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Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment
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A New Case Study Pedagogy for Teaching Psychoanalytic Theory
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- Noreen Giffney 4
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This chapter introduces the Cultural Encounters Case Study Method, a new theoretical-experiential pedagogy for teaching clinical concepts from psychoanalysis by means of a reflexive matrix. This Method focuses on facilitating the development of the capacity for self-awareness and self-reflectivity, as well as the integration of observation, analytical and interpretative skills required for clinical practice as a psychoanalyst or psychotherapist. This chapter situates the evolution of the Method within the context of the importance of the “how” of teaching psychoanalytic theory, alongside the centrality of the case study in psychoanalysis as a clinical, pedagogical, and research tool. The Method can be used for teaching trainee psychoanalysts and psychotherapists, as well as professionals from other practice-based disciplines working with people experiencing distress, in which self-reflectivity is a core competency and ethical requirement.
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Giffney, N. (2024). A New Case Study Pedagogy for Teaching Psychoanalytic Theory. In: Frosh, S., Vyrgioti, M., Walsh, J. (eds) The Palgrave Handbook of Psychosocial Studies. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-30366-1_31
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Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment
2017, Frontiers in psychology
This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) ...
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Beyond Clinical Case Studies in Psychoanalysis: A Review of Psychoanalytic Empirical Single Case Studies Published in ISI-Ranked Journals
Affiliations.
- 1 Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.
- 2 Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium.
- PMID: 29046660
- PMCID: PMC5632659
- DOI: 10.3389/fpsyg.2017.01749
Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation.
Keywords: empirical single case studies; psychoanalysis; psychodynamic psychotherapy; review; single case archive.
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Study Suggests Genetics as a Cause, Not Just a Risk, for Some Alzheimer’s
People with two copies of the gene variant APOE4 are almost certain to get Alzheimer’s, say researchers, who proposed a framework under which such patients could be diagnosed years before symptoms.
By Pam Belluck
Scientists are proposing a new way of understanding the genetics of Alzheimer’s that would mean that up to a fifth of patients would be considered to have a genetically caused form of the disease.
Currently, the vast majority of Alzheimer’s cases do not have a clearly identified cause. The new designation, proposed in a study published Monday, could broaden the scope of efforts to develop treatments, including gene therapy, and affect the design of clinical trials.
It could also mean that hundreds of thousands of people in the United States alone could, if they chose, receive a diagnosis of Alzheimer’s before developing any symptoms of cognitive decline, although there currently are no treatments for people at that stage.
The new classification would make this type of Alzheimer’s one of the most common genetic disorders in the world, medical experts said.
“This reconceptualization that we’re proposing affects not a small minority of people,” said Dr. Juan Fortea, an author of the study and the director of the Sant Pau Memory Unit in Barcelona, Spain. “Sometimes we say that we don’t know the cause of Alzheimer’s disease,” but, he said, this would mean that about 15 to 20 percent of cases “can be tracked back to a cause, and the cause is in the genes.”
The idea involves a gene variant called APOE4. Scientists have long known that inheriting one copy of the variant increases the risk of developing Alzheimer’s, and that people with two copies, inherited from each parent, have vastly increased risk.
The new study , published in the journal Nature Medicine, analyzed data from over 500 people with two copies of APOE4, a significantly larger pool than in previous studies. The researchers found that almost all of those patients developed the biological pathology of Alzheimer’s, and the authors say that two copies of APOE4 should now be considered a cause of Alzheimer’s — not simply a risk factor.
The patients also developed Alzheimer’s pathology relatively young, the study found. By age 55, over 95 percent had biological markers associated with the disease. By 65, almost all had abnormal levels of a protein called amyloid that forms plaques in the brain, a hallmark of Alzheimer’s. And many started developing symptoms of cognitive decline at age 65, younger than most people without the APOE4 variant.
“The critical thing is that these individuals are often symptomatic 10 years earlier than other forms of Alzheimer’s disease,” said Dr. Reisa Sperling, a neurologist at Mass General Brigham in Boston and an author of the study.
She added, “By the time they are picked up and clinically diagnosed, because they’re often younger, they have more pathology.”
People with two copies, known as APOE4 homozygotes, make up 2 to 3 percent of the general population, but are an estimated 15 to 20 percent of people with Alzheimer’s dementia, experts said. People with one copy make up about 15 to 25 percent of the general population, and about 50 percent of Alzheimer’s dementia patients.
The most common variant is called APOE3, which seems to have a neutral effect on Alzheimer’s risk. About 75 percent of the general population has one copy of APOE3, and more than half of the general population has two copies.
Alzheimer’s experts not involved in the study said classifying the two-copy condition as genetically determined Alzheimer’s could have significant implications, including encouraging drug development beyond the field’s recent major focus on treatments that target and reduce amyloid.
