“Detoxification” of destructive clinical material in psychodynamic psychotherapy: A case study of how the therapists’ interpersonal skills are used in a challenging treatment case with a successful outcome

Abstract

ABSTRACT There is a need to gain more knowledge of how interpersonally skilled therapists handle demanding clinical situations to better understand therapist effects. The aim of this single-case study was to investigate how the therapist encountered challenging situations where her interpersonal skills were put to test and how her handling likely contributed to patient change. From a larger research project on learning processes, this case was selected since it was judged to be both challenging and with a good outcome. Interpretative phenomenological analysis of video-recordings of a 42 session long psychodynamic psychotherapy, was conducted. The analysis yielded one superordinate theme: The therapist “detoxifies” demanding clinical material, such as aggression and shame. Three constituent sub-themes expressed different ways in which this process took place (1: The therapist tolerates the patient’s skepticism and criticism in a non-defensive manner by focusing on the patient’s underlying feeling; 2: The therapist responds to the patient’s self-destructive behaviors in a non-judgmental and “containing” way that reduces shame; and 3: The therapist interprets the patient’s rejection as separation anxiety related to termination of the therapy). Our findings provide a more nuanced understanding on how the interpersonal skills of the therapist come into use in a specific, challenging therapy process.