Advertisement

Psychopathological Dimensions and the Clinician’s Subjective Experience

  • Mauro Pallagrosi
  • Angelo Picardi
  • Laura Fonzi
  • Massimo Biondi
Chapter

Abstract

In this chapter, we propose an empirically supported way of following the phenomenological call towards the use of the clinician’s feelings in the diagnostic process. Classical psychopathology highly valued the interaction between clinician and patient, and recent findings have provided preliminary evidence of an association between categorical psychiatric diagnosis and clinician’s subjective experience during the first clinical encounter. This seems to be true also for the dimensional approach. We present here a study that specifically investigated the relation between psychopathological dimensions and the pattern of the clinician’s subjective experience in psychiatric settings. The study provided preliminary evidence of significant and theoretically consistent relationships between the main psychopathological dimensions and the pattern of psychiatrists’ subjective experiences during assessment. Consequently, we discuss the questions raised by our results about the theoretical and methodological implications of an integrated view of psychiatric assessment and, more generally, for theory, practice, research, and training in psychiatry.

Keywords

Intersubjectivity Phenomenological psychopathology Dimensional psychopathology Clinician’s subjective experience ACSE 

References

  1. 1.
    Potuzak M, Ravichandran C, Lewandowski KE, Ongür D, Cohen BM. Categorical vs dimensional classifications of psychotic disorders. Compr Psychiatry. 2012;53:1118–29.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    APA. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
  3. 3.
    Stanghellini G. The grammar of the psychiatric interview. A plea for the second-person mode of understanding. Psychopathology. 2007;40:69–74.CrossRefPubMedGoogle Scholar
  4. 4.
    Fuchs T. Subjectivity and intersubjectivity in psychiatric diagnosis. Psychopathology. 2010;43:268–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Jaspers K. Allgemeine Psychopathologie. Berlin: Springer; 1913.Google Scholar
  6. 6.
    Kraus A. The significance of intuition for the diagnosis of schizophrenia. In: Maj M, Sartorius N, editors. Schizophrenia. Chichester: Wiley; 1999. p. 47–9.Google Scholar
  7. 7.
    Srivastava A, Grube M. Does intuition have a role in psychiatric diagnosis? Psychiatry Q. 2009;80:99–106.CrossRefGoogle Scholar
  8. 8.
    Parnas J. A disappearing heritage. The clinical core of schizophrenia. Schizophr Bull. 2011;37(6):1121–30.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rümke HC. Das Kernsymptom der Schizophrenie und das ‘Praecox Gefuhl’. Z Gesamte. Neurol Psychiatr. 1941;102:168–75.Google Scholar
  10. 10.
    Sagi GA, Schwartz M. The “praecox feeling” in the diagnosis of schizophrenia: a survey of Manhattan psychiatrists. Schizophr Res. 1989;2:35.CrossRefGoogle Scholar
  11. 11.
    Dimic S, Wildgrube C, McCabe R, Hassan I. Non-verbal behaviour of patients with schizophrenia in medical consultations – a comparison with depressed patients and association with symptom levels. Psychopathology. 2010;43:216–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Binswanger L. Welche Aufgaben ergeben sick für die Psychiatrie aus den Fortschritten der neueren Psychologie? Z Gesamte Neurol Psychiatr. 1924;91(1):402–36.CrossRefGoogle Scholar
  13. 13.
    Wyrsch J. Über die Intuition bei der Erkennung der Schizophrenen. Schweiz Med Wochenschr. 1946;46:1173–6.Google Scholar
  14. 14.
    Minkowski E. Le temps vécu. Etudes phénoménologiques et psychopathologiques. Paris: Coll. de l’Evolution Psychiatrique; 1933.Google Scholar
  15. 15.
    Minkowski E. La schizophrénie. Psychopathologie des schizoïdes et des schizophrènes. Paris: Payot; 1927.Google Scholar
  16. 16.
    Binswanger L. Drei Formen missglückten Daseins. Verstiegenheit, Verschrobenheit, Manieriertheit. Tübingen: Niemeyer; 1956.CrossRefGoogle Scholar
