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. "
[Show abstract][Hide abstract] 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 · 3.63 Impact Factor
"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. "
"Her initially lowered SERT binding had increased to the level of healthy age-matched controls after 12 months of therapy, although the Hamilton scores measured for the evaluation of the severity of depression still were unaltered. At the 18-month follow-up, clinical remission with a decline in Hamilton scores was observed, suggesting that SERT recovery may occur before a clinical response is achieved (Saarinen et al., 2005). Thereafter, we collected a naturalistic series of 18 patients with major depression and offered them 6 months of psychotherapy with a supportive technique based on dynamic understanding of their symptoms once a week as outpatients at the Department of Psychiatry, Kuopio University Hospital. "
[Show abstract][Hide abstract] ABSTRACT: Including biological measures such as the serotonin function to the outcome variables of psychotherapy opens novel perspectives, which may enable better integration of diagnostic and neurobiological aspects with psychotherapy research. However, the problems of epistemology, ontology and the conceptual differences pertaining to such interdisciplinary efforts have to be adequately considered in order to avoid confusion between the different explanatory models used in neurobiological and clinical psychotherapy research. A number of studies have already shown that psychotherapy can be connected with significant changes in the function of brain networks. Recently, preliminary evidence has been gained that also changes in the synaptic transmission in serotonin pathways may take place during the psychotherapy of patients with depression. Although these findings have to be repeated and confirmed in future research with larger patient samples, it seems likely that in selected individuals, especially in those with atypical symptoms of depression, the reduced serotonin function can be normalized during psychotherapy.