Psychodynamic Model Research Articles

The Third Party: Healing Eating Disorders Through a Task Model of Couples Therapy

Couples therapy is often overlooked in the treatment of eating disorders yet provides a vital role in healing and recovery. In this article we propose a four-step-task model for couples therapy when the female partner has an eating disorder. This psychodynamic model includes narrative techniques to convey pertinent personal history, attachment work, parts work, and shared communication of emotion. The article describes the composite model and details the four steps.

Mentalization, session-to-session negative emotion expression, symbolic play, and affect regulation in psychodynamic child psychotherapy.

Internalizing and externalizing problems have been related to negative emotionality, and affect regulation deficits in several studies. Certain psychodynamic models of treatment use children's symbolic play activity as a medium to mentalize negative emotions in order to develop children's affect regulation. However, the complex associations among these constructs and their associations with outcome have not been examined. This study aimed to investigate, first, whether average mentalization practices in treatment, as well as session-to-session expression of negative emotions and symbolic play predict gains in affect regulation and, second, whether changes in these variables are associated with clinically significant change in symptoms and global function. The sample included 40 outpatient children, who underwent long-term psychodynamic treatment. Nine hundred seventy-five sessions were coded for children's symbolic play, affect expression (anger and dysphoric affect), and affect regulation characteristics, and each treatment was scored for average adherence to mentalizing principles. Time Series Panel Analyses (TSPA) indicated session-to session use of symbolic play predicted gains in affect regulation. A significant 2-way interaction indicated that dysphoric affect expression in high mentalization adherent treatments was associated with higher affect regulation than in low adherent treatments. Partial correlation analyses indicated that mentalization adherence in treatment was associated with symptomatic improvement at trend level of significance, and changes in affect regulation and symbolic play were significantly associated with gains in global function. Findings point to the importance of use of symbolic play, and dysphoric affect expression in the context of mentalization practices for gains in affect regulation and outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

La dissonance cognitive et disciplinaire de la psychanalyse

ContextSince the founding of the discipline, psychoanalysis has been the subject of dissensions, conflicts, and ruptures that have had a considerable impact on disciplinary and group cohesion, on theoretical constructs, and even on individual constructions during treatment. The defence mechanisms used at the group level, in intra- and intergroup relationships, suggest the existence of a problem of boundaries. The presence and the effects of cognitive dissonance and sociocognitive conflicts (concepts from social psychology) have never been studied in relation to the organization of psychoanalysis. One of the main dissonances seems to be generated by the confrontation of psychoanalysis with scientific theories and, more broadly, with pluridisciplinarity. ObjectiveThis analysis aims to provide transdisciplinary answers to a series of questions regarding implicit cognitive dissonance, its consequences, and its theoretical and clinical resolution in psychoanalysis. MethodWe based this work on the cross-examination of testimonies, of critical points of view of psychoanalytic psychopathology, and of theories exploring models related to dissonance and sociocognitive conflict in social psychology. ResultsThis research highlights that psychoanalytical “suffering” is evident both in successive conflicts and in the marginal place occupied by psychoanalysis in society and in academic circles. Reputable psychoanalysts who are members of recognized psychoanalytical societies underline the totalitarian, dogmatic, and sectarian functioning of these societies, as well as their impermeability to third parties; the organizational life of psychoanalysis is understood here as doubly paradoxical and based on a twofold limit. The hypothesis of a psychoanalysis of limits is explored using the structural and psychodynamic models proposed by psychoanalytic theory; our research reveals the flaws and defences associated with this type of organization. Social psychology provides a key to understanding the relationship between difficulties related to boundaries and beliefs, and their consolidation as a resolution of both conflicts and cognitive dissonance. ConclusionThe author suggests the development of a theoretical and clinical model for the reconstruction of the individual at the intersection of holistic, bio-psychosocial, and even environmental perspectives, making it possible to capture all the interactions that constitute a primary and more current subjective history. The reduction of cognitive dissonance and the development of a permeable epistemic and social boundary in the psychoanalytic realm have a series of advantages, including: the creation of a logical (scientific) boundary protecting the therapeutic setting from the folie à deux and its excesses; better access to the discipline; the possibility of fruitful interdisciplinary dialogues; the reduction of intra- and intergroup conflicts, etc.

