{"title":"Ketamine-Assisted Psychodynamic Psychotherapy.","authors":"John G Cottone","doi":"10.1521/pdps.2023.51.4.467","DOIUrl":"10.1521/pdps.2023.51.4.467","url":null,"abstract":"<p><p>This case report details the treatment of a longtime psychodynamic psychotherapy patient, with a particular focus on a ketamine-assisted psychotherapy (KAP) session, and how the progress achieved during this session compares with the literature on KAP. The patient is a 54-year-old woman with a history of multiple traumas, including sexual assault and life-threatening physical injuries, as well as a recent diagnosis of primary lateral sclerosis (PLS). For most of her life, she relied on extreme idealization of important people in her life as her primary defense mechanism, helping her to maintain physical and psychological survival. However, after a KAP session in January 2023 she discovered the consequences of her extreme idealizing tendencies. Among these was the creation of troubling double binds for the people she idealized, as well as the fomentation of conflict between these individuals with each other. Also unconscious was the secondary gain offered by her escalating physical symptoms and pain-that is, the ability to resolve conflicts between those she idealized-and how this secondary gain increased the likelihood of symptom exacerbations during periods of conflict. After the discovery of these unconscious tendencies during her KAP session, the patient has since been able to avoid extreme idealization of important people in her life and has subsequently experienced fewer episodes of exacerbation of her physical symptoms. Consistent with the opinions of clinicians and researchers published in the literature, the achievement of a psychedelic trance state appeared necessary for the success of the patient's KAP treatment.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 4","pages":"467-478"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
María Jesús Rufat, Jonathan Radcliffe, Tennyson Lee, Philipp Martius, Eric Fertuck, Iván Arango, Heimhild Lappe, Eulàlia Ripoll, Frank E Yeomans
{"title":"Developments in Group Transference-Focused Psychotherapy.","authors":"María Jesús Rufat, Jonathan Radcliffe, Tennyson Lee, Philipp Martius, Eric Fertuck, Iván Arango, Heimhild Lappe, Eulàlia Ripoll, Frank E Yeomans","doi":"10.1521/pdps.2023.51.3.311","DOIUrl":"10.1521/pdps.2023.51.3.311","url":null,"abstract":"<p><p>Several evidence-based psychotherapies for personality disorders have been developed in recent decades, including transference-focused psychotherapy (TFP), a contemporary model of psychodynamic psychotherapy developed by Otto Kernberg. Kernberg established Group TFP (TFP-G) as an alternative or adjunct treatment to individual TFP. Although not yet manualized, TFP-G is used in publicly and privately funded mental health services, including outpatient clinics, subacute hospitals, therapeutic inpatient units, partial hospitalization services, and rehabilitation services serving people with borderline personality. Kernberg's model of TFP-G psychotherapy, its application in clinical settings, and what differentiates it from other group psychotherapy models is described as well as illustrated with some examples useful to practitioners.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"311-329"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychoanalytic Contributions to Psychodynamic Psychiatry and Psychotherapy: Freud's Structural Hypothesis.","authors":"Richard B Corradi","doi":"10.1521/pdps.2023.51.3.254","DOIUrl":"10.1521/pdps.2023.51.3.254","url":null,"abstract":"<p><p>Psychoanalysis has long lost its historical influence on U.S. academic psychiatry. Psychoanalytic theory, however, provides us with a rich and remarkably comprehensive knowledge of human development, both normative and pathologic. This article describes a psychoanalytic concept that enriches our understanding of the mind and its disorders: Freud's structural hypothesis. This core concept provides a theoretical foundation for understanding the clinical features of both neurotic and personality disorders. It also informs a psychodynamic psychotherapy.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"254-260"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unconscious Communications by the Body in Catatonia-A Jungian Perspective.","authors":"Andrew John Howe","doi":"10.1521/pdps.2023.51.3.249","DOIUrl":"10.1521/pdps.2023.51.3.249","url":null,"abstract":"<p><p>Outside of specific motor conditions, bodily movements are rarely considered in contemporary psychiatry. Stereotypies and mannerisms in clinical cases of catatonia are seen as having no deeper meaning in contemporary psychiatry. Perhaps we are missing something that could be important for us and our patients. The psychiatrist and analyst Carl Jung suggested there was an unconscious communication, and therefore a meaning in psychotic symptoms, including the movements in catatonia. The unconscious is rarely considered in psychotic presentations, yet psychosis is a prevalent condition in clinical settings. In this article Jung's ideas are presented along with case examples that invite the reader to consider them in their own future practice.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"249-253"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Navigating Countertransference in Inpatient Settings: Optimizing Interventions for Patients with Borderline Personality Disorder and Repeated Acute Hospitalizations.","authors":"Deborah Lin, Luke Zona, Erin Seery","doi":"10.1521/pdps.2023.51.3.330","DOIUrl":"10.1521/pdps.2023.51.3.330","url":null,"abstract":"<p><p>Over the years, the psychiatric inpatient treatment paradigm has shifted to more brief stays focused on acute stabilization and psychopharmacologic-focused interventions, rather than individual psychotherapeutic engagement. Unfortunately, this has allowed patients with complex interpersonal dynamics, particularly borderline personality disorder, to slip through the cracks of effective treatment. This can contribute to repeated inpatient admissions, where both patients and clinicians feel trapped in a maladaptive, unhelpful cycle. In this article, we examine the evolution of inpatient treatment with de-emphasized psychotherapy practices, review the particular dynamics that patients with borderline personality disorder may evoke within an interdisciplinary treatment team, and provide a framework of clinically based vignettes for scenarios that may arise within inpatient treatment of this patient population. With attention to countertransference patterns and common pitfalls of communication, we offer alternative approaches and conversations with the hopes of improving outcomes and alliances in a new landscape of psychiatric practice.