The family doctor: psychodynamic psychotherapy in tightly knit communities.

Although unusual, psychodynamic psychiatrists engage in the practice of treating multiple members, and constellations of members, of families with psychodynamic psychotherapy as well as other treatment modalities. Such clinicians are considered the "Family Psychiatrist." Psychological characteristics of such families who cannot be referred to other clinicians are articulated. The literature on psychotherapy in small rural communities is reviewed as having relevance to define the ethical issues that arise in such treatments. These issues include: maintaining therapeutic neutrality; creating functional, flexible, and appropriate boundaries; maintaining confidentiality; promoting patient autonomy and growth; as well as managing conflicts of interest. Relevant countertransference issues are examined.

Menopause, depression, and loss of sexual desire: a psychodynamic contribution.

Menopause is a phase of life during which physiological and psychological symptoms may occur. Most women traverse the menopausal transition without significant morbidity. The descriptive literature on menopause indicates that the nature of psychological and physical morbidity is a function of a variety of bio-psychosocial influences. There are distinct subgroups of women who are more likely to become symptomatic during this phase. Rosemary Basson has reconceptualized the female sexual response cycle. Her model allows the clinician to better understand and treat the reciprocal, interacting influences of depression, menopausal changes, and decreases in sexual desire on sexual functioning. Psychodynamic theories about menopause have moved away from the early models which predicted a universally negative experience. It is now believed that past psychological and medical problems, trauma, and the quality of interpersonal relationships are important predictors for the development of symptoms. Psychodynamic psychotherapy, in conjunction with psychoeducation, pharmacotherapy and hormone replacement therapy (HRT) may all be helpful in the treatment of symptoms.

Combined psychotherapies: searching for an order of operations in a disordered world.

Abstract Recent studies of psychotherapy demonstrate that therapists of different orientations-psychodynamic, cognitive-behavioral, interpersonal, and dialectical behavioral-provide beneficial treatment. Despite the stated adherence of clinicans to one orientation or another, review of session transcripts reveals a substantial overlap in the techniques utilized. Nonspecific or patient factors are the chief determinants of how therapy is conducted in practice. Nevertheless, the psychodynamic orientation offers the most comprehensive approach to therapy because it considers unconscious factors, including transference, enactments, and aspects of the patient's personal relationships. The psychodynamic formulation indicates the basis for determing how psychotherapy might best be conducted for the specific patient.

The medical education of generation Rx.

Psychodynamically trained psychiatrists have much to add to the education of all medical students, not only those who will enter Psychiatry. Aspects of the treatment dyad, including the formation of durable bonds between physician and patient, as well as the management of the manifestations of transference and countertransference are several of the areas of particular expertise of psychodynamically oriented clinicians. These principles enhance the professional training of the next generation of clinicians, researchers, and medical educators. In addition, the multiple meanings of illness for physicians and patients, both conscious and unconscious, can be fruitfully explored using psychoanalytic principles. Such an understanding can lead to greater satisfaction with the evaluation and treatment of illness for patients and their families, who are, after all, ourselves. Enlightened self-interest, then, should guide our increased participation in medical education.