Psychodynamic Psychiatry and Psychoanalysis in Thailand.

The authors provide an overview of psychiatry and psychodynamic psychotherapy in Thailand, including a discussion of practice patterns, trends, and the cultural context of the delivery of psychotherapy services in this Southeast Asian country. They discuss a way forward in psychodynamic psychotherapy training that is collaborative, self-sustaining, and leads to competence. They address how to culturally adapt psychodynamic psychotherapy and suggest areas of research that would advance the field. Lastly, they discuss psychodynamic pedagogical strategies that may be acceptable and effective in underserved areas.

The Development of Psychodynamic Psychiatry in Iran.

Iran, as one of the oldest civilizations in the world, is positioned at the crossroads of important trade routes linking Asia, Africa, and Europe, resulting in enormous cultural interactions with the East and West. The development of modern psychiatry and psychodynamic psychiatry in Iran occurred in the context of the broader process of modernization through interactions with the West. Mentioning key scholars and influences that helped establish a psychodynamic tradition within centralized government-led systems of mental health care and medical education, the author describes various stages of the development of psychodynamic psychiatry in Iran.

Psychodynamic Psychiatry in Singapore.

The authors provide an overview of the history of psychiatric services and training in Singapore, and the more recent introduction of psychodynamic psychotherapy training for psychiatric residents. They describe the current state of psychodynamic psychiatry services in the public healthcare system, including efforts at fostering psychodynamic thinking in nonpsychiatric community partners via community mental health integrated care programs and activities such as Balint Groups. They discuss current challenges in psychodynamic practice, such as the impact of language and culture on the Singaporean individual's receptiveness to psychodynamic psychotherapy, as well as systemic challenges in funding and expanding psychodynamic services. They highlight future directions, including challenges and opportunities for the local psychodynamic community in Singapore.

Five Months Later: The Psychodynamic Psychiatrist and Psychiatric Care in the Era of COVID-19.

Five months following an earlier report on the initial impact of COVID-19, the same 24 contributing psychodynamic psychiatrists reported on how matters have shifted in their experience. Spread of the virus, lockdowns, politicization of all aspects of the pandemic, massive unemployment, and social justice frustrations have characterized the interim. The initial burst of acute uncertainty and worry has shifted into a more adaptive but still destabilizing long-term apprehension: distance treatment and its ramifications have become somewhat normalized, training now incorporates virtual treatment approaches, psychodynamically informed counseling has taken a larger role in the content of care. New theories of clinical practice are emerging that address these changes. As before, contributors' narratives are considered from the perspective of administration and training, structure and content of treatment, and the impact of the pandemic both on patients and psychiatrists.

Visiting Psychodynamic Scholars Enhance Psychodynamic Learning for Psychiatric Residents.

Limited resources in psychodynamic education in psychiatry residency training led the American Academy of Psychodynamic Psychiatry and Psychoanalysis to create The Victor J. Teichner Award. This award funds a psychodynamic scholar to visit a psychiatry residency program to teach residents and faculty over a 2-3-day period. Anonymous online surveys were distributed before and after the visit to 88 residents from three residency programs. In comparing pre-visit and post-visit groups, residents rated themselves as significantly improved in psychodynamic psychotherapy regarding (1) their level of competence (p < 0.005), (2) their ability to listen (p < 0.009), and (3) their ability to make interventions (p < 0.002). In addition, residents in psychodynamically underserved programs expressed strong interest in learning both general and psychodynamic psychotherapy skills despite being in programs they view as predominantly biologically oriented. These findings suggest that brief, intensive programs to enhance psychodynamic teaching are useful in psychiatric education and can result in a significant increase in residents' sense of competence in psychodynamic psychotherapy.

Annotated Bibliography for Supervising Psychiatry Residents in Psychodynamic Psychotherapy.

