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Biomedical subjects

Peter Fonagy

Publications and source records attributed to Peter Fonagy.

At least 37 records · Page 2Linked to original sources
PubMed2004

Negative affect in victimized children: the roles of social withdrawal, peer rejection, and attitudes toward bullying.

This study evaluated the validity of mediating pathways in predicting self-assessed negative affect from shyness/social withdrawal, peer rejection, victimization by peers (overt and relational), and the attitude that aggression is legitimate and warranted. Participants were 296 3rd through 5th graders (156 girls, 140 boys) from 10 elementary schools. Self-report measures of victimization, attitudes, and negative affect, and a teacher-report measure of shyness/social withdrawal and peer rejection were completed during the spring semesters of 2 consecutive years. Hierarchical regression analyses supported the mediational model in predicting negative affect at Time 2. However, an increase in negative affect over the 12-month study period was best accounted for by direct effects of increased victimization and changes in attitudes/attributions regarding aggression. Implications for the planning of school interventions designed to interrupt these victimization-maladjustment pathways are discussed.

Adolescent↗
PubMed2004

An investigation into the possible overlap between PTSD and unresolved responses following stillbirth: an absence of linkage with only unresolved status predicting infant disorganization.

It has been suggested that the characteristic lapses in thinking and reasoning of the unresolved/disorganized (U) state of mind following traumatic loss involve psychological mechanisms similar to those found in PTSD and that a fuller understanding of these mechanisms may help explain the disruptions in parental caretaking behaviour that lead to disorganized infant attachment. This paper investigates whether PTSD, assessed in 60 mothers in the pregnancy after stillbirth, predicts infant disorganized (D) attachment in next-born children, and whether there was any association between U and PTSD. We report that in this population there was no significant correspondence between U and PTSD scores or caseness and no association between maternal PTSD and infant D. We discuss possible interpretations of these findings.

Adult↗
PubMed2004

Residential versus community treatment of personality disorders: a comparative study of three treatment programs.

OBJECTIVE: The aim of this study was to compare the effectiveness of three treatment models for personality disorder: 1) a long-term psychoanalytically oriented residential specialist program, 2) a phased "step-down" specialist psychosocial program that included a briefer residential stay and an outpatient component, and 3) a general community psychiatric model. METHOD: One hundred forty-three patients with a personality disorder diagnosis were allocated according to geographical criteria to the three treatment conditions. Outcome was prospectively evaluated at 6, 12, and 24 months through the use of a standardized battery of instruments that included measures of general symptom severity, social adaptation, assessment of mental health functioning, frequency of self-harm and suicide attempts, and rates and duration of hospital readmissions. RESULTS: By 24 months, patients in the step-down condition showed significant improvements on all measures. Patients in the long-term residential model showed significant improvements in symptom severity, social adaptation, and global functioning, while no changes were achieved in self-harm, attempted suicide, and readmission rates. Patients in the general psychiatric group showed no improvement on any variables except self-harm and hospital readmissions. CONCLUSIONS: The results of this study suggest that for personality disorders, a specialist step-down program is more effective than both long-term residential treatment and general psychiatric treatment in the community. Replication is needed that includes a random allocation of patients to conditions to ensure that geographical factors did not account for the observed differences.

Adult↗
PubMed2004

Early-life trauma and the psychogenesis and prevention of violence.

This article considers the development of violence with particular reference to family factors in violence such as the quality of the parent-child relationship. In taking a developmental approach to violence, a link is established between the maltreatment of children in an attachment context and the risk of violence via the child's capacity to envision mental states in the other. Evidence from epidemiology and neuroscience is brought to bear on this link. Finally, some studies of prevention of violence that are likely to enhance attachment and mentalizing are considered.

Age Factors↗
PubMed2004

The role of the bystander in the social architecture of bullying and violence in schools and communities.

