Psychodynamic Observations Research Articles

Impact of Psychoanalysis in Nigeria: A Case Study

The authors set out to examine the impact of Psychoanalysis in Nigeria. In doing this they selected a significant stakeholder, who trained in Germany and returned to Nigeria as a case study. Examining the activities as he set out to indigenize psychotherapy in Nigeria, it was found that psychoanalytic thinking helped in the psychodynamic observations on the frequent somatic complaints of psychological origin which helped to make treatment possible. Family therapy based on psychoanalysis was modeled to treat patients classified as traditional, mixed and westernized. Dream analysis and hypnosis were also used for treatment in Nigeria with good results. Finally the harmony restoration theory was put forward whereby the African is healthy when he is at peace with his world of relationship (cosmos) comprising endocosmos – mind body relationship, mesocosmos relationship with significant others and exocosmos relationship with spirits, ancestors, deities, gods, God. He/she is sick when there is a distortion in the person’s world of relationship. Treatment is restoration of harmony. In every one there is a yearning to reach out to others (cosmic expansion drive) and an inclination to be interested in the self (cosmic reduction drive) at the various levels of the cosmos. Eight personality types were worked out of the combination of expansion and reduction drives. The conclusion was that psychoanalysis has come to stay in Nigeria.

Insights into the lived experience of people with dementia: An observation exercise on in-patient dementia wards

This article presents two psychodynamic observations undertaken in in-patient settings for people with dementia as part of clinical psychology training. It highlights the relevance of this method in gaining insight into lived experiences of people with dementia in institutional settings.

PC-FACS

PC-FACS

Eyes we didn’t know we had

Two clinical psychology trainees relate their experience of four brief psychodynamic observations in a public and an Older Adult mental health setting. They reflect on their learning and the impact this has had on their practice.

Close encounters in qualitative research: Making a case for psychodynamic observation

Our article encourages the use of psychodynamic observation as a valuable qualitative approach for exploring meanings in subjective lived experiences and unconscious processes in organisations. We have included guidelines for assessing quality and also our own experiences of using it.

The Poetics of Loss: Erotic Melancholia in Agamben and Dickinson

Remarking upon "Mourning and Melancholia," Giorgio Agamben notes that Freud writes with "a certain discomfort" of melancholia "'that a loss has indeed occurred, without it being known what has been lost.'" Agamben's elaboration of how a fictive introjection of absence allows melancholy to "open . . . a space for the existence of the unreal" leads to a psychodynamic picture that fuses the mortuary with the erotic. I argue that this psychodynamic observation offers a means for understanding Emily Dickinson's highly erotized, death-driven work. The Dickinsonian "I" gains poetic power to the extent that she simultaneously "buries" the absent other and claims amorous possession as he departs. Through close syntactic and rhetorical readings of canonical poems, I demonstrate that Agamben's psychosexual speculations on melancholia can provide a conceptual frame for a psychoanalytically informed interpretation of this enigmatic, impassioned poet's work.

Psychodynamic observation and emotional mapping: A tool for continuing professional development and research in services for older people

Psychodynamic observation and emotional mapping (POEM) is a professional development (CPD), supervisory and research process, which works from the ‘inside out’. It aims to ensure that staff experience is placed at the heart of understanding meaningful, relationship‐centred care in the workplace. Central to this process is the assumption that feelings occurring ‘under the surface’ in both staff and patients are important channels of communication impacting on staff, care practice and the service setting. In terms of good psychological health for staff and patient, the POEM approach facilitates the digestion and understanding of both conscious and unconscious processes in the workplace. It also contributes towards a healthier, more open workplace in which staff teams are supported in their capacity to think and respond effectively and honestly to everyday clinical and organisational pressures.

The Use of Psychodynamic Observation as a Tool for Learning and Reflective Practice when Working with Older Adults

Working with clients can arouse thoughts and feelings in clinicians that, if not thought about, can limit or undermine their practice. This article, using the experiences of both authors, describes a method of using observation as a learning and reflective practice tool when working with older adults. The method is based on psychoanalytical theory and involves the use of psychodynamic observation, the recording of the observations and regular seminars to facilitate reflection and thinking. It is suggested that such a method of observation, based on psychoanalytical theory, is a valuable learning tool for occupational therapists.