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"330-349"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Revisiting the Concept of <i>Pensée Opératoire</i>: Some Conceptual, Empirical, and Clinical Considerations.","authors":"Graeme J Taylor, R Michael Bagby, Piero Porcelli","doi":"10.1521/pdps.2023.51.3.287","DOIUrl":"10.1521/pdps.2023.51.3.287","url":null,"abstract":"<p><p>The concept of <i>pensée opératoire</i> (operational thinking) was introduced by French psychoanalysts in 1963 and a decade later was included as an essential component of the alexithymia construct as formulated by the U.S. analysts John Nemiah and Peter Sifneos. Despite a large body of research on alexithymia, the <i>pensée opératoire</i> component is not well understood, especially among clinicians and researchers who are not familiar with French psychoanalytic literature. In this article we clarify the definition and metapsychological conceptualization of the concept, review findings from some relevant empirical studies, and critique a recent proposal for redefining the alexithymia construct that departs from the original understanding of <i>pensée opératoire.</i> We also discuss some clinical implications of the concept and some strategies that psychotherapists can employ in the treatment of patients with this mode of thinking.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"287-310"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Maladaptive Personality Traits of Inpatients with Self-Harm Behavior and Its Association with Suicide Intent Severity.","authors":"Andre Teck Sng Tay, Samuel Eng Teck Cheng","doi":"10.1521/pdps.2023.51.3.350","DOIUrl":"10.1521/pdps.2023.51.3.350","url":null,"abstract":"<p><p><i>Introduction:</i> Inpatients with self-harm behavior utilize a high proportion of health care resources, and determining their suicide risk may be challenging. This study examines how maladaptive personality traits in people who self-harm are associated with suicide intent severity. <i>Methods:</i> This was a 5-month cross-sectional study. The International Personality Disorders Examination (IPDE) <i>ICD-10</i> questionnaire, Beck's Suicide Intent Scale (SIS), and the Depression Anxiety Stress Scale (DASS) 21 were administered. Sociodemographic and clinical data were recorded with STATA version 10.1 for statistical analyses. <i>Results:</i> Thirty-seven out of 40 (92.50%) inpatients participated in this study. About two-thirds (<i>n</i> = 24, 64.86%) were first-time self-harmers, with self-poisoning (<i>n</i> = 33, 89.19%) being the most common method. About two-thirds (<i>n</i> = 24, 64.86%) had low to moderate suicide intent. The most common diagnosis was adjustment disorder (<i>n</i> = 21, 56.76%). Around one-third had at least severe ratings for depressive, anxiety, and stress symptoms. All screened positive for at least one class of maladaptive personality traits, with the majority (<i>n</i> = 33, 89.19%) having more than one class of maladaptive personality traits. The three most prevalent classes of maladaptive personality traits were anankastic (<i>n</i> = 28, 75.68%), schizoid (<i>n</i> = 25, 67.57%), and paranoid (<i>n</i> = 23, 62.16%). Only dissocial traits were positively correlated with suicide intent severity (regression coefficient = 1.37, <i>p</i> = .017) following adjustment for the most important confounder, DASS 21. <i>Discussion:</i> Maladaptive personality traits were common in inpatients with self-harm behavior, with dissocial traits being positively correlated with suicide intent severity. This finding may inform suicide prevention strategies for patients who self-harm.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"350-373"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Do Psychedelics Facilitate Emergence of Unconscious Psychological Processes?","authors":"Tomas Lindegaard","doi":"10.1521/pdps.2023.51.3.270","DOIUrl":"10.1521/pdps.2023.51.3.270","url":null,"abstract":"<p><p>Psychedelic substances have a long history of use in traditional healing and religious ceremonies worldwide and are increasingly being investigated for their possible therapeutic usage. However, there is still a lack of consensus regarding how best to characterize the psychological effects of psychedelics and how they bring about the positive therapeutic outcomes observed in clinical studies. The aim of this article is to review available evidence from quantitative and qualitative studies on psychedelic-assisted therapy, as well as neurobiological studies, in relation to the hypothesis that psychedelics facilitate the emergence of emotionally charged unconscious material, originally proposed by pioneering psychedelics researcher Stanislav Grof. The reviewed process studies of therapeutic mechanisms in psychedelic-assisted therapy and qualitative studies of treatment participants clearly indicate that the psychedelic experience is associated with the subjective experience of having increased access to and awareness of emotions, memories, and perceptions that are normally avoided or outside of conscious awareness. Brain-imaging studies point to several different neurobiological effects of psychedelics that might be related to these subjective psychological experiences. Available evidence also indicates that this process might constitute an important therapeutic mechanism in psychedelic-assisted therapy, worthy of further investigation.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"270-286"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychodynamic Psychiatry and Psychoanalysis in Thailand.","authors":"Rasmon Kalayasiri, Kanthee Anantapong, Poom Chompoosri, Warut Aunjitsakul","doi":"10.1521/pdps.2023.51.3.261","DOIUrl":"https://doi.org/10.1521/pdps.2023.51.3.261","url":null,"abstract":"<p><p>The authors provide an overview of psychiatry and psychodynamic psychotherapy in Thailand, including a discussion of practice patterns, trends, and the cultural context of the delivery of psychotherapy services in this Southeast Asian country. They discuss a way forward in psychodynamic psychotherapy training that is collaborative, self-sustaining, and leads to competence. They address how to culturally adapt psychodynamic psychotherapy and suggest areas of research that would advance the field. Lastly, they discuss psychodynamic pedagogical strategies that may be acceptable and effective in underserved areas.</p>","PeriodicalId":38518,"journal":{"name":"Psychodynamic Psychiatry","volume":"51 3","pages":"261-269"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}