The bystander is defined as an active and involved participant in the social architecture of school violence, rather than a passive witness. Bullying is redefined from a triadic (bully-victim-bystander) rather than dyadic (bully-victim) perspective. Teachers, including administrators, and students can promote or ameliorate bullying and other forms of violence when in this social role. Cases are used to illustrate this phenomenon, including one in which a teacher is murdered. Data are presented from a study of teachers' perceptions of other teachers who bully students, suggesting that bullying of students by teachers and bullying of teachers by students is a factor in the aggravation of school bullying and violence that needs to be more openly discussed. An intervention in nine elementary schools involving 3,600 students is outlined to illustrate how a focus on reflective mentalizing and awareness of the importance of the helpful bystander role can promote a peaceful school-learning environment for students and teachers. The paper concludes with an outline for research into how communities and schools adopt bystanding roles when faced with complex problems like youth violence, and how they may avoid facing the problems by blaming law enforcement and educators.

Attitude↗
PubMed2004

Miss A.

Explore the source record for details and available documents.

Adult↗
PubMed2004

Mentalization-based treatment of BPD.

Psychoanalytically oriented partial hospital treatment for BPD has been shown to be more effective than treatment as usual in a randomized controlled trial and over 18 months of follow-up. Focus of treatment, in the context of group and individual psychotherapy, was on increasing the patient's capacity for mentalization, the capacity to think about mental states of oneself and others as separate from, yet potentially causing actions. We summarize the research and outline the essential theoretical and practical components of mentalization-based treatment. Core aspects of treatment include enhancing mentalization, bearing in mind patient deficits, using transference, retaining mental closeness, and working with current mental states. Finally, it is proposed that mentalization is a common theme in psychotherapy of BPD and may explain why different treatments "work."

Borderline Personality Disorder↗
PubMed2003

Some complexities in the relationship of psychoanalytic theory to technique.

This paper considers the current fragmentation of psychoanalytic theory as a result of the illusorily close association of practice and theory. The author argues that the politically motivated assertion of a direct connection between theory and practice should be set aside and that practice should be liberated from theory, permitting theory to evolve in the context of radically modified patterns of practice. If theory were decoupled from practice, technique might progress on purely pragmatic grounds, on the basis of what is seen to work. Psychoanalytic theory of mental function could then follow practice, integrating what is newly discovered through innovative methods of clinical work. Such a pragmatic, principally action-oriented use of theory would bring psychoanalysis more in line with modern, postempirical views of science.

Humans↗
PubMed2003

The ecology of attachment in the family.

In this article we outline a conceptualization of attachment processes within the family. We argue that the key elements of attachment processes are affect regulation, interpersonal understanding, information processing, and the provision of comfort within intimate relationships. Although these have been described and assessed primarily in terms of individual functioning and development, they are equally applicable in family systems, provided three farther steps are taken. First, the description of attachment processes at the individual level is applied to the family using the concept of shared frames or representations of emotions, cognitions, and behaviors. Second, there is an explicit formulation of the way in which individual and family processes are linked. Third, there is a conceptualization of the nature and quality of the dynamic between attachment and other processes in family life. In this "ecology" of family processes, those that entail heightened affect and a need to create certainty through action, particularly in response to threats to safety, attachment needs, and discipline challenges, are contrasted with exploratory processes characterized by low affect, tolerance of uncertainty, and opportunities to review existing assumptions and knowledge.

Affect↗
PubMed2003

Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care.

OBJECTIVE: The authors assessed health care costs associated with psychoanalytically oriented partial hospital treatment for borderline personality disorder compared with treatment as usual within general psychiatric services. METHOD: Health care utilization of all borderline personality disorder patients who participated in a previous trial of partial hospital treatment compared with treatment as usual was assessed by using information from case notes and service providers. Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period. RESULTS: There were no cost differences between the groups during pretreatment or treatment. Costs of partial hospital treatment were offset by less psychiatric inpatient care and reduced emergency room treatment. The trend for costs to decrease in the partial hospitalization group during the follow-up period was not apparent in the treatment-as-usual group. CONCLUSIONS: Specialist partial hospital treatment for borderline personality disorder is no more expensive than treatment as usual and shows considerable cost savings after treatment.

