A clinical heritage of empirical research. In memory of Jeremy Safran

This is Part II of a special issue, Research in Psychotherapy: Psychopathology, Process and Outcome, dedicated in memory of our colleague Jeremy Safran (Part I was published in April 2019). All of the contributions (theoretical papers, clinical cases, qualitative and quantitative studies) presented in this second part of the special issue focus on the topic of ruptures and resolutions in the therapeutic alliance. Each paper demonstrates a unique approach, perspective, and methodology

Introduction to the Special Issue on the Psychodynamic Diagnostic Manual, 2nd edition (PDM-2). The PDM. Yesterday, today, tomorrow

In this introductory essay, we review the development of the second edition of the Psychodynamic Diagnostic Manual. We place the first edition in historical context and note the main responses and critiques of professional colleagues to its publication. We then outline the developing process of this second, comprehensively revised edition. Finally, we preview the contributions to this Special Issue. Overall, we emphasize the Psychodynamic Diagnostic Manual's innovative diagnostic framework, designed to assess the depth as well as the surface of patients' emotional, cognitive, interpersonal, and social patterns and to foster in the field an integration between nomothetic understanding and the idiographic knowledge useful for case formulation and treatment plannin

Single fathers by choice using surrogacy. Why men decide to have a child as a single parent

STUDY QUESTION: Why do men decide to have a child by surrogacy as a single parent? SUMMARY ANSWER: Reasons included feeling that it was the right time (i.e. having 'worked through' concerns about single parenthood; career and financial stability; a fear of getting older; no longer wanting to wait for the 'right' relationship), external encouragement, a desire to reproduce and a fear of separation/divorce. WHAT IS KNOWN ALREADY: Because no research has been conducted on single fathers who used surrogacy, their characteristics, motivations and experiences are unknown. STUDY DESIGN, SIZE, DURATION: This study used a cross-sectional design as part of a larger, multi-method, multi-informant investigation of single father families created by surrogacy. Multiple strategies were used to recruit participants (i.e. from an association of gay parents, Facebook groups of single parents and snowballing) between November 2016 and April 2017. Data were obtained from 33 Italian single fathers (Meanage = 47.33 years, SD = 4.63), most of whom self-identified as gay (n = 24, 72.7%). PARTICIPANTS/MATERIALS, SETTING, METHODS: In-depth semi-structured interviews were conducted in family homes (n = 20, 60.6%) or over Skype (n = 13, 39.4%). Each interview lasted approximately 40 min and was audio recorded, transcribed verbatim and analyzed using thematic and qualitative content analysis, with the aid of the software package MAXQDA. Where appropriate, a two-sided Fisher's exact test was used to compare the gay and heterosexual fathers, and illustrative quotations were reported. MAIN RESULTS AND THE ROLE OF CHANCE: Although all of the single men had experienced mature relationships, about one-third of the fathers (n = 10, 30.3%) had never thought of having a child and the majority of the heterosexual men (n = 7, 77.8%, P = 0.05) had tried to conceive in previous relationships. The gay and heterosexual men differed in their preferred path to parenthood (P = 0.01), with the former (n = 17, 70.8%) having always preferred surrogacy and the latter (n = 6, 66.7%) having considered or attempted conception via casual sex with women. Irrespective of their sexual orientation, most of the fathers chose surrogacy because they wanted a genetic relation to their child (n = 28, 84.8%) and because they felt that surrogacy would be more secure compared to adoption, upon their return to Italy due to Italian laws (n = 26, 78.7%). The majority (n = 20, 60.6%) were satisfied with their decision to 'go it alone', although nearly all (n = 16, 80%) would have preferred to have a child within the context of a relationship. After their child's birth, the majority received support from both their parents/siblings (n = 21, 63.7%) and friends (n = 24, 72.7%). LIMITATIONS, REASONS FOR CAUTION: The risk of socially desirable responding should be taken into account when interpreting the findings, given the ethical concerns surrounding single fatherhood and surrogacy. Furthermore, fathers with a negative surrogacy experience were less likely to participate in this research. The small sample and participant characteristics of older age, an Italian nationality, a mainly gay sexual orientation and high income may limit the generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS: This study is the first to provide insight into the reproductive experience of single men seeking surrogacy. The findings warn practitioners and policy-makers against making assumptions about people with access to fertility treatments on the basis of marital status, gender or sexual orientation. STUDY FUNDING/COMPETING INTEREST(S): None

Adolescenza e omosessualità in un’ottica evolutiva

Il lavoro tratta il tema dello sviluppo dell'orientamento (omo)sessuale in adolescenza

