Psychodynamic Model Research Articles

Application of psychodynamic model in the assessment and management of psychogenic voice disorder: a case report

The psychological state is considered to contribute to the overall well-being of an individual. Disequilibrium due to psychological reasons such as anxiety, stress, depression, or other psychological conditions may affect voice production entirely or partially, significantly affecting the person’s occupational, social, and emotional well-being. The present study discusses a sudden onset of aphonia in a 37-year-old female without an underlying physiological illness. The study illustrates the importance of interpreting the voice problem in the patient considering the influence of the individual's psychological, physiological, physical, emotional, and social health by applying the psychodynamic model.

Conceptualization of Depression among Medical Students and Its Differences during Medical Education.

The definition of mental disorders has been traditionally a matter of discussion, and it has relevant implications in research and healthcare. Our aim was to explore the conceptualization medical students have of depression and to determine differences across academic years. The Maudsley Attitudes Questionnaire was adapted through a double translation, double back-translation and a preliminary validation, obtaining a Spanish edition. All students of the Faculty of Medicine of the University of Zaragoza and doctors who graduated from this University in 2020 were invited to answer the online questionnaire, and we received 222 answers (response rate: 15.2%). The results were compared by years and levels of education using an ANOVA. The social realist, behavioral, biological, cognitive and psychodynamic models were the most endorsed. The psychodynamic and nihilist models were less embraced by students in later educational years. These students also reported greater confidence in their understanding of depression and of its biological, cognitive and behavioral models. In conclusion, the conceptualization of depression among medical students is complex and multidimensional, and appears to be similar across different years of education. In later years, we found less support for the psychodynamic model, increased confidence in psychiatry and greater ease in handling the concepts of its leading models.

Mindless to Mindful Parenting? Videofeedback-Enhanced Psychotherapy for Violence-Exposed Mothers and Their Young Children.

This article presents a frequent dilemma of treatment-seeking mothers suffering from complex posttraumatic stress disorder (PTSD) that is related to exposure to maltreatment and other forms of interpersonal violence. Namely, that complex PTSD symptoms, including dissociative states in mothers that are triggered by normative child emotion dysregulation, aggression, and distress during early childhood, hinder the development of a productive psychotherapeutic process in more traditional psychodynamic psychotherapies for mothers and children. The article thus presents clinician-assisted videofeedback exposure (CAVE) that characterizes a recently manualized brief psychotherapy for this population, called CAVE-approach therapy (CAVEAT). CAVEAT can be used on its own or to preface a deeper process using child-parent psychotherapy or other non-videofeedback-enhanced psychodynamic models. A clinical illustration is provided.

Assessing the potential of ChatGPT for psychodynamic formulations in psychiatry: An exploratory study

Although there were several attempts to apply ChatGPT (Generative Pre-Trained Transformer) to medicine, little is known about therapeutic applications in psychiatry. In this exploratory study, we aimed to evaluate the characteristics and appropriateness of the psychodynamic formulations created by ChatGPT. Along with a case selected from the psychoanalytic literature, input prompts were designed to include different levels of background knowledge. These included naïve prompts, keywords created by ChatGPT, keywords created by psychiatrists, and psychodynamic concepts from the literature. The psychodynamic formulations generated from the different prompts were evaluated by five psychiatrists from different institutions. We next conducted further tests in which instructions on the use of different psychodynamic models were added to the input prompts. The models used were ego psychology, self-psychology, and object relations. The results from naïve prompts and psychodynamic concepts were rated as appropriate by most raters. The psychodynamic concept prompt output was rated the highest. Interrater agreement was statistically significant. The results from the tests using instructions in different psychoanalytic theories were also rated as appropriate by most raters. They included key elements of the psychodynamic formulation and suggested interpretations similar to the literature. These findings suggest potential of ChatGPT for use in psychiatry.

Psychodynamic Psychiatry and Psychoanalysis in Indonesia.

