Psychodynamic Psychiatrists Who Do Not Retire: Practice Wills and Patient Outcomes.

In this issue of , we publish the clinical article "Older Psychodynamic Psychiatrists: Practice Metrics and Subjective Observations," by Douglas Ingram and Myron Glucksman. The authors queried in depth a convenience sample of 20 psychodynamic psychiatrists 65 years of age or older who were still actively practicing and reporting deep satisfaction. A similar unpublished study by Judith Kantrowitz of psychoanalysts in the same age group found high degrees of investment and engagement in their survey participants.

Perspectives on psychotherapy in Southeast Asia: Insights from psychiatrists and trainees (Part I: Attitudes, current practices and training preferences).

Introduction: Psychotherapy is an evidence-based treatment for mental disorders. Despite its global development, neuroscientific advances, and measurable efficacy, attitudes toward psychotherapy in Southeast Asia (SEA) remain underexplored, particularly among psychiatrists and psychiatric trainees.

Objectives: This study aimed to assess attitudes toward psychotherapy, its current use in clinical practice, and stated preferences for future training among psychiatrists and trainees in SEA.

Trauma, Epigenetic Alterations, and Psychotherapy.

Psychotherapy was until recently described from a biological standpoint as causing structural changes in the brain and physiological alterations of neurotransmission pathways. Current research recognizes that psychotherapy also causes changes at the level of the DNA, with alterations in epigenetic mechanisms that correlate with symptom reduction and treatment response. The authors provide a brief overview of the evolving research in epigenetics, highlighting the association between trauma, DNA methylation patterns of specific gene regions, and psychiatric disorders.

Psychodynamic Psychiatry and the Care of Persons with Vision Loss and Blindness.

The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed.

Clinical Implications of Countertransference in the Treatment of Addictions.

The author provides a historical overview of the psychodynamics of addiction with particular emphasis on countertransference awareness and its relationship with treatment outcomes and prognosis. Countertransferences that frequently occur in the treatment of substance use disorders include shared helplessness, hopelessness, sadness, anxiety, fear, anger, rage, shame, and guilt. These emotional states in clinicians may lead to fatigue, avoidance, and acting out unless therapists are able to ground themselves and disidentify with the projected affective states.

An Overview of the Psychodynamics of Addiction.

The author provides an overview of the psychodynamics of addiction, diverging from outdated conceptualizations such as orality and regression, and emphasizing the clinical relevance of the self-medication hypothesis. Rado and Bion paved the way for Khantzian's self-medication hypothesis by describing the drug user's need to escape unpleasure and seek self- containment. The author reviews research corroborating the relevance of the self-medication hypothesis and other relevant constructs such as self-deceptive attempts at adaptation, inability to prioritize self-care or delay gratification, excessive hedonism and novelty seeking, and impulsivity.

Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls.

Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear.

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).

Systematic Review and Meta-Analysis for Sexual Dysfunction in Women With Hypertension.

Introduction: Sexual dysfunction in hypertensive women is an often-neglected subject despite a reported prevalence of 42.1%. Although few reviews exist, a definitive relationship between hypertension and sexual dysfunction in women has not been clearly established.

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.

On the Birth of Psychodynamic Psychiatry.

Psychodynamic psychiatry emerged from psychoanalytic theory, but the influence of the latter has been only partial. Equally important are other disciplines outlined within is article. Modern psychodynamic publications and presentations should honor all of the foundational pillars of the field.

An Integrative Approach to Treatment-Resistant Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes.

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.