"You can't really have a relationship with them because they just ask you questions": understanding adolescent dropout - an empirical single case study.

Introduction: High dropout rates are common in youth psychotherapy, including psychoanalytic psychotherapy, yet the reasons behind this trend remain obscure. A critical focus to enhance adolescent engagement could be the therapeutic alliance, particularly in resolving alliance ruptures. This study sought to clarify the complex relationships between the therapeutic alliance, encompassing alliance ruptures and resolutions, and dropout within the context of poor outcome. It investigated a single case of an adolescent with depression who dropped-out of Short-Term Psychoanalytic Psychotherapy, without showing clinical improvement. Method: Data was garnered from diverse sources, including questionnaires, interviews, and session recordings, and analyzed through a mixed-method longitudinal framework. This encompassed views from the adolescent, therapist, parents, and external evaluators. Results: The study identifies several factors impacting the decision to drop out, including initial profound distrust toward the therapist, a complex and difficult therapeutic relationship characterized by unresolved alliance ruptures, and sporadic attendance. External factors including minimal parental engagement with therapy were also seen as detrimental to the adolescent's involvement and progress. Discussion: The research underscores the challenges in engaging adolescents, especially when there may be distrust of professionals, and in the absence of parental involvement with treatment.

Aggression in Psychodynamic Psychotherapy and Supervision: Becoming a More Effective Therapist.

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. Beginning therapists have a particular susceptibility to minimize their own aggression given certain factors in their choice of profession. Supervisors' modeling of the experience of aggression, as well as the provision of a safe atmosphere in which new clinicians become comfortably aware of their own and their patients' aggression, will help fortify beginning therapists' capacity to harness their aggression in the service of the work.

Psychodynamic Psychiatry and Psychoanalysis in Indonesia.

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. The psychodynamic model and treatments have faced obstacles limiting their acceptance in Indonesia, including importing a Western model that has not been culturally adapted to treat patients in the East, the stigma of mental illness in local communities, and the complex comorbidities of persons who seek psychiatric care. Psychodynamic psychotherapy in Indonesia is presently taught in university-based residency programs for eight semesters. A psychodynamic psychotherapy competency-based curriculum was adopted nationwide. The dissemination of psychotherapy knowledge and skills is greatly assisted by an active psychiatric professional association-the Indonesian Psychiatric Association Psychotherapy Section, a member society of the World Federation for Psychotherapy. The authors propose international and regional academic collaborations to maintain enthusiasm among trainees and improve quality of care.

Patients' perception of side effects in cognitive-behavior, psychodynamic, and psychoanalytic outpatient psychotherapy.

OBJECTIVE: To assess and compare the frequency of psychotherapeutic side effects in different psychotherapeutic approaches. METHOD: Side effects were assessed across 17 domains through structured interviews with 45 outpatients in cognitive-behavior, psychodynamic, and psychoanalytic psychotherapy. RESULTS: Almost every patient (95.6%) reported at least one side effect, with a mean of 4.7 affected domains. Most frequent complaints were that problems were seen as more complex (60.0-80.0%), worsening of pre-existing symptoms (46.7-60%), occurrence of new symptoms (20.0-53.3%), feeling uncomfortable in treatment (33.3-40.0%), tensions with therapist (26.7-46.7%), as well as conflicts with current family and with family of origin (both 13.3-46.7%). Differences between therapeutic orientations were mostly non-significant. CONCLUSION: Psychotherapy is regularly accompanied by side effects, independent of different theoretical orientations. Psychotherapists need to be familiar with side effects in order to inform patients about treatment-associated risks and to recognize and manage side effects.

The multi-level outcome study of psychoanalysis for chronically depressed patients with early trauma (MODE): rationale and design of an international multicenter randomized controlled trial.

