Psychodynamic Psychiatry最新文献

The U.S. Surgeon General, Vivek Murthy, recently declared loneliness a public health epidemic. For therapists, that is not likely to be a surprise: Loneliness is so common in people who seek therapy that it might be seen as the bread and butter of our work. Despite that, there has not been much serious examination of intrapsychic factors that may contribute to this painful condition. Public discourse has focused instead on cultural and societal causes of loneliness, and on practical steps that might be taken to decrease it. But practical advice is not always sufficient for people with longstanding loneliness. Longstanding loneliness may be fueled by intrapsychic dynamics and become embedded in character. In some cases, patients may relish companionship yet steadfastly avoid it in an attempt to master early childhood experiences of being emotionally neglected and deprived of love. They were starved of love as children and now choose to starve themselves in an unconscious attempt to master early deprivation by identifying with the aggressor. For patients like this, chronic loneliness may signal a certain kind of attachment disorder, for it is the visible sign of early attachment to a distant or rejecting parental figure. Loneliness of that kind can be a stubborn problem and one that poses a considerable therapeutic challenge.

Climate change caused by human activities is a serious threat to the survival of our species, and one that we have not yet mustered the perspective and the will to address. Our vision tends to focus on what is useful to ourselves as individuals in the short term, instead of more broadly on what is needed for the long-term good of our species. We do not consider what our purpose and role could be in the life of our planet. We do not ask "What is the point of human beings?" In this time of climate crisis, answering this question by developing a shared sense of purpose, a purpose centered on caring for the world as a whole, might give our species the perspective and will we need to survive.

In the fall of 2019, a much-publicized court case brought to national attention the issues of patient-doctor confidentiality when it comes to reporting the deaths of newborns in the United States. It is unclear whether the recent overturning of Roe v. Wade will lead to more cases like this. This article discusses issues of countertransference, as well as the ethical and legal implications were it to be a psychiatrist, in active treatment of such a patient, who would be required to make such a report. More specifically, as in the publicized court case, the patient could be a minor at the time, receiving treatment from a child psychiatrist. The implications of such a case include how countertransference affects the perception of fatal child neglect compared to intentional neonaticide; the ethical dilemma of generating a mandated report with the goal of child safety when such a report could lead to real legal consequences for a minor child; and considerations regarding continued treatment of a patient after such a report is made. It is likely that countertransference, shaped by attitudes toward mothers and idealized views on mothering, may play a large role in all these circumstances.

This article presents a frequent dilemma of treatment-seeking mothers suffering from complex posttraumatic stress disorder (PTSD) that is related to exposure to maltreatment and other forms of interpersonal violence. Namely, that complex PTSD symptoms, including dissociative states in mothers that are triggered by normative child emotion dysregulation, aggression, and distress during early childhood, hinder the development of a productive psychotherapeutic process in more traditional psychodynamic psychotherapies for mothers and children. The article thus presents clinician-assisted videofeedback exposure (CAVE) that characterizes a recently manualized brief psychotherapy for this population, called CAVE-approach therapy (CAVEAT). CAVEAT can be used on its own or to preface a deeper process using child-parent psychotherapy or other non-videofeedback-enhanced psychodynamic models. A clinical illustration is provided.

This study examined the relationship between trauma, ego functioning, and internet addiction. We recruited 323 participants via Amazon Mechanical Turk, a crowdsourcing platform that can be used for survey research. We gave participants the Internet Addiction Test, the Life Events Checklist, the Ego Function Assessment questionnaire, and a demographic questionnaire. Our results indicate that 41.5% reported no internet addiction, with the majority of our sample reporting behaviors that were consistent with internet addiction: mild internet addiction = 37.8%, moderate internet addiction = 19.8%, and severe internet addiction = 0.9%. The constrictive factor of ego functioning was significantly worse in those with internet addiction. Path analysis showed that the constrictive factor of ego functioning partially mediated the relationship between a self-reported history of trauma and the presence of self-reported internet addiction.

In this article, I employ a psychodynamic lens to describe how women's fantasies of time as standing still, which is encouraged by sociocultural forces, is used to undermine the notion of the biological clock. These fantasies, also fueled by the timeless nature of the unconscious, can lead to hesitancy in not only initiating fertility treatment but also in complying with fertility treatment recommendations. When this happens, hesitancy is often unconsciously utilized in a conflict about becoming a mother. Once these hesitancies are worked through in therapy through a focus on previous losses, fertility treatment often moves forward. I present the psychotherapy treatment of a 45-year-old woman with both fertility treatment hesitancy and fertility compliance hesitancy, who had not only significant childhood losses but also significant losses in her ongoing fertility treatment. I also comment how my countertransference, which urged me to work through issues quickly in therapy, was informed partly by my experience as a former obstetrician and gynecologist and hindered my work with this patient.

The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed. Common psychotherapy themes in the treatment of persons who experience vision loss from systemic illness include reactivation of memories of past traumas resulting in avoidance, social withdrawal, depressive states, catastrophic thinking, a sense of foreshortened future, anhedonia, and fear of disintegration and invisibility. Psychotherapy also serves to correct negative introjects from ableist societal attitudes.

The gold standard of scientific medicine is using knowledge of underlying processes to shape treatment. This has previously not been possible for psychotherapy, but with the science of memory reconsolidation, requirements for change can be more precisely defined and can improve psychotherapeutic technique by focusing on three areas: the activation of maladaptive implicit learning, the provision of disconfirming information, and attention to transmission between consciousness and limbic memory. Overall, better understanding of processes helps liberate psychotherapy from rigidities dictated by set methods.