The Gurū-Chelā Relationship Revisited: A Review of the Work of Indian Psychia...Université de Montréal
In a series of original and pathbreaking publications, Jaswant Singh Neki (1925-2015), a leading Indian Sikh scholar and psychiatrist (Sikhnet contributors, 2021; Wikipedia contributors, 2021), proposed the gurū-chelā (master-disciple) relationship to create a new paradigm for the therapeutic relationship, employing an accessible cultural idiom that Indian patients could understand and identify with (Neki, 1973, 1974, 1975, 1976, 1977, 1978, 1992). Contrasting his new Indian paradigm with the Western patient-therapist relationship, Neki explored both similarities and sharp contrasts between Western and Indian cultures. Neki argued (1974) that “both are voluntary associations wherein a master enables a change-seeker to dispel ignorance and the effects of undesirable social conditioning.” Using ideas adapted from Raymond Prince, one of the founders of Social and Cultural Psychiatry at McGill University, the author identifies the “I-centered assumptions” behind Western-based psychotherapy: based on the individual as the focus of therapy, using introspection and insight as key therapeutic methods, with personal independence as the goal of therapy (Di Nicola, 1985a, 1985b, 1997). The gurū-chelā relationship, by contrast, “encourages permanent dependency, since the guru assumes total responsibility for leading the chela toward self-mastery through the disciplines of persistence and silence,” and would be “most suited to cultures valuing self-discipline rather than self-expression, and creative harmony between individual and society” (Neki, 1974; emphasis added). The author will take stock of the impact of Neki’s paradigm in India (Carstairs, 1980; Parkar, et al., 2001; Sethi & Chaturvedi, 1985), in the Indian diaspora (Shridhar, 2008), among Indian trainees in the West and in their return to India (Ananth, 1981; Pande, 1968; Surya, 1966) and in Western psychiatric and psychotherapeutic cultures (Di Nicola, 1985a, 1985b, 1997), concluding with a synthesis of Neki’s gurū-chelā paradigm with contemporary trends in psychotherapy, psychiatry, and psychoanalysis.
Schizotypal personality disorder and its psychodynamic perspectivesarah rashid
Schizotypal personality disorder is characterized by social deficits, discomfort with relationships, and cognitive/perceptual distortions. It likely stems from genetic, biological, and social factors such as childhood humiliation or distant parenting. Symptoms include ideas of reference, odd beliefs, unusual perceptions, odd thinking/speech, suspiciousness, eccentric behavior, and lack of friends. Psychodynamically, it may relate to issues with Freud's psychosexual stages or Erikson's stages of trust, industry, and intimacy. Differential diagnosis considers disorders with psychotic features or other personality disorders. A case study describes a 15-year-old male client exhibiting odd beliefs, perceptions, thinking, behavior and social anxiety.
The document summarizes the Mental Health Care Act of 2017 in India. Some key points:
- The Act was passed in 2017 to provide legal framework for mental healthcare and protect rights of those with mental illness.
- It outlines provisions for advance directives, nominated representatives, rights of those with mental illness, and establishment of central and state mental health authorities.
- The Act has 16 chapters covering definitions of key terms, determination of mental illness, consent procedures, admission/discharge processes, and offenses/penalties. It aims to improve community integration and access to high quality care for those suffering from mental illness.
There are two main types of thought disorders - delusions and overvalued ideas. Delusions are defined as false beliefs that are firmly held despite evidence to the contrary. Three main criteria define delusions: certainty, incorrigibility, and impossibility of content. Primary delusions cannot be explained by other symptoms, whereas secondary delusions are derived from other abnormalities like hallucinations. Grandiose, paranoid, and delusions of guilt are some common types of delusional content. Disorders of the prefrontal and temporal lobes may underlie generation of delusions.
The Minnesota Multiphasic Personality Inventory (MMPI) is a widely used psychological test that was originally developed in 1943 to aid in diagnosing psychological disorders. It uses a self-report format with true/false questions. The revised MMPI-2 version from 1989 includes validity and personality scales in addition to the original clinical scales. The MMPI provides a comprehensive personality profile used to assess psychopathology and adjust clinical diagnoses. It requires literacy at an 8th grade level and takes an untimed administration, with no right or wrong answers.
Classification in Psychiatry
The concept, reliability, validity, advantages and disadvantages of different classification systems, controversies in psychiatry classification
Interpersonal psychotherapy (IPT) focuses on the importance of interpersonal relationships in determining behavior and psychopathology. IPT aims to change interpersonal functioning by encouraging more effective communication, emotional expression, and understanding of behavior in relationships. The major goal is improving relationships to also improve symptoms and life. In IPT, therapists conduct therapy in three phases - initial session to identify problem areas, intermediate sessions using strategies for the identified problem area, and termination.
Impact of culture on mental illness/ Transcultural Psychiatry Dr. Amit Chougule
This document discusses the impact of culture on mental illness and psychiatry. It begins by defining culture and the components of culture. It then discusses how culture shapes psychopathology in various ways such as pathogenic, pathoplastic, and pathofacilitative effects. Culture also impacts psychodynamics through variables like dependency versus autonomy, linguistic competence, cognitive styles, and social support systems. Overall, the document examines how culture influences the expression and experience of mental illness as well as psychiatric diagnosis and treatment across different cultures.
The Gurū-Chelā Relationship Revisited: A Review of the Work of Indian Psychia...Université de Montréal
In a series of original and pathbreaking publications, Jaswant Singh Neki (1925-2015), a leading Indian Sikh scholar and psychiatrist (Sikhnet contributors, 2021; Wikipedia contributors, 2021), proposed the gurū-chelā (master-disciple) relationship to create a new paradigm for the therapeutic relationship, employing an accessible cultural idiom that Indian patients could understand and identify with (Neki, 1973, 1974, 1975, 1976, 1977, 1978, 1992). Contrasting his new Indian paradigm with the Western patient-therapist relationship, Neki explored both similarities and sharp contrasts between Western and Indian cultures. Neki argued (1974) that “both are voluntary associations wherein a master enables a change-seeker to dispel ignorance and the effects of undesirable social conditioning.” Using ideas adapted from Raymond Prince, one of the founders of Social and Cultural Psychiatry at McGill University, the author identifies the “I-centered assumptions” behind Western-based psychotherapy: based on the individual as the focus of therapy, using introspection and insight as key therapeutic methods, with personal independence as the goal of therapy (Di Nicola, 1985a, 1985b, 1997). The gurū-chelā relationship, by contrast, “encourages permanent dependency, since the guru assumes total responsibility for leading the chela toward self-mastery through the disciplines of persistence and silence,” and would be “most suited to cultures valuing self-discipline rather than self-expression, and creative harmony between individual and society” (Neki, 1974; emphasis added). The author will take stock of the impact of Neki’s paradigm in India (Carstairs, 1980; Parkar, et al., 2001; Sethi & Chaturvedi, 1985), in the Indian diaspora (Shridhar, 2008), among Indian trainees in the West and in their return to India (Ananth, 1981; Pande, 1968; Surya, 1966) and in Western psychiatric and psychotherapeutic cultures (Di Nicola, 1985a, 1985b, 1997), concluding with a synthesis of Neki’s gurū-chelā paradigm with contemporary trends in psychotherapy, psychiatry, and psychoanalysis.
Schizotypal personality disorder and its psychodynamic perspectivesarah rashid
Schizotypal personality disorder is characterized by social deficits, discomfort with relationships, and cognitive/perceptual distortions. It likely stems from genetic, biological, and social factors such as childhood humiliation or distant parenting. Symptoms include ideas of reference, odd beliefs, unusual perceptions, odd thinking/speech, suspiciousness, eccentric behavior, and lack of friends. Psychodynamically, it may relate to issues with Freud's psychosexual stages or Erikson's stages of trust, industry, and intimacy. Differential diagnosis considers disorders with psychotic features or other personality disorders. A case study describes a 15-year-old male client exhibiting odd beliefs, perceptions, thinking, behavior and social anxiety.
