روان‌درمانی

Purpose: This study aimed to phenomenologically explore clients’ lived experiences of the dialectic between success and failure in psychotherapy, with particular emphasis on interactional patterns, therapeutic alliance, and the relational processes underlying perceived therapeutic effectiveness or rupture. Methods and Materials: This qualitative study employed a descriptive–interpretive phenomenological design. The study population comprised individuals with prior experience of individual psychotherapy. Using purposive sampling with maximum variation in successful, unsuccessful, and ambivalent therapeutic experiences, 18 participants were recruited until experiential and thematic saturation was achieved. Data were collected through in-depth semi-structured interviews focused on clients’ perceptions of therapeutic interactions, relational safety, clinical responsiveness, treatment ruptures, and factors contributing to continuation or discontinuation of therapy. Interviews were transcribed verbatim and analyzed according to Colaizzi’s seven-step phenomenological method. MAXQDA software was used to organize, code, compare, and integrate the qualitative data and facilitate the development of overarching thematic structures. Findings: The analysis indicated that perceived therapeutic success emerged from an interconnected relational configuration characterized by a “liberating secure bond,” flexible clinical competence, unconditional acceptance, and empathic regulation of emotions. These processes strengthened clients’ sense of psychological safety, participation, trust, and agency and facilitated sustained therapeutic engagement. Conversely, perceived therapeutic failure was associated with technical rigidity, excessive dependence on inflexible protocols, authoritarian interactional patterns, and violations of client agency. The convergence of these relational disruptions progressively weakened the therapeutic alliance, intensified emotional exhaustion and alienation, and, in some cases, culminated in disengagement or premature termination. Conclusion: Psychotherapy appears to function fundamentally as an intersubjective encounter in which technical interventions become effective when embedded within clinical humility, relational flexibility, democratic collaboration, empathic responsiveness, and respect for clients’ dignity and autonomy.

هدف: این مطالعه با هدف کاوش پدیدارشناختی تجارب زیسته مراجعان از دیالکتیک میان موفقیت و شکست در روان‌درمانی، با تأکید ویژه بر الگوهای تعاملی، اتحاد درمانی و فرایندهای ارتباطی زیربنایی اثربخشی یا گسست ادراک‌شده درمان انجام شد. روش‌ها و مواد: این پژوهش کیفی با رویکرد پدیدارشناسی توصیفی-تفسیری انجام شد. جامعه پژوهش شامل افرادی بود که تجربه قبلی روان‌درمانی فردی داشتند. با استفاده از نمونه‌گیری هدفمند با حداکثر تنوع در تجارب درمانی موفق، ناموفق و دوسویه، ۱۸ نفر تا رسیدن به اشباع تجربی و تماتیک انتخاب شدند. داده‌ها از طریق مصاحبه‌های نیمه‌ساختاریافته عمیق که بر ادراک مراجعان از تعاملات درمانی، ایمنی رابطه‌ای، پاسخ‌دهی بالینی، گسست‌های درمانی و عوامل مؤثر بر ادامه یا قطع درمان متمرکز بود، گردآوری شد. مصاحبه‌ها به‌صورت کلمه‌به‌کلمه پیاده‌سازی و بر اساس روش هفت‌مرحله‌ای پدیدارشناسی Colaizzi تحلیل شدند. نرم‌افزار MAXQDA برای سازماندهی، کدگذاری، مقایسه و یکپارچه‌سازی داده‌های کیفی و تسهیل توسعه ساختارهای تماتیک کلان به‌کار رفت. یافته‌ها: تحلیل داده‌ها نشان داد که موفقیت ادراک‌شده درمانی از پیکربندی رابطه‌ای درهم‌تنیده‌ای ناشی می‌شود که با «پیوند ایمن رهایی‌بخش»، شایستگی بالینی انعطاف‌پذیر، پذیرش بی‌قیدوشرط و تنظیم همدلانه هیجانات مشخص می‌شود. این فرایندها حس ایمنی روان‌شناختی، مشارکت، اعتماد و عاملیت مراجعان را تقویت کرده و تداوم مشارکت درمانی را تسهیل می‌کنند. در مقابل، شکست ادراک‌شده درمانی با خشکی فنی، اتکای بیش از حد به پروتکل‌های غیرقابل انعطاف، الگوهای تعاملی اقتدارگرایانه و نقض عاملیت مراجع مرتبط بود. همگرایی این اختلالات رابطه‌ای به‌تدریج اتحاد درمانی را تضعیف کرده، فرسودگی هیجانی و بیگانگی را تشدید نموده و در برخی موارد به قطع ارتباط یا پایان زودهنگام درمان منجر شد. نتیجه‌گیری: به نظر می‌رسد روان‌درمانی اساساً به‌مثابه یک مواجهه بین‌ذهنی عمل می‌کند که در آن مداخلات فنی زمانی اثربخش می‌شوند که در بستر فروتنی بالینی، انعطاف‌پذیری رابطه‌ای، همکاری دموکراتیک، پاسخ‌دهی همدلانه و احترام به کرامت و خودمختاری مراجعان قرار گیرند.

