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Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist's willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual's psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual's mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism. [ABSTRACT FROM AUTHOR]

Current approaches to the treatment of non-affective psychosis include elements of mentalization-based treatment and the potential in enhancing mentalizing capacity in this patient group has been widely emphasized. This article presents the "psychotic identity dilemma", a concept by Stavros Mentzos, and a therapeutic approach considering this concept as a valuable complementary addition to these treatments. The idea of a dilemma between closeness and distance, which in itself cannot be represented mentally at first, helps to respond to specific needs of patients with psychotic disorders by placing the treatment focus on fundamental interpersonal processes. Following this train of thought, this article attempts to shed light on the importance of the "real relationship" between therapist and patient as well as the exploration of the "here and now", especially at the beginning of psychotherapeutic treatment. Two treatment modes are suggested, one characterized by the experience of interpersonality within the therapeutic relationship and a second one characterized by the reflection of interpersonal phenomena. These modes are framed by Stavros Mentzos' concept of an identity dilemma. We describe how mentalizing first needs to be addressed implicitly in a tolerable, exemplary relationship in which closeness and distance are regulated based on the therapist's countertransference, then explicitly. A series of interventions are described, which allow for moments of shared attention, promote intentionality and contingency and, later in the course of therapy, help to integrate experiences into narratives. [ABSTRACT FROM AUTHOR]

Fanon's work at the day clinic also reflected Fanon's growing (and, according to Gibson and Beneduce, underappreciated) interest in psychoanalysis. In contrast, institutional psychotherapy aimed to create a new, de-pathologized social space - a "neo-society" - inside the hospital where, as Fanon puts it, "madness I is permitted i " (1984, as cited in Gibson & Beneduce, 2017, p. 170), where patients are "able to verbalize, explain things, explain themselves, and take a stance" (1959, as cited in Gibson & Beneduce, 2017, p. 208). (2006, as cited in Gibson & Beneduce, 2017, p. 157-158) The lesson Fanon drew from Blida-Joinville that "psychiatry has to be political" was not empty sloganeering. Why Fanon was such an exception to colonial psychiatry is the subject of Nigel C. Gibson and Roberto Beneduce's I Frantz Fanon, Psychiatry and Politics i (2017). [Extracted from the article]

Background: Some psychodynamic and integrative therapists have written about their experiences of mental imagery (MI), or imagery that arises spontaneously while working therapeutically. However, there have been no empirical investigations of therapists' imagery experiences. This mixed methods study was exploratory and aimed to begin to address this gap. Methods: Forty‐three therapists, mostly psychologists, participated in an online study that collected both quantitative and qualitative data related to experiences of spontaneous mental imagery (SMI) in therapy. They provided written reports and reflections on their personal experiences and completed a series of Likert‐type scales in regard to conceptualisations of SMI. Results: The majority rated SMI as helpful and perceived it as clinically meaningful although they reported little or no training in this area. Symbolic or metaphoric SMI was viewed as providing insight into clients' core issues; as linked to therapist emotion and empathy; and reflective of the therapeutic relationship and countertransference. Some SMI was also experienced as difficult to understand and some was disturbing for therapists especially when the imagery related to clients' trauma experiences. Conclusions: Therapists' SMI is an important new area of research. Initial findings suggest that while many therapists place considerable value on their SMI, there is little research or training available in this area. [ABSTRACT FROM AUTHOR]

This paper discusses the residues of a somatic countertransference that revealed its meaning several years after apparently successful analytic work had ended. Psychoanalytic and Jungian analytic ideas on primitive communication, dissociation and enactment are explored in the working through of a shared respiratory symptom between patient and analyst. Growth in the analyst was necessary so that the patient's communication at a somatic level could be understood. Bleger's concept that both the patient's and analyst's body are part of the setting was central in the working through. [ABSTRACT FROM AUTHOR]

The emotions experienced by a supervisor—including even his private, 'subjective' fantasy experiences and his personal feelings about the supervisee—often provide valuable clarification of processes currently characterizing the relationship between the supervisee and the patient. In addition, these processes are often the very ones which have been causing difficulty in the therapeutic relationship and, because heretofore unrecognized by the supervisee, have not been consciously, verbally reported by him to the supervisor. This thesis is undoubtedly well known to many persons engaged in supervision, and in everyday use by them in this work; but my own experience indicates that it is far from universally recognized, and it has not been presented in the literature, to the best of my knowledge. It would be at least equally valid to express the principle in the following fashion: the processes at work currently in the relationship between patient and therapist are often reflected in the relationship between therapist and supervisor. But it makes for simplicity of presentation to present this material from the viewpoint of the supervisor. [ABSTRACT FROM AUTHOR]

