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In 2009 the Royal College of Psychiatrists revised the curriculum for psychiatric training to include psychotherapy elements into the core curriculum. Trainees are now required to provide evidence of treating patients psychotherapeutically. The therapies that the trainees usually deliver are cognitive behavioural therapy and psychoanalytic psychotherapy (PAP). Psychoanalytic theory has largely viewed homosexuality as immaturity or pathology. Psychoanalytic theory and practice have traditionally been unable to incorporate homosexuality as a normal variant of sexuality and this has had significant consequences both for clinical practice and training. Our aim was to examine whether trainees have perceived their experience of PAP as homophobic. The study was done via an internet-based questionnaire survey. Simple descriptive statistics were used to analyse the results. Most trainees did not find PAP homophobic in theory, practice or supervision. A minority of trainees considered PAP as homophobic prior to undertaking a case and found it homophobic after undertaking a case. Some trainees found their experience of PAP has broadened their views on their sexuality. Participants' experience was positive and PAP was not perceived as homophobic. A negative experience might have significant implications for their mental wellbeing, training and choice of future career. [ABSTRACT FROM AUTHOR]

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Résumé La clinique des enfants violents accueillis en ITEP nous confronte à l’impensable : c’est l’humanité même de l’enfant qui est en péril. L’agir violent est le mode d’expression privilégié, au détriment des mots. Avec Paul Ricœur, nous nous proposons, dans cet article, de suivre la piste de la narrativité pour penser cette clinique. En effet, l’identité narrative, concept qu’il définit comme étant ce que le sujet constitue et ne cesse de reconstituer comme récit de son histoire au cours de sa vie, nous paraît singulièrement fragile chez ces enfants. Nous postulons ainsi que les troubles du comportement des enfants violents sont l’expression de troubles de la narrativité, impactée précocement. Ces troubles prennent de multiples formes sur fond de temporalité bouleversée. Le cas de Max, suivi en psychothérapie d’inspiration psychanalytique de 9 à 12 ans, illustrera notre hypothèse. The clinical case of violent children treated at an ITEP (Institut thérapeutique, éducatif et pédagogique–Therapeutic, Educational and Pedagogical Institute) confronts one to the unthinkable, as their very humanity is or seems to be at stake. Violent action, to the detriment of words, has become their favored mode of expression. With Paul Ricœur, we propose in the present article to follow the trail of narrativity to address their clinical case. Indeed, narrative identity, which Ricœur defines as the outcome of the subject's constant telling or re-telling of his/her story, seems particularly fragile in these children. We therefore hypothesize that violent children's behavioral disorders are in fact the expression of disorders of a precociously impacted narrativity. There is a wide array of disorders in violent children, but the common backdrop for them is that of an upset temporality. The case of Max, a child who was in psychoanalytic psychotherapy from age 9 to 12, shall be used as an illustration of our hypothesis. [ABSTRACT FROM AUTHOR]

Changes in dynamic psychological structures are often a treatment goal in psychotherapy. The present study aimed at creating a typology of self-representations among young women and men in psychoanalytic psychotherapy, to study longitudinal changes in self-representations, and to compare self-representations in the clinical sample with those of a nonclinical group. Twenty-five women and sixteen men were interviewed according to Blatt’s Object Relations Inventory pretreatment, at termination, and at a 1.5-year follow-up. In the comparison group, eleven women and nine men were interviewed at baseline, 1.5 years, and three years later. Typologies of the 123 self-descriptions in the clinical group and 60 in the nonclinical group were constructed by means of ideal-type analysis for men and women separately. Clusters of self-representations could be depicted on a two-dimensional matrix with the axes Relatedness-Self-definition and Integration-Nonintegration. In most cases, the self-descriptions changed over time in terms of belonging to different ideal-type clusters. In the clinical group, there was a movement toward increased integration in self-representations, but above all toward a better balance between relatedness and self-definition. The changes continued after termination, paralleled by reduced symptoms, improved functioning, and higher developmental levels of representations. No corresponding tendency could be observed in the nonclinical group. [ABSTRACT FROM AUTHOR]