Dr. Samuel Gandy, an Alzheimer’s researcher at Mount Sinai in New York, who was not involved in the study, said that patients with two copies of APOE4 faced much higher safety risks from anti-amyloid drugs.
When the Food and Drug Administration approved the anti-amyloid drug Leqembi last year, it required a black-box warning on the label saying that the medication can cause “serious and life-threatening events” such as swelling and bleeding in the brain, especially for people with two copies of APOE4. Some treatment centers decided not to offer Leqembi, an intravenous infusion, to such patients.
Dr. Gandy and other experts said that classifying these patients as having a distinct genetic form of Alzheimer’s would galvanize interest in developing drugs that are safe and effective for them and add urgency to current efforts to prevent cognitive decline in people who do not yet have symptoms.
“Rather than say we have nothing for you, let’s look for a trial,” Dr. Gandy said, adding that such patients should be included in trials at younger ages, given how early their pathology starts.
Besides trying to develop drugs, some researchers are exploring gene editing to transform APOE4 into a variant called APOE2, which appears to protect against Alzheimer’s. Another gene-therapy approach being studied involves injecting APOE2 into patients’ brains.
The new study had some limitations, including a lack of diversity that might make the findings less generalizable. Most patients in the study had European ancestry. While two copies of APOE4 also greatly increase Alzheimer’s risk in other ethnicities, the risk levels differ, said Dr. Michael Greicius, a neurologist at Stanford University School of Medicine who was not involved in the research.
“One important argument against their interpretation is that the risk of Alzheimer’s disease in APOE4 homozygotes varies substantially across different genetic ancestries,” said Dr. Greicius, who cowrote a study that found that white people with two copies of APOE4 had 13 times the risk of white people with two copies of APOE3, while Black people with two copies of APOE4 had 6.5 times the risk of Black people with two copies of APOE3.
“This has critical implications when counseling patients about their ancestry-informed genetic risk for Alzheimer’s disease,” he said, “and it also speaks to some yet-to-be-discovered genetics and biology that presumably drive this massive difference in risk.”
Under the current genetic understanding of Alzheimer’s, less than 2 percent of cases are considered genetically caused. Some of those patients inherited a mutation in one of three genes and can develop symptoms as early as their 30s or 40s. Others are people with Down syndrome, who have three copies of a chromosome containing a protein that often leads to what is called Down syndrome-associated Alzheimer’s disease .
Dr. Sperling said the genetic alterations in those cases are believed to fuel buildup of amyloid, while APOE4 is believed to interfere with clearing amyloid buildup.
Under the researchers’ proposal, having one copy of APOE4 would continue to be considered a risk factor, not enough to cause Alzheimer’s, Dr. Fortea said. It is unusual for diseases to follow that genetic pattern, called “semidominance,” with two copies of a variant causing the disease, but one copy only increasing risk, experts said.
The new recommendation will prompt questions about whether people should get tested to determine if they have the APOE4 variant.
Dr. Greicius said that until there were treatments for people with two copies of APOE4 or trials of therapies to prevent them from developing dementia, “My recommendation is if you don’t have symptoms, you should definitely not figure out your APOE status.”
He added, “It will only cause grief at this point.”
Finding ways to help these patients cannot come soon enough, Dr. Sperling said, adding, “These individuals are desperate, they’ve seen it in both of their parents often and really need therapies.”
Pam Belluck is a health and science reporter, covering a range of subjects, including reproductive health, long Covid, brain science, neurological disorders, mental health and genetics. More about Pam Belluck
The Fight Against Alzheimer’s Disease
Alzheimer’s is the most common form of dementia, but much remains unknown about this daunting disease..
How is Alzheimer’s diagnosed? What causes Alzheimer’s? We answered some common questions .
A study suggests that genetics can be a cause of Alzheimer’s , not just a risk, raising the prospect of diagnosis years before symptoms appear.
Determining whether someone has Alzheimer’s usually requires an extended diagnostic process . But new criteria could lead to a diagnosis on the basis of a simple blood test .
The F.D.A. has given full approval to the Alzheimer’s drug Leqembi. Here is what to know about i t.
Alzheimer’s can make communicating difficult. We asked experts for tips on how to talk to someone with the disease .
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Centre for Psychoanalytic Studies, University of Essex, Colchester, UK. This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field.
Abstract. This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and ...
This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this ...
Abstract. This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of ...
Abstract. This case study describes 1 year of the psychoanalytic psychotherapy using clinical data, a standardized instrument of the psychotherapeutic process (Psychotherapy process Q-Set, PQS), and functional neuroimaging (fMRI). A female dysthymic patient with narcissistic traits was assessed at monthly intervals (12 sessions).