Indonesia, a country with a vast population of approximately 275 million people on over 17,000 islands, currently has 1,221 psychiatrists nationwide. Psychodynamic psychiatry and psychoanalysis are integral to the practice of psychiatry in Indonesia, primarily because of the charismatic influence of Bachtiar Lubis, who trained in Canada in the early 1960s. Upon his return to Indonesia, Bachtiar Lubis supervised a generation of psychiatrists, including two of this article's authors, who carried on his pedagogical work. The psychodynamic model and treatments have faced obstacles limiting their acceptance in Indonesia, including importing a Western model that has not been culturally adapted to treat patients in the East, the stigma of mental illness in local communities, and the complex comorbidities of persons who seek psychiatric care. Psychodynamic psychotherapy in Indonesia is presently taught in university-based residency programs for eight semesters. A psychodynamic psychotherapy competency-based curriculum was adopted nationwide. The dissemination of psychotherapy knowledge and skills is greatly assisted by an active psychiatric professional association-the Indonesian Psychiatric Association Psychotherapy Section, a member society of the World Federation for Psychotherapy. The authors propose international and regional academic collaborations to maintain enthusiasm among trainees and improve quality of care.

Complementary perspectives in subclinical psychosis: From clinical high-risk and personality organization to ordinary psychosis

ABSTRACT In this paper, I try to bring the Lacanian psychoanalytic concept of ‘ordinary psychosis’ (OP) into dialogue with the prevailing paradigms in psychiatry and psychodynamic theory regarding subclinical psychosis: respectively, the model of clinical-high-risk for psychosis and that of personality organization/disorder. OP is a bottom-up clinical approach applicable to both atypical/subclinical psychoses and disordered personality that identifies both the main psychological difficulties encountered and the compensatory mechanisms employed by the individual. Its diagnosis relies on subtle indices or markers of a ‘disturbance of the sense of life’ and of a failure of knotting together the elements of the subjective structure. Many patients typically diagnosed with a personality disorder may be treated as cases of OP. This clinical concept is not limited to a descriptive approach and it offers insights into both subtle psychological deficits and mechanisms contributing to resilience. It avoids the risk of unjustified preventive treatments and stigmatization carried by a model of attenuated psychosis. It facilitates the direction of the psychotherapeutic treatment offering more than support to the individual’s adaptive attitudes. It offers insights into the communication between the medical and the psychodynamic models. OP is therefore a category of clinical utility, psychological validity, and ethical value.

Autism Spectrum Disorders: There Remains a Place for Psychodynamic Psychiatry through Neuroplasticity, Emotion Regulation, Caring Connections, and Hope.

There remains a role for psychodynamic psychiatry in the care of individuals with autism spectrum disorders (ASDs). Contemporary psychodynamic models are uniquely positioned to integrate today's neurobiological understandings of ASD with the subjective experience of those with ASD. Historical psychodynamic formulations of ASD struggled to appreciate the interrelatedness of biological, psychological, and social complexities in individuals with this disorder. Emotionally experienced or "illusory" environmental deprivation, early life stress, and allostatic overload, along with biological factors, current stress, and neuroplasticity, drive maladaptive coping and lead to difficulties with relationships. Fears of caring emotional connections are related to self-protective isolation and other maladaptive efforts to regulate emotions, shutting out what the child needs most-parents' love and help. In a nonlinear way, maladaptive emotion regulation further interferes with the development of the social brain. Thus, a psychodynamic defense-oriented focus upon adaptive emotion regulation provides a therapeutic avenue. Helping build the child's capacity for adaptive emotion regulation, which includes letting others help, can lead to a sense of safety and promote caring connections, a positive outcome. The authors offer guidance in the treatment of individuals with ASD in accordance with contemporary understandings of the disorder and care.

What can Jane Goodall teach us about addiction?

