Psychodynamic Framework Research Articles

Structurally informed psychodynamic theory case conceptualization: Expanding the conceptualization map.

There is a rich history of psychological movements that call upon the field to collaborate with clients to both acknowledge and resist oppression, as well as an increasing emphasis in professional guidelines on conceptualizing clients with attention to the role of the social and physical environment, to contemporary experience with power, privilege, and oppression, and to institutional barriers and related disparities. These calls indicate the need for psychological case conceptualization to move beyond preconceived assessments of which aspects of clients' identities are salient to them, to engage with clients' sociocultural identities as situated within systems of power and oppression, and to engage in advocacy to improve clients' socioenvironmental contexts and to challenge structural oppression. In this article, we attend to the foundational contributions of Black psychology, intersectionality, liberation psychology, Indigenous healing, and radical healing for using case conceptualization to guide structurally responsive and impactful treatment and advocacy. We then present a case example drawn from a composite of clinical encounters that captures client distress interwoven with structural forces such as addiction stigma, intersecting classism and sexism, White privilege, and caregiver leave policies. To demonstrate how to integrate structural forces with theory, we present how this case would be conceptualized utilizing psychodynamic frameworks infused with attention to the ways in which structural forces shape and perpetuate the client's distress. To move from naming to integrating structural competency in case conceptualization, psychotherapy training must address how structural forces shape how client distress develops and is maintained and necessitates advocacy outside of the session. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychodynamic Psychiatry and the Care of Persons with Vision Loss and Blindness.

The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed. Common psychotherapy themes in the treatment of persons who experience vision loss from systemic illness include reactivation of memories of past traumas resulting in avoidance, social withdrawal, depressive states, catastrophic thinking, a sense of foreshortened future, anhedonia, and fear of disintegration and invisibility. Psychotherapy also serves to correct negative introjects from ableist societal attitudes.

Current psychopathology models emphasize very early intersubjectivity-based interventions in children to prevent later mental disorders.

Current psychopathology models have evolved toward dimensional models, in which symptoms and diseases are at the extremes of dimensions. Despite these new dimensional proposals, classifications and third-person approach have shown limitations. Their extraordinary evolution nevertheless underlines the contributions of developmental and psychodynamic frameworks. Developmental contributions have made it possible to evolve from disorders centered on a first-person perspective. Complementarily to the first-person/third-person perspectives, we advocate a second-person perspective, based on intersubjectivity. This perspective reverses the intuitive trend to focus our interventions on the most specific symptoms and syndromes, and advocates instead interventions on a "p" general factor that are both generalized and highly targeted. The implications are (1) to intervene as early as possible, (2) to base the definition of our therapeutic targets on an intersubjective perspective, (3) to identify and enhance children's and parents' strengths. These empirically informed directions are not in the current mainstream of psychopathology frameworks, and need to be developed.

Meeting at the precipice: Creative visualization in the treatment of trauma

ABSTRACT This paper illustrates the integration of guided visualization, drawn from clinical hypnosis, in a self-psychologically informed treatment with a traumatized patient. In providing a hypnotic script, I serve as a witness and felt presence as I accompany the patient as she draws upon her imagination. Images and written reflections engage her capacity to creatively symbolize her childhood trauma with distance and reflective space. Eye Movement Desensitization and Reprocessing (EMDR) therapy unlocks state-dependent memories and stimulates new associations and self-compassion. Within a psychodynamic framework, these creative interventions titrate the destabilizing impact of traumatic recall by empowering the patient as an active agent, utilizing her creative resources to create an expanded, healing narrative.

Psychodynamic Implications of Treating Intensive Care Unit (ICU) Survivors.

The author, an internist and psychiatrist who works with intensive care unit (ICU) patients, offers reflections and clinical insights on implementing a psychodynamic framework when treating survivors of critical illness. In this short essay, contributions from the critical care and psychoanalytic literature are included to highlight the significance of post-intensive care syndrome (PICS) and the psychodynamic considerations that might enhance the treatment of this patient population.

Object Relations: How Early Relationships Create Map for Later Ones

Object Relations: How Early Relationships Create Map for Later Ones

Will this tablet make me happy again? The contribution of relational prescribing in providing a pragmatic and psychodynamic framework for prescribers

SUMMARYWe describe the importance of relational factors in prescribing practices and discuss how they may influence treatment outcomes. Although relational factors play a part in every clinician–patient interaction, they are particularly relevant when managing patients with complex emotional needs. We discuss how relational prescribing can add value when incorporated into standard practice. We introduce psychodynamic theory principles, and we suggest a framework to facilitate reflection and support decision-making when clinicians are faced with complex prescribing decisions.

