Search Results (10)

Japanese narcissism refers to a culturally embedded form of narcissistic personality that emerges within collectivist societies, particularly in Japan, where self-worth is maintained through emotional over-adaptation, perfectionism, self-sacrifice, and conformity to internalized moral obligations. Within the framework of Schema Therapy, this construct is characterized by dominant coping modes, such as Armor mode and Demanding Community mode, that suppress vulnerable emotional states and promote socially sanctioned compliance. Although narcissistic personality disorder (NPD) has been extensively studied in individualistic Western cultures, its manifestation in collectivist cultures remains underexplored. Japanese narcissism offers a culturally contextualized model that integrates psychoanalytic and Schema Therapy perspectives to explain thin-skinned narcissistic vulnerability, disguised as adaptive functioning. Clinical observations and case analyses indicate that patients often develop Armor mode (fusing Detached Protector and Perfectionistic Over-controller functions) and Demanding Community mode (internalizing collective moral expectations). These adaptive-appearing modes mask core maladaptive schemas—Emotional Deprivation, Defectiveness/Shame, Enmeshment, and Self-Sacrifice—while being mistaken for mature or healthy functioning. Historically, such patterns have been reinforced by moral-collectivist ideals, exemplified by the Imperial Rescript on Education, which valorized loyalty, endurance, and self-denial. Japanese narcissism may therefore represent a culturally specific clinical configuration, suggesting the need for contextually adapted Schema Therapy interventions that recognize both the harmony-preserving and narcissism-reinforcing functions of adaptive behavior. This framework contributes to the cross-cultural extension of Schema Therapy by theorizing how narcissistic structures manifest in collectivist societies, and highlights the need for empirical validation of culturally sensitive treatment protocols. Full article

Background/Objectives: Psychoanalytic theories of destructiveness highlight its deep, unconscious origins tied to primal emotional and motivational mechanisms. Traditional psychiatric models of suicidal risk assessment focus on classic risk factors, limiting diagnostic and intervention approaches. This study examines the neuropsychoanalytic foundations of destructive tendencies, integrating sublimation and evolutionary motivational systems, redefining their role in the destruction process. Methods: A total of 480 AI-generated illustrations were assessed for interpretative accuracy. The final set was used in an online projection task with 204 respondents. Analyses included factorial exploration of the structure of the tool, assessment of psychometric properties (Cronbach α, ROC, AUC), logistic regression and analysis of intergroup differences. Results: Factor analysis identified eight subscales. Six of the eight factors showed thematic resemblance to Panksepp’s emotional systems, although this interpretation remains theory-driven and requires empirical validation. The remaining two—pursuit of destruction and its sublimation—extend beyond natural evolutionary mechanisms. Destructiveness was best explained by depression and psychological pain (OR = 1.39, 95% CI [1.26–1.52]), aggression and impulsivity (OR = 1.68, 95% CI [1.36–2.06]), and anxiety and a sense of threat (OR = 1.55, 95% CI [1.27–1.90]). Key predictors of destruction sublimation were curiosity (OR = 3.15, 95% CI [2.43–4.09]), closeness and love (OR = 3.43, 95% CI [2.48–4.76]), and pleasure and fun (OR = 3.08, 95% CI [2.26–4.20]). Analyses showed higher levels of destructiveness in individuals receiving psychological or psychiatric support, those with prior diagnoses, and students compared to employed individuals. Conclusions: Results indicate high reliability (Cronbach’s α > 0.87) and discrimination among internal subscale-defined groups (ROC > 0.7), supporting the tool’s potential in assessing destructive and sublimation tendencies within a neuropsychoanalytic framework. Future studies will explore its external validity and clinical applications. Full article

