Supervisors info:
Ιεροδιακόνου Ιωάννα, Αναπληρώτρια Καθηγήτρια,Τμήμα Ιατρικής, ΑΠΘ, Επιβλέπουσα
Τζινιέρη-Κοκκώση Μαρία, π.μ. Επίκουρος Καθηγήτρια, Τμήμα Ιατρικής, ΕΚΠΑ
Δικαίος Δημήτριος, Καθηγητής, Τμήμα Ιατρικής, ΕΚΠΑ
Summary:
Introduction: Schizophrenia is a universal and chronic disorder that affects the overall functioning of the individual. The treatment involves a combination of medication and psychotherapy.
Purpose: The purpose of the current study is to describe in detail how the theoretical base of the psychodynamic approach can be applied to the psychotic patient within the clinical setting.
Study material and method: The current study is based on the bibliographic reviews of papers published in well-known international journals. The research was conducted via the "PEP WEB" and "PudMed" search engines and books in Greek and English.
Results: The psychotic patient is characterized by personality disorganization and the use of primitive defense mechanisms (denial, projection, projective identification, splitting) in order to alleviate the intense anxiety symptoms. The patient undergoes 3 phases; namely, the acute, the stabilization and the chronic phase. The main therapeutic goals of applied treatment are the following: to improve the symptoms of the patient, to strengthen his/her skills and adaptive capacity, to reduce the risk of relapses and rehospitalization, to support his/her family and to offer psychosocial rehabilitation. To achieve this, a therapeutic relationship is required which is established from the first contact with the therapists and the clinical setting. Through the therapeutic alliance created, the therapeutic group is called upon to contain, process and transform the painful emotions of the psychotic patient and to cope with any transference and countertransference phenomena. The clinical setting can act as restraint mechanism for the patient and the therapists. For this to happen, it must be consistent with both parties involved, it must be patient care-oriented and it must personalize the treatment according to the needs and abilities of the psychotic patient. During the Psychiatric Reform era in Greece, efforts have been made to apply the psychodynamic psychotherapy approach within the clinical setting. Personal analysis, education, external supervision and the concept of group treatment appear to be conducive to the treatment. However, no specialised psychoanalytic knowledge is essential, as long as the therapist develops a psychic contact with the patient as well as the other therapists involved under the supervision of the group leader and the supervisor. It should be highlighted that the keystone of each therapeutic intervention is to benefit the patient according to the latter's needs and capabilities. The psychodynamic way of thinking ought to offer an emotional space that will appease his/her fears, improve the symptoms and decrease the likelihood of any future relapses.
Conclusions: By applying the psychodynamic model within the clinical setting, the psychotic patient is no longer considered as an individual with incomprehensible thoughts and lack of emotion. In addition, the psychodynamic approach becomes more accessible to patients and therapists alike.
Keywords:
Psychosis, Therapeutic group, Clinical setting, Psychodynamic psychotherapy