In 2017, Jane Goodall, the well-known primatologist, wrote a letter to the United States Food and Drug Administration criticising the use of animals to test brain-based theories of addiction. She reasoned that we already know about addiction by observing humans. Several scientists countered that research with humans cannot answer important questions about understanding, preventing, and treating addiction. This commentary draws on epidemiology, psychology, psychodynamic models, learning theories and existentialism. It highlights effective prevention and treatment approaches that are not based on brain models of addiction. Jane Goodall’s letter, has, perhaps unwittingly, provided a focal point for reconsidering what kind of research is required to further our understanding of addiction.

Self-Oriented Empathy and Personality Organisation Level: Insights from a Psychiatric Sample.

ObjectiveEmpathy functioning is among the criteria to delineate psychiatric diagnosis. However, the self-oriented empathy dimension is almost neglected in the existing literature. On the basis of previous fragmented contributions, we hypothesised that an individual’s level of personality organisation is explained by this facet of empathy more than the other components of empathy, both transversally and independently from the specific psychiatric diagnosis.MethodFifty-nine psychiatric inpatients were evaluated with clinical interviews inspired by the Structured Clinical Interview for DSM-5, completed the Symptom Checklist-90-Revised, and Interpersonal Reactivity Index (IRI). A panel of experts established each patient’s psychiatric diagnosis and the level of personality organisation according to DSM-5 and PDM-2. Thirty-two patients were considered functioning at a psychotic level, 27 at a borderline level, and none at a neurotic level. Multinomial models were compared with the corrected AIC to determine if self-oriented empathy, among all IRI subscales, was the best-fitting model for explaining the levels of personality organisation. A further analogue series of models was used to investigate the best IRI subscale to explain each patient’s psychiatric diagnosis.ResultsThe first series of models revealed self-oriented empathy (IRI personal distress subscale) as the best empathic dimension to explain levels of personality organisation. The second series revealed that none of the four IRI subscales explained psychiatric diagnoses.ConclusionsThe consistency of our findings with evolutionary concepts pertaining to both traditional psychodynamic models and contemporary models of psychopathology, such as the p factor theory, was illustrated. Despite the many limitations of our consecutive sampling jeopardising the findings’ generalisability, the insight of self-oriented empathy as the best predictor of the level of personality organisation, irrespective of psychiatric diagnosis, has several implications from both research and clinical/diagnostic perspectives.

Cognitive Control Processes and Defense Mechanisms That Influence Aggressive Reactions: Toward an Integration of Socio-Cognitive and Psychodynamic Models of Aggression.

Research on cognitive processes has primarily focused on cognitive control and inhibitory processes to the detriment of other psychological processes, such as defense mechanisms (DMs), which can be used to modify aggressive impulses as well as self/other images during interpersonal conflicts. First, we conducted an in-depth theoretical analysis of three socio-cognitive models and three psychodynamic models and compared main propositions regarding the source of aggression and processes that influence its enactment. Second, 32 participants completed the Hostile Expectancy Violation Paradigm (HEVP) in which scenarios describe a hostile vs. non-hostile social context followed by a character's ambiguous aversive behavior. The N400 effect to critical words that violate expected hostile vs. non-hostile intent of the behavior was analyzed. Prepotent response inhibition was measured using a Stop Signal task (SST) and DMs were assessed with the Defense Style Questionnaire (DSQ-60). Results showed that reactive aggression and HIA were not significantly correlated with response inhibition but were significantly positively and negatively correlated with image distorting defense style and adaptive defense style, respectively. The present article has highlighted the importance of integrating socio-cognitive and psychodynamic models to account for the full complexity underlying psychological processes that influence reactive aggressive behavior.