Background: Takotsubo Syndrome (TTS), or stress-induced cardiomyopathy, is an acute and typically reversible cardiac condition that mimics acute coronary syndrome without obstructive coronary artery disease. Predominantly affecting postmenopausal women, TTS has been increasingly recognized as a psychobiological disorder involving neuroendocrine dysregulation, autonomic imbalance, psychosocial stress, and gendered patterns of emotional regulation. This review aimed to synthesize multidisciplinary evidence to propose an integrative, gender-informed model of TTS. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science (2000–2025) to identify clinical, neurobiological, psychosocial, and psychoanalytic studies addressing sex/gender differences, psychiatric comorbidities, and emotional regulation in TTS. Results: Evidence indicates that catecholamine surge, hypothalamic–pituitary–adrenal axis dysregulation, estrogen deficiency, and autonomic imbalance provide a biological substrate for stress-induced myocardial stunning. Psychosocial factors, such as caregiving burden, chronic stress, and alexithymia, further decrease resilience. Gendered coping scripts and unconscious symbolic processes may amplify vulnerability and influence clinical presentation. The integrative model combines biological, psychological, and social mechanisms, highlighting the predominance of emotional triggers in women and worse in-hospital outcomes in men. Conclusions: TTS should be approached as both a cardiac and affective disorder. Gender-sensitive, multidisciplinary management, including psychiatric screening, psychocardiology interventions, and psychoanalytically informed care, may improve prevention, diagnosis, and patient outcomes. Full article

Background: Projective instruments have historically been used to explore unconscious dynamics and personality traits in children and adolescents. However, concerns about their psychometric properties have led to ongoing debates in clinical psychology. This review aims to critically reassess the use of construction projective techniques in clinical settings for individuals aged 4 to 18 years, also examining the available psychometric data reported in recent scientific literature, excluding the Rorschach Test due to its extensive coverage in existing literature. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Psychoanalytic Electronic Publishing (PEP), and the Cochrane Library were searched for studies published between 2010 and 2024. Inclusion criteria encompassed studies focusing on construction projective techniques administered to clinical and non-clinical samples aged 4 to 18 years. Results: From an initial pool of 641 articles, 25 met the inclusion criteria. These studies indicate that construction projective techniques remain valuable in accessing children’s and adolescents’ inner worlds, particularly in diagnostic and therapeutic contexts. However, 13 of the 25 analyzed studies lack detailed psychometric evaluations, and the overall methodological quality was medium-low (4.4/9). Recent adaptations of these techniques show promise in increasing their applicability and relevance. Conclusions: Constructive projective tests continue to offer unique insights into the psychological functioning of young individuals. While not definitive diagnostic tools, they serve as effective supplements in clinical assessments and therapeutic interventions when applied with awareness of their limitations. Full article

In this work, we suggest that children’s social withdrawal might be a precursor of Hikikomori, a phenomenon observed among adolescents and young adults. Hence, psychotherapy interventions with preschool children showing signs of social withdrawal might play a critical role in Hikikomori prevention. This paper presents the case of a five-year-old child treated with intensive psychoanalytic psychotherapy who began therapy due to his refusing to go to school and exhibiting isolating behavior from other children. Among other symptoms were regression, emotional tension, nightmares, and nocturnal and diurnal enuresis. Moreover, the relationship in the family was difficult, both between the parents and between the parent and the child. The intensive psychoanalytic treatment involved three weekly sessions for about a year, followed by six months with one weekly session. Besides illustrating the therapeutic process through clinical vignettes taken from the sessions, this paper also provides clues on how early social withdrawal can contribute to the construction of internal personality organizations that lead to social withdrawal up to self-reclusion (or Hikikomori). Full article

To understand processes associated with better or poorer psychotherapy outcomes is vital. This study examined and contrasted interaction patterns between one therapist and two depressed 17-year-old girls, Johanna (good outcome) and Sonja (poor outcome), in short-term psychoanalytic therapies selected from an RCT. Outcome data were collected regarding level of inter- and intra-personal functioning and symptoms of depression. Process data were obtained using the Adolescent Psychotherapy Q-Set on all available sessions. Analyses yielded five relational patterns or “interaction structures” in the two therapy processes; Three explained most of the variance in sessions with Johanna (i.e., ‘positive working alliance’, ‘therapist’s active use of psychodynamic techniques’, and ‘a receptive patient’) and two explained more of the variance in sessions with Sonja (i.e., ‘therapist using a more problem-solving and symptom-oriented approach’ and ‘patient displaying limited capacity for mentalization’). The processes in the two cases presented differences related to mentalization, psychological mindedness, and attachment style of the patients. The therapist used different therapeutic approaches, favouring more psychodynamic interventions in the good outcome case and a more problem-solving and symptom-oriented approach with the poor outcome case. In the latter case, the relationship seemed to be more of a struggle. Full article

Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child’s safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child–parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents’ narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent–child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent–child psychotherapy resulted, which proved to be the most effective. Full article

A significant proportion of adolescents suffering from major depressive disorder (MDD) are likely to have a co-morbid personality disorder (PD). Short-term psychoanalytic psychotherapy (STPP) was found to be one treatment of choice for adolescents suffering from MDD. Background: The first experimental study of transference work-in teenagers (FEST-IT) demonstrated the efficaciousness of transference work in STPP with adolescents suffering from MDD. The usefulness of STPP may be enhanced by exploring possible moderators. Methods: Depressed adolescents (N = 69), aged 16–18 years, were diagnosed with the structured interview for DSM-IV PDs and randomized to 28 weeks of STPP with or without transference work. A mixed linear model was applied. The moderator effect was investigated by a three-way interaction including “time”, “treatment group” and “number of PD criteria”. Results: A small but significant moderator effect was found for cluster B personality pathology. Patients with a higher number of cluster B PD criteria at baseline did better up to one-year post-treatment where therapists encouraged patients to explore the patient–therapist relationship in the here and now. Conclusion: When treated with psychoanalytic psychotherapy for MDD, adolescents with cluster B PD symptoms seem to profit more from transference work than adolescents without such pathology. Full article

This paper presents defense-oriented psychoanalytic psychotherapy as a tailored treatment for boys through a neurophysiological hypothesis. Male central nervous system development is reviewed, with a focus on the development of the emotion regulation system. The organizational effects of pre- and post-natal androgens delay central nervous system development in males relative to females, following a caudal to rostral phylogenetic framework. Ventromedial prefrontal structures mature at an earlier developmental age than dorsolateral prefrontal structures, creating less of a gender gap in the available underlying neural architecture for responsivity to targeted therapeutic intervention. The hypothesized operation of defense analysis upon ventromedial prefrontal cortical structures and corticolimbic connectivity therefore positions boys to benefit from psychotherapy equally as girls. In this study, we explored gender differences in presentation and response to a short-term, manualized defense-oriented psychoanalytic psychotherapy named regulation-focused psychotherapy for children. In a sample size of 43 school-aged children, consisting of 32 boys and 11 girls, with oppositional defiant disorder, we found no statistically significant differences in participant characteristics upon entry nor in treatment response, as measured by changes in scores on the Oppositional Defiant Disorder Rating Scale, the oppositional defiant problems subscale of the Child Behavior Checklist, the suppression and reappraisal subscales of the Emotion Regulation Questionnaire for Children and Adolescents, and the lability and negativity subscale of the Emotion Regulation Checklist. The findings were comparable with the gendered findings of preexisting studies of play therapy, where boys and girls improve equally, but not of behaviorally predominant psychotherapy, where girls appear to have superior responses. Our findings suggest that the treatment as a general play therapy, but with a focus on the implicit emotion regulation system, was successful in meeting boys’ gendered treatment needs. Conclusions are drawn with implications for further study. Full article

Living with cystic fibrosis (CF) exposes patients to the risk of developing anxiety and depression, with therapeutic compliance reduction, hospitalization increase, and quality of life and health outcomes deterioration. As pulmonary infections represent the major cause of morbidity and mortality in patients with CF, environmental contamination due to droplet dispersion and the potential transmission from environment to such patients should be prevented. Therefore, in-person contact, including group-based psychotherapy, are strongly discouraged. Nevertheless, group sharing of disease-related experiences represents a way to recover the inner resources essential for dealing with a chronic pathology. Keeping in mind the guidelines for infection control, the aim of this study is to evaluate the risk of the dissemination of microorganisms in a restricted environment where patients with CF attend group psychotherapy sessions. Five patients, selected according to their microbiological status, attended 32 group-based psychological/psychoanalytic meetings. Before each session, they were asked to observe the infection control recommendations. Microbiological environmental monitoring (MEM) has been performed to evaluate both air and surface contamination. As reported, a strict observation of standard precautions allows one to avoid environmental contamination by pathogens of the CF respiratory tract. Although infection control guidelines discourage group-based psychological/psychoanalytic interventions, our observations report the feasibility and safety of group psychotherapy when strict precautions are taken. Full article