Psychodynamic Aspects of Love: A Narrative Review.

Love is a delicate experience that delves into the foundations of the psyche, and many sources of the emotional experience of love remain unconscious. The nature of love is twofold and contradictory, regressive and progressive, constructive and destructive, connecting and separating, directed toward the object and the self. The ability to idealize is a precondition for "falling in love". Abrupt disappointments can be traumatizing, but gradual ones include the work of mourning and may lead to a more authentic relationship that is less obscured by narcissistic needs. Some aspects of projective identification, which can be a defense, a primitive form of object relation, and a path for psychological change, may be present in all forms of love. These are the close interaction of self and object, blurred boundaries between them, the need that the other person feels what one feels, and a strong desire to continue the relationship. A therapeutic setting can enable the long-term transformation of love in transference and more mature expressions of love in life. The maturation of narcissism is the hallmark of mature love. One of the prerequisites for mature love is a mature superego, which does not require suffering as a prerequisite for satisfying one's needs. Clear differentiation of the boundaries of the self enables safe (temporary) blurring or disappearing of its boundaries and satisfaction of needs for repetition of lost fusion with the primary object of love. Mature love also means the capacity for tolerating ambivalence, i.e., the capacity to integrate both love and hatred experiences of the same person. One can see love as a "glue" that helps integrate different aspects of the psyche into a harmonious whole.

Personality Organization and Depressive Symptoms Among Psychiatric Outpatients: The Mediating Role of Shame.

ABSTRACT: Previous research has demonstrated relations between lower level of personality organization (PO) and multiple indices of mental health disturbances. The goal of this research was to examine whether experience of shame would mediate the relationship between PO and depressive symptoms in a sample of 321 Croatian psychiatric outpatients (64% female; mean age, 38.67 years). The total PO level exhibited positive associations with depressive symptoms and with all three subscales of shame ( p < 0.01). Characterological, behavioral, and bodily shame showed significant mediating effects in the PO-depression relationship, while controlling for the influence of age and sex. PO level seems to be strongly related to depressive disturbances, with the experience of shame representing one of the underlying mechanisms of this relationship. Given that patients with personality disorders ( i.e. , low PO level) suffer from poorer treatment outcomes for major mental disorders, more emphasis should be placed on psychotherapeutic management of shame-proneness.

Shame and COVID-19 Pandemic.

Optimal psychic response during the COVID-19 pandemic is the result of many different factors. One of the main factors is the psychodynamic understanding of essential emotions such as shame. Despite the immense effort by health workers to address stress- and trauma-related disorders in the course of the COVID-19 pandemic, a large proportion of the people affected by the disorder do not have information regarding the emotion of shame. Lack of mentalizing capacity implies disturbed shame dynamics. The therapeutic relationship and optimal alliance offer the frame for acceptance of shame as useful for psychological growth. Empathy should be a cure for dysfunctional shame, at the individual or social level. We believe that including a psychodynamic approach in the national public and mental health emergency system will empower national prevention strategies.

Pathological Narcissism, Negative Parenting Styles and Interpersonal Forgiveness among Psychiatric Outpatients.

BACKGROUND: Pathological narcissism has previously been investigated with regard to negative parenting and interpersonal forgiveness, but inconsistent findings have been obtained in relation to its two phenotypic forms - grandiosity and vulnerability. Moreover, the role of negative parenting in the lack of forgiveness within narcissistic pathology has not been explored thus far. The aim of the current research was to investigate the complex relations among pathological narcissism, negative parenting, and interpersonal forgiveness in psychiatric outpatients. SUBJECTS AND METHODS: A sample of 250 adult psychiatric outpatients (61% female; mean age 39.15 years) were enrolled in this study. The participants filled out the Pathological Narcissism Inventory (PNI), the Tendency to Forgive Scale (TTF), the Measure of Parental Styles (MOPS), and the Depression, Anxiety, Stress Scales (DASS21). RESULTS: Narcissistic grandiosity and narcissistic vulnerability were positively correlated with mothers' and fathers' negative parenting, but this association was significantly stronger in the case of narcissistic vulnerability. Only narcissistic vulnerability was related to interpersonal forgiveness. In the mediation analysis, negative parenting was not directly related to interpersonal forgiveness, however, this association became significant after introducing narcissistic vulnerability. Narcissistic vulnerability served as a full mediator of the mothers' and fathers' negative parenting - interpersonal forgiveness relationships. CONCLUSIONS: Narcissistic vulnerability seems to be more strongly related to negative parenting and interpersonal forgiveness than narcissistic grandiosity, while it also represents one of the underlying mechanisms of the negative parenting - interpersonal forgiveness relationship. The clinical implications of these findings are discussed in relation to pathological narcissism and lack of forgiveness.

