The Nature of the Beast: Commentary on “Can There Be a Recovery-Oriented Diagnostic Practice?”

Abstract

Pavlo, Flanagam, Leither, and Davidson attempt to reconcile the recovery movement in mental health service with a formal diagnostic practice is as courageous as it is timely. Acknowledging this, I note several points of convergence and divergence with the authors’ views. Points of convergence include (1) the inevitability of a diagnostic system when working with (severe) mental illness, (2) the importance of going beyond signs and symptoms in capturing the unique characteristics of the person, (3) the focus on humanistic values, particularly the emphasis on a collaborative assessment and on human strengths, in the diagnostic process, and (4) the role of future-oriented thinking in diagnosis. Divergence with the authors concerns (1) my own reliance on descriptive psychiatry, with its focus on signs and symptoms, as a part and parcel of an effective diagnosis, (2) the potential benefits of psychological tests, for example, self-report questionnaires and projective procedures over and above the clinical interview, and (3) my emphasis on mental representations of self-with-others, termed here and elsewhere as “agents in relations,” as the building blocks of personality and psychopathology.

Using termination as an intervention (UTAI): A view from an integrative, cognitive-existential psychodynamics perspective.

“…We deem CEP most suitable for patients with whom the viability of psychotherapy is not self-evident (e.g., treatment-resistant patients, such as Roy), and/or is likely to fail (treatment-resisting patients, such as Erika). Construed as a broad stance, rather than as s clearly delineated manual, CEP consists of guidelines for complex case formulation and treatment planning (Shahar, 2015, 2019; Shahar & Davidson, 2009), orchestrating interventions (Shahar & Govrin, 2017; Shahar & Schiller, 2016), and the judicious use of therapeutic self-disclosure (Ziv-Beiman & Shahar, 2016). The purpose of this article is to introduce another important component of CEP, namely, UTAI.…”

Psychotherapy for personal growth? A multicultural and multitheoretical exploration

“…Its goals often emphasize insight into interpersonal patterns rather than behavioral change per se (Marble, Høglend, & Ulberg, 2018). Thus, successful psychoanalysis is expected to lead to personal growth, and outcomes with respect to “symptom recovery” are not necessarily assessed (Shahar, 2019). The concept of personal growth, however, is not unique to the psychoanalytic practice.…”