Levels Of Mental Functioning Research Articles

Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: toward the Psychodynamic Diagnostic Manual - third edition.

Depressive disorders in adolescence pose unique challenges for assessment and treatment, particularly due to their high comorbidity with various personality disorders. Moreover, young depressed patients may elicit very intense and difficult-to-manage emotional responses in therapists (in this context, countertransference). This study aimed at empirically identifying specific personality disorders (or subtypes) among adolescents with depressive pathology and exploring distinct countertransference patterns emerging in their psychotherapy: 100 adolescents (58 with depressive disorders; 42 with other clinical conditions) were assessed by their respective clinicians (n=100) using the psychodiagnostic chart-adolescent of the Psychodynamic Diagnostic Manual (PDM) - second edition, and the therapist response questionnaire for adolescents. Results showed that depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant, narcissistic, and borderline) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians' emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant personality subtypes evoked more positive countertransference responses, whereas patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Consistent with the next edition of the PDM, the study emphasizes the importance of comprehensive psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality and mental functioning profiles. This approach, which also relies heavily on the clinician's subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions.

Mental health, suicidal behavior and sexual orientation in Portugal

IntroductionSexual minority individuals consistently report higher rates of mental disorders and suicidal behavior than heterosexuals. However, much of this research is limited to Anglo-Saxon studies and no information on Portuguese reality is available.ObjectivesThe purpose of this study is to compare levels of mental functioning and suicidal behavior among heterosexual, bisexual, and homosexual individuals in Portugal.MethodsUsing online surveys, 1140 individuals (62.40% women, Mage = 36.83, SDage = 13.39, 76.4% heterosexual, 9.4% bisexual, and 14.2% gay or lesbian) completed the BSI subscales for depression and anxiety symptoms, as well as the Suicide Behaviors Questionnaire-Revised.ResultsSelf-identified bisexual participants presented higher levels of depressive and anxiety symptoms and higher levels of suicidal ideation and likelihood of suicidal behavior than homosexual and heterosexual participants (who scored the lowest); yet, homosexual participants showed higher levels of suicide attempts. Also, depression and anxiety symptoms were strongly and positively correlated with all dimensions of suicidal behavior. Finally, hierarchical multiple regression analysis showed that higher levels of depression and non-heterosexual sexual orientations were significant predictors of suicidal ideation and the likelihood of suicidal behavior.ConclusionsThe present study adds to the evidence that sexual minority individuals are at risk of increased mental health problems and suicidal behavior, compared to heterosexuals, and reiterates the need for local political and legislative efforts to normalize LGB identities, fighting continued institutional heterosexism, interpersonal intolerance. Mental health providers and mental health policymakers need to consider these results if they want to address inequalities in mental health and in suicidality among these minority groups.

Religiosidade e Funcionamento Mental em Idosos Portugueses: Uma Perspetiva Sociopsicológica

Resumo O artigo tem como objetivo analisar a relação entre a religiosidade e o funcionamento mental em idosos portugueses. Os instrumentos metodológicos utilizados foram: um questionário sociodemográfico, a Escala de Orientação Religiosa-R e o Mental Health Inventory (MHI-5). Os resultados da análise mostraram que, embora sem uma relação estatisticamente relevante entre religiosidade e funcionamento mental de uma forma geral, existem, no entanto, diferenças significativas entre a frequência de participação em celebrações religiosas e melhores níveis de funcionamento mental.

Burnout and level of mental functioning in oncology staff.

10513 Background: The Burnout Syndrome takes relevance for its investigation since 1986, when Maslach developed a survey for its study with 3 subscales that include the symptoms generated by exhaustion and chronic labor stress. Health workers are especially vulnerable to the development of this syndrome, which is greater centers with exposure to patients with severe and/or chronic ailments. Thus, the mental structure maturity level with which the individual functions takes relevance, since it is linked to the quality of judgment of the clinician. Few studies consider this aspect because of the complexity of having the instruments and professionals to assess it. It has been questioned whether Burnout or this occupational exhaustion damages the quality of life of the individual, and if it also negatively impacts their work performance, and the quality of care provided to patients. Methods: Observational, cross-sectional and correlational study. It analyses the relationship between Burnout and the characteristics of the mental-structural functioning level in oncology staff, and its association with the level of functionality of the mental structures within the work environment. Prior validation of the instrument was conducted, FIAD-15, with acceptable Alpha of 0.81. Results: Data were obtained from 1,060 subjects, including administrative, nursing and medical members of the Oncology Service staff, as well as, students. Out of these, 1,036 subjects answered the questionnaire appropriately and were considered in the analysis. 413 (39.86%) presented Burnout. The prevalence was higher in men (45.17%) than in women (34.56%). A significant association was found between Burnout frequency and levels of mental functioning. On the functionality of the mental structures, 80% had functional, high and intermediate levels, while 20% of the total population showed a borderline level of functionality (severe). In women, Burnout frequency was higher in borderline levels, followed by those of functional and high level. In men, Burnout was higher in those at the borderline level, followed by functional and intermediate; it was much lower in high level subjects. Conclusions: The mental structure functionality levels found in the oncology staff are associated with Burnout; which is lower in men with structures with high functionality and in women in the intermediate level. Subjects with borderline structures suffer greater Burnout. Further studies should be carried out to support these findings in the future and open new lines of research.

