From Fragmentation to Coherence: Psychodynamic Psychotherapy for Psychosis through the Lens of Metacognition

Psychoanalysis has produced important theories that help explain the radical alterations in self-experience central for persons experiencing psychosis. These concepts have led to important clinical developments, case studies, and some research on the efficacy of psychodynamic psychotherapy for psychosis (Gottdiener, 2006). However, psychodynamic psychotherapy has struggled to produce operationalized constructs to measure how it enhances self-development and the therapeutic mechanisms of action that facilitate these changes. Outside of psychoanalysis, some researchers have focused on the construct of metacognition (i.e. thinking about thinking) and its relevance to understanding psychosis. Proponents of this paradigm have created an integrative, exploratory therapy (MERIT, Lysaker & Klion, 2017) that blends various therapeutic traditions that overlap with psychodynamic psychotherapy and mentalization (Ridenour, Knauss, & Hamm, 2019). In this paper, we will present a short-term intensive case study of psychodynamic psychotherapy with a young man experiencing psychosis in residential treatment and then analyze the therapy through the lens of metacognition to provide constructs that illustrate the ways that it promotes recovery and self-integration.

Lust for life: coping with tuberculosis in late nineteenth-century Europe

The paper uses the correspondence of three Finns – Elias Erkko, Henrik Erkko and Hilda Asp – to analyse the conceptual and practical means with which late nineteenth-century-educated Europeans coped with ill health in general and tuberculosis in particular. While the need to gain control over (the threat of) disease may well be universal, the specific coping methods are historical and context-specific. They are both conceptual and practical, both individual and collective. The paper focuses on the 1880s and 1890s, a period when tuberculosis provided an especially lucrative subsector of the booming European medical marketplace. Sanatorium treatment was still only one among many treatment options, and the theory of the bacterial causation of tuberculosis was far from being universally accepted. The paper charts the options available for people suffering from pulmonary tuberculosis and analyses the eclectic, sometimes idiosyncractic, ways that they combined elements from different conceptual scripts and therapeutic traditions.

Learning the Elsewhere of ‘Inner Space’

How is access to the Elsewhere facilitated through affective pedagogy in a contemporary Sufi setting in Germany? This article draws analytical lessons from Inayati healing seminars that took place in the summer of 2013. Participants were instructed to feel the Elsewhere of ‘inner space’ in the material/corporeal realities by attuning to breath, sonic resonance, collective movement, and attentive listening. The affective pedagogy of the teacher extended the spatial-temporal coordinates of the Elsewhere (as framed by Mittermaier) to include ‘fleeting affects’ among its unknown elements. These pedagogic tactics entangled religious and secular life-worlds with aesthetic and therapeutic traditions. Learning to feel the unknown affects emanating from the Elsewhere in this setting aimed to provide existential resources to cope with the everyday struggles of post-secular life.

Medical pluralism, boundary making, and tuberculosis in Lambaréné, Gabon

Scholars of medical pluralism are interested in how healers position themselves and their healing practices within a therapeutic landscape, and how patients navigate an array of therapeutic traditions. Based on fieldwork in Lambaréné, Gabon, this article examines the discursive practices of tuberculosis patients and healers, finding that therapeutic traditions were kept separate. Examining a national programme that fosters traditional medicine, I show how the Gabonese government engages in practices of boundary making by reinforcing traditional healers’ position within the Gabonese therapeutic landscape. This research confirms popular paradigms of boundary making within the medical pluralism debate, wherein boundaries are produced and crossed to contrast, strengthen, purify, and divide the therapeutic landscape. Additionally, formal state-sponsored discursive practices refer to a merging of traditional medicine and biomedical medicine. This stands in contrast with patients’ and healers’ discursive practices, and their wariness of fluid or adaptive boundary-making processes. To explain this, I introduce the concept of ‘conventional boundary making’ and then analyse it in the context of tuberculosis and in relation to theories of state power, Gabonese therapeutic identity politics, and structural violence.

Cascades of Emotion: The Emergence of Borderline Personality Disorder from Emotional and Behavioral Dysregulation

Theories of borderline personality disorder (BPD) have often considered it a disorder involving both emotional and behavioral dysregulation ( Linehan, 1993 ), yet the connection between these phenomena has been elusive. The following paper proposes the Emotional Cascade Model, a model that attempts to establish a clear relationship between emotional dysregulation and the wide array of dysregulated behaviors found in BPD. In this model, subsequent to an emotional stimulus, ruminative processes result in a positive feedback loop that increases emotional intensity, and this emotional intensity leads to ensuing behavioral dysregulation. These behaviors then provide negative feedback, in the form of distraction, which induces temporary reduction of negative emotion and thus relief. The model is presented in a framework in which BPD is considered an emergent phenomenon ( Lewin, 1992 ), in which the disorder arises from the total interactions of a network containing emotional cascades and other important factors. The model is then evaluated in light of various theories and therapeutic traditions, including both cognitive–behavioral and psychodynamic, indicating that it is a model that may transcend traditional theoretical and therapeutic doctrines.