Psychotherapeutic Perspective Research Articles

Focus on the blind spots of clinician-patient interactions: A critical narrative review of collusion in medical setting.

Collusions, interpersonal phenomena with an impact on patients, significant others, clinicians, and care, are mainly described in the psychotherapeutic literature but also occur in the medical setting. Comprehended as an unconscious bond between two or more persons from a psychotherapeutic perspective, definitions and collusive situations described in the medical setting vary. The question arises whether medical collusions, compared to collusions occurring in the psychiatric setting emerge in different clinical situations or are not identified as transference-countertransference experiences, since there is less sensitivity for the unconscious dimensions of care. We systematically reviewed the medical literature on collusions. Even though a read threat, avoidance of unpleasant feelings (mainly anxiety), runs through the described collusions, the unconscious dimensions and associated defensive maneuvers are rarely evoked. Given the expressed desire to act on collusions in medicine, involving third-party psychiatric liaison clinicians, who supervise clinicians, and hereby help to disentangle collusions, could be beneficial.

Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences

The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

Acute depressive reaction as a consequence of war trauma exposure: a case report of a Ukrainian refugee.

We hereby report a case of a young Ukrainian woman refugee who immigrated in Italy after the war outbreak in February 2022. The researcher arrived in Italy in March 2022, thanks to a scholarship of the University of L'Aquila. Shortly after settling in L'Aquila, she started to manifest depressive symptoms, which eventually led her to seek psychological and pharmacological help in the local psychiatric unit. In April 2022, she accessed twice in a week to the emergency department of the "San Salvatore" Hospital of L'Aquila. The second time she presented an acute anxiety attack accompanied by psychomotor disturbances (negativism, mutism) that eventually required admission to the local psychiatric ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC) with the aim of managing the clinical presentation from a pharmacological and psychotherapeutic perspective. The patient submitted a series of validated scales in her own language. After 13 days of hospitalization, the patient was discharged with a diagnosis of "Acute Depressive Disorder, mild severity", according to PHQ-9, and referred to psychiatric services with a dedicated program. The present report aims to underline the need to take into consideration the possibility of developing depressive symptoms and reactions among Ukrainian war refugees and, in light of this evidence, the importance of a cross-country shared program when addressing the mental health of all refugees.

Positive Organizational Scholarship from a Psychotherapeutic Perspective

Many organizational development perspectives and discussions adopt a medical or diagnostic viewpoint of organizational dysfunction, focusing heavily on the numerous deficiencies, mistakes, and other negative aspects of struggling organizations. While any organization has a fair share of problems to address, such an overarching focus on everything that is wrong with an organization can create a harmful cycle of pessimism, depression, and low energy that can be difficult to overcome. Positive Organization Scholarship (POS) practitioners, much like the skilled therapist, help organizations shift from a negative, limiting mindset into a positive, open mindset in order to facilitate positive change. This paper explores how cognitive reappraisal strategies common in psychotherapy could be used by POS practitioners to facilitate change and growth in the organizations they serve.

Integrative Psychotherapy With Physicians In the Trenches: Convergence of Cognitive, Existential, and Psychodynamic Processes

In this article, I present insights gleaned from over a decade of working in therapy with physicians in the trenches who practice at general hospitals located in an area afflicted by the community and political violence, and recently, by the COVID-19 pandemic. Psychotherapy with these physicians requires an integrative psychotherapeutic approach that heeds their changing needs. Espousing cognitive-existential psychodynamics (CEP), a theory-based psychotherapeutic perspective developed for complex cases, I show how cognitive, existential, and psychodynamic processes strongly converge during the treatment of physicians in the trenches. Such convergence is manifested in issues of mental representations (of death, medicine, and the hospital) and choice/meaning.