BACKGROUND: Whether and how psychotherapies change brain structure and function is unknown. Its study is of great importance for contemporary psychotherapy, as it may lead to discovery of neurobiological mechanisms that predict and mediate lasting changes in psychotherapy, particularly in severely mentally ill patients, such as those with chronic depression. Previous studies have shown that psychoanalytic psychotherapies produce robust and enduring improvements in not only symptom severity but also personality organization in patients who have chronic depression and early life trauma, especially if therapy is delivered at a high weekly frequency. METHODS/DESIGN: Patients with chronic major depression and a history of early life trauma will be recruited, assessed, and treated across 3 international sites: Germany, Switzerland, and the United States. They will be randomized to one of two treatment arms: either (1) once weekly psychoanalytic psychotherapies, or (2) 3-4 times weekly psychoanalytic psychotherapies. They will have full clinical characterization as well as undergo MRI scanning at study baseline prior to randomization and again one year later. A group of matched healthy controls will undergo similar assessments and MRI scanning at the same time points to help discern whether study treatments induce brain changes toward or away from normal values. Primary study outcomes will include anatomical MRI, functional MRI, and Diffusion Tensor Imaging measures. Study hypotheses will be tested using the treatment-by-time interaction assessed in multiple general linear models with repeated measures analyses in an intent-to-treat analysis. DISCUSSION: MODE may allow the identification of brain-based biomarkers that may be more sensitive than traditional behavioral and clinical measures in discriminating, predicting, and mediating treatment response. These findings could help to personalize care for patients who have chronic depression patients and early life trauma, and they will provide new therapeutic targets for both psychological and biological treatments for major depressive illness.

Short-term psychoanalytic psychotherapy with depressed adolescents: Comparing in-session interactions in good and poor outcome cases.

OBJECTIVE: To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. METHOD: Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. RESULTS: The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. CONCLUSION: Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process.

Intensive and Brief Psychodynamic Psychotherapy in Severely Depressed Inpatients: A Case Study and Thematic Analysis.

Introduction: Psychotherapy added to usual hospital care is beneficial. This study reports on two contrasting cases, one responder and one nonresponder, from a randomized controlled trial on the effectiveness of intensive and brief psychodynamic psychotherapy (IBPP) for depressed inpatients, in which reduction in depressive severity was maintained for up to 1 year after completion of IBPP. We aimed to explore how the psychotherapist and patient interacted to work through the themes of focalization (described in the IBPP manual) and how their work was part of a potential process of change. Methods: This case study is part of the general framework of mixed methods in psychotherapy combining quantitative analysis of data collected in a randomized controlled trial with a qualitative case study. Results: Two general categories emerged-(1) becoming the subject of one's depression and (2) regaining a sense of support-which combine specific functions. In the first, the functions relate to interactions in line with the psychoanalytic work of mourning, which aims for an appropriation of depressive symptoms. In the second, interactions have as their functions the construction of a therapeutic space and the restoration of an epistemic trust by acknowledging the patient's melancholic state and maintaining emotional contact. Work related to regaining a sense of support was observed in both cases, whereas work related to becoming the subject of one's depression was more specific to the responder case. Discussion: These results highlight the importance of interventions that help generate a sense of support and mobilize the internal processes of symbolization, understanding, and appropriation, leading patients to develop the capacity to give meaning to their symptoms and to understand the personal psychological factors related to the depressive episode.

The Sound of Silence: Engaging the Quiet Adolescent.

Engaging the silent adolescent is a major psychotherapeutic challenge. This article presents a comprehensive approach to this problem, illustrated with clinical material. This approach emphasizes a careful diagnostic assessment, including an assessment of the patient's level of personality organization and capacities to participate in psychodynamic psychotherapy. Three approaches to the silent teenager are explored in depth: a mostly supportive approach focused on containment of maladaptive behaviors; a psychodynamic approach with supportive elements focused on demonstrating safety through humor, play, normalization, and self-disclosure while exploring the patient's automatic relationship patterns; and a psychodynamic approach using transference-focused psychotherapy for adolescents (TFP-A), aimed at effecting long-lasting changes in the patient's views of self and others and their characteristic ways of managing conflict and stress, with gradual movement from a tendency for controlling, protective silence to vulnerable, cooperative sharing.

Trajectories of change among highly challenging patients in intensive long-term psychoanalytic psychotherapy.

OBJECTIVES: This study aimed to identify and describe trajectories of change in distress among highly challenging patients who had received long and intensive psychoanalytic psychotherapy. METHODS: The longitudinal version of the K-means algorithm was applied to the outcome measures data of 74 patients treated in four public mental health centers. The patients were measured five times at 6-month intervals for three outcome measures. RESULTS: For the OQ45 and Symptom Checklist-90, one trajectory was marked by a lower initial distress level. In this trajectory, the improvement occurred in the first half of the measurements, with a plateau thereafter. A second trajectory was characterized by higher initial severity and an improvement, mainly in the second part of the measurements. For the Beck Depression Inventory, one trajectory was marked by lower initial distress. In this group, the improvement occurred throughout the entire period. The remaining patients were characterized by higher initial distress and a decreased level of distress in the last part of treatment. They began to improve only during the third year of therapy. CONCLUSION: The response to treatment is not uniform in long-term treatment for highly challenging patients. A significant number of patients require a longer period of therapy to ignite improvement.