Affective development and etiological implication in body image disorders and anorexia: reflections on bdd manifestations and refusal of food in a psychodynamic view

The literature demonstrates that relational experiences during childhood have a strong impact on the trajectories of psychological growth. This article focuses on the major developmental phases for identity formation, psychological growth, mentalization skills, and ability to share affective states. It presents a careful analysis of some key factors that influence the representation of body image and the relationship with food, from a perspective that integrates relational psychodynamic models. In particular, it looks at the ways in which individuals and caregivers actively co-create the symptomatic process of intrapsychic reality in which body disease and refusal of food are performed.

Toby in Charge: A Mind and Body Mystery

This article discusses the treatment of a fearful and controlling 3-year-old boy who required rigid adherence to his idiosyncratic routines. The author describes her investigation into the etiology of his imperious and self-defeating behavior—reaching beyond psychodynamic models to consider early trauma and physiological aspects of his experience. Proposing an approach that draws on these perspectives, she discusses the i mplications for how we think about symptoms and about personality itself. Through close consideration of vignettes from the play therapy and the collateral sessions with his parents, she describes and explains Toby’s significant and moving progress.

State of the Art Treatment Options for Actual and Potential Sexual Offenders and New Prevention Strategies.

Sexual violence is a significant and devastating issue for men and women throughout the world. Its consequences are not only disastrous for victims of sexual violence but are also extremely costly (estimated cost of $41,000 per rape) for society. Successful treatment of sexual offenders is therefore an important goal for society as well as for victims and offenders themselves. Over the years, multiple treatment approaches for sex offenders have been developed. Treatment programs range from the risk-need-responsivity (RNR) model, which focuses on providing tailored treatment for high-risk and low-risk offenders, to psychodynamic models. This article presents an overview for clinicians of state-of-the-art offender treatment, describing the most common treatment approaches, in particular the RNR model, cognitive-behavioral programs (relapse prevention programs, sexual offender treatment programs), psychodynamic approaches (transference-focused psychotherapy, mentalization-based therapy), the Good Lives Model, as well as pharmacological options. In addition, it provides an evaluation of the various treatment programs. However, given the fact that most acts of sexual violence will never be reported to the police, the question arises if treating convicted perpetrators is enough. Do we need rather-in terms of preventive work-a program for potential sexual offenders and men with delinquent sexual fantasies? Given the prevalence of sexual violence and its impact on victims, society, and the medical community, it would be remiss not to try to reach potential/unconvicted perpetrators. This article offers novel ideas and a project the goal of which is to prevent sexual offenses against women by introducing the "I CAN CHANGE" program from Hannover Medical School.

