Psychodynamic Psychiatry in Clinical Practice – Glen O. Gabard, MD – Fifth Ed. American Psychiatric Publishing 2014


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p. 81  “The psychiatrist can learn a great deal by allowing a patient to ramble freely for a while.  Initial comments should be designed to facilitate this rambling (e.g., “Tell me more,” “Please go on,” “I can understand your feeling that way,” or “That must have been upsetting”).  The distinctiveness of the material produced by this type of free association is supported by evidence from neuroscience research.  Andreasen et. al. (Am J of Psychiatry 152:1576-1585, 1995) used positron emission tomography to study the difference between focused episodic memory, when one recalls past experiences, and random episodic memory, involving uncensored thinking about experience, akin to free association.  They found significant differences between the two types of memory and noted that the free-ranging mental activity associated with random episodic memory produced large activations in association cortex and reflected both active retrieval of past experiences and planning of future experiences.  Hence the alternation between allowing rambling association in the interview and focusing the patient on specific events may produce different kinds of mental activity and different types of useful information to the interviewer.

Besides eliciting essential historical and mental status data, interviewers can discern patterns of association that may reveal significant unconscious connections.  The order in which events, memories, concerns, and other psychological issues are verbalized is seldom random.  Mathematicians have long known that it is impossible for any individual to generate prolonged sequences of random numbers.  Within a short time, the numbers will fall into meaningful patterns.  The mind prefers order to chaos.  So it is with the verbalizations of the patient ….”

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