Investigating the network ties between affect, attachment, and psychopathology

OBJECTIVES

Recent years have seen an increased interest regarding theoretical and empirical associations of adult attachment security and primary affective traits concerning psychiatric disorders. In this study, network analysis technique is applied to dissect the links between both psychodynamic personality constructs and an array of psychopathological symptoms.

METHODS

A total sample of 921 (69.9 % female) participants from the general population was investigated. A regularized cross-sectional partial correlation network between attachment (Experiences in Close Relationships-Revised [ECR-RD8]), primary affective traits (Brief Affective Neuroscience Personality Scales [BANPS-GL]) and psychopathological symptoms (ICD-10-Symptom-Rating Questionnaire [ISR]) was estimated via the EBICglasso algorithm. Node centrality, predictability and bridge centrality were analyzed. To evaluate the stability of the network and evaluate the significance of differences, we employed bootstrap techniques.

RESULTS

The network was found to be stable, allowing reliable interpretations. We observed SADNESS, as well as depressive, PTSD and anxiety symptoms as the most influential nodes within the investigated network. Attachment AV and SADNESS were observed as nodes with the highest bridge centrality.

CONCLUSIONS

The results provide a data-driven in-depth look into the complex dynamics between psychopathological symptoms, attachment security and basic affective traits. Results underscore the critical interconnections between affect, attachment, and psychopathology, advocating for a psychodynamically informed systems approach in psychological research that considers the affective dimensions underlying human mental health.

Examining the Basic Assumption of Psychoanalytic Theory Regarding Normal and Abnormal Grief: Roles of Unfinished Businesses and Bereavement Related Guilt

To date, several theoretical models have been proposed to explain how the expected and natural grief processes turns into psychiatric disorders. Nevertheless, there is a paucity of empirical research examining the basic assumption of psychoanalytic theory regarding pre-death conflict and bereavement related guilt. Accordingly, the current study aimed to investigate the mediator role of bereavement related guilt in the relationship between the pre-death conflict and maladaptive grief process. The sample consisted of 447 bereaved adults who lost a loved one due to death in the last 5 years. The Unfinished Business in Bereavement (UBBS), Bereavement Guilt Scale (BGS), Beck Depression Inventory (BDI), and Prolonged Grief Disorder Scale (PG-13) scales were administered. The results indicated that the UBBS scores were positively correlated with both BDI and PG-13 scores, and BGS scores mediated these relationships. Obtained findings were discussed in relation to psychoanalytic theory and existing studies in the grief literature.

A systematic review and meta-ethnography of client and therapist perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences

This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; 'Working on the edge' and 'Being ready, willing, and able to build an alliance in the context of suicidal experiences'. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety.

Influence of personality disorders on sexual behaviours and response to treatment of psychogenic erectile dysfunction in phosphodiesterase 5 inhibitor non-responders

Background

Personality disorders may influence sexual behaviours and sexual dysfunction.

Aim

Our main objective was to analyse the influence of personality disorders (PDs) in patients with erectile dysfunction (ED) of psychological origin that fail to respond to andrological treatment with Phosphodiesterase-5 inhibitors (IPDE5), assessing whether there are differences in sexual behaviours and response to psychosexual treatment.

Methods

The research is designed as an ex post facto retrospective study with two groups. A control group of 23 men with ED without personality disorders and a group of 51 men with both ED and PDs.

Results

In the case sample, 34.30% of the participants presented more than one personality disorder. No significant differences were found in sexual behaviours except for heteromasturbation (men without PDs masturbated their partners more to satisfy them than men with PDs), and men with PDs considered themselves less premature ejaculators than the control group. Finally, 82.14% of the control group did well with psychosexual therapy compared to 53.85% of the PDs group.

Conclusion

Psychosexual treatment of ED has a worse outcome if the men also have PDs. Strengths and Limitations: from a clinical standpoint, it is important to assess the presence of personality disorders in men with ED and to implement psychosexual strategies to improve the response to treatment in these cases. Confirmation of the results with a much larger sample becomes necessary.

Understanding and Combating Misinformation: An Evolutionary Perspective

UNSTRUCTURED

Misinformation represents an evolutionary paradox: despite its harmful impact on society, it persists and evolves, thriving in the information-rich environment of the digital age. This paradox challenges the conventional expectation that detrimental entities should diminish over time. The persistence of misinformation, despite advancements in fact-checking and verification tools, suggests that it possesses adaptive qualities that enable it to survive and propagate. This paper explores how misinformation, as a blend of truth and fiction, continues to resonate with audiences. The role of narratives in human history, particularly in the evolution of Homo narrans, underscores the enduring influence of storytelling on cultural and social cohesion. Despite the increasing ability of individuals to verify the accuracy of sources, misinformation remains a significant challenge, often spreading rapidly through digital platforms. Current behavioral research tends to treat misinformation as completely irrrational, static, finite entities that can be definitively debunked, overlooking their dynamic and evolving nature. This approach limits our understanding of the behavioral and societal factors driving the transformation of misinformation over time. The persistence of misinformation can be attributed to several factors, including its role in fostering social cohesion, its perceived short-term benefits, and its use in strategic deception. Techniques such as extrapolation, intrapolation, deformation, cherry-picking, and fabrication contribute to the production and spread of misinformation. Understanding these processes and the evolutionary advantages they confer is crucial for developing effective strategies to counter misinformation. By promoting transparency, critical thinking, and accurate information, society can begin to address the root causes of misinformation and create a more resilient information environment.

Fragebogen zur Empirischen Untersuchung von Abwehrmechanismen (FEUA)

Questionnaire for the Empirical Investigation of Defense Mechanisms...

