BackgroundMajor depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology.Methods/designThis study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1:1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16–20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16–20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs.DiscussionThis trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients.Trial registrationIsrctn.com, ISRCTN17130982. Registered on 2 February 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1867-x) contains supplementary material, which is available to authorized users.

<b><i>Introduction:</i></b> Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. <b><i>Objective:</i></b> This study is the first experimental test of the interaction between therapeutic approach and patients’ dependent versus self-critical personality styles. <b><i>Methods:</i></b> A pragmatic stratified parallel trial was carried out with 100 adult patients diagnosed with DSM-IV-TR major depressive disorder. They were randomly assigned to short-term (16–20 sessions) cognitive behavioral therapy (CBT) or short-term psychodynamic psychotherapy (STPP). Patients were assessed at baseline, during therapy, post-therapy, and at 3- and 6-month follow-up. Primary outcome is depression severity measured by the Hamilton Rating Scale for Depression posttreatment. Primary analysis was by intention to treat. This trial is registered with the ISRCTN registry (<ext-link ext-link-type="uri" xlink:href="http://www.isrctn.com" xmlns:xlink="http://www.w3.org/1999/xlink">www.isrctn.com</ext-link>), number ISRCTN17130982. <b><i>Results:</i></b> The intention-to-treat sample consisted of 100 participants; 40 with self-critical and 60 with dependent personality styles were randomized to either CBT (<i>n</i> = 50) or STPP (<i>n</i> = 50). We observed no interaction effect (−0.34 [−6.14, 5.46]) between therapy and personality style and found no evidence for a difference in effectiveness between the treatments in general in terms of symptom reduction and maintained benefits at 6-month follow-up. <b><i>Conclusion:</i></b> We found no evidence that dependent versus self-critical personality styles moderate the relation between treatment and outcome in depression. Research using individual patient data could gain further insight into why specific therapeutic approaches work better for specific patients.

This study aims at mapping and interpreting what is at stake in Lacanian psychoanalytic supervision. Using interview data of participants' personal accounts of supervision, the authors applied a thematic analysis to gain insight into what they believe are crucial components in these accounts of supervision. We interpret the data within the context of Lacan's text, 'Direction of the Treatment and the Principles of its Power', in which he articulates his conceptualization of psychoanalytic treatment. His views on interpretation (tactics), transference (strategy), and lack-of-being (politics) as the three elements that structure the actions of the analyst, guided our data-analysis. Participants indicate how their supervisor focuses on the symbolic dimension of speech, helping them avoid getting deceived by the dimension of the imaginary. During the supervision process, the supervisor does not respond from a master position, nor coach the supervisees. Supervisees develop their own style and framework for clinical work. Through discussing cases, supervisees learn to construct cases and focus on the singularity of the case, beyond structural diagnosis. Lastly, Lacanian supervisors only focus on the cases discussed, not on the person of the supervisee.

Henri Maldiney and the melancholic complaint: the performance of a cryHenri Maldiney offers an evocative analysis of melancholia. He characterizes the melancholic complaint as the only form of action left to the melancholic patient. It is a last stand against a nothingness that threatens to overwhelm. His philosophy directly engages with the psychotic experience, as presented in clinical cases put forth by Binswanger, Kuhn and others. His approach to melancholia does not reduce this experience to one we can easily empathize with. By tracing his steps and elaborating on his work, I aim to clarify why the complaint is so crucial for the melancholic and why listening to the melancholic's complaint can be so challenging. The complaint appears as the melancholic's stilted answer to a devastating event. The deadly repetition and pulsing chant of the complaint might not bring deliverance, but it can offer protection against destruction. Maldiney directs our attention to the act of complaining and how it is ultimately the performance of a cry. With this cry the melancholic patient tries to regain a place in the world from where he can exist.

Mental health care in Belgium (1850-1900): compulsory admission and coercion After the declaration of the Lunacy law of June 18th, 1850, the Belgian government became increasingly involved in the organization of psychiatric care. Doctors were given a huge responsibility by making compulsory admission a medical procedure. The position of the so-called aliéné was ultimately the result of negotiations between the madman himself, his family, doctors and the government. To understand how coercion was inscribed in a reformatory movement that claimed a more humane and scientific approach to insanity I researched the various influences that were at play. Sources from the établissement des aliénés de Frères Alexiens de Louvain were used to study the position of the aliéné in the second half of the nineteenth century. The compulsory admission forms and the data on the use of coercive tactics shed light on the hopeful reformation and its decline caused by low cure rates and a growing overpopulation of asylums. The relation between the government and the alienists was characterized by a complex balance between freedom and control. Families and doctors also had a relationship that was complicated because of mutual distrust. The position of the aliéné grows more complicated when we look at these influences. Most of the time, the mental patient was doomed to undergo the decisions made for him by his family, his doctor or the government. However, as specialized treatment, scientific study and government policy grew, the mental patient also became someone who would no longer be ignored.