Psychodynamic Psychiatry最新文献

Depression is a very common mental health problem in adolescence. Although over the past decades a number of psychological interventions for depression in adolescence have been developed and empirically evaluated, recent systematic reviews and meta-analyses suggest that there is considerable room for improvement of their effectiveness. This is particularly true for the treatment of adolescents with "complex" depression, that is, those where depression is embedded within broader personality and relational problems, often related to a history of attachment trauma. Mentalization-based treatment (MBT) may be particularly effective in these cases, as it has a strong focus on temporary and long-term impairments in mentalizing (i.e., the capacity to understand the self and others in terms of intentional mental states), which are very typical of adolescents with depression. This article outlines a continuum of severity of depression as seen from a mentalizing perspective, ranging from the mild to moderate to the more severe end of the spectrum. This is followed by a summary of the mentalizing approach to understanding depression along the spectrum of severity, the empirical evidence supporting this approach, and a description of the basic principles of MBT for depression. We close with some thoughts about the future of MBT in the treatment of depression in adolescents.

This article seeks to further specify how the mentalization-based approach may inform clinical intervention before the onset of psychosis, that is, during the stage of clinical high-risk for psychosis (CHR-P). We first review the concept of CHR-P, as well as the research evidence of the impact of early intervention. Next, we present evidence for the centrality of mentalizing as a process that may mitigate the risk for psychosis. We then review some of the key contributions in the psychoanalytical and phenomenological traditions concerning the centrality of core self disturbances in psychosis, and relate this to the alien self concept put forward in the mentalization framework. This leads us to expand on the structure of MBT for CHR-P, and to present a clinical vignette illustrating the process of epistemic trust at beginning of an intervention with a young person suffering from CHR-P. We summarize the links between core self disturbances, epistemic trust, and therapeutic communication in the context of CHR-P.

It is now more than 30 years since Peter Fonagy published his classic 1991 paper introducing the concept of "mentalization" into the psychoanalytic literature, and in the period since then mentalization-based treatment (MBT) has emerged as an important therapeutic approach. In reviewing the history of this treatment, it is often assumed that MBT emerged at the interface between three domains: first, the developmental research on theory of mind; second, the clinical challenges of treating borderline personality disorder; and third, the empirical research on intergenerational patterns of attachment. This article suggests that there was one more domain, which was equally important to the development of MBT and which is perhaps less widely recognized. This fourth domain was developments in child analysis, especially those taking place during the late 1980s and early 1990s at the Anna Freud Centre in London. Although the origins of MBT theory and technique in child work is perhaps not widely acknowledged, recognizing these roots helps us to better understand mentalizing therapy. It also enables us to see how the development of MBT for children, young people, and families can be understood as a closing of the circle in the development of mentalization-based interventions.

This article explores the implications of epistemic trust within the mentalizing model of psychopathology and psychotherapy, emphasizing the role of the restoration of epistemic trust in therapeutic settings. At the core of this exploration is the developmental theory of mentalizing, which posits that an individual's ability to understand mental states-both their own and others'-is cultivated through early caregiver interactions. The article expands on this concept by reviewing and integrating evolutionary theories suggesting that humans have evolved a unique sensitivity to teaching and learning through ostensive cues, enhancing our capacity for cultural transmission and cooperation. However, adversities such as trauma or neglect can disrupt this developmental trajectory, leading to epistemic disruption, where individuals struggle to engage with or learn from social experiences effectively. This disruption can manifest in psychological disorders, where mentalizing failures are associated with difficulties in social functioning and in maintaining relationships. The article proposes that psychotherapeutic approaches can effectively address these disruptions, and it outlines three key aspects of communication that unfold in psychotherapeutic interventions. It discusses how the effectiveness of these interventions may hinge on the reestablishment of epistemic trust, enabling patients to reengage with their social environments constructively and adaptively.

