Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 632
Filtrar
1.
Adv Exp Med Biol ; 1191: 451-464, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002941

RESUMO

Psychodynamic theory is founded on the idea that much, if not most, of human behavior is influenced by forces and experiences that lie outside of conscious awareness. It posits that despite what we may or may not recognize about our lived experience, an essential connection exists between unconscious processes and everyday psychological functioning. By extension, psychodynamic theory presumes that unconscious conflicts are pathognomonic of anxiety disorders and anxiety symptoms more generally. At the same time, the term "psychodynamic" refers not only to that which occurs within one's mind but also what happens between people and within families, groups, and systems. A comprehensive psychodynamic treatment of anxiety attempts to take into account these multiple domains of experience and functioning (including biological and genetic considerations) and applies a specific therapeutic approach to working with patients based in part on clinical techniques first developed by Sigmund Freud 100 years ago.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Ansiedade/psicologia , Ansiedade/terapia , Psicoterapia Psicodinâmica , Conscientização , Humanos
2.
Adv Exp Med Biol ; 1180: 233-265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31784967

RESUMO

Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.


Assuntos
Transtorno Depressivo/terapia , Psicoterapia/métodos , Antidepressivos , Terapia Cognitivo-Comportamental , Humanos , Resolução de Problemas , Psicoterapia Psicodinâmica
3.
Trends Psychiatry Psychother ; 41(2): 128-135, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291411

RESUMO

OBJECTIVE: This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. METHODS: The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson's correlation). Through a principal component exploratory factor analysis, four ISs were identified. RESULT: The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. CONCLUSION: Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.


Assuntos
Fibromialgia/psicologia , Lúpus Eritematoso Sistêmico/psicologia , Relações Profissional-Paciente , Psicoterapia Psicodinâmica , Aliança Terapêutica , Idoso , Emoções , Feminino , Humanos
4.
Trends Psychiatry Psychother ; 41(2): 201-210, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291412

RESUMO

INTRODUCTION: The Operationalized Psychodynamic Diagnosis (OPD-2) is an operational multiaxial diagnostic assessment and treatment planning tool. This systematic review sought to analyze empirical studies that used the OPD as an instrument. In addition to identifying the studies, we analyzed the topics covered and the results of research that used the OPD empirically. METHOD: Articles, dissertations and empirical theses that mentioned or used the OPD instrument in the last five years (2012-2017) were included in this review. The strategy included searching with combinations of the descriptors "Operationalized and psychodynamic and diagnosis" from the Portal de Periódicos CAPES on the PubMed, Google Scholar, and ResearchGate databases for work published in English, Portuguese or Spanish in the last five years. RESULTS: The search returned a total of 189 papers, but only 20 were included. The studies selected discussed the validity and reliability of the instrument, the therapeutic process and analysis of outcomes, assessment of different mental disorders, and also included studies comparing different instruments and techniques. Considerable scientific effort has evidently been dedicated to accumulating more consistent data on psychodynamic diagnosis. CONCLUSION: It was demonstrated that the OPD is an essential clinical tool for dimensional comprehension of the subject and for scientific research. However, the number of publications on the subject is not yet significant and the methods employed are diverse. Nevertheless, there is a growing body of data on topics such as applicability in different contexts and to different pathologies, promoting greater visibility and with greater representativeness of professionals who have experience with the instrument.


Assuntos
Transtornos Mentais/diagnóstico , Psicoterapia Psicodinâmica , Humanos
5.
Trends Psychiatry Psychother ; 41(2): 149-158, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31314856

RESUMO

INTRODUCTION: This study developed Brazilian psychodynamic psychotherapy (PDT) and cognitive-behavioral therapy (CBT) prototypes for children with internalizing disorders (ID) and externalizing disorders (ED). METHOD: Eighteen Brazilian experts in PDT (n = 9) and CBT (n = 9) rated the 100 items of the Child Psychotherapy Q-Set (CPQ) describing a hypothetical typical session based on their respective theoretical backgrounds for children with ID. They then rated the same items describing a hypothetical typical session for children with ED. A Q-type factor analysis with varimax rotation was performed. RESULTS: Expert correlations were high within each theoretical approach and each diagnostic category. The factor analysis identified three independent factors. CBT ratings concentrated on one factor, while PDT ratings loaded onto one factor describing treatment of children with ID and another factor describing treatment of children with ED. CONCLUSION: The sole CBT prototype reflected a general conceptualization of this approach and was undifferentiated regarding treatment of children with ID and ED. The PDT prototype for children with ID provided evidence of a process focused on interpretation, while the PDT prototype for children with ED characterized a supportive process with attention to the therapeutic relationship. This infers greater variation in the PDT setting for children with different conditions.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia , Psicoterapia Psicodinâmica/métodos , Adolescente , Brasil , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia
6.
Medicina (Kaunas) ; 55(6)2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31238582

