Steinmair Dagmar, Löffler-Stastka Henriette
Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Wien 1090, Österreich, Austria.
World J Clin Cases. 2022 Mar 6;10(7):2053-2062. doi: 10.12998/wjcc.v10.i7.2053.
A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual's unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis's focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient's inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at upporting the internalization of the superego's functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.
最近的一项荟萃分析显示，心理健康和基线心理障碍会影响不同慢性病的生活质量和治疗结果。在物理治疗服务中实施心理保健仍然不足。因此，治疗提供者之间的跨学科沟通至关重要。诊断统计手册提供的标准化语言有助于清晰的概念化。然而，这种方法可能没有关注个体，因为分类思考可能会阻碍认识到从健康到患病的连续体。精神分析理论关注个体无意识的冲突愿望和动机，这些愿望和动机通过诸如心理症状或（适应不良）行为等表现形式表现出来，如果不加以考虑，会产生长期后果。这些可改变的内部和外部因素往往没有得到充分治疗。然而，与身体慢性病的限制一起，这些因素决定了自主存在的自由度。治疗干预的效果，尤其是治疗依从性，依赖于稳固的治疗关系。结果和过程研究仍在调查心理治疗中变化的机制，精神分析侧重于依恋问题。本文在考虑心理治疗研究新趋势的背景下，审视了关于精神分析变化机制的现有知识。讨论了一个临床实例。此外，还给出了进一步的研究方向。精神分析疗法的理论框架是情感-认知界面。潜意识情感感知能够使人意识到自己和他人的主观意义；塑造这种意识是主要的干预点。互动要素，即患者固有的生物环境历史与临床医生的相遇，是相关变量。观察到几个与行为改变相关的内在潜意识参数。治疗干预旨在支持超我功能的内化，并使这种能力在自我反思的时刻可用。通过支持心理化能力，更好地理解自己和更高的自我调节（包括情绪调节）可以导致更好的判断（形式逻辑和抽象思维的应用）。因此，这有助于持久的行为改变，可能对身心健康产生积极影响。
