Modern Psychodynamics: A New Paradigm

Educational Objectives

The goal of this program is to expand the clinician’s understanding of psychodynamics. After hearing and assimilating this program, the clinician will be better able to:

1. Compare and contrast psychodynamic paradigms with views held by traditional science.

2. Describe potential changes to classical psychoanalytic techniques and patient-therapist relationships spurred by new and ongoing discoveries in the field of psychodynamics.

Summary

Background: in psychodynamic perspective, psychologic developments occur in context (ie, interactional)

Traditional science: flourished in totalitarian as well as postwar eras because of its potential for generating technologic advancement important to economic powers and warlike states; this collaboration between knowledge and power has generated many dynamic conflicts (between, eg, developers of nuclearism and others who sought to use nuclear weapons against humans)

Modern psychodynamic science: seeks better understanding of mind-brain relationship; evolution-based integrating paradigm is intended to complement dualistic metapsychologic assumptions by which Freud split mind and brain; “modern psychodynamics” opens bio-psycho-social model outward to include history and evolution, and inward to include developmental studies, neuroscience, and psychodynamic sciences (preserving work of classical psychoanalysis); proposes nondualistic mind-brain symbiosis (in place of dualistic mind-body split); entirely materialistic while privileging mind and spirit; requires that all accurate self-statements employ dimension of time (because mind and brain exist as emerging processes rather than as static entities)

“Hard problem” of consciousness: progress in solving this problem may require paradigm shift to conceptualize integrated and partially extracranial mental process; speaker speculates traditional science may find itself revolutionized by new vision of psychodynamics recognizing evolutionary powers of mind and cognition (in contrast to frequent present-day subjects of materialism and “brute force”)

Redefining individuality: Renaissance-era concept of isolated individual giving way to representations of culture-dependent interconnected individuals, bound to their family, tribe, and world by complex network of meaning and cultural heredity; these changes would require psychodynamic psychotherapists to renounce position of “isolated maven” to participate in broad scope and social world of traditional science; extending concept of individual mind into group, social, and historical perspectives may also be appropriate

Reconciliation of traditional and psychodynamic scholarship: viewed as inevitable by speaker, because of shared focus on theory of knowledge (from different perspectives); could reshuffle mainstream thinking concerning mind-brain relationship and ideas of human relatedness (based on neural networks, interpersonal resonance, and mindfulness)

Changes to classical techniques and therapeutic relationships: traditional daily psychotherapy using free association could be supplanted by multimodal learning and relational opportunities transmitted face-to-face 1 to 2 times weekly; conversational sessions would rely on goal-focused inquiry about change and symptom improvement; transference would be handled through management rather than neutralization; illuminating power of dreams augmented by their use in constructing new and profoundly personal life plans; increased abstinence from rule of abstinence; increased focus on veracity rather than anonymity; evolution from neutrality to commitment; quasi-mystical therapeutic relationships replaced by simpler relationships

Summary: introduction of modern paradigm of independence and downward causation allows psychotherapists to understand how they may transform their field while contributing to advancement and survival of our culture

Readings

Barutta J et al: Neurodynamics of mind: the arrow illusion of conscious intentionality as downward causation. Integr Psychol Behav Sci 44:127, 2010; Chessick RD: Implications of the current insolubility of the mind-brain problem for the contemporary practice of psychodynamic psychiatry. J Am Acad Psychoanal Dyn Psychiatry 37:315, 2009; Feusner JD et al: Olfactory reference syndrome: issues for DSM-5. Depress Anxiety 27:592, 2010; Gajic T et al: Psychodynamic psychotherapy in psychiatry: the missing link? Psychiatr Danub 24:S361, 2012; Kelly MM et al: A comparison study of body dysmorphic disorder versus social phobia. Psychiatry Res 205:109, 2013; Mataix-Cols D et al: Testing the validity and acceptability of the diagnostic criteria for Hoarding Disorder: a DSM-5 survey. Psychol Med 41:2475, 2011; Phillips KA et al: Body dysmorphic disorder: some key issues for DSM-5. Depress Anxiety 27:573, 2010; Phillips KA et al: A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder. J Psychiatr Res 46:1293, 2012; Phillips KA et al: Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-5? Depress Anxiety 27:528, 2010; Phllips KA et al: Delusional versus nondelusional body dysmorphic disorder: recommendations for DSM-5. CNS Spectr 19:10, 2014; Pope CG et al: Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image 2:395, 2005; Stein DJ et al: Meta-structure issues for the DSM-5: how do anxiety disorders, obsessive-compulsive and related disorders, post-traumatic disorders, and dissociative disorders fit together? Curr Psychiatr Rep 13:248, 2011.

Disclosures

In adherence to ACCME Standards for Commercial Support, Audio-Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, Dr. Whitehead and the planning committee reported nothing to disclose.

Acknowledgements

Dr. Whitehead spoke at the 57th Annual Meeting of the American Academy of Psychoanalysis and Dynamic Psychiatry, held May 16-18, 2013, in San Francisco, CA, and sponsored by the American Academy of Psychoanalysis and Dynamic Psychiatry.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PS430801

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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