The individual psychoanalytic psychotherapy of schizophrenia: scientific and clinical approach through a clinical discussion group

Fifty individual psychotherapies of schizophrenic patients, supervised by a control group for fourteen years, are examined. 80 percent of the patients have shown important clinical progress and, in many cases, have been healed, especially those who continued therapy for more than two years and who had a deep and reciprocal emotional involvement with the therapist during and after treatment; there was a reduction by 70 percent of hospitalizations during this treatment and only one of these had a relapse. Other data confirm the efficacy of psychotherapy; however, to give a new instrument of scientific confirmation to this type of individual and subjective work, we tried to observe how the psychopathological and therapeutic mechanism of "symbiosis" induces personal dynamics in the therapist which are reflected in the control group. The psychopathological symbiotic disturbance of the patient, the therapeutic symbiotic relationship, and the way in which the group reacts to these permit the creation of a useful triangle, both for the therapist to understand his position toward the patient and to confirm or correct the subjective aspects of such a deep and emotional relationship.     

Empathy beyond the conceptual level: core nonspecific factors of psychotherapy

The human mind contains much more than concepts. By only taking into account the conceptual level, a cared-for person may feel utterly lonely and abandoned, not deeply in contact with the caregiver, not deeply understood for who he or she really is. A chronic pain patient, for instance, may react to a purely conceptual-level communication, with its lack of deeper contact, by an increasing sense of loneliness. This in itself may substantially contribute to the suffering of chronic functional pain or even functional disorders in general. In dealing with chronic pain patients, as with any patients, it is therefore very important to develop a sense of empathy that goes beyond this, towards deeply understanding the patient as complete person. This sheds a profound light on the all-important nonspecific factors of psychotherapy, which according to many researchers form the only profoundly active principle in psychotherapy.     

Analytic group psychotherapy; for wives and husbands

The practice of group psychotherapy has its roots in Freudian dynamics and concepts, and varies from play group psychotherapy to analytic group psychotherapy, using the dynamics of transference, catharsis, interpretation, insight, ego building, reality, and sublimation.This presentation is based on the experience of the author with about 40 women patients formed in groups at a sanatorium. The majority were neurotic, psychoneurotic or manic-depressive. Several were psychotic. Some of the patients were treated in groups that included their husbands, after discharge from the sanatorium. Analytic group psychotherapy is a concept of an attenuated mobile and uncensored societal setting, where persons who have failed in the larger and harsher social reality may again attempt resocialization in a permissive, friendly, and protected environment. It is not to be considered the poor man's makeshift for individual psychoanalysis. Group dynamics facilitate the regression and catharsis necessary to produce insight and ego strength, leading to more rapid recovery. Husband and wife participation in the same group led to a more tolerant acceptance by the husband of the concept of mental ailment, and empathy for the spouse. The role of the psychiatrist in group psychotherapy is very similar to that in individual psychoanalysis. He represents the reality to the patient and the group. He is objective but permissive, and not passive. Therapeutic goals are the same as in individual therapy, and may focus on the resolution of pre-oedipal conflicts or on situational maladjustments.     

Personality development in psychotherapy: a synergetic model of state-trait dynamics

Theoretical models of psychotherapy not only try to predict outcome but also intend to explain patterns of change. Studies showed that psychotherapeutic change processes are characterized by nonlinearity, complexity, and discontinuous transitions. By this, theoretical models of psychotherapy should be able to reproduce these dynamic features. Using time series derived from daily measures through internet-based real-time monitoring as empirical reference, we earlier presented a model of psychotherapy which includes five state variables and four trait variables. In mathematical terms, the traits modulate the shape of the functions which define the nonlinear interactions between the variables (states) of the model. The functions are integrated into five coupled nonlinear difference equations. In the present paper, we model how traits (dispositions or competencies of a person) can continuously be altered by new experiences and states (cognition, emotion, behavior). Adding equations that link states to traits, this model not only describes how therapeutic interventions modulate short-term change and fluctuations of psychological states, but also how these can influence traits. Speaking in terms of Synergetics (theory of self-organization in complex systems), the states correspond to the order parameters and the traits to the control parameters of the system. In terms of psychology, trait dynamics is driven by the states—i.e., by the concrete experiences of a client—and creates a process of personality development at a slower time scale than that of the state dynamics (separation of time scales between control and order parameter dynamics).     

