Psychodynamic Framework Research Articles

“Sometimes One Does That With Blinders On”: Revisioning Care for Violent Girls

When girls use violence to discharge their rage, the first response by law enforcement and treatment providers is to stop the behaviors through control of the offender. This article examines extant juvenile justice and child welfare policies and practices that function as social control and surveillance mechanisms of girls who violate behavioral expectations and/or social norms through violent behaviors. Case studies reveal tensions between punishment and mental health and underscore compounded psychological trauma, when girls’ behaviors are considered within a psychodynamic theoretical framework that explains cognitive impairment and other traumagenic effects that challenge providers’ expectations of girls’ normative behaviors. Dynamics of vicarious trauma among staff suggest the perilous impacts of trauma upon the quality and duration of attachments that troubled workers are able to form and maintain with their clients. Instead of a policy framework of social control and top-down silos of prescriptive services (protocols like dialectical behavior therapy), responses to girls and violence as a public health problem must be grounded in developmental theory and within realities of social-cultural context.

Psychosocial Perspectives of Girls and Violence: Implications for Policy and Praxis

Psychosocial and feminist criminologies produce a complex etiology of adolescent female violence, and advance understanding of much female behavior that juvenile authorities formally address: mental health disturbances. When girls’ violent behaviors are considered within a psychodynamic theoretical framework, policy problems are dramatically redefined, resulting in a reformulation of the social problem, newly contextualized, and the collective responses to the troubled girls it has defined. This paper places known etiologies of violent behaviors, including case study material, in a context of extant social policies that impact and determine the social location and control of violent girls. We argue that efficacious policy responses would be psychosocially informed, and focus upon a more holistic mental health praxis, rather than criminal justice practices alone.

Editorial: Diagnosing Drug Problems and the DSM

The articles in this special issue of Contemporary Drug Problems reflect the many problematizing frameworks that have been applied to the consumption of mood-altering drugs at different times and in different locations. In contemporary public debate, drug consumption is variously addressed as medical issue, public health issue, social issue, law and order issue, and moral issue. The resulting field of negative images and associations not only constitutes drug users as certain kinds of people, but is drawn upon to promote particular responses and to silence other possibilities. This editorial discusses key site for the representation and reproduction of habitual and harmful drug use as medical problem: the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.A new edition of the manual, the DSM-V, is currently in preparation, and significant revisions have been proposed for the substance-use disorders, including change in terminology from dependence to addiction. The proposed revisions and the resulting commentary provide an opportunity to critically consider the effects of the DSM' s medicalizing and classificatory framework. This editorial emphasizes the continued reliance of the manual's categories on hybrid combination of ethical and medical judgment, which is at odds with its definition of disorder. It also highlights the distinctions between legitimate and illegitimate drug users that are embedded in the proposed category of substance-use disorder. As one of the rationales for the change in terminology in the DSM-V is the issue of opiate dependence in pain patients, the editorial also briefly discusses the model of addiction found in pain medicine.DSM disorders and diagnosisDiagnosis as classificatory practice is central to medicine. It identifies and constitutes the presenting problem or set of symptoms as disease and implies that the proper response is treatment. It also establishes the authority of the medical professional over the problem, and establishes the identity of the patient as person with certain condition (Jutel, 2011).But as Allan Horwitz has observed, diagnosis had only minor role in psychiatry as it was practiced in the first part of the 20th Century. In the psychodynamic framework that was then dominant, the focus was on neurosis, not disease, and the problems of most patients were seen as the result of psychic conflicts, personality dynamics, and reactions to stresses (2000, pp. 45-46). The publication of the DSM-III in 1980 marked paradigm shift because it established system based on specific and distinct categories of disorder. It ushered in the medicalized framework that Horwitz calls diagnostic psychiatry, an approach based on the premise that clusters of symptoms indicate underlying diseases. The number of distinct disorders recognized by psychiatry has grown with each subsequent edition of the manual, to the 400 diverse behavioral and psychological conditions found in the DSM-IV.But what is disorder, according to the DSM? The definition of mental provided in the introduction to the DSM-IV reflects the assumptions of psychiatry. It describes disorder as a clinically significant behavioral or psychological syndrome or pattern that is associated with distress, disability, or significantly increased risk of suffering death, pain, disability, or an important loss of freedom (American Psychiatric Association, 2000, p. xxxi). But, crucially, to be disorder, the syndrome must be considered a manifestation of behavioral, psychological, or biological dysfunction in the (American Psychiatric Association, 2000, p. xxxi). The manual explicitly states that disorder cannot be merely deviant behavior, nor conflict between the individual and society, nor an expectable response to an event such as the death of loved one. …

