Steps Towards a Unified Theory of Psychopathology: The Phase Space of Meaning Model

Focusing the Clinical Supervision on the Therapist's Developmental Trauma: A Single Case Study

The term developmental trauma (DT) refers to the impact of stressful events which occur cumulatively within the child's relevant relationships and contexts, and usually early in life. According to several authors, DT depends on the caregiver's inadequate intersubjective recognition of one or more aspects of the evolving individual's identity. In the clinical and empirical literature, the study of therapists' developmental trauma, and how it might constitute a relevant variable in the clinical exchange, seem to be underrepresented. In this paper, through the analysis of the supervision process of a clinical case, we show how the therapeutic relationship may implicitly take the form of a "dance" between the patient's and therapist's DT, that prevents the therapist from intersubjectively attuning with the patient; and how a supervision process peculiarly focused on the therapist's DT can effectively promote this attunement and a good clinical outcome.

The Functions of Safety in Psychotherapy: An Integrative Theoretical Perspective Across Therapeutic Schools

Objective

There is a certain consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy and that lack of safety undermines mental health. However, the role of safety in psychotherapy has not yet been thoroughly examined. In this article, we identify and integrate the diferent functions of safety in psychotherapy on a theoretical basis.

Method

We made a panoramic overview of the concept of safety across some of the main psychotherapeutic schools that represent major paradigms in contemporary psychotherapy (psychodynamic, cognitive-behavioral, humanistic). We then analyzed, compared, and synthetized the findings to identify the common functions that safety plays both in ontogenesis and in clinical practice across different therapeutic orientations.

Results

Our analysis showed that safety is indeed rightly prioritized across psychotherapy schools because of its developmental value in promoting change and adaptation both in ontogenesis and clinical settings. The findings suggest that the main functions of safety are to secure survival, facilitate restoration, promote exploration, sustain risk-taking, and enable integration, with these functions being complementary and dependent on the context. However, safety seems to be in a dialectical and paradoxical relationship to psychotherapy and human development. Adequate ontogenetic development and treatment progress do not appear to require continuous maintenance of maximum possible safety. Rather, they seem to require enough safety, adequately and timely modulated according to developmental needs and treatment phases.

Conclusions

Although safety provides the necessary basis that enables restoration, fuels exploration, and facilitates treatment progress, safety's misdosage (e.g., lack, excess), misconstruction (e.g., misattunement, misinterpretation), or misuse (exploitation, idealization) may hinder the healthy development of attachment, identity, autonomy, self/co-regulation as well as the ability to tolerate and cope with dangers, risks, insecurities, or frustrations. Future research is suggested to further explore the role of safety in psychotherapy.

The harmonium model and its unified system view of psychopathology: a validation study by means of a convolutional neural network

The harmonium model (HM) is a recent conceptualization of the unifying view of psychopathology, namely the idea of a general mechanism underpinning all mental disorders (the p factor). According to HM, psychopathology consists of a low dimensional Phase Space of Meaning (PSM), where each dimension of meaning maps a component of the environmental variability. Accordingly, the lower thenumber of independent dimensions in the PSM, and hence its intrinsic complexity, the more limited the way of interpreting the environment. The current simulation study, based on a Convolutional Neural Network (CNN) framework, aims at validating the HM low-dimensionality hypothesis. CNN-based classifiers were employed to simulate normotypical and pathological cognitive processes. Results revealed that normotypical and pathological CNNs were different in terms of both classification performance and layer activation patterns. Using Principal Component Analysis to characterize the PSM associated with the two algorithms, we found that the performance of the normotypical CNN relies on a larger and more evenly distributed number of components, compared with the pathological one. This finding might be indicative of the fact that psychopathology can be modelled as a low-dimensional, poorly modulable PSM, which means the environment is detected through few components of meaning, preventing complex information patterns from being taken into account.

Improving University Students' Mental Health During the COVID-19 Pandemic: Evidence From an Online Counseling Intervention in Italy

Background

The mental health of university students is significantly affected when faced with public health emergencies and requires specific interventions to help support and prevent any long-lasting effects that the pandemic may have on their mental health status. This study aims to evaluate the impact of an online individual counseling intervention provided by the University of Foggia and carried out during the COVID-19 pandemic on the mental health status of a sample of university students.

Methods

32 Italian undergraduate students took part in a one-group pretest-posttest research design. The data was gathered in two times: before the start of the counseling intervention (T1), positive and negative affect, satisfaction with life, global mental distress, anxiety, stress, and future time perspective were collected, at the end of the counseling intervention (T2), the same dimensions were measured. A one-way repeated measures multivariate analysis of variance (MANOVA) was performed, and single Bonferroni-corrected dependent t-tests were conducted on variables showing a significant change over time.

Results

The results showed that positive affect, subjective well-being, and future time perspective increased significantly after the intervention. In contrast, the participants reported significantly lower levels of negative affect, global mental distress, state and trait anxiety, as well as perceived stress over time.

Conclusions

The study demonstrates the promising impact of online counseling intervention and its efficient contribution in promoting the well-being of university students. The results contribute to the ongoing debate concerning the psychological impact of the COVID-19 pandemic on young adults, helping professionals develop more efficient clinical and psychological interventions.

Self-Oriented Empathy and Personality Organisation Level: Insights from a Psychiatric Sample

OBJECTIVE

Empathy functioning is among the criteria to delineate psychiatric diagnosis. However, the self-oriented empathy dimension is almost neglected in the existing literature. On the basis of previous fragmented contributions, we hypothesised that an individual's level of personality organisation is explained by this facet of empathy more than the other components of empathy, both transversally and independently from the specific psychiatric diagnosis.

METHOD

Fifty-nine psychiatric inpatients were evaluated with clinical interviews inspired by the Structured Clinical Interview for DSM-5, completed the Symptom Checklist-90-Revised, and Interpersonal Reactivity Index (IRI). A panel of experts established each patient's psychiatric diagnosis and the level of personality organisation according to DSM-5 and PDM-2. Thirty-two patients were considered functioning at a psychotic level, 27 at a borderline level, and none at a neurotic level. Multinomial models were compared with the corrected AIC to determine if self-oriented empathy, among all IRI subscales, was the best-fitting model for explaining the levels of personality organisation. A further analogue series of models was used to investigate the best IRI subscale to explain each patient's psychiatric diagnosis.

RESULTS

The first series of models revealed self-oriented empathy (IRI personal distress subscale) as the best empathic dimension to explain levels of personality organisation. The second series revealed that none of the four IRI subscales explained psychiatric diagnoses.

CONCLUSIONS

The consistency of our findings with evolutionary concepts pertaining to both traditional psychodynamic models and contemporary models of psychopathology, such as the p factor theory, was illustrated. Despite the many limitations of our consecutive sampling jeopardising the findings' generalisability, the insight of self-oriented empathy as the best predictor of the level of personality organisation, irrespective of psychiatric diagnosis, has several implications from both research and clinical/diagnostic perspectives.