Psychotherapy and the Work Place

eing psychiatrists is a large part of who we are. We spend as much as a third of our everyday lives in that role. As we sit with psychotherapy patients, how often do we think about their work identity and the many issues that come up as they work? How aware are we of their present level of functioning as workers? Do we consider work functioning as part of our measure of mental health, recalling Freud’s definition of mental health as the capacity to love and to work? Do we think of full-time parenthood as being a challenge to both of those capacities, since the home is also a workplace? During my residency, we had frequent case conferences with Brian Bird, author of Talking with Patients, 1 a fine book that could help to ameliorate our dehumanizing medical scene if reprinted today. Generally, a hospitalized patient would be presented and then interviewed by Dr. Bird. He almost always eased into a friendly discussion about the patient’s work life. The patient would light up, get animated, and discuss themes that were enlightening about both the person and the illness. Numerous fresh observations about psychodynamic issues emerged from these interviews. Similar psychodynamic observations can emerge from reading the vivid self-portrayals of working people in Studs Terkel’s Working. 2 Terkel interviewed dozens of people about their job lives—everyone from industrial designers to prostitutes—and presented their stories in their own words. All the complexities of life emerge in the work environment, and these case studies make worthwhile teaching material. Depression, anxiety disorders, and substance abuse are by far the most common psychiatric disorders that interfere with full productivity in the workplace, and they are a source of major concern to employers. Personality disorders also create a lot of difficulty but are less often identified as mental illnesses. As we talk with patients about their work lives, we see how major psychodynamic processes can contribute to these crippling conditions. How do people come to choose their vocations? Granted, innate abilities play a part, but early life experiences also have a profound effect. Consider the child with several sports injuries who becomes an orthopedic surgeon—or the child who struggles with a very difficult, depressed, or borderline mother who winds up in psychiatry or nursing. Perhaps the boy whose father spent time building things with him will become an architect or builder; or the daughter of a musician will herself become a musician; or the kid whose father gave her wires and doorbells to fool around with at the age of 5 will become a computer scientist or electrical engineer. These early influences on career choice—based on identifications, reaction-formations, coping adaptations, or simply loving support and encouragement—may show up in contentment or, conversely, ambivalence about one’s occupation. Transference of feelings from parents to present-day overseers may foment problems in relationships with supervisors, leading to such situations as the line worker who is at odds with every boss. An art student who couldn’t complete his work assignments discovered in psychotherapy that he was going into the field to fulfill the dreams of a very narcissistic father who saw his son as an extension of himself rather than as a person in his own right. Freed up from internal conflict about this constraint, he could begin to develop his own distinctive style.

Managing the stresses of nursing people with severe and enduring mental illness: a psychodynamic observation study of a long-stay psychiatric ward.

The task of nursing people with severe and enduring mental illness can evoke stresses and anxieties for staff which are not consciously known about, but which, nevertheless, impinge upon the quality of care delivered. As a way of exploring this issue, the interactions between staff and between staff and residents in long-term residential care were observed. Alongside efforts to rehabilitate residents, nurses behaved in ways at variance with this task. These behaviours seemed to serve a function of protecting the staff group from the unconscious anxieties the work provoked. These can be understood in terms of three fundamental anxieties regarding the client group, stemming from their mental illness (fears of 'madness' and loss of control), the severity of their disabilities (responsibility and vulnerability), and the chronicity of their difficulties (failure and despair). Better ways of managing these anxieties may be possible if they can be known and thought about.

A psychodynamic view of psychosomatic medicine.

The objective of this article is to assess the relevance of psychodynamic observations and theory for psychosomatic medicine. The evolution of the psychodynamic formulation of psychosomatic symptom formation is described in a brief historical review. There are two distinctly different pathways along which stress-induced psychological arousal is transformed into somatic symptoms. Psychodynamic observations and theory have important implications for psychosomatic research and treatment.

Psychiatric experience with perpetrators and countertransference feelings in the therapist.

Therapeutic work on man-made disaster victims is work which leaves no one untouched. It is the kind of work that, in many ways, frequently involves therapists personally. It may also be the cause of vehement disagreements about treatments, resulting in fights and splits in treatment teams. The work may end tragically. I think this also applies to treatment of that other category of people involved in man-made disaster, the perpetrators. However, we know much less about this. Danieli (1) made a study of the countertransference feelings of about 60 Holocaust survivors' therapists. She came up with, among others, the following themes: guilt, rage, dread and horror, grief and mourning, shame, inability to contain intense emotions, and utilisation of defences such as numbing, denial and avoidance. It is remarkable to find in her description the way in which therapists are inclined, with regard to Holocaust survivors, to act as their 'parent(s)' or their 'child'. Acting the part of the parent, in terms of Transactional Analysis, the Negative Nurturing Parent, the therapist especially wants to prevent, out of fear and guilt, the patients from suffering again. The therapist may also move into the position of the Negative Controlling Parent when he/she gets infuriated by the patient because of his/her very obstinate complaints, or because the patient attributes the part of the persecutor (the Nazis) to the therapist. In terms of Transactional Analysis one may also watch the therapist taking up the Child-part. This is expressed in many ways in the above-mentioned thematical row and the reason behind this is that the therapist wants to behave like a good child, with respect to the parents who have already suffered very much and who have to be spared by all means. Furthermore, the therapist is a fearful child, because he cannot cope with these horrible stories. The therapist is also ashamed because he has not experienced anything of this suffering himself. Moreover, the therapist may act like a strong child that would preferably quickly save its parents by means of its power (and impatience!). Eventually, the therapist may come to look at these helpless, unsavable parents, as being quite tiresome. Also the danger exists that a sadistic child will look for sensational stories that may offer extra suspense: the 'child' in the therapist will continue to ask exaggerated and needless questions about persecution and war stories. The psychological effects of working with victims are described in a different way by McCann and Pearlman (2). The significance of their account is that because of the material the patient's state of being traumatised the therapist risks the danger of becoming traumatised himself. Therapists themselves get nightmares, fearful thoughts, intrusive images and become suspicious towards their fellowmen. These authors think the nature of the material itself is dangerous to several basic securities that the therapist, as a human being, has concerning himself and the world. Under the influence of the powerlessness of the patients the idea arises that having a grip on life is an illusion. In addition, the therapist working with victims may become estranged from his family, his friends and his colleagues, because he is exposed to tales of horror and confonted with a cruel reality. Perpetrators of violence against their fellowmen are numerous in our world. At first sight, it is remarkable that we do not know much about the psychological effect that treating dangerous criminals, torturers and war criminals of major or minor calibre has upon a therapist. Part of the explanation may be that treatment is often restricted to somatic treatment by a general practitioner, a jail practitioner or an internist; as far as psychological or social guidance is concerned, it is frequently of a psychotechnical or psychosocial nature. From forensic psychiatry we know something of the psychological effect on therapists treating perpetrators. Nevertheless, one might expect more literature on the topic, besides that to do with the treatment method and psychodynamic observations. Treating those who commit incest will, for example, indubitably provoke several reactions from the therapist. The following may be looked upon as a series of impressions gained over the last 25 years or so. These are mainly related to psychiatric examinations, psychiatric-medical, and social psychiatric contacts, as well as psychotherapeutic treatment. Being a consultant in the field of psychosomatic diseases, and, later on, working for the Jewish community and for victims of World War II, I came into contact with

