Personalized treatment - which interaction ingredients should be focused to capture the unconscious

Abstract

A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at s upporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae

“…Effective containment and working through uncertainties would be necessary within the doctor-patient relationship in order to (re-) establish a good long-lasting quality of life and a sustainable treatment regimen. The containment of anxieties needs a secure framework and precise patient-centered work on the individual level [ 65 , 66 ].…”

Artificial Intelligence, eHealth – die Bedeutung für Patient*innen

“…Da bekanntermaßen die subjektive Bewertung der Krankheit und die subjektive Krankheitstheorie ausschlaggebend für die Behandlung sind, sind diese Faktoren mittlerweile operationalisiert [14]. Wie sich die unbewussten Faktoren genauer fassen lassen, ist konzeptualisiert [20]. Doch wie können diese abgebildet und durch mathematische Simulation dargestellt der Komplexität des Menschen gerecht werden?…”