Sub-Optimal Compliance to Long-Term Inhalation Strategies and Poorer Health Care Outcomes Associated with Extended Tattoos in Adolescents with Mild-to-Moderate Bronchial Asthma

BACKGROUND

Patients' compliance to inhalation therapy is usually sub-optimal in young asthmatics. Adolescents poorly compliant to regular anti-asthma treatments and those with tattoos (and the associated attitude) can share some personality traits and maladaptive behaviors. This relationship has not been investigated.

OBJECTIVE

To assess if "extended" tattoos can predict long-term compliance to regular therapy of adolescents with mild-to-moderate asthma.

METHODS

A 12-month retrospective observational investigation was conducted on non-smoker asthmatic adolescents of both genders. Patients assuming <70% of prescribed vilanterol/fluticasone furoate o.d. were defined as "non-compliant". Tattoo surfaces were defined as "mild" or "extended" if they were < or ≥400 cm2, respectively. The relationship between tattoos and compliance on the evolution of resources consumption at 6 and 12 months was assessed by generalized estimating equation (GEE) models at the first and second semester of the treatment period.

RESULTS

It was found that 13.2% of compliant adolescents had mild tattoos, while 47.2% of non-compliant adolescents had mild-to-extended tattoos (odds ratio (OR) 6.91, 95% CI 2.49 to 19.17, p < 0.001). The mean annual adherence to treatment was 57.8% ± 10.1 SD expected doses in non-compliant subjects with "mild tattoos" (54.8 cm2 ± 36.9 SD), but 38.6% ± 11.4 SD expected doses in those with "extended tattoos" (568.4 cm2 ± 111.6 SD, p < 0.001). Total cost proved to be a linear trend from the lowest values of compliant patients with no/mild tattoos (EUR 65.22 at 6 months and EUR 33.63 at 12 months) to the highest values of non-compliant adolescents with extended tattoos (EUR 330.75 at 6 months and EUR 297.34 at 12 months).

CONCLUSIONS

Tattoo extension might be used as a reliable predictor of poor compliance and higher health care costs in adolescents with mild-to-moderate asthma. Patients characterized by poor compliance to a long-term therapeutic strategy and tattooing attitude likely share some aspects of their personality profile.

Freud, bullshit, and pseudoscience

This paper critically examines the validity of Freudian psychoanalysis within the framework of Moberger's characterisation of pseudoscience as bullshit with scientific pretensions. The central question addressed is whether Freudian psychoanalysis qualifies as "bullshit," following Moberger's guideline of looking for systematic fallacies. The analysis centres on two fundamental critiques against psychoanalysis: one posited by Popper, contending that psychoanalytic interpretation is excessively flexible, and another by Glymour, asserting that Freud's interpretative method baselessly posits associations as causes. This paper argues that both criticisms rest on misunderstandings and asserts that Freudian psychoanalysis does not commit the alleged fallacies. It also offers positive evidence that Freud was not a bullshitter. The conclusion drawn is that psychoanalysis should not be regarded as bullshit, and hence does not qualify as pseudoscience on Moberger's criteria. Consequently, the paper suggests that Freudian psychoanalysis deserves a fairer hearing then many have given it.

Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing

Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.

A Difficult Beginning: Commencement and Birth in the Analysis of an Adolescent

The author distinguishes between two kinds of beginning, conceptually tied to two ways of approaching the psychoanalytic situation described as epistemological and ontological. Through a clinical case, the author shows how her work with a troubled adolescent had two beginnings that corresponded to these types. In this way, she tries to expand on the literature about the ontological turn, focusing on what beginning means in this context. For treatment to succeed, a birth must emerge, a transformative moment with the potential for significant change. The combined ability to transform the most primitive, somatopsychic pain can be more effective if shared by analysts and patients in a predominantly aesthetic form.

Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review

OBJECTIVE

This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts.

METHODS

An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool.

RESULTS

Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±<1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%-100% of professionals in these samples. Perceptions of support ranged widely, with 11%-87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%-82%), more suicide prevention or postvention training (4%-70%), debriefing or supervision (41%-75%), formal case review (18%-20%), time off (12%), and legal assistance (4%).

CONCLUSIONS

HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs' needs.

The innate story code

Code biology reveals a great many codes beyond the genetic code as integral to biological functioning. Recent scholars have linked the growing field of code biology to analytical psychology, confirming that the encoded information inherited by the human organism is indeed massive and capable of great sophistication. In this discussion, I will expand on this project by showing how developments in embodied cognition reveal a code that links the world of universal emotional responses to common experiences to the world of embodied visuospatial narratives--i.e., the "archetypes" of analytical psychology. Viewed in this manner, archetypes become spontaneous symbolic narratives that symbolize universal emotional responses to typical human environments. Such symbolic narratives aim toward adaptation, and use a universal code that maps such situations to visuospatial narratives, with the adaptor being the human body itself.

Focus on the blind spots of clinician-patient interactions: A critical narrative review of collusion in medical setting

Collusions, interpersonal phenomena with an impact on patients, significant others, clinicians, and care, are mainly described in the psychotherapeutic literature but also occur in the medical setting. Comprehended as an unconscious bond between two or more persons from a psychotherapeutic perspective, definitions and collusive situations described in the medical setting vary. The question arises whether medical collusions, compared to collusions occurring in the psychiatric setting emerge in different clinical situations or are not identified as transference-countertransference experiences, since there is less sensitivity for the unconscious dimensions of care. We systematically reviewed the medical literature on collusions. Even though a read threat, avoidance of unpleasant feelings (mainly anxiety), runs through the described collusions, the unconscious dimensions and associated defensive maneuvers are rarely evoked. Given the expressed desire to act on collusions in medicine, involving third-party psychiatric liaison clinicians, who supervise clinicians, and hereby help to disentangle collusions, could be beneficial.

