Fifty Years of Change: A Shared Journey.

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.

Intermittent Treatment with the Psychodynamic Psychiatrist: A Patient-Centered Approach.

This study examines the experiences of patients in treatment with psychodynamic psychiatrists on an intermittent basis following an initial brief period of intensive psychotherapy and stabilization. Patients with non-psychotic disorders who received intermittent treatment answered a web-based questionnaire describing the usefulness of various supportive, cognitive-behavioral, and psychodynamic interventions. Forty-eight out of 58 patients invited to participate completed the survey (83% response rate). The majority (75%) of respondents welcomed the intermittent treatment frame. Therapeutic factors deemed to be most helpful included supportive interventions such as ability to relate to the clinician, ability of clinician to listen empathically, and feeling supported by a non-judgemental therapist when talking about private matters. The majority of respondents also endorsed as highly beneficial various cognitive-behavioral interventions such as understanding how thinking patterns impact behavior and feelings and discussing alternative coping skills. Also highly rated were psychodynamic interventions, including understanding how the present is modeled from past experiences and expression and regulation of affect. In the open-ended qualitative feedback, therapeutic factors including collaboration, forming an alliance, and empathic attunement emerged as important. Our preliminary findings suggest that the intermittent psychodynamic treatment frame is well received by patients. Patients welcome integration of different psychotherapeutic approaches to individualize treatment. The common factors in psychotherapy are important patient-reported therapeutic factors in the intermittent treatment approach.

Contemporary practice patterns of dynamic psychiatrists--survey results.

UNLABELLED: The authors examine the practice characteristics of dynamic psychiatrists, including the combined use of medication and psychotherapy, and adherence by self-report to psychodynamic, supportive, and cognitive behavioral therapy theoretical principles and techniques. METHOD: Survey of 555 members of the American Academy of Psychoanalysis and Dynamic Psychiatry conducted in 2009. RESULTS: 24.1% response rate; 75% of respondents were between 61 and 80 years old, 61% had over 30 years of experience; 89% have a private practice but work on an average of 1.6 settings; 39% teach. Most respondents treat patients with complex comorbidities; 92.6% prescribe psychotropic medication. The preferred mode of practice is individual psychotherapy and the preferred frequency once a week; 94.5% of sessions are 45-60 minutes. Using Plakun's Y-model framework, psychoanalysts and dynamic psychiatrist subgroups equally support all core psychotherapy and psychodynamic features, with lesser emphasis but substantial endorsement of cognitive-behavioral psychotherapy features. CONCLUSIONS: Dynamic psychiatrists are committed to see most patients once a week for 45-60 minute sessions and use a variety of conceptual frameworks to guide their treatment plans. They endorse supportive and psychodynamic practice elements more than cognitive-behavioral principles.

The interminable patient: a case history.

The author, a psychoanalyst with over 30 years in practice, has been committed when possible to conducting psychodynamic treatments of less than three years duration with a frequency of sessions of once a week. These have been the majority of her cases. The case presented, though, is one of a small number where the author has conducted psychodynamic treatment for over ten years' duration. In this detailed report she discusses her treatment approach and provides theoretical principles for such prolonged therapeutic encounters.

The dynamic psychiatrist: internist of the mind.

Abstract As dynamic psychiatrists our main clinical focus is to understand patients' symptoms and character structure through the exploration of their past and present experiences. This occurs within the context of their biopsychosocial environment. We work with tools such as free association, interpretation of transference distortions, and resistance to retrieving unconscious experiences. Yet, in the past 30 years our understanding of the role of the therapeutic relationship and other curative factors has changed. Through personal experience, the author explores these matters, considering more active participation in the treatment sessions, flexible frequency of meetings, modified use of therapeutic techniques, variable length of treatments, and concomitant use of psychotropic medication. More than in the past, the practice of the dynamic psychiatrist is modeled on that of the internist-a physician who integrates into his/her clinical work the current understanding of the function of the brain. The dynamic psychiatrist actively participates in the resolution of a given symptom picture and fosters improvement of the patient's personality structure to maximize functioning.

Women psychiatrists: personal and professional choices--a survey.

OBJECTIVE: A survey of female psychiatrists' personal and professional choices, their stress levels related to these choices, and their overall personal and professional satisfaction was conducted. METHOD: Members of the Association of Women Psychiatrists residing in the U.S. and Canada were anonymously surveyed. RESULTS: Respondents with children spent significantly less time in career related activities, more time in family related activities, were more satisfied with their careers and with intimate relationships, and had less personal time than respondents without children. Respondents with academic affiliation reported significantly more satisfaction with their careers as a source of economic and personal reward, devoted more time to career related activities, less time to family, and were more stressed by current professional situation than women without academic appointment. Respondents without children and with academic affiliations reported the most stress in their current professional setting. CONCLUSIONS: Female psychiatrists who were able to combine children, intimate relationships, and academic involvement were the most satisfied of all groups.

Personal disclosure revisited.

In this paper personal disclosure is defined as a conscious verbal presentation to the patient by the therapist of a personal vignette accompanied by the appropriate dynamic formulation and resolution of a given personal area of conflict. It is conceptualized within theoretical formulations which consider the therapeutic relationship a dyad, where the reality of the patient and the reality of the therapist influence each other, providing the matrix through which the resolution of the patient's past life experiences takes place in the context of this new interpersonal experience. It is specifically differentiated from a boundary violation, because the personal disclosure is brought to the patient's interactional awareness not for gratification of the therapist's sexual or narcissistic needs, but to provoke a response in the patient's conceptualization of a phenomenon being presented in the session and to actively influence the intersubjective field. Within the conceptual framework developed in this paper, personal disclosure reaffirms the patient's current self-discovery and provides for a different formative experience. Personal disclosure is not to be used by the therapist as a vehicle to resolve personal conflicts or as source of personal gratification. When used within the context developed in this paper, personal disclosure enhances both the patient's therapeutic process and the therapist's ever-evolving growth.