Psychodynamic Insights Research Articles

Psychological Care of Persons with Parkinson’s disease: Neuropsychological and Jungian Perspectives

Parkinson’s disease (PD) is a neurodegenerative disorder associated with progressive physical, cognitive, and emotional impairments. Providing psychological care for these individuals is an important part of their overall medical care and can be guided by experiences obtained from the broad field of neuropsychological rehabilitation. We summarize how the stage of the illness relates to disturbances in functional independence and executive functioning that negatively impacts social integration and produces a fertile ground for depression and loss of hope. It is proposed that integrating knowledge from the neurosciences (especially neuropsychology) with psychodynamic insights (especially those of C.G. Jung) of the person with PD can play an important role in sustaining their resiliency and, in so doing, provides clinically relevant psychological care.

Psychodynamics in Diabetes: The Relevance of Deepening the Symbolic in Treatment Adherence.

Among chronic diseases, diabetes is recognized as a major health risk negatively affecting the quality of life, with significant morbidity and mortality rates (World Health Organization, 2018), which is expected to rise to 552 million people by 2030, leading to considerable health expenditures (Whiting et al., 2011; Khan et al., 2020). Given its long-lasting nature and risky complications, diabetes requires continuous self-care including being active, eating healthily, taking medication, monitoring symptoms, solving problems, reducing risks, and healthy coping (Di Biase et al., 1997; Glasgow et al., 2008), thus making diabetes management and treatment adherence relevant challenges. In this regard, depressive and anxiety symptoms are often reported by patients with diabetes because of the disease-related distress including worry about complications, fear of hypoglycemia, and guilt feelings about uncontrolled blood glucose (Nouwen, 2015; Sartorius, 2018; Shinkov et al., 2018; Wardian et al., 2018). Overall, this difficulty complying with the stressful rigors of diabetes and required lifestyle changes tends to worsen glycemic control, resulting in higher hemoglobin A1c levels and less optimal outcomes (Whithorth et al., 2016; Egan et al., 2017; Fukuda and Mizobe, 2017; Graham et al., 2020; Schmitt et al., 2021). Therefore, to promote higher patient self-care and treatment adherence, a primary task for healthcare professionals is reducing diabetes distress by improving patients' skills at regulating negative emotions (Coccaro et al., 2021). Emotion awareness and management in diabetes care are based on the capacity to deal with feelings and thoughts on both conscious and unconscious levels (Ivinson, 1995). From such a perspective, a psychodynamic approach can provide a significant contribution to a better understanding of the patient's emotional life. This article provides some basic psychodynamic insights with a practical value, focusing on the concepts of alexithymia, defense mechanisms, loss, mourning, and transference–countertransference dynamics in the therapeutic relationship. This may also help medical and nursing professions dealing with diabetes care to reconsider patient difficulties and communication through a new lens, thus improving clinical observation and care.