End-of-life practices in Danish ICUs: development and validation of a questionnaire

ABSTRACT: BACKGROUND: Practices for withholding or withdrawing therapy vary according to professional, cultural and religious differences. No Danish-validated questionnaire examining withholding and withdrawing practices exists, thus the aim of this study was to develop and validate a questionnaire for surveying the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the ICU. METHODS: A questionnaire was developed on the basis of literature, focus group interviews with intensive care nurses and intensivists, and individual interviews with primary physicians. The questionnaire was validated in the following 3 phases: a qualitative test with 17 participants; a quantitative pilot test with 60 participants; and a survey with 776 participants. The validation process included tests for face and content validity (by interviewing participants in the qualitative part of the pilot study), reliability (by assessing the distribution of responses within the individual response categories), agreement (by conducting a test-retest, evaluated by paired analyses), known groups' validity (as a surrogate test for responsiveness, by comparing two ICUs with a known difference in end-of-life practices), floor and ceiling effect, and missing data. RESULTS: Face and content validity were assessed as good by the participants in the qualitative pilot test; all considered the questions relevant and none of the participants found areas lacking. Almost all response categories were used by the participants, thus demonstrating the questionnaires ability to distinguish between different respondents, agreement was fair (the average test-retest agreement for the Likert scale responses was 0.54 (weighted kappa; range, 0.25-0.73), and known groups' validity was proved by finding significant differences in level of satisfaction with interdisciplinary collaboration and in experiences of withdrawal decisions being unnecessary postponed. Floor and ceiling effect was in accordance with other questionnaires, and missing data was limited to a range of 0-7% for all questions. CONCLUSIONS: The validation showed good and fair areas of validity of the questionnaire. The questionnaire is considered a useful tool to assess the perceptions of collaboration and other aspects of withholding and withdrawing therapy practices in Danish ICUs amongst nurses, intensivists, and primary physicians.     

Serum cholesterol concentration and structured individual psychoanalytic psychotherapy in suicidal and non-suicidal male patients suffering from borderline personality disorder

Findings from numerous studies suggest an association between low cholesterol levels and suicidal behavior in patients with different psychiatric diagnoses. The aims of this case-control study were to test whether cholesterol levels in male suicidal patients (N=20) with borderline personality disorder (BPD) are lower than in male non-suicidal patients (N=20) with BPD and male healthy control group (N=20), and to evaluate the influence of structured individual psychoanalytic psychotherapy on suicidal behavior. The groups were matched for age and body mass index (BMI). Results showed that serum cholesterol levels did not differ significantly between suicidal and non-suicidal BPD patients and healthy controls. The level of psychopathology (measured by Brief Psychiatric Rating Scale and Hamilton Depression Rating Scale) was significantly higher in the group of suicidal patients, which indicates the importance of evaluating particular clinical symptoms in BPD, in order to prevent suicidal behavior. Non-suicidal male patients suffering from BPD received more frequently structured individual psychoanalytic psychotherapy prior to the hospitalization than suicidal group. These results emphasized the role of this type of psychotherapy in preventing suicidal behavior in BPD patients.     

Clinical and no-clinical setting specificities in first session short-term psychotherapy psychodrama group

Modern history of short-term group psychotherapy dates back to the late 1950-ies. From then to present day, this psychotherapeutic method has been used in various forms, from dynamic-oriented to cognitive behavioural psychotherapies. Although it has always been considered rather controversial, due its cost-effectiveness, it has been capturing more and more popularity. This paper presents the specificities of first session short-term psychotherapy psychodrama group through session work with two examined groups: a group of 20 adult women who suffer from mild or moderate forms of unipolar depression and a group of 20 students of the School of Medicine in Zagreb without any psychiatric symptomatology. The results indicate the high importance of having structure in first psychodrama session, of relating it with the previously thoroughly conducted, initial, clinical, interviews, and of the clarity and focus in terms of determining the goals of therapy, especially in a clinical context. This study also confirmed assumptions regarding the need for different approaches of warming-up in psychodrama, both in the clinical and in non-clinical samples. A psychodrama psychotherapist should have good time managing skills and capability to convert the time available into an opportunity for directly boosting the group energy and work on therapeutic alliance.     