OBJECTIVE: This paper sought to compile an annotated bibliography for the outpatient year of adult psychiatry residents, providing resources for a foundation in psychodynamic theory which can be utilized in supervision to aid in ongoing psychotherapeutic work. METHODS: In selecting the readings, the ACGME Milestones sub-competencies considered were (i) empathy and process, (ii) boundaries, (iii) alliance and provision of psychotherapies, (iv) seeking and providing supervision, and (v) knowledge of psychotherapy (theories, practice, and evidence base). Once the readings were selected, two authors independently reviewed the articles to determine which key sub-competencies each article addressed. Chance corrected agreement between the reviewers was assessed using the Cohen kappa statistic. The kappa for interrater agreement was 0.83. RESULTS: A list of 32 readings was compiled sequentially, allowing for theoretical concepts to be progressively built upon. The content of the papers aligned well with multiple sub-competencies in the medical knowledge (MK) and patient care (PC) domains. The bibliography allows for close examination of therapeutic frame; active listening and reflecting on the meaning of the therapist's interventions; transference and the use of countertransference as a diagnostic/therapeutic tool; defense mechanisms; patient pressures towards reenactment; theoretical viewpoints on therapeutic action (e.g., ego psychology, self-psychology, relational therapy, object relations, classical/modern Kleinian); and meaning of lateness, treatment breaks, and termination. CONCLUSIONS: This list serves as an ancillary resource which can augment discussions in therapy supervision, while also aiding in standardizing the minimal knowledge base achieved in psychodynamic theory.

Teaching Psychotherapy to Psychiatry Residents.

The rationale, content, and teaching techniques used for a psychiatry residency psychodynamic therapy course based on Psychodynamic Therapy: A Guide to Evidence-Based Practice (Summers & Barber, 2009) are presented in the context of their evolution over the last two decades and the challenges of teaching this topic in the current environment. The central elements of an exciting and engaging psychotherapy teaching program-feelings, framework, and freedom-are explained. Specific topics such as psychodynamic formulation, using videos, self-disclosure, and resistance are discussed.

Introducing a Conversational Model Therapy Approach as a Team Model of Care: The Clinician Experience in a Sexual Assault Service.

This article examines clinician experience in adopting a contemporary psychodynamic model of care by exploring the experiences and perspectives of staff at an Australian hospital-based sexual assault service (SAS), reflecting then on implications for how to best engage clinicians in a model of care change and training. The Conversational Model of Therapy (CMT) is a contemporary psychodynamic approach integrating evidence from developmental psychology, neuroscience and trauma. Training was provided in the CMT approach to Short-Term Intensive Psychodynamic Psychotherapy seeking to enable the service to better provide for the needs of adult clients with less recent sexual assault experiences and/or those able to receive a short-term psychotherapy. Five semi-structured individual interviews and one focus group (with four participants) were undertaken to identify SAS staff perceptions of their experiences after initial training of up to 13 sessions with CMT. Thematic analysis was performed to identify, analyse and report patterns in the responses with the following themes emerging: the challenges staff face in providing a service to clients; coping mechanisms staff utilise in their work; the current service structure and how this compares with their experiences of CMT, and; feelings and thoughts on SAS staff being evaluated. Findings provide evidence that the majority of staff understood the need for change and were able to undertake training towards this due to effective coping mechanisms within their work and good support from within their team. The research also highlights the need to ensure effective training to evaluate participants' understanding of the model being taught. In the context of training experience elsewhere, learning and synthesis of all of the knowledge relevant to a psychodynamic model of care may require experiential learning through supervision of audio-recorded sessions, although this has challenges in the SAS context.

Innovative Educational Initiatives to Train Psychodynamic Psychiatrists in Underserved Areas of the World.

Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere.

O desafio do trabalho com adolescentes em conflito com a lei: intervenção em psicodinâmica do trabalho / The challenge of working with teenagers in conflict with the law: psychodynamic work intervention / Reto de trabajo con los adolescentes en conflicto con la ley: una intervención en psicodinámica del trabajo

Os Atendentes de Reintegração Socioeducativo (ATRS) trabalham no acompanhamento, guarda e segurança dos adolescentes que cumprem medidas socioeducativas por terem cometido atos infracionais previstos no Estatuto da Criança e do Adolescente (ECA). Trata-se de um trabalho, no âmbito das políticas públicas, que possui dimensão educativa e de sanção. Este artigo discute as estratégias coletivas de defesa desses trabalhadores, que lidam cotidianamente com adolescentes em conflito com a lei. Utilizou-se a metodologia proposta em Psicodinâmica do Trabalho. Concluiu-se que, por meio de uma forte união,esses trabalhadores protegem-se das patologias do trabalho, pois saem da posição de isolamento e se inserem em um espaço de relações intersubjetivas que sustentam o trabalho e afastam o medo e as angústias. O fortalecimento do coletivo ocorre pela mobilização da cooperação, em torno de uma disciplina quase carcerária direcionada aos adolescentes em privação de liberdade. Uma disciplina que dissimularia uma estratégia coletiva de defesa que nega o fato de que os adolescentes em conflito com a lei estão em situação de vulnerabilidade psíquica e social. Esta estratégia coletiva de defesa possui a função, nas condições atuais de trabalho, de proteger esses sujeitos do medo de tecerem uma relação de proximidade com os esses adolescentes, baseada na certeza de que em tal relação esses trabalhadores estariam em perigo e desprotegidos.

