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A clinical case of somatoform disorder illustrates the process of a type of psychotherapy informed by attachment theory and research that pays heed to motivational systems that differ from attachment, and to the dynamic tensions between attachment and other motivational systems. The multimotivational theory that underpins case formulation and psychotherapy interventions is based, congruently with Bowlby’s attachment theory, on evolutionary thinking and is summarized in the first section of the article. As a necessary premise to understanding the clinical case, the second section of the article briefly outlines current knowledge on infant attachment disorganization and its developmental sequelae, considered from the perspective of the evolutionary multimotivational theory. [ABSTRACT FROM AUTHOR]

Research on disorganization of infant attachment provides evidence that it can be caused not only by violent aggression or very early sexual abuse, but also by covert maltreating behavior, which includes the abdication of the caregiver’s responsibility to soothe the infant’s distress. This paper argues that both overtly abusive caregivers and merely “abdicating” caregivers may cause disorganization of infant attachment through a simultaneous and conflicting activation of the motivational systems governing attachment and survival defense in the infant. Other inborn motivational systems—regulating caretaking, competitiveness, and sexuality—are disorderly activated, during personality development, within the intra-family relationships of children whose infant attachment has been disorganized. The paper argues that conflicts and abnormal tensions between different motivational systems explain some paradoxical features of the interactions between abusers and abused, and allow for a better understanding of the interpersonal processes involved in the surfacing and exacerbation of dissociative symptoms in the abused. [ABSTRACT FROM PUBLISHER]

A taxonomy of basic motivational systems (reptilian, mammalian, and neo-mammalian), that emerged in phases during the course of millions of years, is proposed. These different phases did not replace each other, but became reorganized in the brain at different hierarchical levels. It is argued that (a) humans are an ultracooperative species and (b) high degrees of cooperation put strong selective pressures toward the development of sophisticated forms of intersubjective communication. These two developments had cascading effects on human evolution, creating both the conditions upon which humans were able to understand intentions, gestures, emotions, and, ultimately, the minds of others, and the emergence of language and symbolic forms of cultural evolution. Possible evolutionary steps that led to this ultracooperative survival strategy and some of their genetic mechanism, with special emphasis on a multilevel model of selection, are described, and the implications for psychotherapy and psychoanalysis are explored. [ABSTRACT FROM PUBLISHER]

Four different models of Borderline Personality Disorder (BPD), each based on a different psychopathological theory, have produced manualised treatments with evidence of efficacy. It can be argued, on the grounds of the comparable results of the outcome studies, that these different treatments share a common mechanism of action related to the same psychopathological kernel of Borderline Personality Disorder, albeit the key role of this kernel in the pathogenesis of the disorder is not explicitly acknowledged in their psychopathological theories. This paper argues that such a psychopathological kernel can be described as dissociative and is caused by chronic psychological traumatisation in the developmental years and by disorganisation of infant attachment -- two common features of Borderline Personality Disorder developmental psychopathology. Following a review of the studies supporting this hypothesis, the paper dwells on the basic psychotherapy processes allegedly shared by the four different models of Borderline Personality Disorder treatment. [ABSTRACT FROM AUTHOR]

In this comment to Paolo Stramba-Badiale’s description of his clinical case, I argue that the therapist’s acknowledgment of feelings of powerlessness both in self and in the patient, without surrendering to them and without untimely attempting to overcome them, is a major factor of therapeutic change in the treatment of dissociative adults who had been chronically traumatized since early childhood. Consideration of the dynamic tension between the motivational system engaged in coping with environmental threats (freezing-fight-flight-feigned death) and the care-seeking (attachment) system provides the background for the argument, together with the knowledge of the controlling interpersonal strategies that typically follow, during childhood, infant attachment trauma. [ABSTRACT FROM PUBLISHER]

Pierre Janet expounded repeatedly, in his writings, the three main differences between his theory, that he had called psychological analysis, and Sigmund Freud's psychoanalytic theory. First, the concept of narrowing of consciousness as the direct effect of vehement emotions is quite different from the idea of an active defensive process displacing unacceptable mental contents outside consciousness. Second, Janet's concept of the sub-conscious (le subconscient) diverges significantly from Freud's view of the Unconscious. Third, Janet's rejected what he labeled Freud's pan-sexualism. This paper is a cursory examination of contemporary psychological and neuroscience contributions to psychotraumatology that may be matched with Janet's three contentions about the main differences between his ideas and Freud's. The aim of the paper is to foster in the reader a reflection on how contemporary psychotraumatology may provide a common background for examining what seems more vital nowadays of the two divergent roots, French and Austrian, of dynamic psychiatry. [ABSTRACT FROM AUTHOR]