Cost-effectiveness of long-term psychoanalytic psychotherapy for treatment-resistant depression: RCT evidence from the Tavistock Adult Depression Study (TADS).

BACKGROUND: Treatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoanalytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP + TAU. METHODS: We conducted a within-trial economic evaluation using a Bayesian framework. RESULTS: Quality-adjusted life years (QALYs) were 0.16 higher in the LTPP + TAU group compared with TAU. The direct cost of LTPP was £5500, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP + TAU group were £5000 more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was ≈£33,000/QALY; the probability that LTPP + TAU was cost-effective at a willingness to pay of £20,000/QALY was 18 %. LIMITATIONS: The sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50 % at all time points. The study was conducted at a single site, potentially reducing generalizability. CONCLUSIONS: Although LTPP + TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation.

Mapping the psychoanalytic literature on bipolar disorder: a scoping review of journal articles

Objective: To provide a review of journal articles discussing clinical cases or vignettes of psychoanalysis or psychoanalytic psychotherapy of patients affected by bipolar disorder. Methods: A thorough search of journal articles was performed in five databases to identify studies published from 1990-2021. Results: Twenty-four articles were included in this review, comprising a total of 29 case reports. The most common theoretical approach adopted by the authors was "object relations." Two main sets of clinical-theoretical considerations and recommendations emerge: the applicability of analytic treatment to patients with bipolar disorder - taking into account their analyzability and practical arrangements for conducting therapy - and theoretical speculations on the nature and development of the illness, as well as on the conceptualization of its different phases. Conclusion: Our findings reveal that there is some psychoanalytic literature providing insight into the psychological dynamics and treatment of patients with bipolar disorder. Elaboration of this literature may help improve our understanding and provide more accurate and comprehensive descriptions of the intrapsychic and interpersonal dynamics of these patients, yielding potentially valuable information for clinical and research purposes, particularly with regard to reducing interpersonal conflict, and increasing insight and engagement with lifestyle changes and other behaviors likely to promote health and stability.

Mapping the psychoanalytic literature on bipolar disorder: a scoping review of journal articles.

OBJECTIVE: To provide a review of journal articles discussing clinical cases or vignettes of psychoanalysis or psychoanalytic psychotherapy of patients affected by bipolar disorder. METHODS: A thorough search of journal articles was performed in five databases to identify studies published from 1990-2021. RESULTS: Twenty-four articles were included in this review, comprising a total of 29 case reports. The most common theoretical approach adopted by the authors was "object relations." Two main sets of clinical-theoretical considerations and recommendations emerge: the applicability of analytic treatment to patients with bipolar disorder - taking into account their analyzability and practical arrangements for conducting therapy - and theoretical speculations on the nature and development of the illness, as well as on the conceptualization of its different phases. CONCLUSION: Our findings reveal that there is some psychoanalytic literature providing insight into the psychological dynamics and treatment of patients with bipolar disorder. Elaboration of this literature may help improve our understanding and provide more accurate and comprehensive descriptions of the intrapsychic and interpersonal dynamics of these patients, yielding potentially valuable information for clinical and research purposes, particularly with regard to reducing interpersonal conflict, and increasing insight and engagement with lifestyle changes and other behaviors likely to promote health and stability.

Implementation and evaluation in low intensity intervention programs from the CONNECT perspective of mixed methods: Application in a case of an autistic child.