Abstract Background Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care. Methods Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data. Results Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group. Conclusions The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT. Trial registration ClinicalTrials.gov NCT05946382 registered July 14, 2023.

Psychotherapy is supported by evidence across several psychological conditions, yet its value cannot be understood solely through symptom change. This thematic integrative review examines psychotherapy as both an intervention and a relational setting in which psychological safety, trust, collaboration, and self-understanding may support change. Literature discussed in the source synopsis is organized around three themes: psychotherapy outcomes across mood, anxiety, trauma-related, and personality difficulties; the therapeutic alliance and safety; and adapted, neurodiversity-affirming support for autistic people. Meta-analytic and theoretical literature generally supports psychotherapy effectiveness, while alliance research identifies the therapeutic relationship as a robust correlate of outcomes. Work on autistic youth suggests that adapted interventions can be beneficial, although outcomes and methods vary. Across these areas, the review identifies a need to connect clinical outcomes with clients? lived experience of safety, identity, accessibility, and agency. The review is integrative rather than systematic: the source material does not document reproducible database searches, screening counts, or formal quality appraisal. Accordingly, conclusions are interpretive and should not be treated as a comprehensive estimate of treatment effects. The paper argues for therapeutic spaces that combine evidence-informed care with collaborative, individualized, and affirming relationships.

ABSTRACT Introduction Anxiety is central to the psychotherapy process, yet psychotherapists routinely infer a client's anxiety intensity from observable behaviour rather than from formal measurement, with no widely accepted framework to organise which observable markers indicate which levels of anxiety. This exploratory study examined how therapists make such classifications. Method Ninety‐one mental health professionals were randomly assigned to classify 41 text‐described behavioural and physiological markers using either a 5‐level or a simplified 3‐level category system, both derived from an integrated model of state anxiety in psychotherapy. Results Response distributions departed significantly from uniformity for nearly all markers in both formats, and the rank ordering of markers by intensity was highly consistent across formats, suggesting that therapists may share broad intuitions about relative marker intensity. Which markers elicited agreement, however, was far less reproducible, depending substantially on the response format. Convergence also depended on where the agreement criterion was set, declining from 90.2% to 51.2% of markers in the 3‐level format and from 63.4% to 22.0% in the 5‐level format as the criterion rose from > 0.50 to > 0.70. The 3‐level format yielded more classifiable markers at every criterion, although this advantage was not consistent across indices, whereas the 5‐level format elicited fewer ‘Insufficient to Determine’ responses. Markers placed at the highest intensity levels were classified most consistently. Discussion These findings offer preliminary groundwork for research on marker operationalisation, contextualised rating tasks and the development of training materials for psychotherapy process research.

Anxiety symptoms can cause distress and interfere with social, occupational, and everyday functioning. Cognitive behavioural therapy (CBT) is a structured psychological intervention widely used in the treatment of anxiety disorders. This manuscript is based on the dissertation titled "A Study to Assess the Effectiveness of Cognitive Behavioural Therapy Among Patients with Severe Anxiety Disorder". The dissertation reports Beck Anxiety Inventory (BAI) results for 20 participants: 12 (60%) were in the minimal or "not at all" category, five (25%) in the mild category, two (10%) in the moderate category, and one (5%) in the severe category. These findings describe the anxiety-severity profile of the sample. The available results do not include verified pre-treatment and post-treatment scores, a comparison-group analysis, or inferential statistics sufficient to establish CBT effectiveness. The reported data therefore cannot demonstrate that CBT reduced anxiety in this sample. Findings should be interpreted cautiously because of the small sample and limited information about recruitment, participant characteristics, and intervention delivery.

Counselling researchers have spent decades arguing about why counselling works. One philosophical camp locates the active ingredient in specific techniques tied to specific disorders. The other locates it in factors common to all bona fide therapies, chiefly the relationship between counsellor and client. This article develops a process-based perspective on the debate, examining how relational and technical elements are used within an unfolding therapeutic interaction. Drawing on the equivalence findings, the contemporary alliance literature, the unresolved question of causal mediation, the routine outcome monitoring evidence, and Australian decolonising scholarship, I propose a culturally situated responsive calibration model. The model reframes the therapist’s continuous, feedback-informed adjustment of relational and technical elements, made within the client’s cultural frame of wellbeing, as a proposed proximal mechanism of change. Calibration is not a new observation about good practice. Building on established responsiveness theory, the proposed contribution is to organise testable episodes of clinical judgement around feedback, action, and the client’s definition of wellbeing. Four testable propositions are advanced, including tests of whether calibration adds explanatory value beyond established process and treatment measures. Implications for practice, training, and measurement are outlined. The model is offered as a conceptual framework awaiting empirical testing, not as an established finding.