The clinical case described in this article illustrates the value of taking into account the dynamics of disorganized attachment in the assessment of attachment-related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized patients. These seemingly opposite phobias typically coexist in the same patient, appear as phobias of both inner states (affect phobias) and relational experiences, and are linked to dissociated representations of self-with-other. Theory and research on attachment disorganization provide a clinician-friendly conceptual framework for capturing both the intrapsychic (e.g., intrusive and nonintegrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment-related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are examined. [ABSTRACT FROM AUTHOR]

For about a century clinical observations suggested the association between dissociative symptoms and developmental trauma. Retrospective and prospective studies confirmed that dissociation is the central pathogenic process of developmental trauma. Dissociative processes generate dissociative symptoms likely to dominate some clinical pictures such as Dissociative Disorders or Borderline personality disorder, or also surface, in different proportions, in practically all DSM-IV diagnostic categories as an index of negative outcome. This paper aims to review some crucial issues on dissociative phenomena and processes originated from traumatic experiences in childhood. The article also purposes the existence of a traumatic-dissociative psychopathological dimension, its clinical meaning and the treatment strategies to overcome the difficulties it causes during psychotherapy. [ABSTRACT FROM AUTHOR]

This paper reviews theoretical, clinical and research studies on the apperance, in a subgroup of obsessive compulsive disorders (OCD), of symptoms related to the disruption of the usually integrated functions of consciousness, memory, identity and perception (pathological dissociation). The coexistence of dissociative and obsessive-compulsive symptoms is a relatively frequent clinical occurrence, that seems to be responsible for unsatisfactory response to the cognitive-behavorial therapy (CBT) of OCD. The aim of the review is to clarify the different types of dissociative symptoms and processes that may appear in OCD, their relation to absorption in compulsive responses, and the role played by traumatic expreriences in the association between dissociative and obsessive-compulsive symptoms. Such a clarification is a necessary premise to the implementation of modified types of CBT interventions able to yield satisfactory outcomes in cases of OCD complicated by dissociative symptoms. [ABSTRACT FROM AUTHOR]

Background. Mentalization has recently been identified as a major process in the origins, maintenance, and recovery from various mental disorders. Aims. Questions arise however, as to the degree to which deficits in mentalization can be trait or state-like: whether they manifest themselves across all types of humaninteraction, or are they relationship dependent, such that different types of relationship (e.g., affiliative vs. competitive) can facilitate or compromise mentalizing? Findings. This paper suggests that mentalization has a complex evolutionary history, has various subtypes and functions, is highly regulated by the experience of threat or safeness within relationships, and can operate differently in different types of socialrelationship. Implications. Awareness of this enables therapists to pay particular attention to the social roles and types of relationships in which mentalization occurs, its specific focus and functions for specific types of relationships. Therapists can be mindful of the kind of specific events in social roles that activate threat and loss of mentalizing (e.g., abandonment threats, feeling controlled by 'the other', status loss, non-reciprocation). [ABSTRACT FROM AUTHOR]

We discuss consciousness from evolutionary and developmental perspectives. The expansion of communicative abilities was a necessary step for the emergence of a new type of cooperation based on equality that probably appeared for the first time among nomadic hunter gatherers during the upper Paleolithic era. In turn, this new level of cooperation gave raise to an expanded form of consciousness. From a developmental perspective an expansion of intersubjective abilities and consciousness go together. Three basic levels of intersubjectivity are present in humans. A primary form of intersubjective communication is accompanied by a primary form of consciousness that is not easily accessible for conscious scrutiny. During the second year of human life secondary forms of intersubjectivity expand consciousness from the immediacy of one-to-one interactions, to include a shared understanding of intentions and goals with caregivers. Secondary forms of intersubjectivity give raise to the type of consciousness characterized by preverbal symbols and images-a primordial form of conceptual knowledge. A further step in intersubjective communication uses the meanings and concepts that have emerged earlier in development and transforms them into words. The leap into language allows our species to conceive past, present, and future simultaneously. The cultural transmission of knowledge and social mores depends on these abilities. This further expands the scope of consciousness and creates conditions for self reflection, a type of consciousness that is uniquely human. [ABSTRACT FROM AUTHOR]