There has been a comprehensive development over the last few years of low intensity intervention programs that are implemented within a user context and that are made up of everyday life activities, and it has been necessary to adapt the necessary methodological channels in order to guarantee an adequate resolution pathway. The mixed method perspective offers a suitable framework, and observational methodology - in itself considered mixed method - is appropriate for studying the implementation and evaluation of low intensity intervention programs, allowing the development of the QUAL-QUAN-QUAL stages that correspond to the connect integration pathway of mixed methods. In this work it was applied to a single case, in a low intensity intervention, retrieving valuable information obtained, but systematizing it and applying quantitizing to the qualitative data that was treated quantitatively in a rigorous manner. The aim was to analyze the psychotherapist-patient interaction in psychoanalytic psychotherapy, in which we sought to identify which of the therapist's techniques stimulated actions of reciprocal social interaction in the child, and which techniques inhibited non reciprocal social interactions. The observational design was nomothetic, follow-up, and multidimensional. The patient was a 4-year-old boy with a diagnosis of severe autism spectrum disorder. We used an ad hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen's kappa using the free QSEQ5 software program. Polar coordinate analysis was carried out using the free program HOISAN 2.0. Polar coordinate analysis allows us to obtain an inter-relational map of the connections detected between focal behavior established in each case and the different categories. The results provide objective evidence - backed up by the application of polar-coordinate-based data analysis - that within a framework of psychoanalytic psychotherapy, the techniques of "verbalization" and "vocalization" significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors in a child with severe autism spectrum disorder with no language. On the other hand, direct gaze promotes the child's withdrawal. The results are of key importance as they show the therapist behaviors most useful for promoting social interaction in a child with severe autism.

LET ME GO: Depression and suicidal fantasies in children.

The paper explores the phenomenology of major depression and suicidal ideation in children, offering a brief overview of relevant findings in psychiatry, with particular reference to statistical evidence, and outlining psychoanalytic models, including Jungian as well as the post-Kleinian and Bionian vertices. Bowlby's seminal contribution to the understanding of mourning processes in relation to Freud's theory is also considered. The case of an eight-year-old boy is examined, with particular attention to a series of drawings that the patient produced over the two years of his psychoanalytic psychotherapy. The therapy was interrupted abruptly by his parents.

Cet article explore la phénoménologie de la dépression grave et de l'idéation suicidaire chez les enfants. Il offre un rapide aperçu des découvertes sur ce sujet en psychiatrie, faisant particulièrement référence aux données statistiques, et donnant les grandes lignes des modèles psychanalytiques, notamment les perspectives Jungiennes ainsi que post-Kleiniennes et Bionniennes. L'apport majeur de Bowlby pour la compréhension des processus de deuil en relation avec la théorie freudienne est également pris en compte. Le cas d'un garçon de huit ans est étudié, en s'appuyant sur une série de dessins que le patient produisit au cours de deux années de psychothérapie psychanalytique. La thérapie fut interrompue abruptement par ses parents.

El presente trabajo explora la fenomenología de la depresión mayor y la ideación suicida en niños, ofreciendo una breve reseña de las conclusiones relevantes en psiquiatría, particularmente en lo referente a evidencia estadística, y describiendo modelos psicoanalíticos, incluyendo una perspectiva Junguiana, así como post-Kleiniana y Bioniana. También se considera la contribución seminal de Bion a la comprensión de los procesos de duelo en relación con la teoría de Freud. Se explora el caso de un niño de ocho años, con particular atención a una serie de dibujos que el paciente produjo a lo largo de dos años de psicoterapia psicoanalítica. La terapia fue interrumpida abruptamente por sus padres.

Personality Disorders as a Possible Moderator of the Effects of Relational Interventions in Short-Term Psychoanalytic Psychotherapy with Depressed Adolescents.

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. BACKGROUND: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. METHODS: Depressed adolescents (N = 69), aged 16-18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including "time", "treatment group" and "number of PD criteria". RESULTS: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient-therapist relationship in the here and now. CONCLUSION: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology.

Defense-Oriented Psychoanalytic Psychotherapy as a Tailored Treatment for Boys: Neurobiological Underpinnings to Male-Specific Response Tested in Regulation-Focused Psychotherapy for Children.

