Psychodynamic Psychiatry最新文献

Introduction: Psychotherapy researchers often recruit students to code psychotherapy process and outcome variables on individual therapy sessions. To do so, graduate students read verbatim psychotherapy transcripts, listen to audio or watch video of psychotherapy sessions, and then rate process and outcome measures on these sessions. Although prior studies have investigated the reliability and validity of graduate student ratings of personality dysfunction, no current study has investigated the reliability and validity of these ratings made on the basis of psychotherapy transcripts and audio. In this study, we evaluated the degree to which graduate students can reliably and validly code observer-rated personality assessments on the Shedler-Westen Assessment Procedure-200 (SWAP-200). Methods: We related graduate student and experienced clinician-researcher's SWAP-200 scores in an existing dataset of 27 patients undergoing psychoanalytic psychotherapy at early and late phases of treatment. Results: Using truth and bias multilevel models, we found that graduate students tended to underestimate personality pathology at the early phase of treatment and overestimate pathology at the late phase in treatment. These responses resulted in smaller effect sizes in the graduate student ratings, such that patients' personality functioning did not appear to change following treatment. By contrast, the experienced clinician's scores supported moderate to large effect sizes in personality change. Discussion: These deviations from expert judgment may have significant ramifications for evaluating pre and post effect sizes in psychotherapy process studies using graduate student coding. Suggestions for research and practice are discussed.

Introduction: Psychodynamic psychotherapy is an effective treatment for borderline personality disorder (BPD), but few specific curricula for psychiatric residents currently exist. The authors developed an online learning module to teach psychodynamic psychotherapy for BPD to psychiatry residents, based on the following educational methods: the ADDIE (analysis, design, development, implementation, evaluation) design process, the Morrison, Ross, and Kemp instructional design model, and the 4C/ID (four-components instructional design) model. Methods: Indonesian residents, psychiatrists, and psychotherapy teaching staff participated in a needs analysis to identify the competencies, subject content, and learning methods that the module should address, through focus group discussions and Delphi survey methodology. The module then underwent content validation. Results: The psychodynamic psychotherapy for BPD learning module was designed as a 12-session online training program. The module addresses three main subjects: phenomenology and pathogenesis of BPD, basic principles of psychodynamic psychotherapy, and the practice of psychodynamic psychotherapy with patients with BPD. It is taught through lectures, case discussions, video discussions, psychodynamic formulation learning assignments, and a review of residents' process notes of psychodynamic psychotherapy sessions. Discussion: Implementation of this module could enhance residents' competency to treat BPD with psychodynamic psychotherapy and fill the current gaps in the field of psychotherapy education, especially in areas of the world with limited access to expert faculty.

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 authors argue that as a diagnostic category "personality disorders" falls short in offering helpful counsel to patients with difficulties in self and interpersonal functioning. The article begins with a discussion of symptom versus disorder in general medicine before critiquing the impulse of psychiatrists and humans more broadly to categorize and sort. The authors summarize well-described limitations to categorical personality disorder diagnoses, including their questionable clinical utility, unsteady empirical support, and potential to reify myriad forms of stigma. These limitations emphasize the multidimensionality of personality and bring attention to the potential harms of offering patients diagnoses so laden in negative judgements, particularly when working with minoritized patient populations. The authors advocate for a reconsidered dimensional approach that may be emphasized in future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

In the consulting room, the existence of anger-a perfectly normal human emotion-is less a concern than our relationship to it, whether our own or our patients'. The ways we frame difficult emotions like anger and how we encourage our patients to hold them are crucial to the task of psychological healing. Offered here are some reflections, situated at the crossroads of psychodynamic theory and Buddhist thought, on how such healing may be rooted in the attitude of equanimity.

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 article explores the ways artificial intelligence (AI) may impact the field of psychotherapy through the perspective of a prospective psychiatric trainee. The author discusses how AI may facilitate psychotherapy training and increase psychotherapy treatment outcomes. Therapy chatbots and their potential to increase access to care, particularly for marginalized populations, are discussed. Concerns regarding the integration of AI with psychotherapy are also examined, including the potential diminishment of the role of psychotherapists, negative sequelae of therapy chatbots, ethical concerns, and limitations of AI. The author concludes that psychotherapists may cautiously embrace and explore AI technology.

Borderline personality disorder is a disorder marked by a pattern of contradictory, paradoxical, and self-defeating behavior, yet the communication methods of patients with the condition have remained largely unexamined since the disorder was first described nearly a century ago. This article applies communication theory to the study of borderline personality disorder in an attempt to understand patients' characteristically paradoxical modes of relating. Three types of double-bind communications are examined-the "be spontaneous" paradox, the covert contract, and the Kafka trap. The potential psychodynamic mechanisms and interpersonal effects of double-bind communication in patients with borderline personality disorder are briefly explored.