On Theoretical Edges and Exclusionary Borders: Towards a Genealogy of "Analyzability" in Jungian Psychoanalysis1

An oft-repeated and largely unexamined assumption in Jungian psychoanalysis is the notion of "analyzability", that is, of an individual's ability or present capacity to think symbolically. It is often taught that if someone is unable to think symbolically, a depth analysis is not possible. Such an individual may be more aptly suited for supportive psychotherapy, the argument goes, an experience that may very well lead to the development of the ego's capacity for symbolic thought but is not, in and of itself, a Jungian analysis. While this sort of categorical thinking has, at times, crossed over into ontological claims about individuals and groups, the notion of analyzability encountered in psychoanalytic theory and praxis is often cloaked in facially neutral language. The impact, however, has been anything but neutral in effect. In this paper, I propose a softening of our theoretical edges through a genealogy of the category of analyzability within the broader history of psychoanalysis. Through this excavation, I explore the contingent nature of the category of analyzability, how it has constricted knowledge, perpetuated inequality, and, more broadly, obscured ways of knowing. In so doing, I recover the radically democratic potential that lies at the heart of Jungian psychoanalysis.

Spiritual coping within medical professions: A psychometric analysis of the Numinous Motivations Inventory short form

AIM

To examine the psychometric properties of a short form version of the Numinous Motivation Inventory (NMI) for use with healthcare providers in measuring their existential engagement with life and to assess its relationship with spiritual coping and emotional dysphoria.

DESIGN

Correlational and psychometric study.

METHOD

Data were collected from June to December 2022. Participants included 102 physicians, recruited from across the United States. Qualtrics was utilized to collect data, and they were evaluated with the NMI short form, Spiritual Coping Questionnaire and Depression, Anxiety, and Stress scale (DASS-21).

RESULTS

Obtained fit statistics from structural equation modelling analysis indicated close fit of the NMI short form with the original model. Multiple regression analyses demonstrated the value of the NMI as a predictor of negative affect independent of spiritual coping. The NMI did not interact with Spiritual Coping, which was independent of negative affect.

CONCLUSIONS

The Numinous represents an important aspect of physicians' coping. The constructs can be utilized in training and clinical settings as a valuable and easy-to-use metric for promoting and assessing wellness. The implications of these findings and the value of the NMI were discussed.

IMPACT

An understanding of existential drivers can equip one to cope with the stressors of healthcare. The NMI short form has the capability to explore an individual's existential drivers through the understanding of three domains.

REPORTING METHOD

Adhered to proper EQUATOR guidelines (GRRAS).

PUBLIC CONTRIBUTION

No patient or public contribution.

Carl Jung: a life on the edge of reality with hypnagogia, hyperphantasia, and hallucinations

Whether the Swiss psychiatrist Carl Jung (1875-1961) became psychotic after his mid-thirties is much debated. His recently published Black Books, a seven-volume journal, reveal new insights into this debate. Based on a phenomenological analysis of his self-reports in these books and in other writings, we here identify several types of anomalous perceptual experiences: hypnagogic-hypnopompic experiences, hyperphantasia, hallucinations, personifications, and sensed presence. We argue that these experiences were not indicative of a psychotic disorder, but rather stemmed from extremely vivid mental imagery, or hyperphantasia, a condition Jung's contemporaries and later biographers were unable to take into account because it had not yet been conceptualised. Recently, the degree of vividness of mental imagery and its potential to become indistinguishable from regular sense perception has been the subject of extensive studies. Unknowingly, Jung may have foreshadowed this line of research with his psychoanalytic concept of reality equivalence, i.e., the substitution of an external world for an inner mental reality that he encountered in individuals diagnosed with schizophrenia. There is a need for future research to investigate the possible role of hyperphantasia in psychotic experiences, but to Jung, psychosis was 'a failure to contain and comprehend' the content of one's experiences in the context of one's own life, whereas he himself did manage to put the content of his perceptual experiences into context, to find meaning in them, and to share them with others - to great acknowledgement and acclaim.

Fifty Years of Change: A Shared Journey

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.

Developing psychoanalytic case conceptualization skills through didactic teaching: A randomized controlled trial

OBJECTIVE

Time-limited didactic interventions have been shown to be effective in developing "generic" case conceptualization skills. The objective of this study is to test whether similar interventions can be used to develop case conceptualization skills that are "specific" to a treatment modality.

METHOD

University psychology students were randomized to a target (n = 62) or a control group (n = 62). The target group received a training on psychoanalytic case conceptualization skills based on the newly-developed operators model. The control group received a training on generic case conceptualization skills based on the well-established 5 Ps model.

RESULTS

The students' self-efficacy for case conceptualization significantly increased in both groups. However, students in the target group reported a significantly greater increase in psychoanalytic case conceptualization skills and in their ability to make clinical inferences. The teaching method, as well as the case conceptualization models, were acceptable to students. However, the 5 Ps model was significantly more acceptable to students than the operators model.

CONCLUSIONS

This is the first RCT to provide evidence that psychoanalytic case conceptualization skills can be developed through didactic teaching and that they constitute a specific set of skills that are not developed by learning generic case conceptualization skills.

The Listening Guide: Illustrating an underused voice-centred methodology to foreground underrepresented research populations

AIM

To highlight the value of utilizing the Listening Guide methodology for nursing research and provide an exemplar applying this methodology to explore a novel concept in an underrepresented group-inner strength in persons newly diagnosed with mild cognitive impairment along with their care partners.

DESIGN

Methodology discussion paper.

METHODS

The exemplar study used the Listening Guide methods for data elicitation and analysis. Methods included adaptations for the study population and novice qualitative researchers.