[Measuring and training of therapeutic competencies]

This article provides an overview of our research concepts on therapeutic competencies with regard to three main questions. The first research question deals with therapists' competencies to succesfully handle transference and countertransference in the cotext of Alliance Ruptures. Research on the Alliance-Focused Training and on subjective countertransference is presented. The second research question deals with therapists' general interpersonal skills. The research approaches outlined here concern the construct of Facilitative Interpersonal Skills (FIS) and the measurement of these skills using the FIS-task. In further studies on this topic, we are focusing on the question of which therapist characteristics are associated with higher interpersonal skills and which linguistic and phonetic features characterise therapist responses that are rated as interpersonally competent. Another study concerns the tendency of therapists to overestimate their interpersonal skills (self-assessment bias). The third main research question deals with the competence to apply therapeutic techniques and to create helpful change processes. An instrument to assess verbal techniques (Psychodynamic Intervention List) and research approaches focusing on the description and the assessment of mediators of change are presented.

Do we want to know?

The weak evidence base and profound consequences of gender-affirming interventions for youth call for a particularly sensitive and complex psychoanalytic exploration. However, prohibitions on knowing at the individual and social levels significantly constrain psychoanalytic work with trans-identified youth. Barriers to exploration and thinking that patients bring to treatment are reinforced and reified by the dominant socio-political trends that saturate the contexts in which young people dwell. These trends increasingly frame any attempt to deeply explore why a young person is seeking medical or surgical gender-affirming interventions as "off-limits" and a form of conversion therapy. Furthermore, politically driven clinicians who promote medical gender-affirming interventions misrepresent and attempt to discredit clinicians who explore the meaning and function of trans identification, or who express concern that transitioning may be a drastic solution to various forms of psychic pain. In doing so, they minimise the significance of the weak evidence base for these interventions and their serious, known risks. At the same time, they obscure or deny the psychic pain that is sometimes humming beneath the experience of gender dysphoria. The author asks: If there are significant uncertainties and risks of harm associated with medical interventions for young people, do we want to know?

Freud's 1926 conjecture is confirmed: evidence from the dorsal periaqueductal gray in mice that human psychological defense against internal instinctual threat evolved from animal motor defense against external predatory threat

In 1926, Freud famously conjectured that the human ego defense of repression against an internal instinctual threat evolved from the animal motor defense of flight from an external predatory threat. Studies over the past 50 years mainly in rodents have investigated the neurobiology of the fight-or-flight reflex to external threats, which activates the emergency alarm system in the dorsal periaqueductal gray (dPAG), the malfunction of which appears likely in panic and post-traumatic stress disorders, but perhaps also in some "non-emergent" conditions like social anxiety and "hysterical" conversion disorder. Computational neuroscience studies in mice by Reis and colleagues have revealed unprecedented insights into the dPAG-related neural mechanisms underlying these evolutionarily honed emergency vertebrate defensive functions (e.g., explore, risk assessment, escape, freeze). A psychoanalytic interpretation of the Reis studies demonstrates that Freud's 1926 conjecture is confirmed, and that internal instinctual threats alone can also set off the dPAG emergency alarm system, which is regulated by 5-HT1A and CRF-1 receptors. Consistent with current psychoanalytic and neurobiologic theories of panic, several other of the primitive components of the dPAG alarm system may also have relevance for understanding of the unconscious determinants of impaired object relationships (e.g., avoidance distance). These dPAG findings reveal (1) a process of "evolution in situ," whereby a more sophisticated dPAG ego defense is seen evolving out of a more primitive dPAG motor defense, (2) a dPAG location for the phylogenetically ancient kernel of Freud's Ego and Id, and (3) a Conscious Id theory that has been conclusively invalidated.

The Relationship between Family Functioning, Emotional Intelligence, Loneliness, Social Support, and Depressive Symptoms among Undergraduate Students

The transition from adolescence to college is a significant developmental stage marked by challenges such as high academic pressure, changes in living environments, and social support systems. These challenges can lead to increased rates of depression among college students. This study investigates the relationships between family functioning, emotional intelligence, loneliness, social support, and depressive symptoms in Chinese college students. A cross-sectional design was employed, with data collected via questionnaires from undergraduate students at Xi'an Jiaotong University. Variables such as family functioning, emotional intelligence, loneliness, social support, and depressive symptoms were assessed. Statistical analyses, including correlation and hierarchical regression, were conducted to explore these relationships. The study found a diverse distribution of depressive symptoms among students, with significant gender differences indicating higher depression rates in females. No significant differences were observed across academic disciplines, grades, or between only children and non-only children. Family functioning, emotional intelligence, and social support were negatively correlated with depressive symptoms, while loneliness was positively correlated. Hierarchical regression analysis confirmed that social support significantly moderated the relationship between family functioning and depressive symptoms. Mediation analysis showed that emotional intelligence and loneliness mediated this relationship. The findings highlight the complex interplay between family dynamics, emotional capabilities, social connectedness, and mental health. Enhancing family functioning, emotional intelligence, and social support can effectively reduce depressive symptoms among college students. These results underscore the need for holistic interventions that address multiple aspects of students' social and emotional lives.

Slovenian validation of the Capacity to Love Inventory: associations with clinical measures and mindfulness

Aim

The main purpose of the present study was to validate the Slovenian version of the 41- item Capacity to Love Inventory (CTL-I). Based on psychoanalytic theory, limitations to capacity to love are expected to be associated with personality dysfunction and disintegration as well as fundamental mental capacities such as self-reflection and self-awareness.

Method

To examine these assumptions, a sample of 552 Slovenian non-clinical individuals were recruited through academic networks. The construct validity of the CTL-I was assessed using a confirmatory factor analysis and convergent validity of the CTL-I and its subscales was established against IPO-16, PID-5 BF, MAAS.

Results

Our findings show that the Slovenian version of the CTL-I replicated the six-factor structure, exhibiting good model fit as well as satisfactory internal consistency of all subscales. In line with expectations, capacity to love was found to be inversely associated with dysfunctional personality traits and structural personality disturbances. Accordingly, higher dispositional mindfulness was coherently associated with all domains of CTL-I.