This paper presents defense-oriented psychoanalytic psychotherapy as a tailored treatment for boys through a neurophysiological hypothesis. Male central nervous system development is reviewed, with a focus on the development of the emotion regulation system. The organizational effects of pre- and post-natal androgens delay central nervous system development in males relative to females, following a caudal to rostral phylogenetic framework. Ventromedial prefrontal structures mature at an earlier developmental age than dorsolateral prefrontal structures, creating less of a gender gap in the available underlying neural architecture for responsivity to targeted therapeutic intervention. The hypothesized operation of defense analysis upon ventromedial prefrontal cortical structures and corticolimbic connectivity therefore positions boys to benefit from psychotherapy equally as girls. In this study, we explored gender differences in presentation and response to a short-term, manualized defense-oriented psychoanalytic psychotherapy named regulation-focused psychotherapy for children. In a sample size of 43 school-aged children, consisting of 32 boys and 11 girls, with oppositional defiant disorder, we found no statistically significant differences in participant characteristics upon entry nor in treatment response, as measured by changes in scores on the Oppositional Defiant Disorder Rating Scale, the oppositional defiant problems subscale of the Child Behavior Checklist, the suppression and reappraisal subscales of the Emotion Regulation Questionnaire for Children and Adolescents, and the lability and negativity subscale of the Emotion Regulation Checklist. The findings were comparable with the gendered findings of preexisting studies of play therapy, where boys and girls improve equally, but not of behaviorally predominant psychotherapy, where girls appear to have superior responses. Our findings suggest that the treatment as a general play therapy, but with a focus on the implicit emotion regulation system, was successful in meeting boys' gendered treatment needs. Conclusions are drawn with implications for further study.

Una experiencia en grupo de madres y padres, paralelo al de niños / An experience in a group of mothers and fathers, parallel to that of children

En defensa de la psicoterapia psicoanalítica, hablaré sobre una experiencia grupal que duró 10 meses, fue desarrollada en la asistencia pública en salud mental y se publicó con el título Psicoterapia en grupo paralelo de madres y padres. Focalizando en la función parental. Los grupos paralelos de niños y padres unas veces ayudan a curar, otras a detener y desactivar situaciones involutivas y de deterioro, y, en general, contribuyen a crear un orden mental más estable que previene trastornos graves de la personalidad. Ofrecen a la asistencia en salud mental pública y a los profesionales considerables ventajas comparativas en cuanto a abordaje, diagnóstico y terapéutica, además de un alto valor preventivo. Compartiré algunas constataciones, ideas, preguntas y sugerencias que envuelven y enmarcan mi experiencia. (AU)

In defense of psychoanalytic psychotherapy, I will talk about a group experience which lasted 10 months, was developed in public assistance in mental health, and was published under the title Psicoterapia en grupo paralelo de madres y padres. Focalizando en la función parental. The parallel groups of children and parents sometimes help to cure, others help to stop and deactivate involutionary and deteriorating situations, and, in general, contribute to create a more stable mental order, which prevents serious personality disorders. They offer considerable comparative advantages to public mental health professionals regarding approach, diagnosis and therapy, as well as a high preventive value. I will share some observations, ideas, questions and suggestions that surround and frame my experience. (AU)

Alliance ruptures and resolutions in short-term psychoanalytic psychotherapy for adolescent depression: An empirical case study.

AbstractMost research on alliance rupture-repair processes in psychotherapy has been carried out with adults and little is known about the alliance dynamics with adolescents, especially in psychodynamic treatments.Objective: This study aimed to better understand the process of alliance rupture-resolution and its role in a good-outcome case of a depressed adolescent treated with short-term psychoanalytic-psychotherapy (STPP).Method: A longitudinal, mixed-methods empirical single-case approach was employed. Multiple sources of information (questionnaires, interviews, sessions recordings) from various perspectives (adolescent, therapist, observer) were assembled and analysed.Results: The different sources of evidence converged and showed that, despite the presence of frequent alliance ruptures, patient and therapist managed to resolve these and develop a good and collaborative relationship. Both patient and therapist regarded the evolution in their relationship as the treatment factor mainly responsible for the positive changes experienced by the adolescent. Based on both theoretical and empirical data, a preliminary model of how to explore and repair alliance ruptures in STPP is presented.Conclusion: This study illustrates one way of applying an empirical, mixed-method approach to a single case. Its finding supports the idea that the process of repairing ruptures is an important mechanism of change. Strengths, limitations, and possible implications are discussed.