Psychodynamic Lessons of Pandemic to Be Explored

Back to table of contents Previous article Next article APA & MeetingsFull AccessPsychodynamic Lessons of Pandemic to Be ExploredMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Mar 2021https://doi.org/10.1176/appi.pn.2021.3.21AbstractPresenters will look through a psychodynamic lens at psychiatric treatment during the pandemic in a variety of settings—including outpatient, consultative inpatient, and public health settings.How has the COVID-19 pandemic and widespread adoption of telehealth—including for psychotherapy—affected the psychodynamics of the psychiatrist-patient relationship and psychiatric treatment? How can psychodynamic insights guide psychiatric treatment that is likely to remain socially distanced for the foreseeable future?Gerald P. Perman, M.D., will chair a session on psychodynamic lessons from the COVID-19 pandemic at this year’s Annual Meeting.Those are questions that Gerald P. Perman, M.D., and four other experts in psychodynamic psychiatry will address in the session “Psychodynamic Lessons From the Novel Coronavirus Pandemic.” Perman is the immediate past president of the American Academy of Psychodynamic Psychiatry and Psychoanalysis (AAPDPP).“Psychiatrists who attend our session, many of whom have been treating and will continue to treat their patients online in the months ahead, will learn some of the factors that make online treatment beneficial, as well as what has gotten lost in the transition from in-person treatment,” Perman and Douglas Ingram, M.D., who will also be speaking at the symposium, told Psychiatric News in a joint statement.“In important ways, it is a safer medium for the psychiatrist and the patient,” Perman and Ingram wrote. “But the loss of immediacy that exists with in-person treatment, connectivity issues, and asynchronies between speech and audio contribute to a weaker engagement with our patients. In learning to recognize the issues that we encounter online and to neutralize their effects, we can serve more effectively as the psychiatrists our patients need. And, in our dedication as mental health professionals, we need it for ourselves as well.”In separate comments to Psychiatric News, Perman said that all of the presenters, who are members of AAPDPP, “view the treatments we provide, in whatever setting, through the lens of a psychodynamic psychiatrist.”Perman will describe how the need for self-quarantine and social distancing has affected patients in outpatient psychiatric treatment, including how common defenses are used by patients to manage the challenges presented by the pandemic and how in other instances social isolation aided the healing of preexisting interpersonal and interfamilial conflict. Perman co-wrote an article in The Forum (fall 2020), a publication of the AAPDPP, titled “Telepsychiatry During the Coronavirus Pandemic: Some Pros, Cons, and the Future.” The co-author was Mahmoud Aborabeh, M.D., a PGY-4 trainee in psychiatry at George Washington University School of Medicine, Ingram, a past president of AAPDPP, will address the impact of COVID-19 on the “therapeutic space” and how recourse to digital technology requires a rethinking of this space within which the psychiatrist and patient work.Kimberly Best, M.D., associate chair and program director at Einstein Medical Center in Philadelphia, will discuss ways in which the pandemic dramatically affected medical student education and psychiatry training. Syed Saba, M.D., a psychiatrist who works for the Department of Health Services in Los Angeles, will recount her work in the public health system caring for patients who have COVID-19 and severe mental illness. She will describe collaboration with primary medical teams to assist with diagnostic clarification, behavioral management, and recovery while balancing staff and patient safety concerns.Eugenio Rothe, M.D, president of the American Association of Social Psychiatry, will present moving vignettes of unresolved mourning on the part of people who lost loved ones to COVID-19 but could not visit them during their hospitalization, as well as their memories of previous separations from loved ones that were elicited by the pandemic lockdown. Perman said lessons and insights discussed at the session will be relevant when the pandemic recedes, too. He said there are advantages to virtual treatment, and the disadvantages are becoming more manageable as both clinicians and patients gain daily experience with it.“At a minimum COVID has always been in the background of video interactions with patients,” Perman said. “Certainly, all patients have been fearful, especially at the beginning, but for most this has lessened over time. Telepsychiatry seemed at first to be dehumanizing, but now over a year later, especially with the extreme convenience it has afforded, it seems almost an afterthought. When the pandemic is over and vaccines become widely disseminated, some patients may prefer to continue with telepsychiatry.” ■“Psychodynamic Lessons From the Novel Coronavirus Pandemic” will be held Sunday, May 2, from 11:30 a.m. to 1 p.m. ISSUES NewArchived

Toys: a Man Has His Reasons. Winnicottian Perspectives on the Playing of Men

The essay draws on the psychodynamic theory of D.W. Winnicott to argue for eight interrelated reasons informing the playing of men. Through playing, men seek to reestablish a holding environment; (re) discover their bodies; dabble with non-pathological insanity or madness; support their true self; experience transformation and enter transitional spaces; toy with destruction; seek healing from physical, emotional, relational, and spiritual wounds; they play to experience ego orgasms; and, men play for play’s own sake. The author’s own playing, in the form of long-distance motorcycling provides a backdrop of lived experience for the essay. The article mirrors Winnicott’s methodology, which resisted grand theory making as it focuses on specific psychodynamic insights and themes. Winnicott’s thought is used to extend William Blake’s wisdom around toys and reasons, wisdom Erik Erikson explored previously.