Conclusion

The results add to the growing evidence for the cross-cultural validity and sound psychometric properties of CTL-I, presented here in the Slovenian version. Our findings also point to the significance of dispositional mindfulness both in relation to capacity to love as well as mental health.

Nature heals: An informational entropy account of self-organization and change in field psychotherapy

This paper reviews biophysical models of psychotherapeutic change based on synergetics and the free energy principle. These models suggest that introducing sensory surprise into the patient-therapist system can lead to self-organization and the formation of new attractor states, disrupting entrenched patterns of thoughts, emotions, and behaviours. We propose that the therapist can facilitate this process by cultivating epistemic trust and modulating embodied attention to allow surprising affective states to enter shared awareness. Transient increases in free energy enable the update of generative models, expanding the range of experiences available within the patient-therapist phenomenal field. We hypothesize that patterns of disorganization at behavioural and physiological levels, indexed by increased entropy, complexity, and lower determinism, are key markers and predictors of psychotherapeutic gains. Future research should investigate how the therapist's openness to novelty shapes therapeutic outcomes.

Dreaming in Bipolar Disorders - Feasibility of the Central Image Method: A Prospective Controlled Trial

Background

Emotions play an important role in the emergence, formation, and experience of dreams. The Central Image (CI) in a dream refers to the dream's dominant or underlying emotion, and it is the best-remembered part of a dream. Bipolar disorders are characterized by strong emotions, particularly during manic and depressive episodes. In these patients, dreams and CIs may serve as a helpful diagnostic and therapeutic tool. This study aims to evaluate the feasibility of the CI Method and to check for differences concerning dreams and CI emotions between healthy controls and patients with bipolar disorder.

Methods

Over a period of 3 weeks, 61 participants were asked to maintain a daily record of all dreams remembered. Dream reports were rated using the Central Image Method (CIM) by two independent, blinded raters. We assessed for interrater agreement on the CIM and for within and between group differences related to negative and positive CI emotions.

Results

Mean agreement rates (weighted Cohen's kappa) for the CI emotion ratings could be classified as very good: For primary CI emotion ratings, the mean weighted Cohen's kappa was 0.99 (± 0.02), and for secondary CI emotions, it was 0.90 (± 0.17). Regarding the CI intensities, the mean agreement rate (Spearman's correlation) was also strong. Evaluation of differences within the groups showed that there were more negative CI emotions than positive CI emotions in healthy controls and currently depressive patients; however, in the latter, the difference was statistically not significant. Analyses of differences between groups indicated that patients who were currently depressed recorded more negative CI emotions in dreams than those who were euthymic or healthy controls.

Discussion

The findings support the feasibility of the CIM. Our results might indicate different emotion regulation and defense mechanisms across bipolar disorder states, as reflected by the occurrence of negative and positive CI emotions.

The Religious Nature of the Psyche, Semiotic Mediation, and the Evanescence of Identity in Liminality

von Fircks' (Integrative Psychological and Behavioral Science 1-20, 2003) essay on the experience of meditation is rich in stimuli and insights. This paper aims at extrapolating and developing a germinal element from it: Semiotic mediation constitutes the core of the religious nature of the human psyche. It represents both the drive for transformation in the transcendence of the relational process and the search for stability and fixedness in the immanence of the experience of the present moment. The religiosity of the mind can be considered the expression of a transcendent function of semiosis in the very act of looking at an elsewhere in the present moment. The semiotic mediation of the religious psyche seeks meaning in the very act of creating it.

Empirical examination of long-term and intensive psychodynamic psychotherapy for severely disturbed patients

Objectives This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. Method: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. Results: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). Conclusion: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients.

A Theoretical Model of Emotional Processing in Visual Artmaking and Art Therapy

Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.

The use of mentalization-based techniques in online psychodynamic child psychotherapy

Objective: Psychodynamic child psychotherapy is an evidence-based approach for a range of child mental health difficulties and needs to constantly adapt to meet the needs of children. This study is the first to investigate whether the use of mentalization-based interventions (i.e., a focus on promoting attention control, emotion regulation, and explicit mentalization) predicted a good therapeutic outcome in online psychodynamic child therapy sessions conducted during the COVID-19 pandemic. Methods: The sample included 51 Turkish children (Mage = 7.43, 49% girls) with mixed emotional and behavioral problems. Independent raters coded 203 sessions from different phases in each child's treatment using the Mentalization-Based Treatment for Children Adherence Scale (MBT-CAS). Results: Multilevel modeling analyses showed children with higher emotional lability benefited more from attention control interventions compared to those with lower emotional lability. Discussion: Interventions that focus on developing the basic building blocks of mentalizing may be effective components of therapeutic action for online delivery of psychodynamic child psychotherapy, especially for children with greater emotional lability.

A Single Case Multimethod Assessment to Detect Significant Changes in the Psychoanalytic Treatment of Psychosomatic Disorders

Mental disorders with body-centered symptoms, such as somatic, eating, and body dysmorphic disorders, present difficulties in psychotherapy because psychological suffering is manifested in the body rather than expressed verbally. The present study illustrates a single case multi-method investigation sensitive to detecting characteristic change manifestations in the treatment of these disorders. We investigated a treatment of a patient with body dysmorphic disorder. Computerized linguistic measures were applied to 86 sessions to assess changes in symbolic processing; out of the 86 sessions, 40 were analyzed to calculate the proportion of speech focused on bodily symptoms versus on relationships. Changes in personality were assessed using the SWAP-200 on nine sessions from different treatment stages. Measures of linguistic style, speech content, and personality showed marked changes over the treatment. The patient manifested schizoid and schizotypal personality traits that decreased over time, along with an increase in personality high-functioning dimension. The patient's ability to translate his emotional experience into words steadily increased, switching the primary focus of narratives from bodily symptoms to relationships. A multimethod assessment of the treatment of body dysmorphic disorder shows that improvement in personality functioning is accompanied by a shift from a focus on bodily experiences to a focus on relationships.