Brief Therapy Techniques Can Make All Therapists Better

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessBrief Therapy Techniques Can Make All Therapists BetterMantosh DewanM.D., Roger GreenbergPh.D.Mantosh DewanSearch for more papers by this authorM.D., Roger GreenbergSearch for more papers by this authorPh.D.Published Online:2 May 2019https://doi.org/10.1176/appi.pn.2019.5a26Mantosh Dewan, M.D., is interim dean of the College of Medicine and the SUNY Distinguished Service Professor at SUNY Upstate Medical University, where Roger Greenberg, Ph.D., is a distinguished professor of psychiatry and behavioral sciences. They are the co-editors of The Art and Science of Brief Psychotherapies: A Practitioner’s Guide, Third Edition, which APA members may purchase the book at a discount.Today, most psychiatric patients receive brief therapy, and the majority of research on the effectiveness of psychotherapy is on brief therapies.Studies show that about 50% of patients show significant benefits after 10 to 20 sessions of psychotherapy, while an additional 25% to 30% respond within 50 sessions.Brief therapies can be helpful in many ways. Any evidence-based model provides a theoretical framework to anchor the therapist, and a specific technique may be particularly effective with certain conditions (for example, exposure and response prevention for obsessive-compulsive disorder or interpersonal therapy [IPT] for postpartum depression) or with certain patients (for example, solution-focused therapy for high-functioning college students). More importantly, specific techniques from one brief therapy can be integrated to make another brief therapy—or even long-term therapy—more effective. How can it make your work better?All successful therapies require a robust treatment alliance based on common factors (empathy, hope, and expectancy) and a clear contract. Patients seek “help,” but only 20% understand and are ready to actively participate in therapy. Several easy-to-use brief therapy techniques can help in this early phase. Eliciting the patient’s own motivation for change is a core motivational interviewing technique. Sometimes the “miracle question” borrowed from solution-focused therapy can do wonders (“Suppose a miracle occurs, and the changes you had hoped for are suddenly made. How would you realize the changes had occurred? What differences would you notice as a result?”) Cognitive-behavioral therapy uses psychoeducation to provide a clear and credible treatment rationale that enables patients to appreciate the therapeutic goals and strategies that will be employed and to feel they are on the right track.The middle phase allows for the artful mixing of many approaches and techniques, especially when patients are “difficult” and when therapy is “stuck.” The insistent focus and active stance of the therapist are key ingredients of all brief therapies. When the patient is “all over the place,” dynamic therapy helps by recognizing themes. Patients with intolerable anxiety can relax by practicing mindfulness—a core skill of dialectical behavior therapy (DBT) that can be integrated within all therapies. Similarly, DBT skill building leads to little-known but surprisingly easy-to-learn techniques that can reduce or prevent frustration and anger. An interpersonal inventory as used in IPT can help construct an accurate picture of the supportive and damaging relationships in a patient’s life. Problem solving can be approached through IPT or cognitive therapy techniques.Processing narratives using interpretations and experiential learning based on psychodynamic models can ease patient anxieties and guilt by promoting understanding of the origins of maladaptive behaviors and self-defeating thought patterns. It is helpful to use scaling questions (say, on a scale of 1 to 10), as solution-focused therapists do, to assess the levels of patients’ symptoms and plot their progress.Of particular importance for accelerating progress in psychotherapy is the use of homework assignments (now called action plans), as suggested by cognitive-behavioral therapists. These develop skills in the real world and give a sense of mastery and confidence.How termination is handled is important in brief therapy, and some schools deliberately set a firm end date or fix the number of sessions at the start. However, the conclusion of therapy is different for interpersonal therapists: They leave open the possibility that patients may return for additional treatment or booster sessions.The techniques and skills noted in this article are among those described in our book The Art and Science of Brief Psychotherapies, Third Edition. More importantly, they are demonstrated on the book’s accompanying video by the leading experts in the field, including Judith Beck, Edna Foa, and Marsha Linehan. Some can be learned very quickly. We hope learning more about these techniques and how to integrate them in your work will be as rewarding for you as it has been for us. ■ ISSUES NewArchived

The Focal Play Therapy: A Clinical Approach to Promote Child Health and Family Well-being.

Eating and evacuation disorders can cause serious health problems for children. Early recognition and early treatment require a multifactor intervention based on a collaborative relationship between pediatricians, psychotherapists and other health professionals. In this context the Focal Play Therapy (FPT) with children and parents is a psychodynamic model of intervention that improves parental ability to cope with child's difficulties. Parental engagement in child interventions allows to understand child's symptoms within family dynamics and to build an alliance with parents that represents a crucial variable of an effective psychological support for children and families. In the present study data were collected from 17 parental couples and their preschool children at two time points (1st and 6th FPT sessions) marking the first phase of this intervention. This phase was aimed to the assessment of child's symptoms within family relationships and to the promotion of the alliance with parents. Families were in treatment at the Psychological Consultation Center for Children and Parents located at the Department of Psychology of the University of Bologna (Italy). This Center provides health assessment and intervention services to children and their families. We investigated the alliance from both parents and therapist points of view along with other parental and child outcome variables implied in clinical works with children and families. Alliance scores were obtained through the Working Alliance Inventory and the System for Observing Family Therapy Alliances, two measures used in individual and family settings, respectively. Parenting stress and parent-child interactions were investigated using the Parenting Stress Index and the Emotional Availability Scales. Furthermore, paired t-tests were run to detect changes on parental and child variables. Findings advise that special attention should be paid to the building of an early alliance with parents. In this regard the FPT is specifically designed to promote the parent-therapist alliance in the context of child health and family well-being.

