Skip to content
Callahan K, et al. "ABA Versus TEACCH: The Case for Defining and
Validating Comprehensive Treatment Models in Autism," Journal
of Autism and Developmental Disorders (Jan. 2010): Vol. 40,
No. 1, pp. 74–88.
Dawson G, et al. "Randomized, Controlled Trial of an Intervention
for Toddlers with Autism: The Early Start Denver Model,"
Pediatrics (Jan, 2010): Vol. 125, No. 1, pp. e17–23.
Johnson CP, et al. "Identification and Evaluation of Children
with Autism Spectrum Disorders," Pediatrics (Nov. 2007):
Vol. 120, No. 5, pp. 1183–215.
Brakemeier EL, et al. "Patterns of Response to Repetitive
Transcranial Magnetic Stimulation (rTMS) in Major Depression:
Replication Study in Drug-Free Patients," Journal of
Affective Disorders (May 2008): Vol. 108, No. 1–2, pp.
Fregni F, et al. "Predictors of Antidepressant Response in
Clinical Trials of Transcranial Magnetic Stimulation,"
International Journal of Neuropsychopharmacology (Dec.
2006): Vol. 9, No. 6, pp. 641–54.
Gaynes BN, et al. "The STAR*D Study: Treating Depression in the
Real World," Cleveland Clinic Journal of Medicine (Jan.
2008): Vol. 75, No. 1, pp. 57–66.
Abbass AA, et al. "Short-Term Psychodynamic Psychotherapies for
Common Mental Disorders," Cochrane Database of Systematic
Reviews (Oct. 2006): Doc. No. CD004687.
De Maat S, et al. "The Effectiveness of Long-Term Psychoanalytic
Therapy: A Systematic Review of Empirical Studies," Harvard
Review of Psychiatry (Jan.–Feb. 2009): Vol. 17, No. 1, pp.
Gabbard GO, ed. Textbook of Psychotherapeutic Treatments
(American Psychiatric Publishing, 2009).
Psychodynamic therapy has its roots in psychoanalysis, the
long-term "talking cure." Like psychoanalysis, psychodynamic
therapy recognizes that the relationships and circumstances of
early life continue to affect people as adults, that human behavior
results from unconscious as well as conscious or rational motives,
and that the act of talking about problems can help people find
ways to solve them or at least to bear them.
Both psychoanalysis and psychodynamic therapy rely on the
therapeutic alliance in order to work. The therapeutic alliance is
the personal connection between therapist and patient that enables
them to work in tandem so that the patient can gain insight into
aspects of experience that may be difficult to talk and think
about. As the therapeutic alliance deepens, a therapist helps
patients to understand themselves in new ways, and to become more
mindful of a greater range of their thoughts, feelings,
perceptions, and experiences. Dr. Glen Gabbard, professor of
psychiatry and psychoanalysis at Baylor College of Medicine, has
called the therapeutic alliance the "envelope" within which
psychodynamic therapy takes place.
Although modern therapists frequently question the distinction, it
is useful to note that psychodynamic therapy and psychoanalysis
differ in some ways. During psychoanalysis, patients generally
attend meetings three to five days a week, whereas in psychodynamic
therapy, a patient typically sees a therapist once or twice a week.
Thus the intensity of the therapeutic relationship is greater in
psychoanalysis. Both psychoanalysis and the long-term form of
psychodynamic therapy may be conducted in an open-ended manner,
over many years, with the patient and therapist/analyst taking as
much time as they need to decide about the duration of treatment.
Short-term treatment with psychodynamic therapy, in contrast, is
time-limited and usually lasts less than six months.
The Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV)
describes five pervasive developmental disorders: autistic
disorder, childhood disintegrative disorder, Asperger's disorder,
Rett's disorder, and pervasive developmental disorder not otherwise
specified. Although they differ in some specifics, these disorders
share three core features: impaired social interactions, difficulty
in communicating with others, and repetitive or inflexible
behavior. Recognizing that these disorders differ mainly in terms
of severity, authors of the draft DSM-V, now undergoing review, have
proposed deleting Rett's disorder and including the other four
under the single category of autism spectrum disorder (ASD).
It remains unclear what causes an ASD, but most risk factors are
genetic. When one identical twin develops an ASD, then 82% to 92%
of the time the other one (who shares the same genes) will also
develop the disorder. The concordance rate drops to 10% or less in
fraternal twins, who share only some genes.
ASDs affect roughly one in 150 children, although some studies
suggest the prevalence may be higher. ASD diagnoses have been
increasing since the 1960s, but it remains unclear whether this is
because of better awareness and assessment, or some unknown
environmental factor that triggers these disorders in children who
are genetically susceptible.
There is no cure for any ASD, but early interventions — mainly
educational and psychosocial — take advantage of the developing
brain's ability to change in response to experience. As such, early
interventions may help improve a child's ability to communicate and
interact with others. An ongoing challenge, however, is making the
diagnosis as early as possible. In the United States, children are
4 to 5 years old, on average, when first diagnosed with an ASD,
even though parents generally express concerns about atypical
development much earlier, when children are 12 to 18 months old.
Although multiple psychotherapy and medication options exist for
treating major depression, they don't work for everyone. Patients
who have not responded to medication, or who have not been able to
tolerate other options, may be eligible for repetitive transcranial
magnetic stimulation (rTMS). The FDA in 2008 approved the first
repetitive rTMS device specifically for treating major depression
that has not responded to at least one medication taken at adequate
dose and duration (usually defined as at least four weeks). A
federally funded study provided further guidance about its use.
First, some caveats. Repetitive TMS is likely to be offered only
after several mainstream treatments for major depression have
already been tried; this method is not recommended for patients
with mild depression or newly diagnosed major depression. And rTMS
has not been studied in pregnant women or youths younger than 18.
A survey of hundreds of thousands of Americans found that people
in middle and older age were happier overall than younger people.
Researchers used a driving simulator to explore why talking on a
cell phone while driving is more distracting than talking to a
passenger in the car.
What is catatonia? You hardly hear about it anymore. Has it been