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PubMed2000

Treating career burnout: a psychodynamic existential perspective.

This article presents an approach for treating career burnout based on a psychodynamic existential perspective. Psychodynamic theory contributes the idea that people choose an occupation that enables them to replicate significant childhood experiences. Existential theory contributes the idea that people attempt to find existential significance through their work. It is suggested that when treating career burnout it is essential to address three questions: Why, psychodynamically, did this person choose this particular career, and how was it expected to provide existential significance? Why does this individual feel a sense of failure in the existential quest, and how is the sense of failure related to burnout? What changes need to take place for this individual to derive a sense of existential significance from work? A case illustration is presented that demonstrates the application of this approach.

Burnout, Professional↗
PubMed1996

An empirical study of the psychodynamics of suicide: a preliminary report.

Preliminary results from a study of psychodynamic constructs are presented based on data from inpatients following a suicide attempt. The study examines the association between four psychodynamic constructs, severity of suicidal intent, and severity of depressive symptomatology in a sample of hospitalized suicide attempters. Higher levels of suicidal intent were associated with less differentiated self and object representations and less emotional investment in relationships. More severe depressive symptoms in suicide attempters were correlated with more self-targeted anger, less eternally directed anger, higher levels of shame and guilt, more affectively negative views of relationships, greater use of maladaptive and self-sacrificing defenses, and more impaired reality testing. These findings offer some preliminary empirical support for the validity of psychodynamic theories of suicidal behavior.

Adult↗
PubMed1983

Psychodynamics of the mildly retarded and borderline intelligence adult.

In psychiatric literature there is a lack of interest in the psychodynamics of mildly retarded and borderline intelligence adults, despite the fact that these patients are known to be plagued by emotional problems and that their psychic conflicts, mobilization of defenses, and neurotic/psychotic solutions often represent a model of psychodynamic transparency. The authors discuss the special problems of development and adjustment to the community of these patients, and provide four case studies with psychodynamic formulations.

Adult↗
PubMed2005

Psychodynamic theory and counseling in predictive testing for Huntington's disease.

This paper revisits psychodynamic theory, which can be applied in predictive testing counseling for Huntington's Disease (HD). Psychodynamic theory has developed from the work of Freud and places importance on early parent-child experiences. The nature of these relationships, or attachments are reflected in adult expectations and relationships. Two significant concepts, identification and fear of abandonment, have been developed and expounded by the psychodynamic theorist, Melanie Klein. The processes of identification and fear of abandonment can become evident in predictive testing counseling and are colored by the client's experience of growing up with a parent affected by Huntington's Disease. In reflecting on family-of-origin experiences, clients can also express implied expectations of the future, and future relationships. Case examples are given to illustrate the dynamic processes of identification and fear of abandonment which may present in the clinical setting. Counselor recognition of these processes can illuminate and inform counseling practice.

Adult↗
PubMed2001

The crucial role of psychodynamic understanding in the treatment of eating disorders.

Psychodynamic interventions for eating-disordered patients can provide a unique pathway to understanding the illness. Contemporary practice strives to integrate insights derived from drive theory, ego psychology, object relations, self-psychology, relational and attachment theories, and intersubjectivity to claim a more thorough understanding of the antecedents of the eating-disorder symptoms. Placing emphasis on the unique personal history of the individual and finding a safe haven in which to process that history are cornerstones of psychodynamic treatment embraced by each of these schools of thought. This article has emphasized the importance of creating a safe space for these patients to speak, processing the most salient affects that arise in the therapeutic dyad, assessing potential transference and counter-transference paradigms, and assisting these patients in mastering symptomatic behaviors by making healthier identifications with their therapists. Although the selected topics merely sketch how psychodynamic treatment may apply in some cases, it is hoped that they will whet the appetite for a more sustained inquiry for readers. Contemporary psychoanalysis aims to be more "user-friendly" for patients and treaters and eschews a "one interpretation fits all" approach to any person suffering from a particular diagnosis. Attachment theory, infant and developmental studies, and in-depth outcomes research are shaping the way that psychoanalytically informed treatments are carried out. Within the next decade, insights derived from these kinds of psychoanalytic research will be even more concretely and meaningfully used in the treatment of eating disorders and other Axis I conditions.

