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The interest in treating underlying core vulnerability factors or transdiagnostic processes has been a focus of much attention. In this paper we describe our application of group dynamic-relational psychotherapy to the treatment of perfectionism, a core personality vulnerability factor associated with various forms and types of dysfunction and disorders that have profound costs to the individual both socially and subjectively. Over the course of the past three decades, we developed an evidence-based integrative group treatment that targets the psychodynamic and relational underpinnings of perfectionism. The treatment is based on an integration of psychodynamic and interpersonal perspectives and therapeutic approaches. In this paper we present our model of perfectionism and describe our group dynamic-relational therapy for the treatment of its pernicious outcomes. By drawing on illustrative case material, we describe the approach as applied to one such group as it progresses through four phases of group development that we have termed engagement and pseudo attachment, pattern interruption, self-redefinition/painful authenticity, and termination. Finally, we present some of the accumulating evidence of the effectiveness and efficacy of dynamic-relational therapy. [ABSTRACT FROM AUTHOR]

A challenge has recently been levelled against the legal and/or moral legitimacy of some advance directives. It has been argued that in certain cases an advance directive carries no weight in a decision on whether to withhold treatment, since the individual in the debilitating state is not the same person as the person who created the advance directive. In the first section of this paper, I examine two formulations of the argument against the moral legitimacy of the advance directives under review. The second section reviews, and criticizes, an objection to such arguments. In the penultimate section, possible models supporting the viability of the advance directives are considered. The final section makes good on an obligation incurred by the title of the paper. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to evaluate if depressed patients have an increased level of morning serum cortisol compared to healthy persons and to assess the relation between high levels of cortisol and prosocial coping mechanisms, in the context of Recurrent Major Depressive Disorder. Methods: Morning serum cortisol level was measured in 15 depressed patients hospitalized in First Clinic of Psychiatry Tirgu Mures and in 15 healthy controls. We have analyzed 3 behavioral coping strategies with The Strategic Approach of Coping Scale (SACS): social joining (SJ), seeking social support (SSS) and cautious action (CA). Results: 30 participants were included, the mean value of the cortisol for females was Mcort_female= 16.38 μg/dl and for males Mcort_male= 16.31 μg/dl. Independent sample t test showed that the cortisol level in depressed group was higher than the cortisol level in the control group: t = 2.394, p < 0.05 (0.024). In the MDD group the Spearman correlation between the level of serum cortisol and prosocial coping strategies was: rcortisol-SJ= -0.519; rcortisol-SSS= -0.107; rcortisol-CA= -0.382. Conclusions: Although the studied sample patient was small, we can conclude that the patients with Recurrent Major Depressive Disorder have an increased level of morning serum cortisol compared to healthy persons. In these patients there is an inverse correlation between the increased levels of morning cortisol and the frequency of use of the effective prosocial coping strategies, particularly the social joining type. [ABSTRACT FROM AUTHOR]

There is a long list of addictive behaviours, such as gambling, drug abuse, compulsive smoking or eating, Obsessive Compulsive Disorder, and some self-harming behaviours. Each has in common the need to escape from negative feelings. An addictive personality is the psyche of the person who has not yet resolved past trauma, and who has found a means to escape from that trauma by being able to zone out in some way into addictive behaviour, or in the case of drugs, has found a chemical substance that blocks the trauma feeling ego state. Until this trauma is resolved the person may go from one addiction to another, continually being dissatisfied until an addiction is found that the person is able to live with. Compulsively working is an example of an addiction that some find compatible. Others include compulsively following a hobby, gardening, or any other activity that allows the person a seemingly safe escape from unresolved trauma. This paper will provide a theoretical understanding of addictive behaviour and will provide techniques for addressing the cause of addictions. [ABSTRACT FROM AUTHOR]

This paper is about a case study of a brief psychotherapeutic sandplay process with a vitiligo barrier patient. Based on analytical psychology theory that understands the disease as part of the psychological self regulation process, it discusses the symbolic nature of the skin and its pathological expressions. During the ten psychotherapeutic sessions an evolution of the initial situation was observed through the symptoms displacement and the increase of imaginative abilities. Sandplay scenes building helps shadow aspects of the patient personality to became more conscious. Psychological characteristics described in literature are observed, such as the conflictive relation with the mother's figure, the appearance of the symptoms after an emotional stress due to situation of loss and so on. At the end of the psychotherapeutic process the interruption of the vitiligo stain development was observed. [ABSTRACT FROM AUTHOR]

This paper reviews longer term treatment for unipolar depression. Antidepressant continuation for prevention of early relapse has been routine for many years. Recent evidence supports a longer period of 9 months to 1 year after remission. Antidepressants are also effective in maintenance treatment for recurrent depression, and are indicated where there is clear risk of further episodes. Antidepressant withdrawal after continuation and maintenance should always be gradual, over a minimum of 3 months and longer after longer maintenance periods, to avoid withdrawal symptoms or rebound relapse. Trials of interpersonal therapy in the prevention of recurrence show some benefit, but effects are weaker than those of drug and additional benefit in combination is limited. There is better evidence for effects of cognitive therapy in preventing relapse and an emerging indication for its addition to antidepressants, particularly where residual symptoms are present. [ABSTRACT FROM PUBLISHER]