The document summarizes the Mental Health Care Act of 2017 in India. Some key points:
- The Act was passed in 2017 to provide legal framework for mental healthcare and protect rights of those with mental illness.
- It outlines provisions for advance directives, nominated representatives, rights of those with mental illness, and establishment of central and state mental health authorities.
- The Act has 16 chapters covering definitions of key terms, determination of mental illness, consent procedures, admission/discharge processes, and offenses/penalties. It aims to improve community integration and access to high quality care for those suffering from mental illness.
There are two main types of thought disorders - delusions and overvalued ideas. Delusions are defined as false beliefs that are firmly held despite evidence to the contrary. Three main criteria define delusions: certainty, incorrigibility, and impossibility of content. Primary delusions cannot be explained by other symptoms, whereas secondary delusions are derived from other abnormalities like hallucinations. Grandiose, paranoid, and delusions of guilt are some common types of delusional content. Disorders of the prefrontal and temporal lobes may underlie generation of delusions.
The Minnesota Multiphasic Personality Inventory (MMPI) is a widely used psychological test that was originally developed in 1943 to aid in diagnosing psychological disorders. It uses a self-report format with true/false questions. The revised MMPI-2 version from 1989 includes validity and personality scales in addition to the original clinical scales. The MMPI provides a comprehensive personality profile used to assess psychopathology and adjust clinical diagnoses. It requires literacy at an 8th grade level and takes an untimed administration, with no right or wrong answers.
Classification in Psychiatry
The concept, reliability, validity, advantages and disadvantages of different classification systems, controversies in psychiatry classification
Interpersonal psychotherapy (IPT) focuses on the importance of interpersonal relationships in determining behavior and psychopathology. IPT aims to change interpersonal functioning by encouraging more effective communication, emotional expression, and understanding of behavior in relationships. The major goal is improving relationships to also improve symptoms and life. In IPT, therapists conduct therapy in three phases - initial session to identify problem areas, intermediate sessions using strategies for the identified problem area, and termination.
Impact of culture on mental illness/ Transcultural Psychiatry Dr. Amit Chougule
This document discusses the impact of culture on mental illness and psychiatry. It begins by defining culture and the components of culture. It then discusses how culture shapes psychopathology in various ways such as pathogenic, pathoplastic, and pathofacilitative effects. Culture also impacts psychodynamics through variables like dependency versus autonomy, linguistic competence, cognitive styles, and social support systems. Overall, the document examines how culture influences the expression and experience of mental illness as well as psychiatric diagnosis and treatment across different cultures.
Core slides from my presentation about the new DSM diagnostic system. The full presentation has more zing but I removed some to streamline and to whet the appetite.
Psychodiagnosis refers to the process of classifying information about an individual's emotional and behavioral state in order to understand their psychological functioning. It aims to develop both a classification or label for any disorders (categorical diagnosis) as well as a deeper understanding of the individual's personality and experiences (characterological diagnosis). The objectives of psychodiagnosis are to describe psychopathology, provide diagnoses, formulate case studies to understand causes, and guide treatment planning.
Aaron Beck is an American psychiatrist known as the father of cognitive therapy. He developed widely used assessment tools for depression and anxiety. Beck attended Brown University and Yale Medical School. He believed that depression stems from negative views of oneself, the world, and the future. Cognitive therapy aims to help patients overcome difficulties by identifying and changing dysfunctional thoughts and behaviors. It involves helping patients develop skills to modify beliefs and identify distorted thinking.
The document summarizes recent advances in psychiatry, with a focus on advances related to dementia. It discusses improvements in dementia classification systems, understanding of disease mechanisms, early detection methods, and treatments. Key points include: the DSM-5 updated dementia diagnosis criteria; genetics research identifying new risk genes; brain imaging techniques detecting amyloid plaques and glucose metabolism changes; cerebrospinal fluid tests measuring amyloid and tau levels; and new drug combinations and disease-modifying therapies targeting amyloid, tau, inflammation, and cholesterol.
The document discusses changes in diagnoses of common childhood disorders in the DSM-5. It notes that the DSM-IV grouped several disorders together, but the DSM-5 eliminates this approach. Specific changes include intellectual disability replacing mental retardation, social communication disorder being added to autism spectrum disorder, autism spectrum disorder encompassing four previously separate diagnoses, modifications to ADHD criteria and subtypes, and alterations to conduct disorder, oppositional defiant disorder, and other diagnoses.
H'vovi Bhagwagar, Clinical Psychologist & CBT Expert shares the presentation made by her at World Bipolar Day, Mumbai 2017 Event.
This presentation talks about how by correcting one's though processes, one can alter moods as well.
A psychologist is not the primary Professional in Bipolar Disorder treatment but, counseling from a good practitioner can be used as conjunctive therapy and aid recovery.
The document provides an overview of the changes between editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the evolution of the DSM from earlier editions to the current DSM-5, which was approved in 2013. Some key changes in the DSM-5 include combining and splitting certain diagnoses, adding several new disorders, removing the multiaxial system, and including emerging measures and models for further study. The document outlines these changes in detail and provides background on the development process of the DSM-5.
Identify the distinction of DSM 5 vs ICD.
Explain the significant change in the fifth edition .
Discuss and differentiate the purposes of mental illness classification.
This document discusses key concepts relating to culture and mental health. It defines culture and related terms, and explains how culture can influence various aspects of mental health, including definitions of normality and abnormality, symptom presentation, help-seeking behavior, and response to treatment. It also discusses culture-bound syndromes and how non-biological factors like cultural beliefs, traditional medicine use, and patient compliance can impact psychopharmacology.
The document provides guidelines for assessing and evaluating disabilities in India. It describes the following:
1. Authorities in India that are responsible for providing disability certificates according to the Persons with Disabilities Act of 1995.
2. The Indian Disability Evaluation and Assessment Scale (IDEAS) which was developed to measure and quantify disability in mental disorders.
3. How the IDEAS evaluates four areas - self-care, interpersonal activities, communication and understanding, and work - to determine the level of global disability on a scale from 0-100%.
The document provides an overview of consultation-liaison psychiatry, including basics, common conditions, and management approaches. It defines consultation-liaison psychiatry and its roles in a general hospital setting. Common conditions addressed include delirium, suicide, depression, agitation, and medical issues like hepatic or renal impairment. Management prioritizes identifying and treating underlying causes, coordinating pharmacological and non-pharmacological approaches, and effective communication with medical teams.
The document provides a historical overview and current understanding of mood disorders as categorized in the DSM-5 and ICD-11 diagnostic systems. Some key points:
- Mood disorders include depressive disorders and bipolar disorders, with major categories being major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, bipolar I disorder, and bipolar II disorder.
- Important changes from previous editions include removing the bereavement exclusion in DSM-5 and adding specifiers like with anxious distress, with mixed features, and seasonal pattern.
- ICD-11 retains the mood disorders category and bipolar/related disorders grouping, with some organizational differences from DSM-5 like a
This document discusses core values in community psychology including wellness, sense of community, and respect for human diversity. It notes that core values help clarify research and action choices and identify disconnects between actions and espoused values. Community psychology values promoting individual wellness through strengthening family and studying how sense of community balances individual and family wellness while not always being positive. Respecting human diversity recognizes variety in communities and identities and helps effective community work if diversity is respected.
1) Depression has a lifetime prevalence of 10-30% and is the third leading cause of disability worldwide. 2) Only about 33% of patients achieve full remission after their first antidepressant, and 30-45% fail to respond adequately to two treatments. 3) Achieving full remission is important for preventing relapse and reducing risks of suicide, medical comorbidities, and impaired functioning. Treatment resistance is defined as failing to respond to two adequate antidepressant trials.