Adolescent↗
PubMed1989

Structural family versus psychodynamic child therapy for problematic Hispanic boys.

Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six-to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction.

Child↗
PubMed1992

Taking context seriously in psychotherapy research: relating therapist interventions to patient progress in brief psychodynamic therapy.

This study examined the process of brief psychodynamic therapy in a way that preserved the context of the dialogue between therapist and patient. Data were drawn from transcripts of the complete therapies of 2 anxious and depressed women, which lasted 16 to 17 sessions. Patient utterances were rated on a psychodynamically oriented progress-stagnation scale, and all therapist interventions were rated on scales measuring (a) their compatibility with the content of a psychodynamic formulation (Plan) and (b) their quality. Within-session sequential analyses and by session and by phase-of-therapy correlational analyses were performed. Plan compatibility of therapist interventions correlated significantly with patient progress in the early and middle phases, and the quality of therapist interventions correlated significantly with patient progress in the middle phase.

Adaptation, Psychological↗
PubMed1993

Comparing the process in psychodynamic and cognitive-behavioral therapies.

Archival records were used to compare the therapy process in 30 brief psychodynamic and 32 cognitive-behavioral therapies. Verbatim transcripts of 186 treatment sessions were rated with the Psychotherapy Process Q-set, designed to provide a standard language for the description of process. Results demonstrated that although some features were common to both treatments, there were important differences. Cognitive-behavioral therapy promoted control of negative affect through the use of intellect and rationality combined with vigorous encouragement, support, and reassurance from therapists. In psychodynamic psychotherapies, there was an emphasis on the evocation of affect, on bringing troublesome feelings into awareness, and on integrating current difficulties with previous life experience, using the therapist-patient relationship as a change agent. The clinical theoretical precepts underlying psychodynamic treatments received considerable support. In cognitive-behavioral therapies, there was evidence for the importance of developmental, as opposed to rationalist, intervention strategies for treatment outcome.

Adaptation, Psychological↗
PubMed1993

Comparative study of emotional experiencing in psychodynamic-interpersonal and cognitive-behavioral therapies.

Despite increased interest in the role of emotion in the process of psychotherapy, we currently lack a valid gauge of its importance in the change process. Significant sessions obtained from 13 experienced psychodynamic-interpersonal and 17 experienced cognitive-behavior therapists were examined to determine the extent of affective exploration and therapists' views of these client states. Results indicate that affective experiencing is present in equivalent amounts in the change sessions of these two orientations. However, therapists' clinical views were dissimilar. Psychodynamic-interpersonal therapists viewed portions containing higher affective experiencing as more critical to the change process, whereas cognitive-behavior therapists viewed lower levels of experiencing as being therapeutically more significant. These findings suggest that, with regard to emotional experiencing, psychodynamic-interpersonal therapists may share common ground with experiential therapists, whereas cognitive-behavior therapists appear to have a unique perspective.

Adaptation, Psychological↗
PubMed2004

[Operationalized psychodynamic diagnostics (OPD) in patients with central serous chorioretinopathy].

Central Serous Chorioretinopathy (CSC) is a degenerative retinal disease still considered within ophthalmology as being of psychosomatic origin. Psychotherapeutic treatment of CSC patients has been demanded by several authors who, however, have failed to investigate the relevant preconditions. The present study examined subjective illness experience, treatment preconditions, and psychodynamic conflicts in 31 patients with CSC by means of axes I and III of the Operationalized Psychodynamic Diagnostics (OPD). Illness experience, psychological symptoms, capacity for insight into psychodynamic contexts and motivation towards psychotherapy were but slight. The conflicts of one half of the patients was evaluated as important. Predominant conflicts were dependency vs. autonomy, submission vs. control, providing vs. autarchy and self-esteem conflicts. All in all, the patients examined were more or less clinically inconspicuous, giving rather few reasons for psychotherapy. In order to control the results, further studies with higher case numbers are required.