Narcissistic Personality Disorder: Descriptive Features and Differential Diagnosis

This article brings the scattered literature on narcissistic personality disorder together and synthesizes its various descriptive aspects into a multifaceted profile of the condition. The disorder is viewed as consisting of characteristic "overt" and "covert" findings in six areas of psychosocial functioning: (1) self-concept; (2) interpersonal relations; (3) social adaptation; (4) ethics, standards and ideals; (5) love and sexuality; and (6) cognitive style. Overtly, and individual with narcissistic personality disorder is grandiose, exploitative, moralistic, often successful, seductive, charming, and impressively knowledgeable and articulate. Covertly, however, he is doubt ridden, deeply envious of others, chronically bored, corruptible, unable to love, forgetful of details, and inattentive to objective aspects of events. Such conceptualization is superior to ordinary checklist methods of diagnosis, as it combines descriptive and psychodynamic observations and correlates the behavioral and psychostructural (hence developmental) aspects of the narcissistic character pathology. This profile also helps in more meaningful differential diagnosis of narcissistic from related personality disorders.

Schizoid personality disorder: a synthesis of developmental, dynamic, and descriptive features.

Various views of schizoid personality disorder in descriptive psychiatry, psychoanalysis, DSM-III and DSM-III-R are reviewed and synthesized to develop a composite picture of the syndrome. The disorder is seen as consisting of characteristic deficits in six areas of psychosocial functioning: (1) self-concept, (2) interpersonal relations, (3) social adaptation, (4) ethics, standards and ideals, (5) love and sexuality, and (6) cognitive style. Such a view maintains historical continuity in the use of the term "schizoid," combines descriptive and psychodynamic observations and correlates the behavioral and psychostructural aspects of the schizoid pathology. The paper also identifies guidelines for distinguishing the schizoid personality from other personality disorders as well as areas needing continued research.

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

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

Psychodynamic Observations of the Research Worker in Psychiatry: Further Considerations

Psychodynamic Observations of the Research Worker in Psychiatry: Further Considerations

Attempted Suicide in Children and Adolescents: Psychodynamic Observations

Attempted Suicide in Children and Adolescents: Psychodynamic Observations

PSYCHODYNAMIC OBSERVATIONS ON THE SIDE EFFECTS INDUCED BY NEUROLEPTICS.

It has been pointed out above that every side effect produced by neuroleptics is invested with a psychodynamic significance in relation to the evolution of the psychosis. This side effect can, independently from its neurobiochemical cause, momentaneously act in a favourable or unfavourable way on the course of the disease. Moreover, the patient's attitude during the follow-up will be conditioned by what he experienced when he took the drug, for schizophrenics can generally establish no cause and effect relation between the absorption of a drug and their improvement. It is therefore important to assess, for every patient, the way in which he experiences side effects at different stages of the treatment, in order to correct them or not, according to whether they are psychologically noxious or beneficial. This empirical line is defensible on the grounds that a review of the various viewpoints now prevailing on the role of neurologic symptoms provoked by neuroleptics, shows that there is no agreement on their therapeutic value and that everyone tries, in fact, to correct them without compromising the efficacy of these drugs.

Studies on mescaline. VIII. Psychodynamic observations.

Psychodynamic observations made during the mescaline-induced state in 124 patients are reviewed. Mescaline produces a "state of being" in which the clinical spectrum can range from sleep to rage and from normalcy to thoroughly disorganized mental states. Anxiety is considered the background upon which the mescaline experience evolves. One may consider the mescaline-induced state under three headings: 1. Hostility-aggression, 2. Sexuality, and 3. The transference. Various recurring symbolic gestures were noted, and many were frequently of a sexual nature. The primary role of anxiety is reviewed and some theoretical concepts presented. Much further work remains to be done.