An outcome of psychodynamic psychotherapy: A case study of the change in serotonin transporter binding and the activation of the dream screen

Adult Psychiatry Division, Department of Psychiatry, Kuopio University Hospital, Finland.
American journal of psychotherapy 02/2005; 59(1):61-73.
Source: PubMed

ABSTRACT We explored the outcome of psychodynamic psychotherapy of a female patient with major depression using clinical evaluation and serotonin transporter (SERT) binding assessed with [123I]nor-beta-CIT SPECT. The psychotherapy process was analyzed with special emphasis on the change that was recognized in the dreaming process. The activation of the dream screen in transference seemed to form a turning point during the psychotherapy. Normalization of SERT binding at the midbrain level was found on 12-month follow-up. Major alleviation of depressive symptoms assessed by rating scales was evident only six months after SERT normalization.

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    • "While these originally psychodynamic concepts are currently investigated in the neuroscientific context, the neural basis of core elements of psychoanalysis and psychodynamic psychotherapy has not been elucidated yet. Though neurobiological changes in some single cases undergoing psychodynamic psychotherapy have been reported (Viinamäki et al., 1998; Overbeck et al., 2004; Saarinen et al., 2005; Lai et al., 2007; Lehto et al., 2008; Kessler et al., 2011a, 2012), systematic and well-controlled brain imaging studies of the neural effects of psychodynamic psychotherapy are still lacking. "
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    ABSTRACT: The paper focuses on the essentials of psychoanalytic process and change and the question of how the neural correlates and mechanisms of psychodynamic psychotherapy can be investigated. The psychoanalytic approach aims at enabling the patient to "remember, repeat, and work through" concerning explicit memory. Moreover, the relationship between analyst and patient establishes a new affective configuration which enables a reconstruction of the implicit memory. If psychic change can be achieved it corresponds to neuronal transformation. Individualized neuro-imaging requires controlling and measuring of variables that must be defined. Two main methodological problems can be distinguished: the design problem addresses the issue of how to account for functionally related variables in an experimentally independent way. The translation problem raises the question of how to bridge the gaps between different levels of the concepts presupposed in individualized neuro-imaging (e.g., the personal level of the therapist and the client, the neural level of the brain). An overview of individualized paradigms, which have been used until now is given, including Operationalized Psychodynamic Diagnosis (OPD-2) and the Maladaptive Interpersonal Patterns Q-Start (MIPQS). The development of a new paradigm that will be used in fMRI experiments, the "Interpersonal Relationship Picture Set" (IRPS), is described. Further perspectives and limitations of this new approach concerning the design and the translation problem are discussed.
    Frontiers in Human Neuroscience 08/2013; 7:355. DOI:10.3389/fnhum.2013.00355 · 2.90 Impact Factor
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    • "The team members were not involved in the development of the questionnaires. The psychotherapy consisted of approximately 80 sessions per year, held twice a week, in the outpatient clinic of the Department of Psychiatry of Kuopio University Hospital (Saarinen et al., 2005; Tolmunen et al., 2004). The patients' motivation and aptitude for long-term psychodynamic psychotherapy without medication was assessed by an evaluation group consisting of a psychiatrist and a psychologist and/or a specially trained nurse. "
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    • "Furthermore, three case studies (Saarinen et al., 2005; Tolmunen et al., 2004; Viinamaki, Kuikka, Tiihonen, & Lehtonen, 1998) and a case series (Lehto et al., 2008) reported an increase in serotonin transporter densities in response to 1 year of psychodynamic psychotherapy treatment. These studies followed up a patient with depression and borderline personality disorder (Viinamaki et al., 1998), a patient with depression (Saarinen et al., 2005), a patient with mixed mania (Tolmunen et al., 2004), and a sample of eight patients classified as having atypical depression (Lehto et al., 2008). Such results indicate that psychopharmacotherapy and psychotherapy both yield important and similar changes in neural activity, although likely through different mechanisms (Beutel et al., 2003). "
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    ABSTRACT: We present a review of several hypotheses concerning the possible neurobiological correlates of the main processes involved in analytic therapy. Attachment theory may represent an interesting link between psychoanalysis and neurobiology. According to Bowlby's conception, interactions with parental figures during infancy lead to the formation of an "internal working model." This determines how the individual will relate with others and cope with stress throughout life. The patterns formed are in many cases pathological. The internal working model is stored as implicit memory, which is expressed independently of consciousness. Clinical improvement in analytic therapy ultimately depends on changes in the implicit memory system, which entails structural brain modifications. Implicit memory system changes may be related to alterations in explicit memory systems, which result from interpretative work. They may also occur directly as a result of the emotional experiences in the patient-analyst relationship.
    Psychology and Neuroscience 12/2011; 4(3):417-427. DOI:10.3922/j.psns.2011.3.015
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