We describe the introduction of dynamic interpersonal psychotherapy (DIT) into an National Health Service (NHS) tertiary psychoanalytic specialist psychotherapy service. Training in DIT began as our contribution to Improving Access to Psychological Therapies and primary care services, supporting the training and supervision of their DIT practitioners. We then discovered DIT could be a valuable treatment within our own tertiary NHS service for patients with complex presentations. Currently fighting for survival, like many NHS psychoanalytic psychotherapy services nationally, we have adopted a manual-guided, psychoanalytically based therapy to broaden our tertiary clinical psychoanalytic service and accommodate trends in mental health service provision, whilst protecting the quality and integrity of our psychotherapy. DIT helped us continue providing relevant and beneficial psychoanalytic and psychodynamic services to individual patients despite limitations of the financially challenged NHS, NICE guidelines and Payment by Results. We outline the progress and outcomes for patients with complex mental health presentations, include individual case discussion and our experience of using the DIT approach within a traditionally longer term psychoanalytic psychotherapy service. [ABSTRACT FROM AUTHOR]

This article examines the cultural practices through which a group of professionals infuse their work and community with charisma. Although previous research has theorized the 'charisma of office' (Weber ), we know little about how the occupants of such offices sustain it. I focus on a group of psychoanalytically-inclined psychotherapists, whose field, despite its early charismatic beginnings, has been especially embattled in recent decades. Drawing on ethnographic and interview data, I reveal how they share stories emphasizing their 'idealization' by others, draw boundaries between their professional and private lives to manage their work identities, and perform interpersonal affective work that shores up their claims to extraordinary abilities. Together, these cultural practices constitute charisma within the professional group. This article thus makes a case that, as expertise becomes increasingly contested, we must look beyond social organization and the evidentiary bases of knowledge to understand professional authority. [ABSTRACT FROM AUTHOR]

The nature of psychoanalysis and long-term psychoanalytic psychotherapy makes it difficult to perform efficacy study including randomized controlled trial (RCT). Several RCTs are focused on the effectiveness of psychoanalytic psychotherapy; and more RCTs are conducted across multiple disorders for short-term psychoanalytic psychotherapy. As a result, there were more studies on psychoanalytic psychotherapy, as compared with that of cognitive behavioral therapy or pharmacotherapy. Moreover, psychoanalytic psychotherapy yielded significant benefits in terms of psychiatric symptoms but also the aspects of quality of life, adaptive capacities, and the reduction of maladaptive interpersonal behaviors. The psychotherapies of various types applying psychoanalytic theories were generally effective. Consequently, it can be inferred that long-term and intensive psychoanalysis is also effective. [ABSTRACT FROM AUTHOR]

A single case study for a psychoanalytic psychotherapy process in a girl and her mother is presented from the perspective of the Object Relations Theory framework. Of interest are the empirical findings of therapeutic change and the effectiveness of the tool using a method created by a team of researchers from a university chair. A qualitative and quantitative analysis of textual observational records of sessions was conducted using codes constructed ad hoc from specific manuals for children and adults. The results of the application of the method are contrasted with results from psychological assessment techniques. Therapeutic change indicators are linked to progress in the processes of symbolization; therapeutic efficacy is recorded when the psychotherapist’s interventions favour symbolization and mentalization processes. [ABSTRACT FROM AUTHOR]

Extreme and complex traumatization represents a severe problem in today's world. Many traumatized individuals and their families live in difficult conditions in refugee camps, in shelters, and in exile. Treatment and rehabilitation approaches thus need to take social and cultural conditions into consideration. This paper will discuss how psychoanalytic therapy may be helpful for severely traumatized patients, as well as the mechanisms of change in the therapeutic process. It focuses on how traumatic experiences are actualized in the transference and bring the analyst into a situation where enactments inevitably occur. It will be shown how these processes may lead to a symbolization of nonsymbolized reminiscences of traumatic experiences. Psychoanalytic therapy with patient with complicated loss experiences will be analyzed, and some conclusions based on this and others researched therapies will be discussed. The advantages of working with trauma-related material in the transference will be considered. [ABSTRACT FROM AUTHOR]

Copyright of Paideia (0103863X) is the property of Paideia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The transference analysis takes the central position of the work in psychoanalytic psychotherapy. The work in extratransference sphere and experience in practical work with extratransference interventions are not often reported in expert literature. Extratransference sphere includes less transferring relation to the psychotherapist, transference on the other objects, or may refer to the external reality rather than the psychic reality or fantasy. In our illustration, we gave emphasis to extratransference interventions. Application of genetic interpretation and reconstruction were demonstrated as well, which can restore and establish connections between past and present, in order to understand influences of the past and current reality, and helping us to resolve infantile conflicts. Interpretation of extratransference situations is an important part of the analytical work and it is the essential category of interpretation. Analytic understanding should include transference and extratransference spheres, fantasy and reality, past and present. Working with neurotic patterns and character resistance needs an optimal choice of intervention in a given moment of analytic process. Extratransference interventions are the essential category of intervention, irreplaceable for their effectiveness in analytic process.