  17. 17.
    Tellenbach H. Geschmack und Atmosphäre. Medien menschlichen Elementarkontaktes. Salzburg: Otto Müller Verlag; 1968.Google Scholar
  18. 18.
    Heimann P. On countertransference. Int J Psychoanal. 1950;31:81–4.Google Scholar
  19. 19.
    Racker H. The meanings and uses of countertransference. Psychoanal Q. 1957;26(3):303–57.PubMedCrossRefGoogle Scholar
  20. 20.
    Kernberg O. Notes on countertransference. J Am Psychoanal Assoc. 1965;13:38–56.CrossRefPubMedGoogle Scholar
  21. 21.
    Klein M. Notes on some schizoid mechanisms. Int J Psychoanal. 1946;27:99–110.PubMedGoogle Scholar
  22. 22.
    Spillius E, O’Shaughnessy E, editors. Projective identification: the fat of a concept. New York: Routledge; 2012.Google Scholar
  23. 23.
    Kohut H. Forms and transformations of narcissism. J Am Psychoanal Assoc. 1966;14(2):243–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Bolognini S. L’empatia psicoanalitica. Torino: Bollati Boringhieri; 2002.Google Scholar
  25. 25.
    Winnicott DW. Hate in the countertransference. Int J Psychoanal. 1949;30:69–74.Google Scholar
  26. 26.
    Grube M. Towards an empirically based validation of intuitive diagnostic: Rümke’s ‘praecox feeling’ across the schizophrenia spectrum: preliminary results. Psychopathology. 2006;39:209–17.CrossRefPubMedGoogle Scholar
  27. 27.
    Ungvari GS, Xiang Y, Hong Y, Leung HCM, Chiu HFK. Diagnosis of schizophrenia: reliability of an operationalized approach to ‘praecox-feeling’. Psychopathology. 2010;43:292–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Brody EM, Farber BA. The effects of therapist experience and patient diagnosis on countertransference. Psychotherapy. 1996;33:372–80.CrossRefGoogle Scholar
  29. 29.
    McIntyre SM, Schwartz RC. Therapists’ differential countertransference reactions toward clients with major depression or borderline personality disorder. J Clin Psychol. 1998;54(7):923–31.CrossRefPubMedGoogle Scholar
  30. 30.
    Holmqvist R. Staff feelings and patient diagnosis. Can J Psychiatr. 2000;45(4):349–56.CrossRefGoogle Scholar
  31. 31.
    Schwartz RC, Smith SD, Psychotherapists CB. Countertransference reactions toward clients with antisocial personality disorder and schizophrenia: an empirical test of theory. Am J Psychother. 2007;61(4):375–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Thylstrup B, Hesse M. Substance abusers’ personality disorders and staff members’ emotional reactions. BMC Psychiatry. 2008;8:21.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Røssberg JI, Karterud S, Pedersen G, Friis S. Psychiatric symptoms and countertransference feelings: an empirical investigation. Psychiatry Res. 2010;178(1):191–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Betan E, Heim AK, Conklin CZ, Westen D. Countertransference phenomena and personality pathology in clinical practice: an empirical investigation. Am J Psychiatry. 2005;162(5):890–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Røssberg JI, Karterud S, Pedersen G, Friis S. An empirical study of countertransference reactions toward patients with personality disorders. Compr Psychiatry. 2007;48:225–30.CrossRefPubMedGoogle Scholar
  36. 36.
    Colli A, Tanzilli A, Di Maggio G, Lingiardi V. Patient personality and therapist response: an empirical investigation. Am J Psychiatry. 2014;171:102–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Tanzilli A, Colli A, Muzi L, Lingiardi V. Clinician emotional response toward narcissistic patients: a preliminary report. Res Psychother Psychopathol Process Outcome. 2015;18(1):1–9.Google Scholar
  38. 38.
    Lingiardi V, Tanzilli A, Colli A. Does the severity of psychopathological symptoms mediate the relationship between patient personality and therapist response? Psychotherapy. 2015;52(2):228–37.CrossRefPubMedGoogle Scholar
  39. 39.
