Integration of psychoanalytic concepts in the formulation and management of hospitalized psychiatric patients.

Although psychoanalysis and psychodynamic psychotherapy have flourished theoretically and in practice for an increasingly widespread population of patients, the mental health professions have in recent decades experienced a hegemony of managed care, a preoccupation with pharmacological approaches at the expense of psychological approaches, and a predilection for brief symptom-focused, more easily researchable manualized psychotherapies, in spite of literature demonstrating the effective contribution of psychoanalysis and psychodynamic thought to the practice of the mental health professions. In this article a psychiatric inpatient is considered from the point of view of what psychodynamic theory can offer practically to understanding and managing her. It is not suggested that this patient might necessarily benefit from formal psychodynamic psychotherapy, but rather that incorporation of a psychodynamic understanding of her can lead to a more effective management approach, especially regarding dealing with staff reactions to disturbing patients.

Narcissism and relational representations among psychiatric outpatients.

Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety.

Predicting response to day treatment for personality disorder.

Objective: Efforts to improve the effectiveness of day treatment should attend to factors that influence treatment response. Our prospective study identified predictors of response to day treatment for personality disorder (PD).

Method: Patients with a PD, consecutively admitted to a day treatment program, were assessed with self-report and interview measures.

Interpersonal problems associated with narcissism among psychiatric outpatients.

Narcissistic personality disorder is the subject of extensive discussion in the literature. Yet, the validity of this diagnostic category remains questionable. This is owed, in large part, to the relative absence of empirical work that has examined narcissism in clinical samples.

Predictors of premature termination of day treatment for personality disorder.

Background: Premature termination is a common problem in the treatment of personality disorder. Efforts to improve compliance should begin by recognising risk factors for premature termination. This prospective study identified predictors of premature termination from a day treatment program for personality disorder.

Threats of violence to third parties in group psychotherapy.

This article considers threats of violence toward third parties during group therapy. An approach to preserve the group work, protect the threatened individuals, maintain the threatening patient's treatment, and protect the group leader medicolegally is described. Obtaining expert legal advice is very important.

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history.

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work.

Threats of violence in group-oriented day treatment.

Threats of violence in a group-oriented day treatment program are examined regarding the patient's motivation to make threats, and what occurs among patients and staff that fosters threats. Effects of threats on other patients, the program, and therapists are considered. Management of the threatening patient, the group, and staff reactions are described.