Objective: To provide a review of journal articles discussing clinical cases or vignettes of psychoanalysis or psychoanalytic psychotherapy of patients affected by bipolar disorder., Methods: A thorough search of journal articles was performed in five databases to identify studies published from 1990-2021., Results: Twenty-four articles were included in this review, comprising a total of 29 case reports. The most common theoretical approach adopted by the authors was "object relations." Two main sets of clinical-theoretical considerations and recommendations emerge: the applicability of analytic treatment to patients with bipolar disorder - taking into account their analyzability and practical arrangements for conducting therapy - and theoretical speculations on the nature and development of the illness, as well as on the conceptualization of its different phases., Conclusion: Our findings reveal that there is some psychoanalytic literature providing insight into the psychological dynamics and treatment of patients with bipolar disorder. Elaboration of this literature may help improve our understanding and provide more accurate and comprehensive descriptions of the intrapsychic and interpersonal dynamics of these patients, yielding potentially valuable information for clinical and research purposes, particularly with regard to reducing interpersonal conflict, and increasing insight and engagement with lifestyle changes and other behaviors likely to promote health and stability., Competing Interests: The authors report no conflicts of interest.

We consider very important to remember here and now the creative approach to the psychoanalytic psychotherapy of psychosis of our master and founder Gaetano Benedetti. So, we are re-presenting this interview-dialogue by Patrick Faugeras, just published in La parola come cura. La psicoterapia della psicosi nell'incontro con Gaetano Benedetti, edited by A.S.P. (Psicoterapie, FrancoAngeli, Milan, 2006). In Benedetti's view, the psychotherapic relationship shows how inner and external reality are confused in the psychotic world, where symbiosis and splitting empower each other. The splitting functioning as a defence (splitting between Ego and Super-ego, between Ego and Es, between subject and object, between the symbiotic Self and the separated Self) is one of the core early concepts in Benedetti's theory, and will bring him to the concepts of "Symbiotic Self" and "Separated Self". If the psychotic psychopathology limits and divides, a patient-centered psychotherapy gathers and enlarges: so, the Author can introduce his new concept of "progressive psychopathology". We can recognize the role of transference and counter-transference, interpretation and structural change in the psychotherapy with psychotic patients in different forms and by different technical means if compared with the neurotic patients'standard analysis. This psychoanalytic psychoterapeutical model let us organize our inner experience with the patient in order to make it acceptable to ourselves and to other clinicians, so transforming an apparently impossibile and confusing meeting of two so different minds into a human existential and meaningfull encounter. [ABSTRACT FROM AUTHOR]

This paper presents the impact of clinical supervision on once-weekly psychoanalytically-informed training psychotherapy. The development of Oedipus complex theory is presented, culminating in Britton's work on the triangular space that opens up by working through the complex. The geometry of psychic space is described to highlight the importance of supervision, especially when training in therapy. The theme of spiders and cobwebs emerging from the clinical material provides a powerful metaphor for the tensions in psychic space. In the course of this training, the trainee therapist was at times less able to benefit fully from supervision, and thus the third position partially collapsed. Vignettes from anonymised clinical work are presented in the three 'phases' of this therapeutic process, illustrating the impact of the presence – and relative absence – of supervision. [ABSTRACT FROM AUTHOR]

Background Evaluation of psychotherapy impact and effect has advanced substantially in the last half century. The development of reliable standardised measures has been especially important. However, several issues remain controversial. One such issue is the extent to which standardised measures adequately capture change and their integration with normal clinical practice. A second is how to deal with the not uncommon situation where one outcome measure indicates change and another does not. Finally, researchers are often confronted with cases where standardised measures are used, but some participants quit therapy without completing them. Aim In this study, we present and discuss an outcome assessment method developed in the context of a naturalistic, mixed-methods study of 22 treatments of psychosomatic patients. Methodology This multimodal, multi-informant method involved a thorough and individualised analysis of transcripts, questionnaires and other clinical data, the consideration of patient and therapist's opinions about outcome, and the use of clinical judgment to integrate different indicators and classify outcome, with the aid of two auditors reviewing the process. Findings Eight cases improved, six deteriorated, and eight did not change. Three case vignettes illustrate the application of the method, and some possible sources of bias of patient and therapist's opinion about outcome are identified. Implications Clinical judgment can help integrate results from standardised measures and other data sources into outcome assessment normally practised by clinicians. This method, besides its high cost in time and resources, can also be useful in research to rescue outcome assessment when collection of outcome measures fails. [ABSTRACT FROM AUTHOR]