Carl Rogers developed client-centered therapy in the 1940s as an alternative to traditional psychoanalytic approaches. In client-centered therapy, the therapist takes a non-directive approach, actively listening without judgment to help clients gain self-understanding and acceptance. The therapist provides empathy, genuineness, and unconditional positive regard to create an environment where clients can explore their feelings and find their own answers. Research shows client-centered therapy can be as effective as cognitive behavioral therapy and has influenced other approaches like motivational interviewing. While criticism includes the lack of diagnoses, some find it less effective for certain disorders, client-centered therapy changed psychotherapy by making it more client-focused and flexible.
This document provides an overview of personality disorders, including Cluster B personality disorders. It defines personality disorders as rigid and unhealthy patterns of thinking, functioning and behaving that cause problems in relationships, social interactions, and work or school. Cluster B disorders are characterized by dramatic, emotional or unpredictable behaviors and include antisocial, borderline, histrionic and narcissistic personality disorders. Antisocial personality disorder involves disregard for others' rights through behaviors like violating laws, aggression, and lack of remorse.
(a) Several brain areas have been found to have abnormal activity or structure in patients with major depressive disorder (MDD) compared to healthy controls, including the prefrontal cortex, anterior cingulate cortex, hippocampus, amygdala, and orbitofrontal cortex.
(b) Imaging studies have found both hypoactivity and hyperactivity in different areas, and treatment has been shown to help normalize some of these abnormalities.
(c) The prefrontal cortex and limbic system including the hippocampus and amygdala appear to be particularly involved, and their structural and functional connections may contribute to MDD.
From a psychoanalytical perspective, there are two main types of psychopathology: those related to conflicting mental representations which result in neurotic pathology, and those related to failures of the mentalizing process which result in personality disorders. Borderline personality disorder is characterized by instability in interpersonal relationships, self-image, and affect as well as impulsivity, while paranoid personality disorder involves a pervasive mistrust and suspiciousness of others. Both disorders stem from failures early in life to develop stable and coherent mental representations of oneself and others.
Psychoanalysis
The relational focus was there from the beginning.
In between Biology and Psychology: genetic vulnerabilities in interaction with the primary caregivers.
How do somatic sensations develop into human feelings?
How do emotions develop into feelings?
How develop somatic sensations into intentional behavior with a symbolic meaning?
How do biological factors, genetic vulnerabilities and environmental factors interact with each other?
Core slides from my presentation about the new DSM diagnostic system. The full presentation has more zing but I removed some to streamline and to whet the appetite.
Psychodiagnosis refers to the process of classifying information about an individual's emotional and behavioral state in order to understand their psychological functioning. It aims to develop both a classification or label for any disorders (categorical diagnosis) as well as a deeper understanding of the individual's personality and experiences (characterological diagnosis). The objectives of psychodiagnosis are to describe psychopathology, provide diagnoses, formulate case studies to understand causes, and guide treatment planning.
Aaron Beck is an American psychiatrist known as the father of cognitive therapy. He developed widely used assessment tools for depression and anxiety. Beck attended Brown University and Yale Medical School. He believed that depression stems from negative views of oneself, the world, and the future. Cognitive therapy aims to help patients overcome difficulties by identifying and changing dysfunctional thoughts and behaviors. It involves helping patients develop skills to modify beliefs and identify distorted thinking.
The document summarizes recent advances in psychiatry, with a focus on advances related to dementia. It discusses improvements in dementia classification systems, understanding of disease mechanisms, early detection methods, and treatments. Key points include: the DSM-5 updated dementia diagnosis criteria; genetics research identifying new risk genes; brain imaging techniques detecting amyloid plaques and glucose metabolism changes; cerebrospinal fluid tests measuring amyloid and tau levels; and new drug combinations and disease-modifying therapies targeting amyloid, tau, inflammation, and cholesterol.
The document discusses changes in diagnoses of common childhood disorders in the DSM-5. It notes that the DSM-IV grouped several disorders together, but the DSM-5 eliminates this approach. Specific changes include intellectual disability replacing mental retardation, social communication disorder being added to autism spectrum disorder, autism spectrum disorder encompassing four previously separate diagnoses, modifications to ADHD criteria and subtypes, and alterations to conduct disorder, oppositional defiant disorder, and other diagnoses.
H'vovi Bhagwagar, Clinical Psychologist & CBT Expert shares the presentation made by her at World Bipolar Day, Mumbai 2017 Event.
This presentation talks about how by correcting one's though processes, one can alter moods as well.
A psychologist is not the primary Professional in Bipolar Disorder treatment but, counseling from a good practitioner can be used as conjunctive therapy and aid recovery.
The document provides an overview of the changes between editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It discusses the evolution of the DSM from earlier editions to the current DSM-5, which was approved in 2013. Some key changes in the DSM-5 include combining and splitting certain diagnoses, adding several new disorders, removing the multiaxial system, and including emerging measures and models for further study. The document outlines these changes in detail and provides background on the development process of the DSM-5.
Identify the distinction of DSM 5 vs ICD.
Explain the significant change in the fifth edition .
Discuss and differentiate the purposes of mental illness classification.
This document discusses key concepts relating to culture and mental health. It defines culture and related terms, and explains how culture can influence various aspects of mental health, including definitions of normality and abnormality, symptom presentation, help-seeking behavior, and response to treatment. It also discusses culture-bound syndromes and how non-biological factors like cultural beliefs, traditional medicine use, and patient compliance can impact psychopharmacology.
The document provides guidelines for assessing and evaluating disabilities in India. It describes the following:
1. Authorities in India that are responsible for providing disability certificates according to the Persons with Disabilities Act of 1995.
2. The Indian Disability Evaluation and Assessment Scale (IDEAS) which was developed to measure and quantify disability in mental disorders.
3. How the IDEAS evaluates four areas - self-care, interpersonal activities, communication and understanding, and work - to determine the level of global disability on a scale from 0-100%.
The document provides an overview of consultation-liaison psychiatry, including basics, common conditions, and management approaches. It defines consultation-liaison psychiatry and its roles in a general hospital setting. Common conditions addressed include delirium, suicide, depression, agitation, and medical issues like hepatic or renal impairment. Management prioritizes identifying and treating underlying causes, coordinating pharmacological and non-pharmacological approaches, and effective communication with medical teams.
The document provides a historical overview and current understanding of mood disorders as categorized in the DSM-5 and ICD-11 diagnostic systems. Some key points:
- Mood disorders include depressive disorders and bipolar disorders, with major categories being major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, bipolar I disorder, and bipolar II disorder.
- Important changes from previous editions include removing the bereavement exclusion in DSM-5 and adding specifiers like with anxious distress, with mixed features, and seasonal pattern.
- ICD-11 retains the mood disorders category and bipolar/related disorders grouping, with some organizational differences from DSM-5 like a
This document discusses core values in community psychology including wellness, sense of community, and respect for human diversity. It notes that core values help clarify research and action choices and identify disconnects between actions and espoused values. Community psychology values promoting individual wellness through strengthening family and studying how sense of community balances individual and family wellness while not always being positive. Respecting human diversity recognizes variety in communities and identities and helps effective community work if diversity is respected.
1) Depression has a lifetime prevalence of 10-30% and is the third leading cause of disability worldwide. 2) Only about 33% of patients achieve full remission after their first antidepressant, and 30-45% fail to respond adequately to two treatments. 3) Achieving full remission is important for preventing relapse and reducing risks of suicide, medical comorbidities, and impaired functioning. Treatment resistance is defined as failing to respond to two adequate antidepressant trials.