Neurology versus Psychiatry? Hallucinations, Delusions, and Confabulations.

Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. The neurological diseases manifesting with such symptoms (dementia, epilepsy, Korsakoff's disease, brain tumors, Parkinson's disease, migraine, right hemisphere stroke and others) would be the key to understand their biological mechanisms, while the cognitive sciences, neuropharmacology and functional neuroimaging would be the tools of such researches. It is possible to understand the perceptive rules of the mind and the mechanisms of the human consciousness based on these symptoms. However, hallucinations and delusions manifest with extraordinary vehemence with psychiatric disorders such as psychosis and schizophrenia, with which there is no evidence of brain lesions. Furthermore, they are subjective symptoms, and they do not have biological markers. Hence, they are prone to high inter-individual variability and depend on other variables (such as education, history of trauma), and are therefore difficult to reduce to unequivocal constructs. Causative mechanisms are probably multiple. For understanding these symptoms, a common framework between neurology and psychiatry is still missing. The psychopathology of French alienists over the 19th century, of S. Freud, and of Henry Ey over the 20th century gave way, in the second half of the 20th century, to the adoption of the DSM and neurosciences, to pursue a pure neurological perspective. However, although psychodynamic models seem nowadays (in a technological era) less influential, detailed clinical evaluations focusing on emotional-cognitive paradigms are probably the only way to lead to new neurobiological researches.

A psychodynamic model of Self-nature

ABSTRACTIn order to bridge the gap between humanistic psychology and positive psychology, this article proposes a psychodynamic model of Self-nature (自性, zixing) by integrating the Mandala model with several core ideas of Jung’s psychology for the future development of cultural psychology. The Mandala model of self, as well as the relationship between Freud and Jung, will be discussed in the context of an ogdoad formal structure in order to illuminate the psychological topography of conscious, personal unconscious and collective unconscious. Jung had been inspired by the philosophy of Daoism in his long-term search for the undiscovered Self. His Seven Sermons to the Dead will be reinterpreted to show the sharp cultural contrast between East and West. The potential contribution of this model to cultural psychology will be discussed, it is expected that this new model of Self-nature may bridge the gap between humanistic psychology and positive psychology.

Between love and behaviour management: the psychodynamic reflective milieu at the Mulberry Bush School

ABSTRACTThis article presents findings from a qualitative research study of the Mulberry Bush School (MBS), a therapeutic residential primary school caring for children with severe social, emotional and behavioural difficulties. The article notes the challenges of working with children who have experienced traumatic relationship breakdown, and reviews ideas and practices developed at MBS to support the children’s development. There is a discussion of the research study’s methodology and main findings. The researchers argue that the therapeutic milieu at MBS maintains a creative tension between a secure, playful context and one where emotional disorder and disturbance are not suppressed. The study describes how a particular psychodynamic model of reflective practice has been successfully instituted at MBS to create a ‘staff therapeutic milieu’ supporting the group living and group learning through which therapy principally occurs. The article closes with comments on the applicability of this model to residential child care practice generally.

Integrative psychodynamic model for understanding and assessing the suicidal patient.

Integrative psychodynamic model for understanding and assessing the suicidal patient.

Introducing a Conversational Model Therapy Approach as a Team Model of Care: The Clinician Experience in a Sexual Assault Service

This article examines clinician experience in adopting a contemporary psychodynamic model of care by exploring the experiences and perspectives of staff at an Australian hospital-based sexual assault service (SAS), reflecting then on implications for how to best engage clinicians in a model of care change and training. The Conversational Model of Therapy (CMT) is a contemporary psychodynamic approach integrating evidence from developmental psychology, neuroscience and trauma. Training was provided in the CMT approach to Short-Term Intensive Psychodynamic Psychotherapy seeking to enable the service to better provide for the needs of adult clients with less recent sexual assault experiences and/or those able to receive a short-term psychotherapy. Five semi-structured individual interviews and one focus group (with four participants) were undertaken to identify SAS staff perceptions of their experiences after initial training of up to 13 sessions with CMT. Thematic analysis was performed to identify, analyse and report patterns in the responses with the following themes emerging: the challenges staff face in providing a service to clients; coping mechanisms staff utilise in their work; the current service structure and how this compares with their experiences of CMT, and; feelings and thoughts on SAS staff being evaluated. Findings provide evidence that the majority of staff understood the need for change and were able to undertake training towards this due to effective coping mechanisms within their work and good support from within their team. The research also highlights the need to ensure effective training to evaluate participants’ understanding of the model being taught. In the context of training experience elsewhere, learning and synthesis of all of the knowledge relevant to a psychodynamic model of care may require experiential learning through supervision of audio-recorded sessions, although this has challenges in the SAS context.