The article focuses on the cultural and other issues facing lesbian, gay, bisexual and transgender (LGBT) psychiatric patients. It discusses the social and psychological implications of coming out. Factors that physicians should consider when taking sexual history of LGBT patients are mentioned. It provides an overview of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People published by the World Professional Association for Transgender Health.

The author suggests that a paradigm shift in therapists' understanding of therapeutic efficacy from making the unconscious conscious to repeating past experience in the transference/counter-transference has resulted in counter-transference enactment and analysis being considered as central in the resolution of repressed introjected pathological object relations. This shift marks a return to Ferenczi's early technical innovations and ideas concerning a repetition in the transference of past traumatic object relations but with a new and benign object, the analyst, resulting in a different outcome. The author outlines the analysis of a regressed patient in which the analyst's immersion into the patient's world of paranoia, magical thinking, dissociation and the uncanny, analysis of counter-transference enactment, and role reversal contributed to a resolution of pathological introjects in the context of a new object relationship with the analyst. Experiencing the patient's tortured inner world and the analyst's ability to symbolize the experience resulted in a new-found ability in the patient to reflect on and analyze his internal object relations. [ABSTRACT FROM AUTHOR]

Research from several domains indicates that genetic factors, childhood environment, and later interpersonal experiences are important sources of how patients relate to their therapists (transference). Transference work, a core specific technique in psychodynamic psychotherapy, focuses on exploring the patient-therapist relationship, with the idea that this may lead to improvement of the patients' relationships outside therapy. Many psychotherapy researchers hold the position that specific techniques do not contribute much to the outcome of psychotherapy. However, more than 30 studies have reported significant associations between transference work and outcome. These findings indicate that transference work interventions are indeed active ingredients (for better or worse). Naturalistic studies suggest that a high frequency of transference interventions may have negative effects. Randomized clinical trials indicate that transference-based treatments and alternative treatments work equally well with regard to symptom improvement. However, transference-based treatments appear to be much more effective with regard to interpersonal relations and other measures of personality functioning. The average between-groups effect size for the experimental studies listed in this article was large. Contrary to common clinical wisdom, transference interventions seem to be most important for (mainly female) patients with difficult interpersonal relationships and more severe personality pathology. Gain of insight may be a specific mechanism of change in dynamic psychotherapy, but only one treatment component study has linked transference work directly to gains in insight and subsequent improvement in interpersonal functioning. Research that examines how transference phenomena may be responded to in non dynamic therapies is scarce. [ABSTRACT FROM AUTHOR]

The paper describes and discusses some aspects of the countertransference in relation to two patients whose state of mind could be described as psychotic during treatment. The clinical work took place in the context of a private psychotherapy practice, but some aspects of the countertransference became evident in relation to external, but related figures connected with the treatment. It was not until the treatment with both patients had ended, and the author had done a considerable amount of work on her own processes, that she was able to acknowledge, think about, and eventually write about, the ways in which the two patients had impacted upon her own psyche. In order to achieve this aim of understanding, the author undertook a research degree at MA level as the frame in which to study psychotic processes in more depth, along with studying the transference and the countertransference. As she worked upon her degree thesis she became more aware of, and less embarrassed about, the countertransferential processes that taken place. The paper makes particular use of Stephen Purcell's contributions to identifying the countertransference and Harold Searles's work with psychotic patients. [ABSTRACT FROM AUTHOR]

