Psychodynamic Psychiatry in the General Medical Setting

Abstract

For more than half a century analytically trained psychiatrists have been making observations about psychodynamic factors impacting on medical illness and treatment. Some of these reports have been subsequently supported by evidence-based research while others have been found to be clinically useful to varying degrees even if not substantiated by research. In this article we have presented some of the highlights of the application of psychodynamics to the treatment of physical illness in the general medical setting. It is not meant to be a comprehensive review but we hope it will demonstrate how psychodynamic thinking has permeated many aspects of care in the general medical setting. Topics considered include onset of disease (giving up complex, specificity, role of stress, anniversary reactions), reactions to illness (psychological defenses, fantasies, role of psychotherapy), specific conditions (pregnancy, cancer, human immunodeficiency virus, conversion and alexithymia, heart disease, death and dying), and the doctor-patient relationship.

To stress or not to stress: Brain-behavior-immune interaction may weaken or promote the immune response to SARS-CoV-2

“…The present discussion of if, when, where and how to wear masks and what the necessary distance is to prevent virus spread gives a vivid example of the psychosocial stress generated by psychodynamic processes in the context of the COVID-19 pandemic. To address psychodynamic aspects of the pandemic and viral disease can therefore be instructive and stress-reducing ( Kent and Blumenfield, 2011 ; Marcinko et al, 2020 ; Rogers, 1989 ). If psychodynamic therapy has the capacity to improve neuroendocrine-immune virus control, however, is open to debate.…”

The application of psychodynamic psychotherapy within a preexisting primary care assessment and treatment approach.

“…Conspicuously absent from much of the mainstream primary care literature are psychoanalytic treatments. Although several psychodynamic clinicians have tested the waters in this domain (see Balint & Shelton, 2002;Covino, 2008;Kent & Blumenfield, 2011;Lichtman, 2010;Mollen, 2001;Moore, 2011;Stern, 1999;Wain & Gabriel, 2007 for work exploring the psychodynamic conceptualizations and treatments of medical conditions), a robust linkage has yet to be achieved. This may not seem shocking, even to (or especially with) psychoanalysts given the leaning toward longer term treatment coupled with the emphasis on the clearly explicated therapeutic parameters of psychodynamic psychotherapy and psychoanalysis proper.…”