The Affective Origin and Treatment of Recurrent Maladaptive Patterns

Recurrent maladaptive patterns (RMPs) have been a foundational concept in psychodynamic therapy (PDT) and psychoanalysis for over a century. Typically associated with character pathology (i.e., personality disorders), they highlight the remarkable correspondences frequently observed between relationship patterns in a person’s family of origin, their current adult relationships, and the transference relationship with the therapist. These patterns can be understood as an expression of schemas and therefore share a common conceptual foundation with other major psychotherapy modalities. Yet, the centrality of affect in the origin/development of these maladaptive patterns and their treatment may not be widely appreciated among practitioners of PDT or any other modality. The basic thesis of this chapter is that RMPs as described in the PDT literature could potentially become more widely recognized, understood, and treated in an integrated manner if their developmental and affective origin were more generally appreciated. Doing so would not only improve interpersonal functioning but could also alter the affective dysfunction that predisposes to the development of symptoms that are a common reason for seeking treatment. Consistent with newer developments in psychodynamic theory grounded in observations from early childhood development, this chapter briefly reconsiders the fundamental elements of RMPs, including unconscious processes, development, conflict, defenses, and mechanisms of change from the perspective of affective science and computational neuroscience. In so doing, the goals are to broaden appreciation of the importance and ubiquity of RMPs by explaining them in nonclinical language, to increase the likelihood of enduring change by promoting an integrative approach to their treatment focusing on new emotional experiences in meaningful contexts and to facilitate research that can potentially establish the benefits of such an approach.

Personnel management in Russia: vector of humanization. Book 7

The monograph contains the results of studies concerning: first, the evolution of ideas and practice of humanization in the personnel policy of the state; second, the implementation of the principles of humanization in work with the personnel of economic subjects: talent management, renewal of working capacity of older workers, building a dual career, building a strong corporate culture, the development of the additional professional education system; thirdly, problems related to industry characteristics personnel work, drawing on international experience of vocational rehabilitation and employment promotion of persons with disabilities, concerning the roles of personal characteristics and character pathology in the context of modern life; fourth, approaches to the weakening of the precarization of labor, University teachers, gender discrimination in the labour market, working with a "toxic" staff, to prevent stress in the workplace. Addressed to scientific-pedagogical and practical workers in the sphere of work with personnel; graduate students, undergraduates, students, professional interests which relate to issues of personnel management.

How Does ECT Work?

The major puzzle in ECT is its mechanism of action. How do seizures, which can be dangerous and damaging when they occur spontaneously, change a dysfunctional brain into one that performs normally? Why do repeated epileptic seizures relieve psychiatric disorders? The originator of the therapy, Ladislas Meduna, believed in a biological antagonism between mental illness and seizures, an antagonism we no longer consider credible. But though we may smile at this belief, we acknowledge that it led Meduna to devise methods to induce seizures safely, select patients who were likely to benefit, develop a plan for a successful course of treatments, demonstrate the safety of inducing seizures, evaluate the merits and risks of seizures as treatment, and convince others to continue his work. His observations have been repeatedly verified, leaving little doubt about the effectiveness of ECT in treating mental illnesses. We know a great deal about the essential features of a successful course of ECT. The generalized brain seizure is the central therapeutic event. The biochemical and physiological consequences of the seizure are the basis for the behavioral effects; neither anesthesia nor electric current alone is useful, nor, except rarely, is a single seizure. To be of benefit, seizures must be repeated two or three times a week for many weeks. The more recent the mood, thought, or movement disorder, the more fully it can be relieved. Illnesses involving lifelong problems, character pathology, neuroses, and the mood disorders secondary to the abuse of drugs are not amenable to this treatment. We know how to avoid the risks of anoxia, unmodified convulsions, and prolonged seizures, and we recognize that these aspects of the treatment course do not explain how ECT works. Two aspects of the brain seizure have been extensively studied. The EEG records electrical activity of the brain under electrodes that are symmetrically placed over the scalp. Immediately after the stimulus, the “seizure” EEG is recorded on a moving strip. The electrical waves show a sharp buildup of frequencies and amplitudes, then the frequencies slow, mixtures of slow brain waves and sharp spike-like waves appear, with ever higher amplitudes and slower waves in runs and bursts.