RESULTS

The Listening Guide methodology with adaptations enabled the research team to centre the voices of persons living with mild cognitive impairment, highlight an abstract phenomenon and attend to the influences of the sociopolitical context. Further, this methodology helped address common challenges emerging qualitative researchers encounter, including understanding methods of application, engaging reflexively and immersing in the data.

CONCLUSION

The Listening Guide is a voice-centred qualitative methodology that is well suited to foreground the experiences of groups underrepresented in research and explore emerging phenomena.

IMPLICATIONS FOR NURSING

Nurses are central to striving for health equity. The Listening Guide methodology offers a valuable and accessible research tool to understand the experiences and needs of underrepresented groups and shape healthcare in response.

IMPACT

The Listening Guide methodology can be broadly applied to research with persons with mild cognitive impairment, and other underrepresented groups, to explore other phenomena beyond inner strength and move the science forward in representing the perspectives of groups underrepresented by research.

PATIENT OR PUBLIC CONTRIBUTION

Persons living with cognitive impairment and their care partners participated in study conceptualization, interview guide development, methods development and dissemination plans.

Structural Aspects of Synchronistic Moments in Psychotherapy-Findings of an Empirical Study of Synchronicities in Psychotherapy and Psychoanalysis1

Synchronicity describes a meaningful coincidence of events, which is familiar to us from treatments of our patients, but unfortunately has not yet been empirically substantiated. Adding to previous findings that point out beneficial aspects of synchronicity (Marlo, 2022; Lagutina, 2021; Connolly, 2015), in this paper I will show through a series of five synchronistic moments which happened in the context of therapy and analysis and which have been documented empirically, how synchronicities occur and can be used therapeutically. In my research I found several situational factors that can be considered structural aspects of synchronistic moments. Furthermore, I will show that synchronistic phenomena can have a positive influence if certain relational and transference-countertransference referential aspects are considered by the therapist and analyst. The concept of synchronicity brings the possibility of a further therapeutical instrument for the patient-analyst-dyad.

Nightmare experiences and perceived ethnic discrimination amongst female university students in the United Arab Emirates: a cross-sectional study

Perceived ethnic discrimination is known to be associated with anxiety and depression, and in turn, anxiety and depression are known to be associated with nightmare frequency and distress. This elicits a question: is perceived ethnic discrimination associated with nightmare frequency and distress? In this study, 179 female university students from the United Arab Emirates were assessed to answer that question. Results showed that while anxiety and depression were related to nightmare experiences, perceived ethnic discrimination was a stronger predictor of nightmare experiences. We posit two explanations for this finding: one based on psychoanalytical insights, and the other based on the Disposition-Stress model with neurobiological correlates. No significant differences were found across ethnicity when it comes to nightmare experiences or perceived ethnic discrimination. This is an encouraging sign of optimal societal integration in the United Arab Emirates.

A misinterpreted psychoanalyst: Herbert Silberer and his theory of symbol-formation

The primary aim of this article is to give a more detailed exposition of the cultural, personal, and theoretical contexts in which the Viennese psychoanalyst, Herbert Silberer's theories were born. When assessing the broader picture that this approach offers, it can be concluded that Silberer was an innovative thinker who inspired several of his contemporaries. Recognized in many respects by the society and scholars of this time, he represented quite a different viewpoint that was significantly influenced by several forms of Western esoteric thinking. Yet his main aim was to contribute to the field of psychoanalysis and develop a theory in which rationalistic psychoanalytic interpretations were combined with nonreductive approaches to mystical experiences. Silberer's name is frequently mentioned in a specific context in which his tragic suicide is emphasized rather than his innovations. Upon evaluating the materials recording Silberer's private life, it seems very likely that his suicide was not triggered by the criticism of Freud alone. Silberer's family affairs, his relationship with his father, and his financial and professional struggles could have all contributed to his tragic decision. This paper contends that Silberer's oeuvre deserves greater attention and must be evaluated based upon its own merit.

(Post)confessional mode and psychological surveillance in The Crown and Fleabag

Contemporary television's portrayals of psychotherapy reveal anxieties surrounding surveillance and intimate self-disclosure in clinical and therapeutic settings. This paper analyses two twenty-first century television series featuring therapy sessions that observe and monitor mental states for prognostic purposes, engaging in what Alan Westin terms psychological surveillance: Peter Morgan's The Crown (2016-2023) and Phoebe Waller-Bridge's Fleabag (2016-2019). These shows feature contrasting modes of intimate self-disclosure-confessions and postconfessions-that emerge in psychotherapy. The confessional mode emphasises authenticity and a desire for healing. Postconfessions, on the other hand, are a parodical mode of revelation that refuse the authenticity and intimacy elicited by therapy and traditional confessional modes. Confessional discourses in The Crown reveal that state power, reinforced by genetic authentication, can benefit from psychological surveillance. In contrast, Fleabag uses postconfessional discourse to implicate the audience in the therapeutic encounter, capitalising on the increasingly decentralised self-care modalities sustained through social media, television and other audience-driven mediums.

Doing-together with words: the sequential unfolding of a moment of meeting in a psychoanalytic therapy session

Changes in psychoanalytic therapy have been traditionally attributed to self-knowledge (insight) in the client, provided by the therapist's interpretations. In recent years there has been growing realization that such changes can also be the consequence of the development of new forms of relatedness through client-therapist interaction, particularly through special intersubjective moments called moments of meeting. Drawing on the methods and findings of Conversation Analysis about the sequential organization of psychotherapeutic interaction, this single-case study examines the unfolding of a moment of meeting in the final session of a brief psychoanalytic therapy in Peru (in Spanish) with a female client victim of domestic violence. Our analysis shows that the moment of meeting, which resolves a challenge to the intersubjective relationship posed by a now moment, comes about interactionally through a sequentially accomplished shared practice of co-animation. In this sequence the client, who had previously assumed a passive role, exercises her own agency to assume an active role, which the therapist ratifies through his response. In this way, a momentary but significant transformation in the here-and-now relationship between client and therapist occurs. Thus, our analysis contributes to the understanding of how a transformation of relation-the transitory emergence of a new form of relatedness-can take place in and through sequentially organized talk and action in psychotherapy. Our study also sheds light on the role of language in moments of meeting, as the moment of meeting in our segment does not occur in parallel with the exchange of linguistic utterances between client and therapist, but through the exchange of such linguistic utterances and through the sequence of actions carried out by that exchange. In this way, the sequential doing-together with words leads to a moment of meeting, bringing about change, at least momentarily, in the implicit ways-of-being-with-others of the client.