Poor Agreement Between Two Commonly Used Measures of Shame- and Guilt-Proneness.

This study sought to assess the agreement between commonly used measures of shame- and guilt-proneness, the Test of Self-Conscious Affect-3 (TOSCA-3), representing scenario measures, and the Personal Feelings Questionnaire-2 (PFQ-2), representing checklist measures. To overcome the limitations of the widely used correlation analysis, the 2 measures were compared by the Bland-Altman method. We administered both measures at once to the same sample of 138 graduate students (67.39% were female; median age = 27 years). A randomly selected sample of 46 students repeated the procedure 8 weeks later. We tested how well our data fit the hypothesized measurement models, analyzed internal consistency of measures, evaluated their repeatability, and analyzed the agreement between them. To account for the different ranges, both measures' scores were expressed as the percentages of their maxima. The observed data fit the proposed models well. Both measures showed good internal consistency and repeatability. In the shame domain, TOSCA-3 exceeded PFQ-2 scores by 22.32% on average (49.81, -5.13%; 95% limits of agreement), and even more in the guilt domain, by 38.4% (67.75, 8.20%). Our results question the often-assumed congruence of the shame domains assessed by scenario and checklist measures.

The role of psychodynamic and personality assessment in psychopharmacotherapy of suicidal psychotic patients.

Optimal psychopharmacotherapy is based upon the results of many different factors. One of the main factors is therapeutic alliance. The role of psychodynamic is very important in the context of good therapeutic alliance. Lack of mentalizing capacity implies disturbed view of psychopharmacotherapy. Therapeutic relationship and optimal alliance offers the frame for acceptance of psychiatric drugs as positive and useful for psychological growth. Our literature search of a recent papers relating psychopharmacology and psychodynamic have revealed progress in psychoanalytic theory related to medication.

Assessing psychosocial factors in depressed patients--accordance of patient's and physician's assessment.

Aim of this study was to investigate the differences in the assessment of psychosocial factors by depressed and non depressed patients, and their congruence with physicians' assessment for both groups. The cross-sectional study was conducted in three family physicians' practices in Zagreb, Croatia, during 2007. Sample of depressed patients included 76 patients out of 85, and randomized comparison group of 189 out of 235. Questionnaire recommended by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice was used for the assessment of psychosocial factors. Depressed patients significantly more frequently reported about social isolation (p(alone) = 0.013; p(close confident) = 0.005; p(help) = 0.001), family stress (p < 0.001), work stress (p(appropriate reward) = 0.029) and lower life satisfaction (p < 0.001) than non depressed. Their worse psychosocial functioning was noticed by family physicians who assessed social isolation (p(alone) = 0.013; p(close confident) = 0.032), family stress (p < 0.001) and life satisfaction (p < 0.001) significantly lower for depressed patients than for the random sample. Incongruence between family physicians and depressed patients assessment was valued by physicians to be of higher economic status (p < 0.001), and more intense family stress (p < 0.001). Assessment of psychosocial factors varied within the group of depressed patients and the random sample assessed either by themselves or by physicians. Congruence between family physicians and non depressed patients in the assessment of observed psychosocial factors was better than between physicians and depressed patients.

Super-ego in patients with coronary artery disease.

In this paper, we explored the super-ego ofpatients with coronary artery disease. Research results have confirmed the initial hypothesis that a significant number of patients with coronary artery disease has rigorous super-ego. Among patients with coronary artery disease (N=50), and control group (N=50), we have found significant differences in the quality of super-ego and ego attitude towards the demands of the super-ego. The results of this research contribute to understanding the impact of psychological factors in coronary artery disease.

Serum cholesterol concentration and structured individual psychoanalytic psychotherapy in suicidal and non-suicidal male patients suffering from borderline personality disorder.