Reflective Practice (RP) is widely regarded as a cornerstone of psychotherapy training, supervision, and continuing professional development. Yet, despite its prominence across psychotherapeutic traditions, it remains conceptually vague and empirically contested. Recent critiques from basic psychological science (e.g., Lilienfeld & Basterfield, 2020) have argued that reflection may amplify cognitive bias and foster illusions of insight rather than improve clinical judgment. We argue that these criticisms carry weight precisely because the field has often failed to clearly define what RP is, how it functions, and under what conditions it becomes beneficial or harmful. Drawing on developmental models of therapist learning, we conceptualize RP as a multidimensional construct encompassing reflexivity as a capacity, reflective stance as an attitude, and reflection as activity. We propose that RP is most likely to support development when relationally scaffolded, informed by external feedback, and oriented toward testing and revising interpretations rather than confirming them. Reviewing developmental, quantitative, qualitative, and process-oriented evidence, we further argue that RP operates primarily as a probabilistic, context-dependent contributor to therapist development rather than as a discrete intervention with predictable outcomes. We conclude that RP is neither a panacea nor an illusion. Rather, when relationally scaffolded, theoretically informed, and oriented toward learning rather than certainty, it may provide a central mechanism through which therapists learn from clinical experience. Effective psychotherapy depends not only on therapeutic concepts and techniques but also on therapists’ ability to reflect on their clinical work, relationships, and decision-making. This paper conceptualizes Reflective Practice as a developmental process through which therapists may learn from experience, adapt to complex clinical situations, and develop their understanding and skills throughout their professional careers.

Mental health systems face a persistent gap in accessible, continuous, and person-centred support. Conversational AI can expand access to psychoeducation, emotional check-ins, self-management, and service navigation, but may also introduce risks of digital exclusion, cultural mismatch, privacy concerns, unsafe advice, and overreliance on automation. This paper develops a conceptual framework integrating Orange Technology, which promotes emotional wellbeing, cultural sensitivity, social connectedness, and resilience, with empathetic AI for mental health support. An integrative literature review examined peer-reviewed systematic reviews and WHO and UN guidance published from 2021 to 2026. Evidence suggests that conversational AI can improve depression, distress, anxiety, and engagement, although effects are heterogeneous and may decline over time. Personalization and empathic interaction may enhance engagement, while the framework's effects on community resilience, cultural sensitivity, and community resource integration require further empirical validation. The framework therefore positions AI as a supportive, human-in-the-loop layer rather than a replacement for clinicians, families, peers, or communities. It connects emotional sensing, empathetic dialogue, personalized support, escalation pathways, community connection, inclusive access, and governance, while aligning mental health innovation with SDG 3, 9, and 17.

Background Helping professionals face elevated risks of compassion fatigue and burnout, yet the daily processes through which emotional transformation occurs during therapeutic interventions remain poorly understood. This study examined how participants’ daily reflections shifted across the Emotion-Focused Training for Helping Professions (EFT-HP), analyzed through three complementary theoretical frameworks: Emotion-Focused Therapy's inner dialogue model (self-criticism, self-compassion, self-protection), Compassion-Focused Therapy's three-systems framework (threat, drive, soothing), and Ekman's basic emotion theory (primary emotions). Method Two hundred twenty-five helping professionals (88.0% female; M age = 38.7 years) from healthcare, social work, psychology, and education began the 14-day online EFT-HP intervention. Primary analyses focused on the 146 participants who completed at least 9 of the 14 days (completers), whose daily written reflections yielded 7,307 coded reflection units. Reflections were analyzed with directed content analysis and frequency quantification, applying non-exclusive, AI-assisted coding within three theoretical frameworks—EFT inner-dialogue categories, CFT emotion-regulation systems, and Ekman's discrete emotions—with a verbatim textual evidence excerpt retained for every assigned code. Results Across the intervention, participants’ reflections shifted from threat- and self-criticism-related content toward soothing and self-compassion. Within the EFT inner-dialogue framework, Self-Compassion was the most frequent category (17.9% of units) and was sustained throughout (Day-13 peak 30.8%), while Self-Criticism fell from 14.3% on Day 1 to 3.9% on Day 14 (73% relative decrease) and Self-Protection peaked on Day 6 (11.3%). Within the CFT emotion-regulation framework, the soothing system was the most frequently coded system overall (31.8% of units), followed by drive (20.4%); over the 14 days the threat system declined from 35.4% on Day 1 to 7.0% on Day 14 (80% relative decrease). Within Ekman's discrete-emotion framework, specific emotions were named less frequently: Fear declined from 2.7% to 0.8%, Anger peaked on Day 6 (15.0%), Joy rose to a Day-13 peak (14.8%), and Love was comparatively prominent (11.9% overall, Day-5 peak). Conclusions Across the 14-day intervention, participants’ daily reflections showed substantial shifts in emotional content, characterized by marked self-criticism and threat reduction alongside sustained self-compassion and soothing activation. Triangulated findings across three analytical frameworks: EFT inner dialogue, CFT emotion systems, and Ekman's primary emotions, are consistent with the emotional-transformation processes proposed by EFT-HP and with findings from previous controlled trials. Because the three frameworks were applied to the same reflection data, their convergence reflects analytic (theoretical) triangulation rather than independent confirmation.