Socio-educational Reintegration Workers play a role in the custody, safety and monitoring of teenagers, complying with socio-educational measures for having infringed the law according to Brazil's Child and Teenager Statute. This study in terms of public policies has to do with education and sanction. Further, it discusses collective defense strategies from social reintegration workers, who deal on a daily basis with teenagers in conflict with the law. The methodology applied is based upon Work Psychodynamics. The study concludes that given their strong unity, social reintegration workers protect themselves from work-related pathologies given that they preserve themselves from isolation by inserting themselves in a space of intersubjective relations that support their work and keep them from fear and anxiety. Collective strength comes through cooperation built around the almost prison-like discipline shown towards teenagers deprived of their freedom. This discipline disguises a collective defense strategy that denies the fact that teenagers in conflict with the law are in a vulnerable psychosocial situation. This collective defense strategy serves under current work conditions to protect social reintegration workers from the fear of building a close relationship with teenagers given the certainty that this relationship will leave the first group at risk and unprotected.

Los asistentes de Reintegración socioeducativo (ATRS) trabajan en el seguimiento, la vigilancia y la seguridad de los adolescentes que están cumpliendo medidas socioeducativas por la comisión de actos ilegales previstas en Estatuto de la Infancia y la adolescencia (ECA). Es un trabajo en el contexto de la política pública, que tiene una dimensión educativa y sanción. Este artículo analiza las estrategias colectivas de defensa de los profesionales que tratan a diario con adolescentes en conflicto con la ley. Se utilizó la metodología propuesta para la psicodinámica del trabajo. Se concluyó que, por intermedio de una unión fuerte a los trabajadores a protegerse de las condiciones de trabajo, al salir de la posición de aislamiento y se insertan en un espacio interpersonal las relaciones que apoyan el trabajo y lejos del miedo y la angustia. El fortalecimiento del colectivo es la movilización de la cooperación en torno a una disciplina de la prisión casi dirigido a adolescentes de privación de libertad. Una disciplina que ocultaría una estrategia de defensa colectiva que niega el hecho de que los adolescentes en conflicto con la ley están en situación de vulnerabilidad psicológica y social. Esta estrategia colectiva de defensa tiene la función, las condiciones actuales de trabajo, para proteger a estos temas desde el miedo trenzó una estrecha relación con estos adolescentes, basado en la certeza de que a este respecto que estaban en peligro y sin protección.

Learning Psychodynamic Psychotherapy in Southeast Asia.

The subjective nature of psychodynamic psychotherapy (PP) makes training and supervision more abstract compared to other forms of psychotherapy. The issues encountered in the learning and supervision process of PP of Malaysian psychiatry trainees are discussed in this article. Issues of preparation before starting PP, case selection, assessment of patients, dynamic formulations, supervision, anxieties in the therapy, countertransference, termination of therapy, the treatment alliance, transfer of care, the therapeutic setting, and bioethical considerations are explored. Everyone's experience of learning PP is unique and there is no algorithmic approach to its practice. With creative thinking, effort, and "good enough" supervision, a trainee can improve PP skills, even in underserved areas of the world.

Does the supervisor's teaching style influence the supervisee's learning prescribed techniques?

