Australasian Psychiatry Feature on Psychotherapy –

Edwin Harari 2104 Ghost Busting: Re-introducing psychotherapy for the psychiatrist

Abstract

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.

Keywords: psychotherapy, doctor–patient relationship, treatment resistance, psychotherapy and medication

Australasian Psychiatry 2014, Vol 22(5) 433–436 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav

Australasian Psychiatry – Signposts http://www.apy.sagepub.com DOI: 10.1177/1039856214546673

Ghost Busting: re-introducing psychotherapy for the psychiatrist

Edwin Harari Consultant Psychiatrist, St. Vincent’s Hospital Area Mental Health Service, Fitzroy, VIC, Australia

Psychotherapy (‘healing the mind’) is a particular type of interpersonal influence, wherein one person, acknowledged by society as possessing relevant skills (the psychotherapist) seeks to change the thoughts, feelings, attitudes, behaviours, relationships or personality of a suffering other (the patient):

If one posits that the relation between doctor and patient has been critically wounded, how are we to understand whether, and on what basis, that relationship may be reasserted ? AI Tauber

The pedagogy for engaging hidden values and divided selves is the moral building of the clinician as a full developed human being. A Kleinman

I do not favour the way Descartes ontologically screwed up a reasonable search for mind-brain docking during the past four centuries yielding life-denying monstrosities like radical behaviourism and an emotionless information processing cognitivism… J Panksepp

The possibility of intersubjective knowledge offers a welcome relief from a forced choice between pure subjectivity (Descartes) and true objectivity (Kant). EM Hundert

The outcome of the game is to convert what would otherwise be a nameless trauma into a loss. J Lear

As a general rule throughout Asia, the more patriarchal the society, the more the Buddha looks like a woman: the more egalitarian the society, the more the Buddha looks like a man. L Shlain

Psychotherapists, especially, appreciate [that]… this painful ambivalence is as old as the ice-age, a hallmark of Cro-Magnon man, torn between his craving for consolation and his fear of revenge. J Cawte

Each of the above quotations may serve as a conceptual signpost or creative condensation of the argument each of the authors’ advances in their respective texts which bear on the nature, subject matter and practice of psychotherapy.

Read more here

References
 Tauber AI. Confessions of a medicine man: an essay in popular philosophy. Cambridge, MA: MIT Press, 2002, p.103.
 Kleinman A. The divided self, hidden values and moral sensibility in medicine. Lancet 2011; 377: 804–805.
 Panksepp J. The self and ‘its’ vicissitudes. Critique of commentaries. Neuropsychoanaly-sis 2002; 4: 50.
 Hundert EM. Philosophy, psychiatry and neuroscience. Three approaches to the mind. Oxford: Clarendon Press, 1990, p.297.
 Lear J. Happiness, death and the remainder of life. Cambridge, MA: Harvard University Press, 2000, p.92.
 Shlain L. The alphabet versus the goddess. New York: Penguin, 1998, p.200.
 Cawte J. Aboriginal healing: psychotherapy in ancient society. Aust J Psychother 1988; 7: 14.
 Doidge N. The brain that changes itself. Melbourne: Scribe, 2007, p.216.
 Wolff HH. The therapeutic and developmental functions of psychotherapy. Br J Med Psychol 1971; 44: 117–130.
 Markowitz JC and Milrod BL. The importance of responding to negative affect in psycho-therapies. Am J Psychiatr 2011; 168: 124–128.
 Frank JD and Frank JB. Persuasion and healing: a comparative study of psychotherapy (3rd edition). Baltimore: Johns Hopkins University Press, 1991.
 Kernberg OF. Severe personality disorders: psychotherapeutic strategies. New Haven, CT: Yale University Press, 1984.
 Gabbard G and Kay J. The fate of integrated treatment: whatever happened to the biopsychosocial psychiatrist? Am J Psychiatr 2001; 158: 1956–1963.

Deconstructing schizophrenia among Australia’s First People

In places where an increase in the incidence of schizophrenia has been reported, these can be attributed mainly to substance abuse (eg Drug Induced Psychosis). However, there are additional explanations for psychosis differential diagnoses. The most important of these is stress, and especially complex or traumatic stress – presenting as depressive psychosis in both its unipolar and bipolar forms.

19th ISPS International Congress in New York City | ISPS NY 2015

Abstract submission now open

March 18 – 22, 2015 at The Cooper Union in New York City

19th ISPS International Congress in New York City | ISPS NY 2015.

Psychoanalytic Treatment of Psychoses

Three recent issues of The American Psychoanalyst are devoted to the treatment of psychosis, and are freely downloadable. They include topics such as:

Psychotic Disorders: From DNA to Neighborhood

Establishing Empathy by Analyzing Psychosis

Working at the Limits of Human Experience

Psychosis as a Personal Crisis

A new book has been added to the the ISPS book series (published by Routledge) late in 2012

Edited by Professor Marius Romme and Dr Sandra Escher, “Psychosis as a Personal Crisis” describes an approach which is fundamentally about the person, and finding traditional medical approaches at best providing band-aid treatment for these crises, this book seems to provide a framework for this personalised response to  distressing symptoms, like voices (auditory hallucinations) and beliefs (delusions).

A sample chapter, “Psychiatry at the crossroads: The limitations of contemporary psychiatry in validating subjective experiences “, by Dr Brain Martindale, is available for download here.

Dr Martindale has written extensively on psychosis – two of his freely available papers are here:

Psychodynamic contributions to early intervention in psychosis

The rehabilitation of psychanalysis and the family in psychosis: Recovering from blaming