Two Perspectives of Mental Distress

ABSTRACT This article explores an imbalance between two perspectives on mental distress. The Broken Brain perspective sees mental distress as largely caused by discrete mechanical failures of organic brain function. In tension with this, the Symphonic perspective of mind (encompassing, but not limited to, psychodynamic models) refers to a non-local, wholistic and distributed process spread across the entirety of the mental capacity in which mental distress results from the impacts of tragic life experience on the normally functioning mind. While overlapping in some areas, these two perspectives often lead to dramatically different ways of understanding and treating mental distress. While the Broken Brain perspective has had preeminence in recent decades, it is suffering from increasingly serious scientific and clinical obstacles. Conversely, the Symphonic perspective is increasingly supported both theoretically and clinically by emerging scientific evidence as an efficacious, reasonable, and cost-effective treatment approach.

Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder.

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

Implementation of Psychodynamic Multifamily Groups for Severe Mental Illness: A Recovery-Oriented Approach.

Background: Among Family-Based Services for the treatment of severe mental illnesses, multi-family models gained particular attention, given the potential usefulness of mutual feed-back, motivation and encouragement among families.Methods: The Psychodynamic Multi-Family Group Model has been proposed since 1997 in some Community Mental Health Services in Rome. Since 2011 multifamily groups are held weekly in all the six Districts of the Department of Mental Health that serves a population of more than one million people, and data have been collected since 2015 in three Districts. A total of 794 individuals attended the meetings in the period 2015–2019.Results: Eighty-six percent of those who started, attended more than one meeting. The mean of occurrences of participation among patients was 18.6, among mothers 25.6 and among fathers 21.6. The 794 participants belonged to 439 family units, among which 180 comprised only the patient, 76 only parent(s) or other close person(s), and 183 comprised parent(s) or close person(s) with the patient. Patients participating alone were older than those of families who participated as a whole. Families including the patient showed the longest duration of attendance and the highest prevalence of a diagnosis of schizophrenia in the index patient. Families who had been attending the multifamily groups since a long time maintained a high rate of attendance.Conclusions: Multifamily groups represent a setting where patients can meet with other people and professionals in a free still structured way, and with not strictly therapeutic objectives. The high number of patients who attended alone suggests that such participation corresponds to a self-perceived need of open and free setting facilitating sharing of problems and solutions. The good tenure of the interventions, the high participation, and the feasibility in the long-term suggest that multifamily groups can be implemented in the mental health services of a large city, are sustainable over many years, and can represent a valuable resource for many patients and families.

“Perrotta Integrative Clinical Interview” (PICI) for adults and teenagers (1TA version) and children (1C version): new theoretical models and practical integrations between the clinical and psychodynamic approach

Starting from the general concept of “personality”, this work dwells on the analysis of the different theories, to then expand the theme on practical, applicative, psychodynamic, and clinical profiles, proposing a revision of the classic and modern psychodynamic model, in an integrative key.

Psychodynamic psychotherapy of depression

Psychodynamic psychotherapy has a long tradition in the treatment of depression. Its effectiveness lies, according to previous studies on the same level as other bonafide therapies. The review first presents the guideline recommendations for the therapy od depression in Germany. Furthermore, classical and modern psychodynamic models of depression are introduced. From these, general and specific therapeutic aspects are derived. The presentation of the therapeutic approach begins with a section on how to deal with acutely depressive patients. In this regard, contextual factors such as medication and social support measures are described as well as how to deal with suicidal tendencies. In addition, typical pitfalls in dealing with these patients are described. In a further section, two particularly typical personality constellations in depressive patients are addressed (avoiding versus ambivalent-preoccupied patterns). These are derived from traditional models of depression as well as from clinical attachment research. Finally, measures for relapse prophylaxis and possible maintenance therapy strategies are presented.

Language use as a manifestation of leadership anxiety dynamics : a conceptual analysis and systems psychodynamic model

Language use as a manifestation of leadership anxiety dynamics : a conceptual analysis and systems psychodynamic model

A systematic review of psychodynamic theories in community psychology: Discovering the unconscious in community work.

