Considering Psychodynamic Therapy for Older Adults.

As the neuroscientific bases for conceptualizing and treating psychiatric and psychological conditions have become increasingly emphasized in recent years, application of relatively more traditional theoretical frameworks, such as psychodynamic theory, has somewhat fallen out of favor. Nonetheless, the effectiveness of psychodynamic therapy in both short- and long-term episodes of care has been established in numerous outcome studies and meta-analyses from the last two decades. Specifically, psychodynamic therapy may be particularly well suited for use with older adults (ages 65 years and older) for a number of clinically and logistically indicated reasons. In this exploratory commentary piece, we consider the potential origins of the notion that psychodynamic therapy may not be well suited for use with older adults. We then present evidence in favor of utilizing psychodynamic interventions with older adults. In doing so, we hope to spur critical thought among clinicians who work with older adults and encourage continued research in this area to strengthen the existing evidence base.

Narcissistic pathology as core personality dysfunction: comparing the DSM-IV and the DSM-5 proposal for narcissistic personality disorder.

Narcissistic personality disorder and related concepts have a complex history and have been subject to extensive theoretical discourse but relatively little empirical research. An initial proposal for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) that suggested eliminating this disorder as a discrete personality disorder type met with considerable controversy that ultimately led to its reinstatement in subsequent proposals. Nonetheless, the DSM-5 proposal for personality disorders as a whole would involve a significantly different formulation of narcissistic personality from that described in DSM-IV-one that places a greater emphasis on shared deficits among all personality disorders that tap elements thought to fall on the narcissistic spectrum, such as deficits in empathic capacity. This article describes this revised formulation, and presents a case study that illustrates the similarities and differences in the DSM-IV and proposed DSM-5 portrayal of narcissistic issues and related clinical problems over the course of a particular treatment.