团体心理治疗对脑梗死患者抑郁状态的影响

目的探讨脑梗死后患者抑郁状态下团体心理治疗的干预效果。方法选取100例脑梗死后抑郁状态患者为研究对象,随机分为对照组和干预组各50例,对照组给予常规治疗,干预组在常规治疗基础上进行团体心理治疗,并采用问卷调查的方式对所有患者的基本资料进行调查分析,采用汉密尔顿抑郁量(HAMD)-17观察干预前后的变化。结果干预组团体心理治疗后患者抑郁状态明显改善,两组比较有明显统计学意义(P0.05)。结论团体心理治疗可明显改善脑梗死后患者抑郁状态,提高患者生活质量。     

I-BIND: International Blue intensity network development working group

Blue Intensity (BI) is coming of age in dendrochronology, although some methodological challenges still need resolution. In the last 20 years, 59 papers have been published focussing mainly on climatological based studies, although BI has also been shown to be useful both for historical dating and dendroecological studies. This short paper briefly reviews the BI method development of the last two decades and introduces a new collaborative initiative called I-BIND (International Blue Intensity Network Development Working Group), which is supported by the Association of Tree-Ring Research. The main aims of I-BIND are to promote continued methodological development, communicate best practice via workshops, encourage the development of BI data networks to enhance both dendroclimatology and dendro-historical dating, and to create a rich environment in which innovative and novel initiatives can be explored and discussed.     

Pragmatic randomized controlled trial of long‐term psychoanalytic psychotherapy for treatment‐resistant depression: the Tavistock Adult Depression Study (TADS)

This pragmatic randomized controlled trial tested the effectiveness of long‐term psychoanalytic psychotherapy (LTPP) as an adjunct to treatment‐as‐usual according to UK national guidelines (TAU), compared to TAU alone, in patients with long‐standing major depression who had failed at least two different treatments and were considered to have treatment‐resistant depression. Patients (N=129) were recruited from primary care and randomly allocated to the two treatment conditions. They were assessed at 6‐monthly intervals during the 18 months of treatment and at 24, 30 and 42 months during follow‐up. The primary outcome measure was the 17‐item version of the Hamilton Depression Rating Scale (HDRS‐17), with complete remission defined as a HDRS‐17 score ≤8, and partial remission defined as a HDRS‐17 score ≤12. Secondary outcome measures included self‐reported depression as assessed by the Beck Depression Inventory ‐ II, social functioning as evaluated by the Global Assessment of Functioning, subjective wellbeing as rated by the Clinical Outcomes in Routine Evaluation ‐ Outcome Measure, and satisfaction with general activities as assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire. Complete remission was infrequent in both groups at the end of treatment (9.4% in the LTPP group vs. 6.5% in the control group) as well as at 42‐month follow‐up (14.9% vs. 4.4%). Partial remission was not significantly more likely in the LTPP than in the control group at the end of treatment (32.1% vs. 23.9%, p=0.37), but significant differences emerged during follow‐up (24 months: 38.8% vs. 19.2%, p=0.03; 30 months: 34.7% vs. 12.2%, p=0.008; 42 months: 30.0% vs. 4.4%, p=0.001). Both observer‐based and self‐reported depression scores showed steeper declines in the LTPP group, alongside greater improvements on measures of social adjustment. These data suggest that LTPP can be useful in improving the long‐term outcome of treatment‐resistant depression. End‐of‐treatment evaluations or short follow‐ups may miss the emergence of delayed therapeutic benefit.