In this article I explore the issues surrounding confidentiality and consent in the writing of psychotherapy case reports. An important theme is the challenge of protecting a patient's privacy while furthering knowledge in the field through publication. I discuss some of the complexities as well as the relevance of present day requirements for informed consent, including a consideration of the provisions within the Declaration of Helsinki (1964, last revised 2013). To illustrate the difficulties inherent in writing about our work I give examples of three cases: Freud's patient Sergei Pankejeff (the ' Wolf Man'), Gloria (the patient in the ' Gloria Films'), and a contemporary patient, ' Jeremy', whose therapist published an account of her work with him. The writing of case material is complex and resists easy solutions; there can be no 'one-size-fits-all' approach but instead the therapist writer's careful consideration on a case by case basis of his or her motivations for writing, what the patient is really consenting to, whether patient consent can ever be truly informed, and how writing and publishing a case might impact on the safety and well-being of the patient (including others connected to the patient), as well as on the therapeutic relationship itself. [ABSTRACT FROM AUTHOR]

Bilingual clients in psychotherapy with bilingual therapists have choices as to which language to use. Psychoanalytic case studies suggest that the use of the second language, learned post childhood, reduces access to deeper emotional material and is mainly viewed as a defensive manoeuvre leading to intellectualizing detachment. Linguistic and neurological studies support the view that the use of the second language can lead to a reduced degree of emotionality in the recall of memories. However, this paper suggests that there is a different and enabling dimension to such clients' language choices. Their own and their therapist's bilingualism and biculturalism open a transferential field where language choices are mapped onto deeper inter- and intra-psychic conflicts and can thus allow access to them rather than defensively hide them. Case material from work with bilingual clients is explored to illustrate this. [ABSTRACT FROM AUTHOR]

This paper has two aims: first, it seeks to understand the absence of treatment manuals in psychoanalysis. Secondly, it summarizes the treatment manual of the Tavistock Adult Depression Study, which describes the form of psychoanalytic psychotherapy whose effectiveness has been evaluated both in the Tavistock Adult Depression Study ( TADS); and in the German Die Langzeittherapie bei chronischen Depressionen ( LAC) Studie. Throughout the history of psychoanalysis, opinions about treatment manuals, empirical research and their antecedents have been deeply divided. After tracing the often polarized unfolding of these matters, the paper proposes that emotional and cognitive difficulties as well as scientific ones underpin their persistence. It is suggested that greater familiarity with them may lead to better combinations of outcome research and psychoanalysis: for example, the Tavistock manual seeks to match one account of the objects, aims, values, spirit and methods of psychoanalysis (as well as of connected forms of psychoanalytic psychotherapy); and also to meet what is required of treatment manuals by random allocation controlled trials. It has been a crucial element in the above studies of the outcome of long-term psychoanalytic psychotherapies with chronically depressed patients. After describing the Tavistock Manual, the paper concludes suggesting that, if appropriately constructed, treatment manuals can make a contribution to the advancement of specifically psychoanalytic knowledge. [ABSTRACT FROM AUTHOR]