I, Me, You & Us: can a psychodynamic model provide a relational perspective on psychosis?

The concept of psychosis existed long before the current diagnostic definitions we have today. However, current opinion and treatment of psychosis is often dominated by a narrow psychiatric discourse. As a result of this conceptualisation, a diagnosis of psychosis can often feel limiting and disempowering for the individual, especially if he or she holds an alternative perspective. A psychodynamic model may therefore provide a method to examine psychosis from a relational perspective; this may, in turn, broaden one’s understanding and experience of a psychotic episode. In this article, two case examples from different cultural perspectives are used to highlight and explore the potential benefit of psychodynamic theory in the formulation and treatment of psychosis. A psychodynamic model using object relations theory is used for the exploration of both internal and external relational experiences. Both psychodynamic and psychiatric rationales are thus challenged to reflect on the impact of rigid perspectives and how they may limit treatment efficacy. Current research and literature around the use of psychodynamic theory in the treatment of psychosis is reviewed in light of this perspective.

The theoretical basis of the Conversational Model of Therapy

The Conversational Model of Therapy, which is also known as Psychodynamic-Interpersonal Therapy is an evidence-based psychological treatment. The model has a set of distinctive therapist behaviours, which can be taught and learnt in a short space of time. Although the model can be practised without an appreciation of the theory which underpins it, the theoretical basis of the model is rooted in psychodynamic ideas, and it shares many common theoretical approaches with other psychodynamic models. In this article, we describe the theoretical underpinnings of the model, include a description of basic model behaviours, an explanation of why these behaviours are important, and how they directly relate to and are derived from the theoretical stance. We also provide a case example, and show why the model can be practised without detailed theoretical knowledge to good effect, if its common guiding principles are followed.

Psychoanalysis: Science of the Mind?