Borderline Personality Disorder↗
PubMed2003

Psychosocial treatment for severe personality disorder. 36-month follow-up.

BACKGROUND: In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care. AIMS: To evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period. METHOD: Two samples allocated to the in-patient treatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake. RESULTS: Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patients in the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group. CONCLUSIONS: Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model.

Adult↗
PubMed2003

When less is more: An exploration of psychoanalytically oriented hospital-based treatment for severe personality disorder.

This paper discusses the main findings of a prospective study based at the Cassel Hospital, a centre dedicated to the psychoanalytically informed residential treatment of severe personality disorders. The results--showing that significantly greater improvements on a number of outcome indicators were found in patients exposed to the psychoanalytically informed treatment programmes compared to a general psychiatric approach based on management and pharmacotherapy alone--underscores the importance and the centrality of the psychoanalytic input in the treatment of severe personality disorders. However, the results of the study also suggested that some features of long-term hospital treatment might carry the risk of iatrogenic and anti-therapeutic effects for a sub-group of patients with severe borderline core pathology. The authors present the clinical and psychodynamic implications of the study results based on an understanding of the internal and interpersonal mode of functioning of borderline patients.

Adult↗
PubMed2003

The development of an attachment-based treatment program for borderline personality disorder.

The treatment of borderline personality disorder (BPD) remains controversial. The authors have developed an evidence-based treatment program rooted in attachment theory that integrates research on constitutional factors with environmental influences. BPD is conceived of as a disorder in the self-structure brought about through environmentally induced distortion of psychological functioning, which decouples key mental processes necessary for interpersonal and social function. The primary mental function involved is mentalization, which is enfeebled by an absence of contingent and marked mirroring during development. Treatment strategies target mentalization in order to foster the development of stable internal representations, to aid the formation of a coherent sense of self, and to enable to borderline patient to form more secure relationships in which motivations of self and other are better understood. Destabilization of the self leads to emotional volatility, so treatment also needs to focus on identification and appropriate expression of affect. This article describes some of the techniques used to enhance mentalization within the context of group and individual psychotherapy. Targeting of current symptomatology and behavior is insufficient. Therapists need to retain their own ability to mentalize, maintain mental closeness, focus on current mental states, and avoid excessive use of conflict interpretation and metaphor while paying careful attention to the use of transference and countertransference.

Affect↗
PubMed2003

Psychoanalysis today.

The paper discusses the precarious position of psychoanalysis, a therapeutic approach which historically has defined itself by freedom from constraint and counted treatment length not in terms of number of sessions but in terms of years, in today's era of empirically validated treatments and brief structured interventions. The evidence that exists for the effectiveness of psychoanalysis as a treatment for psychological disorder is reviewed. The evidence base is significant and growing, but less than might meet criteria for an empirically based therapy. The author goes on to argue that the absence of evidence may be symptomatic of the epistemic difficulties that psychoanalysis faces in the context of 21st century psychiatry, and examines some of the philosophical problems faced by psychoanalysis as a model of the mind. Finally some changes necessary in order to ensure a future for psychoanalysis and psychoanalytic therapies within psychiatry are suggested.

Journal Article↗
PubMed2002

The place of psychoanalytic treatments within psychiatry.

Psychoanalytic treatments may be necessary when other treatments are ineffective. An empirically grounded framework for the use of these treatments involves sources of evidence from both efficacy and effectiveness studies. Preliminary evidence suggests that psychoanalysis appears to be consistently helpful to patients with milder disorders and somewhat helpful to those with more severe disturbances. A greater number of controlled studies are necessary to confirm these impressions. A multisite process and outcome study is proposed.

Clinical Trials as Topic↗