Psychodynamic Psychiatry最新文献

The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective experiences of incompetence and helplessness. The authors review the literature of the subject and highlight the work of Rajagopalan and colleagues in Singapore, who implemented a one-time reflective group session to help clinicians process the experience of patient suicide to reduce psychological distress and prevent burnout and moral injury.

El número creciente de adolescentes con identidad de género no conforme parece estar asociado a lo que los autores consideran ser la manifestación contemporánea del fenómeno de la crisis de identidad adolescente. Ésta se expresa a través de un rechazo deliberado y una revaloración de los roles y las normas convencionales de género. La crisis de identidad adolescente, tal y como fue conceptualizada inicialmente por Erik Erikson (1956), constituye un fenómeno multifacético inconsciente que se manifiesta en el contexto familiar y social. Los autores hacen una revisión histórica de la terminología pertinente, seguida de la presentación de cuatro bocetos clínicos, seleccionados para mostrar este fenómeno y los conflictos familiares que comúnmente se producen como resultado. A continuación, se presenta un caso clínico que abarca el proceso de evaluación clínica, formulación psicodinámica, consideraciones del tratamiento y el trabajo con los padres. Se enumeran las fuentes de información disponibles para los pacientes y sus familias. Las ilustraciones clínicas están compuestas de varios casos sobrepuestos y los datos se han alterado para proteger la privacidad y confidencialidad de los pacientes. Por último, los autores hacen un llamado a la comunidad científica a realizar indagaciones profundas a largo plazo sobre este fenómeno clínico.

"La Cura" is one of the tracks in Franco Battiato's L'Imboscata album (1996), the 19th published by the Italian composer and songwriter, who died 3 years ago. In the lyrics several references to psychiatric terminology appear. The purpose of this article is to consider the lyrics of the song from psychodynamic and mental health care perspectives and offer associations that reflect the process of forming a therapeutic alliance with patients.

Reproductive endocrinologists often recommend sperm donation to two groups of patients. The first are women with partners with azoospermia. The second are women who do not have a partner and yet desire to become a parent. This article focuses on a subset of women in these two groups who hesitate to accept this recommendation from their reproductive endocrinologist. Winnicott's writings on transitional phenomena, especially his description of how the infant creates good, not-me possessions, may be helpful in our understanding of some of these women's fantasies of sperm as a bad, not-me possession. Case material is used to highlight treatment recommendations that utilize a reframing of the understanding of the donor's motivation, which may create the possibility of an acceptance of sperm as a good, not-me possession. This moves the patient toward what Winnicott calls acknowledgement of indebtedness and toward what the patient may perceive as a good-enough donor.

The growing occurrence of adolescents with gender nonconforming identities appears to be associated with what the authors believe is the contemporary manifestation of the adolescent identity crisis phenomenon. This phenomenon is expressed through a deliberate rejection and reappraisal of conventional gender roles and norms. The adolescent identity crisis, as initially conceptualized by Erik Erikson (1956), constitutes an unconscious multifaceted phenomenon that is outwardly displayed within familial and societal frameworks. A historical overview of pertinent terminology is provided, followed by the presentation of four clinical vignettes chosen to exemplify this phenomenon, alongside the resultant family conflicts that often ensue. Additionally, an anonymized clinical case is presented, encompassing the evaluation process, the subsequent psychodynamic formulation, treatment considerations, parent work, and the available resources for patients and families. The clinical illustrations are case composites and the data disguised to protect patient privacy and confidentiality. A plea is made to the scientific community for in-depth long-term research into this clinical phenomenon.

This case report details the treatment of a longtime psychodynamic psychotherapy patient, with a particular focus on a ketamine-assisted psychotherapy (KAP) session, and how the progress achieved during this session compares with the literature on KAP. The patient is a 54-year-old woman with a history of multiple traumas, including sexual assault and life-threatening physical injuries, as well as a recent diagnosis of primary lateral sclerosis (PLS). For most of her life, she relied on extreme idealization of important people in her life as her primary defense mechanism, helping her to maintain physical and psychological survival. However, after a KAP session in January 2023 she discovered the consequences of her extreme idealizing tendencies. Among these was the creation of troubling double binds for the people she idealized, as well as the fomentation of conflict between these individuals with each other. Also unconscious was the secondary gain offered by her escalating physical symptoms and pain-that is, the ability to resolve conflicts between those she idealized-and how this secondary gain increased the likelihood of symptom exacerbations during periods of conflict. After the discovery of these unconscious tendencies during her KAP session, the patient has since been able to avoid extreme idealization of important people in her life and has subsequently experienced fewer episodes of exacerbation of her physical symptoms. Consistent with the opinions of clinicians and researchers published in the literature, the achievement of a psychedelic trance state appeared necessary for the success of the patient's KAP treatment.

Several evidence-based psychotherapies for personality disorders have been developed in recent decades, including transference-focused psychotherapy (TFP), a contemporary model of psychodynamic psychotherapy developed by Otto Kernberg. Kernberg established Group TFP (TFP-G) as an alternative or adjunct treatment to individual TFP. Although not yet manualized, TFP-G is used in publicly and privately funded mental health services, including outpatient clinics, subacute hospitals, therapeutic inpatient units, partial hospitalization services, and rehabilitation services serving people with borderline personality. Kernberg's model of TFP-G psychotherapy, its application in clinical settings, and what differentiates it from other group psychotherapy models is described as well as illustrated with some examples useful to practitioners.

Psychoanalysis has long lost its historical influence on U.S. academic psychiatry. Psychoanalytic theory, however, provides us with a rich and remarkably comprehensive knowledge of human development, both normative and pathologic. This article describes a psychoanalytic concept that enriches our understanding of the mind and its disorders: Freud's structural hypothesis. This core concept provides a theoretical foundation for understanding the clinical features of both neurotic and personality disorders. It also informs a psychodynamic psychotherapy.