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Open Dialogue had some of its origins in the need-adapted approach to psychosis developed by Yrjo Alanen and colleagues in Finland. These services were led by a psychotherapeutic attitude influenced by psychoanalytic understandings of psychosis and achieved good results. This chapter looks at some probable unstated links between Open Dialogue and psychoanalysis and speculates that if Open Dialogue practitioners learned more about unconscious processes this would facilitate the meaning making of psychotic phenomenology in their work. An example is given of therapy with a person with unconscious destructive and envious processes which seriously interfere with relationships.

Christopher Bollas begins his latest book by revealing that at the time when he was studying history and Puritan ‘miscreants’ at University and was also ‘caught up in the passions of the Free Speec...

I offer some psychoanalytic perspectives and hypotheses to contribute to understanding why family interventions are rarely offered in psychosis. This is despite decades of evidence that family difficulties often predate onset of psychosis and that skilled family interventions are at least as effective as medication in reducing relapse rates. I contend that it is often unbearably disturbing for some families to even consider the possibility of having contributed to the vulnerability of a member to psychosis and that professionals fear accusations of ‘blaming’. Multisystem defences, involving both families and professionals, shift explanations for psychosis, reducing them as a disorder of brain chemistry and somewhat exclusively allowing the logical consequence that only pharmacological interventions ‘make sense’. I summarize the unfortunate consequences of these defences and suggest that there is denial of the important difference between describing possible family environmental contributing factors in psychosis and attributing ‘blame’. Whole team training that involves families and social networks in a highly respectful and humane manner overcomes some of these obstacles. Several decades of increasingly successful research in the Finnish psychodynamically orientated ‘need-adapted approach to psychosis’ resulting in recent more global interest in open dialogue indicate an effective way of engaging families and of achieving superior outcomes in returning individuals to social engagement as students or to employment.

There is limited empirical evidence as to how psychodynamic therapy should be conducted when working with people who experience psychosis. We describe here a three stage Delphi study exploring the degree of consensus about this among an international group of experienced psychotherapists. Of the 52 participants who received the survey questionnaire, 41 (78.8%) responded in the first round and 30 (57.6%)responded in the second. The participants agreed on many aspects of therapy, including aspects of classical technique (e.g. requirement for consistent setting) and some supportive modifications (e.g. therapists not restricting themselves to remaining emotionally neutral), but consensus was not received for other supportive modifications (e.g. guiding the patients if they are unsure of what to talk about). Participants commented that the technique should be adapted to individual needs. We believe that the findings have implications for therapy and research.

SummaryThe UK National Institute for Health and Care Excellence guidance suggests that psychodynamic principles may be used to understand the experiences of people with psychosis. In this article we consider the application of psychodynamic principles in psychotherapy for psychosis, focusing on one particular model: supportive psychodynamic psychotherapy (SPP). We describe this approach with a detailed fictitious case example and discuss how SPP has developed through significant modifications of classical psychoanalytic therapy and the evidence base for it. We consider its overlap with cognitive–behavioural therapy, its advantages and disadvantages, and the arguments for making SPP available as a treatment option in services for psychosis.

SummaryWe try to demonstrate that using psychodynamic principles as part of case formulation is both possible and useful in everyday practice. We consider steps to developing a psychodynamically informed formulation, frameworks that can be used to structure this, and processes and resources needed to support good-quality formulation. We discuss the potential value of incorporating psychodynamic thinking and emphasise that this is complementary to other frameworks for understanding psychosis. Detailed case studies are provided.

Alcuni recenti editoriali del British Journal of Psychiatry hanno argomentato che la psichiatria sta attraversando una crisi, e che tra le soluzioni vi sarebbe un rafforzamento della sua identita come essenzialmente "neuroscienza applicata". Senza sminuire l’importanza delle neuroscienze e della psicofarmacologia, gli Autori sostengono che la psichiatria deve superare l’attuale paradigma tecnologico dominante. Questo rifletterebbe maggiormente le evidenze empiriche e servirebbe anche a rafforzare una collaborazione piu significativa col movimento degli utenti dei servizi psichiatrici. Vengono presi in rassegna vari studi controllati randomizzati (RCT) che mostrano l’efficacia degli interventi non specifici e non tecnologici.

SummaryThis article outlines common psychodynamics in psychosis. We consider psychosis as a response to unbearable aspects of reality and illustrate how psychodynamic concepts of psychological defence can be used as a framework for understanding this. We also present a psychodynamic approach to understanding the development of psychosis, using the stress–vulnerability model, and discuss interpersonal dynamics in psychosis, particularly their relevance to therapeutic relationships and to interactions between patients and their families. The perspectives presented are intended to complement and enrich other frameworks rather than compete with them.

