Constantinides Prometheas, Dauphin Julie
Institut Universitaire en Santé Mentale de Montréal; Department of Psychiatry, University of Montreal.
Institut Minerve, Montréal; Department of Psychology, University of Montreal.
Psychodyn Psychiatry. 2023 Mar;51(1):76-97. doi: 10.1521/pdps.2023.51.1.76.
Overt psychotic symptoms, currently understood as resulting from both neurobiological and developmental etiological factors, are also associated with deficits in mentalization in a subgroup of patients presenting with psychotic personality structure. Neurodevelopmental and traumatic impairments seen in this subtype of psychotic disorders create a pressure or need for what has been called a transformational mentalizing process. This specific form of mental elaboration focuses explicitly on finding words and images that help patients to grasp their emotional and mental states. It thus differs from mainstream mentalization treatment, which puts a greater emphasis on reflective functioning. A psychodynamically informed mentalization-based individual and group psychotherapy for this subgroup of patients was developed, aiming at augmenting the patient's psychological resources through explicit transformational mentalization, rather than primarily targeting symptom reduction. This program stimulates curiosity about one's mental states, progressively aiming to give shape to and explore affectively charged mental states, and is integrated with other treatment modalities. This article presents a psychological model of psychotic personality structure and its psychotherapeutic implications, as well as clinical illustrations. Preliminary findings from a pilot study provide encouraging support for the model, including emerging reflective capacities and symptom reduction, as well as overall improvement of social and occupational functioning.
目前认为，明显的精神病性症状是由神经生物学和发育病因因素共同导致的，在具有精神病性人格结构的患者亚组中，这些症状还与心理化缺陷有关。在这种亚型的精神障碍中所见的神经发育和创伤性损害，对所谓的转化性心理化过程产生了一种压力或需求。这种特定形式的心理加工明确聚焦于寻找有助于患者理解自身情绪和心理状态的词语和意象。因此，它不同于主流的心理化治疗，后者更强调反思功能。针对这一患者亚组，开发了一种基于心理动力学的、以心理化为导向的个体和团体心理治疗方法，旨在通过明确的转化性心理化增强患者的心理资源，而不是主要针对症状减轻。该项目激发对自身心理状态的好奇心，逐步致力于塑造和探索充满情感的心理状态，并与其他治疗方式相结合。本文介绍了精神病性人格结构的心理模型及其心理治疗意义，以及临床实例。一项初步研究的结果为该模型提供了令人鼓舞的支持，包括出现的反思能力和症状减轻，以及社会和职业功能的总体改善。