Developing effective therapeutic protocols for LGBTQIA+ individuals requires a commitment to practices that do not perpetuate suffering. Addressing negative internalizations and minority stress are two common transdiagnostic aspects within this population. Therapeutic models, such as Schema Therapy (ST), have emerged as a promising strategy; however, research in this area is scarce. This study aimed to evaluate an Affirmative ST program for LGB individuals. The program was tested in a pilot study involving nine participants. A total of 10 sessions were conducted, and the evaluation focused on: positive and negative affect, anxiety, stress (including minority stress), and depression. The effects of the intervention were analyzed using the Hageman-Arrindell approach and GEE. Significant differences were found for: reduction in depression; stress; anxiety; negative affect; and an increase in positive affect and stigma perception. This research represents a pioneering effort in the field of ST with LGBTQIA+ individuals, and further studies are encouraged.

Recent advances in artificial intelligence (AI) call for a renewed examination of the ontological meaning of the human being and the nature of psychoanalytic treatment.AI-based mental health interventions show potential for improving the accessibility and efficiency of care; however, current AI systems generate verbal responses on the basis of statistical patterns, and it remains difficult to regard them as capable of performing, in the same manner as human therapists, the embodied emotional experience and relational internal transformation that psychoanalytic treatment entails.This paper conceptualizes the persistent delegation of psychological functions to external systems as the "outsourced ego" and examines the possibility that this phenomenon may, over time, lead to a weakening of ego functions and a delay in the formation of subjectivity.It also discusses the structural problems of AI-based treatment, including the lack of explainability, the reinforcement of self-deceptive narratives through hallucination, and the absence of ethical responsibility.In addition, this paper considers the difficulty of implementing, in an AI-mediated environment, core mechanisms of psychoanalytic interaction such as containment, transference and countertransference, and the analytic third.In response, it proposes four practical virtues for preserving humanity in the age of AI: reflexivity, negative capability, relational courage, and responsible subjectivity.In conclusion, the development of AI technology should not remain confined to the question of whether human therapists can be replaced; rather, it should serve as an opportunity to reflect more clearly on the distinctiveness of human existence, which lies in the capacity to endure imperfection and live with others.

Background Stroke is a leading cause of disability worldwide and is frequently accompanied by psychological and functional impairments. Acceptance and Commitment Therapy (ACT), a third-wave behavioral intervention focusing on psychological flexibility, has been increasingly applied in stroke rehabilitation. Although previous reviews have suggested beneficial effects of ACT in stroke patients, whether these benefits persist in the short term after the intervention ends, and the certainty of the evidence, remain unclear. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261325108). Randomized controlled trials evaluating ACT in stroke patients were included. Pooled effects were calculated using random-effects models, with separate analyses for post-intervention and follow-up outcomes. Sources of heterogeneity were explored using subgroup analyses and meta-regression. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE framework. Results Twenty-two RCTs involving 1,975 participants were included. ACT may be associated with reductions in depressive symptoms (post-intervention: SMD = −1.32, 95% CI: −1.80 to −0.84; follow-up: SMD = −0.76, 95% CI: −1.07 to −0.45) and anxiety symptoms (post-intervention: SMD = −1.36, 95% CI: −1.90 to −0.82; follow-up: SMD = −0.51, 95% CI: −1.42 to 0.40, not significant); depressive symptoms remained statistically significant at follow-up. Heterogeneity was considerable for both outcomes at post-intervention ( I 2 = 93.68% for depression and 93.60% for anxiety), so the pooled estimates represent average effects across studies. ACT may also be associated with improvements in psychological flexibility, quality of life, and sleep quality; however, these outcomes were based on a limited number of studies and showed considerable heterogeneity ( I 2 = 74.68 to 92.26%), so they should be interpreted cautiously. However, no statistically significant effects were observed for activities of daily living, neurological function, or hope. ACT did not appear to increase dropout rates in the available studies ( K = 16; RR = 0.99, 95% CI: 0.58–1.69). Meta-regression analyses indicated that intervention duration may not be a significant moderator of treatment effects. The certainty of evidence ranged from very low to moderate, mainly due to risk of bias and inconsistency. Conclusion Acceptance and Commitment Therapy may be a useful adjunctive intervention for improving psychological outcomes in people with stroke. However, evidence for functional recovery remains insufficient. Future high-quality RCTs with standardized protocols, larger samples, and longer follow-up are needed to confirm the long-term effectiveness of ACT. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifer CRD420261325108.

