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PubMed1989

Empirical coverage of psychodynamic configurations of anorexia nervosa.

For the last several years, the clinical picture of anorexia nervosa has been covered at the following three levels: (1) symptomatology (including partner and family relations); (2) psychodynamics; (3) narcissistic level. As far as the psychodynamic level is concerned, this paper presents the pertinent theory in its operationalized form for a clinical rating. The convergent validity of the five psychodynamic configurations is tested by a comparison of clinical rating, a questionnaire (IATAN) and a standardized interview (SIAN); divergent validity is tested by verifying the mutual differences of the five configurations.

Adolescent↗
PubMed1984

Psychodynamic variables as predictors of psychotherapy outcome.

Predicting the outcome of psychotherapy is a central concern in psychiatry. Twenty-one medical students seeking psychotherapy were evaluated on a number of psychodynamic and process variables using self-report scales and scales completed by the therapist before, during, and after psychotherapy. There were significant differences between patients and a comparison group on eight variables before therapy. Ten psychodynamic variables (six representing ego defense mechanisms) and four process variables were found to be highly correlated with outcome measures; the process variables were the best predictors of outcome. The data support the use of psychodynamic and process variables as predictors of outcome in psychoanalytically oriented psychotherapy.

Adult↗
PubMed1995

The borderline patient: update on the diagnosis, theory, and treatment from a psychodynamic perspective.

This paper presents an overview regarding the borderline patient including historical background, diagnosis, developmental theory, prognosis, and psychotherapy, all from a psychodynamic perspective. The overview is succinct, current, and practical; it is comprehensive although certainly not all-inclusive. Five clinical vignettes are presented, reflecting various aspects of borderline patients. These vignettes are used to illustrate phenomena elaborated later in the paper. Regarding diagnosis, an approach based on ego strengths and ego weaknesses is detailed. This "ego-psychological diagnostic approach" leans on the ideas of Kernberg, but simplifies and occasionally modifies his work, in addition to including aspects of the borderline patient not stressed by him. It provides a simple, integrated summary of current psychodynamic diagnostic thinking. The paper compares and contrasts two of the most useful developmental theories regarding the borderline patient, those of Kernberg and Adler. The clinical usefulness of the two theories is noted, as is their relationship to etiology. Relying on the work of Stone, there is a brief section on prognosis, followed by an even briefer discussion of referral yield. The paper concludes with a discussion of psychotherapy. A continuum of psychodynamically related psychotherapies is detailed, then related to borderline individuals.

Adult↗
PubMed1997

Psychodynamic psychotherapy with the older adult: challenges facing the patient and the therapist.

The subject of advanced age is often neglected in discussions of diversity and intersubjectivity in psychodynamic psychotherapy. In addition, psychologists historically have underestimated the ability of older individuals to utilize and benefit from psychodynamic treatment. This article provides support for the belief that many older individuals are capable of engaging in insight-oriented treatment and addresses some of the unique challenges faced by the older patient and the psychotherapist. The importance of determining the impact of age on intrapsychic conflicts is examined. Concepts from developmental psychodynamic theory are reviewed and applied to the clinical case of A., an 81-year-old widow. This case illustrates several themes that often emerge in work with older patients. The significance of changes in family structure and roles, object loss, and narcissistic injury in the life of this patient and older individuals in general is discussed.

Adaptation, Psychological↗
PubMed2000

The use of the psychodynamic life narrative in crisis supervision.

The psychodynamic life narrative is a statement that is made to the patient that gives current emotional reaction meaning in the context of his life history, and shows it to be a logical and inevitable product of previous life experiences. Because the patient in crisis characteristically present feeling overwhelmed, confused and needy, there is a sense of urgency and helplessness which impacts on the resident therapist's intervention. Common countertransference reactions which can result are assuming omnipotent control, a grandiose rescue fantasy or passivity. The authors present a clinical vignette to illustrate the supervisory process and its vicissitudes in the use of the psychodynamic life narrative in supervision of crisis work. The early identification of the "rescuing" response led to the rapid formulation of the psychodynamic life narrative and a successful outcome.

Adult↗
PubMed2004

A psychodynamic clinician's foray into cognitive-behavioral therapy utilizing exposure-response prevention for obsessive-compulsive disorder.

Research suggests that, by itself or as an adjunct to pharmacotherapy, cognitive-behavioral therapy (CBT) involving exposure with response prevention (ERP) is an effective treatment for Obsessive-Compulsive Disorder (OCD). However, there is a shortage of clinicians trained in this form of therapy. Although many psychodynamic clinicians treat individuals with OCD using traditional therapy that may assist them with their relationships, there is little evidence that such treatment is effective in ameliorating the OCD symptoms. As there is a clear need for more clinicians trained in CBT for OCD, it may be possible for practitioners trained in psychodynamic or other modalities to learn ERP. Such cross-theoretical training involves a number of challenges. These include the therapist's own anxiety about ERP, understanding resistance, and reconsidering therapeutic boundaries. The first author describes his experiences as a psychodynamically-trained psychologist venturing into ERP in an attempt to demonstrate that although there are barriers they are not insurmountable.