Carl Rogers developed client-centered therapy in the 1940s as an alternative to traditional psychoanalytic approaches. In client-centered therapy, the therapist takes a non-directive approach, actively listening without judgment to help clients gain self-understanding and acceptance. The therapist provides empathy, genuineness, and unconditional positive regard to create an environment where clients can explore their feelings and find their own answers. Research shows client-centered therapy can be as effective as cognitive behavioral therapy and has influenced other approaches like motivational interviewing. While criticism includes the lack of diagnoses, some find it less effective for certain disorders, client-centered therapy changed psychotherapy by making it more client-focused and flexible.
This document provides an overview of personality disorders, including Cluster B personality disorders. It defines personality disorders as rigid and unhealthy patterns of thinking, functioning and behaving that cause problems in relationships, social interactions, and work or school. Cluster B disorders are characterized by dramatic, emotional or unpredictable behaviors and include antisocial, borderline, histrionic and narcissistic personality disorders. Antisocial personality disorder involves disregard for others' rights through behaviors like violating laws, aggression, and lack of remorse.
(a) Several brain areas have been found to have abnormal activity or structure in patients with major depressive disorder (MDD) compared to healthy controls, including the prefrontal cortex, anterior cingulate cortex, hippocampus, amygdala, and orbitofrontal cortex.
(b) Imaging studies have found both hypoactivity and hyperactivity in different areas, and treatment has been shown to help normalize some of these abnormalities.
(c) The prefrontal cortex and limbic system including the hippocampus and amygdala appear to be particularly involved, and their structural and functional connections may contribute to MDD.
From a psychoanalytical perspective, there are two main types of psychopathology: those related to conflicting mental representations which result in neurotic pathology, and those related to failures of the mentalizing process which result in personality disorders. Borderline personality disorder is characterized by instability in interpersonal relationships, self-image, and affect as well as impulsivity, while paranoid personality disorder involves a pervasive mistrust and suspiciousness of others. Both disorders stem from failures early in life to develop stable and coherent mental representations of oneself and others.
Psychoanalysis
The relational focus was there from the beginning.
In between Biology and Psychology: genetic vulnerabilities in interaction with the primary caregivers.
How do somatic sensations develop into human feelings?
How do emotions develop into feelings?
How develop somatic sensations into intentional behavior with a symbolic meaning?
How do biological factors, genetic vulnerabilities and environmental factors interact with each other?
This document discusses principles of psychology related to trust and strengths-finding. It covers positive psychology and its focus on individual strengths rather than problems. Freud's psychoanalytic concepts are examined, including the id, ego, and superego structures of personality. Defense mechanisms are outlined at different levels from psychotic to mature. The document also discusses cognitive dissonance theory and Erikson's stages of psychosocial development related to trust vs. mistrust and autonomy vs. shame and doubt.
Psychological models of depression include psychodynamic, interpersonal, behavioral, and cognitive theories. Psychodynamic theories view depression as resulting from unresolved conflicts around loss, impaired self-esteem, and inadequate early caregivers. Interpersonal theories link mood to disruptions in relationships and social support. Behavioral theories explain depression as learned through reinforcement and social interactions. Cognitive theories emphasize negative thought patterns and schemas involving negative views of self, world, and future as central to depression.
This document discusses psychoanalysis and human development from several perspectives. It addresses how emotions, attachment, and relatedness develop from biological and psychological factors through interactions with primary caregivers. Key topics covered include the relational focus of psychoanalysis from the beginning, the debate between Freud and Ferenczi on autonomy versus relatedness, and how internal working models form based on early attachment relationships. Developmental theorists discussed include Freud, Klein, Winnicott, Bowlby, and Kohut.
Cluster B personality disorders are characterized by dramatic, emotional or erratic behaviors. They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder. Biological factors like genetics and hormones play a role in etiology. Psychological factors during development like attachment issues and maladaptive defenses also contribute to Cluster B personalities. Antisocial personality disorder specifically involves a persistent disregard for social norms with impulsive and aggressive tendencies, affecting mostly males.
Psychoanalysis was founded by Sigmund Freud (1856-1939). Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining insight. The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e. make the unconscious conscious
Attachment, Antisocial, And Antisocial BehaviorDiane Allen
Secure early attachments help develop empathy and emotional regulation, promoting prosocial behavior. Those lacking these skills display antisocial behavior like disrespecting others' rights. Antisocial behavior in adolescents can predict later adjustment issues and criminality. While some defiance is normal in teens, consistent antisocial behavior signals a disorder requiring treatment.
This document discusses the concept of insight and judgment in mental health. It defines insight as involving introspection, empathy, understanding how one's behavior affects others, and recognizing illness and need for treatment. Judgment requires weighing factors to make decisions. Both insight and judgment rely on intact cognitive functions. The document outlines several models of insight and factors that can impair judgment, such as mental illnesses like schizophrenia, bipolar disorder, and depression. It also discusses various scales used to measure insight.
Antisocial personality disorder is a psychological disorder characterized by dysfunctional and destructive thinking and relating to others. People with this disorder have no regard for others' rights and feelings and manipulate or antagonize others for pleasure or gain, showing no remorse. Symptoms often begin in childhood and become fully evident in the 20s-30s, potentially including cruelty to animals and bullying. Half of male inmates meet criteria for this disorder.
Schizophrenia is a group of biological disorders that produce impairments in thinking, learning, and relationships. It affects around 1% of the population and often begins in late adolescence or early adulthood. While there is no known cure, treatments can help manage symptoms and improve quality of life. Biological factors like genetics and brain abnormalities are involved in schizophrenia, as are psychological and social factors. Medications are effective in reducing positive symptoms like hallucinations and delusions, while psychosocial therapies also play an important role in treatment and recovery.
Sigmund Freud developed psychoanalytic theory, which focuses on unconscious processes and how early childhood experiences shape personality. He proposed that the mind is divided into the id, ego, and superego, which are in constant conflict. Defense mechanisms like repression help resolve this intrapsychic conflict unconsciously. Freud believed psychosexual development occurs in stages like oral and phallic, and fixations can result from conflicts in these stages. Psychoanalytic treatment uses techniques like free association and analysis of transference to develop insight. Freud made major contributions by emphasizing the role of sexuality and the unconscious.
The document discusses the character of the Joker from the Batman movies as an example of someone suffering from antisocial personality disorder. It describes key characteristics of the disorder according to the Mayo Clinic, including disregard for others, manipulation of others, lack of guilt or remorse. The document then discusses how childhood traumas, genetics, and societal stereotypes can contribute to misdiagnosis of the disorder. Researchers are still working to better define personality disorders and find more effective treatments.
This document provides an overview of Sigmund Freud's psychoanalytic theory and Carl Jung's analytical psychology perspective on personality development. It discusses key concepts in Freudian psychoanalysis like the structure of personality consisting of the id, ego and superego. Defense mechanisms and psychosexual stages are also explained. Jung diverged from Freud in rejecting his sexual theory and emphasis on biological drives, focusing more on spirituality and individuation. The document also outlines techniques used in psychoanalytic therapy like free association, dream analysis, and interpretation of transference and resistance.
This document provides an overview of Chapter 14 on Psychological Disorders from a PowerPoint presentation. It discusses defining and classifying psychological disorders, as well as specific disorders like anxiety disorders, mood disorders, schizophrenia, and others. For each disorder type, it examines diagnostic criteria, prevalence, causes and explanations from different perspectives like biology, learning, and culture. The goal is to understand the nature of psychological disorders and how they are diagnosed and treated.
Sigmund Freud, Carl Jung, And Traditional Psychodynamic...Diana Turner
This document discusses psychodynamic theories of personality, including those proposed by Sigmund Freud, Carl Jung, and others. It explains that traditional psychodynamic theories focused on the unconscious mind and believed personality traits were innate, while contemporary theories emphasized how personality develops through interactions with the external world. The document also briefly describes some of the key ideas from Freudian psychoanalysis and Jungian analytical psychology.
