The journal of the American Academy of Psychoanalysis and Dynamic Psychiatry
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J Am Acad Psychoanal Dyn Psychiatry · Jan 2006
Case ReportsPsychodynamic psychotherapy: a core conceptual model and its application.
Contemporary American psychiatry, influenced by the "biologic revolution" with its emphasis on a brain-disease model of mental illness, and operating in a managed care delivery system, is in danger of relinquishing its listening and talking functions--psychotherapy--in favor of prescribing drugs. However, despite remarkable advances in the neurosciences, there is still no pharmaceutical magic bullet. ⋯ This core conceptual model has significant heuristic value in treating patients and in teaching psychotherapy to psychiatric residents. With its emphasis on the power of the doctor-patient relationship, it teaches residents an effective body of knowledge that helps them define their professional identity-as psychiatrists whose most effective therapeutic tool is themselves, not the drugs they dispense.
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J Am Acad Psychoanal Dyn Psychiatry · Jan 2004
ReviewIntegrating psychoanalysis and psychopharmacology: a review of the literature of combined treatment for affective disorders.
Affective distress has been a double-edged sword in psychoanalytic treatment. Motivation for treatment develops when emotional discomfort reaches a threshold of intolerable pain. When distress rises above a certain limit, the patient becomes flooded and overwhelmed by affects that severely compromise his/her capability of utilizing psychoanalytic treatment. ⋯ The efficacy of combining pharmacotherapy and psychoanalytic therapy is more firmly validated by recent studies. The focus shifts now toward the indications, and contraindications, for integrated treatment. An essential issue remaining is whether, and when, the treating analyst should be the prescribing analyst.
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Chronic mental illness results in the patient becoming adhered to a DSM-IV diagnostic label. Over time, this diagnosis can expand and become a "mask" that invisibly covers over the true person of the patient. Most commonly, two things then occur. ⋯ A focus on affect can help achieve these dual goals. By utilizing Semrad's (Semrad and van Buskirk, 1969) method of noticing and asking about "feelings" as conveyed by hallucinations, delusions, or bodily sensations, a reliable relationship can evolve and the clinician can come to have an important "selfobject" (Kohut, 1971) meaning for the patient. By attuning to the patient's "vitality" affects (Stern, 1985), great stability and a new sense of "aliveness" is made possible to help the patient emerge from the deadening effects of the illness and the mask of the diagnosis.