Psychodynamic Psychiatry最新文献

Charles Darwin's theory of evolution was founded on the core belief that natural history is one of slow, incremental change, a concept he called "speciation." A hundred years later Eldredge and Gould challenged Darwin's theory, arguing that the data of paleontology reveals something quite different: long periods of stasis followed by bursts of change, a concept they called "punctuated equilibria." This article will follow that progression and then describe the three punctuated equilibria that I believe led to Homo sapiens. I argue that two of the three transitions are revealed in the hard data of the fossil record. The third is in the soft tissue of the brain. This third punctuated equilibrium placed Homo sapiens outside of evolution. Its arrival, 50,000 years ago, marked the beginning of the end of evolution.

Erik Erikson gives us a comprehensive psychosocial schema encompassing the life cycle from birth to death. In elucidating key issues at each life stage-the epigenetic crises-he defines important parameters of development that distinguish between the normative and the pathologic. Individuals at any developmental stage can be evaluated with respect to these fundamental milestones.

This article presents the findings of an ongoing supervision group (founded in 1999) researching the after-effects of the Nazi period on people in psychotherapy in Germany today. The unacknowledged collective shadow hidden behind half-truths, prevarications, and silence itself prevents a genuine working through of the Nazi past. Patients' lack of knowledge concerning their families' own past leads to unconscious guilt, which often then leads to psychosomatic disturbances. But this is not only a problem in Germany. Unacknowledged collective shadows are prevalent in many countries worldwide. Psychological difficulties on the individual and societal levels result.

Il crescente numero di adolescenti con identità di genere non conforme sembra essere associato a quello che gli autori considerano essere, in epoca contemporanea, una manifestazione del fenomeno della crisi d'identità dell'adolescente. Questa si presenta con un deliberato rifiuto del proprio genere e con una rivalutazione dei ruoli e delle norme di genere convenzionali. La crisi d'identità dell'adolescente, così come inizialmente concepita da Erik Erikson (1956), costituisce un fenomeno poliedrico inconscio che si manifesta nel contesto familiare e sociale. Gli autori conducono una revisione storica della terminologia pertinente, seguita dalla presentazione di quattro casi clinici, selezionati al fine di illustrare questo fenomeno ed i conflitti familiari che comunemente ne derivano. Successivamente, viene riportato un caso clinico specifico che concerne il processo di valutazione clinica, la diagnosi psicodinamica, le considerazioni sul trattamento psicoterapeutico ed il lavoro con i genitori. Sono inoltre citate le fonti di informazione disponibili per i pazienti e per le loro famiglie. Al fine di proteggere la privacy e la riservatezza dei pazienti, i casi clinici sono raccontati in modo combinato. Infine, gli autori concludono l'articolo con un invito rivolto alla comunità scientifica a condurre indagini prospettiche a lungo termine su questo nuovo fenomeno clinico.

When Covid-19 was declared a pandemic, most people felt helpless, fearful, and demoralized while health care workers put their own lives at risk to support and heal others. The uncertainties expressed by experts and the ambiguous and protracted nature of the pandemic compounded the sense of frustration caused by the scarcity of protective equipment and effective medications. This combination of factors led to exhaustion, burnout, and moral injury. As a result, mental health practitioners worldwide realized that health care staff needed to stay motivated and resilient. Our contribution in this regard was to start Balint groups throughout Iran, online, for a full year. We learned some lessons worth sharing. Our insights were wrapped around challenges but proved helpful to preserve the integrity of delivering medical services in times of crisis.

In many academic centers a generation of psychiatrists has undergone training with little or no exposure to Freud's contributions to our profession. Our profession is diminished if we ignore Freud's remarkable insights into the human psyche. Not only does Freud give us a comprehensive theory of human nature-of our mental life and its psychopathology-his concepts are foundational to dynamic psychiatry and its psychotherapeutic application. This article describes one of his core concepts: Freud's theory of anxiety.

Indonesia, a country with a vast population of approximately 275 million people on over 17,000 islands, currently has 1,221 psychiatrists nationwide. Psychodynamic psychiatry and psychoanalysis are integral to the practice of psychiatry in Indonesia, primarily because of the charismatic influence of Bachtiar Lubis, who trained in Canada in the early 1960s. Upon his return to Indonesia, Bachtiar Lubis supervised a generation of psychiatrists, including two of this article's authors, who carried on his pedagogical work. The psychodynamic model and treatments have faced obstacles limiting their acceptance in Indonesia, including importing a Western model that has not been culturally adapted to treat patients in the East, the stigma of mental illness in local communities, and the complex comorbidities of persons who seek psychiatric care. Psychodynamic psychotherapy in Indonesia is presently taught in university-based residency programs for eight semesters. A psychodynamic psychotherapy competency-based curriculum was adopted nationwide. The dissemination of psychotherapy knowledge and skills is greatly assisted by an active psychiatric professional association-the Indonesian Psychiatric Association Psychotherapy Section, a member society of the World Federation for Psychotherapy. The authors propose international and regional academic collaborations to maintain enthusiasm among trainees and improve quality of care.

The experience of patient suicide can have a profound impact on clinicians, yet there are limited opportunities for them to express and process their emotional responses. We organized a reflective group session for psychiatrists in Singapore who had encountered patient suicides. Ten psychiatrists participated, with five in the "inner" group (those who had experienced patient suicide) and the remaining five forming the "outer" group. Led by a senior psychiatrist trained in psychodynamic psychotherapy, the inner group shared their reflections on patient suicides, while the outer group provided their insights thereafter. Participants provided written feedback about their session experiences. The session was recorded, transcribed, and analyzed to identify key themes. Three main narrative themes emerged from the analysis. Firstly, there was the acute response to the suicide, involving intense emotional reactions. Secondly, the relationship between clinicians and patients with suicidal thoughts was explored, encompassing countertransferential responses, superego defenses, and resulting anxiety. Lastly, the study examined how clinicians feel about suicidality itself, shedding light on complex attitudes and perceptions. Our findings confirm previous research, indicating that the response to patient suicide is stressful and traumatic for clinicians, who grapple with emotions such as grief, guilt, incompetence, and fear. Moreover, we delve into the intricate connections clinicians have with the concept of suicidality, shaped not only by their own experiences but also by the insights of those who have yet to confront patient suicide. The reflections shared by the participants emphasize the significance of establishing therapeutic spaces for clinicians to process these complex emotions effectively.

Burdening guilt refers to the belief that one's emotions, needs, and ways of being are a burden to others, and is one type of interpersonal guilt proposed by the control-mastery theory (CMT). The aim of this article is to validate two new measures of burdening guilt. In the two studies conducted, we examined the psychometric properties of these scales and the relationship between burdening guilt and self-perceived burden (burdensomeness), self-esteem, shame, anxiety, depression, mental health, attachment insecurity, adverse childhood experiences, social desirability, empathy, and suicidal ideation. In Study 1, we presented a newly developed Burdening Guilt Rating Scale (BGRS) and its correlation with measures of the abovementioned dimensions. In Study 2 we verified, through confirmatory factor analysis and correlation techniques, the possibility of expanding the Interpersonal Guilt Rating Scale-15 with a shorter, 5-item burdening guilt scale derived from the BGRS, and showed that this shorter scale correlates similarly to the longer one. Findings allowed us to validate these new scales providing empirical measures of burdening guilt-a theoretical concept with important clinical implications.