Psychoanalysis occupies a unique position in psychiatry, simultaneously a body of knowledge, a method of clinical investigation, and a form of treatment. Despite its relevance to clinical practice, postgraduate psychiatry residents often encounter the subject with limited structured exposure, resulting in either fascination or dismissal. This primer aims to bridge that gap by providing an accessible, theoretically grounded introduction to psychoanalysis and its derivatives psychoanalytic psychotherapy and psychodynamic psychotherapy for postgraduate psychiatry residents. It outlines the core principles of psychoanalytic theory, the evolution of the field since Freud, key underlying neurobiological concepts, and the common factors shared across various dynamic therapies. The paper does not serve as a training manual, nor does it provide detailed accounts of individual defense mechanisms, models of mind, dream analysis, drive theory, or the historical development of analytic schools. It is intended to sensitize residents to the field and provide a foundation for further independent study.

Background: Individuals with complex trauma may continue to experience emotional distress, rumination, and maladaptive response patterns despite pharmacological treatment. Integrative interventions addressing affective responses, maladaptive patterns, and adaptive functioning warrant further clinical investigation. Case presentation: This report describes a 23-year-old woman diagnosed with complex trauma who her psychiatrist referred because she was not responding adequately to prescribed antidepressant and anti-anxiety medication. She received an eight-session intervention delivered in three phases: one session of Wiring Affect with ReAttach (W.A.R.A.®) on Day 1; one session of Brain-Switch 2.0® on Day 2 to address maladaptive brain patterns; and six subsequent ReAttach® sessions, emphasizing Cognitive Bias Modification (CBM) 3, followed by CBM 1 and CBM 2. Clinical observations: Following the Day 1 W.A.R.A.® session, the client reported a quieter mind, reduced rumination, greater calmness, and sleeping that night without sleeping medication. Brain-Switch 2.0® was administered on Day 2, which further enhanced her self-agency. Subsequent ReAttach® sessions integrated her sense of identity and improved boundary setting with her parents. At one-month post-therapy follow-up, the client reported improved management of rumination, greater emotional regulation, anxiety within normal ranges, preserved cognitive functioning despite ongoing family difficulties, and greater satisfaction with herself. Pre–post quantitative electroencephalography (qEEG) data showed changes in several recorded measures. The qEEG data indicated the absence of previous mental sluggishness, a clinically significant improvement in the trauma-related marker and emotional regulation within the normative range, and the absence of a depression-related marker.

Background Clinical research on psychedelic-assisted therapy (PAT) has expanded substantially in recent years, particularly for post-traumatic stress disorder (PTSD) and depressive disorders. Contemporary studies have generally evaluated psychedelic administration within controlled therapeutic settings that include psychological support, preparation, and integration. However, variability in clinical response and methodological challenges have highlighted the importance of individual, relational, and contextual factors, often described as “set and setting,” in understanding therapeutic outcomes. The role of psychotherapy and the broader therapeutic context therefore remains an important area of investigation. Objective This scoping review aimed to map the contemporary evidence on PAT, characterize the clinical and psychotherapeutic approaches used with psilocybin, MDMA, LSD, and DMT, summarize reported clinical and safety findings, and identify methodological, mechanistic, ethical, and implementation considerations across existing protocols. Methods A structured search of PubMed, PsycINFO, Scopus, and ClinicalTrials.gov was conducted on 23 February 2026. Sources published or publicly available between January 2020 and November 2025 were eligible. The review included peer-reviewed and relevant non-peer-reviewed sources addressing psychedelic-assisted interventions, including primary clinical studies, reviews, clinical trial registrations, regulatory documents, and other relevant contextual sources. Records were managed using Zotero and screened against predefined Population, Concept, and Context criteria. Findings were synthesized descriptively according to source type and evidence domain. Results The mapped evidence was most developed for MDMA-assisted therapy in PTSD and psilocybin-assisted interventions for depressive disorders. Randomized clinical trials reported reductions in PTSD and depressive symptoms following MDMA- and psilocybin-based interventions, respectively, while emerging clinical evidence also investigated LSD-based treatment for generalized anxiety disorder. Evidence for DMT-assisted therapy remained comparatively preliminary, with several available sources consisting of trial registrations or industry-reported information. Across the literature, preparation, supervised psychedelic administration, and integration were common therapeutic components, although the structure and intensity of psychotherapy varied substantially. Functional unblinding, expectancy effects, heterogeneity of psychotherapeutic approaches, and limitations in long-term safety data were recurring concerns. Ethical issues included informed consent during altered states of consciousness, therapist competence and boundaries, cultural considerations, and equitable access. Conclusion PAT represents a rapidly developing area of clinical research, but the evidence base remains heterogeneous across compounds, indications, therapeutic models, and levels of evidential maturity. Future research should improve the standardization and reporting of psychotherapeutic interventions, strengthen methods for assessing blinding and expectancy, establish consistent long-term safety monitoring, and develop robust ethical and equity frameworks. Clear distinction between peer-reviewed clinical findings and preliminary or contextual evidence will also be essential as PAT research progresses toward broader clinical implementation.