Improving the physician-patient relationship utilizing psychodynamic psychology: a primer for health professionals

ABSTRACT Background The quality of the physician-patient relationship is associated with improved healthcare outcomes and patients’ complaints due to dissatisfaction. Factors that influence the quality of the physician-patient relationship include verbal communication, nonverbal communication, and clinical empathy. These factors have been studied from diverse theoretical approaches hindering their integration into a theoretical framework applicable in clinical practice and accessible for lay clinicians. Objective The aim of this paper is to put forward a psychodynamic framework that includes the factors associated with a better quality of the physician-patient relationship and is applicable in clinical practice and accessible for lay clinicians. Theoretical discussion Basic concepts necessary to comprehend transference and countertransference phenomena were outlined. Then, based on the concepts of transference and countertransference, a psychodynamic framework to understand and manage the physician-patient relationship was put forward. Conclusion This is the first paper that presents a psychodynamic framework applicable in clinical practice and accessible to lay clinicians for understanding and managing the physician-patient relationship. Additionally, this work could serve as introductory material to Balint groups.

"This Isn't Being a Doctor."-Qualitative Inquiry into the Existential Dimensions of Medical Student Burnout.

Recent studies report that up to 50% of medical students feel burned out. Medical student burnout has significant public health consequences-as students detach, the quality of patient care is impacted, and students themselves suffer, as evidenced by the increased risk in substance use and suicide. While some theorize that medical student burnout is due to an inability to confront suffering, death, and their own mortality, this hypothesis fails to explain why pre-clinical students also experience burnout despite having minimal clinical exposure. /r/medicalschool, a news-aggregating website for medical students, was queried for posts from the creation of the subreddit, December 11, 2009, to July 1, 2018, for the term "burnout" and its grammatical variations. Three hundred fifty-two posts and their comment threads were analyzed using a grounded theory approach. When the causes of burnout were interpreted using an existential psychodynamic framework, the predominant themes that arose were difficulties dealing with freedom (groundlessness), existential isolation, and meaninglessness, rather than death anxiety stemming from witnessing the suffering of patients. Students feel as if they are not living up to their own values of what a physician should be like and are troubled by the inconsistent values within the hidden, informal, and formal curriculum. Individualized interventions are temporary fixes that allow people to withstand their environment and complete their training; however, the learning environment needs change to better empower students to live a life full of existential meaning.

Childhood Trauma, Personality, and Substance Use Disorder: The Development of a Neuropsychoanalytic Addiction Model.

BackgroundWhile traditional psychoanalysis has been criticized as insufficient for the treatment of substance use disorder (SUD), recent progress in the field of neuropsychoanalysis has generated new and promising hypotheses regarding its etiology. However, empirical research applying this framework has been sparse.Aim and ScopeThe present overview aims at developing and empirically validating a neuroscientifically informed psychodynamic framework regarding the etiology of SUD. For this purpose, this review provides a concise overview of the most relevant historical and contemporary psychoanalytic theories on SUD etiology. Furthermore, the original research summarized in this paper consists of three studies investigating connections between childhood trauma, primary emotions, personality structure and attachment, as well as their relation to SUD development and treatment.ConclusionsThe results highlight the empirical validity of the neuropsychoanalytic approach towards SUD etiology. In particular, the findings underscore the conceptualization of SUD as a disorder related to dysfunctional attachment and affect regulation abilities especially linked to increased SADNESS and ANGER dispositions, which mediated the relationship between SUD and traumatic childhood relationships. Based on these findings, a refined model of SUD etiology is proposed, which should be tested in future studies.

Online narratives about panic attacks: interpreted within a psychodynamic framework

ABSTRACTThe objectives of the study were to investigate what individuals posting narratives on four online forums dedicated to the issue of panic attacks wanted to discuss and how they made meaning of their experiences related to panic. A narrative approach was used to analyze 208 posts sampled randomly. Online discussions were centered around attempts to uncover, and make sense of, the hidden meaning of panic attacks occurring unpredictably by linking events and experiences from the past and the present with emotional reactions. The onset of panic tended to be related to life transitions that interacted with relational issues of emotional commitment as well as with expectations of increased independence or with separation and loss. Dysfunctional attachments in childhood may impair the integration of affective and cognitive information leading to problems with the recognition and expression of affects. Online forums provide fresh avenues for exploring narration of sensitive topics from an inside perspective.