The Affective Charge of Sulphur and Salt in Working with Compulsion

The author presents a long analysis of a patient, Giulia, whose obstinate will to achieve evokes the workings of alchemical sulphur at its fieriest and a dread of its coniunctio with alchemical salt. Jung's description of these symbols in Mysterium Coniunctionis offers a useful imaginal perspective to clinical work in the area of compulsion and its possible transformations. Right from the start, the analytic relationship appeared to be mirrored and affected by this alchemical perspective. However, it was only after much time, uncertainty and emotional endurance that a fuller psychological experience of sulphur and salt could be accessed, allowing the analysis to take a more imaginative and mercurial turn. In the course of his work with Giulia the author has witnessed and experienced a range of intense affects-the many colours that the combustion of sulphur can generate-whether on the verge of unstoppable creation or ruthless destruction, often of archetypal intensity. This experience has been lived through and has undergone a transformative relation with salt, which until then had lived a dissociated existence in the fixed trauma of the compulsion and in a nocturnal underworld of tears.

Recapitulation, Heredity, and Freud's View of Human Nature

There's something strange about Freud's Civilization and its Discontents (1930). Biologically, Freud was a Neo-Lamarckian, who believed in both the modification of organisms through need and the inheritance of acquired characteristics. However, in Civilization, Freud argued that because human nature is immutable, society has dim odds of improving substantially. Lamarckians, of course, rejected that any species-nature is immutable, as species can always be transformed via the inheritance of acquired characteristics. In fact, many of Freud's Viennese contemporaries-such as Wilhelm Reich, Julius Tandler, and Paul Kammerer-took their Lamarckism to license precisely the sorts of radical social projects Freud deemed impossible. Thus the Freud of Civilization helped himself to a rigid view of human nature which, given his associated biological views, he seemingly ought to have rejected. In this paper, I explain this apparent inconsistency, and suggest Freud resolved it in the following way: Freud was not merely a Lamarckian, but also a strong and peculiar kind of recapitulationist, who believed stages of psychological development both recapitulate phylogeny, and "remain with us" throughout both individual lives and future species-history. I suggest Freud's recapitulationism supposed a certain inertia: what occurred in phylogenetic history cannot un-occur, and therefore there are aspects of our nature which we cannot un-acquire. In this way, Freud reached a rigid conception of human nature despite his Lamarckism.

Trauma and Dream Work: Mending Tears in the Fabric of Time

Working with dreams in the context of trauma can open unique avenues for healing, in particular for patients who report feelings of numbness or a loss of meaning in their lives. Dream exploration can make facing aspects of trauma and dissociated experience more tolerable than explicitly addressing them at a conscious level. It can also reignite the capacities for reflection and meaning making disrupted by trauma. Dreams also reconnect patients to aspects of their history that can provide context for and meaning to experiences from which they have come to feel emotionally disconnected. Finally, dreams offer a way of regaining the capacity to connect with wishes, hopes, and desires that have become difficult to access because of trauma. In this article, the authors present case examples of patients with trauma and discuss how therapists worked with dream material to unlock new possibilities for these patients' lives.

Addressing At-the-Moment Defenses against Painful Affects: A Core Mechanism of Change in Psychodynamic Treatment

There is an ongoing tension in the psychodynamic field between interpreting the meaning of a patient's verbal productions or actions and addressing the defenses utilized by the patient. Some authors maintain that implicit interactions between analyst and patient may be more important than the verbal interventions by the analyst. This article stresses the importance of observing and appropriately addressing how patients manage painful affects in the sessions. Focusing the patients' attention on their at-the-moment defenses as they occur in the session is an experience-near intervention and minimizes interventions that address issues far from the patient's consciousness and that require a high level of conjecture by the therapist. This technique can be utilized at any point in treatment, regardless of its duration and intensity. Several vignettes are provided that suggest that addressing defenses against painful affect is a pantheoretical construct and may be a common factor in psychodynamic treatment. A successful randomized control trial utilizing this technique with children (regulation-focused psychotherapy) is described. There have been limited empirical studies of the impact of therapists addressing defenses in sessions, but the work of J. Christopher Perry and colleagues, particularly the development of the Psychodynamic Intervention Rating Scales, offers an opportunity to further study the impact of defense interpretations and other interventions.

Demystifying Jung's "Archetypes" with Embodied Cognition

Since he first proposed it, Carl Jung's "archetype" theory has faced resistance from a pervasive but seldom examined set of underlying Cartesian assumptions embedded in mainstream psychology. This paradigm assumed a physical universe (and hence body) free of psyche that coincided with an essentially disembodied mind largely concerned with abstract symbol manipulation. This situation led archetype theory to remain largely within insulated psychoanalytic circles for decades. Since the 1980s, however, cognitive psychology has increasingly become embodied from a variety of standpoints. This article shows how the results of embodied cognition and spontaneous thought "demystify" many of the attributes Jung described in his archetype theory, making archetype theory not only more comprehensible but clinically applicable. Combining approaches suggests new avenues of inquiry for experimental research and enriches the psychoanalytic perspective.