The archetype of the double in middle adolescence: Theoretical reflections based on action research

Abstract Background Stories written under musical induction allow studying symbolic figures emerging during the psychotherapeutic process. During multimodal arts psychotherapy, based on a combination of active music therapy and the production of stories under musical induction, the archetype of the alter ego frequently appears in texts written by adolescents (Schiltz, 2008). This archetype shows its different facets during the psychotherapeutic process. Methods and research questions With the help of a qualitative study, based on the phenomenological content analysis of the TAT and the stories written under musical induction with N=52 students suffering from emotional (subgroup I) or conduct disorders (subgroup D), we answered the following questions: • Can we recognise in these symbols compensatory features regarding the person’s initial problems? • Do they gradually expand during the therapeutic progress, so that they reflect the integration of the hidden and split parts of the self? • What is generally their role in the adolescents’ search for identity, beyond the realm of the pathology? Results The results of the study opened psychotherapeutic perspectives for tertiary prevention in adolescence.

Virginia Satir’s Transformational Systemic Therapy: A Transpersonal Approach to Family Therapy

The work of Virginia Satir, a pioneer family therapist, is examined as a transpersonal approach to family therapy. Ways in which transpersonal perspectives may be applied in family therapy are explored in Satir’s notions of grounding and centering, the evolving and transcending concept of congruence using the Self/I AM concept in the Satir iceberg model, as well as the Satir conceptualization of the therapist’s use of self. Aspects of transpersonal psychotherapy relevant to the practice of family therapy are examined, including the creation of a transpersonal space of trust in order to strengthen the therapeutic alliance, going beyond meaning in working with the family system to apply transpersonal (e.g. nondual psychotherapeutic) approaches to the therapist’s use of self in therapy. A discussion of intersubjectivity and the role of the beingness of the family therapist in promoting transcendence, awareness, and healing for the family is included. Satir family therapy is consistent with transpersonal psychotherapeutic perspectives and is therefore recommended as a prospective family therapy modality for the transpersonally-oriented psychotherapist. KEYWORDS Satir, Family Therapy, Transpersonal Psychology, Transpersonal Psychotherapy, Transcendence, Consciousness, Transformation, Intersubjectivity, Nondual Psychotherapy.

Seelsorge bei Patientinnen mit Anorexia nervosa

Anorexia Nervosa as a global increasing illness has historically and in contemporary spirituality an ascetic drive with self-destructive as well as liberating potentials. A spiritual care approach from a psychotherapeutic perspective is helpful in identifying and change the underlying toxic spiritual orientation into life giving connectedness and its symbols in a process supporting the refeeding in a hospital before therapy in a clinical setting.

Partner attachment and the development of traumatic and anxious-depressive symptoms among university students

Summary Context : A wide literature has demonstrated how attachment style can impact symptomatology, for instance anxious, depressive, and post-traumatic symptoms. Life as a student, as a transition period between adolescence and adulthood, constituting a at-risk population in terms of health measures, may be particularly interesting to study regarding attachment to a partner and anxiety, depression, and trauma. The aims of this study were to evaluate in a French University student population: (1) the presence of anxious, depressive, and post-traumatic symptoms; and (2) the relationship between those symptoms and the attachment style with the partner. Method: Based on volunteer French students, we conducted an internet-based data collection procedure with online questionnaires (PCLS, HADS, ECR). Results: Both attachment dimensions (i.e., abandonment anxiety and intimacy avoidance) impacted post-traumatic symptoms (PCLS score). The higher the attachment anxiety score, the higher the HAD scores of anxiety and depression. In contrast, a decrease in the attachment avoidance score was associated with an increase in the anxiety and depression HAD score. Discussion: From a psychotherapeutic perspective, consideration might be given to attachment style as a risk factor, maybe even a psychopathological vulnerability. From a clinical point of view, we must take that parameter into account to explain the clinical situation of patients.

A study on how basic psychotherapy training is perceived by Swedish physicians in psychiatry

ABSTRACT In Sweden, physicians training to be psychiatrists must complete a basic course in psychotherapy. This study investigated the perceptions of this course by 18 physicians who completed a basic course in psychotherapy. All participants answered a paper-and-pencil questionnaire and four were also interviewed. The results show that most physicians were satisfied with the course, especially with its focus on different psychotherapeutic perspective that gave them the opportunity to train in both cognitive behavioural therapy and psychodynamic therapy. Continuing to offer physicians high-quality psychotherapy training, especially one that encourages knowledge of several theories and methods that will later be useful in clinical practice as a psychiatrist, will benefit future psychiatrists and their patients.

