonly reported negative self-representations of patients in treatment who are adopted include feelings of being unwanted and therefore undesirable. In patients in which adoption plays a central role, there are seven core issues that can be used as a guideline in psychotherapy with an individual affected by adoption: loss, rejection, guilt and shame, grief, identity, intimacy, and control. It is very difficult to predict the risk for psychopathology and long-term outcomes of adoptees because of the many variables and their complex interplay, yet research findings reveal that the majority of adoptees are functioning well. Research studies support the advantage of adoption over placement in foster care, in institutions, or with uncaring, abusive, or neglectful biological parents.

Some patients, especially those encountered early in one's career, become emblazoned in memory. Such was the case for this author with Rudy. His is a moving story by virtue of who he was and what happened to him. From him, I learned of the potential for deeply mutative work with medically ill patients, even in the context of infrequent meetings. I learned how and why in supportive, dynamically oriented therapy, there are times when bending the frame is essential. Rudy taught me-and my students-how important the "art" of medicine is and about the potential for "healing" even in the absence of cure. His story conveys the deep psychological impact of childhood illness and demonstrates the potential to reverse some of that impact when illness is encountered once again in adulthood. The theme of the "music" of the consulting room provides an organizing metaphor for the dialectic of spontaneous, emotionally engaged responsiveness and disciplined restraint that optimally characterizes dynamic psychotherapeutic work.

This invited Editorial provides a commentary on Jenifer Nields's article published in the Narrative Medicine section of this issue of Psychodynamic Psychiatry. The author, who is familiar with Nields's clinical work and pedagogical skills, reflects on countertransference awareness and harmonious alignment of psychotherapeutic technique oscillating along the supportive and psychodynamic spectrum to better serve the needs of complex and challenging patients. He further emphasizes the importance of exploring spiritual and religious dimensions when relevant in therapeutic encounters.

This year marks 50 years since John Gunderson and Margaret Singer identified borderline personality disorder as a distinct psychiatric disorder, yet the history of the syndrome predates this pioneering work by several decades. Undoubtedly, the evolution of the borderline personality disorder construct occupies a position of great importance in the history of psychiatry; debates surrounding its nature, etiology, and diagnosis continue to fill the pages of psychiatric and psychotherapy journals around the world. This article seeks to provide a brief overview of the history of borderline psychopathology, from early descriptions of "borderline schizophrenia" to Gunderson's identification of borderline personality disorder and beyond. It focuses mainly on the evolution of psychoanalytic models of borderline personality disorder, including work by theorists such as Kernberg, Masterson, and Adler, but also covers Linehan's development of dialectical behavior therapy and more recent discussions regarding the relationship between borderline personality disorder and complex trauma. We argue that understanding the history of borderline personality disorder can enrich contemporary practice and inform current discussions regarding the disorder's nosological status.

Traumatic shame is a source of deep psychological suffering and can become so pervasive that it hinders the possibility of a life worth living. Furthermore, it represents a complex treatment challenge in psychotherapy. Drawing from the perspective of control-mastery theory (CMT), we elucidate how traumatic shame can stem from processes of compliance with negative parental messages or identification with traumatizing caregivers. Additionally, traumatic shame can manifest as self-punishment motivated by guilt. In the first part of the article, we focus on the main features of traumatic shame and describe its origins, pathogenesis, and psychopathology manifestations through recent empirical research studies. In the second part, we explore how CMT offers a comprehensive framework for understanding and treating traumatic shame, particularly in severely traumatized patients. Finally, a clinical vignette illustrates the application of CMT in psychotherapy, showing how therapists can navigate the complexities of traumatic shame and promote the achievement of a more fulfilling life.

Transcranial magnetic stimulation (TMS) is an established treatment for mood disorders, yet its relevance to psychodynamic psychotherapy remains underexplored. This conceptual article integrates neuroscience and psychoanalytic theory to examine how TMS may influence insight and affect regulation and the therapeutic relationship. By enhancing neuroplasticity, TMS may reduce resistance and support deeper emotional processing, potentially increasing receptivity to psychodynamic work. At the same time, neuromodulation may alter transference dynamics and perceptions of the therapeutic alliance. The article also explores how the treatment environment, including sensory input, relational context, and the symbolic role of the TMS provider, shapes psychodynamic engagement. A dedicated section outlines what a psychodynamically informed TMS setting may look like. Rather than viewing TMS as solely biological, the article proposes an integrative model in which neuromodulation and psychodynamic therapy are mutually reinforcing, emphasizing the importance of setting, psychoeducation, and relational attunement in maximizing therapeutic impact.

Introduction: Intensive short-term dynamic psychotherapy (ISTDP) focuses on emotional processing and the resolution of internal conflicts. This randomized pilot and feasibility study evaluated the implementation of a novel 12-week group program based on ISTDP model, and compared clinical outcomes in reducing symptoms associated with personality vulnerabilities (e.g., emotion regulation, self-harm). The setting of the study was an Australian Public Hospital Service. Methods: Participants were referred to a brief intervention service for personality disorders and were randomly assigned to either the ISTDP group or the dialectical behavior therapy (DBT) group. Outcome measures included questionnaires assessing mood and distress, emotion dysregulation, disassociation, and DBT skill use. Feasibility outcomes, such as recruitment, attrition, and potential participants' experiences of the therapy, were also evaluated. Results: A total of 15 participants were recruited, with nine randomly allocated to the ISTDP group and six to the DBT group. Both groups showed improvements in clinical symptoms, including reductions in depression, emotion dysregulation, and dissociation. The ISTDP group also demonstrated a reduction in anxiety and stress. Follow-up surveys indicated that participants found both group interventions relevant, useful, and beneficial for managing their thoughts and emotions. Conclusion: Both the ISTDP and DBT interventions were well received by participants, and no adverse events were reported, further supporting their potential for implementation in public hospital settings and feasibility.

In 2021, in the wake of rising anti-Asian violence in the United States and abroad, we piloted a group psychotherapy intervention for Asian American and Pacific Islander (AAPI) patients in the outpatient services department of McLean Hospital. The group, which lasted 12 weeks and took place virtually, included five group members and combined an interpersonal process group psychotherapy approach with the multicultural orientation framework. In this article, we discuss the intervention design as well as three key clinical vignettes from the group that challenged fundamental assumptions about ourselves as Asian American therapists and about the creation of a group that centers race, culture, and mental health. In particular, through discussion of the vignettes, we explore three scenarios that group therapists may face when facilitating similar multicultural groups: (1) drawing on notions of racial melancholia and racial dissociation, how to manage intragroup conflict between individuals with starkly different relationships to race and racial identity; (2) how to respond to intersectional microaggressions occurring between group members within a multicultural framework; and (3) where to draw the limits of psychodynamic approaches to psychotherapy in multicultural settings. Ultimately, we find that clinical encounters cannot be divorced from the histories and institutions that frame those encounters. Failure to recognize the impacts of such historical and institutional forces on clinical work risks perpetuating the inequities seen in mental health outcomes for AAPI individuals and communities.

Reflecting on early-career experiences working with patients with severe personality disorders in a therapeutic community, this article explores the counter-transference challenges faced by novice clinicians. I discuss how intense patient projections can activate unresolved conflicts within therapists, often influencing their clinical responses. Countertransference is examined as a co-created experience shaped by both therapist and patient dynamics. Emphasizing the importance of self-awareness, personal analysis, and supportive environments, this perspective offers insights to help early-career clinicians manage the unique emotional demands of working with personality pathology.