\u201cI don\u2019t need a flat tummy; I just want to run fast\u201d \u2013 self-understanding and bodily identity of women in competitive and recreational sports

BackgroundWomen who exercise intensively, whether competitive or recreational, devote a lot of time and energy into exercise, which requires high levels of ambition and motivation. The aim of the study is to investigate the self-understanding and bodily identity of different (competitive vs recreational) forms of exercise, and to investigate the role of important others (parents, siblings and social relations) for this self-understanding.MethodsA qualitative study using semi-structured interviews. An interactional psychodynamic framework informed the development of the interview questions focusing on the influence of their family, peers, and the meaning of exercise for their identity. Participants were recruited via local training centers and via the Danish Athletic Sports Association. A total of twenty highly physically active female athletes were interviewed, ten of whom participated in competitions (“competitve athletes”) and ten of whom did not (“recreational athletes”).ResultsSelf-related and social similarities and differences between competitive athletes and recreational athletes were found. Recreational athletes had supportive but not ambitious parents and used sport to reinforce their bodily self-efficacy and identity, while competitive athletes had highly engaged parents, especially fathers, and competed to externalize their identities as athletes. Correspondingly, the meaning of exercise was the activity itself, for recreational athletes, while competition was the means to the end of achievement, for competitive athletes.ConclusionAll athletes are affected and triggered by their biography and their environment. The biographical tradition of sport culture must be recognized as important for the engagement in different forms of physical activity in health and competition settings. If research can make the conflicts and relations of the self visible in sports culture, this could strengthen the recognition that the overall bodily well-being of athletes is important for women’s health.

Psychodynamic approaches to violence

SUMMARYThe assessment and management of violent behaviour in mentally disordered patients are no longer the sole domain of forensic psychiatrists, but are increasingly part of the day-to-day work of all psychiatrists and mental health professionals. Violence risk assessment has become a huge industry, and although the importance of dynamic, as well as actuarial, risk factors is now recognised, a more systematic approach exploring the psychodynamics in the aetiology, assessment and treatment of violent behaviour is often lacking. In this article I revisit some of the key psychodynamic principles and concepts relevant to an understanding of violence, summarising the historical contributions of key psychoanalytic writers on violence and aggression, and exploring the ideas of more contemporary writers working in the field of forensic psychotherapy. A psychodynamic framework for working with violent patients is introduced, focusing on the setting and containment, specific therapeutic interventions and monitoring countertransference reactions.LEARNING OBJECTIVES•Understand historical and contemporary psychoanalytic theories of the aetiology of aggression and violence•Utilise a psychodynamic framework for working with violent patients and offenders•Understand the use of countertransference in the risk assessment and treatment of violenceDECLARATION OF INTERESTNone.

In-depth learning in field education: evaluating the effectiveness of process recording

Process recording is the anamnestic recollection of narratives and behaviours of the participants in client interviews. Through critical incidents of teaching, this study explores how the process recording teaching and learning activity was operationalised in a field education seminar for postgraduate social work students, at an Australian University. Further, the study evaluates the student satisfaction aspect of the effectiveness of the activity. Assuming the practitioner/lecturer-researcher role, the author adopted a psychodynamic theoretical framework to identify relational roots in client problems, support students to carry out holistic bio-psychosocial assessments, correct practice mistakes and separate facts from thoughts—conceptualised as theories of practice—and emotions. An anonymous mixed-method questionnaire evaluated the satisfaction of students with the activity. The clear majority evaluated process recording as very beneficial for their learning and rated the reflections of the lecturer on the process recorded material as highly satisfactory.

Anaclitic personality dimension in women with Alzheimer's disease: Comparison with control groups

This study sought to determine the evaluation of current and pre-morbid personality traits in Alzheimer's disease, as well as personality changes. Psychodynamic framework and Sidney Blatt's personality developmental perspective, anaclitic vs introjective, are taken as references. The study was conducted with four groups which were assessed using the Depressive Experiences Questionnaire, mainly in the form of individual interview sessions. Current personality measure: Alzheimer's disease Group, consisting of 44 female participants (MAge=81.36 years); Control Group, consisting of 80 female participants from the population at large (MAge=75.84 years). Pre-morbid personality measure: Alzheimer's disease Group Informants (n=40); Control Group Informants (n=42). Results are in line with the psychodynamic literature review and provide new research data. Findings suggest that there is stability across the life cycle in a relatedness/anaclitic/dependency personality style in dementia. Implications of the findings for future research are discussed.