Findings from numerous studies suggest an association between low cholesterol levels and suicidal behavior in patients with different psychiatric diagnoses. The aims of this case-control study were to test whether cholesterol levels in male suicidal patients (N=20) with borderline personality disorder (BPD) are lower than in male non-suicidal patients (N=20) with BPD and male healthy control group (N=20), and to evaluate the influence of structured individual psychoanalytic psychotherapy on suicidal behavior. The groups were matched for age and body mass index (BMI). Results showed that serum cholesterol levels did not differ significantly between suicidal and non-suicidal BPD patients and healthy controls. The level of psychopathology (measured by Brief Psychiatric Rating Scale and Hamilton Depression Rating Scale) was significantly higher in the group of suicidal patients, which indicates the importance of evaluating particular clinical symptoms in BPD, in order to prevent suicidal behavior. Non-suicidal male patients suffering from BPD received more frequently structured individual psychoanalytic psychotherapy prior to the hospitalization than suicidal group. These results emphasized the role of this type of psychotherapy in preventing suicidal behavior in BPD patients.

Clinical experiences in treating PTSD patients by combining individual and group psychotherapy.

PTSD is a complex psychobiological disorder that causes disfunctionality in many areas. In treating PTSD different models have been applied, however, no general consensus on the method of treatment has yet been achieved. At the Clinic for Psychological Medicine we have developed the model of combined treatment for PTSD patients that involves outpatient individual psychotherapy, psychopharmacotherapy and group psychotherapeutic techniques introduced within repeated day-hospital treatments. In this paper the efficiency of the above mentioned model has been explored. Three PTSD patients have been presented. We assessed changes in psychological functioning of our subjects on the basis of clinical observation and analysis of the session protocols. The model of combined and long-term treatment of PTSD in which the approach to traumatized patients has been mostly supportive, including supportive psychotherapeutic interventions and psychopharmacotherapy, has proved to be efficient in achieving integration of traumatic experiences and consolidation of the traumatised Self. Combination of individual and group approach facilitates the analysis of traumatic transference, whereas more mature defence patterns become stronger and integration of traumatic experiences improved. Consolidation of the Self leads to better socialization.

Comorbidity of kidney stones and psychiatric disease.

This paper describes a patient who is suffering from PTSD with elements of hypochondria, panic attacks and episodes of depression in comorbidity with kidney stones. Kidney stones provoked egzacerbation of psychiatric symptoms. Kidney stones and frustration about them have taken part of provoking factor, the last drop, which led to regression of otherwise precarious, but compensated patient's mental functioning which resulted in development of psychiatric symptoms.

Family therapy as addition to individual therapy and psychopharmacotherapy in late adolescent female patients suffering from borderline personality disorder with comorbidity and positive suicidal history.

The treatment of patients with BPDs is more hopeful than it was in the past. During the past period, psychiatrists have become overly dependent on pharmacological treatments, neglecting psychotherapies even when they are evidence-based. There is much stronger evidence for the effectiveness of psychotherapy in BPD than for any pharmacological intervention. One of the important psychotherapy for BPD is family therapy. Our work emphasized the protective role of family therapy in late adolescent female patients suffering from borderline personality disorder with eating disorder comorbidity.

The efficacy of a brief supportive psychodynamic therapy in treating anxious-depressive disorder in Daily Hospital.

Study objective is to determine the efficacy of brief supportive psychodynamic therapy in treating anxious-depressive disorder in Daily hospital within the Psychological Medicine Clinic. The study comprised a total of 45 male subjects, in which an admission to the Daily Hospital was indicated. On the occasion of the hospital admission, as well as following the completion of a one month-lasting partial hospitalisation within the Daily Hospital, the subjects had undergone testing using a number of psychological instruments. There weren't established statistically significant differences in clinical presentations of the treated patients. A partial, one month-lasting hospitalisation, did not yield any changes in clinical presentation an anxious-depressive disorder. Due to the fact that this psychotherapeutic method should be applied for quite some time in order to yield results, and is not expected to be effective in a close range, a one-month lasting treatment is definitely not long enough to be effective.

[Balint group--aid to general practitioner]. / Balintova grupa--pomoc u radu lijecnika obiteljske medicine.

Professional education of general practitioner is mainly focused on biomedical aspects of treating somatic diseases, while psychological components of somatic diseases, as well as doctor-patient relationship, are generally neglected. General practitioner is in healing process daily exposed to considerable frustrations in relationships with patients. Some frustrations stem from unrecognized and neglected psychological and emotional aspects of somatic diseases which manifest in the doctor-patient relationship. The aim of this work is to show that Balint group can enhance general practitioner's professional capability, as well as his professional satisfaction, teaching him how to recognize psychological needs and problems which are integral part of somatic diseases and doctor-patient relationship as well.