The aim of this systematic review is to provide a narrative synthesis of the peer-reviewed literature regarding the role of psychodynamics in community psychology. The authors screened 301 records on the topic, found in major citation databases (Scopus and Web of Science) without time or language restrictions. Ten articles addressing the review question were identified, showing the contributions of interpersonal psychoanalysis, Adlerian psychology, the Tavistock psychodynamic model, and Lacanian psychoanalysis. Several points of synergy between community psychology and psychodynamics were outlined mainly concerning empowerment theory, preventative and ecological perspective, power, and social order. Besides, the view on the community life, the role of emotion, and the conceptualization of the unconscious domain are discussed. Implications for community interventions are highlighted, regarding clients' demands, the role of community practitioners, and the use of transference/countertransference in consultative work. Limitations and future directions are also considered.

Dementia with Lewy bodies

Psychodynamic psychotherapy has a long tradition in the treatment of depression. Its effectiveness lies, according to previous studies on the same level as other bonafide therapies. The review first presents the guideline recommendations for the therapy od depression in Germany. Furthermore, classical and modern psychodynamic models of depression are introduced. From these, general and specific therapeutic aspects are derived. The presentation of the therapeutic approach begins with a section on how to deal with acutely depressive patients. In this regard, contextual factors such as medication and social support measures are described as well as how to deal with suicidal tendencies. In addition, typical pitfalls in dealing with these patients are described. In a further section, two particularly typical personality constellations in depressive patients are addressed (avoiding versus ambivalent-preoccupied patterns). These are derived from traditional models of depression as well as from clinical attachment research. Finally, measures for relapse prophylaxis and possible maintenance therapy strategies are presented.

COPING STRATEGIES AND MODELS OF OVERCOMING POST-STRESS CONDITIONS

The article is devoted to the research of coping strategies on the adaptation process. Actions associated with the COVID 19 pandemic touched many areas of life. They provided increased requirements for human mental activity, creating additional stresses, which led to an increase in neuropsychiatric disorders. Models of overcoming post-stress states are considered. The role of external and internal factors in the formation and overcoming of post-stress states and disorders of adaptation is analyzed in the article. In the process of studying the underlying patterns and mechanisms of adaptation to normal life, two psychological models of overcoming post-stress states were identified: psychodynamic and cognitive. The psychodynamic model notes that successful adaptation of personality requires awareness of all aspects of traumatic experience and integration through the scheme "traumatic stress - negation - relapse - acceptance". The cognitive model is a cognitive theory of stress, that is, a cognitive assessment of a person's most traumatic event, and himself in it. Three types of assessment were proposed to determine a person's response to a traumatic event: primary, secondary stress assessment, and reassessment. Many researchers consider the impact of stress adaptation to be one of the leading causes of disorders of adaptation. Also, the manifestations of adaptation disorders are greatly exacerbated by the simultaneous complex action of several stressors. The severity of active stressors does not always correlate with the severity of adaptation disorders, as personality traits and cultural and social norms and values contribute to the response to stress. Also, the features of the development of these disorders of adaptation disorders depend on the features of cognitive processes, personal resources of the individual involved in their regulation.

The Bridge in Schools: a psychodynamic impact model for child mental health in disadvantaged areas

ABSTRACT What role does child psychotherapy have to play in addressing the mental health needs of children in areas of disadvantage? This paper will discuss an innovative programme of school-based mental health work, led by child psychotherapists in Bristol. Referencing child psychotherapy’s early work with severely deprived children, and the pioneering work in schools by colleagues such as Youell and Jackson, the paper describes how the Bridge in Schools (BiS) has developed a local response to the high level of unmet mental health needs of children, especially in deprived areas of the city. We consider the challenges and opportunities to be found in building partnerships with school teams, and applying child psychotherapy in a school environment. We explore the relevance of child psychotherapy, both in developing therapeutic approaches to learning and behaviour management that provide containment for vulnerable children, and in offering effective and timely therapeutic interventions. We draw on evaluation data to show that this approach can significantly improve access and outcomes for families who currently do not reach CAMHS thresholds. Finally, we consider how these developments in child psychotherapy give us unique opportunities to contribute to the government’s current re-design of child mental health services.