OBJECTIVES: This study examined the directive and non-directive supervisors' instructional styles, supervisees' interactive communications within supervision sessions as well as the relative success of supervisees' learning to apply specific techniques within psychotherapy. METHOD: The developers of Time-Limited Dynamic Psychotherapy (TLDP) provided the supervised training for 16 therapists as part of the "Vanderbilt II" psychotherapy project. Supervision sessions were rated for supervisors' adherence to TLDP content. Both supervisors and supervisee were rated for classroom interactive behaviors of "initiation" speech (e.g., introducing ideas) and "responsive" speech (e.g., amplifying the other speaker's topic). The third therapy session was targeted for discussion within supervision. Therapy sessions immediately before and after supervision were rated on TLDP adherence. RESULTS: One of the supervisors (Supervisor A) was found to use an instructional style of relatively more initiation-based speech, whereas the other (Supervisor B) used more response-based speech. Technical adherence for supervisees of Supervisor A was significantly higher than those assigned to Supervisor B. Supervisees' initiation-based speech during supervision predicted less use of TLDP techniques in the therapy session after supervision. Supervisors' interactive style was not associated with therapy adherence. CONCLUSIONS: Relatively more directive and structured supervision may influence the acquisition and use of manual-prescribed therapy techniques.

Practicing Psychoanalysis and Psychodynamic Psychotherapies in Developing Societies.

Vital to the contemporary exercise of psychiatry is the biopsychosocial approach, with psychotherapy as its well-defined, and requisite, constituent. The key objectives of psychoanalysis and other related therapies are the amelioration of symptoms and modification of character by probing the unconscious. But the practice of psychoanalysis and similar insight-oriented techniques is in developing nations is different from developed countries due to cultural and educational reasons, along with a shortage of required facilities. The result often is ignorance of exploratory techniques and the substitution of approaches, such cognitive and behavior therapies, which operate at the conscious and subconscious levels of mind. Additionally, decreased implementation of psychotherapy by psychiatrists in industrialized countries may discourage its use by therapists in developing societies. This article is devoted to developing, traditional, or conservative societies and the obstacles confronted in the progression of applied (clinical) psychoanalysis and related methods in the classroom and practice. Possible solutions also are discussed briefly.

What is the right time for supportive versus expressive interventions in supervision? An illustration based on a clinical mistake.

Although supportive-expressive (SE) psychotherapy is one of the most studied psychodynamic therapies today, little is known empirically about effective strategies in SE supervision, or in psychodynamic supervision in general (Diener & Mesrie, 2015; Watkins, 2011). One of the important questions in SE psychotherapy is how to decide when to use supportive and when to use expressive interventions. As a parallel process, this type of decision is relevant also to SE supervision. The present case study focuses on the decision-making process in an SE supervision session: when should supervisors use supportive as opposed to expressive strategies with their supervisees? Our aim is to develop decision rules that reliably support supervisors' decisions. We analyze a clinical error made by supervisors in this type of decision making, and show how mistakes of this type can either be avoided or, when they occur, how to turn them into opportunities for learning and for the formation of new understanding and growth. Similarly to the finding that therapists with better skills in managing their countertransference feelings were shown to have better outcomes with their patients (Gelso, Latts, Gomez, & Fassinger, 2002; Hayes, Gelso, & Hummel, 2011), we suggest that the management of the supervisors' feelings, and working through their mistakes with the therapists, can contribute to the supervisory relationship and to the development of the psychodynamic therapists' skills. (PsycINFO Database Record

The effect of educational information about treatments for schizophrenia on stigmatizing perceptions.

BACKGROUND: A promising strategy for reducing stigmatizing perceptions towards people with schizophrenia is education about treatment and recovery. The effects of different kinds of treatment information on stigmatizing perceptions, however, have yet to be compared directly. This study compared three different educational interventions focusing on medication, CBT, and psychodynamic psychotherapy in their potential to reduce stigmatizing perceptions towards people with schizophrenia. METHODS: In an online experiment 178 participants received one of three psychoeducation texts that focused on medication, CBT or psychodynamic therapy. The effects on stereotypical beliefs about psychosis (dangerousness, unpredictability, blame, prognostic pessimism) and emotional responses towards people with schizophrenia (anxiety, anger, sympathy) were tested. RESULTS: Perceptions of dangerousness, unpredictability, and anxiety towards people with schizophrenia were reduced in all conditions. Prognostic pessimism was reduced only after reading the CBT information. LIMITATIONS: No neutral control group was included. The sample was not representative with respect to level of education or gender. CONCLUSIONS: Stigmatizing perceptions may be reduced by receiving information about any type of treatment for psychosis and without producing negative side-effects, although this needs to be replicated in a controlled study. However, information on CBT seems most suitable to reduce stigma, since it was able to reduce prognostic pessimism.