The poisoned father: Jane Campion's The Power of the Dog and the unexpected relevance of Lacan to psychiatric practice

OBJECTIVE

Lacan is often deemed an obscure theorist with little clinical application. However, in film studies his psychoanalytic theory has been highly influential. This paper is part of a series of articles published in this journal accompanying a psychiatry registrar teaching programme on film and psychodynamic concepts. It introduces the Lacanian ideas of the Symbolic, Imaginary and Real as they appear in Jane Campion's The Power of the Dog, and discusses their societal and clinical significance.

CONCLUSIONS

A Lacanian reading of Power of the Dog offers insights into 'toxic masculinity'. Furthermore, it demonstrates how clinical symptoms can represent an escape from socially mediated toxicities.

The Alchemical Oedipus: Re-Visioning the Myth

The Oedipus myth is foundational to depth psychology due to Freud's use of Sophocles' play Oedipus Rex in the creation of psychoanalysis. But analytical psychology's engagement with the myth has been limited despite the importance Jung also places upon it. The absence of a developed Jungian response to Oedipus means the myth's psychologically constructive elements have been overlooked in favour of reductive Freudian interpretations. I examine whether analytical psychology can fruitfully re-engage with Oedipus by reinterpreting his story as a paternal rebirth. This is achieved by reincorporating those parts of the myth that occur before and after the period portrayed in Oedipus Rex. Such a move reintegrates Oedipus' father, King Laius, into the story and unveils important parallels with the alchemical trope of the king's renewal by his son. Using Jung's method of amplification, Oedipus is recast as Laius' redeemer and identified with the archetype of psychological wholeness, the Self. The contention is that such an understanding of Oedipus supports a clearer recognition of the potentially generative quality of human suffering, restoring to the myth the quality of moral instruction it possessed in antiquity.

Joint family consultations for psychiatric inpatients with severe eating disorders transitioning to adulthood: psychoanalytic design of a therapeutic setting

While family work is acknowledged as relevant in the care of eating disorders (EDs), not much literature has explored it in the period of transition from adolescence to young adulthood (16-18 to 30 y.o.). Yet this period is of significant importance in the prognosis and evolution of EDs; but its particular stakes require specific therapeutic settings-especially for inpatient EDs. In this paper, we start from the paradoxical observation that some families refuse this type of work in its usual form, with a family-dedicated therapist, and require to only exchange with the psychiatrist in charge of the treatment plan. We use a psychosomatic-informed psychoanalytic approach to shed light on this refusal as a latent denial of the contribution of family dynamics to the current symptom, and an unconscious tendency to stick to a dependency-laden family scheme. We then explain the conception of a specifically dedicated therapeutic setting, designed to address this specific type of resistance, offered to families as a therapeutic compromise designed to give them a specific position in the care of their child. In our joint therapeutic consultations, family dynamics are addressed on the basis of exchanges regarding treatment and in particular feeding. While such exchanges start from medical considerations, the therapeutic couple (psychiatrist-psychologist) uses them to address the parent and patient expectations underlying the symptom. We propose to call this act "inscription"; it enables a separation from the underlying dependency-oriented family scheme, while stressing the importance to care for associated parental anxieties.

The Reception of Lacanian Theory and Practice by American Psychoanalytic Training Programs

This paper explores the principal reasons for the exclusion of Lacanian ideas from psychoanalytic training institutes in the United States. The history of Lacan's role in the International Psychoanalytical Association, from which essentially he was expelled, occupies a central place in this story. Significant issues arose also from his practice style and technical innovations, whose rationale remains controversial today. Another major obstacle for the reception of his work is the theoretical framework of Lacanian analysis, so different from that of other schools. Inclusion of its unfamiliar vocabulary and concepts poses practical problems for training programs. At a more fundamental level, the strong antihumanist evolution of Lacan's thought runs contrary to the increasingly relational and intersubjective orientation of American psychoanalysis. The incompatibility between the disparate languages of a scientific theory aiming at objectivity and a phenomenology of personal intentionality and meaning greatly limits the possibilities for dialogue. The tension between these perspectives cannot be resolved, but a productive exchange between them is possible if they are accepted as valid and complementary ways of speaking about human behavior.

[Les demoiselles de Rochefort, or a clinical illustration of madness in pairs]

Although folie à deux is a confidential entity that has disappeared from psychiatric textbooks and is disguised in current international classifications of mental disorders, which tend to obscure the fundamental notion of the dyad, recent case reports highlight the topicality of the disorder. The richness of the clinical encounter with twin sisters, presenting a common delusion of parasitic infestation, may prompt us to question the disorder differently, guided in particular by ancient writings and the analytic compass.

An Introduction and Brief Overview of Psychoanalysis

The field of psychology has been shaped by the views and perspectives of Sigmund Freud and his former students: Carl Jung, Alfred Adler, Erik Erikson, and Karen Horney. These psychologists and their respective schools of thought provide distinct views on psychology and influences on personality and psychosocial development. The foundation for psychoanalysis was laid by Freud, his work on the unconscious mind, and his emphasis on early childhood experiences. His students also made substantial contributions that expanded, sharpened, and challenged his theories. This review will begin by highlighting the work of Sigmund Freud; it will then compare his theories with the theories of his students. This review will introduce and bring attention to the most important figures of psychoanalysis and give a brief overview of their theories.

