International Journal of Applied Psychoanalytic Studies最新文献

This paper offers a preview of a forthcoming article on the world's first, universal free-to-access, evidence-based talking therapies programme to treat depression: Improving Access to Psychological Therapies. It was pioneered not in the USA, but the UK, in 2007. At one time it could have been led by psychoanalysts, but it wasn't. It was a New Deal, in fact, for CBT. But did this New Deal in 2007 also offer psychoanalysis an opportunity to renew its vitality as a discipline, after decades of being eroded by our long-term retreat into private practice? Illustrated in the film From Here to Eternity, through characters played by Burt Lancaster, Montgomery Clift and Frank Sinatra, this Preview shows how applied psychoanalysis can once again aspire to become a universal, genuinely popular, relevant professional discipline. How would we engage ethically with psychiatric casualties of war, for example, within an evidence-based practice framework today? A novel, brief psychoanalytic treatment for depression, Dynamic Interpersonal Therapy, was developed for use in the UK's Improving Access to Psychological Therapies (IAPT) programme. It is recommended by NICE (National Institute for Health and Care Excellence) as cost-effective for treating depression. By engaging with evidence-based practice in this way—as Street Level Bureaucrats—we can reclaim our position at the centre of contemporary publicly funded mental health services.

This article examines the interplay between psychodynamic psychotherapy and other approaches to psychotherapy in mental health services in Israel, describing the history of psychotherapy approaches, education and training, current dilemmas and service examples. Israel has a system of universal healthcare, education and social care which includes mental health services for all citizens and permanent residents. Mental health services and interventions are provided by psychiatrists, clinical psychologists, educational psychologists, social workers, clinical criminologists and creative arts therapists. Despite being public, accessibility is undermined by long waiting times, inequitable geographic distributions and cultural-linguistic barriers. The interplay between approaches is clearly visible in public mental health services. Many therapists are trained primarily in psychodynamic approaches and receive psychodynamic-oriented supervision. However, public services often cannot provide suitable conditions for psychodynamic oriented psychotherapy, and the therapists are required to adjust their interventions to treatment plans, reimbursement and reporting. This paper describes in detail two programs that implement psychodynamic approaches in the medical and education systems respectively. The first is “Lkol Nefesh” (“for every soul”) that provides long-term intensive psychoanalytic psychotherapy for individuals suffering from severe mental disorders. The second is the system of creative arts therapies delivered in schools that provide psychotherapy as part of special education services. The paper concludes with a discussion of the influence of the spirit of time on psychotherapy, and the opposite tendencies evident in the state of affairs of psychodynamic psychotherapy in Israel.

There is an increasing tendency in the field to develop partnerships between schools and mental health (MH) clinics to address the MH needs of children in schools. Such initiatives are particularly important in providing services to children who attend underfunded and understaffed schools in underserved communities. These initiatives face several challenges that can interfere with the delivery of services. The present paper presents the challenges the Derner Hempstead Child Clinic clinic has faced in providing MH services to the children and families in the town of Hempstead, and in striving to become a source of support to the community.

In the following text the Austrian health system will be presented as well as its current model for training psychoanalysts. In Austria, everyone has an equal right to health insurance, no matter whether they are working or unemployed, on maternity leave or legally approved as refugees. With regard to psychotherapy, 24 psychotherapeutic modalities are currently recognized by the Austrian health care system. Patients can rely on a partial or full reimbursement when they engage in psychotherapy, no matter what modality they choose. Most training institutions and universities have walk-in clinics where the general public and students can make their first contacts with psychotherapy. There are also psychoanalytic clinics, specifically tailored towards women, children and refugees at very low or no cost to them. If a patient can obtain a Kassenplatz at a psychoanalyst, s/he can benefit from long-term therapy that is largely refunded by the Austrian State insurance company.

In order to study the psychological consequences of isolation measures, we decided to take the example of protective isolation in hematology. Most patients there had arrived as emergency cases. They were still shocked, stunned by the announcement of double jeopardy: a cancerous pathology with a high risk of death and a 5-week isolation period. In addition to carrying out technical monitoring, the medical staff exhibits a high level of personal commitment on a daily basis. The support they provide is very intense, commensurate with the need to pick up any signs of somatic or psychological decompensation. In such a regressive context, there is a necessary lack of differentiation between patients and healthcare staff. The intensity of the care given in the hospital contrasts starkly with the total lack of human support at the point of discharge. Two case studies illustrate how the nature of the relationship between patient and family may be changed by hospitalization. Relatives must be able not only to take a back seat during hospitalization, but also to reassert themselves when their loved one is discharged or, more tragically, reaches the end of life. Unconscious aspects of the familial relationships and of the individual's reactions potentiated by this ordeal are described and analyzed.

