Psychodynamic Psychiatry最新文献

Since the 1980s, psychiatrists, psychologists, and diplomats have proposed psychoanalytic theories to inform peacemaking in international relations through Track II negotiations, defined as unofficial meetings among influential stakeholders with access to government policymakers. These contributions have focused on initiating or maintaining Track II negotiations (Aggarwal et al., 2023). In this article, we apply psychoanalytic concepts to the problem of restarting negotiations that have previously failed. This study introduces theories based on a dialogue that a cultural psychiatrist trained in South Asian Studies moderated with the past directors of India's and Pakistan's foreign intelligence agencies to consider how both countries could recommence negotiations. The two former directors have participated together in five Track II initiatives between India and Pakistan. All three authors reviewed best practices for addressing impediments to Track II negotiations and how Track II negotiations may be reinstituted once stalled. We did this in a far-reaching discussion devoted to the psychology of peacemaking. We introduce the theories of trust as interpersonal authenticity, the normalization of conflicts, the back channel as a process to work through diplomatic resistance, and negotiator selection criteria. Our theories and method present new ways to apply psychoanalytic concepts to diplomacy.

There remains a role for psychodynamic psychiatry in the care of individuals with autism spectrum disorders (ASDs). Contemporary psychodynamic models are uniquely positioned to integrate today's neurobiological understandings of ASD with the subjective experience of those with ASD. Historical psychodynamic formulations of ASD struggled to appreciate the interrelatedness of biological, psychological, and social complexities in individuals with this disorder. Emotionally experienced or "illusory" environmental deprivation, early life stress, and allostatic overload, along with biological factors, current stress, and neuroplasticity, drive maladaptive coping and lead to difficulties with relationships. Fears of caring emotional connections are related to self-protective isolation and other maladaptive efforts to regulate emotions, shutting out what the child needs most-parents' love and help. In a nonlinear way, maladaptive emotion regulation further interferes with the development of the social brain. Thus, a psychodynamic defense-oriented focus upon adaptive emotion regulation provides a therapeutic avenue. Helping build the child's capacity for adaptive emotion regulation, which includes letting others help, can lead to a sense of safety and promote caring connections, a positive outcome. The authors offer guidance in the treatment of individuals with ASD in accordance with contemporary understandings of the disorder and care.

Introduction: Psychotherapy added to usual hospital care is beneficial. This study reports on two contrasting cases, one responder and one nonresponder, from a randomized controlled trial on the effectiveness of intensive and brief psychodynamic psychotherapy (IBPP) for depressed inpatients, in which reduction in depressive severity was maintained for up to 1 year after completion of IBPP. We aimed to explore how the psychotherapist and patient interacted to work through the themes of focalization (described in the IBPP manual) and how their work was part of a potential process of change. Methods: This case study is part of the general framework of mixed methods in psychotherapy combining quantitative analysis of data collected in a randomized controlled trial with a qualitative case study. Results: Two general categories emerged-(1) becoming the subject of one's depression and (2) regaining a sense of support-which combine specific functions. In the first, the functions relate to interactions in line with the psychoanalytic work of mourning, which aims for an appropriation of depressive symptoms. In the second, interactions have as their functions the construction of a therapeutic space and the restoration of an epistemic trust by acknowledging the patient's melancholic state and maintaining emotional contact. Work related to regaining a sense of support was observed in both cases, whereas work related to becoming the subject of one's depression was more specific to the responder case. Discussion: These results highlight the importance of interventions that help generate a sense of support and mobilize the internal processes of symbolization, understanding, and appropriation, leading patients to develop the capacity to give meaning to their symptoms and to understand the personal psychological factors related to the depressive episode.

Apprehending the full range of one's countertransference presents a challenge for the new therapist and psychiatry resident. Experiencing negative or aggressive feelings while also striving to consolidate one's professional identity and self-experience as a good, helpful, and competent doctor feels dissonant and contradictory. Developing and practicing the skills of countertransference awareness and analysis are crucial aspects of psychiatry and psychotherapy training. These skills can help the trainee navigate difficult clinical interactions through reflection on their own anxieties, as well as the unconscious social and personal biases and motivations that shape their countertransferences. This article examines some of the countertransference reactions that may be colored by social and personal stigma toward patients with substance use disorders. Acknowledging and exploring such countertransference reactions in training not only can provide valuable insights into the psychodynamic experiences of the patient and the treatment dyad, but also can sharpen a lifelong tool, helping the trainees weather powerful and disorienting countertransference currents, untangle their personal motivations and prejudices, and recognize the times when supervision may help to provide containment and clarity throughout their careers.

Engaging the silent adolescent is a major psychotherapeutic challenge. This article presents a comprehensive approach to this problem, illustrated with clinical material. This approach emphasizes a careful diagnostic assessment, including an assessment of the patient's level of personality organization and capacities to participate in psychodynamic psychotherapy. Three approaches to the silent teenager are explored in depth: a mostly supportive approach focused on containment of maladaptive behaviors; a psychodynamic approach with supportive elements focused on demonstrating safety through humor, play, normalization, and self-disclosure while exploring the patient's automatic relationship patterns; and a psychodynamic approach using transference-focused psychotherapy for adolescents (TFP-A), aimed at effecting long-lasting changes in the patient's views of self and others and their characteristic ways of managing conflict and stress, with gradual movement from a tendency for controlling, protective silence to vulnerable, cooperative sharing.

The author, an internist and psychiatrist who works with intensive care unit (ICU) patients, offers reflections and clinical insights on implementing a psychodynamic framework when treating survivors of critical illness. In this short essay, contributions from the critical care and psychoanalytic literature are included to highlight the significance of post-intensive care syndrome (PICS) and the psychodynamic considerations that might enhance the treatment of this patient population.

Taking the liberty of imagining the lawyer in Melville's "Bartleby, the Scrivener" as narrator/therapist and Bartleby as patient, this article, written with the therapist/reader in mind, traces the vicissitudes of countertransference and speculates on what constitutes a "good enough" therapeutic effort.

Starting with Sigmund Freud, psychoanalysts have considered the psychological dimensions of peacemaking in international relations. In the 1980s, psychiatrists, psychologists, and diplomats began developing theories on Track II negotiations, defined as unofficial meetings among influential stakeholders with access to government policymakers. In recent years, psychoanalytic theory building has waned with the decline of interdisciplinary collaborations among mental health professionals and practitioners of international relations. This study seeks to revive such collaborations by analyzing the reflections of an ongoing dialogue between a cultural psychiatrist trained in South Asian studies, the former head of India's foreign intelligence agency, and the former head of Pakistan's foreign intelligence agency on applications of psychoanalytic theory to Track II initiatives. Both former heads have participated in Track II initiatives to build peace between India and Pakistan and agreed to react on the record to a systematic review of psychoanalytic theories on Track II. This article describes how our dialogue can offer new directions for theory building and the practical conduct of negotiations.

This article explores how the therapeutic relationship facilitates intrapsychic and behavioral changes in both the patient and the analyst. Key elements of the therapeutic relationship are reviewed, including transference, countertransference, introjective and projective identification, as well as the "real relationship." Special attention is paid to the "transformative relationship," which is a special kind of bond that develops between analyst and patient that is unique and transformative. It consists of mutual respect, emotional intimacy, trust, understanding, and affection. Empathic attunement is a key element in the evolution of a transformative relationship. This attunement optimally promotes intrapsychic and behavioral changes in both the patient and the analyst. This process is illustrated by a case presentation.