What makes a good psychiatrist? What particular skills are needed to practice a ‘medicine of the mind’? Although it is impossible to answer such questions fully we believe that there is mounting evidence that good practice in psychiatry primarily involves engagement with the non-technical dimensions of our work such as relationships, meanings and values. Psychiatry has thus far been guided by a technological paradigm that, although not ignoring these aspects of our work, has kept them as secondary concerns. The dominance of this paradigm can be seen in the importance we have attached to classification systems, causal models of understanding mental distress and the framing of psychiatric care as a series of discrete interventions that can be analysed and measured independent of context. 1 In recent years this Journal has published a series of editorials arguing that the profession should adopt an even more technological and biomedical identity, and that psychiatrists should focus on their mastery of technology to allow progress in the development of brain research, genetics, pharmacology and neuroradiology. 2–4 These resonate with calls in North

Psychoanalysts suggested psychological work with families where a member has a psychosis back in the 1950s and 1960s. The paper gives a brief historical outline and then describes a number of reasons – including compatibility with NICE Guidelines – why a psychodynamic approach should be made available. A case example is given of psychodynamic family work in an Early Intervention in Psychosis service where the father of three children had a protracted psychosis and the mother's own history had played into a lack of expectations of her husband; this couple dynamic played an important role in infantilizing the patient rather than supporting him in his role as father and husband. Psychological work that involved the mother was an essential key to supporting her husband's development and confidence with substantive benefits to all members of the family including the children.

This article considers the contribution that psychodynamics can make to the work of teams providing early intervention in psychosis. Psychodynamic understanding enriches the stress and vulnerability psychosis model; can contribute to resolving the issues involved in relapse prevention; informs individualised formulations; and can make sense of patients' reactions to prescribing in psychosis. A rationale is given for longer-term individual, group and family dynamic psychotherapies within early intervention teams.

The paper focuses on some psychological factors specific to the psycho-developmental tasks involved in ageing that may lead to a considerable loss of resilience and psychological breakdown for the first time since becoming adult. Issues connected with the potential increase of dependency, especially physical dependency are often central. The paper gives an account of reasons why this may be more threatening to some than others including the reawakening of childhood failures of dependency and also identifications with disturbing dependency experiences of late life of one’s parents.

There has been growing appreciation of the role that a range of psychological treatments have to play in the treatment of the psychoses. Pharmacological approaches usually assist in containment of the more florid psychotic symptoms but psychological approaches can be most useful in aiding the patient and the family in facilitating a fuller psychosocial recovery as well as themselves contributing to symptomatic improvement and reduction in relapse rates. This article describes both the common and distinguishing features of a range of important psychological therapies some of which should be part of everyday practice and some of which require more specialist training and made available to patients when needed. It emphasises the centrality of building durable relationships with the patient and his or her family or carer, the importance of identifying the stressful and protective factors that are relevant to each individual and tailoring the type of intervention according to the capacities and readiness of the patient (the need-adapted approach). The article outlines these according to setting (individual, group and family) and according to modality: psycho-dynamic, cognitive and systemic. Brief vignettes are given. The potential psychological impact of psychosis on professionals and their organisational functioning is acknowledged.

SUMMARY In this article, some of the developmental issues that are confronted in the later phases of life are discussed. I describe the inevitable (a) reawakening of the internalisation of earlier dependent state, and (b) identifications with the dying experience of key other persons. I show how both points may cloud external reality and give rise to symptoms. I also dwell on how the difficulty, if not impossibility, for the unconscious to know about nothingness (‘not experiencing’) means that the concept of death cannot be fully grasped. The study of any individual's anticipated ‘life after death’ is therefore potentially of great clinical significance and of relevance to the provision of care for the elderly.

The lead up to the publication of DSM-5 was accompanied by a great deal of debate and argument within psychiatry. The director of the American National Institute of Mental Health (NIMH) stated of current diagnostic systems that ‘Patients … deserve better … the weakness is [the systems’] lack of validity’ and that NIMH would be re-orienting its research away from DSM categories. As this excellent pocket book makes clear, giving a psychiatric diagnosis, whatever its usefulness, may have serious consequences. The book is one of a series that highlights alternative perspectives on mental health problems. It is written not only for psychologists and people with personal experience of mental disorder, but also for psychiatrists. There are many psychiatrists who genuinely think about their ‘patients’ in psychosocial, biological and developmental terms, but there is much research evidence referred to in this book which supports my own experience that, sadly, much of psychiatric thinking and practice sees mental illness as essentially organic. The author herself equates the medical model with an organic one, rather than understanding that a medical model that does not pay attention to psychosocial factors is very limited. Nevertheless, the book is concise, well written and with full references. Johnstone states the arguments clearly and lays out short chapters giving a well-balanced mix of theory, research evidence and personal experiences. She gives an introduction to an alternative to diagnosis: that of building formulations with patients. She gives sound reasons why she prefers formulation as an alternative, rather than an addition, to diagnosis. I agree with her that there can be a risk to many patients in giving a diagnosis, but there can also be benefits. The book should be useful in the training of all psychiatrists, for continuing professional development (CPD) and for team development.