Psychodynamic insights from narratives of people with amyotrophic lateral sclerosis: A qualitative phenomenological study

This study explored the illness experience of people with amyotrophic lateral sclerosis (ALS) to widen narrative research on patients’ perspectives, adopting object relations theory as interpretative framework. A qualitative phenomenological analysis was conducted on the illness stories of 12 adult Italian patients with ALS, collected through an Internet-based database for the sharing of illness experiences of people with rare and chronic degenerative diseases. Three thematic areas were identified: “the experience of ALS from symptom onset to diagnosis”, “impact of illness”, and “coping with illness”. Overall, the central conflict experienced by people with ALS refers to the progressive loss of control on bodily experience, that is handled by means of denial and splitting defences to contrast such a process of somatic depersonalization. As well, the investment on interpersonal domain responds to a repairing strategy ensuring psychic vitality and sensorial integration to rebuild the relation between the self and the external world.

Women Leaders as Containers: Systems Psychodynamic Insights into their Unconscious Roles

The purpose of this article is to explore the self-defined roles of women leaders working in higher education institutions (HEIs) in South Africa. The aim is to explore women leadership roles in the context of systems psychodynamics to increase the understanding of unconscious dynamics in HEIs from the perspective of women leaders. The article reports on a qualitative study based on the research paradigm of Dilthey's modern hermeneutics. Interviews were conducted with 23 women leaders from the HERS-SA (Higher Education Research Services) network across eight institutions. Observations were made in one organization to support the data analysis and interpretation. Data was analysed through content analysis. Women leaders are containers of anxieties in South African HEIs, while they also act out defense mechanisms, such as splitting, projection, projective identification, introjection, idealization, simplification and rationalization. Splitting seems to be one important defense mechanism in terms of mother/professional, mother/daughter, women/men leaders and White/Black women leaders. Women leaders further seem to have introjected the roles of their mothers and female family members from their past and childhood. They do not seem to embrace the full authority and agency of their leadership positions, and they explore their own difficulties and negative emotions in others through projective identification. The findings create awareness of the roles of women leaders, strengthen women leadership and emphasise the need for leadership training taking the systems psychodynamic perspective into account.

“And Yet It Was a Blessing”: Psychodynamic Insights for Well-Being While Coping with Serious Illness (TH368)

•Highlight moments in coping with terminal illness from the narrative and firsthand reflections of a patient's spouse.•Identify key insights from psychodynamic theory that provide a useful framework for psychological coping.•Strategize techniques and best practices in providing stability, wisdom and supportive structures to accompany patients and spouses facing terminal illness. Some patients and families make striking statements amid the tragedy of illness, such as, “…and yet it was a blessing.” It appears that these patients have a sense of holistic well-being as they approach death, which has developmentally emerged throughout the trajectory of their life-limiting illness. This phenomenon of “Existential Maturity” provides foundational principles to both capture and comprehend the unique nuances that foster psychologically coping. Lessons from traditions such as self-psychology, development and attachment theory provide inroads for better understanding this process. Moreover, clinicians' awareness of Existential Maturity can enhance patients' well-being, identity, relationships and quality of life as they face mortality. In this concurrent session, a patient's spouse will speak from her experience of accompanying her husband through the dying process. Her narrative will serve as a platform for highlighting various psychodynamic processes normative in terminal illness. A friend and psychoanalyst who accompanied the patient and spouse will reveal how the works of thinkers such as Winnicot, Bolwby, Kohut, Erickson and others illuminated the dynamics of their journey with serious illness. Finally, experts in palliative care and psychodynamic theory will provide practical techniques for clinicians to utilize these insights when caring for patients and families. The groundbreaking elements of this presentation are the firsthand, synthesized reflections from a patient's spouse and a collaborative discovery of the dimensions of the couple's experiences that are generalizable to many who face mortality. Moreover, clinicians of all disciplines will acquire skills to apply this framework of Existential Maturity in psychological coping towards a state of thriving at the end of life. As the field of palliative care quickly expands in breadth, this session offers greater depth to the psychological processes of each clinical encounter.