Mindfulness, defined as “a purposeful, non-anxious, reflective presence,” (Epstein, 2003a, p. 1) has been identified as a potentially key practice skill of effective health care practitioners working in mental-health settings. The purpose of this mixed-methods study was to explore the cultivation and use of mindfulness in the clinical practice and everyday lives of occupational therapists who practice in mental health. Results revealed that mindfulness is perceived as being an important clinical quality, which enhances therapist well-being and effectiveness, and contributes to improved client outcomes. Relevance to occupational therapy practice philosophies and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objectives. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome. Design. In this dismantling, randomized clinical study, 100 out-patients who sought psychotherapy due to depression, anxiety, and personality disorders, were assigned to 1 year of dynamic psychotherapy with and without transference interpretation. Methods. Patients' pre-treatment target expectancies and global expectancy were measured in this clinical trial. Tests of mediation were performed with two patient-rated and one therapist-rated measure of the therapeutic alliance, using regression analyses. Six putative moderators of the mediational paths were explored. Results. Global Optimism was significantly associated with two clinician-rated outcome measures - the Psychodynamic Functioning Scales and Global Assessment of Functioning. Both patient ratings, but not the therapist rating of alliance mediated the association between global expectancy and clinician-rated outcome. None of the putative moderators had a significant effect. Conclusion. The results, together with previous findings, indicate that the expectancy-alliance-outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment. [ABSTRACT FROM AUTHOR]

The article discusses the role of empathy to psychotherapy. It says that a therapist must help patients to reappropriate and reclaim themselves by applying translations, adaptation, and empathy. It notes that a therapist must surrender to the subjective experience of the patient in order to become empathic, setting aside objective evaluation. It adds that empathy is linked to real relationship and therapeutic alliance in terms of transference-countertransference matrix.

The author considers the paper by William Lubart, PhD, drawing attention to the therapist's feelings of fear and revulsion to death and physical suffering in the treatment of a patient with chronic debilitating physical illness, and to the therapist's feelings of shame around straying from therapeutic ideals in the treatment of this patient. Themes of erotic transference and anti-erotic countertransference are also explored. [ABSTRACT FROM AUTHOR]

Literature on the analyst's positive countertransference with patients diagnosed with schizophrenia is scarce. The literature review and study summarized in this article aims at shedding light on the clinician's experience in the therapeutic relationship with a psychotic patient, specifically the integrative or transformative properties of such an experience for the clinician. The study proposes that while in therapeutic relationships with these patients, an analyst may find insight into him- or herself. This may be due to several components specific to the psychosis: certain interpersonal mechanisms, an unfiltered access to (collective) unconscious operations, and/or their unique social position. The study draws on phenomenological interview data collected from five psychoanalytic clinicians who were asked detailed questions about a therapeutic relationship with a patient diagnosed with schizophrenia in which they experienced positive countertransference. Analysis of the interviews reveals both transformational and learning experiences of psychoanalytic psychotherapists who have worked with patients diagnosed with schizophrenia on a long-term basis. Further interpretation of the transcripts point to these patients' abilities to illuminate the human condition. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand how the real relationship (RR) relates to important process and outcome variables from both the clients' and therapists' perspectives. Using a sample of 31 therapist/client dyads at a university counseling center, the authors examined the RR at the 3rd session of therapy and at termination. The results revealed that client adult attachment avoidance was negatively correlated with client RR, while client adult attachment anxiety was uncorrelated. Therapists' ratings of negative transference were negatively correlated with therapist-rated RR and were uncorrelated with client-rated RR. Hierarchical linear modeling analyses were conducted to predict postintervention outcome from client and therapist perceptions of the RR. Therapists' ratings of the RR accounted for a significant amount of variance in client posttreatment symptoms while controlling pretreatment symptoms. Client-rated RR total scores and client and therapist 3rd-session alliance scores were not significant predictors of postsymptom ratings. Implications of the usefulness of measuring the RR in psychotherapy are discussed, as are recommendations for future study. [ABSTRACT FROM AUTHOR]

The sweeping revisions in the understanding of major mental illness brought about by the biological revolution in psychiatry moved the spotlight away from the treatment relationship. In recent years, however, a resurgence of interest in subjectivity underscored the fact that despite dramatic scientific breakthroughs the existential realities of illness were largely unaltered. Even with this shift in inquiry, however, little attention was shown to the inner experience of practitioners engaged in long-term therapeutic relationships where movement of any kind was barely detectable. Clinicians and clients alike frequently travel a long and difficult road in search of pathways to recovery. Tracing their shared journey through a detailed case presentation illuminates the interior worlds of both travelers and illustrates that neither is left untouched by the complexities of change. [ABSTRACT FROM AUTHOR]