R/S CBT. Religiously/spiritually sensitive cognitive-behavioral therapy – ethical remarks

Cognitive-behavioral therapy is one of the most prominent psychotherapeutic perspectives, which clinical efficacy has gained strong empirical validation, but at the same time it is considered as characterized by reductionistic view of humanity. Since the 1980’a development of the so-called R/S CBT, or religiously/spiritually sensitive cognitive-behavioral therapy, can be observed. The article presents the R/S CBT in its most important aspects; the issue of its effectiveness in the treatment of mental disorders and existential crises is also considered. Including religious/spiritual issues in the process of psychotherapy may raise ethical questions. The decision to include religious content in the process of psychotherapy puts high demands on psychotherapists’ professional ethics, not only in terms of compliance with the ethical and professional standards, but with regard to the development of personal competences or professional virtues.

Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution.

Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as "a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity", is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.

Neurological disease or conversion disorder? Important aspects of differential diagnosis - psychiatric and psychotherapeutic perspective. Case report

Introduction: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease with undetermined etiology. Due to diverse symptomatology, it requires a thorough differential diagnosis, with consideration of conversion disorders. The presented thesis describes a case of a young man hospitalized in the Department of Psychiatry in order to verify the possible psychogenic basis of his symptoms, which previously were considered to be a manifestation of neurological disease with an unfavorable prognosis. Aim: The aim of the thesis is to raise the issue of a multidisciplinary approach to diagnostic process in medicine, as well as taking into account the legitimacy of including psychiatrists, psychologists, and psychotherapists in diagnostic teams. Case study: We present a case report of a man who has been experiencing progressive feeling and walking problems for the past several years, which originally suggested a neurological or rheumatological disease. Earlier observations and medical tests had led to a diagnosis of amyotrophic lateral sclerosis. After several years, the diagnosis was excluded, and the patient was referred to the Department of Psychiatry to determine the possible psychogenic basis of his symptoms. Diagnostic methods used during the patient’s hospitalization confirmed the conversational nature of his symptoms, and both pharmacological and psychotherapeutic treatment caused reduction of severity of his symptoms and allowed him for a gradual return to independent functioning. Conclusion: Analysis of the collected data, including patient’s life history and a course of his treatment, indicates the validity of a holistic approach to medical problems, which implies the inclusion of specialists in the field of psychiatry, psychology, as well as psychotherapists in diagnostic teams. Such a multidimensional view of the patient and the source of his symptoms may allow for faster diagnosis and may also contribute to reducing the risk of making mistakes such as an incorrect assessment of factors triggering the disease process. Keywords: conversion disorders, amyotrophic lateral sclerosis, differential diagnosis

Interpersonal Psychotherapy for PTSD: Treating Trauma without Exposure.

Interpersonal Psychotherapy (IPT) is a time-limited, diagnosis-targeted psychotherapy originally developed for the treatment of major depression. Research studies have repeatedly demonstrated its efficacy in treating mood disorders and other psychiatric disorders over the past forty years. As IPT is a life-event based treatment that focuses on improving interpersonal functioning, it seemed natural to adapt it for the treatment of posttraumatic stress disorder (PTSD), a life-event based illness that affects interpersonal functioning. Preliminary data suggest that IPT has equal efficacy in alleviating PTSD symptoms as Prolonged Exposure, the best tested exposure-based treatment. We describe the principles of IPT and its modifications for treating PTSD. A case illustration describes a patient with PTSD related to military trauma. The authors discuss their reluctance to integrate IPT for PTSD with other psychotherapeutic perspectives.

