Current Psychiatry Reviews - Volume 14, Issue 3, 2018

Background: Short-term dynamic psychotherapy is a well-established treatment modality. Habib Davanloo, MD was a pioneer in bringing it to the forefront of psychotherapy. Objective: The aim of this paper is to highlight Habib Davanloo's unique contribution to the field of dynamic psychiatry and psychotherapy by tracing the development of his metapsychological theory of the unconscious, placing it in historical perspective. Method: The origin and development of dynamic psychiatry, from the early work of Mesmer through classical psychoanalysis and contemporary theories will be reviewed. Next, the movement aimed at shortening the course of psychotherapy while maintaining a psychodynamic perspective will be explored. Davanloo's unique contributions to the field will be elaborated. The development of Davanloo's metapsychology of the unconscious from his earliest work beginning in the 1960's and further developed in his technique of “Unlocking the Unconscious” in the 1980’s will be examined. I will then turn to Davanloo's work in the 1990's and early 2000's, which focused on widening the range of patients who could be successfully treated with his technique, and on expanding his training programs. Davanloo's most recent work in the 2000's and 2010's involving Audiovisual Closed Circuit Training Workshops on the Mobilization of the Unconscious, Total Removal of Resistance and Multidimensional Unconscious Structural Change will be reviewed. Conclusion: Davanloo was indeed a pioneer in short-term psychotherapy. He remains at the cutting edge, continuing to shorten the course, increasing the depth and the range of this powerful treatment modality, and developing innovative teaching methods.

Background: Davanloo's IS-TDP has gained attention as a uniquely targeted and effective short-term dynamic psychotherapy. Despite this awareness, the psychotherapeutic community seems relatively uninformed about his active teaching and research programs over the last decade. Method: The purpose of this paper is to update readers about several new metapsychological and technical concepts which have been developed by Davanloo in his Montreal Closed Circuit Training Program. While readers may be familiar with his focus on bond and attachment, unconscious anxiety, the neurobiological pathways, and the central dynamic sequence, they are less likely to be familiar with his newer concepts. These include his ongoing research into and subsequent theortical advancements with regard to transference neurosis (and its various presentations), intergenerational transference neurosis, and impairment in the unconscious defensive organization. Results: This paper is the first of the two article series on these concepts. The first paper will focus on definitions and discussions of these concepts. This will lay the foundation for their clinical application. The second paper will feature a case seen in the private practice of one of the authors. This case will demonstrate many of these concepts in clinical operation. Conclusion: While the case was not supervised by Davanloo, it was reviewed at the 38th Annual Metapsychology Meeting in Montreal, Canada in October, 2017.

Background: Davanloo's ISTDP has been the subject of much focus and attention. He has published extensively on his earlier work. But many of his newer theories and techniques, developed during the last decade in the Montreal Closed Circuit Training Program, have not been disseminated as widely as his original publications. These include his opinions and theories on transference neurosis (and its various presentations), intergenerational transference neurosis, and impairment in the unconscious defensive organization. Objective: This paper is the second of a two-article series on these newer concepts. The first paper focused on definitions and discussions of these concepts. This second paper will now focus on the application of these principles in a case seen in the private practice of one of the authors. Method: The authors have translated (from German into English) several vignettes from a therapeutic interview. The patient is a 17-year-old girl with anorexia nervosa and a complex unconscious. The psychotherapeutic techniques used in each vignette will be underscored and explained in subsequent analyses. Results: Davanloo's newer principles and techniques will be illustrated and made easy to understand in the case of an adolescent with a complex unconscious. Conclusion: This case was reviewed at the 38th Annual Metapsychology Meeting in Montreal, Canada in October, 2017 and highlights the new discoveries and techniques of this psychotherapeutic modality.

Background: Meaning Centered Psychotherapy (MCP) was developed by Breitbart and collaborators for patients with advanced cancer and suffering from an existential distress in the face of death. It was first settled in a group format (MCGP) and subsequently has been adapted to an individualized format (IMCP). To this point, MCP is adapted to cancer caregivers (MCP-C), cancer survivors (MCGP-CS), bereaved parents (MC-GT) and palliative care (MCP-PC). The goal of this article is to review the framework of MCP and its subsequent adaptations. Method: A nonsystematic review of a PubMed search of articles written in English, during 2000 and 2018. Results: In 2010, Breitbart et al. published the first results of MCGP presenting it as an effective intervention to improve spiritual well-being, quality of life (QoL) and to reduce hopelessness and desire for hastened death in advanced cancer patients. Subsequent studies established the benefits of IMCP and MCGP for the same outcomes. They also confirmed the potential of MCP-C to mitigate caregiver burden, it´s efficacy improving personal meaning, psychological well-being and mental adjustment, and MC-GT as a means to help parents recognize meaningful experiences as they cope with grief. In the adaptation of MCP-PC, evidence suggests the feasibility, acceptability, and the potential for improving coping in the face of end of life issues. Conclusion: MCP has proven effectiveness in improving QoL, reducing hopelessness, and desire for hastened death. The subsequent adaptations had positive outcomes, showing that meaning is important in the face of any kind of suffering that imposes limitations on life.

