Psychoanalysis and research: some reflections and opinions

Developing a prototype for relationship therapy psychoanalysis: an empirical study with the Psychotherapy Process Q-set

Psychotherapy Process Q-set (PQS) prototype characteristic of psychoanalytic relationship therapy does not yet exist. Experts in psychoanalysis of relationship therapy [from the Italian Society of Psychoanalysis of the Relationship (SIPRe)] used the 100-Item PQS questionnaire to rate an ideal SIPRe therapy. Agreement between rates was high (Cronbach's alpha=0.84). The prototype for SIPRe therapy showed a significant correlation to the psychoanalytic prototype (r=0.68, p<0.000) and to the short expressive-supportive therapy (r=0.69, p<0.000) prototype. Correlations with Cognitive Behavioural Therapy (r=0.28, p<0.005) and Interpersonal Therapy (r=0.22, p<0.031), prototypes were significant, but weaker. The correlation between the two SIPRe samples (junior and expert therapists) was highly significant (Spearman's rho=0.936; p<000).

Psychodynamic Psychiatry in the 21st Century: Constructing a Comprehensive Science of Experience

Psychodynamic psychiatry is not limited to psychotherapy practice. It is defined by systematic attention to the "common factors" underlying both psychotherapy and psychopharmacology outcomes, which include the patient's subjective systems of meaning and the complex flow of the patient-provider relationship in addition to the patient's "objective" psychopathology. It allows for a non-reductionist milieu where the meaning of the illness and the full complexity of the treatment process can be explored in order to achieve a qualitative and lasting change in the patient's psychopathology. The author proposes an integrated psychobiological model of psychiatric care where attention to the patient's subjective experience and the unique flow of the patient-provider relationship stand on an equal footing with the patient's objective behavioral and symptomatic presentation. This model provides a common foundation for diverse psychopharmacological and psychotherapeutic interventions to enable a paradigm shift from symptom- or syndrome-focused approach to individualized, process-oriented philosophy of care. Psychodynamically informed treatment provision helps to unify psychiatric practice by integrating objective, subjective, and intersubjective science in order to construct a systematic science of experience.

Psychotherapy and its Role in Psychiatric Practice: A Position Paper. I. Psychiatry as a Psychobiological Discipline

Economic, political, and ideological landscapes have impacted the practice of psychiatry throughout its evolution as a medical discipline. Despite enormous scientific advances over the course of the past century, many psychiatrists continue to operate with a split Cartesian picture of mind versus brain and entrenched ideological positions ranging from biological "chemical imbalance" to rigidly followed manualized psychotherapy approaches, both of which frequently result in fractured clinical care. With the impact of systemic economic and political pressures in Canada and the United States, the attention to the doctor-patient relationship has taken a back seat to high-volume practices, computerized assessment tools, and the focus on evidence-based treatments for behaviorally defined syndromes in the Diagnostic and Statistical Manual of Mental Disorders that often come at the expense of the patient's experience of his or her illness. We spend much time teaching the next generation of psychiatrists what to prescribe versus how to prescribe; what manualized treatments to administer versus questioning why our patients engage in dysfunctional patterns of thinking, feeling, and relating to others, and what impact these patterns may have on their interaction with us in the here-and-now of the treatment setting. In this paper, we propose an integrative psychobiological model, in which biological interventions carry personal meanings, and relational transactions in the treatment setting are a form of learning that results in lasting physiological changes in the brain. Psychiatry needs to reconnect with its roots as a science of attachment and meaning, in which attention to the objective, subjective, and relational domains of the patient-provider experience is equally foundational for any successful treatment outcome.