Psychoanalytic and Psychotherapeutic Perspectives on Stepfamilies and Stepparenting by ProphecyColes. Published by Routledge, Abingdon, 2017; 120 pp, £27.99 paperback

Psychoanalytic and Psychotherapeutic Perspectives on Stepfamilies and Stepparenting by ProphecyColes. Published by Routledge, Abingdon, 2017; 120 pp, £27.99 paperback

The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry

The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry This article presents an integrative treatment model for infants and toddlers between zero to three years and their parents by integrating different complementary psychotherapeutic perspectives. Between 2012 and 2014 a total of 214 children between zero and three years have been treated, the diagnostic and process data of 53 % (N = 113) of the children were evaluable. The parents have been consulted in the beginning, at the end and six months post-treatment with different questionnaires concerning distress of the children and of the parents as well as regarding the social and the emotional behavior of the toddlers. The psychotherapists filled in different instruments at the beginning and at the end of the treatment. Our research demonstrates that a clearly conceptualized intervention has a measurable and persistent positive effect on the symptoms of the children, on the parent-child-relationship and on the wellbeing of the parents.

Madness of the Mind

The art of psychotherapy has been defined as the capacity of the psychotherapist’s mind to receive the psyche of the patient, particularly its unconscious contents. This deceptively simple definition implies the enormously complex art of receiving the most disturbed, dissociated, maddening, often young and primitive, frightening, and fragmented aspects of the patient’s multiple ages and selves, in the hope perhaps that we might make available to our own mind, to the patient’s mind, and within the therapeutic relationship, whatever it is that we discover together, perhaps with the possibility that this may allow that these dissociated, fragmented, lost, and potentially transformative aspects of self might become more accessible to both therapist and patient. The complexity of this process is further intensified when cultural difference is an important aspect of therapeutic engagement. This paper will explore this rich and complex art. It will include exploration of psychoanalytic, relational, and transpersonal psychotherapeutic perspectives as they inform the potentials and mysteries of this deeply receptive process. The paper will consider the potential this receiving of the other might have for the growth of both the therapist and patient within the life span of clinical engagement and will include consideration of implications for cross cultural clinical work. Clinical vignettes illustrating and informing the ideas explored in this paper will be woven throughout the paper. Whakarāpopotonga Kua tautuhia te toi whakaora hinengaro ko te kaha o te hinengaro o te kaiwhakaora hinengaro ki te pupuri i te hinengaro o te tūroro, mātuatua nei ko ngā matū maurimoe. E tohu ana te tautuhinga ngāwari nei i te kaha uaua o te mahi pupuri i ngā maramara tirohanga, ngā tau, ngā whaiaro tini o ngā tūroro arā noa atu te wairangi, te noho wehe, te kārangirangi, he taiohi, he māori, whakawehiwehi, i runga i te wawata tērā pea ka tuwhera ki ō tātau ake hinengaro, ko tō te tūroro ki waenga hoki i te whakapiringa haumanu. E kene pea mā te mea ka kitea, e tuku ēnei tirohanga pūreirei, kongakonga, ngaro, ā, ngā tirohanga hurihanga whaiaro e whakamāmā ake ki te kaiwhakaora me te tūroro. Ka kaha ake te auatanga o tēnei hātepe i te mea ko te rerekētanga o te ahurea te wāhanga nui o te mahi haumanu. Ka wheraina e tēnei tuhinga te tirohanga toitaurea mōmona nei. Ka whakaurua te wherawherahanga o te wetewetenga hinengaro, te tātanga, me ngā tirohanga whakaoranga hinengaro wairua i te mea ko ēnei ngā kaiwhakamōhio i ngā pirikoko o tēnei hātepe toropupū tino hōhonu. Ka whakaarohia e te pepa nei te ēkene pea o te whakaurunga mai o tētahi kē atu mō te whakatipuranga o te kaihaumanu me te tūroro i roto i te wā huitahi ai. Ka whakaarohia ake anō hoki ngā hīkaro mō te mahi haumanu ahurea whakawhiti. Ka rarangahia ngā kōrero haumanu e whakaahua e whakaatu ana i ngā whakaaro tūhuraina i roto i tēnei tuhinga.

