Psychodynamic Psychiatry最新文献

In transference-focused psychotherapy (TFP), an evidence-based treatment for patients with borderline personality disorder (BPD), the attention paid to establishing and tracking goals is both organizing and distinctive. The objective of this article is to describe TFP's unusual emphasis on first elucidating and then focusing on a patient's concrete, measurable personal goals. We review the critical distinction between the patient's goals and the therapist's goals. We also provide pertinent examples of material related to goals in TFP. The examination of the role of goals in the treatment of patients with BPD has significant salience given accumulating data that suggests that symptom remission does not reliably lead to enhanced functioning (sustained work/study performance, stable relations with a partner or parents) in this patient population.

In this issue of Psychodynamic Psychiatry, we publish the clinical article "Older Psychodynamic Psychiatrists: Practice Metrics and Subjective Observations," by Douglas Ingram and Myron Glucksman. The authors queried in depth a convenience sample of 20 psychodynamic psychiatrists 65 years of age or older who were still actively practicing and reporting deep satisfaction. A similar unpublished study by Judith Kantrowitz of psychoanalysts in the same age group found high degrees of investment and engagement in their survey participants. The editors commend these carefully and vividly described studies. We note that more attention needs to be paid to outcome in longtime patients who lose their psychodynamic or psychoanalytic clinicians to illness or death, in alignment with the bioethical principles of beneficence and nonmaleficence. A professional will is recommended to all clinicians, not just those beginning at 65, since sudden, unexpected inability to work may affect psychodynamic psychiatrists and psychoanalytic clinicians at any age. Patients may for a variety of reasons be uniquely vulnerable to unresolved grief reactions or other negative sequelae from disruptions in this important care.

Paleologic thinking, a prelogical mode of reasoning described by Silvano Arieti, is characterized by emotion-driven, retrospective reasoning and has been observed in severe mental illnesses such as schizophrenia. The author explores its relevance to borderline personality disorder, an area that has been historically understudied. Patients with borderline personality disorder often regress into paleologic modes of thought during interpersonal distress, resulting in illogical conclusions driven by feelings rather than evidence. It is argued that this process underlies symptoms of paranoia, misperceptions of rejection, and interpersonal dysfunction. Historical perspectives linking borderline personality disorder and schizophrenia, as well as empirical findings from unstructured psychological tests, highlight overlaps in thought disorders between the two conditions. Clinical implications suggest that addressing paleologic thinking can improve treatment outcomes. Structured psychotherapies, such as transference-focused psychotherapy and dialectical behavior therapy, offer pathways to target and mitigate the impact of this pathological reasoning process in patients with borderline personality disorder.

Greenland, the world's largest island, is home to approximately 57,000 people. Given the country's vast area and sparse population, the provision of psychiatric services can be challenging. Telemedicine and coastal visits contribute to the accessibility of psychiatric care outside of the capital, Nuuk, where the country's only psychiatry ward is located. Other specialty psychiatric services are provided through collaboration with hospitals in Denmark. One of the major challenges faced by Greenlandic psychiatry is high staff turnover, including a lack of permanent consultant psychiatrists. Considering the need for psychiatric services, as well as the world's highest suicide rate, Greenlandic psychiatry confronts a unique set of clinical challenges as it explores creative solutions tailored to its specific sociocultural needs. The author shares his personal experience having worked as a psychiatrist in Greenland.

Mentalization-based therapy (MBT) formulates eating disorders as disorders of the self. This article examines the meaning of self-hatred and self-directed negativity as manifestations of self-alienation and vulnerable mentalizing. Relevant concepts are examined to substantiate MBT as a clinical approach to negative self-representations and epistemic mistrust. In this context, MBT states that a clinician's not-knowing stance is crucial to help elucidate underlying states of mind. Additionally, representing the patient as possessing an agentic-self is seen as crucial to the generation of curiosity about rigidified definitions of the self. Clinical vignettes are provided, and guidelines relevant to clinical practice are proposed.

