Psychodynamic Tradition Research Articles

Intensive Short-Term Dynamic Psychotherapy

Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a transdiagnostic treatment method rooted in the psychodynamic tradition. A basic assumption is that many of our feelings, thoughts, desires and inner conflicts are inaccessible to our consciousness and thereby trigger and maintain psychological problems. In the 1960s, the Canadian psychoanalyst and psychiatrist Habib Davanloo began developing the original ‘standard format’ of ISTDP. After continuously studying video recordings of his treatment sessions, Davanloo systematised effective factors which he could use in subsequent treatment sessions. In the 1990s, he further developed a ‘graded format’ of ISTDP with interventions that could be adapted to patients who are easily overwhelmed by anxiety and other emotions. In this article, we take a closer look at how ISTDP operationalises ‘unconscious anxiety’ and ‘unconscious therapeutic alliance’ as observable markers that provide the therapist with information about the therapeutic process and about the choice of interventions, illustrated through the case of Nadine. Keywords: Intensive Short-Term Dynamic Psychotherapy, ISTDP, conflicting emotions, unconscious anxiety, unconscious therapeutic alliance

The Development of Psychodynamic Psychiatry in Iran.

Iran, as one of the oldest civilizations in the world, is positioned at the crossroads of important trade routes linking Asia, Africa, and Europe, resulting in enormous cultural interactions with the East and West. The development of modern psychiatry and psychodynamic psychiatry in Iran occurred in the context of the broader process of modernization through interactions with the West. Mentioning key scholars and influences that helped establish a psychodynamic tradition within centralized government-led systems of mental health care and medical education, the author describes various stages of the development of psychodynamic psychiatry in Iran.

SCALE OF SELF-ASSESSMENT OF MENTALIZATION AND SELF-AGENCY DEVELOPMENT IN MENTALIZATION-BASED THERAPY PROCESS (SAMS): FIRST VALIDATION

Developing reliable and valid tools for measuring the effectiveness of psychological and psychotherapeutic interventions is a critical task of modern psychological science and practice in Ukraine. The article presents a description of approbation of the psychological questionnaire (scale) for measuring self-assessment of development mentalization and self-agency in the process of mentalization-based psychological counseling (therapy) (SAMS). SAMS was developed within the theoretical psychoanalytic paradigm based on the psychodynamic tradition of empirical studies of the effectiveness of psychological interventions. The theory of mentalization by P. Fonagy and the theory of self-agency by J. Knox became the theoretical foundation of the SAMS. The purpose of the empirical study is to develop the body of SAMS and to check it for reliability and validity. Psychometric strengths of the SAMS were checked on a sample of clients of the project “Poradnya” (psychological counseling center) of psychology and psychotherapy Department of the Ukrainian Catholic University. 86 people were studied in the initial research and 32 in the re-test research. The study examined the SAMS methodology for internal, constitutional, and re-test reliability and its structural and constitutional convergent validity. According to the results of the conducted empirical research, it can be stated that the SAMS technique has high reliability and validity. Therefore, it can be used in further scientific studies of the effectiveness of psychological interventions in the same way as in psychological practice in Ukraine.

Reflections on the integration of poetry therapy and psychodynamic practice based on an analysis of the book Tribute to Freud by the poet H.D.

ABSTRACT This paper concerns the book Tribute to Freud, by Hilda Doolittle (H.D.) (1886–1961). In the book, H.D. – an important person in the modernist poetry scene – presents her psychoanalysis with Sigmund Freud (1856–1939). She describes how literature, sculptures, mythology, and symbols were central to their dialogues. I have analysed these dialogues with respect to the three components of poetry therapy, the receptive, the expressive, and the symbolic. Based on the analysis, I discuss how poetry therapy and psychodynamic practice can be integrated and how practitioners from the two orientations can learn from and inspire each other. I reflect on the presence of symbols and mythology in the book and suggest that the symbolic component, which has received the least attention, could be strengthened by the psychodynamic tradition’s acknowledgement of symbols and mythology. I also discuss how poetry therapy could inspire psychodynamic practitioners to acknowledge the expressive component.