In the past, the human life span has been divided into childhood and adulthood. The importance of education has been evident since the Industrial Revolution, thus, a transitional stage called "adolescence" has emerged. Although adolescence was once consistent with puberty, when the release of hormones increases sharply, the definition of adolescence has been changing with socio-cultural changes. In Korea, social problems related to adolescence, such as suicide, internet gaming, juvenile delinquency, violence, and dropping out of school, are increasing. Apart from external problems, internal problems such as Japanese Hikkikomori are also increasing. With these changes, there is an important need to discuss the nature of adolescence. Whereas childhood is the stage that requires care-giving, adolescence is the stage when duty and responsibility emerge. In late adolescence, there is a transition period into adulthood and participation in society. Currently, as the importance of adolescence has been highlighted from various sectors, "the endpoint of the adolescence" is a stimulating theme in the psychiatric field. From a neuro-biological perspective, a greater understanding of adolescence becomes more important to solve adolescents' emotional problems and for the legal demarcation of adolescence related to school violence and juvenile delinquency. If adolescence is not just the transition stage between childhood and adulthood, the exact endpoint for adolescence should be determined. Therefore, in this article we try to define the stage of adolescence in modern society from various approaches, including the historical background, the process of changes in the definition, and psycho-socio-bio-cultural aspects. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) is characterized by obsessive thoughts or repetitive actions - compulsions present most of the day for at least two weeks. In Slovenia, patients with OCD get very little clinical attention and there is no special treatment regime for their needs. Therefore, we created a treatment algorhythm for OCD that includes cooperation between psychiatrist and psychotherapist to introduce holistic care for patients with OCD. We included current knowledge in the algorhythm and the availability of treatment modalities was taken in account. The essence of the algorhythm is a constant focus on patient needs and individual treatment for each patient, which includes pharmacotherapy, cognitive behavioural therapy, group and individual psychoanalytic psychotherapy. The algorhythm defines the expectations of all three participants (patient, a psychiatrist and psychoanalytic psychotherapist). The results of two years of experiences of the algorhythm are much better than we expected, because 15 of the 19 patients included in group therapy and 20 out of 21 patients(in individual therapy?) remained in therapy. All patients who remained in the treatment are clinically improved. [ABSTRACT FROM AUTHOR]

From the work of Dr. Michael Robbins in Massachusetts, USA, it is known that nine schizophrenic patients out of a series of 18, and a further schizophrenic patient, treated by him achieved positive outcomes using psychoanalytic methodology. Four of these had strikingly successful outcomes, for example completing their treatment without a need for further medication, and also becoming happily married or graduating at university. This paper aims to illustrate the stages identified by him through which this can be accomplished. Dr. Robbins' Stages of Psychological Therapy of Schizophrenia are compared with Dr. Steggles' detailed case study of a patient's recovery from schizoaffective disorder. These two data sources are juxtaposed and compared. Dr. Robbins' therapeutic stages are found to parallel exactly Dr. Steggles' findings from her case study, which she summarized as her psychodynamic pentapointed cognitive construct (PPCC) model of her schizoaffective patient's experience. Psychological therapy of schizophrenia is still in its early stages of development. However, Dr. Robbins' psychoanalytic psychotherapeutic technique has given rise to positive outcomes in 10 of the 19 patients he treated, that is, his series of 18 patients together with a further patient; these 19 patients he gave full psychological treatment, i.e., usually four sessions per week. The Stages he identifies in his therapeutic process match perfectly the stages Dr. Steggles identified in her own patient's healing mind. Not all schizophrenic patients are likely to be able to benefit from this psychological therapy. Females seem to be better able than males to respond to the treatment, and motivation is necessary for a successful outcome. It is not known how to identify precisely those patients who will be successful. But those patients who do benefit may counterbalance by their economic activity the healthcare costs of those who do not recover, as well as achieving benefit from their human suffering. Many of the other groups of patients suffering from schizophrenia can be helped by engaging with a clinician for social skills or family therapy, and where appropriate this should always be done. [ABSTRACT FROM AUTHOR]

Through one clinical example involving complex post-traumatic stress disorder, this paper explores the ways in which the psychoanalytic psychotherapist may need to find creative ways of working which incorporate findings from neuroscience whilst holding the basic frame and methods of the traditional psychoanalytic approach. This entails bringing knowledge of how the body (including the brain) works into the consulting room. In particular, the author describes ways of accompanying the patient during florid flashbacks to chronic and severe childhood abuse and of using grounding techniques afterwards, so that anxiety levels can be sufficiently contained for the necessary therapeutic work to take place. The role of supervision is also explored in terms of how the dynamic of rescuer/victim/persecutor may be played out in the supervisory relationship. Unusually, some of the patient's own reflections, written at the end of the therapy, have been incorporated into the paper. Consideration is given to whether departures from standard psychoanalytic technique constitute boundary violations or useful enactments, which can be seen as a form of creativity which enables the work to move on. [ABSTRACT FROM AUTHOR]

Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered. [ABSTRACT FROM AUTHOR]

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments. [ABSTRACT FROM PUBLISHER]

Psychological assessment can provide important information on patient's symptoms, personality, diagnosis and prognosis assisting in the development of therapeutic strategies. This retrospective cohort study aimed to determine whether there is association between performing a psychological assessment prior to psychotherapy and keeping the treatment. Medical records of 2,106 children seen in two outpatient mental health clinics in Porto Alegre were analyzed. Children who had undergone psychological assessment before starting psychotherapy were 65% more likely to adhere to the treatment and 44% less likely to drop it out than were children who had not been assessed. Psychological assessment helps parents understand their children's treatment, making it a less coercive process and provides a more concrete foundation for the otherwise subjective psychotherapeutic process. [ABSTRACT FROM AUTHOR]