Teachers’ Emotional and Educational Reactions toward Children with Behavioral Problems: Implication for School-Based Counseling Work with Teachers

Teachers’ Emotional and Educational Reactions toward Children with Behavioral Problems: Implication for School-Based Counseling Work with Teachers Elias Kourkoutas, Ph.D; Pilios-Dimitris Stavrou, Stefanos Plexousakis Abstract Disruptive behaviour and conduct problems among children have a significant effect in their school presence, and affect the quality of their interactions with their teachers. As a consequence, teachers face difficulties in their work, resulting in higher dropout rates and burn out, while students are not supported adequately. The present review discusses the need for teachers working with children exhibiting challenging behaviour to receive help from professionals, in order to gain better insight into the psychological processes of such children. Studying the interaction between disruptive children and their teachers within the classroom, it can be deducted that each child requires an understanding of the roots of their problematic behaviour, as it is critical to find out which clinical/ therapeutic or psychosocial/psycho-educational intervention fits best each case. The need for the implementation of a holistic model that incorporates therapeutic interventions in school is explained; it is critical to integrate counsellors, who will connect with the children and alleviate part of the stress that causes the disruptive behaviour. Meanwhile, the role of counsellors in this context should be to facilitate communication among students and teachers, helping the latter to gain a psychodynamic insight into each case, and to handle conscious or unconscious hostile feelings and rejecting attitudes toward the ―problematic‖ pupil. Finally, key points are presented that summarize the steps that need to be done in order to develop a productive and functioning relationship among all parts within a school framework. Full Text: PDF DOI: 10.15640/jpbs.v6n2a3

Essential Ingredients of Psychotherapy that Matter the Most: My Reconciliation with the Theories of Grand Masters

Therapeutic ingredients form the backbone of psychological intervention. The breadth and method for learning skills, quality of teaching and the recipient i.e., therapist in training's ability to capture the knowledge combined with skills is a fluid, intense and time-limited induction process. This may encapsulate attachment theory, self-psychology, psychodynamic insight oriented psychotherapy, tools of cognitive behavior therapy, problem solving and crisis management therapy and psychodrama, and systemic, structural and strategic models of family therapy.

The Holocaust and the Revival of Psychological History. By Judith M. Hughes (New York, Cambridge University Press, 2015) 188 pp. $67.50 cloth $24.00 paper

Hughes, a historian and a psychiatrist, makes an eloquent argument in this book for historians’ existing “reliance on a psychoanalytically inflected commonsense psychology” (11). She argues that many, or even most, historians working on both sides of the turn of the twenty-first century have used such an approach in “recognizing agency” on the part of human beings in their times and places (5, 179). In this claim, Hughes is certainly correct, particularly since the discipline of history has become more interested than ever in documenting in rich detail the experience of human beings as revealed in the many sources that they have left behind. This experience, for Hughes, is filled with deep, complex motives and actions that demonstrate the central role played by fantasy as well as fact. As a case study, Hughes analyzes several works about the history of the Holocaust that engage, with varying degrees of success in her view, this search for agency and motive in history.The great strength of this book is its clear and detailed comparative analysis of these texts. Hughes spends a great deal of time following the narrative of each work that she analyzes for the sake of the general-interest audience that she targets. Historians and graduate students will find these narratives too long and too full of direct quotations, especially in the case of Hugh Trevor-Roper’s The Last Days of Hitler (New York, 1947). Most of the analysis of the relative poverty of psychodynamic insight in Trevor-Roper’s portrait of Hitler—compared with Ian Kershaw’s full-length Hitler: A Biography (New York, 2010)—is confined to a couple of pages at the end of the first chapter. This organizational imbalance is less evident in the comparison between Daniel Goldhagen’s Hitler’s Willing Executioners: Ordinary Germans and the Holocaust (New York, 1996) and Saul Friedländer’s two-volume Nazi Germany and the Jews (1997, 2007). For Hughes, Goldhagen’s account, in contrast to Friedländer’s, lacks psychoanalytical sophistication as well as attention to historical detail in its “unnuanced and tendentious treatment of German anti-Semitism” (47). Hughes could have stressed that Goldhagen is a political scientist and not a historian. His tendency, therefore, is toward the type of categorical and causal thinking that can preempt idiographic concern with the multiple and overdetermined conditions affecting an individual in history.In this regard, Hughes would have done well to discuss Christopher Browning’s disagreement with Goldhagen in the afterword to the second edition of Ordinary Men: Reserve Police Battalion 101 and the Final Solution in Poland (New York, 1993) about the motives of perpetrators. Hughes mentions the afterword in a footnote but does not exploit it in her well-founded criticism of Goldhagen for transforming “his subjects into automata” (180). Likewise, Hughes cites Deborah Lipstadt’s The Eichmann Trial (New York, 2011) but does not mention Lipstadt’s argument concerning Eichmann’s deep antisemitism, which has been recently documented by other historians of the Holocaust. This theme would also have helped to further an argument in her book—criticism of Hannah Arendt’s view of Eichmann as a man without any psychological depths in Eichmann in Jerusalem: A Report on the Banality of Evil (New York, 1963).Hughes’ pronouncement that “assertions about the childhood origins of adult beliefs and behaviors” should be omitted is too strict (4). Documenting the childhood of a historical figure may well be difficult, with the attendant danger of reductionism, but it is hardly impossible. This stricture is also at odds with Hughes’ reliance on Sigmund Freud as a source of psychoanalytical insight for historians. But this apparent contradiction aside, why does Hughes ignore later neo-Freudian and even post-Freudian psychoanalysis? Some mention of Heinz Kohut or Nancy Chodorow would only strengthen her clear, compelling, and essential argument for the utility, indispensability, and inevitability of depth psychology in examining and understanding the past.