Introduction: Process notes contain unique information concerning core elements of a psychodynamic treatment. These elements may be both conscious and unconscious for the author. One element for study is the tendency to which a therapist writes about providing either supportive or expressive interventions. This study sought to establish a method of systematically and reliably identifying the records of therapists' interventions as supportive or expressive. Methods: Three early-career clinicians were trained in the use of a process note intervention rating scale constructed specifically for this study. Quantitative statistical analyses assessed the scale's reliability and internal consistency. Results: Interrater reliability analysis determined at a p of 0.005 a Fleiss's kappa of 0.24 and an intraclass correlation coefficient of 0.264, suggesting a low but statistically significant reliability between the raters. A Cronbach's alpha of 0.67 and a McDonald's omega of 0.53 suggested questionable internal consistency. Discussion: Early-career clinicians can reliably code the manifestations of interventions in psychodynamic process notes as supportive or expressive. Future studies may improve the reliability and internal consistency of the scale, add measures of interpretation content, and evaluate these data in relation to other core elements of process notes, such as the author's emotional engagement as manifested in language measures and clinical outcome.

The development of psychoanalysis and psychodynamic psychiatry in China is influenced by political, economic, cultural, and social ideology. The process of psychoanalysis entering China is also a reflection of Chinese history, mirroring China's transition from conservatism to openness, from focusing on tradition to embracing modernity, and from focusing on community and family to individualism. These changes align with the Chinese continuous exploration and pursuit of integration, adaptation, and individuation in the process of globalization, urbanization, and modernization. This article describes the continuous expansion and development of psychoanalysis and psychodynamics in China parallel to societal changes and how an increasing number of people have begun to engage in psychoanalysis or psychoanalytic practices and research. The author describes challenges to how psychoanalysis can better serve the Chinese people through clinical practice and in-depth research under the country's unique social, cultural, historical, and political background.

The transformative therapeutic relationship is a unique interpersonal and intrapsychic phenomenon between analyst and patient. It occurs within the therapeutic framework, and is characterized by specific boundaries of time, place, and verbal and behavioral interactions. Collectively, these interactions may facilitate mutual trust, caring, respect, and affection between analyst and patient. The shared experience of the transformative therapeutic relationship can result in significant intrapsychic and interpersonal changes for both patient and analyst. Clinical case presentations are provided.

Borderline personality disorder is a common, treatable condition that usually presents in late adolescence or early adulthood. Patients with borderline personality disorder are disproportionately represented in many clinical settings. Early identification and intervention of borderline personality disorder could help address the current mental health affecting young adults. College and university mental health settings have an opportunity to identify borderline personality disorder and to help guide students and families to appropriate treatment. College-based clinicians also have a role in educating campus administrators who may have little or no familiarity with standard borderline personality disorder symptoms or the trajectory of the disorder.

Since he first proposed it, Carl Jung's "archetype" theory has faced resistance from a pervasive but seldom examined set of underlying Cartesian assumptions embedded in mainstream psychology. This paradigm assumed a physical universe (and hence body) free of psyche that coincided with an essentially disembodied mind largely concerned with abstract symbol manipulation. This situation led archetype theory to remain largely within insulated psychoanalytic circles for decades. Since the 1980s, however, cognitive psychology has increasingly become embodied from a variety of standpoints. This article shows how the results of embodied cognition and spontaneous thought "demystify" many of the attributes Jung described in his archetype theory, making archetype theory not only more comprehensible but clinically applicable. Combining approaches suggests new avenues of inquiry for experimental research and enriches the psychoanalytic perspective.

This article delves into fundamental themes within Margaret Mahler's separation-individuation theory, placing particular emphasis on the rapprochement phase. It illustrates how these themes are crucial for comprehending and effectively managing inpatients grappling with borderline personality disorder. Mahler's conceptual framework offers valuable insights for caregivers and staff, equipping them to navigate the clinical and emotional complexities inherent in the treatment of this distinct patient population during their stay in psychiatric wards.