RESUMO

Psychotherapy with suicidal patients is inherently challenging. Psychodynamic psychotherapy focuses attention on the patient's internal experience through the creation of a therapeutic space for an open-ended exploration of thoughts, fears, and fantasies as they emerge through interactive dialogue with an empathic therapist. The Boston Suicide Study Group (M.S., M.J.G., E.R., B.H.), has developed an integrative psychodynamic approach to psychotherapy with suicidal patients based on the authors' extensive clinical work with suicidal patients (over 100 years combined). It is fundamentally psychodynamic in nature, with an emphasis on the therapeutic alliance, unconscious and implicit relational processes, and the power of the therapeutic relationship to facilitate change in a long-term exploratory treatment. It is also integrative, however, drawing extensively on ideas and techniques described in Dialectical Behavioral Therapy (DBT), Mentalization Based Treatment (MBT), Cognitive-Behavioral Therapy (CBT), as well on developmental and social psychology research. This is not meant to be a comprehensive review of psychodynamic treatment of suicidal patients, but rather a description of an integrative approach that synthesizes clinical experience and relevant theoretical contributions from the literature that support the authors' reasoning. There are ten key aspects of this integrative psychodynamic treatment: 1. Approach to the patient in crisis; 2, instilling hope; 3. a focus on the patient's internal affective experience; 4. attention to conscious and unconscious beliefs and fantasies; 5. improving affect tolerance; 6. development of narrative identity and modification of "relational scripts"; 7. facilitation of the emergence of the patient's genuine capacities; 8. improving a sense of continuity and coherence; 9 attention to the therapeutic alliance; 10. attention to countertransference. The elements of treatment are overlapping and not meant to be sequential, but each is discussed separately as an essential aspect of the psychotherapeutic work. This integrative psychodynamic approach is a useful method for suicide prevention as it helps to instill hope, provides relational contact and engages the suicidal patient in a process that leads to positive internal change. The benefits of the psychotherapy go beyond crisis intervention, and include the potential for improved affect tolerance, more fulfilling relational experiences, emergence of previously warded off experience of genuine capacities, and a positive change in narrative identity.


Assuntos
Psicoterapia Psicodinâmica/normas , Ideação Suicida , Adulto , Boston , Feminino , Humanos , Masculino , Psicoterapia Psicodinâmica/métodos , Psicoterapia Psicodinâmica/estatística & dados numéricos , Suicídio/prevenção & controle , Suicídio/psicologia
7.
J Consult Clin Psychol ; 87(8): 745-755, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31204838

RESUMO

OBJECTIVE: Our goal was to evaluate treatment attendance patterns, including both treatment completion and premature termination from treatment, for 2 evidence-based psychotherapies for major depressive disorder (MDD) delivered in a community mental health setting. We explored rates of premature termination across the course of treatment as well as the factors that predicted and moderated premature termination and treatment completion. METHOD: This investigation included 237 patients with MDD who participated in a noninferiority trial comparing short-term dynamic psychotherapy (DT) to cognitive therapy (CT). Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. All patients completed an extensive self-report battery at treatment baseline as well as measures of the therapeutic alliance and opinions about treatment following Session 2. RESULTS: Premature termination from both treatments was high with 27% of patients discontinuing treatment very early after only an intake session or a single treatment session. Patients in CT were significantly more likely to terminate treatment prematurely, χ²(3) = 14.35, p = .002. Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services. Trauma history significantly moderated very early termination of treatment, χ²(3) = 10.26, p = .017, with patients with high trauma histories more likely to complete DT but terminate prematurely from CT. CONCLUSIONS: Very early termination from services was higher in CT compared with DT. Including techniques to improve engagement in both therapies and matching patients to treatment based on predictors/moderators may be effective ways to optimize treatment engagement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior/terapia , Saúde Mental , Participação do Paciente , Psicoterapia Psicodinâmica , Serviços Comunitários de Saúde Mental , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Aliança Terapêutica
8.
Trends Psychiatry Psychother ; 41(2): 112-120, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31166563