The use of an object: exploring physician burnout through object relations theory

The crisis of physician burnout has been widely and repeatedly reported across the mainstream press and medical journals around the world, in the closing years of the second decade of the 21st century. Despite multiple systematic reviews and commentary on the scale of this 'global epidemic', understandings of both the phenomenon and the most effective interventions remain limited. Practice-based medical humanities represents the collaborative sharing of conceptual tools for understanding illness and clinical practice and the shouldering of responsibility for mapping the shape of care, in all its local, national and global contexts, thinking-with rather than critique on the profession and its practices. In keeping with this approach, this article offers a new perspective on the contemporary crisis of physician burnout by exploring the objectification of the clinician's body within the systems and practice of healthcare. Within the context of medical humanities' scholarship, discussions of objectification usually navigate towards a discussion about patient identity and its potentially reductive objectification within the frameworks of biomedical science. However, this article crosses the cultural divide between clinician and patient, and comes to focus on the objectification of the clinician herself, using object relations theory from the field of psychoanalysis to excavate the psychodynamics of care and their impact on clinicians, and the systems of healthcare in which care is delivered.

Psychoanalytic Contributions to Psychodynamic Psychiatry and Psychotherapy: Freud's Structural Hypothesis

Psychoanalysis has long lost its historical influence on U.S. academic psychiatry. Psychoanalytic theory, however, provides us with a rich and remarkably comprehensive knowledge of human development, both normative and pathologic. This article describes a psychoanalytic concept that enriches our understanding of the mind and its disorders: Freud's structural hypothesis. This core concept provides a theoretical foundation for understanding the clinical features of both neurotic and personality disorders. It also informs a psychodynamic psychotherapy.

'Freudism' and modernity: transcultural impact of psychoanalysis in the modern Turkish novel

The theory of psychoanalysis came to Turkey in the early 1900s, but it was dismissed as being unmedical in a psychiatric context shaped by the Kraepelinian model. Still, it rapidly entered the intellectual discourses of the period, and in literature, it became a contact zone to discuss broader issues concerning the modernisation of the country. Novelists in particular undertook a critique of its epistemology to explore what they deemed the conflictual relationship between the native values and the westernising attitudes as broadly conceived at the time. Two early examples of such novelistic engagements with psychoanalysis are Peyami Safa's Matmazel Noraliya'nın Koltuğu and Ahmet Hamdi Tanpınar's Saatleri Ayarlama Enstitüsü This article focuses on the novelists' engagement with psychoanalysis in their critique of the modernisation project adopted in Turkey through the theme of the 'self-in-crisis'. Both texts contribute to the broader discussions of their milieu in a way that presents psychoanalysis as being representative of that which is modern and portray it critically to underline the dissonances between the old, traditional values and the new, imported ones.

A Psychoanalytic Approach to Internet Gaming Disorder

BACKGROUND

Internet Gaming Disorder (IGD) is now an official diagnosis and significant public health challenges have been already identified regarding the provision of appropriate care to patients of all ages and the preparedness of mental health professionals to manage the disorder. Despite the existence of psychotherapeutic treatment modalities available for some time now, there is a paucity of any psychoanalytically driven treatments and the disorder is widely regarded and classified as being 'behavioral'. This has profound implications for patients with long-standing character pathology and psychiatric comorbidities, who are underserved by the provision of health services that could efficiently address their issues.

METHODS

This study presents a psychoanalytic perspective on IGD, based on Kohut's Self Psychology as applied in the treatment of other addictions. An outline of the theory, assessment and treatment modalities is presented with two case reports that illustrate its application.

RESULTS

The presentation outlines the challenges in treating IGD, expanding on the concept of guided imagery, resistance to treatment, selfobject transference and comorbidity with marijuana use and bipolar disorder.

CONCLUSIONS

A psychoanalytically driven protocol can be effective in treating IGD, especially in cases with marked character pathology and low motive to engage in other treatment modalities.

Cross-cultural, transnational or interdisciplinary? Eric Wittkower's psychosomatic medicine and transcultural psychiatry in historical context

This article traces the career, scientific achievements, and emigration of the Berlin-born physician, psychoanalyst, and psychosomatic researcher Eric Wittkower. Trained in Berlin and practicing internal medicine, he became persecuted by the Nazi regime and, after fleeing Germany via Switzerland, continued his professional career in the United Kingdom, where he turned to psychosomatic medicine and worked in the service of the British Army during World War II. After two decades of service in the UK, Wittkower joined McGill University in Canada. His increasingly interdisciplinary work contributed to the establishment of the new research field of transcultural psychiatry. Finally the paper provides a detailed history of the beginning of the section of transcultural psychiatry at the Allan Memorial Institute.

Limits on Love: A Critical Discourse Analysis of Psychoanalytic Texts

Critical discourse methodology and a Black feminist lens were used to examine the discourse of contemporary psychoanalysis, specifically to investigate the relationship between language, love, and power. Findings of the analysis include the following. The discourse encourages engagement with linguistic shortcuts, wherein concepts such as oppression and bigotry are used as conduits to discuss intrapsychic experiences. The discourse frames whiteness as the center of experience and marginalizes Blackness, Indigenousness, and other nonwhite perspectives. The discourse is vague about what constitutes love and what place love should have in clinical work. Ultimately, the discourse of the texts in this analysis suggests there is more work to do, more areas in the discipline to disrupt, and more love to give.