The clinical management of borderline personality disorder (BPD) commonly employs treatments administered in different settings by different clinicians (e.g., individual psychotherapy and drug prescriptions, or individual and group psychotherapies). The general consensus of clinicians on the importance of using different therapists and different settings simultaneously in treating borderline patients is acknowledged by the guidelines for the treatment of BPD provided by the American Psychiatric Association. This widespread type of clinical practice is not supported, however, by a unifying theoretical model explaining the specific effects of a multiple therapist, multi-setting approach in treating BPD. [ABSTRACT FROM AUTHOR]

Freud viewed the unconscious as being roughly equivalent to dynamically repressed wishes, needs, and motivations. Findings from developmental psychology, cognitive psychology, psychoanalysis, and neuroscience over the past 40 years have dramatically changed our views of unconscious processes and the human mind. It is now clear that Freud's dynamic unconscious is only a minor segment of information that is processed at subsymbolic, implicit, and automatic levels. Only a fraction of this information is further processed at explicit conscious levels. Moreover, the vast majority of the information that remains nonconscious is adaptive and has major consequences for development. We examine some clinical implications of these views. [ABSTRACT FROM AUTHOR]

The article offers an historical review of studies on the role played by attachment processes in dissociative psychopathology. The treatise proceeds from Bowlby's first insights, through Main and her collaborators' empirical studies on attachment disorganization, to the first formulation of the hypothesis linking disorganized early attachment to pathological dissociation. Recent research supporting the hypothesis is then reviewed. It is concluded that infant attachment disorganization is in itself a dissociative process, and predisposes the individual to respond with pathological dissociation to later traumas and life stressors. Four implications of this theory are interspersed in the re- view and are discussed in the final section: (I) pathological dissociation should be viewed as a primarily intersubjective reality hindering the integrative processes of consciousness, rather than as an intrapsychic defense against mental pain; (2) early defenses against attachment-related dissociation are based on interpersonal controlling strategies that inhibit the attachment system; (3) dissociative symptoms emerge as a consequence of the collapse of these defensive strategies in the face of events that powerfully activate the attachment system; (4) psychotherapy of pathological dissociation should be a phase-oriented process focused primarily on achieving attachment security, and only secondarily on [ABSTRACT FROM AUTHOR]