RESUMO

INTRODUCTION: Different instruments and methods for measuring factors related to the progress and effectiveness of psychodynamic psychotherapy (PDT) have been widely discussed in the literature. However, there are no established guidelines on the most appropriate time to perform these measurements. OBJECTIVES: The aim of this study is to problematize what is the appropriate time to measure the initial outcomes (symptoms, interpersonal relationships, quality, and social role) and process factors (alliance) in the early stages of PDT. METHODS: A naturalistic cohort study was conducted, following 304 patients during the first six months of psychotherapy. The therapeutic alliance was evaluated after four sessions; symptoms, interpersonal relationships, and social role were evaluated at intake and after 12 and 24 sessions. RESULTS: Our results indicate that four sessions were sufficient to measure the bond dimension of the therapeutic alliance, while more time is probably needed to adequately measure other aspects of the therapeutic alliance, such as tasks and goals. However, 12 sessions of treatment proved sufficient to detect improvements in all dimensions of the outcome instruments with moderate effect sizes, and those gains were stable at the 24th session. CONCLUSION: According to our findings, 12 sessions seem to be sufficient to assess initial gains in PDT, although more studies are needed to evaluate the appropriate time to assess all aspects of the therapeutic alliance. Further studies are also required to evaluate the appropriate time to assess intermediate and long-term progress with regard to symptoms, interpersonal relations, social role and personality reorganization.


Assuntos
Transtornos Mentais/terapia , Psicoterapia Psicodinâmica , Aliança Terapêutica , Adulto , Feminino , Humanos , Relações Interpessoais , Estudos Longitudinais , Masculino , Transtornos Mentais/psicologia , Personalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Z Psychosom Med Psychother ; 65(2): 198, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31154929

RESUMO

Long-term effectiveness of psychodynamic inpatient therapy on depressive disorders - Catamnestic- Results of the STOP-D-Study Objectives: Depression is one of the most common disorders with a rate of recurrence between 60-75 %. The effectiveness of psychodynamic therapy is well-proven, but there is still a lack of studies proving the long-term effectiveness of inpatient treatment on depressive symptom load. Methods: After psychodynamic inpatient treatment in a psychodynamically oriented psychosomatic hospital unit, the reduction in general and depressive symptom load (e. g. BDI, HAMD, SCL-90-R) was evaluated by a six-month follow up design. The study was set up as naturalistic multicenter intervention study including a female follow-up sample (N = 291; age 25-45 years). Results: The symptom improvement reached by the inpatient treatment remained stable at the follow-up survey. Patients treated with antidepressant medication showed stronger depressive symptom load at discharge and follow-up survey compared to patients without antidepressant medication. Sociodemographic variables and a comorbid personality disorder were not associated with increased drop-out rates, but depressive symptom load and a premature ending of the treatment. Conclusions: The obtained results demonstrate the long-term effectiveness of inpatient psychodynamic psychotherapy. Further studies about the influence of post-hospital psychotherapy and medical treatment as well as patient satisfaction seem necessary.


Assuntos
Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Pacientes Internados/psicologia , Psicoterapia Psicodinâmica , Adulto , Depressão/complicações , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/complicações , Fatores de Tempo , Resultado do Tratamento
10.
Z Psychosom Med Psychother ; 65(2): 144-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154930

RESUMO

Objectives: Integrating a stronger focus on patients' existing strengths in traditional psychotherapy approaches is suggested by recent developments in psychological science, positive psychology, and psychotherapy research. However, the empirical status of treatments focusing on patients' existing strengths is unclear. The aim of this study was to conduct a systematic review (PROSPERO registration CRD42017054362) of studies on adaptations of traditional treatment approaches (e. g., cognitive-behavior therapy or psychodynamic therapy) explicitly focused on using patients' existing resources and strengths (hereafter, resource-focused treatments; RFT). Methods: Extensive systematic literature search yielded k = 11 treatment comparisons from 10 studies contrasting RFTs with either an alternative psychotherapeutic approach or wait list. Effect sizes controlling for pre-treatment differences (gPPWC) and standard Hedges's g effect sizes (gPOWC) were aggregated with random-effects methods Results: Across 8 direct comparisons, RFTs were superior to other psychotherapeutic approaches, as indicated by small to moderate (gPPWC = -0.349, 95 % CI -0.576, -0.122, p = .003, I2 = 46.50 %) and small effect sizes (gPOWC = -0.190, 95 % CI -0.355, -0.025, p = .024, I2 = 0.00 %) in favor of RFTs. Sensitivity analyses corroborated results. Many included studies were characterized by limited sample size, risk of bias or researcher allegiance. Conclusions: This meta-analysis showed preliminary evidence for the benefits of RFTs and suggests an intensification of further research efforts. The evidence was most convincing for hypnotherapeutic-systemic interventions as an add-on for cognitive-behavioral therapy.