Pragmatism or idealism: a systematic review and visual analysis of Winnicott's psychoanalytical treatment views

Winnicott is an outstanding representative of the School of Object Relations, and his unique psychoanalytic treatment views have been greatly influential to the psychoanalytical community. Winnicott emphasizes the impact of facilitating environment and the key role of the maternal-child relationship in the early psychological growth of individuals. He puts forward the ideas of the development mechanism of the true self and the false self, which builds a bridge between the characteristics of adult psychopathology and the characteristics of early maternal-child relationships, providing a new perspective for research on individual self-development and psychoanalysis. Winnicott creatively introduces the concepts of the transitional object and the transitional phenomena into the theories of Object Relations. He relates the transitional experience to the field of mental health, and extends it from the relationship between the mother and the child to adult life, which not only has had a revolutionary impact on modern psychoanalysis but also literature, aesthetics, and other fields. Winnicott highlights the importance of the patient's emotional development in the treatment. He advocates holding the patients' sentiments and meeting their emotional needs. He also approves of the emotional reparenting of the patients, to make them gain the ability to establish a relationship with the real world. His treatment views formed through a large number of clinical practices are very practical and full of humanistic care. This review summarizes Winnicott's psychoanalytical treatment views as well as his marvelous original concepts, and analyzes the hot topics of academic research on his theories based on a visualization analysis by using the software CiteSpace, which includes data in the Web of Science Core Collection published from 1978 to 2023 with 365 papers involved. The study provides a macroscopic and panoramic review of Winnicott's theories, and it clearly shows Winnicott's significant influence on the field of psychoanalysis and related fields.

The Development of Psychodynamic Psychiatry in Iran

Iran, as one of the oldest civilizations in the world, is positioned at the crossroads of important trade routes linking Asia, Africa, and Europe, resulting in enormous cultural interactions with the East and West. The development of modern psychiatry and psychodynamic psychiatry in Iran occurred in the context of the broader process of modernization through interactions with the West. Mentioning key scholars and influences that helped establish a psychodynamic tradition within centralized government-led systems of mental health care and medical education, the author describes various stages of the development of psychodynamic psychiatry in Iran.

Free-Association Session Scale: factor structure and preliminary validity test

One of the main concepts of the psychoanalytic method postulated by Freud in 1912 is the fundamental rule, which involves asking the patient to say whatever comes to mind as the analyst follows the patient's speech with fluctuating attention. Despite different theoretical models, this concept has remained an invariant element that characterizes the psychoanalytic method. For this reason, the purpose of the current study is to present a new instrument that measures this process based on the clinician's assessment. The Free-Association Session Scale (FASS) has been designed according to the psychoanalytic framework. Study 1 presented the preliminary validation of the FASS factor structure. Experienced Italian psychoanalysts (N = 281; 196 women) completed the FASS and sociodemographic questionnaire. The following two factors were identified using exploratory factor analysis: (1) Perturbing, and (2) Associativity. Study 2 cross-validated the two factors using an independent sample (N = 259; 187 women) of experienced psychoanalysts and confirmatory factor analysis (CFA). The FASS has been tested for concurrent validity using the Session Evaluation Questionnaire (SEQ) and Linguistic measures of the Referential process. The two-factor model achieved a close-fit test, and the FASS items were found to measure the corresponding factors with good reliability. The Perturbing factor is negatively associated with three SEQ factors (Depth, Smoothness, and Positivity) and negatively correlated with symbolization (IWRAD and IWRAD_IWRRL), confirming a more complex and unexpected session. The Associativity factor is positively associated with all four SEQ factors (Depth, Smoothness, Positivity, and Arousal). In conclusion, the FASS is a promising new questionnaire for assessing psychoanalytic session quality processes with satisfactory validity and reliability.

A clinical seminar on Spinoza and Bion: a conversation between Miller AND Koritar

The present transcript follows an online discussion held on April 3, 2022, between Ian Miller, author of Clinical Spinoza: Integrating His Philosophy with Contemporary Therapeutic Practice (2022), and Endre Koritar.

Case report: Suicide and inhibitions of thinking-An integrative view from traditional psychoanalytic and mentalizing perspectives

Suicide has been the subject of exploration in psychoanalysis. From Freud's internalized aggression and self-objectification in melancholic depression to contributions from object relation and self-psychology theorists, several of these central clinical concepts seem to share the commonality that one encounters an inhibition of thinking in a suicidal state of mind. Their freedom of thought is inhibited unswervingly despite the notion that we are born to think. Most psychopathologies, including suicide, relate to how we are often stuck with our thoughts. Thinking beyond this sense comes with significant emotional resistance. This case report follows through an attempt to integrate the hypothesized inhibitions on one's capability to think, involving one's own core conflicts and dysfunctional mental processing from the traditional psychoanalytic and mentalizing perspectives. The author hopes that further conceptualizations and research will empirically investigate these assumptions, potentially improving suicide risk assessment and prevention and enhancing psychotherapeutic outcomes.

Social Withdrawal in Preschool Age: A Clinical Case in Intensive Psychoanalytic Psychotherapy

In this work, we suggest that children's social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori).

Psychoanalysis of COVID-19 Patient Narratives: A Descriptive Study

Background and Objectives: COVID-19 patients are a psychologically vulnerable patient group who suffer from both physical symptoms and psychological problems. The present study is a psychoanalytic investigation of COVID-19 patients utilizing Lacan's desire theory. We aimed to explore the manner in which patients' desire is presented in their lived experience narratives and sought to discover factors which directly impacted on this process. Materials and Methods: In-depth semi-structural interviews were conducted with 36 COVID-19 patients in China. During each interview, participants narrated their lived experiences of COVID-19 infection. Emotions, metaphors, and behaviors in patient narratives were collated as the main points for psychoanalysis. Results: Our findings demonstrated that the desire for being a healthy person made patients emotionally sensitive to the social environment. Anxiety and obsessive behaviors emerged in the process, which reveals their desire for that which they lack. Furthermore, public fear with respect to COVID-19 was somehow converted to psychological pressure on COVID-19 patients. Thus, these patients attempted to "de-identify" their identity as "patients". Positive responses of COVID-19 patients to the external world included admiring medical personnel, government, and country, while negative responses included interpersonal conflicts or complaints about discrimination. Following the rules of the Other, COVID-19 patients were influenced by the Other's desire in constructing their own image of a healthy person. Conclusions: This study revealed COVID-19 patients' psychological need to rid themselves of the identity of "patient" at the individual and social level. Our findings have clinical implications in helping COVID-19 patients to reshape their identity and to live a normal life.