Adult↗
PubMed1998

An empirical study of the psychodynamics of suicide.

This paper presents results from an empirical study of four key psychodynamic concepts (self-directed aggression, object loss, ego functioning disturbance, pathological object relations) of suicidal behavior. The sample consists of hospitalized psychiatric patients following a suicide attempt (attempters: n = 52) and demographically similar hospitalized psychiatric patients with no history of suicidal behavior (controls: n = 47). The study was designed to ascertain whether attempters differed from matched psychiatric control patients on the four psychodynamic constructs hypothesized to be associated with suicide. It was predicted that attempters would manifest higher levels of depression and self-targeted anger, a more significant history of loss, less adaptive defenses, and more primitive object representations. Results strongly supported an object-relational view of suicidal behavior. In addition, support for the loss hypothesis was found in the identification of one specific constellation of losses. Namely, attempters were significantly more likely to report a history of childhood loss combined with a recent loss in adulthood than were their nonattempter counterparts. Limited support was provided for the other two hypotheses in differentiating suicidal from nonsuicidal severely ill psychiatric patients. This unexpected finding is examined and suggestions are made for the refinement and greater specification of psychodynamic theories regarding the etiology of suicidal behavior, with the aim of differentiating individuals prone to such action from those with similar psychopathology and dynamic issues who do not actually attempt suicide. Limitations of the study are discussed and implications of the findings for the theory and treatment of suicidal behavior are offered.

Adolescent↗
PubMed1987

Psychodynamic group treatment of young adult bulimic women: preliminary positive results.

This paper presents preliminary results of symptomatic and behavioral changes and psychodynamic observations for 9 young adult bulimic women treated with psychodynamic group psychotherapy. Pre/post group test results showed significant improvement on all measures of eating pathology, on the EDI ineffectiveness item and the Janis-Field feelings of inadequacy scale as well as on the total score of the Hopkins Symptom checklist. These results were consistent with independent clinical conclusions and with verbal reports of improvements in binging and purging behaviour. Clinical content shed light on the role of the parents, especially the father, in the development of body-image, sense of adequacy and self-esteem, life goals and feminine identification. The authors conclude that clinical observations to date have yielded interesting psychodynamic hypotheses and the initial symptomatic improvements warrant cautious therapeutic optimism.

Adult↗
PubMed2002

[Gaining insight and structural capability as goals of psychodynamic psychotherapy].

Psychodynamic psychotherapy in the sense of German psychotherapy guidelines is currently the most frequently used treatment in outpatient psychotherapy. This report summarizes the psychodynamic fundaments of this method and distinguishes the conflict exposure and the structure formation as significant therapeutic aims. The subject of personality structure is dealt with according to the OPD (operationalized psychodynamic diagnosis) system which allows an operationalization and empirical investigation of structural aspects. The treatment techniques used to achieve structure-related therapy aims (e.g. the ability to differentiate affects, impulse control, empathy, emotional expression, attachment, separation, etc.) are described in detail.

Ambulatory Care↗
PubMed2004

[The phenomenology and psychodynamics of affects in borderline patients].

This paper presents a review of the phenomenology and psychodynamics of affects in borderline patients. The first part demonstrates that in most current conceptions of the borderline disorder affective disturbances are regarded as to be characteristic. In this context, the strong overlap between borderline disorders and affective disorders found in many empirical studies is described and different hypotheses are presented to explain this phenomenon. The second part of this review is concerned with the psychodynamics of affects in borderline patients. The role of affects in thinking, behaviour, self perception and the regulation of object relations is discussed. Borderline and other severe personality disorders are assessed from the perspective of affective disturbances. The psychodynamic functions of particularly characteristic affects such as anger, anxiety, depression and boredom are discussed. The close connection between affective and cognitive functioning in borderline patients is described and evaluated with regard to modern theories of affect and cognition. Finally, the role of affects in the treatment of borderline patients is discussed.

Borderline Personality Disorder↗
PubMed2004

A review of interpersonal-psychodynamic group psychotherapy outcomes for adult survivors of childhood sexual abuse.

This article discusses the use of interpersonal-psychodynamic group treatments for survivors of childhood sexual abuse. Empirically based interpersonal-psychodynamic group outcome studies are reviewed according to efficacy and effectiveness models of treatment outcome research. To facilitate the evaluation and comparison of clinically significant change across studies, effect size indicators were calculated when descriptive data were reported. Findings suggest that interpersonal-psychodynamic group therapy is an effective treatment approach for many survivors of childhood sexual abuse. Implications for future research are considered.

Adult↗
PubMed2004

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history.

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.

Alberta↗
PubMed2005

Amplification of the concept of meaning as the validating principle in psychodynamic science.