Hartmann’s Boundaries Questionnaire: Measuring Psychometric Properties and the Structure in a Russian-speaking Sample

Psychological boundaries are defined as one's ability to distinguish various components of psychological life: conscious and subconscious, self and others. The Boundaries in the Mind concept by E. Hartmann belongs to the psychodynamic tradition and is implemented in the Boundaries Questionnaire, which assesses the thinness of one's psychological boundaries. Its shortest version (18 items) has been adapted in Russian but is a one-scale tool. The BQ-46 version, developed by D. Rawlings, consists of six subscales which allow for structural analysis. The objective of this study was to develop a Russian version of the questionnaire based on the BQ-46 and analyze its structure in a Russian-speaking sample. The BQ-46 was translated into Russian and back. Data collection was arranged online. Three hundred eighty-seven (387) participants filled in the Russian version of the questionnaire. Two hundred ninety-six (296) of them also filled out four additional questionnaires for convergent validity assessment, and one hundred and one (101) subjects completed a BQ-46 retest. The Russian version of the questionnaire (referred to as BQ-33) consists of 33 items and is a five-scale measurement tool. Its subscales are generally in line with the original BQ-46 version by D. Rawlings. The BQ-33 demonstrated acceptable-to-good reliability and good test-retest stability (r = 0.86). The convergent validity of the BQ-33 was supported by associations with the respective psychological concepts. My findings supported the idea of boundaries getting thicker with age, along with some tendency for gender differences for particular subscales. The study results supported the validity and reliability of the BQ-33 in a Russian-speaking sample. This tool can be used to measure psychological boundaries and assess their structure.

ICD-11 Personality Disorders: A Psychodynamic Perspective on Personality Functioning.

The new ICD-11 introduces a fully dimensional classification of personality disorders representing a fundamental change in personality disorder diagnosis with major implications for clinical practice and research. The new system centers on the evaluation of the severity of impairment in the areas of self and interpersonal functioning. This focus on personality functioning converges with long-standing psychoanalytic/psychodynamic conceptualizations of personality pathology. In a detailed conceptual analysis and review of existing empirical data, points of convergence and notable differences between major exponents of the psychodynamic tradition—object relations theory as developed by Kernberg et al. and the Operationalized Psychodynamic Diagnosis—and the ICD-11 system are critically discussed. Personality functioning can be considered to be the current “common ground” for the assessment of personality disorders and constitutes a considerable step forward in making personality disorder diagnosis both clinically meaningful and suitable for research purposes.

Catharsis as a therapy: an overview on health and human development

The word catharsis is derived from the Greek word which is translated as cleansing or purification. Most of the definitions emphasize two essential components of catharsis: the emotional aspect (strong emotional expression and processing) and the cognitive aspect of catharsis (insight, new realization, and the unconscious becoming consciousness) and as a result - positive change. Aristotle defined catharsis as purging of the spirit of morbid and base ideas or emotions by witnessing the playing out of such emotions or ideas on stage [1]. Breuer and Freud described catharsis as an involuntary, instinctive body process, for example crying [2]. Schultz and Schultz (2004) followed the psychodynamic tradition and defined catharsis as the process of reducing or eliminating a complex by recalling it to conscious awareness and allowing it to be expressed [3]. The American Psychological Association [4] also associates catharsis with the psychodynamic theory and defines it as the discharge of affects connected to traumatic events that had previously been repressed by bringing these events back into consciousness and reexperiencing them.

« La raison derrière chaque action ». Les premières années de la psychiatrie de l’enfant en Suède, 1930-1945

The development of Swedish child psychiatry is not a coherent, straightforward narrative of a steady progression. Child mental health was raised as a topic in the early twentieth century and in the 1920s and 30s child guidance activities began to take shape in the larger municipalities, carried out by philanthropic or public agents. In this period the neuropsychiatric oriented child psychiatrists were challenged by those with an interest in psychoanalysis in defining and treating childhood mental ill health. There was no sign of a cohesive national approach to child mental health services until the early 1940s, when the first steps in such direction were taken by the Swedish government. The political ideas underpinning these actions were based on a psychodynamic tradition combined with a political vision of social change.