Uncanny Teletherapy: Working with Extimacy

Responses to the question of teletherapy have multiplied over the past decades, yet many therapists are grappling with the challenges and opportunities of teletherapy for the first time in the wake of the Covid-19 pandemic. For many clinicians, teletherapy was, at least initially, unfamiliar and unsettling. Much of the literature construes teletherapy as a degradation of an original-incapable of providing the intimacy achieved and maintained in two-bodies-in-a-room therapy-or as a good enough simulation. Both positions risk enshrining the consulting room as offering an unmediated scene of therapy. An alternative approach to the strangeness, distance, and mediations so prominent in the transition to teletherapy takes up a qualified sense of Freud's concept of the uncanny: the "minimal uncanny" and its reformulation in Lacanian theory as extimacy, a lens through which to explore intimacy and bodily proximity in the transition to teletherapy. Through the logic of extimacy, a theoretical view emerges that approaches teletherapy not as a poor substitute for real therapy, or a good enough substitute, but as an exemplary case of the therapeutic encounter.

TRAUMA AND THE DISRUPTION OF TEMPORAL EXPERIENCE: A PSYCHOANALYTICAL AND PHENOMENOLOGICAL PERSPECTIVE

A deep understanding of the subjective experience of time in traumatized individuals may require a comprehensive framework that takes into account both psychoanalytic and phenomenological contributions. Referring to the retroactive interpretation of past experiences, the concept of Nachträglichkeit is critical to analyze how trauma can be signified in the form of the après-coup, in which the original traces of traumatic experiences are signified only at a later time. Trauma alters the temporal sequence of past, present, and future, thus leaving the psyche in a time-shifted dimension, where the shadow of the past extends over the present, and the unbearable present hinders growth and development. A clinical vignette is presented to illustrate how trauma can disrupt the temporal nature of subjective experience by reshaping the meaning of psychic events. Ultimately, trauma treatment aims at inscribing the person's experience into a unified and coherent self-narrative.

12 Psychiatrists who Shaped Psychiatry in Turkey in the Republic's First Century

Who are the influential figures that molded Turkish Psychiatry into what it is today? This review introduces 12 psychiatrists who shaped psychiatry in Turkey during the first century of the Republic. The article presents Rasit Tahsin, the first neuropsychiatrist who establish an academic psychiatry department in Turkey; Mazhar Osman, who had so much influence that his name became a phrase to describe the mentally ill, and still lives on with the institutions he built; Ihsan Sukru, the founder of neuropathology in Turkey, a historical figure in viral encephalitis research; Fahrettin Kerim Gokay, famous for his political career and his fight against alcohol and tobacco; Rasim Adasal, a Cretian who is a cornerstone in Ankara psychiatry and a well-known figure in Turkish society life; Abdulkadir Ozbek, who introduced psychodrama to Anatolia-his 'earth'; Leyla Zileli, who disseminated psychoanalysis from Ankara to Turkey; Orhan Ozturk, a founding figure for the Journal, the Association, and Hacettepe; Ayhan Songar, a prominent figure in society and also in state bureaucracy; Ozcan Koknel, the amiable face of psychiatry in society and a respected voice; Oğuz Arkonaç, a vigorous advocate for the establishment of contemporary psychiatry with DSM III in Bakırköy and then in Turkey; and Gunsel Koptagel-Ilal, who progressed the work in the psychosomatics as one of Turkey's first female psychiatry academics. As with any list, we acknowledge that absolute consensus is not possible; we are preparing a more extensive selection to be published as a book next year. We present our selection to your liking, hoping that one or more of our colleagues reading this article will be included in the selection for the next century, reflecting our collective conscious creation of psychiatry in Turkey. Keywords: Neuropsychiatry, History, Medicine, Turkey, Psychoanalysis, Psychosomatics.

Recovery from chronic depression and structural change: 5-year outcomes after psychoanalytic and cognitive-behavioural long-term treatments (LAC depression study)

OBJECTIVE

Psychotherapy of chronic depression has remained a challenge due to limited prognosis and high rates of recurrence. We present 5-year outcome data from a multicentre trial comparing psychoanalytic (PAT) and cognitive-behavioural (CBT) long-term treatments with randomized and preferred allocations analysing symptom (N = 227) and structural change (N = 134) trajectories.

METHOD

Self- and blinded expert ratings of depression symptoms were performed at yearly intervals using the Beck Depression Inventory-II (BDI-II) and Quick Inventory of Depressive Symptoms (QIDS-C). Blinded expert ratings of Operationalized Psychodynamic Diagnosis (OPD) and the Heidelberg Restructuring Scale (HRS) at baseline, 1, 3, and 5 years assessed structural change in a subsample.

RESULTS

Lasting and comparable symptom changes were achieved by PAT and CBT. However, compared to CBT, PAT was more successful in restructuring, a major goal of long-term psychodynamic treatments with high frequency and duration.

LIMITATIONS

Due to practical reasons, the time criterion for chronic depression of an acute phase had to be defined for over 1 year in the present study, which does not correspond to the DSM-5 criterion of 2 years. Therapy duration and session frequency were not incorporated into the statistical models.

CONCLUSION

Long-term psychotherapy helps patients with a yearlong history of depression and often multiple unsuccessful treatment attempts to achieve lasting symptom changes. Future follow-up will clarify whether restructuring promotes further sustainable improvements.