“Am I too emotional for this job?” An exploration of student midwives' experiences of coping with traumatic events in the labour ward

Backgroundmidwifery is emotionally challenging work, and learning to be a midwife brings its own particular challenges. For the student midwife, clinical placement in a hospital labour ward is especially demanding. In the context of organisational tensions and pressures the experience of supporting women through the unpredictable intensity of the labour process can be a significant source of stress for student midwives. Although increasing attention is now being paid to midwives’ traumatic experiences and wellbeing few researchers have examined the traumatic experiences of student midwives. Such research is necessary to support the women in their care as well as to protect and retain future midwives. Aimthis paper develops themes from a research study by Davies and Coldridge (2015) which explored student midwives’ sense of what was traumatic for them during their undergraduate midwifery education and how they were supported with such events. It examines the psychological tensions and anxieties that students face from a psychotherapeutic perspective. Designa qualitative descriptive study using semi-structured interviews. Settinga midwifery undergraduate programme in one university in the North West of England. Participants11second and third year students. Analysisinterviews were analysed using interpretative phenomenological analysis. Findingsthe study found five themes related to what the students found traumatic. The first theme Wearing the Blues referred to their enculturation within the profession and experiences within practice environments. A second theme No Man's Land explored students’ role in the existential space between the woman and the qualified midwives. Three further themes described the experiences of engaging with emergency or unforeseen events in practice and how they coped with them (“Get the Red Box!”, The Aftermath and Learning to Cope).This paper re-examines aspects of the themes from a psychotherapeutic perspective. Key conclusionsresearchers have suggested that midwives’ empathic relationships with women may leave them particularly vulnerable to secondary traumatic stress. For student midwives in the study the close relationships they formed with women, coupled with their diminished control as learners may have amplified their personal vulnerability. The profession as a whole is seen by them as struggling to help them to safely and creatively articulate the emotional freight of the role. Implications for practicefor midwifery educators, a focus on the psychological complexities in the midwifery role could assist in giving voice to and normalising the inevitable anxieties and difficulties inherent in the role. Further research could explore whether assisting students to have a psychological language with which to reflect upon this emotionally challenging work may promote safety, resilience and self-care.

El Mindfulness en su Contexto: Logros y Retos de las Intervenciones Psicológicas Basadas en Mindfulness desde una Perspectiva Psicoterapéutica, Constructivista, Relacional e Integradora

Este artículo presenta una reflexión sobre los logros y retos de las intervenciones psicológicas basadas en mindfulness desde una perspectiva psicoterapéutica, es decir, considerándolas formas de intervención psicoterapéutica. Además se abordan desde la perspectiva del constructivismo relacional, es decir desde la visión de que la construcción de significado a partir de la experiencia es un logro lingüístico, relacional y narrativo. Por último, el tema se enfoca desde una actitud integradora de la práctica y conceptualización de la psicoterapia.

Narcissistic vulnerability is a common cause for depression in patients with Gilles de la Tourette syndrome

The aim of this study was to assess for the first time different dimensions of narcissistic self-regulation in a large cohort of adult patients with Gilles de la Tourette syndrome (GTS) (n=50). From preliminary studies it is suggested that narcissistic personality trait and disorder, respectively, are relatively uncommon and occur in only 6–10% of GTS patients. In this study we used the Narcissism Inventory (NI), a 163-items questionnaire that measures four different dimensions of narcissism. The main result was that the prevalence of narcissism strongly depends on the subtype of narcissism: while the vulnerable narcissism (“threatened self” and “hypochondriac self”) was common, the “classic narcissistic self” (grandiose narcissism) was rare. From our data an association between comorbid depression and increased values of the “threatened self” and comorbid OCD with increased values of the “hypochondriac self” is suggested. Narcissism correlated positively with the personality domain neuroticism and had a significantly negative impact on patients' quality of life. Therefore it can be speculated that vulnerable narcissism is – among several others – one cause for depression in patients with GTS. These findings may open new psychotherapeutic perspectives in the treatment of depression in patients with GTS.