The Clinician in the Psychiatric Diagnostic Process

Foreword
Preface
Contents
1: The Clinician’s Subjective Feeling in Psychiatric Diagnosis: A Historical Excursus
	1.1	 Introduction
	1.2	 The first Half of the 1900s: Empathy, Intuition, and Feeling
		1.2.1	 Karl Jaspers
		1.2.2	 Elmer Ernest Southard
		1.2.3	 Ludwig Binswanger
		1.2.4	 Eugène Minkowski
		1.2.5	 Henricus Cornelius Rümke
		1.2.6	 Jakob Wyrsch
	1.3	 From 1950 to the Early 2000s: Atmosphere and Intersubjectivity
		1.3.1	 Hubertus Tellenbach
		1.3.2	 Bin Kimura
		1.3.3	 Wolfgang Blankenburg
		1.3.4	 Bruno Callieri
	1.4	 Conclusions
	References
2: The Psychiatric Assessment: First Person, Second Person, and Third Person Perspectives
	2.1	 Introduction
	2.2	 Positivistic or Third Person Approach
	2.3	 Phenomenological or First Person Approach
	2.4	 Hermeneutic or Second Person Approach
	2.5	 Conclusion
	References
3: A Cookbook Recipe for the Clinical and Phenomenologically Informed, Semi-structured Diagnostic Interview
	3.1	 Introduction
	3.2	 The Style of the Clinical Diagnostic Interview
		3.2.1	 The Empathic Attitude
		3.2.2	 The Format of the Interview
		3.2.3	 Diagnoses, Diagnostic Manuals, and Comorbidity
	3.3	 Conducting the Clinical Diagnostic Interview
		3.3.1	 The Presenting Complaint(s)
		3.3.2	 The Chronological, Psychosocial History
		3.3.3	 Exploring Psychopathology
	3.4	 Synthesizing the Information: Making a Comprehensive Diagnostic Decision
	References
4: The Distinction Between Second-Person and Third-Person Relations and Its Relevance for the Psychiatric Diagnostic Interview
	4.1	 Introduction
	4.2	 The Psychiatric Diagnostic Interview
	4.3	 Spectatorial Observation, Engagement, and Openness: “Where Has ‘You’ Gone?”
	4.4	 Reciprocity and Communication
	4.5	 Back to the Diagnostic Interview: What Kind of Methodological Pluralism?
	4.6	 Concluding Remarks
	References
5: Understanding Other Persons. A Guide for the Perplexed
	5.1	 Introduction
	5.2	 A Priori Understanding Others in a Shared Life-World
	5.3	 Second-Order Understanding
	5.4	 Understanding Others in the Psychotherapeutic Setting
	5.5	 Why Understanding?
	References
6: Intersubjectivity and Neuroscience in the Diagnostic Process
	6.1	 Attempts at Neurobiological Explanation of “Objective” Psychiatric Disorders and Symptoms
	6.2	 The Intersubjective Construction of Mental Symptoms in Clinical Practice
	6.3	 The Neuroscientific Study of First-Person, “Lived” Experience
	6.4	 The Neuroscientific Study of Intersubjective Experience: The Case of Empathy
	6.5	 Discussion
	References
7: Origin and Development of the Assessment of Clinician’s Subjective Experience (ACSE)
	7.1	 Introduction
	7.2	 Background and Development
		7.2.1	 Clinical and Theoretical Foundations
		7.2.2	 Current Empirical Evidence About the Clinician’s Subjective Experience
			7.2.2.1	 The Praecox Feeling in the Diagnosis of Schizophrenia
			7.2.2.2	 Psychometric Scales Measuring the Therapist’s Countertransference
		7.2.3	 Development of the Preliminary Questionnaire
	7.3	 The Assessment of Clinician’s Subjective Experience (ACSE)
		7.3.1	 Validation of the Preliminary Questionnaire
			7.3.1.1	 Methods
			7.3.1.2	 Results
				Factor Structure
				Reliability and Convergent Validity of the Scales
		7.3.2	 A Five-Dimensional Profile of the Clinician’s Subjective Experience
	7.4	 Final Reflections
	Appendix
	References
8: Evidence Supporting a Role for the Intersubjective Dimension in the Clinical Encounter: Empirical Findings from ACSE Research
	8.1	 Introduction
	8.2	 ACSE Dimensions and the Clinical Encounter: A Detailed Review
		8.2.1	 Tension
		8.2.2	 Difficulty in Attunement
		8.2.3	 Engagement
		8.2.4	 Disconfirmation
		8.2.5	 Impotence
	8.3	 Clinical Significance of the ACSE Profiles
		8.3.1	 ACSE Profiles as a Potential Contribution to Differential Diagnosis
		8.3.2	 The Paradigm of Praecox Feeling Examined Through the ACSE Lens
		8.3.3	 The ACSE in Psychotherapeutic Settings
	8.4	 Conclusions
	References
9: Clinical Judgment of Schizophrenia: Praecox Feeling and the Bizarreness of Contact—Open Controversies
	9.1	 Praecox Feeling as an Expert Judgment
	9.2	 The Conceptual History of the Praecox Feeling
	9.3	 Empirical Evidence
	9.4	 On the Phenomenological Givenness of the Praecox Feeling
	9.5	 Conclusions
	References
10: The Diagnostic Use of Countertransference in Psychodynamic Practice
	10.1	 The Origins of Countertransference
	10.2	 The Rediscovery of Countertransference
	10.3	 The Relational and Intersubjective Turn of Countertransference
	10.4	 Countertransference and Psychodynamic Diagnosis
	10.5	 Conclusion
	References
11: A Cognitive Therapy Perspective on Therapists’ Feelings and Interpersonal Processes
	11.1	 Introduction
	11.2	 Experience-Centred Post-rationalist Cognitive Psychotherapy
	11.3	 Clinical Aspects of Personal Meaning Organisations
	11.4	 Building the Therapeutic Alliance and Working with Emotions in Experience-Centred Post-rationalist Cognitive Psychotherapy
	11.5	 A Pilot Study of the Therapist’s Emotional Reaction to Features of Personal Meaning Organisation During the Early Phase of Therapy
		11.5.1	 Methods
		11.5.2	 Results
		11.5.3	 Conclusions
	11.6	 Clinicians’ Management of Their Own Emotions Throughout Therapy to Maintain Effective Working Alliances
	11.7	 Metacognition
	11.8	 The Problematic Nature of Interpersonal Cycles
	11.9	 Inner Discipline Procedures
	11.10	 Sharing Interventions
	11.11	 Overall Conclusions
	References
12: The Clinician and the Human Side of Mental Illness
	References
13: Mental Illness as a Pathology of Intersubjectivity
	13.1	 Introduction
	13.2	 Psychiatry as Science of Humanity
	13.3	 The Italian School of Phenomenological Psychopathology
		13.3.1	 Aldo Masullo: The Contribution of the Philosophy of Life
		13.3.2	 Bruno Callieri: A Life for Psychopathology
			13.3.2.1	 The Lived Experience of the Encounter: Body to Body
			13.3.2.2	 Understanding the Ineffable Failure of the Encounter
	13.4	 Intersubjectivity and Therapy
		13.4.1	 Being-Between: The Human as an Unexpected Encounter and Event
		13.4.2	 The Pathic Way to Care: The We-ness-in-Loving
			13.4.2.1	 Dasein-Group Analysis
	13.5	 Conclusion: Toward a Psychiatry on a Human Scale
	References