Assuntos
Pesquisa Comportamental/tendências , Terapia Cognitivo-Comportamental , Pacientes/psicologia , Psicoterapia Psicodinâmica , Adaptação Psicológica , Humanos
11.
Psychiatr Danub ; 31(Suppl 2): 185-189, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158120

RESUMO

BACKGROUND: The experience gained in working with psychotic persons as well as the findings from the literature have pointed to the need for systematic inclusion of the families of affected individuals, facilitating the creation of partnership within treatment, and to the need for a better understanding of family dynamics that reflects on the psychological conditions of the patients. AIM: The aim of this paper is to explore the changes in self-esteem and loneliness of group members during the therapeutic process and whether the use of more mature defence mechanisms is the answer to the treatment of group psychotherapy. SUBJECTS AND METHODS: We followed three groups of 30 members (18 women and 12 men). At the beginning of inclusion in group psychodynamic psychotherapy and after 18 months of psychotherapy, members completed the following questionnaires: Rosenberg Self-esteem Scale, short version of UCLA Loneliness Scale (ULS-7) and Lifestyle Questionnaire (LSI). RESULTS: The research results show a statistically significant increase in self-esteem, a significant reduction in loneliness, and significantly reduced use of defence mechanisms after 18 months of group psychotherapy. CONCLUSION: Research findings confirmed positive changes in family members who gradually feel better and safer, with less anxiety and fear, all positively reflecting on the family atmosphere, the ability to accept and understand the sick member, as well as his better quality of recovery.


Assuntos
Psicoterapia de Grupo , Psicoterapia Psicodinâmica , Transtornos Psicóticos , Transtornos de Ansiedade , Família , Feminino , Humanos , Masculino , Transtornos Psicóticos/terapia
12.
Psychodyn Psychiatry ; 47(2): 183-196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31107165

RESUMO

OBJECTIVE: Patients with mental disorders do not only show specific symptoms but also impairments in personality functioning, especially those with personality disorders. Recent developments in DSM-5 and ICD-11 suggest a dimensional approach to personality disorders. Few studies, however, have examined changes in personality functioning. METHODS: In a large sample of 2,596 patients treated by inpatient psychodynamic therapy, changes in personality functioning were studied. Two patient groups were examined, one with (N = 1152, BPO) and one without a presumptive diagnosis of a borderline personality organization (N = 1444, NBPO). For the assessment of personality functioning, the Borderline-Personality Inventory (BPI) was used. The BPI taps personality functioning as defined by Kernberg's structural criteria of personality organization. Symptom distress and interpersonal problems were examined with the Symptom Checklist SCL-90-R and the Inventory of Interpersonal Problems (IIP). Patients were assessed at admission and discharge. RESULTS: In the BPO sample significant and substantial pre-post effect sizes in overall personality functioning, identity integration, and defense mechanisms/object relations were found (d = 0.68, 0.60, 0.78). In addition, large improvements in symptoms (SCL-90-R) were achieved (d = 0.97). For interpersonal problems effect sizes were medium (0.56). At discharge 36% of the BPO patients scored below the BPI-Cut-Off score for a BPO (remission). Pre-post effect sizes in the NPBO sample (N = 1444) were significant but small for changes in personality functioning (d = 0.31-0.46) and substantial for improvements in symptoms (d = 0.77). CONCLUSIONS: Both personality functioning and symptom distress can be substantially improved by inpatient psychodynamic therapy. Future research is recommended to study both improvements in symptoms and personality functioning.


Assuntos
Personalidade/fisiologia , Psicoterapia Psicodinâmica , Adulto , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Inventário de Personalidade , Resultado do Tratamento , Adulto Jovem
14.
Psychodyn Psychiatry ; 47(2): 167-182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31107168

RESUMO

Chronic physical pain is prevalent condition and has gained considerable attention in the wake of the opioid crisis and epidemic. As a medical phenomenon, it has highlighted significant gaps in healthcare training, finances, clinical service, and administration. The psychodynamic determinants of pain symptoms or the need for analgesia are rarely considered in the medical management of this problem. The specific objective of this article is to offer a general psychodynamic understanding of chronic physical pain. As a psychodynamically oriented, medically informed psychiatrist practicing in a multidisciplinary pain management program, I propose a clinical construct of psychologically rich "parallel pains" to chronic physical pain, and that these pains inform important interpersonal issues dubbed "dynamic dilemmas." Chronic physical pain is defined, clinical examples are provided, and general implications are considered.


