Clinical Issues

Richard C. Friedman, M.D., Editor

This volume of Psychodynamic Psychiatry is the first that contains our new Clinical Issues Section. Psychodynamic Psychiatry is currently the only psychiatric journal exclusively devoted to psychodynamic thought and clinical practice. As we know, clinical psychiatry is a complex discipline and clinicians must rely on more than one model of psychological functioning to do justice to this complexity. For therapists to construct adequate models for treatment, descriptive perspectives about assessment and treatment as embodied in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, IV, and 5) often require supplementation by psychodynamic ones.

Psychodynamic Psychiatry focuses on the interface between psychoanalytic psychology and scientific scholarship and research. The journal links selected psychoanalytic ideas with those of organized psychiatry. Psychiatric assessment has emphasized descriptive diagnoses since 1980 when the anchoring conceptual format for diagnosis radically changed from psychoanalytic to Kraepelinian, that is, descriptive. At the same juncture, organized psychiatry, at least in the United States, de-emphasized psychoanalytic thought about psychopathology as well as coping behaviors. While the historical influences leading to this are understandable, it appears that the proverbial baby has been discarded with the bathwater. Selected psychoanalytic ideas remain useful as long as they are empirically supported, or are compatible with common sense and sound clinical judgment.

In our new Clinical Issues Section, the discussions and commentaries are meant to illustrate the way a psychodynamically informed therapist might think about a patient's motivation, symptoms and coping mechanisms.

The patient discussed here by Dr. Kaplan is a composite based on extensive clinical experience all authors have had with patients struggling