The affective grounds of the mind. The Affective Pertinentization (APER) model

The paper presents the Affective Pertinentization model (APER), a theory of the affect and its role it plays in meaning-making. APER views the affect as the basic form of making sense of reality. It consists of a global, bipolar pattern of neurophysiological activity through which the organism maps the instant-by-instant variation of its environment. Such a pattern of neuropsychological activity is constituted by a plurality of bipolar affective dimensions, each of which maps a component of the environmental variability. The affect has a pluri-componential structure defining a multidimensional affective landscape that foregrounds (i.e., makes pertinent) a certain pattern of facets of the environment (e.g., its pleasantness/unpleasantness) relevant to survival, while backgrounding the others. Doing so, the affect grounds the following cognitive processes. Accordingly, meaning-making can be modeled as a function of the dimensionality of the affective landscape. The greater the dimensionality of the affective landscape, the more differentiated the system of meaning is. Following a brief review of current theories pertaining to the affect, the paper proceeds discussing the APER's core tenets - the multidimensional view of the affect, its semiotic function, and the concepts of Affective Landscape and Phase Space of Meaning. The paper then proceeds deepening the relationship between the APER model and other theories, highlighting how the APER succeeds in framing original conceptualizations of several challenging issues - the intertwinement between affect and sensory modalities, the manner in which the mind constitutes the content of the experience, the determinants of psychopathology, the intertwinement of mind and culture, and the spreading of affective forms of thinking and behaving in society. Finally, the unsolved issues and future developments of the model are briefly envisaged.

Disclosure and child exploration of surrogacy origins in gay father families: Fathers' Adult Attachment Interview coherence of mind matters

OBJECTIVE

The present study aimed at investigating whether gay fathers' coherence of mind within the Adult Attachment Interview (AAI) moderated the influence of parental disclosure on children's exploration of their surrogacy origins during middle childhood and early adolescence.

BACKGROUND

Once children of gay fathers are disclosed to about their surrogacy conception, they may start exploring the meanings and implications of their conception. Very little is known about the factors that may enhance such exploration in gay father families.

METHOD

A home-visit study was conducted with 60 White, cisgender, gay fathers and their 30 children born through gestational surrogacy, all residing in Italy and with medium to high socioeconomic status. At time 1, when children were aged 6-12 years (M = 8.31, SD = 1.68), fathers were rated for AAI coherence of mind and interviewed about their disclosure of the surrogacy origins to their child. At time 2, approximately 18 months later (M = 9.87, SD = 1.69), children were interviewed about their exploration of their surrogacy origins.

RESULTS

In the context of more information disclosed about the child conception, only children whose fathers showed greater AAI coherence of mind explored their surrogacy origins in more depth.

CONCLUSION

Gay fathers' ability to show an internally consistent, but not emotionally overwrought, state of mind regarding their own attachment experiences impacted the extent to which their children felt safe and legitimated in sharing their curiosity about their conception.

Reflections on Attacks on Linking and the Thinking-Function in the Writings of W. R. Bion

This article revisits W. R. Bion's theory of thinking by highlighting how thinking and linking are attacked. The author's theoretical reflections and clinical vignettes draw attention to the fact that patients may attack the analyst's thinking-function in two particular states: when they experience the analyst as attacking them precisely when the analyst is able to create a link, but one that is too threatening, painful, unsettling and frustrating or in response to the analyst's failure to create the link the patient had been expecting. How the analyst deals with and reacts to the complexity of the analytic relationship and to these two kinds of attacks is what will be internalized. In turn, it will affect the methods of communication within the psyche and with the environment and the development of a patient's emotional thinking.

A Meta-Analysis of Interpersonal and Psychodynamic Psychotherapies for Posttraumatic Stress Disorder

OBJECTIVE

Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD.

METHODS

Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale.

RESULTS

Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk=0.61, p=0.098 for IPT alone).

CONCLUSIONS

Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.

Experiences of mental health practitioners after clients' suicide: a qualitative systematic review protocol

OBJECTIVE

The objective of this qualitative systematic review will be to understand the experiences of mental health practitioners after clients' suicide.

INTRODUCTION

Mental health practitioners inevitably encounter client suicide during their careers, which can significantly affect their personal lives and professional outcomes. A deeper understanding of mental health practitioners' experiences in the aftermath of clients' suicide is necessary to provide effective support and assist with adaptation to this situation.

INCLUSION CRITERIA

This systematic review will consider qualitative studies that explore the experiences of mental health practitioners, including psychotherapists, psychiatrists, psychological counselors, clinical psychologists, psychiatric mental health nurse practitioners, and social workers following clients' suicide. Experiences may include emotional responses, coping strategies, changes in social relationships, and reflections on practice.

METHODS

This review will follow the JBI methodology for qualitative systematic reviews. The databases to be searched will include PubMed, CINAHL (EBSCOhost), Embase, PsycINFO (EBSCOhost), SocINDEX (EBSCOhost), Web of Science, CNKI, Wanfang, VIP, Bibliographia Medica Čechoslovaca, and Bibliographia Medica Slovaca. Gray literature sources will include Google Scholar, and ProQuest. Studies in English, Czech, Slovak, and Chinese will be assessed for inclusion regardless of publication date. Studies that are initially selected will be assessed for methodological quality using the JBI critical appraisal tool for qualitative studies. Then, findings with illustrations will be extracted for subsequent meta-aggregation and ConQual assessment. All the above steps will be conducted by 2 independent reviewers.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42023410523.

Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences

OBJECTIVES

Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability.

DESIGN

The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines.

SETTING

The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway.

PARTICIPANTS

Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted.

RESULTS

Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned.

CONCLUSIONS

We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.

Specificity and integration of meaning in self-defining memories of breast cancer survivors: clinical reflections to promote a narrative identity integration

Potential traumatic events, such as breast cancer, can influence autobiographical memory (AM), interrupting the continuity of narrative identity. AM is based on a hierarchical search across different levels of specificity that are indexed from top to bottom when a memory is retrieved. In the breast cancer field, non-specific AMs are an observed clinical phenomenon. In particular, breast cancer survivors report issues related to self-defining memories (SDMs), specific and significant AMs that evoke strong emotions and sensory details at the time of memory. SDMs are linked to life goals and facilitate adaptation to critical experiences, preserving the continuity of identity. This study explored the narrative identity integration process of breast cancer survivors, analyzing themes, specificity, and integrative meaning in SDMs. Ten women participated in an online group support program centered on the integration of AMs linked to the cancer journey. Participants were asked to assess their body image perceptions, filling out an online survey three times, in which they had to report three SDMs each time. A reflexive thematic analysis of the SDMs identified three main themes: the onset of breast cancer; the labeling of negative emotions, and changes in the body. The results indicated inhibited retrieval of specific episodes, fostering a progressive failure in memory characterization and the concurrent meaning-making process. Participants struggled with connecting the memories to insights regarding their self and life, as well as relating the memories to external conditions and other individuals. Further studies might examine the impact of these difficulties on the psychological adjustment of BC long-term survivors. They could also explore cognitive reconstruction by reframing the memories and re-evaluating their traumatic meanings.