Adult↗
PubMed1990

The frequency and effect on outcome of different types of interpretation in psychodynamic and cognitive-behavioral group psychotherapy.

The therapeutic effects of interpretations by both therapists and other clients were recorded by observers in three cognitive-behavioral and three psychodynamic groups over a period of thirty one-and-one-half-hour group therapy sessions. There was no significant difference in the overall frequency of interpretations made in the two different therapy modalities; however, there was the expected difference in the types of interpretations made. Cognitive-behavior therapists and group members tended to interpret patterns of behavior or impact on others more frequently than did psychodynamic therapists and group members; while psychodynamic therapists and group members made more historical cause interpretations. However, contrary to expectations, both therapy modalities made more interpretations of patterns of present behavior than any other type. When these interpretations were converted into problem statements that were sent to outside raters after the termination of the groups, the outside raters judged that clients improved most when interpretations of a pattern of behavior were made; next most when interpretations of impact on others were made; and did not improve when interpretations of motive were employed in either modality.

Analysis of Variance↗
PubMed2003

Experienced therapists' opinions on central issues in psychodynamic psychotherapy of patients with personality disorders.

Individual psychodynamic psychotherapy is a recommended, but controversial, treatment for patients with personality disorders (PDs). The aim of this study was to examine the relationship between demographic and professional characteristics of experienced psychotherapists and their attitudes and opinions towards aspects of this kind of psychotherapy. A questionnaire covering these issues of psychodynamic psychotherapy with patients belonging to all three DSM-IV clusters of PD was developed. A sample of 324 Norwegian psychiatrists and clinical psychologist with considerable experience in individual dynamic psychotherapy of patients with PDs filled in valid questionnaires. The therapists' age, gender, profession, postgraduate courses and degree of experience were examined as to their opinions on the following issues: alliances, aims, contraindications, needs to terminate, suicides, use of drugs, length of treatment, need for supervision and complaints to colleagues about patients' behaviour in such therapy with PD patients. Independent sample t-tests of the mean z-transformed group scores were the main statistical method applied. Therapist experience made the most significant differences as to treatment issues, while some differences also were found for age, gender and profession. The influence of postgraduate courses was negligible. Our study might have a selection bias towards therapist with strong psychodynamic orientation and particular interest in the psychotherapy of patients with PDs.

Adult↗
PubMed2004

Treatment of traumatized refugee children with Eye Movement Desensitization and Reprocessing in a psychodynamic context.

This study examines the effects of a psychodynamic approach of Eye Movement Desensitization and Reprocessing (EMDR) in treatment of traumatized refugee children. Among a child psychiatric outpatient refugee team, 13 children with post-traumatic stress disorder (PTSD), were treated by EMDR incorporated in a traditional psychodynamic therapeutic approach. The Posttraumatic Stress Symptom Scale for Children (PTSS-C) and the Global Assessment of Functioning (GAF) were administered before and after the treatment, to measure the effects. After treatment, a significant improvement was noticed in the functioning level and all PTSS-C scales, mostly in re-experiencing and least in the avoidance symptoms. The improvement in the functioning level was significantly correlated with the reduction of the PTSD-non-related and the depression, but not with that of the PTSD-related symptoms. Used in a psychodynamic context, EMDR is suggested to be effective treatment for traumatized refugee children. Our findings support the hypothesis of child-specific criteria for PTSD.

Adaptation, Psychological↗
PubMed1989

The psychodynamic formulation in child and adolescent psychiatry.