Clinician emotional response toward narcissistic patients. A preliminary report

Patients with narcissistic personality disorder (NPD) are among the most difficult to treat in therapy, especially for their strong resistance to treatment and several difficulties in establishing a therapeutic relationship characterized by intimacy, safety, and trust. In particular, therapists’ emotional responses to these patients can be particularly intense and frustrating, as often reported in the clinical literature; however, rarely they were investigated empirically. The aims of this preliminary study were: 1) to examine the associations between patients’ narcissistic personality disorder and distinct therapists’ countertransference patterns; and 2) to verify whether these clinicians’ emotional reactions were influenced by theoretical orientation, gender and age. A national sample of psychiatrists and clinical psychologists (N = 250) completed the Therapist Response Questionnaire (TRQ) to identify patterns of therapist emotional response, and the Shedler-Westen Assessment Procedure-200 (SWAP-200) to assess personality disorder and level of psychological functioning in a patient currently in their care, and with whom they had worked for a minimum of eight sessions and a maximum of 6 months (one session per week). From the complete therapist sample, we identified a subgroup (N = 35) of patients with NPD. Results showed that NPD was positively associated with criticized/mistreated and disengaged countertransference, and negatively associated with positive therapist response. Moreover, the relationship between patients’ NPD and therapists’ emotional responses was not dependent on clinicians’ theoretical approach (as well as their age and gender). These findings are consistent with clinical observations, as well as some empirical contributions, and have meaningful implications for clinical practice of patients suffering from this challenging pathology

Response regarding Existential Issues in Sexual Medicine. The relation between death anxiety and hypersexuality

The recent article published by Dr Watter, “Existential Issues in Sexual Medicine: The Relation Between Death Anxiety and Hypersexuality,” deals with an interesting issue: the unique relation between death and sexuality

Il benessere dei bambini e delle bambine con genitori gay e lesbiche

La finalità di questo documento è quella di chiarire parole e dimensioni concettuali legate al genere, con specifico riferimento alle famiglie omogenitoriali, mirando a fornire informazioni basate sulla competenza e la ricerca di esperti del settore. Le famiglie omogenitoriali, specie quelle visibili, in cui i figli sono cresciuti da due madri o due padri, sono infatti considerate da alcuni quasi “la somma di tutti i mali” perché rimettono in discussione concetti chiave della nostra storia culturale (come la filiazione e i ruoli di genere all’interno della copia genitoriale). In effetti, chi fomenta paura rifacendosi alla spaventosa “teoria del gender” sogna un mondo immutabile e immutato, in cui le donne e gli uomini hanno ruoli ben definiti, in cui c’è un solo modo di essere e un solo modo di comportarsi e le donne devono rimanere al loro posto. I cambiamenti terrorizzano chi non vuole cambiare, non chi aspira a più libertà e più diritti per tutti e lavora alla convivenza civile, al superamento delle disuguaglianze, al miglioramento delle relazioni fra le persone al di là del loro genere, orientamento sessuale, sesso biologico

The legacy of Jeremy Safran

Not available

Psychodiagnostic Chart–Child (PDC–C): a valid and clinically sensitive diagnostic tool for patient-tailored intervention planning

The reliable clinical-diagnostic evaluation of child patients is crucial. The present research sought to examine the validity of the Psychodiagnostic Chart – Child (PDC–C) in assessing children’s mental functioning and personality organization, according to the framework of the Psychodynamic Diagnostic Manual, Second Edition (PDM–2). A sample of 209 clinicians assessed 209 children (aged 4–11 years) who had been in their care between 2–12 months, using the PDC-C. Each clinician also completed a clinical questionnaire to provide demographic information, the Child Behavior Checklist to evaluate children’s behavioral problems and social competences, and the Childhood Personality Assessment Q-Sort measure to assess children’s emerging personality patterns. The findings suggest that the PDC–C is a valid diagnostic tool that takes into account children’s full range of functioning. Moreover, the measure has good sensitivity and appears clinically useful in differentiating between certain clinical populations according to psychological characteristics. The PDC–C could promote more accurate assessment during childhood and inform the development of individualized therapies. One of the advantages of the tool is its ability to capture individual variations in child functioning (illuminating strengths and psychological vulnerabilities), even within children in the same diagnostic group. Of note, additional research is needed to establish the utility of PDC–C ratings in predicting clinically relevant constructs and to monitor the processes and outcomes of interventions

The relationship among the health-related quality of life, illness severity, personality and psychiatric symptoms in patients with psoriasis: an empirical investigation

Background: Psoriasis is a complex and chronic inflammatory skin disorder. The mechanisms underlying this immune-mediated disease are not clear, but some evidence indicates that specific personality features and symptom patterns may play an important role in the development and clinical presentation of the disorder and influence the quality of patients’ lives. This study aimed at evaluating the associations among the quality of life, illness severity, psychiatric symptoms and personality patterns in patients with psoriasis treated with biological or topical therapy. Methods: Fifty psoriatic patients were evaluated with self-report measures: the Symptom Checklist-90-R (SCL-90R) and the Psoriasis Index of Quality of Life (PSORIQoL). Their personality and psychological functioning were assessed by external raters using the Shedler-Westen Assessment Procedure (SWAP-200) applied to the Clinical Diagnostic Interviews (CDI). Finally, the severity and the area of psoriatic lesions were evaluated by dermatologists with the Psoriasis Area Severity Index (PASI). Results: Significant differences between the groups (biological vs topical therapy) were found in PASI scores: patients assigned to biological therapy showed lower levels of illness severity. No differences were found in PSORIQoL scores. The quality of life was negatively associated with various dimensions of SCL-90R and with borderline (r = .39; p< .01), dependent (r = .41; p< .01) and avoidant (r = .35; p< .05) personality styles/disorders; conversely, it did not relate to PASI. Conclusions: The results seem to suggest that the quality of life in psoriatic patients is more influenced by personality characteristics and psychiatric symptoms than by the severity of psoriatic lesions