How a Dream Led Me to Psychoanalysis.

This column addresses the role of dreams in psychoanalysis and psychodynamic therapy. It includes an autobiographical perspective on how a dream led this psychiatrist to become a psychoanalyst and an introduction to social dreaming.

Psychotherapy and Artificial Intelligence.

This column explores the challenges involved in providing psychotherapy through artificial intelligence. It reviews artificial intelligence's capacity across schools of therapy to address relevant issues related to privacy, the use of technical interventions, and the therapeutic relationship.

Psychodynamic Therapy: An Overview for Trainees and Their Teachers: Part 2-The Therapeutic Stance.

This second column in a series on psychodynamic therapy (PDT) offers an overview of concepts related to the therapeutic stance of PDT. It reviews resistance, components of the therapeutic relationship, and elements that constitute the therapeutic stance of PDT.

Psychodynamic Therapy: An Overview for Trainees and Their Teachers: Part 1-The Basics.

This first column in a series on psychodynamic therapy (PDT) offers an overview of the basics required to understand and master the provision of PDT. It offers a way of understanding what patients struggle with when viewed through a psychodynamic lens and then examines evidence-based core elements of psychotherapy and PDT.

Medications, Genes, Environmental Stress, and Pursuit of Recovery.

This column summarizes the findings of 2 recent studies of interest to psychotherapists. One study reports that the use of antidepressant medication is not associated with long-term improvement in health-related quality of life, while the other finds that psychotic experiences in adolescents are more closely associated with environmental experiences than with genetic risk. The column discusses the implications of these studies for psychotherapists and for the field at large.

A Verdict Overturned: Are We at Our Wit's End?

Despite the 2008 Mental Health Parity and Addiction Equity Act, access to psychotherapy through health insurance is quite limited. The 2019 landmark verdict in Wit v. United Behavioral Health offered hope of change.

Finding Psychodynamic Psychiatry's Lost Generation.

This paper describes forces that have adversely affected the place of the psychodynamic perspective within psychiatric practice and training over the last generation. One effect of these forces has been to create a lost generation of psychiatrists with little knowledge or experience with psychodynamic treatment. The article addresses opportunities to reverse some of the detrimental effects of recent changes.

Harnessing the Synergy Between Mindfulness and Psychotherapy.

This column explores mindfulness as one part of Buddhist teaching and practice that has attracted attention in the treatment of mental and substance use disorders. Cognitive neuroscientific correlates of mindfulness are presented. Mindfulness is offered as a potentially valuable technique that can not only help patients in individual psychotherapies endure the painful emotions that are part of psychotherapy sessions and of managing life between sessions but also help patients and clinicians across modalities move beyond adherence to particular techniques that focus primarily on symptom reduction, to better meet patient needs and improve treatment outcomes.

Another Step Toward Implementing Mental Health Parity.

This column describes a recent $14.3 million settlement in a case brought against United Behavioral Health by the Department of Labor and New York State Attorney General Letitia James. United Behavioral Health agreed to stop 2 practices that were in violation of the Mental Health Parity and Addiction Equity Act.

COVID-19: Preliminary Data on the Impact of Social Distancing on Loneliness and Mental Health.

The COVID-19 pandemic and its need for social distancing as a response have the potential to increase the experience of loneliness in the population, with an associated increase in symptoms of mental disorders. As the world has largely adapted to remote platforms for employment, socializing, and health service delivery, the degree to which virtual opportunities for social engagement may offset the impact of limited in-person interactions on mental health functioning is unknown. This column offers preliminary data from an ongoing experience sampling study of the prevalence, course, and impact of loneliness on mental health in a community adult sample living under social distancing requirements during the COVID-19 pandemic.

Drink, Don't Think: The Role of Masculinity and Thought Suppression in Men's Alcohol-Related Aggression.

Alcohol consumption is a well-established risk factor for aggressive behavior. However, evidence suggests that alcohol's effect on aggression varies as a function of individual- and situational-based instigating and inhibiting factors. Endorsement of traditional masculine gender norms has been consistently identified as an instigating factor for alcohol-related aggression.

Emerging Psychotherapies for Psychosis.

Recent developments in the research and clinical literatures have highlighted the importance of focusing on higher-order cognitive processes in the treatment of psychotic disorders. A particular emphasis has been placed on how impairments in self-monitoring and the ability to form mental representations of others uniquely manifest in psychosis. At the same time, the recovery movement has influenced clinical innovations by emphasizing the importance of subjective domains of recovery that privilege the individual's phenomenological experience.

Unrepresented states and the challenge of historicization.

Bernd Nissen has been developing a metapsychology of hypochondria and 'autistoid' states for 20 years, working within the Kleinian object relations tradition to formulate the earliest events of psychic life. His imaginative work shows careful thinking about early catastrophic developmental experiences which may lead to various forms of psychopathology. In the current paper, Hypochondria as an actual neurosis, Nissen extends his progressive work on hypochondria and joins his evolving theory of autistoid encapsulation to a revival of interest in Freud's concept of actual neurosis, the experience of unrepresentable early trauma, the problems of historicization, and to Winnicott's description of the fear of breakdown.

Clinician recommendation of 12-step meeting attendance and discussion regarding disclosure of buprenorphine use among patients in office-based opioid treatment.

Background: Clinicians are encouraged to include 12-step meetings, such as Alcoholics or Narcotics Anonymous (AA/NA), as ancillary services for the treatment for opioid use disorders (OUDs), even though some of these groups may not fully accept individuals receiving buprenorphine. Little is known about whether clinicians actually discuss with patients the issue of disclosure of buprenorphine use at 12-step meetings.

Methods: An anonymous survey was offered to patients enrolled in office-based opioid treatment with buprenorphine to assess whether their clinicians recommended attendance at 12-step meetings and discussed the issue of disclosing their use of buprenorphine to other members.

Teaching all the evidence bases: reintegrating psychodynamic aspects of prescribing into psychopharmacology training.

The discipline of psychiatry appears poised at the edge of a paradigm shift. Enthusiasm about psychopharmacological treatments and neuroscientific understandings is giving way to a sobering recognition of the limitations of current biologically oriented approaches. Psychiatry training programs have both an opportunity and a responsibility to address the challenges presented by the evidence.

How (not what) to prescribe: nonpharmacologic aspects of psychopharmacology.

Despite advances in psychopharmacology over the past several decades, treatment outcomes for depression have not substantially improved. Depression is not being eradicated. If anything, the evidence suggests that the problem of depression and treatment-resistant depression is growing, not shrinking.