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Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
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MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
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2. 22
Psychopathology 1Psychopathology 1
Biology and PsychologyBiology and Psychology
Behavior is the result of the mutualBehavior is the result of the mutual
relation between “nature” andrelation between “nature” and
“nurture”.The result of a complicated“nurture”.The result of a complicated
interaction between “genes” andinteraction between “genes” and
“environment”→ integration Mind and“environment”→ integration Mind and
Brain.Brain.
3. 33
Psychopathology 2Psychopathology 2
Consequences for looking atConsequences for looking at
pathologypathology
1.1. No causal relation between risc factors and theNo causal relation between risc factors and the
development of pathology; the amount of riscdevelopment of pathology; the amount of risc
factors is in a way predictable.factors is in a way predictable.
2.2. The quality of the early attachmentThe quality of the early attachment
relationships is important for the possiblerelationships is important for the possible
development of pathologydevelopment of pathology
4. 4
Psychopathology 3Psychopathology 3
The process of internalising early experiencesThe process of internalising early experiences
and the creation of an internal psychologicaland the creation of an internal psychological
model of the interpersonal world →model of the interpersonal world →
mentalization/ creation of a mind or mentalmentalization/ creation of a mind or mental
representations.representations.
Internal representations of the earlierInternal representations of the earlier
experiences with the primairy care givers willexperiences with the primairy care givers will
influence later relationships and theinfluence later relationships and the
development of psychopathology later ondevelopment of psychopathology later on
5. 5
Psychopathology 4Psychopathology 4
There are 2 types ofThere are 2 types of
psychopathologypsychopathology
1.1. Related to conflicting mental representations:Related to conflicting mental representations:
neurotic pathologyneurotic pathology
2.2. Related to the failing of the mentalizingRelated to the failing of the mentalizing
process itself: personality disorders this is theprocess itself: personality disorders this is the
area of the borderline personality organizationarea of the borderline personality organization
6. 6
Difference between BPD and BPO 1Difference between BPD and BPO 1
Borderline Personality DisorderBorderline Personality Disorder
1.1. A descriptive diagnosis. Manifest andA descriptive diagnosis. Manifest and
observable behaviorobservable behavior
2.2. An enduring pattern of internal experiencesAn enduring pattern of internal experiences
that manifest themselves in a broad area ofthat manifest themselves in a broad area of
personal and social situations.personal and social situations.
3.3. DSM IVDSM IV
7. 77
Difference between BPD and BPO 2Difference between BPD and BPO 2
Borderline PersonalityBorderline Personality
OrganizationOrganization
Structural Diagnosis/ KernbergStructural Diagnosis/ Kernberg
Underlying structure which is not directlyUnderlying structure which is not directly
observable.→observable.→
Dyade/Schema/I.W.M./I.I.M.Dyade/Schema/I.W.M./I.I.M.
Includes the whole area of personalityIncludes the whole area of personality
disordersdisorders
8. 8
Two types of pathologyTwo types of pathology
Mental process disordersMental process disorders
Inability to represent inside what is outsideInability to represent inside what is outside
The dependency from the external world isThe dependency from the external world is
therethere
Anxieties are interpersonal instead of intraAnxieties are interpersonal instead of intra
personalpersonal
9. 99
Two types of pathologyTwo types of pathology
Mental Process disordersMental Process disorders
No psychological Self but the body is the selfNo psychological Self but the body is the self
No Somatization as a defense but SomaNo Somatization as a defense but Soma
Alexithymia: medically unexplained physicalAlexithymia: medically unexplained physical
symptoms/ conversionssymptoms/ conversions
They live in a frightened world instead of a worldThey live in a frightened world instead of a world
they are experiencing as frighteningthey are experiencing as frightening
10. 10
Mental Process DisordersMental Process Disorders
1.1. Anxiety neurosisAnxiety neurosis
2.2. External Regulated / MotivatedExternal Regulated / Motivated
3.3. Developmental pathologyDevelopmental pathology
4.4. Building structuresBuilding structures
5.5. The area of the personality disorders Axis 2The area of the personality disorders Axis 2
cluster A and Bcluster A and B
6.6. Axis 1 Somatization, Somatoform disorder,Axis 1 Somatization, Somatoform disorder,
Panic disorder Dissociative disorder andPanic disorder Dissociative disorder and
PTSD.PTSD.
12. Mental process / mental representations
Paranoid/Schizoid versus Depressive Pos.
Primary love versus Basic Fault
Primary versus Secondary Process
Pre Oedipal versus Oedipal
Neurotic versus Structural
Neurotic versus Personality dis.
12
13. 13
M.KleinM.Klein
Par. Schizoid PositionPar. Schizoid Position
Annihilation anxietyAnnihilation anxiety
Identity undermining defensesIdentity undermining defenses
No adequate self/object differentiationNo adequate self/object differentiation
No adequate object constancyNo adequate object constancy
Archaic Object RelationsArchaic Object Relations
Ambivalences are not bearableAmbivalences are not bearable
““doing” instead of “containing”/”feeling”doing” instead of “containing”/”feeling”
14. 14
M.KleinM.Klein
Par.Schizoid PositionPar.Schizoid Position
Interventions related to the inner experiencingInterventions related to the inner experiencing
are raising the anxiety and by that stimulatingare raising the anxiety and by that stimulating
“acting out”“acting out”
Interventions should relate inner and outerInterventions should relate inner and outer
sources of stresssources of stress → facilitating mentalization→ facilitating mentalization
Therapist as external Obs.Ego → beingTherapist as external Obs.Ego → being
introjected / mirroringintrojected / mirroring
15. 15
M.KleinM.Klein
Depressive positionDepressive position
Anxieties related to inner ambivalencesAnxieties related to inner ambivalences
Defenses in favour of identityDefenses in favour of identity
Adequate S/O differentiationAdequate S/O differentiation
Adequate Object constancyAdequate Object constancy
Realistic Object RelationsRealistic Object Relations
Containing instead of doingContaining instead of doing
16. 16
AttachmentAttachment
A safe attachment style supposesA safe attachment style supposes
Adequate sensitivityAdequate sensitivity : being aware that: being aware that
there is something going on in the otherthere is something going on in the other
personperson
Adequate responsivityAdequate responsivity : reacting to the: reacting to the
other in such a way that it is clear what isother in such a way that it is clear what is
from me and what from the otherfrom me and what from the other
17. Failing sensitivity: Externalizing pathology
They minimize their need for relatedness. As a strategy
against the pain of the separation and the feeling not
been seen.
Predisposition for Externalizing pathology because
there is no attention for the self, and the solution of
negative inner representations is not there → faling
sensitivity
(Dozier 1999)
17
18. Failing responsivity: Internalizing pathology
They maximalizing their need for relatedness and they
are continually occupied with the emotional pain and
the not being available of the attachment figures.
Predisposition for Internalizing pathology: attention
will be fixated to the availability of the caring other and
negative representations stay painfully alive → failing
responsivity
18
19. 19
S. Blatt: Two Basic Drives
1. Relatedness
2. Autonomy
(Blatt 1998)
Anaclytical pathology
Preoccupied/Ambivalent
Faling responsivity/not marked
mirroring
I can not be on my own
Introjective pathology
Avoiding
Failing sensitivity
I do it myself
26. 26
Identity - 2 -Identity - 2 -
FragmentationFragmentation - cohesive- cohesive
Acting outActing out - containing- containing
Momentaneous - timeMomentaneous - time
perspectiveperspective
panicpanic - signal anxiety- signal anxiety
Splitting - repressionSplitting - repression
27. Structural Diagnosis/ Kernberg
Underlying structure which is not directly
observable.
Object Relational Dyade; Schema
Internal Working Model. Intersubjective.