Theories on the Etiology of Deviant Sexual Interests: A Systematic Review

Not much is known about the etiology, or development, of deviant sexual interests. The aim of this systematic review was to provide a broad overview of current theories on the etiology of sexual deviance. We conducted a systematic search of the databases PubMed and APA PsycInfo (EBSCO). Studies were included when they discussed a theory regarding the etiology or development of sexual deviance. Included studies were assessed on quality criteria for good theories. Common etiological themes were extracted using thematic analysis. We included 47 theories explaining sexual deviance in general as well as various specific deviant sexual interests, such as pedophilia and sadism/masochism. Few theories (k = 7) were of acceptable quality as suggested by our systematic assessment of quality criteria for good theories (QUACGOT). These theories indicated that deviant sexual interests may develop as the result of an interplay of various factors: excitation transfer between emotions and sexual arousal, conditioning, problems with "normative" sexuality, and social learning. Neurobiological findings could not be included as no acceptable quality neurobiological theories could be retrieved. The important roles of excitation transfer and conditioning designate that dynamic, changeable processes take part in the etiology of sexual deviance. These same processes could potentially be deployed to diminish unwanted deviant sexual interests.

Childhood trauma and differential response to long-term psychoanalytic versus cognitive-behavioural therapy for chronic depression in adults

BACKGROUND

Childhood trauma is a major risk factor for chronic depression. It has been suggested that adults with chronic depression who have experienced childhood trauma may require long-term treatment owing to a breakdown of basic trust and related difficulties in developing a productive therapeutic relationship.

AIMS

As empirical studies have been preliminary and scarce, we studied the effects of psychoanalytic therapy (PAT) versus cognitive-behavioural therapy (CBT) for chronic depression in adults with a history of childhood trauma. In this subgroup, we expected a greater symptom reduction in PAT compared with CBT.

METHOD

In a large trial of long-term psychotherapies for chronic depression (LAC-Study; Clinical Trial Register ISRCTN91956346), 210 adults received open-ended CBT or PAT in an out-patient setting and were examined yearly over 5 years on the Beck Depression Inventory - II (BDI-II). Based on a linear mixed model approach, we tested participant-reported childhood trauma based on the Childhood Trauma Questionnaire (CTQ) as a predictor and moderator of treatment outcome. CTQ subscales were examined exploratively.

RESULTS

Depressive symptoms decreased over time (b = -4.55, s.e. = 0.90, 95% CI -6.32 to -2.81, T = -5.08; P < 0.001). A significant three-way interaction between childhood trauma, time and therapy group (b = -0.05, s.e. = 0.02, 95% CI -0.09 to -0.01, T = -2.42; P = 0.016) indicated that participants with childhood trauma profited especially well from PATs.

CONCLUSIONS

Our results indicate differential benefits from PAT compared with CBT among adults with chronic depression and a history of childhood trauma. The results have important implications for differential indication and policy.

Mourning, melancholia and machines: An applied psychoanalytic investigation of mourning in the age of griefbots

Death and mourning are being shaped by posthumous opportunities for the dead to affect current life in ways not possible in pre-digital generations. The psychological and sociological impact of the dead 'online' and of 'grief tech' is only beginning to be understood. It has not yet been explored psychoanalytically until this paper that examines one type of grief tech, namely the griefbot. This development is critically explored through a psychoanalytic reading of an episode of Black Mirror. I suggest that a psychoanalytic model of mourning provides an invaluable perspective to help us to think about this technology's potential as well as the psychological and ethical risks it poses. I argue that the immortalisation of the dead through digital permanence works against facing the painful reality of loss and the recognition of otherness, which is fundamental to psychic growth and to the integrity of our relationships with others. Drawing on Derrida's conceptualization of 'originary mourning', I suggest that mourning is an interminable process that challenges us to preserve within the self the otherness of the lost object. The tools we use for mourning need to be assessed first and foremost against this psychological and fundamentally ethical process.

E-mmortal: Death Anxiety is Related to Selfie Behaviors

Given the widespread phenomenon of selfies, numerous studies are examining the motivations behind taking and sharing selfies. The current paper suggests an additional possible motivation, namely, decreasing death anxiety. People are motivated to decrease their death anxiety by preserving a fake feeling of immortality. One known way to achieve this goal is by using photography. Therefore, we suggest that selfie behaviors are a way to fulfill the need to remain immortal. A hundred undergraduate students (Mage = 22.33) answered self-reported questionnaires regarding selfie motivations, selfie-taking frequency, selfie-sharing frequency, and death anxiety. All of those selfie measurements were indeed positively related to death anxiety. Moreover, many previous studies suggested that narcissism motivates selfie behaviors. In an exploratory approach, we examined whether death anxiety mediates this relationship. Indeed, death anxiety fully mediated the relationships between narcissism and selfie motivations and between narcissism and selfie-taking frequency, suggesting that the well-documented association between selfie behaviors and narcissism might be driven by death anxiety. Those preliminary results indicate that death anxiety is associated with selfie behaviors, opening new avenues for understanding the motivations underlying selfie behaviors.