Grief, After Death Communications and Childhood Abuse: Two Substance Use Case Reports

The following two case reports discuss the effect of grief on their drug-use behaviour. Both case descriptions of substance use disorders are comorbid with depression and/or an anxiety-related disorder. Case 1 and 2 have a history of childhood sexual and physical abuse and report multiple drug relapses as a consequence of unresolved grief associated with the abuse. The maladaptive grief process of case 1 and 2 had presented itself in the subjective belief of having after death communications with the deceased. The application of cognitive behavioural techniques driven by psychodynamic insights, revealed a relationship between the grief experienced, childhood abuse and the use of prescription medication and illicit drug use. The case descriptions of grief are discussed in the context of substance misuse, mental health and the triggers associated with relapse in an attempt to further our understanding of substance abuse and therapy.

Psychodynamic psychotherapy, insight, and therapeutic action.

It has often been observed that, in general, different psychotherapies do equally well. Some have taken this as good evidence that therapeutic action in psychotherapy rests not on the factors specific to individual therapies, but on common factors. I argue against this view in favor of a theory of therapeutic action deriving from psychodynamic psychotherapy. This identifies the therapeutic relationship (and with it, many so-called common factors) and ‘psychodynamic insight’ as therapeutic factors. I review the evidence from outcome studies and from studies into two concepts related to insight, viz. reflection function and psychological defense. I argue that the best interpretation of the evidence supports the claim that insight, in interrelation with the therapeutic relationship, contributes to therapeutic action.

‘Knowing all this just makes it harder’: Psychodynamic Ideas on the Frontline

This paper was given as the fifth Annual Ellen Noonan Counselling Lecture on 12 July 2011 and retains some of the spoken style of the lecture. The theme pursues an aspect of Ellen Noonan’s thinking, in that she always valued equipping students with learning they could take back into the workplace rather than purely training clinicians. The paper addresses both the usefulness and potential difficulties of providing front-line workers with psychodynamic insight. It might appear self-evidently worthwhile to offer staff in the caring and educational professions greater understanding of the roots and meaning of the difficulties faced by their clients and of the dynamics involved in working with them. This paper, while stressing the immense value of such awareness, looks at what can be problematic about it, both for staff and their employing agencies. It also describes ways of addressing such issues, both at an individual and organisational level.

When Unconscious Wishes Become Laws: Policing Memory and Identity in Israel and Palestine

