The Addiction Concept and Technology: Diagnosis,Metaphor, or Something Else? A Psychodynamic Point of View

Many today suffer from an imbalance between life and life on the screen. When extreme, such as excessive gaming, clinicians retreat to familiar explanations, such as “Internet addiction.” But the addiction concept is of limited value, limiting both research and treatment options. This article discusses an alternative. Pathological overuse is seen as a failed solution in which people become entrapped by technology's promise of delivering that which only life can offer, such as the grand adventure simulated in World of Warcraft. A two‐part treatment approach of such “simulation entrapment” is described in which both the original problem and the entrapment are treated, the former by traditional psychodynamic psychotherapy and the later by highlighting differences between the technologically mediated experience and traditional experiences of being bodies together. The case of a college student suffering from pathological shame with excessive gaming as the failed solution is offered as an illustration.     

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Attachment-related psychodynamics

Because there has been relatively little communication and cross-fertilization between the two major lines of research on adult attachment, one based on coded narrative assessments of defensive processes, the other on simple self-reports of ‘attachment style’ in close relationships, we here explain and review recent work based on a combination of self-report and other kinds of method, including behavioral observations and unconscious priming techniques. The review indicates that considerable progress has been made in testing central hypotheses derived from attachment theory and in exploring unconscious, psychodynamic processes related to affect-regulation and attachment-system activation. The combination of self-report assessment of attachment style and experimental manipulation of other theoretically pertinent variables allows researchers to test causal hypotheses. We present a model of normative and individual-difference processes related to attachment and identify areas in which further research is needed and likely to be successful. One long-range goal is to create a more complete theory of personality built on attachment theory and other object relations theories.     

动力性心理治疗合并帕罗西汀对强迫症患者疗效及防御机制的影响

目的 评价心理动力性心理治疗对强迫症患者疗效及防御机制的影响.方法 将符合入组标准的强迫症患者随机分成研究组和对照组,研究组42例,对照组45例.研究组接受心理动力性心理治疗联合帕罗西汀治疗,对照组单用帕罗西汀治疗,分别于治疗前、治疗第4周末、第8周末和第12周末评定Y-BOCS,在治疗前后评定防御方式问卷.结果 研究组有效率为73.8％,对照组有效率为53.3％,差异具有统计学意义(x2=3.92,P＜0.05);自治疗第8周末开始,研究组在Y-BOCS强迫思维因子分[(8.25±4.29)分]及总分[(16.42±5.78)分]均低于对照组[(11.44±5.54)分,(21.74±4.88)分],在第12周末时Y-BOCS强迫行为因子分[(5.55±3.81)分]也低于对照组[(8.24±3.27)分],差异均有统计学意义(t=2.99,4.65,3.54,P＜0.05);研究组不成熟防御机制的评分在治疗后[(4.24±1.27)分]较治疗前[(5.74±1.28)分]降低,而成熟防御机制的评分在治疗后[(5.56±1.74)分]较治疗前[(4.01±1.45)分]升高,差异均有统计学意义(t=5.39,4.44,P＜0.05).结论 心理动力性心理治疗对强迫症患者有较好疗效且能改善患者的心理防御机制.     

Experienced therapists’ opinions on central issues in psychodynamic psychotherapy of patients with personality disorders

Individual psychodynamic psychotherapy is a recommended, but controversial, treatment for patients with personality disorders (PDs). The aim of this study was to examine the relationship between demographic and professional characteristics of experienced psychotherapists and their attitudes and opinions towards aspects of this kind of psychotherapy. A questionnaire covering these issues of psychodynamic psychotherapy with patients belonging to all three DSM-IV clusters of PD was developed. A sample of 324 Norwegian psychiatrists and clinical psychologist with considerable experience in individual dynamic psychotherapy of patients with PDs filled in valid questionnaires. The therapists’ age, gender, profession, postgraduate courses and degree of experience were examined as to their opinions on the following issues: alliances, aims, contraindications, needs to terminate, suicides, use of drugs, length of treatment, need for supervision and complaints to colleagues about patients’ behaviour in such therapy with PD patients. Independent sample t-tests of the mean z-transformed group scores were the main statistical method applied. Therapist experience made the most significant differences as to treatment issues, while some differences also were found for age, gender and profession. The influence of postgraduate courses was negligible. Our study might have a selection bias towards therapist with strong psychodynamic orientation and particular interest in the psychotherapy of patients with PDs.