Assuntos
Dor Crônica/terapia , Manejo da Dor/psicologia , Psicoterapia Psicodinâmica , Dor Crônica/psicologia , Humanos
15.
J Consult Clin Psychol ; 87(7): 603-616, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31070387

RESUMO

OBJECTIVE: This study investigated therapeutic alliance (TA) trajectories, their demographic and symptomatic predictors, and associations with outcome in psychodynamic child psychotherapy. METHOD: The sample included 89 Turkish children (Mage = 6.87, SD = 2.11, 46% girls) with internalizing (37.11%), externalizing (21.14%), and comorbid (38.20%) problems; 12% of the children were in the nonclinical range. Independent raters coded 328 sessions from different phases of treatment using the Therapy Process Observational Coding System-Alliance Scale. Outcome measures were collected at intake and termination (Children's Behavior Checklist and Teacher Rating Form). RESULTS: Multilevel growth curve modeling indicated that TA showed a quadratic trend (high-low-high) over the course of treatment. The shape-of-change methodology indicated three subgroups following a stable pattern, a slow and an accelerated quadratic TA trajectory. Externalizing problems (teacher report) negatively predicted average TA strength. Boys and children with internalizing problems showed a declining TA trajectory, whereas children with externalizing problems (teacher report) showed an upward TA trajectory. Multivariate multiple regression analyses showed that the average TA (i.e., intercept) and the positive quadratic slope (the high-low-high pattern) positively predicted changes in internalizing and externalizing problems (teacher report). DISCUSSION: This study was the first to show the course of TA development in psychodynamic child psychotherapy, identify a number of child characteristics that facilitate and impede TA. Investigating both the strength and patterns of TA development when examining associations with outcome is important. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos do Comportamento Infantil/terapia , Psicoterapia Psicodinâmica , Aliança Terapêutica , Criança , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Humanos , Masculino
16.
Z Kinder Jugendpsychiatr Psychother ; 47(5): 412-425, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31012796

RESUMO

Changes in the scales "attachment" and "control" of the OPD-KJ "structure" axis for inpatients of a pediatric and adolescent psychiatric clinic Abstract. Abstracts: Despite the great importance of structural deficits in adolescent patients, studies on changes that occur in the course of their inpatient psychiatric treatment are lacking. This study assesses the effectiveness of inpatient psychodynamic psychotherapy, the scales "attachment" and "control" of the "structure" axis of Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-KJ). The study was carried out by dual case leaders (psychotherapist and pedagogue/nurse) on 75 patients (12-18 years) at the beginning and at end of 8 weeks of therapy. Correlations between the dimensions were investigated Pearson's r. Subsequently, we analyzed the four subdimensions of control and attachment using analyses of variance with repeated measurement (RM-ANOVA) to determine whether and to what extent these different subdimensions changed over time. Finally, we performed analyses of variance with age, sex, and diagnosis as between-person factors to assess their influence on the trajectories of both dimensions. Results show that both the attachment and the control dimension of OPD-CA improved in the course of the adolescents' treatment. This finding, however, was diagnosis-specific: Only adolescents with affective disorders and phobias showed these improvements, whereas no change was found for adolescents with emotional and behavioral disorders beginning in childhood and adolescence. Implications for research and clinical practice are discussed.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Adolescente , Criança , Humanos , Transtornos Mentais/terapia , Psicometria , Psicoterapia Psicodinâmica , Reprodutibilidade dos Testes
17.
Clin Psychol Psychother ; 26(4): 502-509, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31018254

RESUMO

The current study seeks to explore the relationship between patient-reported interpersonal problems and therapist interventions in early psychodynamic psychotherapy for 71 outpatients. Pretreatment ratings on the Inventory of Interpersonal Problems Circumplex Scales (IIP-C) total and subscale scores were examined in relation to early treatment process. Independent clinicians reliably rated therapist use of psychodynamic-interpersonal (PI) and cognitive-behavioural (CB) interventions using the Comparative Psychotherapy Process Scale (CPPS) over two early treatment sessions (third and ninth). Intraclass correlation (ICC) values were in the excellent range for CPPS-PI and CPPS-CB scale scores (CPPS-PI = 0.86; CPPS-CB = 0.78). A significant positive correlation was found between interpersonal problems and global PI therapist technique. A significant positive correlation was also found between interpersonal problems and specific PI interventions, most significantly experience and expression of feelings in session. In specific interpersonal problem subscales, most significant was that Cold/Distant and Socially Inhibited octants positively related to global PI and to specific PI techniques, including exploration of uncomfortable feelings. Multiple regression analyses revealed most significantly that CPPS Intervention 7 (discussion of patient-therapist relationship; positive) and CPPS Intervention 11 (therapist explanation of rationale behind treatment; negative) explained 15.6% of variance in interpersonal problem score. These findings demonstrate that the use of psychodynamic techniques tend to occur alongside patient-reported interpersonal problems early in psychotherapy treatment. Clinical implications are discussed for this area of research, and future directions are explored.