Interpretive Mechanism.
Includes the whole area of personality
disorders
27
28. 28
Structural PersonalityStructural Personality
OrganizationOrganization
KernbergKernberg (1984)(1984)
NeuroticNeurotic BorderlineBorderline PsychoticPsychotic
IdentityIdentity integratedintegrated diffuusdiffuus fragmentatedfragmentated
DefenseDefense maturemature archaicarchaic archaicarchaic
RealityReality
TestingTesting
in tactin tact in tact in a wayin tact in a way absentabsent
39. A pervasive pattern of detachment from social
relationships
Introjective/externalizing pathology
39
40. Restricted range of expression of emotions in
interpersonal relationships
No desire or missing or enjoying close
relationships
Indifferent to praise or criticism
Like being alone
40
41. In the internal world intense relations
Anxiety of being rejected;of being
persecuted;of desintegration
A lot of splitting
Fairbairn: internal life compensates deficits in
external life → inner life is pathological
Balint: Inadequate mothering → basic fault
41
42. 42
PersonalityPersonality
DisorderDisorder
SchizoidSchizoid
View ofView of
selfself
Self-sufficient. LonerSelf-sufficient. Loner
View ofView of
othersothers
IntrusiveIntrusive
MainMain
beliefsbeliefs
Others are unrewarding.Others are unrewarding.
Relationships are messy, undesirable.Relationships are messy, undesirable.
MainMain
strategystrategy
Stay away!Stay away!
TherapeutiTherapeuti
cc
strategiesstrategies
Realize that he is basically very insecure and that contactRealize that he is basically very insecure and that contact
with people is a real threat.with people is a real threat.
So let him decide how much contact he wants.So let him decide how much contact he wants.
Do everything to increase his sense of self-efficacy.Do everything to increase his sense of self-efficacy.
43. The same as Schizoid but also:
Ideas of reference
Suspicious/paranoid,excessive social anxiety
Magical thinking
Eccentric and odd behavior
43
44. 44
PersonalityPersonality
DisorderDisorder
SchizotypalSchizotypal
View ofView of
selfself
Unreal, detached, loner.Unreal, detached, loner.
Vulnerable, socially conspicuous.Vulnerable, socially conspicuous.
Supernaturally sensitive and gifted.Supernaturally sensitive and gifted.
View ofView of
othersothers
Untrustworthy. Malevolent.Untrustworthy. Malevolent.
MainMain
beliefsbeliefs
(irrational, odd, superstitious, magical thinking; e.g. belief in(irrational, odd, superstitious, magical thinking; e.g. belief in
clairvoyance, telepathy or ‘sixth sense’.)clairvoyance, telepathy or ‘sixth sense’.)
““It is better to be isolated from others.”It is better to be isolated from others.”
MainMain
strategystrategy
Watch for and neutralize malevolent attention from others.Watch for and neutralize malevolent attention from others.
Stay to self.Stay to self.
Be vigilant for supernatural forces or events.Be vigilant for supernatural forces or events.
TherapeutiTherapeuti
cc
strategiesstrategies
See next slide.See next slide.
45. 45
How to deal with SchizotypicalsHow to deal with Schizotypicals
Realize that he is basically very insecure and thatRealize that he is basically very insecure and that
contact with people is a real threat.contact with people is a real threat.
So let him decide how much contact he wants.So let him decide how much contact he wants.
Do everything to increase his sense of self-efficacy andDo everything to increase his sense of self-efficacy and
his reality testing.his reality testing.
Don’t argue about telepathy, but simply state that youDon’t argue about telepathy, but simply state that you
don’t have such experiences.don’t have such experiences.
46. A pervasive mistrust and suspiciousness of
others
Fixated in the paranoid/schizoid position
Reads hidden meanings in everything
Externalizing, others are aggressors
No trust in others → problems with basic trust
4646
47. The dominant dyade is that of victim and
persecutor
Emotional cold in intimate relations
Arrogant on the outside feelings of inferiority in
the inside
Hyperalert
In a way they are right the problem is in the
enlargement
47
48. Splitting as defense mechanism
Continuous Anxiety
Concrete Magic Thinking → Taking things at
face value
Projective Identification
Problems with Object Constancy
Relations are in it self dangerous and
discontinuous
48
49. 49
PersonalityPersonality
DisorderDisorder
ParanoidParanoid
View ofView of
selfself
Righteous, innocent, noble, vulnerableRighteous, innocent, noble, vulnerable
View ofView of
othersothers
Interfering, malicious, discriminatory, abusive motivesInterfering, malicious, discriminatory, abusive motives
MainMain
beliefsbeliefs
Others’ motives are suspect.Others’ motives are suspect.
I must always be on guard.I must always be on guard.
I cannot trust people.I cannot trust people.
MainMain
strategystrategy
Be wary. Look for hidden motives.Be wary. Look for hidden motives.
Accuse. Counterattack.Accuse. Counterattack.
TherapeutiTherapeuti
cc
strategiesstrategies
Realize that he is basically very insecure.Realize that he is basically very insecure.
So accept the suspiciousness.So accept the suspiciousness.
Accept that you have to earn his trust, by being extremelyAccept that you have to earn his trust, by being extremely
transparant and open about what you are doing.transparant and open about what you are doing.
Do everything to increase his sense of self-efficacy.Do everything to increase his sense of self-efficacy.
51. Pervasive pattern of instability of interpersonal
relationships, self image and affects and
marked impulsivity
Anaclytical / internalizing pathology
51
52. Alternating between idealizing and devaluating
Chronic feelings of emptiness
Inappropriate intense anger
Self-mutilation
52
53. Frantic efforts to avoid real or imagined
abandoment
Identity disturbances
Impulsivity / problems with bounderies
Affective instability / moodswings including
anxiety
Paranoid ideation
53
54. 54
PersonalityPersonality
DisorderDisorder
BorderlineBorderline
View ofView of
selfself
Vulnerable (to rejection, betrayal, domination)Vulnerable (to rejection, betrayal, domination)
Deprived (of needed emotional support)Deprived (of needed emotional support)
Powerless. Out of control.Powerless. Out of control.
Defective. Unlovable. Bad.Defective. Unlovable. Bad.
View ofView of
othersothers
(idealized:) poweful, loving, perfect.(idealized:) poweful, loving, perfect.
(devaluated:) rejecting, controlling, betraying, abandoning.(devaluated:) rejecting, controlling, betraying, abandoning.
MainMain
beliefsbeliefs
I cannot cope on my own. I need someone to rely on.I cannot cope on my own. I need someone to rely on.
If I rely on someone I will be mistreated, found wanting, andIf I rely on someone I will be mistreated, found wanting, and
abandoned.abandoned.
The worst possible thing would be to be abandoned.The worst possible thing would be to be abandoned.
I cannot bear unpleasant feelings.I cannot bear unpleasant feelings.
It is impossible for me to control myself.It is impossible for me to control myself.
I deserve to be punished.I deserve to be punished.
MainMain
strategystrategy
Subjugate own needs to maintain connection.Subjugate own needs to maintain connection.
Protest dramatically, threaten and/or become punitive toward thoseProtest dramatically, threaten and/or become punitive toward those
that signal possible rejection.that signal possible rejection.
Relieve tension through self-mutilation and self-destructiveRelieve tension through self-mutilation and self-destructive
55. 55
How to deal with borderlines.How to deal with borderlines.
They provoke intense countertransference feelings: Anxiety ,They provoke intense countertransference feelings: Anxiety ,
Compassion, Powerlessness,Rage.Compassion, Powerlessness,Rage.
They constantly test the limits. So stop them in time, in spite ofThey constantly test the limits. So stop them in time, in spite of
their vehement emotions, reproaches, suicide threats.their vehement emotions, reproaches, suicide threats.