In two previous articles by this author, the concept of psyche was given legitimate scientific status insofar as a necessarily new and unique scientific paradigm for psychodynamics was elaborated, stemming from the idea that positivistic science is not appropriate to the subjective data of psychoanalysis. This paradigm includes the idea that the concept of meaning as scientific validation is central to psychodynamic science. The concepts of erroneous meaning, synchronicity, and numinosity were introduced as aspects of this new scientific paradigm. In the present article, the complementary relationship between psychodynamic and traditional science is explored. The concepts of synchronicity, numiosity, and meaning are elaborated, together with discussion of the phenomenon of anxiety as it impinges on these dynamics. The concept of erroneous meaning is in this article separated from the concept of meaning itself through the idea that the activation of anxiety separates the two.

Anxiety↗
PubMed2006

Teaching psychodynamic psychotherapy in the 21st century.

Special challenges face the 21st century teacher of psychodynamic psychotherapy. Time for careful psychodynamic reflection, of necessity, competes for space with the current explosion of psychiatric knowledge in psychopharmacology, genetics, health care policy and multiple other agendas. Thus educators must be clear about the goals of psychodynamic psychotherapy, engage students in the special interviewing techniques to elicit sensitive information and appreciate the special needs of today's physicians launching into this field. Educational objectives must be clear, the goals of psychoanalysis and psychoanalytic psychotherapy well articulated and the means to gather information enhanced. With the expansion of neuroscience into the mysteries of implicit and explicit memory this is also an area where the 21st century educator must develop integrative expertise. There are tools available to expand ones proficiency in each of these areas.

Curriculum↗
PubMed2006

The place of psychodynamic psychiatry in consultation-liaison psychiatry with special emphasis on countertransference.

Psychodynamic theory can be applied to all aspects of consultation-liaison work. There are various psychodynamic treatment approaches that can have a powerful meaning to the patient. This can include understanding the patient's life trajectory through the elicitation of a life narrative, understanding defense mechanisms, and utilizing the patient's fantasies about illness. Patients who are physically ill regress and want to be understood. When this is achieved through a psychodynamic approach, the patient will be more likely to accept a referral for psychiatric follow-up when it is indicated. The consultation-liaison psychiatrist will also encounter transference and countertransference manifestations. Of particular usefulness can be derivatives of classical countertransference, which can be seen as reactions and identifications by the treating psychiatrist or the medical team to the patient that may interfere with effective care. "Countertransference Rounds" is a technique for examining such manifestations during the C-L team's discussion of patients.

Adult↗
PubMed2006

Psychodynamic psychiatry--past, present, and future.

At this point in the history of psychiatry it is important for psychodynamic psychiatry to strengthen its identity as a discipline in its own right-distinct from organized psychoanalysis. Although some of its principles overlap with psychoanalytic psychology, there are important differences. Psychodynamic psychiatry places a greater emphasis on immediate therapeutic outcome. It has a much wider patient base, and flexible models of duration and frequency of treatment. Its assumptions also rest on scientifically validated data to a much larger degree than psychoanalysis. A sturdier identity might help psychodynamic psychiatry stand alongside bio-descriptive psychiatry as a core component of American Psychiatry.

Humans↗
PubMed2004

[Psychodynamic group treatment for generalized social phobia].

OBJECTIVES: The aim of this study is to assess the effectiveness of psychodynamic group therapy in patients with generalized social phobia. METHODS: Thirty patients were included in a randomized single-blind clinical trial comparing psychodynamic group treatment (PGT) with a credible placebo control group (CPC). PGT was carried out within a 12-session psychodynamically-oriented group psychotherapy. Control patients received a treatment package of lecture-discussion and support group for 12 weeks which was compared to PGT. Each participant completed the Liebowitz Social Anxiety Scale (LSAS), the Hamilton Anxiety Scale (HAS) and the Clinical Global Impression Scale(CGI) at pretreatment assessment and after 12 weeks of treatment. Data analysis was carried out using a repeated measures ANOVA. Patients were excluded if they were under any kind of pharmacotherapy or psychotherapic treatment. RESULTS: Both groups demonstrated significant pretreatment-to-posttreatment change on most measures. On the LSAS, PGT patients were rated as more improved than controls at posttest assessment (F(1,28)=4.84, p=0.036). Baseline data of completers did not show differences between both groups in the demographic variables and outcome variables used. CONCLUSIONS: The present study showed that PGT was [corrected] superior to a credible placebo control group in the treatment of generalized social phobia, in a 12-week randomized single-blind clinical trial.

Adolescent↗
PubMed1991

Review of auditory subliminal psychodynamic activation experiments.

Subliminal psychodynamic activation experiments using auditory stimuli have yielded only a modicum of support for the contention that such activation produces predictable behavioral changes. Problems in many auditory subliminal psychodynamic activation experiments indicate that those predictions have not been tested adequately. The auditory mode of presentation, however, has several methodological advantages over the visual one, the method used in the vast majority of subliminal psychodynamic activation experiments. Consequently, it should be considered in subsequent research in this area.

Aggression↗