Psychoanalysis:Science of the Mind? Richard G. T. Gipps (bio) In his paper on 'The Science of Psychoanalysis,' Lacewing helpfully distinguishes a central psychodynamic model of the mind, elaborated in the clinical theory of psychoanalysis, from certain of its metapsychological and etiological theories. Critics who view psychoanalysis as unscientific have tended to focus on the lack of evidential support for certain of its developmental claims or the lack of reliability and validity in its theoretical posits. Lacewing claims, however, that the model contained in the clinical theory is much more scientifically respectable than its critics have made out. The data may not always be in, but Lacewing's argument is that there is nothing pseudoscientific about the central model that precludes it in principle from receiving meaningful and objective confirmation or disconfirmation. I agree about the value of the central and the clinically widely shared psychodynamic model of the mind compared with some of the speculative trajectories or intrapsychic structures posited with too much scientific and dialectical confidence by many early psychoanalysts. I am also convinced by Lacewing's careful and thoughtful disposal of the charges of ineradicable suggestion and confirmation bias in psychoanalysis. In this response, however, I take a step back and offer an alternative take on the best characterization of aspects of the core model. To begin by putting my own cards on the table: much of what Lacewing takes to be empirical truth claim that can be scientifically grounded in independently assayable evidence, I prefer instead to describe as phenomenological articulation of what are already the grounds of psychoanalytic knowing. In this way, I agree with the critics of psychoanalysis who claim that much of the core clinical model is not itself aptly described as scientific, yet I agree too with Lacewing that the critics' criticisms are ill-judged; my argument, however, is that the core clinical model is not so much scientific or unscientific but rather non-scientific. If the central model cannot receive meaningful or objective confirmation or disconfirmation then this, I believe, is not because it is pseudoscientific but rather because we have not really specified what we would be talking about if we were to talk of confirming or disconfirming propositions that—after we have developed the sensibility to grasp the character, and discern the expressive manifestations, of that which they articulate—we might only want to call truistic. Talk of 'science,' 'evidential support,' 'inferences,' 'explanations,' 'posits,' 'postulates,' 'theoretical claims,' 'underlying causes,' 'mechanisms,' 'data,' 'mental functioning,' and so on largely belongs, as I see it, to a less fundamental stage of the logical food chain than we are commonly at when we articulate to ourselves the core features of the psychodynamic model. (I acquiesce here in talking of a psychodynamic 'model,' although this too could also be questioned; a less committed term might be a psychodynamic 'understanding' of mind.) That is to say, although we can certainly deploy the core model to frame this or that empirical [End Page 113] investigation, it is not, I believe, so clear that the core model is itself best understood as something for which evidence could be sought. Articulations of the main contours of the psychodynamic model are, I maintain, more often more helpfully understood as statements of what can be seen and what we are to call what we see than as articulations of inferences or of anything which it would, in the actual contexts of our lives, make sense to talk of our just being wrong about. By way of analogy: a meteorologist may gather data in support of this or that empirical claim about what goes on in the sky or in the clouds, but if she started trying to gather evidence for the existence of the sky or the clouds themselves, we would rightly be confused. 'There is a sky' might look like a falsifiable empirical claim, and we can, of course, imagine that things may have been otherwise. Nevertheless, for those who have a living grasp of the meaning of 'sky' and 'cloud,' for those who know how to spontaneously apply these terms in their daily life, it is not clear what it would really mean for them to doubt...

The Science of Psychoanalysis

For psychoanalysis to qualify as scientific psychology, it needs to generate data that can evidentially support theoretical claims. Its methods, therefore, must at least be capable of correcting for biases produced in the data during the process of generating it; and we must be able to use the data in sound forms of inference and reasoning. Critics of psychoanalysis have claimed that it fails on both counts, and thus whatever warrant its claims have derive from other sources. In this article, I discuss three key objections, and then consider their implications together with recent developments in the generation and testing of psychoanalytic theory. The first and most famous is that of ‘suggestion’; if it sticks, clinical data may be biased in a way that renders all inferences from them unreliable. The second, sometimes confused with the first, questions whether the data are or can be used to provide genuine tests of theoretical hypotheses. The third will require us to consider the question of how psychology can reliably infer motives from behavior. I argue that the clinical method of psychoanalysis is defensible against these objections in relation to the psychodynamic model of mind, but not wider metapsychological and etiological claims. Nevertheless, the claim of psychoanalysis to be a science would be strengthened if awareness of the methodological pitfalls and means to avoid them, and alternative theories and their evidence bases, were more widespread. This may require changes in the education of psychoanalysts.