A survey of 20 older psychodynamic psychiatrists was conducted to determine practice metrics, venues of clinical care, and clinician's subjective observations. The post-pandemic normalization of teletherapy, societal acceptance of psychoactive medication into the practice of psychotherapy, significant advances in medical care for older persons, and increased utility of computer technology have enabled clinicians to work into their later years. The integration of supportive therapeutic techniques with psychoanalytic principles coupled with long-term weekly or biweekly treatment has largely replaced intensive formal psychoanalytic therapy of an earlier era. How aging may impact the therapeutic relationship and matters of health and mortality may need to enter the therapeutic dialogue. Minor deficits in cognitive function may be offset by note-taking and session reviews. The benefits of wisdom and experience often unburdened by the demands of earning a livelihood or furthering professional ambitions may render care by secure older psychodynamic psychiatrists effective.

This study investigated the relation between defense mechanisms and Dark Triad traits using a cross-sectional correlational design with a sample (N = 307) recruited online using the Prolific platform. We hypothesized that immature defense mechanisms would positively correlate with the so-called Dark Triad traits of narcissism, psychopathy, and Machiavellianism. We found this hypothesis supported for psychopathy and Machiavellianism, but not narcissism. Instead, we found that mature defense mechanisms were positively correlated with narcissism. Our findings partly replicate previous research on this topic by Jonason and colleagues and Richardson and Boag.

This article immerses the reader in the psychoanalytically oriented psychotherapy of an adult patient suffering from extreme loneliness. It describes healing that occurs slowly and involves the psychotherapist's active searching-through historical research, dreaming, and countertransference-to locate and recognize the patient. It demonstrates how the confluence of personal history with larger sociohistorical forces can be revealed through enactment in the transference and countertransference.

Introduction: This study investigated the relationship between illness anxiety and interpersonal guilt as conceived in control-mastery theory. Additionally, we explored how illness anxiety symptoms relate to general anxiety, depression, alexithymia, autonomic nervous system reactivity, personality functioning impairment, sociodemographic factors, and childhood experiences. Methods: A sample of 201 participants completed measures of illness anxiety (Health Anxiety Questionnaire), interpersonal guilt (Interpersonal Guilt Rating Scale-20s), anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory-II), alexithymia (Toronto Alexithymia Scale-20), personality dysfunction (Level of Personality Functioning-Brief Form 2.0), and autonomic nervous reactivity (Body Perception Questionnaire-22). Sociodemographic and childhood traumas and adverse experiences data were collected via an ad hoc questionnaire. Results:. Individuals with worried and autonomy-limiting caregivers reported higher levels of illness anxiety. Correlation analyses revealed significant positive associations with illness anxiety and all the variables measured. As expected, partial correlation demonstrated that separation/disloyalty guilt and burdening guilt are the most associated with illness anxiety symptoms. Unexpectedly, however, survivor guilt lost significance when controlling for other types of guilt. Hierarchical multiple regression identified anxiety as the strongest overall predictor of illness anxiety, followed by separation/disloyalty guilt and bodily reactivity indices. Discussion:. This study suggests that interpersonal guilt may be a key component in sustaining illness anxiety symptoms in anxious people. In particular, the interplay between anxiety, separation/disloyalty guilt, and autonomic overreactivity appears to contribute to illness anxiety concerns and behaviors. Working on these aspects may be essential for positive long-term outcomes of psychotherapy.

Objective: Countertransference research has demonstrated the importance of countertransference management for successful therapy outcomes. In this study we expand the notion of countertransference management by investigating the relationship between countertransference experienced within sessions and the elaborative activity taking place between sessions. Method: Twenty-three in-training psychotherapists were asked to rate their emotional reactions through the Therapist Response Questionnaire at the end of 69 counseling sessions and to complete a Post Session Therapist Questionnaire, an instrument assessing three relevant reflexivity activities in the post-session time. The 69 sessions were also recorded, transcribed, and evaluated by three external raters, who applied the Countertransference Behavior Measure. Results: Results showed significant correlations between some dimensions of countertransference experienced in the session and some dimensions of the therapists' post-session working through. Conclusion: Our results highlight the centrality of therapists' in-between session reflexivity processes in addition to awareness of countertransference within sessions, a process that has a potential impact on therapeutic outcomes.