Thin-skinned or vulnerable narcissism and thick-skinned or grandiose narcissism: similarities and differences

ABSTRACTThis paper explores two clinical forms or aspects of narcissism and their psychopathological implications: thin-skinned, or vulnerable, narcissism (VN) and thick-skinned, or grandiose, narcissism (GN). The different names used and the characteristics with which they have been described are reviewed. Clinical vignettes are examined for both types of narcissism, emphasising their diagnostic characteristics and discussing their similarities and differences, in addition to the factors that may confer additional complexity to the clinical case. The importance of the experiences of shame and humiliation are emphasised. Based on these comparisons, the psychodynamic mechanisms at play are examined in both cases, especially their relation to the levels of mental functioning. The paper concludes that both VN and GN constitute failed ways to face the difficult dialectic articulation between self-affirmation and acknowledgement of the other.

The Latin American contribution to the psychoanalytic concept of phantasy

The author argues that the ubiquity of phantasies at various levels of mental functioning is undisputed in the current schools of psychoanalytic thought; however, she demonstrates some variations in their understanding of how the psychotherapeutic access to different configurations occurs. In the process of examining and acknowledging the central role played by unconscious phantasies in his patients’ symptoms, Freud gradually broadened the vernacular meaning of the German word ‘Phantasie’ that refers to imagination and the world of imagination, conferring on it the specific features that came to characterize its use in the psychoanalytic vocabulary. Later, the expansion of the concept derived from Melanie Klein’s clinical material obtained from child analyses gave rise to important debates. The author discusses the main points of disagreement that led to these debates, as well as their various theoretical and technical implications. Psychoanalytic associations in Latin America were strongly influenced by Klein and her followers. Thus, most of their scientific writings use the concept of unconscious phantasy put forward by the Kleinian school. Taking Kleinian principles as their starting point, Baranger and Baranger made the most original Latin American contribution to the concept of unconscious phantasy with their works on the unconscious phantasies generated by the analytic pair.

The Body Emerging from the “Neverland” of Nothingness

The author considers sensory perceptions arising from the body to be the first expressions of self-consciousness and mental existence in patients who are overwhelmed by a dimensionless abyss of nothingness. This perspective can help the analyst in catalyzing the patient’s integration with his deepest levels of mental functioning. Clinical material from the four-session-per-week analysis of a psychotic patient is discussed. To this analysand, finding the body meant finding “the land that never was,” a “land” that could begin to exist in analysis thanks to a relational working through within the analytic couple.

Symmetric frenzy and catastrophic change: A consideration of primitive mental states in the wake of Bion and Matte Blanco

The author explores the connections between Matte Blanco’s notion of symmetric frenzy, i.e. the turbulence characteristic of the deepest levels of mental functioning, and Bion’s concept of catastrophic change. For Bion, mental links are retrieved from the formless darkness of infinity. With catastrophic change, emotional violence and the confining nature of representation come into conflict, leaving the subject prey to an explosiveness that paralyses mental resources. Matte Blanco identifies indivisibility as the abyss in which all differentiation ceases; he bases his model on the conflict between symmetry and asymmetry. Infinity, he maintains, is where the first forms of mentalization develop. Both Bion and Matte Blanco emphasize the contrast between the immensity of mental space and the spatio‐temporal order introduced by the activation of thinking functions. The author presents clinical material from the analysis of a psychotic patient, stressing the need to encourage both working through the defect of thinking (Bion) and ‘unfolding’ manifestations of symmetry (Matte Blanco) so as to foster the activation of the resources of thought, meanwhile postponing transference interpretation. He concludes with two later sessions, in which recognition of the analyst in the transference allows the analysand to develop his capacity for containment and asymmetric differentiation.

Play therapy with emotionally damaged adolescents

Adolescence is a critical period of development for all individuals, but particularly for those who have suffered earlier emotional difficulties or abuse. If these problems go unresolved, patterns of behaviour which become established during this period may be more difficult to change later on. However, more traditional talk therapies may be resisted by adolescents. This article argues that non-directive play therapy, given age-appropriate adaptations, offers an approach which, since it encompasses both play and verbal communication, is well suited to addressing adolescent concerns, particularly those of early adolescence.This argument is illustrated by two accounts of therapy with a boy and a girl, both in early adolescence, which show how a more traditional non-directive counselling approach was combined with play therapy by the adolescents themselves, allowing exploration of emotional difficulties on all levels of mental functioning. The cases show how traumatic or painful early memories may be reworked on a bodily and emotional level, without the feeling of over-intrusion risked by a directive or interpretive stance.

Hypnotic analysis of the recognition of a sex symbol

A very important modern-day attitude towards sex is reflected in the fact that direct representations of the genital organs are rarely if ever found in works of art or architecture. Still it is a well known fact that both art and architecture contain symbolic representations of the genital organs; and this is perhaps especially true in connection with church design and decoration. Among ancient and primitive peoples and at times during the middle ages, frank worship of the generative organs has been widespread. However, the association of sexual activity with sin and guilt in the Judaic-Christian tradition has tended to drive overt sex underground, such that its direct representation with any but a derogatory intent (as in dirty drawings and jokes) is taboo. Thus it is possible for churches to contain thinly disguised sex symbols which are not recognized as such by most viewers. Presumably the churchgoer derives satisfaction from the symbols without having to cope with the problem of sex-related guilt and shame. The present investigation was aimed at determining the extent to which the symbolism of sex is recognized at different levels of mental functioning. That is, an effort was made to determine the extent to which the mind defends itself against recognizing the reality behind the symbol.