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Complex Depression in High-Pressure Care Settings: Strategies and Therapeutic Competences

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Depression and Personality Dysfunction

Part of the book series: Depression and Personality ((DP))

Abstract

As shown in this volume and others in this series, it is untenable nowadays to regard depression as a unidimensional phenomenon in terms of diagnosis and treatment. The notion of complex depression is closer to the clinical-etiological reality of the disorder and also provides a clearer impression of what professionals must deal with in highly demanding settings, including primary care (PC). This is especially true in low-medium-income countries (LMICs), where patients with complex depression are often likened to those who mental health practitioners call “difficult patients.” From this perspective, the present chapter addresses complex depression and highlights its heterogeneous nature, marked by the functioning of patients’ personality structure, depressive experience style, suicide risk, contextual factors, and medical comorbidities that have an impact on their response to treatment. After discussing how the treatment context and the characteristics of the professionals who treat these patients interact with the aforementioned factors, we present a model for the psychotherapeutic management of complex depression in high-demand settings, with an emphasis on the handling of personality dysfunctions.

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Notes

  1. 1.

    In the present chapter, we do not cover the psychotherapeutic treatment of the depressive symptoms of noncomplicated depression, since this topic is discussed in other chapters of this book and there is abundant literature on it.

  2. 2.

    We reiterate the need to take these illustrations as a clinical exercise how to work structurally oriented, since a later study in another sample (Dagnino et al. 2018) did not replicate the same associations between dependence and self-criticism and specific structural dysfunctions. More research in greater clinical samples is needed.

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Acknowledgments

This work was funded by the ANID-Millennium Science Initiative/Millennium Institute for Research on Depression and Personality-MIDAP and by ANIS/FONIS Project N° SA19I0021.

We wish to thank Catalina Aravena for her valuable support in the production of this chapter and Susana Morales for her contribution to several sections of the text.

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Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Guillermo de la Parra & Elyna Gómez-Barris

  2. Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile

    Guillermo de la Parra, Ana Karina Zúñiga, Paula Dagnino & Elyna Gómez-Barris

  3. Programa de Doctorado en Psicoterapia, Pontificia Universidad Católica de Chile y Universidad de Chile, Santiago, Chile

    Ana Karina Zúñiga

  4. Faculty of Psychology, Universidad Alberto Hurtado, Santiago, Chile

    Paula Dagnino

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  1. Guillermo de la Parra
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  3. Paula Dagnino
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  4. Elyna Gómez-Barris
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Correspondence to Guillermo de la Parra .

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Editors and Affiliations

  1. Millennium Institute for Research in Depression and Personality; Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, RM - Santiago, Chile

    Guillermo de la Parra

  2. Millennium Institute for Research in Depression and Personality; Faculty of Psychology, Universidad Alberto Hurtado, Santiago, RM - Santiago, Chile

    Paula Dagnino

  3. Millennium Institute for Research in Depression and Personality; School of Psychology, Pontificia Universidad Católica de Chile, Santiago, RM - Santiago, Chile

    Alex Behn

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de la Parra, G., Zúñiga, A.K., Dagnino, P., Gómez-Barris, E. (2021). Complex Depression in High-Pressure Care Settings: Strategies and Therapeutic Competences. In: de la Parra, G., Dagnino, P., Behn, A. (eds) Depression and Personality Dysfunction. Depression and Personality. Springer, Cham. https://doi.org/10.1007/978-3-030-70699-9_9

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