    Pallagrosi M, Fonzi L, Picardi A, Biondi M. Assessing clinician’s subjective experience during interaction with patients. Psychopathology. 2014;47:111–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Pallagrosi M, Fonzi L, Picardi A, Biondi M. Association between clinician's subjective experience during patient evaluation and psychiatric diagnosis. Psychopathology. 2016;49:83–94.CrossRefPubMedGoogle Scholar
  41. 41.
    Gabbard GO. Countertransference issues in psychiatric treatment. Washington DC: American Psychiatric Press; 1999.Google Scholar
  42. 42.
    Picardi A, Pallagrosi M, Fonzi L, Biondi M. Psychopathological dimensions and clinician’s subjective experience. Psychiatry Res. 2017;258:407–14.CrossRefPubMedGoogle Scholar
  43. 43.
    APA. Diagnostic and statistical manual of mental disorders. 4th ed Rev (DSM-IV-TR) ed. Washington: American Psychiatric Publishing; 2000.Google Scholar
  44. 44.
    World Health Organization. The ICD-10 classification of mental and Behavioural disorders. Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.Google Scholar
  45. 45.
    Lukoff D, Nuechterlein KH, Ventura J. Manual for expanded brief psychiatric rating scale. Schizophr Bull. 1986;12:594–602.Google Scholar
  46. 46.
    Ventura J, Lukoff D, Nuechterlein KH, Liberman RP, Green M, Shaner A. Appendix 1: brief psychiatric rating scale (BPRS) expanded version (4.0) scales, anchor points and administration manual. Int J Methods Psychiatr Res. 1993;3:227–44.Google Scholar
  47. 47.
    Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10:799–812.CrossRefGoogle Scholar
  48. 48.
    Overall JE. The brief psychiatric rating scale in psychopharmacology research. In: Pichot P, Olivier-Martin E, editors. Psychological measurements in psychopharmacology: modern problems in psychopharmacology. Basel: Karger; 1974. p. 67–78.Google Scholar
  49. 49.
    Morosini P, Roncone R, Impallomeni M, Marola V, Casacchia M. Presentazione dell’adattamento italiano della Brief Psychiatric Rating Scale, versione 4.0 ampliata (BPRS 4.0). Riv Riabil Psichiatr Psicosoc. 1995;3:195–8.Google Scholar
  50. 50.
    Roncone R, Ventura J, Impallomeni M, Falloon IR, Morosini PL, Chiaravalle E, Casacchia M. Reliability of an Italian standardized and expanded brief psychiatric rating scale (BPRS 4.0) in raters with high versus low clinical experience. Acta Psychiatr Scand. 1999;100:229–36.CrossRefPubMedGoogle Scholar
  51. 51.
    Dazzi F, Shafer A, Lauriola M. Meta-analysis of the brief psychiatric rating scale - expanded (BPRS-E) structure and arguments for a new version. J Psychiatr Res. 2016;81:140–51.CrossRefPubMedGoogle Scholar
  52. 52.
    Tabachnick B, Fidell L. Using multivariate statistics. New York: Harper Collins College Publishers; 1996.Google Scholar
  53. 53.
    Picardi A, Toni A, Caroppo E. Stability of alexithymia and its relationships with the ‘big five’ factors, temperament, character, and attachment style. Psychother Psychosom. 2005;74:371–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Picardi A, Martinotti G, Paci M, Simi C, Caroppo E. Reliability of self-reported attachment style in patients with severe psychopathology. J Pers Assess. 2011;93:491–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Picardi A, Caroppo E, Porcelli P, Di Maria G, Munittola G, Martinotti G. Alexithymia and severe psychopathology: a study on psychiatric inpatients. Psychopathology. 2012;45:159–66.CrossRefPubMedGoogle Scholar
  56. 56.
    Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion. Philos Ethics Humanit Med. 2012;7:14.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mauro Pallagrosi
    • 1
  • Angelo Picardi
    • 2
  • Laura Fonzi
    • 3
  • Massimo Biondi
    • 4
  1. 1.Department of Human NeurosciencesSapienza University of RomeRomeItaly
  2. 2.Centre for Behavioural Sciences and Mental HealthItalian National Institute of HealthRomeItaly
  3. 3.Training InstituteItalian Psychoanalytical SocietyRomeItaly
  4. 4.Department of Human Neurosciences, Policlinico Umberto I HospitalSapienza University of RomeRomeItaly

Personalised recommendations