Psychodynamic psychiatry in the XXI century: Evidence-based principles of care and nonlinear dynamics of clinical interaction
This workshop starts with a comprehensive review of the evidence base for psychodynamic psychotherapy in comparison with other forms of psychiatric treatment, both psychopharmacological and psychotherapeutic. Problems with the current evidence-based model that emphasizes statistical treatment algorithms based on randomized controlled trial data are reviewed, and a shift to evidence-based principles of individualized care is proposed (Shapiro, 2018). Psychodynamic principles of care include systematic attention to objective, subjective and intersubjective domains of clinical interaction including patterns of explicit and implicit affect, cognition and relationality; the shifting dynamics of therapeutic alliance; and attention to individual systems of meaning (why we do what we do).
The second part of the workshop introduces the Dynamical Systems Therapy model (DST – Shapiro, 2015). Linear models of psychopathology and its treatment are severely limited in integrating the full range of the patient’s experience and perpetually shifting complexity of the dyadic matrix with their caregiver. Dynamical Systems Therapy (DST) integrates the information-based language of complexity theory, where recurrent patterns of thinking, feeling, and relating can be mapped on the individual’s adaptive landscape. This model provides a roadmap for individualized treatment, allowing clinicians to create a psychobiological “map of the mind” that effectively eschews brain/mind dichotomy and incorporates both the patient’s first-person experience, the second-person process of the treatment provision, and the third-person language of neuroscience. Treatment involves dyadic interaction between the two complex adaptive systems to re-shape pathological attractor/repellor configurations and re-establish self-organizing process.
- Shapiro, Y. (2015). Dynamical Systems Therapy (DST): Theory and practical applications. Psychoanalytic Dialogues, 25(1): 83‒107
- Shapiro, Y. (2018). Psychodynamic psychiatry in the 21st century: Constructing a comprehensive science of experience. Psychodynamic Psychiatry, 46(1): 49–79
Dr. Yakov Shapiro is a clinical professor of psychiatry, psychodynamic psychotherapy supervisor and scholar at the Integrative Health Institute at the University of Alberta, Edmonton, Canada. He specializes in integrated individual and group treatment of complex psychiatric disorders and runs a regional Integrated Psychotherapy/Psychopharmacology Service (IPPS). He teaches post-graduate courses in Neuroscience of Psychotherapy, Evolutionary Psychiatry, Psychodynamic Psychopharmacology and Integrated Treatment.