Reações contratransferenciais de psicoterapeutas frente a uma paciente borderline em psicoterapia: um estudo qualitativo / Countertransferential reactions of psychotherapists towards a borderline patient in psychotherapy: a qualitative study

A contratransferência (CT) é um elemento do relacionamento terapêutico que possui valor clínico, especialmente com pacientes com personalidade borderline (PB). Este estudo, qualitativo e exploratório, visou identificar os sentimentos despertados em psicoterapeutas frente a um caso de paciente com PB, buscando compreendê-los em relação às características da paciente ou da sua narrativa, bem como explorar de que forma a CT seria idealmente manejada. Oito psicoterapeutas assistiram ao vídeo de uma sessão real com paciente com PB e, após, responderam a uma entrevista. As transcrições das entrevistas foram analisadas com o método Consensual Qualitative Research (CQR). Os dados organizaram-se em relação às facetas da CT, características da paciente que mobilizam afetos, e manejo da CT. Os resultados sugerem que pacientes com PB tendem a suscitar sentimentos intensos, vinculados a sua história e seu funcionamento em situação observacional, apontando para a viabilidade do método para o estudo empírico da CT. Resultados de estudos como esse podem ser utilizados como guia para jovens terapeutas compreenderem o mundo interno dos seus pacientes. A validação empírica de hipóteses clínicas fortalece a teorização e enriquece a prática psicanalítica.(AU)

Countertransference (CT) is an element of the therapeutic relationship that has clinical value, especially with borderline personality patients (BP). This qualitative and exploratory study aimed to identify the feelings aroused in psychotherapists in the case of a BP patient, seeking to understand them in relation to the patient's characteristics or her narrative, as well as exploring how the CT would be ideally managed. Eight psychotherapists watched the video of a real session with a BP patient and responded to an interview. The interview transcripts were analyzed using the Consensual Qualitative Research (CQR) method. The data were organized in relation to the facets of the CT, characteristics of the patient that mobilize affections, and management of the CT. The results suggest that patients with BP tend to elicit intense feelings, linked to their history and functioning, in an observational situation, pointing to the feasibility of the method for the empirical study of CT. Results from studies like this one can be used as a guide for young therapists to understand the inner world of their patients. Empirical validation of clinical hypotheses strengthens theorization and enriches psychoanalytic practice.(AU)

La contratransferencia (CT) es un elemento de la relación terapéutica que tiene valor clínico, especialmente en pacientes con personalidad límite (BP). Este estudio cualitativo y exploratorio tuvo como objetivo identificar los sentimientos que despiertan los psicoterapeutas en el caso de un paciente con BP, buscando comprenderlos en relación con las características de la paciente o su narrativa, así como explorar cómo se manejaría idealmente la CT. Ocho psicoterapeutas vieron el video de una sesión real y luego respondieron a una entrevista. Las transcripciones de las entrevistas se analizaron utilizando el método de Investigación Cualitativa Consensual (CQR). Los datos se organizaron en relación a las facetas del CT, características del paciente que movilizan afectos y manejo de la CT. Los resultados sugieren que los pacientes con BP tienden a provocar sentimientos intensos, ligados a su historia y funcionamiento, en una situación de observación, lo que apunta a la viabilidad del método para el estudio empírico de la CT. Los resultados de estudios como este pueden usarse como una guía para que los terapeutas jóvenes comprendan el mundo interior de sus pacientes. La validación empírica de hipótesis clínicas fortalece la teorización y enriquece la práctica psicoanalítica.(AU)

Chasing infinity: Why clinical psychoanalysis' future lies in pluralism.

Part of an ongoing political and scholarly effort to move the psychoanalytic project towards greater cohesiveness, the author proposes a standard method, borrowing the phrase from physics, for a structured, eclectic clinical pluralism. She [or he] uses psychoanalytic and philosophical arguments, as well as considerations of patients' personal idiosyncrasies, to conclude that achieving one, over-arching metapsychology will prove impossible. In other words, and despite their ardent efforts, psychoanalytic theorists, including Freud (1895/1991), Rangell (1975, 2006), Greenberg and Mitchell (1983), Wallerstein (1988, 1990, 2002, 2005, 2013), and others, failed to create models accounting for the dynamically interacting variables creating human subjectivity. Their struggles to bridge psychoanalytic theories of mind and method also fell short. As a result, the author suggests, clinical psychoanalysis' ultimate fate lies in organizing what Wallerstein (2005) called the "common ground" (p. 626) into methodology which invites psychoanalytic practitioners to mine the psychoanalytic opus for its "plethora of theoretical metaphors" (Wallerstein, 2013, p. 36), "controlling fictions" (Greenberg, 2015, p. 17), "useful untruths" (Lament,020, p. 196), or "regional dialects" (Fulgencio, 2020, p. 15). Cohesively applying a pluralistically based metapsychology to guide clinical processes, rather than provide maps of the mind, offers much-needed unity to psychoanalysis' applied wing.