After a long period when the treatment of major mental illness was under the decisive influence of the biological revolution in psychiatry, there are now growing signs of a revival of the role of psychotherapy in understanding the lived experience of psychotic disorders. Despite increased attention to the subjective world of persons afflicted with severe mental illness, considerably less has been written about the devastating effects of a loss of reality on memory and meaning and about the especially complex ordeals facing therapists who enter into long-term relationships with clients cut off from the past and the future. The ensuing quest for meaning amid the breakdown of memory is the focus of this paper. [ABSTRACT FROM AUTHOR]

Treatment resistance has emerged as a significant issue in our era emphasizing biological treatments for psychiatric disorders. This article suggests that, particularly when Axis II disorders are part of the clinical presentation, a subset of treatment refractory patients responds to a psychodynamic treatment approach that includes careful attention to the meaning of treatment resistance, and to the importance of relationships and of patient authority in recovery. The importance of engaging the negative transference and countertransference in treatment is also emphasized. A case example is offered to illustrate the article's thesis. [ABSTRACT FROM AUTHOR]

Discusses some psychodynamic issues in combining psychotherapy and pharmacotherapy in the treatment of psychiatric disorders. Relationship between doctor and patient; Meaning and symbolism of medication and diagnosis; Transference.

Abstract: The psychoanalytical therapy of schizophrenic patients is traditionally based on the development of a positive transference and on an interpreting, holding analytic work. In this paper, we present the case-study of a patient for whom all “making-sense” work became persecuting. We will name this very ambivalent person an “alterno-valent” patient. Within this conflicting transference, only a humoristic approach allowed us to develop a trustful relationship with the patient. We describe the subversive nature of this relationship-humour, which is to take a completely opposite position to the analytical position, but to remain nevertheless attentive and empathic. We show further how this humoristic play serves us to interpret the transference. The humour-concept is assimilated to the Freud''s “Witz”. We refer further to the literature in order to describe the psychotic transference as an oscillating movement between “transference-erotomania” and the “let-down-position”, both also deleterious. We propose the idea that the therapist''s effort to make sense could induce in psychotic patient a psychic disorder who acts first as a defence (against the confusing pointing of the Big Other), second as a guarantee for the permanency of the relationship (the subject''s disorder engage the Big Other in an organizing work). We also use “the concept of “projective identification””-concept, which is considered not only as the projection against bad objects, and also as a mechanism that allows the projection of the working-out abilities. [Copyright &y& Elsevier]

The article presents a perspective on topics related to psychoanalysis. According to the author, psychoanalysis is concerned, not with what happens to a man, or has happened to him in childhood and infancy, but with what has been experienced. He added that psychoanalysis does not exercise the familiar functions of a science. Furthermore, the author indicated that psychoanalysis should not try to team up with strangers who want none of it, but should seek the companionship and company of its friends.

The article offers information on a study related to patients' representation of therapeutic dialogue and the outcome of therapy. Topics discussed include enhanced sustained improvement after termination is by positive representations of the therapeutic dialogue; use of Therapist Representation Inventory to assess the impact of dialogues in recovery; and the result of the study that showed no significant impact of conscious positive memory of the therapist on outcome.

Ethnic minority and immigrant patients are subject to what are termed “health disparities” wherein the quality of services received is not at the same level as that of majority group members. These disparities are a consequence of both erroneous diagnosis and, relatedly, inadequate treatment. Culture impacts both diagnosis and therapy by circumscribing how an individual understands distress. The experience, expression, and explanation of what psychiatry understands to be psychopathology are eminently “cultural”, for the clinician as well as for the patient. The very identification of a “symptom”, its relationship to psychopathology, and even what constitutes the specific diagnostic categories is in large part a function of the impact of these three “exes”. The therapeutic process and relationship is impacted in part by the fourth “ex”, the expectations of both clinician and patient, and, once again, when distinct can lead to early termination and/or poor outcome. Ethnicity, particularly in the context of ethnic minority status, can impact both diagnosis and treatment in the context of both overt and covert prejudice, particularly on the part of the clinician. Ethnocultural countertransference involves the unconscious projection of ethnic and racial prejudice onto the patient, which has a direct impact on diagnosis and the development of the therapeutic relationship. The presentation will review both barriers and suggest strategies for effective intercultural diagnosis and treatment. [ABSTRACT FROM AUTHOR]