Overview of Intellectual/Developmental Disabilities

Patients with intellectual/developmental disabilities (IDD) present many challenges to mental health professionals. The capacity to work with such patients requires a working knowledge of IDD as well as an awareness and understanding of the factors that affect the clinical presentation of mental health disorders across the spectrum of IDD.

The Role of Affects in Culture-Based Interventions: Implications for Practice

The study aimed to show the relevance of two types of sense-making processes (i.e. cognitive and affective) in culture-based interventions. A hierarchical model based on a psychodynamic theoretical framework was tested. According to this model, a generalized affective meaning connoting the whole field of participants’ experience would have a regulative, downward, and causal influence on the specific meanings related to the issues addressed by the intervention. Secondary analyses—namely PLS Path Modeling with higher order constructs—were performed on a dataset resulting from a survey involving three hundred and ninety freshmen enrolled in a psychology course at the University of Salento, Italy. These analyses were aimed at detecting the anticipatory images of the University. Our findings provide evidence supporting the theoretical model proposed. Implications for culture-based interventions are discussed.

Models of care delivery in mental health nursing practice: a mixed method study

The aim of this study was to identify the conceptual models that underpin mental health nursing care in clinical settings. This study is a modification of a previous study which evaluated the influence of implicit models of mental disorder on processes of decision making within community-based teams. Participants completed questionnaires in response to a scenario. A range of explanatory conceptual models were identified in respect to aetiology, treatment and recovery. In a forced choice the participants ranked a medical model of care above other models as underpinning care delivery. The content analysis found that the participants used a psychodynamic framework for understanding the causes of mental distress but described the nursing interventions in terms of supporting a medical model of care. Nursing care is dominated by a medical model which constrains mental health nursing. This potentially creates tension between what nurses believe to be the problem and the responses available for nurses in their clinical setting. A range of psychosocial approaches to mental health care delivery have been developed, but there seems to be problems with their implementation in practice. Further research is required to explore how broader therapeutic interventions can be implemented by nurses within multidisciplinary systems of mental health care delivery.

Assessing Changes in Psychoanalytic Psychodynamic Therapy with an Early Adolescent

This paper describes changes in personality functioning according to Exner’s Rorschach Comprehensive System (CS) in an early adolescent boy, Gabriele, referred for anxiety and obsessive compulsive symptoms. The DSM-IV diagnosis was General Anxiety Disorder (GAD). The therapy lasted about 2 years, and sessions were all audio-taped to create a more objective database. A total of 50 sessions were analyzed. The therapist employed a broadly defined, object-relations-focused, psychodynamic framework, with particular emphasis placed on balancing supportive versus insight-oriented modes of therapy ( Skean, 2005 ). After a brief introduction of Gabriele’s clinical history and anamnesis, the paper illustrates (a) changes in the symptoms from the beginning to the end of the supportive psychodynamic psychotherapy, which also included some cognitive-behavioral therapy (CBT) interventions; (b) changes in the CS administered at the beginning and at the end of the psychotherapy; and (c) the relevance of therapeutic alliance measured by the Collaborative Interactive Scale (CIS; Colli & Lingiardi, 2007 ) as a fundamental intervening variable in the psychotherapy process.