The basic rule is:The basic rule is: setting clear and consistent limits.setting clear and consistent limits.
Keep in mind that their life-long dilemma is: fear of utter lonelinessKeep in mind that their life-long dilemma is: fear of utter loneliness
↔ fear of engulfment and loss of identity.↔ fear of engulfment and loss of identity.
This causes the instability between intense need for contact andThis causes the instability between intense need for contact and
intense rejection when you try to be helpful.intense rejection when you try to be helpful.
Be clear about the conditions by which you can help her.Be clear about the conditions by which you can help her.
Be consistent in maintaining these conditions and setting limits.Be consistent in maintaining these conditions and setting limits.
This helps you to prevent your anger.This helps you to prevent your anger.
56. Pervasive pattern of grandiosity, need for
admiration, for being loved
Introjective / Externalizing pathology
56
57. Oblivious: need for being loved / admired
arrogant; thick skinned; phallic narc. char.
No awareness of reactions of others
Arrogant / Agressive
Self centered, need to be the center
Lack of empathy
untouchable
57
58. Hypervigilant: need to be loved / admired
Depressed; thin skinned; shy narcissist.
Highly sensitive to reactions of others
Inhibited or shy
Directs attention to others instead of himself
Shuns to be the center
Listens to others for evidence or criticism
Easily hurt
58
59. 59
PersonalityPersonality
DisorderDisorder
Narcissistic.Narcissistic.
View ofView of
selfself
Special, unique, superior.Special, unique, superior.
Deserves special rules.Deserves special rules.
Is above the rules.Is above the rules.
View ofView of
othersothers
Inferior.Inferior.
Admirers.Admirers.
MainMain
beliefsbeliefs
Since I am special ISince I am special I deservedeserve special rules.special rules.
I am above the rules.I am above the rules.
I am better than others.I am better than others.
MainMain
strategystrategy
Use others. Transcend rules, manipulate, compete.Use others. Transcend rules, manipulate, compete.
TherapeutiTherapeuti
cc
strategiesstrategies
See next slide.See next slide.
60. 60
How to deal with narcissists.How to deal with narcissists.
Keep in mind that their arrogance is needed in order notKeep in mind that their arrogance is needed in order not
to feel inferior.to feel inferior.
Therefore accept the fact that there can be only oneTherefore accept the fact that there can be only one
grandiose person in the room.grandiose person in the room.
So overcome your own narcissistic hurt and use praiseSo overcome your own narcissistic hurt and use praise
and flattery to get things done.and flattery to get things done.
But resist unreasonable demands, for then they looseBut resist unreasonable demands, for then they loose
respect.respect.
But tolerate their rage when you don’t fulfil theirBut tolerate their rage when you don’t fulfil their
demands.demands.
61. Pervasive pattern of disregard for and violation
of the rights of others
Introjective /Externalizing pathology
61
62. Failure to conform to social norms
Impulsivity or failure to plan ahead
Irratability / agression
No empathy
No responsability for their behavior
62
63. Strong genetic factor
Failing in emotional attunement → no
caring/soothing objects
Lack of remorse
Grandiose Self is an agressive introject
Lack of basic trust
63
65. 65
PersonalityPersonality
DisorderDisorder
AntisocialAntisocial
View ofView of
selfself
A lonerA loner
View ofView of
othersothers
VulnerableVulnerable
MainMain
beliefsbeliefs
““I am entitled toI am entitled to breakbreak rules.”rules.”
MainMain
strategystrategy
Attack. Rob. Steal.Attack. Rob. Steal.
TherapeutiTherapeuti
cc
strategiesstrategies
See next slide.See next slide.
66. 666666
How to deal with antisocialsHow to deal with antisocials
Don’t let yourself be flattered by his charm.Don’t let yourself be flattered by his charm.
Be aware that he always wants something from you.Be aware that he always wants something from you.
So be especially suspicious if he offers you to participateSo be especially suspicious if he offers you to participate
in some partly illegal, but very profitable offer.in some partly illegal, but very profitable offer.
As he has no conscience, teaching morals makes noAs he has no conscience, teaching morals makes no
sense.sense.
So teach him to become a better psychopath, moreSo teach him to become a better psychopath, more
clever and long-sighted, directed to his best interests.clever and long-sighted, directed to his best interests.
67. Pervasive pattern of excessive emotionality
and attention seeking
Anaclytical / Internalizing pathology
67
69. Hysterical
Adequate internal structure
Triadic relations
Mature defense
Take and give relations
Emotional reserve; sexual naiveté; conversions
and somatizations
69
70. 70
PersonalityPersonality
DisorderDisorder
Histrionic.Histrionic.
View ofView of
selfself
Glamorous. Impressive.Glamorous. Impressive.
View ofView of
othersothers
Seducible. Receptive. Admirers.Seducible. Receptive. Admirers.
MainMain
beliefsbeliefs
People are there to serve me or to admire me.People are there to serve me or to admire me.
People have no rights to deny me what I deserve.People have no rights to deny me what I deserve.
I can go by my feeling.I can go by my feeling.
MainMain
strategystrategy
Use dramatics, charm, temper tantrums, crying, suicideUse dramatics, charm, temper tantrums, crying, suicide
gestures.gestures.
TherapeutiTherapeuti
cc
strategiesstrategies
See next slide.See next slide.
71. 71
How to deal with histrionics.How to deal with histrionics.
Natural reactions to them are: Rescuer phantasies,Natural reactions to them are: Rescuer phantasies,
Sexual desire, Irritation.Sexual desire, Irritation.
So be wary of the intense emotional contact they seemSo be wary of the intense emotional contact they seem
to promise.to promise.
Resist the temptation to become the all-powerfulResist the temptation to become the all-powerful
rescuer.rescuer.
Interrupt their impressionistic, dramatic style of thinking.Interrupt their impressionistic, dramatic style of thinking.
Teach them toTeach them to think throughthink through,, in order to be able to makein order to be able to make
their own decisions, and totheir own decisions, and to decatastrophizedecatastrophize the futurethe future
and to improve their problem solving skills.and to improve their problem solving skills.
73. Pervasive pattern of preoccupation with
orderliness, perfectionism, mental and
interpersonal control. Less flexibility, openness
and efficiency.
In Control
Details, rules, procedures, organization
Rigid, stubbornness
73
74. Intimacy is dangerous
They were never good enough
Severe internal parental objects
Workaholics
Love is related to high performances
Selfdoubt
deep depression when they realize that
perfection doesn’t exist
74
75. 75
PersonalityPersonality
DisorderDisorder
Obsessive-compulsive.Obsessive-compulsive.
View ofView of
selfself
Responsible. Accountable. Fastidious. Exacting. Competent.Responsible. Accountable. Fastidious. Exacting. Competent.
View ofView of
othersothers
Irresponsible. Casual. Incompetent. Self-indulgent.Irresponsible. Casual. Incompetent. Self-indulgent.
MainMain
beliefsbeliefs
I know what is best.I know what is best.
Details are crucial.Details are crucial.
PeoplePeople shouldshould do better, try harder.do better, try harder.
MainMain
strategystrategy
Apply rules. Perfectionism. Evaluate, control.Apply rules. Perfectionism. Evaluate, control.
““shoulds”. Criticize. Punish.shoulds”. Criticize. Punish.
TherapeutiTherapeuti
cc
strategiesstrategies
See next slide.See next slide.
76. 76
How to deal with obsessive-compulsivesHow to deal with obsessive-compulsives ..
Respect his meticulousness, but state clearly whenRespect his meticulousness, but state clearly when
things are clear enough.things are clear enough.
Do behavioral experiments to let him discover that doingDo behavioral experiments to let him discover that doing
something less-than-perfect does not bring the fearedsomething less-than-perfect does not bring the feared
catastrophy.catastrophy.