The Oedipal Virtual Citadel: Varieties of Isolation, Oedipal Conflict, and Cover-Up

The author elaborates some of the fantasies and defenses that protect some patients in their oedipal fixations, particularly those related to forms of personal isolation. To some extent, cover-up is intrinsic to oedipal conflict and fantasy, but what is covered up is quite variable. In this paper, the author highlights elements of personal isolation that the patient cultivates in order to protect love for a desired oedipal parent and the conscious and unconscious fantasies associated with this love. The patients described here use forms of personal isolation to cover up and secure the gratification of oedipal fantasies. Their isolation also serves to protect them from fantasies of unique forms of destructiveness in relation to self and the desired other. The citadel, a concept from Guntrip's description of defenses protecting the schizoid patient's fear of destructive love, is characterized here for the neurotic patient as virtual because in some ways, each of the participants in oedipal conflict turn a "blind eye" to a staged cover-up. Clinical illustrations examine the transference-countertransference process of shifts from turning a blind eye to sustaining a process of seeing what is being covered up but has already been seen.

Examination of a case of "treatment failure" in long-term psychoanalytic psychotherapy for treatment-resistant depression

Randomized controlled trials have reported psychoanalytic psychotherapy to improve longer-term post-treatment outcomes in patients with treatment-resistant depression. In this case study, we examine the therapy process of a female trial participant diagnosed with treatment-resistant depression. Structured clinical assessments indicated that the patient's level of depression remained unchanged during and after treatment. Over the course of the therapy, she repeatedly broke away from important others and finally also from the therapy itself, which we linked to the impact of earlier experiences of abandonment on her internal world. In the discussion, we present a variety of reflections that were put forward by the authors during a series of case discussion meetings. Some of these reflections relate to how the inner world of this patient might have triggered a negative therapeutic reaction and a destructive pattern of repetition. The interpretative stance, in which the therapist interpreted this reaction as indicative of a psychic conflict and linked this conflict to the therapeutic relationship, seemed to be experienced by the patient as unhelpful and persecutory. Other elements that were brought up include basic distrust, lack of symbolization and trauma in the patient, as well as the constraints of the research context.

Embodied intersubjectivity: Forms of psyche-soma structuring in the encounter between self and other-than-self

This paper explores the mechanisms that lead to a destructive tendency in the formation and functioning of the psychic apparatus, to the characteristic states of subjects who are drawn to non-life. The dynamics of the primary mother-child relationship involve a structural interaction between mind and body, subject and object. The dialectic between the life drive and the death drive is conceptualized as the structuring of homeostatic dynamic equilibria, in which both drives belong to the living, provided they are kept in a non-isolated system. This conception has analogies with other disciplines that have changed their paradigms, such as neurobiology, which, for living beings in open systems, hypothesises a continuous interconnected Becoming of undivided separation and of discontinuity. In unitary psyche-soma functioning, a dynamic homoeostatic balance marks the state of health of the relating subject; or if, instead, the system is isolated, a pathological dysregulation depending on the emotional-affective vicissitudes it undergoes. Two clinical cases illustrate these dynamics. For this tendency on the level of the somatopsychic unit, the name alloiosis has been put forward, in analogy with cellular apoptosis.

Traumatic experience and loss: A brief therapy with a traumatized refugee boy and his parents in exile

In this paper, the author portrays the psychoanalytic therapy with a twelve-year-old refugee boy and his parents, prior to which the boy had been traumatised by the deaths of both his brothers in the civil war. In 2015 he had travelled with his father to Austria, where he was warmly received in a small community. The author examines how this child reacted to the traumatising experiences, as well as which resilience factors played a role in overcoming them. The psychoanalytic process is illuminated in a detailed analysis of the therapy sessions, which created a space for overcoming the helplessness, mourning the loss and furthering the integration process of the identity, disturbed after the traumatic experiences.

Receptivity to the Weight and Heft of the Natural World in our Inner Selves

Through the literary explorations and poetry of Alice Oswald, and through analysis of detailed clinical material from a Kleinian perspective, the authors expand the bounds of reverie as it is usually construed in psychoanalytic consulting rooms. The authors draw attention to the presence of a relationship to the more-than-human world as an integral aspect of our internal experience, and to the value of consideration of the quality and dynamic meaning of connections to the natural world in ordinary analytic work. The relationship to the primary object heavily influences the form taken by the relationship to the natural world, but once established, this connection has the possibility for a life of its own, that can provide a different kind of containment than the human variety, allow experimentation with new ways of being, and can strengthen the ego. The authors address the clinical implications of listening enhanced by an ear for affiliation to the natural world.

A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress

BACKGROUND

More than half the domestic population in China were infected with COVID-19 in two months after ending "zero-infection policy", which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism.

METHODS

A cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis.

RESULTS

When other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria.

CONCLUSIONS

The higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.

Experiences of Patients Living in a Unique Leprosy Hospice in Greece: An Interpretative Phenomenological Analysis

BACKGROUND

Hansen's disease, or leprosy, has a long-standing presence in human history, and our study uniquely delves into the experiences of individuals who are among the last survivors of this condition in Greece. During the early 1930s, patients with Hansen's disease from Spinalonga, an isolated location in Crete, were moved to a medical facility in Athens. This event represents a significant historical change in the management and treatment of the disease. Following Spinalonga's closure, a Sanatorium emerged, evolving into Greece's sole Hansen's disease center and the present-day refuge for patients, underscoring the enduring stigma and abandonment associated with the disease.

METHOD

Our study, conducted through six interviews with unstructured schedules, provides a unique opportunity for these individuals to share personal insights, offering a profound understanding of their interpretations and experiences.

RESULTS

Through interpretative phenomenological analysis, we unearthed four superordinate themes: the pivotal nature of the diagnosis, the visible impact of the disease on the body, the stigma associated with leprosy and its effects on individuals, and the significance of 'home' as a place of solace and acceptance.

CONCLUSIONS

These themes collectively depict the deep emotional trauma experienced by the participants, shedding light on the enduring impact of historical stressors, confinement practices, and the challenges of living with a devalued identity, shaping their profound sense of self.