Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Psychotherapies

TABLE 29-1. Scope of Psychoanalytic Practice: A Clinical Continuum ( continued ) Psychoanalytic Psychotherapy Feature Psychoanalysis Expressive Mode

Supportive Mode

Auxiliary or surrogate ego as temporary sub stitute; holding environ ment; insight to degree possible Severe character disor ders; latent or manifest psychoses; acute crises; physical illness

Putative change agents

Insight predominates within relatively de prived environment.

Insight within empathic environment; identifi cation with benevolent object Neuroses; mild to moderate character psychopathology, espe cially narcissistic and borderline personality disorders High to moderate moti vation and psychological mindedness; ability to form a therapeutic alli ance; some frustration tolerance Partial reorganization of personality and defenses; resolution of preconscious and conscious derivatives of conflicts; insight into current interpersonal events; improved object relations; symptom relief a goal or prelude to fur ther exploration Limited free association; confrontation, clarifica tion, and partial inter pretation predominate, with emphasis on here and-now interpretation and limited genetic interpretation May be necessary (eg, psychotropic drugs as a temporary measure); if applied, negative im plications explored and diffused.

Patient population Neuroses; mild character psychopathology

Some degree of motiva tion and ability to form a therapeutic alliance; limited frustration tolerance

Patient requisites

High motivation; psy chological mindedness; good previous object relationships; ability to maintain transference neurosis; good frustra tion tolerance Structural reorganization of personality; resolution of unconscious conflicts; insight into intrapsychic events; symptom relief an indirect result Free association method predominates; fully dynamic interpretation (including confronta tion, clarification, and working through), with emphasis on genetic reconstruction Primarily avoided; if applied, all negative and positive meanings and implications thoroughly analyzed

Psychotherapies

Reintegration of self and ability to cope; stabili zation or restoration of preexisting equilibrium; strengthening of de fenses; better adjustment or acceptance of pathol ogy; symptom relief and environmental restruc turing as primary goals Free association method contraindicated; sugges tion (advice) predomi nates; abreaction useful; confrontation, clarifica tion, and interpretation in the here and now sec ondary; genetic interpre tation contraindicated Often necessary (eg, psychotropic drugs, family therapy, rehabil itative therapy, or hos pitalization); If applied, positive implications are emphasized.

Basic goals

Major techniques

Adjunct treatment

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This division is not categoric; all practices reside on a clinical continuum. From Toksoz Byram Karasu, MD.