77. Pervasive pattern of social inhibition, feelings
of being inadequate, hypersensitive for
negative evaluation
Introjective /Externalizing pathology
77
78. Anxious for being related because of the
anxiety to be rejected
Avoids getting involved with people unless
certain of being liked
Low self esteem, intense need for affection and
appreciation
78
79. Feelings of inferiority related to shame →
related to narcissistic p.d. → sensitive type
Shame related to Self Exposure which is
avoided
Neurotic variant of the Schizoid P.D.
Phobic Personality
Often in conjunction with Axis I diagnosis
79
80. 80
PersonalityPersonality
DisorderDisorder
AvoidantAvoidant
View ofView of
selfself
Vulnerable to depreciation, rejection.Vulnerable to depreciation, rejection.
Socially inept. Incompetent.Socially inept. Incompetent.
View ofView of
othersothers
Critical. Demeaning. Superior.Critical. Demeaning. Superior.
MainMain
beliefsbeliefs
It is terrible to be rejected or put down.It is terrible to be rejected or put down.
If people know the ‘real’ me, they will reject me.If people know the ‘real’ me, they will reject me.
I cannot tolerate unpleasant feelings.I cannot tolerate unpleasant feelings.
MainMain
strategystrategy
Avoid evaluative situationsAvoid evaluative situations
Avoid unpleasant feelings or thoughts by keeping everythingAvoid unpleasant feelings or thoughts by keeping everything
vague.vague.
TherapeutiTherapeuti
cc
strategiesstrategies
See next slide.See next slide.
81. 81
How to deal with avoidant patients.How to deal with avoidant patients.
How much you do your best to be accepting, keep inHow much you do your best to be accepting, keep in
mind that they can only see you as critical, and so theymind that they can only see you as critical, and so they
will try to be as vague as possible, in order not to bewill try to be as vague as possible, in order not to be
caught.caught.
Show them the price they pay by avoiding and help themShow them the price they pay by avoiding and help them
to confront the feared situations in small steps, and toto confront the feared situations in small steps, and to
tolerate the tension.tolerate the tension.
Confront them with the fact that others will judge themConfront them with the fact that others will judge them
anyway.anyway.
Offer social skills training.Offer social skills training.
82. Pervasive need to be taken care of that leads
to submissive and clinging behavior related to
fears of separation or being abandoned
Anaclytical /Internalizing pathology
82
83. Difficulties in making decisions without
enormous advices from others
Enormous need for appreciation and
encouragement
Difficulties in expressing feelings of
disagreement because of fear of loss of
support or approval
83
84. Enormous need for nurturance and support
By being so dependent they provoke what they
want to avoid
Passive-Agressive versions of dependent p.d.
84
85. 85
PersonalityPersonality
DisorderDisorder
DependentDependent
View ofView of
selfself
Needy. Weak. Helpless. Incompetent.Needy. Weak. Helpless. Incompetent.
View ofView of
othersothers
(Idealized:) Nurturant. Supportive. Competent.(Idealized:) Nurturant. Supportive. Competent.
MainMain
beliefsbeliefs
I need people to survive and be happy.I need people to survive and be happy.
I need to have a steady flow of support and encouragement.I need to have a steady flow of support and encouragement.
MainMain
strategystrategy
Cultivate dependent relationships.Cultivate dependent relationships.
TherapeutiTherapeuti
cc
strategiesstrategies
Resist the invitation to take the initiative and to become theResist the invitation to take the initiative and to become the
all-powerful magical helper, but make a deal:all-powerful magical helper, but make a deal:
““I can only help you if you gradually do things on your own.”I can only help you if you gradually do things on your own.”
Promote small steps toward autonomy.Promote small steps toward autonomy.
Offer assertiveness training.Offer assertiveness training.
86. 86
PersonalityPersonality
DisorderDisorder
Passive-aggressivePassive-aggressive
View ofView of
selfself
Self-sufficient.Self-sufficient.
Vulnerable to control, interference.Vulnerable to control, interference.
View ofView of
othersothers
Intrusive, demanding, interfering, controlling, dominating.Intrusive, demanding, interfering, controlling, dominating.
MainMain
beliefsbeliefs
Others interfere with my freedom of action.Others interfere with my freedom of action.
Control by others is intolerable.Control by others is intolerable.
I have to do things my own way.I have to do things my own way.
MainMain
strategystrategy
Passive resistance.Passive resistance.
Surface submissiveness.Surface submissiveness.
Evade, circumvent rules.Evade, circumvent rules.
TherapeutiTherapeuti
cc
strategiesstrategies
Avoid power struggles and being pushed into theAvoid power struggles and being pushed into the
authoritarian role. Focus explicitely on collaboration.authoritarian role. Focus explicitely on collaboration.
88. Introjective ( melancholic)
Guilt, self criticism, perfection
Depressive personality disorder those people
suffer fromchronic dysphoric affect and have a
disposition for feeling guilty and/or ashamed
Looking inside to find explanations
“Mood disorders”
88
89. Anaclitical
shame; high reactivity to loss and rejection;
vague feelings of inadequacy and emptiness;
weak capacity to be alone
Looking in the outside for explanation
Dependent; narcissistic or borderline
personality disorder.
89
90. Depressive P.D. : a pervasive and repetitive
pattern that intensifies under stress → more
chronic state
Major depression : the vegetative symptoms
are on the foreground (decreased
appetite,decreased sexual desire; sleep
disturbances; psychomotor retardation etc)
90
91. Introjective
Concerned with self definition, autonomy, self
worth,self critical thoughts
Anaclitic
Concerned with relatedness, trust, preservation
of attachments
91
92. 92
Somatization P.D.Somatization P.D.
Anxiety neurosisAnxiety neurosis (Actual Neurosis(Actual Neurosis))
Somatic (hartbeating; sweating; trembling;Somatic (hartbeating; sweating; trembling;
nausea; problems with respiration etc.)nausea; problems with respiration etc.)
Not related to mental representationsNot related to mental representations
Related to mental process disordersRelated to mental process disorders
DSM IV; somatization,somatoform disordersDSM IV; somatization,somatoform disorders
panic disorders and PTSD.panic disorders and PTSD.
93. 93
Somatization P.D.Somatization P.D.
Mental Process disordersMental Process disorders
No psychological Self but the body is the selfNo psychological Self but the body is the self
No Somatization as a defense but SomaNo Somatization as a defense but Soma
Alexithymia: medically unexplained physicalAlexithymia: medically unexplained physical
symptoms/ conversionssymptoms/ conversions
They live in a frightened world instead of a worldThey live in a frightened world instead of a world
they are experiencing as frighteningthey are experiencing as frightening
94. 94
Somatization P.D.Somatization P.D.
1.1. Anxiety neurosis instead of psycho-Anxiety neurosis instead of psycho-
neurosisneurosis
2.2. Panic / momentaneous anxietyPanic / momentaneous anxiety
3.3. External Regulated / MotivatedExternal Regulated / Motivated
4.4. The area of the personality disordersThe area of the personality disorders
Axis 2 cluster A and BAxis 2 cluster A and B
5.5. Somatization, Somatoform disorder,Somatization, Somatoform disorder,
Panic disorder and PTSD.Panic disorder and PTSD.
95. Dissociative Identity Disorder
Dissociation as reaction to trauma
Vertical split
Dissociative amnesia → problems in
remembering specific episodes related to the
trauma
Dissociative fugue → problems in remembering
the own history, past or identity confusion.
95
96. Appearance of alters
Distinct identities or personality states each
with his own relatively enduring pattern of
percieving,relating to and thinking about the
environment and the self.
They recurrently take control of the persons
behavior
96
Dissociative P.D.Dissociative P.D.
97. Ever met a normal person ?
And did you like it ?
mdw@wxs.nl
97