Multi-motivational theories of human relatedness state that different motivational systems with an evolutionary basis modulate interpersonal relationships. The reliable assessment of their dynamics may usefully inform the understanding of the therapeutic relationship. The coding system of the Assessing Interpersonal Motivation in Transcripts (AIMIT) allows to identify in the clinical the activity of five main interpersonal motivational systems (IMSs): attachment (care-seeking), caregiving, ranking, sexuality and peer cooperation. To assess whether the criteria currently used to score the AIMIT are consistently correlated with the conceptual formulation of the interpersonal multi-motivational theory, two different studies were designed. Study 1: Content validity as assessed by highly qualified independent raters. Study 2: Content validity as assessed by unqualified raters. Results of study 1 show that out of the total 60 AIMIT verbal criteria, 52 (86.7%) met the required minimum degree of correspondence. The average semantic correspondence scores between these items and the related IMSs were quite good (overall mean: 3.74, standard deviation: 0.61). In study 2, a group of 20 naïve raters had to identify each prevalent motivation (IMS) in a random sequence of 1000 utterances drawn from therapy sessions. Cohen's Kappa coefficient was calculated for each rater with reference to each IMS and then calculated the average Kappa for all raters for each IMS. All average Kappa values were satisfactory (>0.60) and ranged between 0.63 (ranking system) and 0.83 (sexuality system). Data confirmed the overall soundness of AIMIT's theoretical-applicative approach. Results are discussed, corroborating the hypothesis that the AIMIT possesses the required criteria for content validity. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this study, we evaluated cortical connectivity modifications by electroencephalography (EEG) lagged coherence analysis, in subjects with dissociative disorders and in controls, after retrieval of attachment memories. We asked thirteen patients with dissociative disorders and thirteen age- and sex-matched healthy controls to retrieve personal attachment-related autobiographical memories through adult attachment interviews (AAI). EEG was recorded in the closed eyes resting state before and after the AAI. EEG lagged coherence before and after AAI was compared in all subjects. In the control group, memories of attachment promoted a widespread increase in EEG connectivity, in particular in the high-frequency EEG bands. Compared to controls, dissociative patients did not show an increase in EEG connectivity after the AAI. Conclusions: These results shed light on the neurophysiology of the disintegrative effect of retrieval of traumatic attachment memories in dissociative patients. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to evaluate the efficacy of Cognitive Evolutionary Therapy (CET) in an intensive short residential treatment of a wide range of severe personality disorders (PDs) that resulted in a reduction of social functioning and significant personal distress. Design. Each patient was assessed at admission, discharge, and 3 months later in order to determine if there was a reduction in symptoms and an improved adherence to former outpatient programs and to check if patients were undergoing new treatment after discharge. Method. Fifty-one patients participated in this study. The 20-hr weekly program consisted of two individual sessions and various group modules. Outcome measures included: self-reported measures of depression, anxiety, general symptoms, number and duration of inpatient admissions after the programme, and continuation in an outpatient treatment programme. Results. The results show an overall improvement in general psychopathology after the release and in follow-up sessions, a decrease in the number of further hospital admissions, and an increased level of attendance of outpatient therapy. Conclusions. This study shows that intensive short residential treatment is an effective treatment for patients with a wide range of PDs. [ABSTRACT FROM AUTHOR]

In recent years interest in dissociative phenomena has been growing steadily, both in the are of pathology related to trauma as well as in the study of the mental processes involved in various psychopathological conditions. This study aims to explore the relatioship between dissociative symptoms and other symptom areas. Our hypothesis is that a greater extent of dissociative phenomena is associated with having a larger variety of serious symptoms. To this end, we used the DES scale to measure and assess dissociative phenomena and scales SCL-90 R and BDI to measure the general psychpathology and in particular depressive features. The sample consisted of 263 patients admitted to a psychiatric ward of a nursing home because of problems related to depression and partly due to difficulties in managing their acting out impulse. The data analysis shows that patients with high scores on the scale of dissociation display significantly different symptom profiles, more serious and varied, compared to patients with low scores on the dossociative scale. In addition, we not that these same patients are hospitalized more often for problems related to impulsive acts and for presenting a diagnostic profile within the parameters of personality disorders. [ABSTRACT FROM AUTHOR]

This study explores the relationship between psychotherapists' validation interventions and patients' metacognitive responses at the beginning of treatment of borderline personality disorder (BPD). A model of BPD based on disorganized attachment provides the hypothesis that, before patients' internal working model of attachment has been corrected within the therapeutic relationship, therapist interventions that are likely to activate patients' attachment system are also likely to induce temporary disorganization of patients' metacognitive functions. Any validation intervention implies that therapists openly display an understanding and accepting attitude when they comment on patients' reported experiences and is, therefore, likely to activate the patients' attachment system. Linehan's (1993) manual of dialectic-behavioral therapy (DBT) was used as a guideline to assess validation interventions adopted by therapists. The transcripts of the second individual session in the psychotherapy of 19 consecutive patients were analyzed. Checklists based on the DBT manual were used to identify therapists' validating, supportive, and neutral interventions. The Metacognitive Assessment Scale was used to assess changes in specific aspects of patients' metacognitive processes during therapeutic dialogues. Following validation interventions, patients' responses revealed significantly higher rates of temporary metacognitive failure in comparison to the responses solicited by neutral intervention. [ABSTRACT FROM AUTHOR]

The attachment and social rank systems are biological‐evolutionary systems that can serve as models for conceptualizing family interaction. By exploring both their unique and interrelated impact on affect regulation, we can differentiate between processes that foster healthy growth and those leading to individual psychopathology. This perspective facilitates the integration of biological and psychological models, and has therapeutic implications. It also integrates well with other family therapy models. [ABSTRACT FROM AUTHOR]