This article establishes the intersection of psychiatry and refugeedom as an area of historiographical inquiry. It traces how psychoanalysis was refracted through the paradigm of interwar mental hygiene and rescaled to a community level in the post-Second World War refugee camp, thereby contributing to the genesis of postwar international mental health. I examine the career of the Swiss Maria Pfister-Ammende from psychiatrist and psychoanalyst, to director of a refugee psychotherapeutic service in refugee camps in Switzerland, to international mental health expert at the World Health Organization. I situate her attempt at codifying an ‘uprooting neurosis’ within the genealogy of the medicalization of mobility and migration from nostalgia in the late 17th century to trauma in the late 20th. Implications for the historiography of refugee psychiatry and global mental health are considered.

این مقاله تلاقی روان‌پزشکی و پناهندگی را به‌عنوان حوزه‌ای برای پژوهش‌های تاریخ‌نگارانه مطرح می‌کند. مقاله به بررسی این می‌پردازد که چگونه روان‌کاوی از خلال پارادایم بهداشت روانی میان‌دوره‌ای بازتاب یافته و در سطح اجتماع در اردوگاه‌های پناهندگان پس از جنگ جهانی دوم بازمقیاس شده است و بدین‌ترتیب به پیدایش سلامت روان بین‌المللی پس از جنگ کمک کرده است. نگارنده مسیر حرفه‌ای Maria Pfister-Ammende، روان‌پزشک و روان‌کاو سوئیسی، را از فعالیت به‌عنوان روان‌پزشک و روان‌کاو تا مدیریت خدمات روان‌درمانی پناهندگان در اردوگاه‌های سوئیس و سپس به‌عنوان کارشناس سلامت روان بین‌المللی در سازمان جهانی بهداشت بررسی می‌کند. تلاش او برای تدوین مفهوم «نوروز ریشه‌کنی» را در تبارشناسی پزشکی‌سازی جابه‌جایی و مهاجرت، از نوستالژی در اواخر قرن هفدهم تا تروما در اواخر قرن بیستم، جای می‌دهد. پیامدهای این موضوع برای تاریخ‌نگاری روان‌پزشکی پناهندگان و سلامت روان جهانی مورد بررسی قرار می‌گیرد.

Background Resilience is increasingly understood as a dynamic, ecological process; however, prevailing psychiatric models continue to emphasize individual traits, thereby neglecting collective and culturally embedded forms of endurance. Sumud (Arabic: صمود), broadly translating as steadfastness, perseverance, and endurance, sustains identity, dignity, and daily life under chronic adversity across the Arab world and functions as a relational and ethical orientation. This review examines sumud as a resilience framework for transcultural psychiatry and psychotherapy. Aims To synthesize conceptualizations of sumud in relation to resilience, coping, and adaptation, and to evaluate implications for narrative, family-based, group, community-oriented, and arts-informed therapeutic approaches. Methods A PRISMA 2020-guided systematic narrative review was conducted. Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched covering publications up to 1 June 2026. English-language studies were eligible if they explicitly examined sumud as a cultural, psychological, or collective construct with relevance to resilience, coping, or psychotherapy. Eligible publication types included qualitative, quantitative, and mixed-methods empirical studies; theoretical and conceptual papers; ethnographies; narrative analyses; and reviews. Data were thematically synthesized using a predefined extraction matrix. The review was registered with PROSPERO (CRD420261279052). Results Thirty-nine studies met the inclusion criteria. Descriptively sumud emerged as a multilevel, collective form of resilience enacted through family systems, intergenerational narratives, cultural practices, and institutional structures. Substantively, it supported meaning-making, emotional regulation, and identity continuity. Critically, ethical tensions and cumulative burdens were documented, particularly for women, caregivers, and professionals., and rigorously evaluated, sumud-informed psychotherapeutic interventions remain scarce, notwithstanding a general preference in mental health studies for social-ecological models and narrative, family-based, group, and arts-based therapeutic approaches. Conclusions Theoretically, sumud challenges individualistic psychiatric frameworks by offering a culturally embedded, collective model of resilience. Clinically, it urges clinicians to engage with patients’ narratives, relational worlds, and cultural practices, while remaining attentive to the costs of endurance. Prospectively, in the context of ongoing conflicts and humanitarian crises affecting parts of the Middle East and Gulf region, sumud warrants renewed scholarly and clinical attention for the development of culturally responsive, resilience-informed psychotherapies. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420261279052.