Background: First person, or subjective, experiences of persons with schizophrenia are recognized to play a fundamental role in the outcome. From psychoanalytic, existential, phenomenological, rehabilitation-oriented and dialogical perspectives, this review explores five descriptions of alterations in subjective experience, which are sometimes called self-disorders. While each provides rich accounts of these experiences, we conclude that each fails in some way to adequately account for how persons move into, or develop, alterations in self-experience, and how they move out of them or recover. Method: To address these limitations, we review research on the integrated model of metacognition in schizophrenia which offers an account of how self-experience may be compromised and later recaptured in ways that could be influenced by a range of psychological, social and biological phenomena. Results: We argue that research on metacognition suggests decrements in metacognitive function may partially account for the emergence of these difficulties and also explain how their resolution contributes to recovery. Conclusion: With the loss or recapture of metacognitive capacities, the socially-positioned, interpersonal lives of persons seem to lose or gain saliency, which in turn undermines or enables persons to develop a working sense of themselves that orients them purposefully and allows them to address challenges. Metacognitively oriented treatments which promote awareness of personal experience regardless of the level of fragmentation and work with persons as they slowly develop the ability to integrate information about themselves and others may offer unique promise for promoting recovery.

Background: Ethical dilemmas are common in the field of mental health, and often, ethical guidelines fail to provide clear courses of action. Historically, ethical decision-making models have been proposed which utilize a position rationality and positivism. While these ethical decision-making models have expanded over time to incorporate contextual factors, they often fail to adequately integrate personal imperatives and remain flexible enough to be generalized across settings and situations. Method: The goal of the present article is to provide those in the field of mental health with a virtue- driven ethical decision-making model that provides a balance between guided structure and personalization with the intent of integrating personal and professional identities for use in confronting ethical dilemmas. Results: An ethical decision-making model is presented that incorporates virtues found to be relevant to the field of mental health, characterized by six stages: observation, identification, consultation, balance, action and reflection. Conclusion: Ethical practice is heightened when professionals engage in synthesizing personal and professional values in order to increase a personal ethical imperative, rather than a rule-based ethical imperative, and when structured models are put in place for use when ethics codes fail or are deemed not useful.

Background: Studies on the effects of microorganisms living in the guts of human health and the etiopathogenesis of diseases, especially psychiatric disorders, have rapidly increased in recent years. According to the results of these studies, evidence has been found that there is direct and indirect (immune system) interaction between the microbiota bacteria and their metabolites and neurons. Objective: The purpose of this review is to discuss the current research findings focusing on the relationship between the gut microbiota and psychiatric disorders. In this context, the effectiveness of microbiota-based treatments (probiotics and fecal microbiota transplantation) on the treatment of psychiatric disorders is also discussed. Method: A review of the literature was conducted that includes the following words: gut-brain axis, microbiota, dysbiosis, psychiatry and mental disorders. Results: There are few clinical studies examining the gut-brain relationship. In the light of the evidence from these clinical trials and animal experiments, it can be suggested that gut microbiota has a distinct and determinative role in brain function. Conclusion: Gut microbiota creates a determining and life-long effect on the emergence of the immune system and the brain in the fetus starting with birth. Delivery mode, breastfeeding, diet, drugs (antibiotics, psychotropics) and aging may change the composition of gut microbiota. Disruption of microbiota composition (dysbiosis) may lead to the emergence of psychiatric disorders. Microbiotabased treatments have a therapeutic potential by repairing dysbiosis. There is a need for more randomized controlled studies in order for the effects of gut microbiota on psychiatric disorders to be completely understood.

Background: This study aims to review the connection between socioeconomic status and schizophrenia and the many ways by which social class of origin contributes to the epidemiology of schizophrenia. For almost a century, numerous studies have reported that the prevalence of schizophrenia varies by social class. A clear majority of these reports uncovered a significantly higher prevalence in the lower class. However, the specific risk factors underlying the connection have not been fully explored. Method: One goal of this review is to report the risk factors that have been identified. The second goal is to examine more recent studies about underresearched factors that may also contribute to high risk among the poor. These include prenatal illness, obstetrical complications, family history of the psychosis, stressful life events and early onset. My research team used a unique combination of variables which highlighted symptoms of schizophrenia and social class of origin. Results: We consistently found that the combination of lower social class of origin and the risk factors above exacerbate the likelihood of an especially unfavorable outcome. Conclusion: The central finding of this review is that being born into poverty not only elevates risk for schizophrenia in general but also for patients to have negative symptomatology.