This paper follows the 22-year journey of a small community-based program with roots in a psychoanalytic training institute, to the program's current status as an independent non-profit organization serving families throughout the Bronx with psychodynamic, attachment-based parent-infant treatment. The product of an unusual collaboration among a psychoanalytic training institute, a program of the NYC Department of Education and several generous foundations, we aimed to offer teen mothers a dyadic model of parent-infant intervention based on the principles of psychodynamic theory, attachment theory, and mentalization through the lens of an infant mental health perspective. Underlying the creation, implementation, and expansion of the Chances for Children organization at every level were questions of basic trust and mistrust, class, and culture. With this in mind, we describe the development of the model, collaborations with institutions and communities, and the obstacles we encountered along the way. On a macro level, we consider questions of class, culture, and institution that we encountered on every level in institutional bureaucracy, in community outreach, and in collaborating programs. On a more micro level, we use the contexts of a teen-parent therapeutic group and a dyadic mother-child treatment to address issues that arise when white, middle-class clinicians of privilege work in communities of color that are frequently suffering insufficiencies in food, housing, jobs, and experiencing random violence. Finally, we reflect on what has made the work of Chances for Children possible, successful, and enduring even as we embarked on the telehealth practices necessary during the COVID pandemic.

This paper explores connections between Francis Ford Coppola's biography and recurrent themes in the choice and assemblage of The Conversation and Apocalypse Now. Framed broadly by the psychobiography tradition, the paper deploys key concepts from the independent school (Bollas, Winnicott and Phillips), coupled with textual analysis so as to expand the meaning-making opportunities available to the two films and Coppola's psychobiography. With such partnering, the paper explores Coppola's autobiographical renderings as a projective feature in the assemblage and production of the films, with dedicated attention to evolving under-standings of agony and horror as a unified affective state.

This special issue on community mental health focuses on the ways in which several innovative mental health programs across the United States have risen to the challenge of incorporating psychodynamic principles into their clinical practice. Contrasted with these domestic programs are reports from a number of countries in Europe, Latin America, and the Middle East in which local clinicians describe how community mental health programs in their countries are tackling these issues. In this introduction, we emphasize factors common to the populations these authors serve, the organizational challenges they face, and the successes they achieve by way of their skill, creativity, and perseverance. We underscore the ways in which they articulate how psychoanalytic thinking, training, and practices have evolved in response to lessons learned and changing political, economic and cultural climates. We conclude that applied psychoanalysis, and particularly psychoanalysis applied to community mental health has, in some ways, been at the forefront of change in psychoanalytic practice in general. The modifications made by those in community mental health are viewed as necessary accommodations for both the communities served and for the psychoanalytic enterprise itself.

We use the recent destructive Irish residential real estate bubble and its parlous economic and social consequences to explore the role of repressed ancestral suffering in driving institutional and broader societal responses to contemporary events. We demonstrate how a traumatic past can become interwoven in the fabric of the social order, rendering state and parastatal organizations and their leaders powerless. The concept of intergenerational transmission of trauma is key to our analysis. We show how the Irish obsession with owning property and land is a psychic attempt to transcend the traumatic past to “inhabit” an idealized pre-colonial land leading to emergent feelings of empowerment, euphoria and omnipotence. We also explain why the Irish real estate bubble is being re-enacted so soon. The potential to enhance interpretation through insights from literature, drama, and poetry is illustrated.

As the necessity of meeting state regulations has continued to mount in the public mental health sector, and insurance companies limit the number of therapy sessions covered in a year, the emphasis on evidence-based treatments, most often in the guise of some form of Cognitive Behavioral Therapy, continues unabated. Meanwhile, knowledge about and the ability to practice psychodynamically have all but vanished from most community mental health clinics in the United States. With shrinking funds, increasing demand for services, and increasing costs, therapists and their supervisors in these settings are expected to meet productivity and documentation requirements imposed by state and federal regulations and by the clinics themselves. These demands leave little time for therapists to discuss actual cases with their supervisors, to reflect on their experiences with patients and to wonder about the patient's experience with them, skills that are in themselves among the essential tools of psychodynamic clinical training and are crucial to patient care. This paper summarizes the qualitative data collected at the conclusion of a pilot study in which a dozen staff therapists in a community mental health center met weekly individually with psychodynamic supervisor/consultant volunteers to discuss their ongoing cases.