This study represents a contribution toward the systematic and empirical investigation of psychoanalytic treatments. The method used, the Q-technique, allows the transformation of clinical data into a form amenable to quantitative analysis, thereby providing an empirical means to test theoretically and clinically derived understandings of psychoanalytic process.
While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the ...
This case study describes 1 year of the psychoanalytic psychotherapy using clinical data, a standardized instrument of the psychotherapeutic process (Psychotherapy process Q-Set, PQS), and functional neuroimaging (fMRI). A female dysthymic patient with narcissistic traits was assessed at monthly intervals (12 sessions). In the fMRI scans, which took place immediately after therapy hours, the ...
How the case study method is being applied in different schools of psychoanalysis is summarized, and the unique strengths of this method and areas for improvement are clarified. This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to ...
Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies ...
Since the earliest days of psychoanalytic scholarship, observations gained from self-analysis or from the author's own psychoanalytic treatment have often been disguised as data obtained from clinical practice with patients. Some significant portion of our intellectual history originates in the analysis or self-analysis of analysts themselves ...
Learn from real-world examples of psychoanalytic and psychodynamic treatment, with insights from leading experts in the field.
The purpose of writing a clinical case study is to illustrate the vital importance of a psychoanalytically-informed approach in the treatment of a very ill patient in the public sector. At a time when there is a decrease in the provision of long-term psychoanalytic psychotherapy my aim is to illustrate its value in the understanding and ...
Psychoanalytic or psychodynamic psychotherapy is an umbrella term that describes the psychotherapeutic clinical application of a larger group of theories and principles stemming from psychoanalysis. Psychoanalysis began as the work of Sigmund Freud and quickly expanded through the work of his contemporaries, including Sandor Ferenczi, Carl Jung, Otto Rank, and Alfred Adler.
Abstract and Figures. This case study describes 1 year of the psychoanalytic psychotherapy using clinical data, a standardized instrument of the psychotherapeutic process (Psychotherapy process Q ...
In the 1974 volume, five of the seven papers are case studies, describing either the whole of a treatment or the first year of a therapy. In contrast, the 2004 volume has only one clinical case study. Of the other five articles, one is purely historical, and the other four all use clinical examples or vignettes to discuss a particular theme.
The case study is the pedagogical tool par excellence in clinical psychoanalysis as an exemplar of the psychoanalytic approach to treatment (Rustin, 2019, pp. 95-110), and indeed Lauren Berlant remarks that "the case is always pedagogical" (p. 665).
Description. Clinical Psychoanalytic Case Studies with Complex Patients is a collection of key case studies that provides a rich resource of information and inspiration for clinicians working psychoanalytically with complex and disturbed patients in a range of contexts. The book is presented in six parts, each introduced with commentary that ...
Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment. Sue Kegerreis. 2017, Frontiers in psychology. This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical ...
Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjec …
1 Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; 2 Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium; Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice ...
Centre for Psychoanalytic Studies, University of Essex, Colchester, UK. This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field.
Clinical Case Studies (CCS), peer-reviewed & published bi-monthly electronic only, is the only journal devoted entirely to innovative psychotherapy case studies & presents cases involving individual, couples, & family therapy.The easy-to-follow case presentation format allows you to learn how interesting & challenging cases were assessed & conceptualized, & how treatment followed such ...
Artificial intelligence has potential to enhance healthcare outcomes through applications such as early diagnosis and enhanced treatment planning but can only deliver such potential if it is integrated into clinical practice. Using eyecare as a case study, my research explores optometrists' requirements for an AI clinical decision support ...
Later, in 1895, Freud and Breuer published a book discussing Anna's case and other similar clinical cases called "Studies in Hysteria." ... "The original case material of psychoanalysis", American journal of psychiatry, cviii (1952), 829-34. Suzanne Reichard confirmed Goshen's rediagnoses in "A re-examination of 'Studies in hysteria'".
May 6, 2024 Updated 12:19 p.m. ET. Scientists are proposing a new way of understanding the genetics of Alzheimer's that would mean that up to a fifth of patients would be considered to have a ...
The authors call them the "operators" of psychoanalytic clinical reasoning. According to the operators model, the process of psychoanalytic clinical reasoning consists in the chaining together of operations using functions from different families. A specific collection of "clinical reasoning styles" seems to be interwoven in this process.
Reconstruction of craniomaxillofacial bone defects using 3D-printed hydroxyapatite (HA) bioceramic patient-specific implants (PSIs) is a new technique with great potential. This study aimed to investigate the advantages, disadvantages, and clinical outcomes of these implants in craniomaxillofacial surgeries. The PubMed and Embase databases were searched for patients with craniomaxillofacial ...