Assuntos
Relações Interpessoais , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Relações Profissional-Paciente , Psicoterapia Psicodinâmica/métodos , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento
18.
Acad Psychiatry ; 43(4): 417-424, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30997655

RESUMO

OBJECTIVE: This paper sought to compile an annotated bibliography for the outpatient year of adult psychiatry residents, providing resources for a foundation in psychodynamic theory which can be utilized in supervision to aid in ongoing psychotherapeutic work. METHODS: In selecting the readings, the ACGME Milestones sub-competencies considered were (i) empathy and process, (ii) boundaries, (iii) alliance and provision of psychotherapies, (iv) seeking and providing supervision, and (v) knowledge of psychotherapy (theories, practice, and evidence base). Once the readings were selected, two authors independently reviewed the articles to determine which key sub-competencies each article addressed. Chance corrected agreement between the reviewers was assessed using the Cohen kappa statistic. The kappa for interrater agreement was 0.83. RESULTS: A list of 32 readings was compiled sequentially, allowing for theoretical concepts to be progressively built upon. The content of the papers aligned well with multiple sub-competencies in the medical knowledge (MK) and patient care (PC) domains. The bibliography allows for close examination of therapeutic frame; active listening and reflecting on the meaning of the therapist's interventions; transference and the use of countertransference as a diagnostic/therapeutic tool; defense mechanisms; patient pressures towards reenactment; theoretical viewpoints on therapeutic action (e.g., ego psychology, self-psychology, relational therapy, object relations, classical/modern Kleinian); and meaning of lateness, treatment breaks, and termination. CONCLUSIONS: This list serves as an ancillary resource which can augment discussions in therapy supervision, while also aiding in standardizing the minimal knowledge base achieved in psychodynamic theory.


Assuntos
Internato e Residência , Psiquiatria/educação , Psicoterapia Psicodinâmica/educação , Humanos
19.
Trends Psychiatry Psychother ; 41(1): 43-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994785

RESUMO

INTRODUCTION: Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. OBJECTIVE: To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. METHODS: In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. RESULTS: The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. CONCLUSION: Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.


Assuntos
Sintomas Afetivos/terapia , Transtornos de Ansiedade/terapia , Mecanismos de Defesa , Transtorno Depressivo/terapia , Apego ao Objeto , Psicoterapia Psicodinâmica/métodos , Adulto , Sintomas Afetivos/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo/fisiopatologia , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
20.
Psychotherapy (Chic) ; 56(1): 28-34, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30816760

RESUMO

Brief psychodynamic psychotherapy (BPP) begins with an assessment to gauge client appropriateness for treatment, generate treatment goals, and build a dynamic focus. During this assessment, other goals must also be achieved for treatment to have a successful start. Building a strong alliance, empathizing and bonding with the client, and clarifying the client's understanding of key therapeutic activities are all common factors known to improve treatment course and outcome. Although these goals are desirable across treatment approaches, clinicians typically pursue them in a manner aligned with their treatment orientation. Ideally, common factor goals are achieved alongside treatment-specific aims. In BPP, therapists strive to help clients develop insight, improve self-understanding, and enhance relational functioning. This article argues that exploration of relationship episodes, using techniques from the core conflictual relationship theme method during the assessment phase of BPP is an efficient way to simultaneously pursue common factor goals and BPP-specific aims. Specifically, exploring relationship episodes aids in the selection of treatment goals, bolsters the therapeutic alliance, and helps clarify the value of therapeutic endeavors, while also promoting greater insight and self-understanding. Exchanges from clinical cases are provided to demonstrate each of these points. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Metas , Transtornos Mentais/terapia , Relações Profissional-Paciente , Psicoterapia Psicodinâmica/métodos , Adulto , Feminino , Humanos , Transtornos Mentais/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA