Clinical wisdom, science and evidence: The neglected gifts of psychodynamic thinking.

We review five key areas of contemporary psychodynamic practice and research to highlight the contributions psychodynamic concepts can make to clinical psychiatry. These areas are as follows: (1) Contributions to understanding the development of subjectivity. (2) The psychodynamic understanding of the effects of early childhood trauma and their consequences in adult life. (3) The vital importance of the psychodynamic notion of the 'holding environment' based on an understanding of the dynamics of the development of subjectivity and trauma which, if applied, might improve the quality of psychiatric care in the public mental health system and enhance both the clinical competence and morale of clinicians in the system. (4) The emerging scientific disciplines of Neuropsychoanalysis and Affective Neuroscience, which illustrate the importance of seriously studying the mind as well as the brain. (5) A brief summary of some research into the clinical effectiveness and efficacy of psychoanalysis and its related psychodynamic therapies.

Supportive psychotherapy.

AIM: The aim of this article is to describe the principles of supportive psychotherapy. CONCLUSION: The author illustrates the principles of supportive psychotherapy with a case vignette. Supportive psychotherapy is an important clinical skill for all psychiatrists.

Ghost Busting: re-introducing psychotherapy for the psychiatrist.

OBJECTIVE: The purpose of this paper is to provide a clinically relevant historical and conceptual overview of psychotherapy as an introduction to a forthcoming series of papers on specific models of psychotherapy. The author offers a selective review of some key ideas in the history and practice of psychotherapy. CONCLUSION: The principles of psychotherapy should inform all psychiatric practice, including the doctor-patient relationship, multidisciplinary teams caring for patients with complex or 'treatment resistant' problems, and patients who are non-compliant with psychotropic medication.

Mind the evidence gap: do we have any idea about how to integrate the treatment of anorexia nervosa into the Australian mental health context?

OBJECTIVE: The aim of this paper is to review recent developments in the treatment of anorexia nervosa (AN) and how this translates to clinical and population-based care in the Australian context. CONCLUSIONS: Overall, there is a paucity of high-quality research into treatments for AN, albeit that a number of biological and psychological interventions show promise as avenues for further research. There are significant impediments to the provision of comprehensive longitudinal care for people with AN within Australian mental health services. Evaluation of novel strategies, such as home-based support, is required as part of enhancing options for Australians suffering with AN and their families.

Psychoanalysis, science and the seductive theory of Karl Popper.

OBJECTIVE: To present a critique of the ideas of Karl Popper, the philosopher of science, whose depiction of psychoanalysis as a pseudoscience is often used to justify attacks on psychoanalysis. METHOD: Published sources are used to provide a brief intellectual biography of Popper, a summary of his concept of science and a summary of criticisms of Popper's view of science. His depiction of psychoanalysis and Freud's reply are presented. Clinical, experimental and neurobiological research which refutes Popper's view is summarized. RESULTS: There is a vast scholarly published work critical of Popper's falsifiability criterion of science. Less recognized is Popper's misunderstanding and misrepresentation of psychoanalysis; his argument against it is logically flawed and empirically false. Even if Popper's theory of science is accepted, there is considerable clinical, experimental and neurobiological research in psychoanalysis which meets Popper's criterion of science. CONCLUSION: Attacks on psychoanalysis based on Popper's theory of science are ill-founded and reflect inadequate scholarship.

Use of the psychiatric consultation letter as a therapeutic tool.

OBJECTIVE: Carefully crafted medical consultation letters can serve the dual purpose of transmitting the consulted psychiatrist's opinion to the referring doctor and enhancing the quality of the doctor-patient therapeutic relationship. Using the same document for both purposes simultaneously can enhance the consultation letter's overall effectiveness, as illustrated by three case examples. CONCLUSIONS: Future teaching programmes for undergraduate and postgraduate psychiatry students should incorporate consultation letter writing workshops to improve students' skills in clearly expressing their opinions and management recommendations in written form.