Part I: The Past: Early History of the Treatment of Schizophrenic Psychoses and the Pioneers of the Psychotherapeutic Approach. Alanen, Can We Approach Schizophrenic Patients from a Psychological Basis? Chavez, Treatment of Psychoses Before the Twentieth Century. Alanen, The Schreber Case and Freud's Double-edged Influence on the Psychoanalytic Approach to Psychosis. Hoffmann, The Burgholzli School: Bleuler, Jung, Spielrein, Binswanger and Others. Alanen, The Pioneering Work of Paul Federn. Silver, Pioneers of the Psychoanalytically Oriented Treatment of Psychosis in the USA. Part II: From Past to Present: World Developments from the 1940s to the Present. United States of America. Silver, Stedman, Psychodynamic Developments, 1940s to the Present. Great Britain. Jackson, The Contribution of Kleinian Innovations to the Treatment of Psychotic Patients. Kennard, Psychological Therapies for Schizophrenic Psychoses in the UK. German-speaking Central Europe. Hoffmann, The Development of Psychosis Psychotherapy in Switzerland. Mentzos, The Development of Psychosis Psychotherapy in Germany and Austria. France. Gaudilliere, Davoine, The Contribution of Some French Psychoanalysts to the Clinical and Theoretical Approaches to Transference in the Psychodynamic Treatment of Psychosis. Italy. Alessandrini, Di Giannantonio, The Psychiatric Care Reform Bill and Development of Psychotherapeutic Approaches. Northern Europe. Aaltonen, Alanen, Cullberg, Haugsgjerd, Levander, Rosenbaum, Developments in the Scandinavian Countries. Levander, Cullberg, Sweden: From Bjerre to the Parachute Project. Haugsgjerd, Norway: Wards for Intensive Psychotherapy. Rosenbaum, Denmark: Progress by Means of Project Work. Aaltonen, Alanen, Finland: Continuous Efforts to a Shared Space of Understanding. Eastern Europe. Bomba, Did the Iron Curtain Influence the Use of Psychotherapy in the Treatment of People Diagnosed as Having Schizophrenic Disorder? Eastern Asia. Chua, Developments in Eastern Asia: A Focus on Singapore. Huh, Taopsychotherapy in Korea. New Zealand: Geekie, Taitimu, Rook, Ang, Read, A History of Treatment Approaches to Psychosis. Part III: From Present to Future: Different Modalities of Treatment and Interventions. Koehler, Silver, Psychodynamic Treatment of Psychosis in the USA: Promoting Development Beyond Biological Reductionism. Stierlin, The Family in Schizophrenic Disorder: Systemic Approaches. Chavez, Group Psychotherapy and Schizophrenia. Dudley, Brabban, Turkington, Cognitive Behavioural Therapy for Psychosis. Hietala, Psychopharmacological Treatment and Psychotherapy in Schizophrenic Psychoses. Rakkolainen, Aaltonen, The Principles of Using and Not-using Neuroleptics in the Finnish Need-adapted Approach to the Treatment of Schizophrenic Psychoses. Larsen, Prevention and Early Intervention in Psychosis. Harding, McCrory, Psychotherapy and Rehabilitation: A Comparison Between Psychotherapeutic Approaches and Psychiatric Rehabilitation for Persons with Serious and Persistent Mental Illness. Aderhold, Soteria: A Treatment Model and a Reform Movement in Psychiatry. Whitaker, Deinstitutionalization and Neuroleptics: The Myth and the Reality. Alanen, Chavez, Silver, Martindale, Further Development of Treatment Approaches to Schizophrenic Psychoses: An Integrated View.

In many cases after 25 plus years of service it may be time to look at the replacement/ upgrade of the instrumentation associated with the stator water cooling skid applicable to armature bars that need to operate in a high or low oxygenated environment. Standards, codes, consolidation, location, redundancy, obsolescence, environmental, safety concerns and runback functionality should be reviewed prior to the next outage or scheduled stator rewind and prudent instrumentation enhancements, if deficient from the list above, should be considered. At the time of instrumentation upgrades, consideration should be given to relocation and improvement of the runback system, e.g. timers, relays, power supplies, and system functionality. Field adjustments quantifying the runback circuit is operating correctly, from both the series of on-off pulses to the turbine reference motor causing a proper load reduction rate and the two trip timers activating at the time the runback begins, need to be verified for proper operation.Copyright © 2007 by ASME