Back to basics: A re-evaluation of the relevance of imprinting in the genesis of Bowlby's attachment theory

Attachment theory is one of the key theoretical constructs that underpin explorations of human bonding, taking its current form in John Bowlby's amalgamation of ideas from psychoanalysis, developmental psychology and ethology. Such a period of interdisciplinary exchange, and Bowlby's interest in Lorenz' concept of imprinting in particular, have been subject to rather historical and biographical studies, leaving a fine-grained theoretical scrutiny of the exact relationship between imprinting and attachment still pending. This paper attempts to remedy such an omission by exploring the relationships between these two constructs. It critically reviews the theories of imprinting in general, of human imprinting in particular, and of attachment; analysis of the links between these processes bring to the foreground the distinction between supra-individual vs. individual aspects of bonding, the relevance of 'proto-attachment' phases before 'proper' Bowlbyan attachment is attained, and the role of communicative signals during such early phases. The paper outlines potential benefits of considering such elements in the study of early social cognition, particularly in respect of the study of the gaze and the infant-directed communicative register.

Neural correlates of psychodynamic and non-psychodynamic therapies in different clinical populations through fMRI: A meta-analysis and systematic review

Background

The COVID-19 pandemic has exacerbated the ongoing crisis in psychiatric and psychological care, contributing to what we have identified as a new psychological and psychiatric pandemic. Psychotherapy is an effective method for easing the psychological suffering experienced also by the various impacts of COVID-19. This treatment can be examined from a neurological perspective, through the application of brain imaging techniques. Specifically, the meta-analysis of imaging studies can aid in expanding researchers' understanding of the many beneficial applications of psychotherapy.

Objectives

We examined the functional brain changes accompanying different mental disorders with functional Magnetic Resonance Imaging (fMRI), through a meta-analysis, and systematic review in order to better understand the general neural mechanism involved in psychotherapy and the potential neural difference between psychodynamic and non-psychodynamic approaches.

Data sources

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were employed for our systematic review and meta-analysis. We conducted a computer-based literature search, following the Population, Intervention, Comparison and Outcomes (PICO) approach, to retrieve all published articles in English regarding the above-described topics from PubMed (MEDLINE), Scopus, and Web of Science.

Study eligibility criteria participants and interventions

We combined terms related to psychotherapy and fMRI: ("psychotherapy" [All Fields] OR "psychotherapy" [MeSH Terms] OR "psychotherapy" [All Fields] OR "psychotherapies" [All Fields] OR "psychotherapy s" [All Fields]) AND ("magnetic resonance imaging" [MeSH Terms]) OR ("magnetic"[All Fields] AND "resonance"[All Fields] AND "imaging"[All Fields]) OR ("magnetic resonance imaging"[All Fields] OR "fmri"[All Fields]). We considered (1) whole brain fMRI studies; (2) studies in which participants have been involved in a clinical trial with psychotherapy sessions, with pre/post fMRI; (3) fMRI results presented in coordinate-based (x, y, and z) in MNI or Talairach space; (4) presence of neuropsychiatric patients. The exclusion criteria were: (1) systematic review or meta-analysis; (2) behavioral study; (3) single-case MRI or fMRI study; and (4) other imaging techniques (i.e., PET, SPECT) or EEG.

Results

After duplicates removal and assessment of the content of each published study, we included 38 sources. The map including all studies that assessed longitudinal differences in brain activity showed two homogeneous clusters in the left inferior frontal gyrus, and caudally involving the anterior insular cortex (p < 0.0001, corr.). Similarly, studies that assessed psychotherapy-related longitudinal changes using emotional or cognitive tasks (TASK map) showed a left-sided homogeneity in the anterior insula (p < 0.000) extending to Broca's area of the inferior frontal gyrus (p < 0.0001) and the superior frontal gyrus (p < 0.0001). Studies that applied psychodynamic psychotherapy showed Family-Wise Error (FWE) cluster-corrected (p < 0.05) homogeneity values in the right superior and inferior frontal gyri, with a small cluster in the putamen. No FWE-corrected homogeneity foci were observed for Mindful- based and cognitive behavioral therapy psychotherapy. In both pre- and post-therapy results, studies showed two bilateral clusters in the dorsal anterior insulae (p = 0.00001 and p = 0.00003, respectively) and involvement of the medial superior frontal gyrus (p = 0.0002).

Limitations

Subjective experiences, such as an individual's response to therapy, are intrinsically challenging to quantify as objective, factual realities. Brain changes observed both pre- and post-therapy could be related to other factors, not necessary to the specific treatment received. Therapeutic modalities and study designs are generally heterogeneous. Differences exist in sample characteristics, such as the specificity of the disorder and number and duration of sessions. Moreover, the sample size is relatively small, particularly due to the paucity of studies in this field and the little contribution of PDT.

Conclusions and implications of key findings

All psychological interventions seem to influence the brain from a functional point of view, showing their efficacy from a neurological perspective. Frontal, prefrontal regions, insular cortex, superior and inferior frontal gyrus, and putamen seem involved in these neural changes, with the psychodynamic more linked to the latter three regions.