Evidence, Inference and Causal Explanation in Psychoanalysis

Evidence, Inference and Causal Explanation in Psychoanalysis Michael Lacewing (bio) In my paper, 'The science of psychoanalysis,' I make two assumptions. First, I assume that a 'hermeneutic science' is not a contradiction in terms (p. 96). Second, I assume that explanations of why someone behaved as they did in terms of motives are a form of causal explanation (p. 101), and therefore that inferring what someone's motives are from their behavior is a form of causal inference. In his commentary, Gipps objects to both of these assumptions, and this gives me the opportunity to clarify them. Following the focus of Gipps's commentary, I shall concentrate primarily on the issue of science, and discuss causation only in relation to this. Herein, I am not concerned to defend a detailed positive theory of what, exactly, we are talking about when we are talking about 'mental states.' I want to establish the minimum necessary for my assumptions to be true, and a good range of views is compatible with what I have to say here, although most will make additional commitments. I am more concerned to reject the monolithic conception of 'science' and the resultant sharp division between science and commonsense psychology that characterizes Gipps's response, a conception which has bedeviled debates in the philosophy of psychiatry since its inception and in the philosophy of mind since the 1950s. To begin, let me clarify the ideas of evidence and inference to the best explanation in common-sense psychology and the psychodynamic model of mind. I did not say, and did not mean to imply that we always infer someone's mental state from their behavior. First, I concerned myself only with motives. Second, Gipps is certainly right that we can often simply, directly, and immediately recognize a mental state in behavior. Hence, there are occasions on which I can see that Andrew is happy (emotion), that Barbara wants her cup (motive), and that Claude is opening the bottle intentionally (action). These are exercises of acquired perceptual skills (most likely acquired very early on and with a firm genetic basis), skills that, in the right circumstances, enable these facts about Andrew, Barbara, and Claude to form part of how the situation perceptually appears to me. To describe knowledge gained through their exercise as 'inferential' is misleading at least. What we recognize, even if we cannot articulate it as such, is a specific pattern in the person's behavior in the situation, a pattern constructed out of a complex combination of facial expression, bodily posture, subtleties of movement (e.g., that typically distinguish intentional from unintentional movements), all within a particular setting within which joint attention is typically available. Hence, I recognize the pattern [End Page 119] of behavior that characterizes desire in Barbara's strained frown, her outstretched arm that is not merely straight but reaching, specifically toward a cup, upon which her gaze is also focused, and that I can also see. This kind of case is analogous to Gipps's case of the cloud. This, Barbara learns, is what we call 'wanting,' in this case, 'wanting your cup.' But now take the example of revenge. Unless revenge is an instant response, there is no pattern of occurrent behavior that manifests revenge in the way that Beatrice's behavior manifests desire, that is, that makes the motive of revenge apparent in the same way. The behavior is undoubtedly an expression of revenge, but the pattern here is diachronic not synchronic, and far more complex. I cannot simply see that someone is taking revenge in the same way I can see a cloud or see that Beatrice wants her cup. Suppose Edna takes revenge on David. I can see that Edna is acting intentionally and from anger. But to know that Edna is taking revenge, I must also know, at least, that (Edna believes that) David previously harmed Edna. I must also know that this previous harm remains of concern to Edna, and more besides. To say that Edna is taking revenge is to place her behavior in a wider pattern, only part of which is currently occurring. To understand behavior by placing it in a complex diachronic pattern typically...

Mentalizing in Organizations: A Psychodynamic Model for an Understanding of Well-Being and Suffering in the Work Contexts

Moving from the paradigms of “mentalization” and “reflective function” (Fonagy and colleagues), this article develops the concept of “mentalizing” in organizations, understood as a process of construction of shared meaning in the work contexts, and whose absence or deterioration produces suffering in organizational experience, exposing individuals to significant psychosocial risks. This model converges in outlining a framework in which the absence of a reflective competence and the lack of symbolization of the experience of work fall on the perception of one's own job, and on the relationship with colleagues and management, producing unsustainability of the work experience. The availability of reflective spaces that are inscribed in the ordinary dimension of work thus appears as a solution capable of promoting organizational well-being.

Psychotherapy Technique Related to Changes in Anxiety Symptoms With a Transdiagnostic Sample.

The current study examined how techniques in a psychodynamic model of therapy (Blagys and Hilsenroth, Clin Psychol Sci Pract. 7, 167-188, 2000) were related to changes in anxiety symptoms across early treatment process among a transdiagnostic sample of patients with primary anxiety disorder, subclinical anxiety disorder, and no anxiety disorder. Secondary analyses examined the use of specific psychodynamic techniques in relation to symptom change. Results revealed that therapists' use of psychodynamic-interpersonal (PI) techniques were significantly and directly related to changes in anxiety symptoms, in line with previous findings (Pitman, Slavin-Mulford, and Hilsenroth, J Nerv Ment Dis. 202, 391-396, 2014). In addition, patients with co-occurring axis I and II disorders demonstrated positive changes in anxiety symptoms regardless of level of PI technique used, whereas patients without co-occurring disorders experienced greater improvement with more PI. Implications for transdiagnostic treatment protocols for anxiety, notably Leichsenring and Salzer's (Psychotherapy 51, 224, 2104) Unified Psychodynamic Protocol for Anxiety Disorders, are discussed in relation to the current findings.