Intermittent Treatment with the Psychodynamic Psychiatrist: A Patient-Centered Approach.

This study examines the experiences of patients in treatment with psychodynamic psychiatrists on an intermittent basis following an initial brief period of intensive psychotherapy and stabilization. Patients with non-psychotic disorders who received intermittent treatment answered a web-based questionnaire describing the usefulness of various supportive, cognitive-behavioral, and psychodynamic interventions. Forty-eight out of 58 patients invited to participate completed the survey (83% response rate). The majority (75%) of respondents welcomed the intermittent treatment frame. Therapeutic factors deemed to be most helpful included supportive interventions such as ability to relate to the clinician, ability of clinician to listen empathically, and feeling supported by a non-judgemental therapist when talking about private matters. The majority of respondents also endorsed as highly beneficial various cognitive-behavioral interventions such as understanding how thinking patterns impact behavior and feelings and discussing alternative coping skills. Also highly rated were psychodynamic interventions, including understanding how the present is modeled from past experiences and expression and regulation of affect. In the open-ended qualitative feedback, therapeutic factors including collaboration, forming an alliance, and empathic attunement emerged as important. Our preliminary findings suggest that the intermittent psychodynamic treatment frame is well received by patients. Patients welcome integration of different psychotherapeutic approaches to individualize treatment. The common factors in psychotherapy are important patient-reported therapeutic factors in the intermittent treatment approach.

Folie à deux and Fregoli syndrome with greater severity in the 'secondary' - A case report.

Folie à deux and Fregoli syndrome are rarely seen in clinical practice. We present a case in which these rare syndromes co-occur. Remarkably, in this case the 'secondary' develops a more serious illness course than the 'primary' and reciprocally induces a de novo Fregoli delusion in the 'primary'. This case discusses how socio-cultural factors, such as interdependent family dynamics, could have precipitated this rare variant of folie à deux. It also highlights the importance of making culturally-sensitive formulations for treatment.