ABSTRACTThis paper proposes a psychoanalytically‐informed model for the policing of memory and identity in Israel and Palestine. Borrowing from both empirically‐ and clinically‐validated insights into psychopathology, it purports to account for the increasingly frequent attempts of the Israeli government to suppress alternatives to the extant Zionist narrative using legislative and administrative means. The model explains why, counter‐intuitively, these attempts to impose an idealized Zionist narrative have markedly increased in the past several years, at a time when Israel's military power, geographical expansion and economic prosperity are arguably at an all‐time high. Supported by examples from both world history and Israeli documents, the proposed model suggests a dynamic link between trauma, annihilation anxiety, hyper‐vigilance and defensive behavior on a nation‐wide level, which runs as a leitmotiv in both Israeli government actions and in sentiments expressed by a considerable portion of Israeli society, from the foundation of the state of Israel in 1948. The model further uses psychodynamic insights to account for the cognitive‐emotional rigidity underpinning the discrepancy in the perceptions of reality between Israel's narrative and its sundry worldwide alternatives. The model posits that this growing discrepancy between worldwide public opinion and Israeli internal reasoning may underlie the growing disapproval and isolation of Israel in both diplomatic circles and world media. Finally, following psychodynamically‐oriented therapeutic practices, the explanatory power of the model is harnessed to suggest potentially effective remedial attitudes and interventions, whose mutative powers may be of use to psychodynamically‐trained mental health professionals who may be involved in future reconciliation efforts between Israel and Palestine. Copyright © 2012 John Wiley & Sons, Ltd.

A relationship‐based approach to engaging involuntary clients: the contribution of recognition theory

ABSTRACTThis paper focuses on the process of engaging with families where a child is at risk of harm, and considers a relationship‐based approach to work with ‘involuntary clients’ of child protection services. Contextualizing the discussion within a broader understanding of the role and importance of relationship‐based practice, a conceptual and ethical framework is outlined that can, it is suggested, support effective relationship‐based work and moral decision‐making with involuntary clients. Making use of psychoanalytic and more broadly psychodynamic insights, along with perspectives drawn from recognition theory, it is argued that relationship‐based practice offers the potential for recognition, respect and reciprocity, and that these three aspects of relationship provide a foundation for ethical engagement with involuntary clients. However, such an approach is not without tensions, so the latter part of the paper considers some of the challenges and dilemmas that accompany the process of trying to engage parents who do not want to be ‘worked with’.

Jungian Contributions to Successful Neuropsychological Rehabilitation

Neuropsychological rehabilitation of persons who have suffered brain injury requires that the treating clinician have a good grasp of neuropsychology as well as psychodynamic and analytic psychological insights regarding the nature of human beings. This paper provides clinical examples of how various Jungian insights have contributed to a successful neuropsychological rehabilitation outcome for some patients. The importance of symbols in influencing human behavior and providing meaning in life, the impact of fairytales on determining how an individual functioned before and after brain injury, and the process of individuation in the psychotherapy of individuals who have suffered brain injury are discussed. The role of synchronicity and the importance of dreams are also briefly considered. Interest in Jung’s concepts continues to flourish because he was interested in the complexity of human experiences, and his concepts and observations were not limited to a single method of intellectual discovery.

In Memoriam

In Memoriam

Nurses and their Patients – Informing Practice through Psychodynamic InsightsNurses and their Patients – Informing Practice through Psychodynamic Insights

Nurses and their Patients – Informing Practice through Psychodynamic InsightsNurses and their Patients – Informing Practice through Psychodynamic Insights

Nurses and their patients – informing practice through psychodynamic insightsNurses and their patients – informing practice through psychodynamic Insights Raeve Louise de , Rafferty Mic and Paget MaryM&K Publishing266pp£28978 1 905539 31 41905539312

Nurses and their patients – informing practice through psychodynamic insightsNurses and their patients – informing practice through psychodynamic Insights Raeve Louise de , Rafferty Mic and Paget MaryM&K Publishing266pp£28978 1 905539 31 41905539312

Salvaging the self in adult learning

This paper stems from a dialogue on the subjects of learning and learners: one forged out of experiences in research and teaching, and the application of psychodynamic insights, developmental psychology and recent work in the neurosciences, to thinking about adult learning and subjectivity. We argue that some notion of the self needs to be salvaged, in a poststructuralist and postmodern world, when considering processes of learning, teaching and, fundamentally, what it means to be human. We recognise that this is a complex topic and that we can only touch on limited aspects of it here, but our paper represents an attempt to bring new trans-disciplinary understanding of selfhood into conversations about adult learning. The paper builds on our other recent writing, which explored the border country between psychotherapy and educational processes, and between different epistemological perspectives, including the place of unconscious processes in understanding learners and learning (Hunt and West, 2006).