Psychodynamic Psychiatry

Charles Darwin's theory of evolution was founded on the core belief that natural history is one of slow, incremental change, a concept he called "speciation." A hundred years later Eldredge and Gould challenged Darwin's theory, arguing that the data of paleontology reveals something quite different: long periods of stasis followed by bursts of change, a concept they called "punctuated equilibria." This article will follow that progression and then describe the three punctuated equilibria that I believe led to Homo sapiens ...

In this article, I employ a psychodynamic lens to describe how women's fantasies of time as standing still, which is encouraged by sociocultural forces, is used to undermine the notion of the biological clock. These fantasies, also fueled by the timeless nature of the unconscious, can lead to hesitancy in not only initiating fertility treatment but also in complying with fertility treatment recommendations. When this happens, hesitancy is often unconsciously utilized in a conflict about becoming a mother. Once these hesitancies are worked through in therapy through a focus on previous losses, fertility treatment often moves forward...

This article presents the findings of an ongoing supervision group (founded in 1999) researching the after-effects of the Nazi period on people in psychotherapy in Germany today. The unacknowledged collective shadow hidden behind half-truths, prevarications, and silence itself prevents a genuine working through of the Nazi past. Patients' lack of knowledge concerning their families' own past leads to unconscious guilt, which often then leads to psychosomatic disturbances. But this is not only a problem in Germany...

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings...

The gold standard of scientific medicine is using knowledge of underlying processes to shape treatment. This has previously not been possible for psychotherapy, but with the science of memory reconsolidation, requirements for change can be more precisely defined and can improve psychotherapeutic technique by focusing on three areas: the activation of maladaptive implicit learning, the provision of disconfirming information, and attention to transmission between consciousness and limbic memory. Overall, better understanding of processes helps liberate psychotherapy from rigidities dictated by set methods...

The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed...

Access to one's healthy aggression is critical for both patient and therapist. On the patient's end, the ability to access and modulate aggression is fundamental to the establishment of healthy self-esteem and the capacity to sustain relationships and pursue life goals. On the therapist's end, access to aggression allows for the setting of a secure therapeutic frame and the subsequent conduct of the deep work of therapy. Conversely, lack of access to aggression creates burdensome and problematic situations that may subvert the treatment...

Erik Erikson gives us a comprehensive psychosocial schema encompassing the life cycle from birth to death. In elucidating key issues at each life stage-the epigenetic crises-he defines important parameters of development that distinguish between the normative and the pathologic. Individuals at any developmental stage can be evaluated with respect to these fundamental milestones.

An approach to a once-weekly, or bimonthly (every second week), ongoing psychodynamic psychotherapy is described. The detailed description of individual sessions is intended to show the process of the uncovering of unconscious phenomena using this approach, though the therapies described are not complete. Important changes that have already occurred are described. The approach is characterized by a direct method of discovery of early painful situations that underlie specific problematic experiences in the present...

"La Cura" is one of the tracks in Franco Battiato's L'Imboscata album (1996), the 19th published by the Italian composer and songwriter, who died 3 years ago. In the lyrics several references to psychiatric terminology appear. The purpose of this article is to consider the lyrics of the song from psychodynamic and mental health care perspectives and offer associations that reflect the process of forming a therapeutic alliance with patients.

The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective experiences of incompetence and helplessness. The authors review the literature of the subject and highlight the work of Rajagopalan and colleagues in Singapore, who implemented a one-time reflective group session to help clinicians process the experience of patient suicide to reduce psychological distress and prevent burnout and moral injury.

Burdening guilt refers to the belief that one's emotions, needs, and ways of being are a burden to others, and is one type of interpersonal guilt proposed by the control-mastery theory (CMT). The aim of this article is to validate two new measures of burdening guilt. In the two studies conducted, we examined the psychometric properties of these scales and the relationship between burdening guilt and self-perceived burden (burdensomeness), self-esteem, shame, anxiety, depression, mental health, attachment insecurity, adverse childhood experiences, social desirability, empathy, and suicidal ideation...

The growing occurrence of adolescents with gender nonconforming identities appears to be associated with what the authors believe is the contemporary manifestation of the adolescent identity crisis phenomenon. This phenomenon is expressed through a deliberate rejection and reappraisal of conventional gender roles and norms. The adolescent identity crisis, as initially conceptualized by Erik Erikson (1956), constitutes an unconscious multifaceted phenomenon that is outwardly displayed within familial and societal frameworks...

No abstract text is available yet for this article.

This case report details the treatment of a longtime psychodynamic psychotherapy patient, with a particular focus on a ketamine-assisted psychotherapy (KAP) session, and how the progress achieved during this session compares with the literature on KAP. The patient is a 54-year-old woman with a history of multiple traumas, including sexual assault and life-threatening physical injuries, as well as a recent diagnosis of primary lateral sclerosis (PLS). For most of her life, she relied on extreme idealization of important people in her life as her primary defense mechanism, helping her to maintain physical and psychological survival...

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...

Reproductive endocrinologists often recommend sperm donation to two groups of patients. The first are women with partners with azoospermia. The second are women who do not have a partner and yet desire to become a parent. This article focuses on a subset of women in these two groups who hesitate to accept this recommendation from their reproductive endocrinologist. Winnicott's writings on transitional phenomena, especially his description of how the infant creates good, not-me possessions, may be helpful in our understanding of some of these women's fantasies of sperm as a bad, not-me possession...

When Covid-19 was declared a pandemic, most people felt helpless, fearful, and demoralized while health care workers put their own lives at risk to support and heal others. The uncertainties expressed by experts and the ambiguous and protracted nature of the pandemic compounded the sense of frustration caused by the scarcity of protective equipment and effective medications. This combination of factors led to exhaustion, burnout, and moral injury. As a result, mental health practitioners worldwide realized that health care staff needed to stay motivated and resilient...

In many academic centers a generation of psychiatrists has undergone training with little or no exposure to Freud's contributions to our profession. Our profession is diminished if we ignore Freud's remarkable insights into the human psyche. Not only does Freud give us a comprehensive theory of human nature-of our mental life and its psychopathology-his concepts are foundational to dynamic psychiatry and its psychotherapeutic application. This article describes one of his core concepts: Freud's theory of anxiety...

The experience of patient suicide can have a profound impact on clinicians, yet there are limited opportunities for them to express and process their emotional responses. We organized a reflective group session for psychiatrists in Singapore who had encountered patient suicides. Ten psychiatrists participated, with five in the "inner" group (those who had experienced patient suicide) and the remaining five forming the "outer" group. Led by a senior psychiatrist trained in psychodynamic psychotherapy, the inner group shared their reflections on patient suicides, while the outer group provided their insights thereafter...