The Interns Play: A Mimetic Approach to Introducing and Working with Countertransference in Professional Training

An approach is presented that introduces the concept of countertransference to predoctoral interns and externs in a unique way during their professional training. This approach goes beyond a didactic presentation of the concept and even beyond discussion of case material in supervision. Through an experiential role-play process called Mimesis, trainees are encouraged to enact scenes from literature that depict typical dilemmas that psychotherapists working in a psychodynamic framework must face. By using carefully chosen stories, supervisors can highlight aspects of the therapeutic process such as managing countertransference feelings. This approach fosters a more flexible and open inquiry into one of the most daunting aspects of professional development for both trainees and supervisors.

Parenting a Child with Disabilities: Personal Reflections

This paper describes the complex experience of being the parent of a child with significant developmental disabilities. The author, who is the mother of a child with an autistic spectrum disorder, considers several phases that many parents pass through and some of the associated difficulties; the uncertainty, the dread, and the profound loss that surround the diagnosis of a disability. Based on her own experience, the author identifies the valuable role of a developmental, psychodynamic framework in understanding, processing and navigating these challenges. The paper discusses the significant contributions that psychoanalytically oriented clinicians can make in supporting parents' efforts to make sense of their own and their child's experience, and to manage the ongoing processes of adaptation, acceptance, and the challenges of parenting.

The psychodynamics of forensic mental health nursing

The aim of this paper is to clarify some important interpersonal dynamics that underpin forensic patients’ presentations within the clinical environment, in a way that is accessible to nurses. The world of forensic mental health nursing is often difficult to describe to those who have not experienced first hand prolonged clinical contact with patients at the therapeutic interface of secure services. Even then, the characteristic, intense emotional phenomena that tend to arise out of interpersonal relationships with patients and colleagues is not easy to articulate. Yet, for those of us who consider our professional identity to be one of “forensic mental health nurse,” it seems important to find a way to put words to what appears to occupy a large component of our working lives. More importantly, if we can develop a way to make sense of the way our work makes us feel and the way we can find ourselves relating to others within our professional roles, we will be in a better position to harness our energy and enthusiasm in the service of supporting forensic patients towards effective care and treatment pathways. Of course, forensic patients are supported through services with or without a framework for articulating emotional and interpersonal experiences. However, this frequently occurs in the context of significant struggle. For patients, this struggle is often characterized by difficulty communicating what their needs are, and for nurses this struggle is often characterized by feeling emotionally overwhelmed by their task of providing containing, therapeutic relationships for patients whose interpersonal needs are not clear to them. This article will use case examples to describe some of the complex interpersonal and emotional challenges faced by forensic nurses, and explain how a psychodynamic framework could support nursing practice in each of the case examples.

A leap across a basic fault: Brief Supportive Dynamic Therapy

The author explores the evidence-base and selection criteria for a short-term supportive dynamic approach for patients whose psychological mindedness and quality of object relationships is low. Illustrating this approach with a case example he outlines the central features of Supportive Dynamic Therapy. He describes a psychodynamic conceptual and developmental framework that can be used to guide the therapist's interventions and responses, and modulate the patient's anxiety. A dynamic focus presented in the form of a central issue is shown to have a significant function both in containing the patient's anxiety, and in giving shape to the therapist's efforts to support the patient's ego-strengths and adaptive abilities. The therapeutic work can be seen to result in an alteration in the trajectory or reiterating pattern of the patient's life.

Understanding the Role of Relational Factors in Christian Spirituality

Researchers developing multidimensional models of relational quality have largely neglected to consider the potential role of relational spirituality in their models. Recent relational spirituality models have emerged predominantly from a psychodynamic framework. The current study of 385 Christian adults was designed to expand the understanding of the associations between spiritual and relational dimensions. A principal components analysis of 10 measures of spirituality produced two components accounting for just over 50% of the variance. The components were labeled Positive Relationship with God and Instrumental Relationship with God. A second principal components analysis of 7 relationship scales resulted in a single component accounting for 55% of the variance and seemed to measure negative relational quality. This component was labeled Negative Relationships with Others. Using component scores, a multiple regression analysis was then conducted in which the two spirituality components were used to predict relational quality. The two spirituality components accounted for approximately 35% of the variance in the relational component. Theoretical and practical considerations are discussed and areas for further research are recommended.