The critical periods of cerebral plasticity: A key aspect in a dialog between psychoanalysis and neuroscience centered on the psychopathology of schizophrenia

Through research into the molecular and cellular mechanisms that occur during critical periods, recent experimental neurobiological data have brought to light the importance of early childhood. These have demonstrated that childhood and early environmental stimuli play a part not only in our subjective construction, but also in brain development; thus, confirming Freud's intuition regarding the central role of childhood and early experiences of the environment in our psychological development and our subjective outcomes. "Critical periods" of cerebral development represent temporal windows that mark favorable, but also circumscribed, moments in developmental cerebral plasticity. They also vary between different cortical areas. There are, therefore, strictly defined temporal periods for learning language, music, etc., after which this learning becomes more difficult, or even impossible, to acquire. Now, research into these critical periods can be seen as having a significant part to play in the interdisciplinary dialog between psychoanalysis and neurosciences with regard to the role of early experiences in the etiology of some psychopathological conditions. Research into the cellular and molecular mechanisms controlling the onset and end of these critical periods, notably controlled by the maturation of parvalbumin-expressing basket cells, have brought to light the presence of anomalies in the maturation of these neurons in patients with schizophrenia. Starting from these findings we propose revisiting the psychoanalytic theories on the etiology of psychosis from an interdisciplinary perspective. Our study works from the observation, common to both psychoanalysis and neurosciences, that experience leaves a trace; be it a "psychic" or a "synaptic" trace. Thus, we develop a hypothesis for an "absence of trace" in psychosis; reexamining psychosis through the prism of the biological theory of critical periods in plasticity.

Hyperactivity of the default mode network in schizophrenia and free energy: A dialogue between Freudian theory of psychosis and neuroscience

The economic conceptualization of Freudian metapsychology, based on an energetics model of the psyche's workings, offers remarkable commonalities with some recent discoveries in neuroscience, notably in the field of neuroenergetics. The pattern of cerebral activity at resting state and the identification of a default mode network (DMN), a network of areas whose activity is detectable at baseline conditions by neuroimaging techniques, offers a promising field of research in the dialogue between psychoanalysis and neuroscience. In this article we study one significant clinical application of this interdisciplinary dialogue by looking at the role of the DMN in the psychopathology of schizophrenia. Anomalies in the functioning of the DMN have been observed in schizophrenia. Studies have evidenced the existence of hyperactivity in this network in schizophrenia patients, particularly among those for whom a positive symptomatology is dominant. These data are particularly interesting when considered from the perspective of the psychoanalytic understanding of the positive symptoms of psychosis, most notably the Freudian hypothesis of delusions as an "attempt at recovery." Combining the data from research in neuroimaging of schizophrenia patients with the Freudian hypothesis, we propose considering the hyperactivity of the DMN as a consequence of a process of massive reassociation of traces occurring in schizophrenia. This is a process that may constitute an attempt at minimizing the excess of free energy present in psychosis. Modern models of active inference and the free energy principle (FEP) may shed some light on these processes.

Psychoanalysis and Neuropsychological Explanations

Psychoanalysis is an explanatory science, and if our aim is to develop accurate theories of the mind, psychoanalysis would benefit from integrating explanations developed by psychology and neuroscience. The main part of the essay shows how psychoanalysis can be integrated with neuroscience and psychology. The concept of integration is defined in terms of six criteria, and the author argues that no matter how tight the integration is, it does not entail that neuropsychological explanations can replace psychoanalytic theory.

In our own words: key terms and trends in psychoanalytic history

Inspired by the work of Fonagy (2008) and Dent and Christian (2019), this study applies a form of quantitative textual analysis to 300 terms of psychoanalytic interest in the PEP archives by tracking their historical prevalence in five-year increments using the aggregate number of articles featuring each term in the field's journals. Our results confirm some of the more well-known inflection points in the history and application of psychoanalytic theory, while also revealing some intriguing surprises. Psychoanalysis remains fundamentally a depth psychology, yet it has increasingly acknowledged the external causes of distress and trauma. Changes in the prevalence of terminology around psychopathology, defense mechanisms, development, gender and sexuality, and psychoanalytic technique are discussed.

Safety: From the Paris Morgue to Oxytocin

On Tuesday April 21, 1896, Freud gave a lecture to the Viennese medical community arguing that "hysteria," as it was then known, was caused by memories of actual physical and sexual abuse suffered in childhood. Freud rightly felt that he had made a major discovery about the science of hysteria, of psychotherapy, and of the mind. However, his idea was ridiculed. Freud's reaction to his detractors was swift: "They can go to hell." Freud withdrew "into a cocoon." When he emerged a year later, he brought with him a new science-the "science" of psychoanalysis, which for all its creativity and imagination, was devoid of science. One of the core concepts that would be sacrificed was safety itself. The "reality" of safety (and thus the reality of danger) was replaced by the "phantasy" of safety (and thus the phantasy of danger). This article reexamines some of the science that psychoanalysis took out. In particular the article looks at early attachment, safety, oxytocin, and the role of the autonomic nervous system. The reintroduction of science to psychotherapy is critical if psychotherapy is to be a science of the mind.

Psychoanalysis and Psychodynamic Psychiatry in Germany

The authors relate the complex and eventful history of psychoanalysis and psychodynamic psychiatry in Germany. After highlighting Wilhelm Griesinger's pioneering efforts, they describe the founding of the first psychoanalytic associations and their evolution under National Socialism and during the post-World War II period. They discuss the contributions of Günter Ammon, the state of psychoanalysis and psychodynamic psychiatry in Germany, current trends, and future directions.

Wilhelm Reich and Sexology from Below

One of sexologist Wilhelm Reich's most ambitious and enduring theories claims that sexuality and sexual repression play a central role in the production and reproduction of class structures and hierarchies. From 1927-1933, Reich combined his sexological work with his communist political convictions in a movement that became known as sex-pol. Reich developed some of his most provocative and potentially emancipatory theories through this empirical work with members of working-class communities. Though they often remain anonymous in his writings, the traces of their voices remain audible throughout. In this paper, I employ a Gramscian method, developed by post-colonial scholars, to read for the trace of proletarian voices in Reich's archive. I argue that these subjects helped to theorize the role of sex in producing and reproducing class oppression. Reading for the trace of proletarian voices in the archive expands our understanding of how working-class subjects in early twentieth-century Germany and Austria helped to produce concrete sexological knowledge from below.