زمینه: تاب‌آوری به‌طور فزاینده‌ای به‌عنوان فرایندی پویا و بوم‌شناختی درک می‌شود؛ با این حال، مدل‌های غالب روان‌پزشکی همچنان بر ویژگی‌های فردی تأکید دارند و بدین‌ترتیب اشکال جمعی و فرهنگیِ تاب‌آوری را نادیده می‌گیرند. صمود (عربی: صمود)، که به‌طور کلی به معنای استواری، پایداری و بردباری است، هویت، کرامت و زندگی روزمره را در شرایط دشواری مزمن در سراسر جهان عرب حفظ می‌کند و به‌عنوان رویکردی رابطه‌ای و اخلاقی عمل می‌کند. این مرور، صمود را به‌عنوان چارچوبی برای تاب‌آوری در روان‌پزشکی و روان‌درمانی فراملی بررسی می‌کند. اهداف: تلفیق مفاهیم صمود در ارتباط با تاب‌آوری، مقابله و سازگاری و ارزیابی پیامدها برای رویکردهای درمانی مبتنی بر روایت، خانواده‌محور، گروهی، جامعه‌محور و مبتنی بر هنر. روش‌ها: مرور روایی نظام‌مند با راهنمای PRISMA 2020 انجام شد. چهار پایگاه داده الکترونیکی (PubMed، Scopus، Web of Science و Embase) تا تاریخ ۱ ژوئن ۲۰۲۶ جست‌وجو شدند. مطالعات انگلیسی‌زبان در صورتی واجد شرایط بودند که صمود را به‌عنوان سازه‌ای فرهنگی، روان‌شناختی یا جمعی با ارتباط با تاب‌آوری، مقابله یا روان‌درمانی به‌طور صریح بررسی کرده باشند. انواع انتشارات واجد شرایط شامل مطالعات تجربی کیفی، کمی و روش‌های ترکیبی؛ مقالات نظری و مفهومی؛ قوم‌نگاری‌ها؛ تحلیل‌های روایی؛ و مرورها بودند. داده‌ها با استفاده از ماتریس استخراج از پیش تعیین‌شده، به‌صورت موضوعی تلفیق شدند. این مرور در PROSPERO (CRD420261279052) ثبت شد. نتایج: سی‌ونه مطالعه معیارهای ورود را داشتند. به‌صورت توصیفی، صمود به‌عنوان شکلی چندسطحی و جمعی از تاب‌آوری که از طریق نظام‌های خانوادگی، روایت‌های میان‌نسلی، رویه‌های فرهنگی و ساختارهای نهادی تحقق می‌یابد، ظاهر شد. به‌طور اساسی، صمود از معنا‌بخشی، تنظیم هیجانی و تداوم هویت حمایت می‌کرد. به‌طور انتقادی، تنش‌های اخلاقی و بارهای تجمعی، به‌ویژه برای زنان، مراقبان و حرفه‌ای‌ها، مستند شده است. با وجود ترجیح کلی در مطالعات سلامت روان برای مدل‌های اجتماعی-بوم‌شناختی و رویکردهای درمانی روایی، خانواده‌محور، گروهی و مبتنی بر هنر، مداخلات روان‌درمانی مبتنی بر صمود که به‌طور دقیق ارزیابی شده باشند، همچنان کمیاب‌اند. نتیجه‌گیری: از نظر نظری، صمود با ارائه مدلی جمعی و فرهنگی از تاب‌آوری، چارچوب‌های فردگرایانه روان‌پزشکی را به چالش می‌کشد. از نظر بالینی، صمود درمانگران را به درگیر شدن با روایت‌ها، جهان‌های رابطه‌ای و رویه‌های فرهنگی بیماران فرا می‌خواند، در حالی که باید به هزینه‌های تاب‌آوری نیز توجه داشت. از منظر آینده، در زمینه تداوم منازعات و بحران‌های انسانی در بخش‌هایی از خاورمیانه و منطقه خلیج فارس، صمود شایسته توجه مجدد علمی و بالینی برای توسعه روان‌درمانی‌های مبتنی بر تاب‌آوری و پاسخگو به فرهنگ است. ثبت مرور نظام‌مند: https://www.crd.york.ac.uk/prospero/ ، شناسه CRD420261279052.

Borderline personality disorder (BPD) may be overlooked when the therapist does not occupy the role of primary attachment object. In such cases, characteristic borderline dynamics emerge chiefly in external relationships rather than within psychotherapy, leading clinicians to underestimate the disorder. Drawing on Gunderson's original ego psychology-object relations model, this paper argues that BPD is fundamentally organised around relationships with emotionally significant others. Diagnostic formulations that rely heavily on transference dynamics may therefore miss BPD in seemingly organised patients whose central conflicts are enacted outside treatment. Gunderson's model thus remains essential for understanding the interpersonal core of borderline psychopathology.

اختلال شخصیت مرزی ممکن است زمانی نادیده گرفته شود که درمانگر نقش شیء دلبستگی اصلی را ایفا نمی‌کند. در چنین مواردی، پویایی‌های مرزی شاخص عمدتاً در روابط بیرونی و نه درون روان‌درمانی ظاهر می‌شوند و این امر منجر به کم‌برآوردی این اختلال توسط درمانگران می‌گردد. با استناد به مدل روان‌شناسی ایگو ـ روابط شیء گاندرسون، این مقاله استدلال می‌کند که اختلال شخصیت مرزی اساساً حول روابط با دیگرانِ هیجانی مهم سازمان می‌یابد. بنابراین، فرمول‌بندی‌های تشخیصی که به‌شدت بر پویایی‌های انتقالی تکیه دارند، ممکن است اختلال شخصیت مرزی را در بیمارانی که به ظاهر سازمان‌یافته‌اند و تعارضات مرکزی آن‌ها خارج از درمان به نمایش گذاشته می‌شود، از دست بدهند. مدل گاندرسون همچنان برای فهم هسته بین‌فردی آسیب‌شناسی روانی مرزی ضروری باقی می‌ماند.