DSM-III and DSM-III-R aid diagnostic clarity but do not help clinicians plan for common therapies available. A psychodynamic formulation has been described for adults to complement diagnosis and guide management. Child and adolescent psychiatrists would benefit if such a scheme were available for their use. Psychodynamic formulations based on current models are offered and their elements are described. Case vignettes and therapeutic plans are presented to show the practical value of a formal psychodynamic formulation, regardless of the treatment employed.

Adolescent↗
PubMedDate not supplied

A psychodynamic view of psychosomatic medicine.

OBJECTIVE: The objective of this article is to assess the relevance of psychodynamic observations and theory for psychosomatic medicine. METHODS: The evolution of the psychodynamic formulation of psychosomatic symptom formation is described in a brief historical review. RESULTS: There are two distinctly different pathways along which stress-induced psychological arousal is transformed into somatic symptoms. CONCLUSIONS: Psychodynamic observations and theory have important implications for psychosomatic research and treatment.

Affective Symptoms↗
PubMed1994

An empirical comparison between the DSM and psychodynamic approaches for assessment of child disorders in children attending outpatient clinics.

The DSM and psychodynamic approaches provide different perspectives on child psychiatric diagnoses. Taking advantage of the recent publication of a psychodynamically oriented classification of child disorders, correspondences between these approaches were studied in a sample of outpatient clinic children. Clinician judges and a psychiatric interview schedule provided for diagnoses. Classifications of child psychopathology are still imperfect to a large extent. As a result, statistical comparisons can only yield limited relationships and caution is necessary when using classification tools. Methodological difficulties notwithstanding, various associations showed that DSM and psychodynamic constructs, while different, are not entirely independent.

Affective Symptoms↗
PubMed1996

Containers, mental space and psychodynamics.

The concept of the container has a place within cognitive science as well as within psychodynamic theories. Cognitive semantics has shown that many metaphors giving meaning to daily life-events use the container as a basic reference point. Psychoanalytic theory, most notably, Freud's psychosexual developmental model, illustrates how the container of the body results in meaning. Object relations theory in psychoanalysis has shown how patients with borderline personality disorder behave according to the dynamics of container and containment. Both the cognitive and the psychodynamic conceptions of containers are clinically relevant. The fundamental notion of the container leads to an exploration of 'container dynamics' both in cognitive semantics and in psychodynamic work. A model of the cusp may be of help in the description of the dynamics at the border of the container. Furthermore, the descriptions of the patient's communication of emotion and thoughts may involve three interacting dimensions: an effective-perceptual dimension, a phantasy dimension and a socio-interactive dimension. The interaction between these dimensions has implications for dealing with container dynamics and the process of containment.

Borderline Personality Disorder↗
PubMedDate not supplied

Changes in conflict, symptoms, and well-being during psychodynamic and cognitive-behavioral alcohol inpatient treatment.

BACKGROUND: According to Grawe's psychological therapy approach, conflict reduction can be expected not only in psychodynamic, but also in cognitive-behavioral therapy (CBT). This was tested in an effectiveness study. Changes in cognitive conflicts, along with those of symptom severity and well-being were analyzed during alcohol inpatient treatment. METHODS: Four times during treatment, groups of patients receiving psychodynamic therapy (n = 45 patients) or CBT (n = 49 patients) were measured and compared. Lauterbach's Online Conflict Test was used to measure conflict. Symptom severity and well-being were measured using questionnaires. RESULTS: Results showed significant conflict decrease in both groups with a tendency towards faster reduction under CBT. There was also significant change in symptom severity and well-being in both groups with no difference regarding reduction gradient. Moreover, patients in the psychodynamic treatment group exhibited lower symptom scores at treatment begin which may be a consequence of clinical group assignment. CONCLUSIONS: In general, the findings confirmed Grawe's theoretical assumptions. Generalizability to other diagnostic groups and other clinical settings remains to be tested.

Adult↗