The concept of “brief therapy” contains internal contradictions. The techniques suggested by brief therapists are the same techniques that have been discussed historically in debates on theory of technique, both within and without psychoanalysis (e.g., the experiential factor at the center of the Freud-Ferenczi confrontation is also an important aspect of Gestalt therapy). A time limit is the only operational criterion that allows a rigorous definition of brief therapy; without this criterion it is impossible to discriminate between “brief” and simply “good” therapies (i.e., those in which patients are successfully treated in a short time). An important question is why, with a given patient, a therapist should decide, a priori, to terminate a treatment within a set time. Two clinical examples are presented, illustrating the usefulness of Eissler’s concept of parameters as a heuristic framework to identify the potentially defensive nature of both “brief” and “long-term” therapy. [ABSTRACT FROM PUBLISHER]

Aims and methods: To show that long-term psychoanalytic psychotherapy can offset costs of psychiatric care when offered to a patient affected by borderline personality disorder with a severe presentation and co-morbid psychopathologies. Costs of mental health services were calculated for a nine-year period. Cost offset was calculated comparing the five years preceding therapy with the four years during and post-therapy.Results: In this case study the provision of long-term psychoanalytic psychotherapy has consistently and progressively reduced use of mental health services and related costs during the intervention and post-intervention period. Significant reduction in use of services and savings of approximately £5000 were obtained for the post-intervention year.Limitations: The research findings are limited by the lack of control conditions over confounding factors. Besides, cost-effectiveness could not be established.Clinical implications: Long-term psychoanalytic psychotherapy is rarely available in the modern National Health Service (NHS) and is unlikely to be offered to patients with severe character pathology. Although specialist tertiary services have been created to cater for this group, patients who cannot engage with these services risk not to be adequately treated. This case study suggests that long-term psychoanalytic psychotherapy could be used as a viable and cost-saving alternative for some of these patients. [ABSTRACT FROM AUTHOR]

Three interacting challenges are facing all aspects of health care in the United Kingdom: financial restraint in the context of a global economic downturn; a move to services being commissioned and decommissioned by primary care Clinical Commissioning Groups; and a need to provide evidence based practice through 'payment by results'. Psychoanalytic psychotherapy faces more difficulty than most services in mental health, with long and frequent criticisms of it being expensive and under-researched; and it is not as well understood by GPs as cognitive behavioural therapy, with which it is frequently unfavourably compared. This review provides an overview of the existing evidence for psychoanalytic psychotherapy, identifying strengths and areas that are under explored. We also argue that psychoanalytic psychotherapy has a unique clinical role but this will need to be clearly stated in the future, and promoted by clinicians to encourage future commissioning in the UK. [ABSTRACT FROM AUTHOR]

In this paper, we describe the use of an aim-based outcome measure used in routine outcome monitoring of child and adolescent psychotherapy within a child and adolescent mental health service. We aim to explore the clinical feasibility and implications of the routine use of this measure. We argue that use of the measure provides a simple and useful way of clarifying the focus of the clinical work and reflecting its progress, while also having the potential to illuminate the clinical picture by contributing an additional source of clinical information from a collaborative process with the patient, parents or both. We argue that while there are some cases where use of the measure may be impossible, or even perverse, in general it enhances rather than detracts from clinical work. [ABSTRACT FROM PUBLISHER]

Patients make first contact with group analysts in a dyadic relationship and the entry into the group of six to eight can be perceived as a psychic leap across a wide chasm. In this article the transition from dyad to the group is conceptualized as equivalent to achieving a triadic capacity for relatedness. A central consideration will be of the maturation from predominantly ‘linear’ relating and thinking (n=2) to stable triangular configurations involving ‘threeness’ and ‘thirdness’, with the development of a triangular space, which represents reflective thinking and the capacity to observe and be observed. The triangular potential is opposed by destructive processes, which cause instability and collapse of triangular configurations, with a regression towards ‘two-dimensional’ group structures. The role of the triangle and the key importance of the ‘third eye’ will be conceptualized in terms of a stable parental coupling which provides a corrective component of the experience for group members. The symbol of a triangle inside a circle is used to represent the combining of male and female elements in the group, to form a combined holding, containing but also development promoting ‘parental relationship’ function. [ABSTRACT FROM AUTHOR]