A Coding Scheme for the Evaluation of the Relationship in Music Therapy Sessions

This study presents a coding system for observation and monitoring of changes in the interactive behaviour between patient and therapist during music therapy sessions. The coding scheme was developed from a psychodynamic framework and mainly consists of four behavioural classes: Verbal Communication, Nonverbal Communication, Countenance, and Sonorous Musical Communication. The 15 minutes in the middle of each videotape concerning the first active music therapy session--based on the sonorous musical improvisation--were coded. Subjects were children (4 boys; 3 girls) ages 3 to 10 years (M age = 6.3), diagnosed with Pervasive Developmental Disorder, and seven therapists. The method for data collection was continuous recording, applied through The Observer Video-Pro 5.0. For the reliability indexes there was a substantial agreement between assessments by video raters.

Introducing educators to a psychodynamically informed teaching practice

Prompted by the observation that many recently trained teachers find themselves unprepared to cope with many aspects of classroom life despite considerable subject matter competence and technical proficiency, this paper proposes and describes a brief instructional programme designed to enhance teachers' understanding of classroom interactions from a psychodynamic perspective. Published autobiographical accounts of gifted teachers serve as texts for reading and discussion. These personal narratives are conceptualized within psychodynamic frameworks illuminating in meaningful fashion mundane as well dramatic moments in classroom interaction. The course is intended to enhance teacher competence and morale, to stimulate further reflection and to facilitate professional discourse about children and teaching.

The Case of "CG": Balancing Supportive and Insight-Oriented, Psychodynamic Therapy with a Client Undergoing Intense Life Stresses

"CG," a 28-year-old graduate student, initially presented with complaints of depression, in response to social isolation and academic problems that had resulted in being placed on probation. Based on a history with non-nurturing parents who either neglected or physically abused him, CG had developed as an independent, interpersonally cut-off individual with a suspicious, paranoid view of the world, making initial therapeutic access to him quite challenging. Not surprisingly, in spite of a very problematic personal history, he had never before sought any kind of therapy, stating at intake that he was trying it as a &uotlast resort." As the therapist, I employed a broadly defined, object-relations-focused, psychodynamic framework, with a particular emphasis upon balancing supportive versus insight-oriented modes of therapy. This balance turned out to be a key factor in developing an effective therapeutic relationship with this client and in helping him to move towards a more engaged and connected bond with his social world.

The Psychological Treatment of Children Recovering from Leukemia

This article focuses on the psychological experience and treatment of children and families who recover from acute lymphoblastic leukemia. This is important because of the improved prognosis and therefore the increased number of children and families who move forward with their lives after treatment is completed. It is increasingly likely that some of these children or family members may be seen in outpatient psychotherapy (perhaps even years later). The issues are significantly different from those children who die. This article has three main goals: (1) to depict the medical and psychological experience of treatment and its impact on patients, siblings, and parents; (2) to provide a psychodynamic framework for intervention in the active phase of medical treatment; and (3) to assist clinicians in the community who may treat a survivor or family member by increasing clinician awareness of the experiences that patients may have had and how these may resurface in the present treatment.

Traumawiederholung und Reviktimisierung nach körperlicher und sexueller Traumatisierung

The tendency of victims of physical or sexual childhood abuse to become revictimized in later life has well been documented empirically. Moreover, there is a high stability of violent and abusive relationships. The aim of this paper was to summarize perspectives from psychodynamic theory, attachment theory, and posttraumatic stress research to explain revictimization phenomena. The term repetition compulsion has little explanatory value without additional theoretical assumptions. Within the psychodynamic framework, an ego-psychological view conceives trauma repetition as an attempt to master traumatic experience, while in the object relations perspective, revictimization is explained by the influence of traumatic introjects. Negative cognitions of being worthless, bad and guilty can endorse the conviction that abuse is justified and reduce the capacity of self-care. Negative learning experiences from traumatic helplessness and powerlessness account for low self-efficacy expectations and prevent the establishment of self-boundaries. Trauma repetition can also be understood as an enactment in the service of affect regulation. Research in the field of attachment theory identified attachment styles predisposing to revictimization. Research dealing with posttraumatic stress disorder emphasizes the importance of traumatic affects recurring in daily life and, consequently, the tendency of abuse victims to actively produce dangerous situations in order to cope with these affects, furthermore, the role of dissociation in missing warning signals of impending traumatization. For therapeutically addressing revictimization, a detailed analysis of underlying phenomena is required.