Evaluating the efficacy of psychodynamic treatment on a single case of autism. A qualitative research

Autism spectrum disorder refers to a group of diseases determined by multiple conditions and primarily defined on the basis of behavioral patterns. The literature and guidelines provide indications regarding adequate treatments, underlying how psychologically and behaviorally structured interventions, should be considered the best programs. Anyway, there is still a scarcity of studies evidencing the effectiveness of therapeutic and developmental approaches situated in a psychodynamic framework and researches aimed to evaluate the quality of psychodynamic interventions on autism are rare. The present study illustrate a qualitative research on the single-case intervention with an autistic adolescent, admitted to the Educational - Rehabilitation Centre Antenna 112. The Centre bases its intervention on a specific psychodynamic approach, Lacanian Psychoanalysis, named Pratique à Plusieurs. The efficacy of the psychodynamic intervention is evaluated by monitoring the therapeutic process with the adolescent from his admission. The evaluation took place in three different stages of the intervention: at the beginning of the treatment, after 6 months and after 12 months. In particular, the level of adaptive behaviors (Vineland Adaptive Behavior Scale), Social Communication (Social Communication Questionnaire), and the seriousness of behavioral patterns, specific for the autism disorders (Childhood Autism Rating Scale) have been assessed. Results highlight that the psychodynamic setting of the Centre and the therapeutic intervention, which takes place in it, foster an improvement of adaptive behavior, such as life skills and socialization. Limitations of the present study and clinical implications regarding residential psychodynamic treatments in cases of autism disorders are discussed.

Transactional analysis in the classroom, staffroom and beyond

The author considers the application of transactional analysis (TA) in the field of education. Initially, the focus is on the use of TA in reducing conflict in the classroom and staffroom before offering observations about its broader relevance to contemporary UK schooling. Concepts covered include the egostate model of personality, functional fluency, psychological game-playing and contracting. Finally, the author considers issues raised in considering the application of a psychodynamic framework in the context of education.

Eating Disorders and Attachment: A Contemporary Psychodynamic Perspective

A contemporary psychodynamic framework can add much to our understanding of eating disorders. Eating disorders are associated with complex comorbidities, high levels of mortality, and therapist countertransferences that can complicate psychological treatments. Mainstream models currently focus on cognitive, biological, or cultural factors to the near exclusion of attachment functioning, and the individual’s dynamics. As such, standard models appear to exclude person-centred and developmental considerations when providing treatments. In this article, we describe a contemporary psychodynamic model that understands eating disorder symptoms as a consequence of vulnerability to social pressures to be thin and biological predispositions to body weight. Individual vulnerabilities are rooted in unmet attachment needs causing negative affect, and subsequent maladaptive defenses and eating disorder symptoms as a means of coping. We describe how this model can inform transdiagnostic eating disorder treatment that focuses on symptoms as well as specific attachment functions including: interpersonal style, affect regulation, reflective functioning, and coherence of mind. Two clinical examples are presented to illustrate case formulations and psychological treatments informed by these conceptualizations.

New frontiers and applications of attachment theory.

New frontiers and applications of attachment theory.

What the National Dementia Strategy forgot: providing dementia care from a psychodynamic perspective

The 2009 National Dementia Strategy exhorted the National Health Service to raise the profile of dementia in the UK and to make the diagnosis in 75% of sufferers within a few years. While this aspiration is commendable in the sense that ideologically it is an attempt to improve things for dementia sufferers, it is likely to have other consequences which may not be so well understood or considered. Raising expectations in a vulnerable population is fine if those peoples’ lives can be improved even a little by making a diagnosis. It is, however, a lot to ask services to deliver at the same time that the country is experiencing one of the worst economic crises of our generation. This paper sets out what a pathway into dementia diagnosis might look like using a psychodynamic framework, including giving a dementia diagnosis and offering aftercare. The author considers some of the thoughts and feelings in the sufferers, carers and the staff who offer the service; the challenges posed by a diverse group and how to deliver best practice. The services described are from within community psychiatric settings: those used to delivering not only dementia diagnoses, but also managing delusions, hallucinations and mood disturbances associated with dementia. Mental health services do not exclusively provide memory clinics and the author is not extending these observations to services delivered by neurologists or physicians in medicine for the elderly.