The purpose of the article is to integrate psychoanalytic knowledge on adolescence with the anthropological changes that have occurred in recent decades and that have had significant effects on the process of identity maturation. There is a shift in the mental center of gravity, from identifications with parents to the group of peers, which helps to address this detachment. The group of peers not only fosters ego capacities for collaboration and friendship but also elicits deep unconscious resonances. To illustrate the relationship established between childhood identifications with parents and the group of peers, the psychoanalytic therapy of an adolescent girl Silvia, victim of her classmates is reported.

هدف این مقاله، تلفیق دانش روان‌تحلیلی درباره نوجوانی با تغییرات انسان‌شناختی است که در دهه‌های اخیر رخ داده‌اند و تأثیرات قابل توجهی بر فرایند بلوغ هویت داشته‌اند. در این زمینه، مرکز ثقل ذهنی از همانندسازی با والدین به سوی گروه همسالان تغییر می‌کند که این امر به تسهیل جدایی از والدین کمک می‌کند. گروه همسالان نه تنها ظرفیت‌های ایگو برای همکاری و دوستی را پرورش می‌دهد، بلکه طنین‌های عمیق ناخودآگاه را نیز برمی‌انگیزد. به منظور تبیین رابطه‌ای که میان همانندسازی‌های دوران کودکی با والدین و گروه همسالان برقرار می‌شود، روان‌درمانی تحلیلی یک دختر نوجوان به نام Silvia که قربانی همکلاسی‌های خود بوده است، گزارش می‌شود.

OBJECTIVE: Prior evidence suggests that people from racial/ethnic minority (REM) groups experience greater psychological distress, especially if they are isolated from their cultural ingroup. This study examined associations between REM status and psychological symptoms measured before and after therapy, as well as interactions with neighbourhood-level REM density. METHOD: Electronic health records from 130,857 patients who accessed psychological interventions in primary care services in England were analyzed. Pre- and post-treatment depression (PHQ-9), anxiety (GAD-7) and functional impairment measures (WSAS) were linked to individual-level and neighbourhood-level demographic and socioeconomic data. Multilevel (mixed effect) models were used to examine associations between individual and neighbourhood socioeconomic variables with available measures of psychological distress. RESULTS: Specific (rather than all) REM groups had higher indices of psychological distress, and there was little evidence of a moderating effect of neighbourhood ethnic density in the hypothesized direction. After controlling for socioeconomic variables, consistently higher indices of distress before and after therapy were evident for patients from White-other, Pakistani, Bangladeshi, and "Other" backgrounds. CONCLUSIONS: Mental health inequalities are evident for people from specific REM groups.

هدف: شواهد پیشین نشان می‌دهد که افراد متعلق به گروه‌های اقلیت نژادی/قومی (REM) پریشانی روان‌شناختی بیشتری را تجربه می‌کنند، به‌ویژه اگر از گروه فرهنگی خود جدا باشند. این مطالعه ارتباط بین وضعیت REM و نشانه‌های روان‌شناختی اندازه‌گیری‌شده پیش و پس از درمان، همچنین تعامل با تراکم REM در سطح محله را بررسی کرد. روش: پرونده‌های سلامت الکترونیک ۱۳۰٬۸۵۷ بیمار که به مداخلات روان‌شناختی در خدمات مراقبت اولیه در انگلستان دسترسی داشتند، تحلیل شد. سنجه‌های افسردگی (PHQ-9)، اضطراب (GAD-7) و اختلال عملکرد (WSAS) پیش و پس از درمان با داده‌های جمعیت‌شناختی و اجتماعی‌اقتصادی در سطح فردی و محله‌ای پیوند داده شد. مدل‌های چندسطحی (اثر مختلط) برای بررسی ارتباط متغیرهای اجتماعی‌اقتصادی فردی و محله‌ای با سنجه‌های موجود پریشانی روان‌شناختی به‌کار رفت. نتایج: گروه‌های خاص (نه همه) REM شاخص‌های بالاتری از پریشانی روان‌شناختی داشتند و شواهد اندکی از اثر تعدیل‌کننده تراکم قومی محله در جهت فرض‌شده وجود داشت. پس از کنترل متغیرهای اجتماعی‌اقتصادی، شاخص‌های بالاتر و مداوم پریشانی پیش و پس از درمان برای بیماران با پیشینه White-other، پاکستانی، بنگلادشی و «سایر» مشاهده شد. نتیجه‌گیری: نابرابری‌های سلامت روان برای افراد متعلق به گروه‌های خاص REM مشهود است.