University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne; Center for Primary Care and Public Health (Unisanté).
University Institute of Psychotherapy, Department of Psychiatry, Lausanne University Hospital and University of Lausanne.
Psychodyn Psychiatry. 2023 Jun;51(2):224-240. doi: 10.1521/pdps.2023.51.2.224.
Psychotherapy added to usual hospital care is beneficial. This study reports on two contrasting cases, one responder and one nonresponder, from a randomized controlled trial on the effectiveness of intensive and brief psychodynamic psychotherapy (IBPP) for depressed inpatients, in which reduction in depressive severity was maintained for up to 1 year after completion of IBPP. We aimed to explore how the psychotherapist and patient interacted to work through the themes of focalization (described in the IBPP manual) and how their work was part of a potential process of change. This case study is part of the general framework of mixed methods in psychotherapy combining quantitative analysis of data collected in a randomized controlled trial with a qualitative case study. Two general categories emerged-(1) becoming the subject of one's depression and (2) regaining a sense of support-which combine specific functions. In the first, the functions relate to interactions in line with the psychoanalytic work of mourning, which aims for an appropriation of depressive symptoms. In the second, interactions have as their functions the construction of a therapeutic space and the restoration of an epistemic trust by acknowledging the patient's melancholic state and maintaining emotional contact. Work related to regaining a sense of support was observed in both cases, whereas work related to becoming the subject of one's depression was more specific to the responder case. These results highlight the importance of interventions that help generate a sense of support and mobilize the internal processes of symbolization, understanding, and appropriation, leading patients to develop the capacity to give meaning to their symptoms and to understand the personal psychological factors related to the depressive episode.
心理治疗联合常规医院护理有益。本研究报告了一项关于强化和简短心理动力学心理治疗（IBPP）对住院抑郁患者有效性的随机对照试验中的两个对比案例，一个是应答者，一个是非应答者，在完成 IBPP 后长达 1 年的时间内，抑郁严重程度的降低得以维持。我们旨在探讨心理治疗师和患者如何互动，以解决聚焦（IBPP 手册中描述）的主题，以及他们的工作如何成为潜在变化过程的一部分。本病例研究是心理治疗中混合方法的一般框架的一部分，将随机对照试验中收集的数据的定量分析与定性病例研究相结合。出现了两个一般类别-(1)成为自己抑郁的主体和(2)重新获得支持感-这两者结合了具体的功能。在第一个中，这些功能与符合哀悼精神分析工作的互动有关，旨在对抑郁症状进行适当处理。在第二个中，互动的功能是构建治疗空间，并通过承认患者的忧郁状态和保持情感联系来恢复认知信任。在两个案例中都观察到了与重新获得支持感相关的工作，而与成为自己抑郁的主体相关的工作则更具体地出现在应答者案例中。这些结果强调了干预措施的重要性，这些干预措施有助于产生支持感，并调动符号化、理解和适当处理的内部过程，使患者发展出赋予症状意义和理解与抑郁发作相关的个人心理因素的能力。