The Abyss Experience and the Trauma Complex: A Jungian Perspective of Posttraumatic Stress Disorder and Dissociation

ABSTRACT This article analyzes Carl G. Jung's theory of universal archetypes and complexes in the context of understanding traumatic experiences and the development of PTSD and dissociation. First, Jung's idea of psychological complexes as emotionally formed constellations of experiences centered around a unifying theme are discussed. Second, Jung set forth eight dimensions of constellated complexes, which are reviewed and compared to the core processes of PTSD, dissociation and their associated features. Based on comparisons to Jung's model of generic complexes, it is possible to define the Trauma Complex as a set of psychological processes which are archaic and typical, i.e., “archetypal.” The Abyss Experience is discussed as the core set of fear based emotional responses inherent in traumatic experiences and integral to understanding the unconscious dynamic of traumas impact to psychological functioning, with implications for psychotherapy. The implications of the Trauma Complex are discussed as a more inclusive psychodynamic conceptualization of PTSD and dissociative processes. The inner and outer worlds of trauma (i.e., conceptual paradigms) are explored from different etiological models. By identifying the underlying structures of the Trauma Complex and the Trauma Archetype, a wide array of post-traumatic intrapsychic dynamics involving the self, unconscious mechanisms, dissociative processes and symptom manifestations can be seen in a psychodynamic framework.

The relevance of immigration in the psychodynamic formulation of psychotherapy with immigrants

AbstractThe main goal of this article is to highlight the relevance of the immigration process in psychodynamic psychotherapy with immigrants. Conceived of as a general phenomenon, immigration challenges the stability of the individual's psychic structure and family organization and it has significant transgenerational implications. Its psychodynamics includes interrelated processes of mourning, discontinuity of identity and imbalance of self‐esteem. Clinically, in the psychodynamic formulation of the adult immigrant's unique experiences, behaviors and symptoms, immigration operates as a complex precipitating factor, and its three interrelated processes need to be contextualized in the patient's history, organization of identifications and defenses, central conflicts and system of beliefs and ideals. In order to capture the intersection of personal, familial and cultural meanings, the conceptual framework for the psychodynamic formulation of psychotherapy cases includes intrapsychic, interpersonal and cultural dimensions of psychic reality. The theoretical foundation of this article draws on the integration of relational psychoanalysis and social cognition. The outcome of the psychological process of immigration is considered to depend not only on the restructuring of dynamic aspects but also on non‐dynamic factors such as the immigrant's age, socioeconomic background, linguistic and cultural differences, forced or voluntary migration, and the possibility of revisiting the country of origin. Two psychotherapy case presentations illustrate the three interacting processes of the psychodynamics of immigration formulated in the context of each immigrant's history and personality from a psychodynamic framework that includes intrapsychic, interpersonal and cultural perspectives. Copyright © 2004 Whurr Publishers Ltd.

280-THE IMPACT OF PSYCHOANALYTICALLY ORIENTED PSYCHOTHERAPY FOR THE TREATMENT OF PSYCHOSOMATIC PATIENTS. IN MEMORY OF CHRISTEL SCHÖTTLER—A PIONEER IN PSYCHOANALYTIC PSYCHOSOMATIC

Therapists working in the addictions field and practicing from a psychoanalytic psychodynamic framework are often confronted with the patient’s need to know, the demand for therapist self-disclosure. Consistent with Alcoholics Anonymous (AA) principles, many patients state that they cannot be helped unless the therapist is revealing of their personal background. This paper discusses the theoretical roots of therapist self-disclosure and the AA philosophy and offers suggestions for how the two might be reconciled.