The impact of suicide prevention on experienced Irish clinicians

AbstractBackgroundEmerging research coming from the person‐centred and psychodynamic traditions in the past 15 years has examined the traumatic dimension of suicidal behaviour on clinicians. However, there is limited empirical literature on the impact of suicidality on Irish psychotherapists. In Ireland, it is estimated that 500 citizens die by suicide each year, while approximately 11,000 accident and emergency admissions are the consequence of suicide attempts.AimThis elicits the question, how does suicide prevention impact Irish mental health professionals who work solely with these vulnerable populations?MethodIn this article, the process of interpretative phenomenological analysis (IPA) was applied to the narratives of seven experienced therapists.FindingsThe Irish Poet W.B. Yeats coined the famous refrain ‘All changed, changed utterly, a terrible beauty is born’ in his poem ‘Easter 1916’ (as cited in Martin, ). This quote aptly encapsulates the reality of seven experienced Irish psychotherapists who work exclusively in the field of suicide prevention. Three salient superordinate themes emerged: (1) Overworking; (2) All changed, changed utterly/identity disruption; (3) A terrible beauty is born/A spiritual practice.DiscussionClinicians were ‘changed, changed utterly’ with identity disruption evident in their self, bodies, intimate relationships and professional identity. ‘A terrible beauty was born’ was demonstrated in the overarching theme of the restorative nature of client engagement in the life of the therapist. This was particularly evident in humanistic practitioners, who were acutely aware of their own sublimation of melancholia.ConclusionMost striking across all seven transcripts was the mix of the corrosive nature of suicide prevention on the self of the therapist, combined with unparalleled opportunities for personal growth and spiritual reformulation.

Can Relational Therapy be Appropriate for Clients with Schizophrenia?

Relational theory, a part of the psychodynamic tradition, assumes a positive worker–client relationship as the major factor in a client’s psychological growth. It emphasises that intervention is a ‘two-person’ activity in which the subjective perspectives of both the client and practitioner combine to create a unique healing encounter. The goal of relational theory is to help clients overcome interpersonal problems that impair satisfactory functioning by developing a more cohesive sense of self through the clinical relationship. Given that people with schizophrenia often have major difficulties with social connection, relational therapy may hold promise for them as an intervention strategy, although the sometimes-intensive modality may heighten their anxiety, interpersonal boundary problems and other active symptoms. The purpose of this article is to consider whether relational therapy might be appropriate for some clients who have schizophrenia. Two case vignettes are utilised to illustrate the process.

Group Psychotherapy in Germany

This article gives an overview of the development of group psychotherapies in Germany originating from a psychodynamic tradition. The German health system provides access to inpatient and outpatient psychotherapy for all of its citizens. Whereas groups are common in inpatient settings, the provision of outpatient group treatment still could be improved, as it is the case for the general training of group psychotherapists. Group research in Germany largely reflects clinical practice, with more studies coming from the inpatient field. It is stated that the general image of group treatment seems to be largely positive, which could provide a basis for political initiatives to improve the dissemination of group therapy in this country.

A Response to “Thinking About Our Work: Supervision”

A Response to “Thinking About Our Work: Supervision” J. Scott Rutan1 issn 0362-4021 © 2015 Eastern Group Psychotherapy Society group, Vol. 39, No. 1, Spring 2015 53 1 Private practice. Correspondence should be addressed to J. Scott Rutan, PhD, 71 Waban Hill Road, Chestnut Hill, MA 02467. E-mail: scottrutan@scottrutan.com. In his article, Dr. Stone focuses on supervision of group therapy, with specific emphasis on setting clear goals. I applaud Dr. Stone for calling our attention to the need to be thoughtful about teaching and practicing the art of supervision, which is the foundation of our work. It is often overlooked, such that Anne Alonso (1985) termed it the “Quiet Profession.” I will comment on supervision from a somewhat broader perspective, not focusing exclusively on the supervision of group therapy. Ours is an apprenticeship trade. We learn under the watchful eyes of our supervisors. Fundamentally, supervision is the loaning of experience to neophyte therapists. Venturing into the world of emotional healing can be daunting when we begin. There are powerful emotions—eruptions of old countertransferences, the seduction of projective identifications, receiving sexual and angry transferences. These can be bewildering and frightening to new therapists. In group therapy, the swirl of emotions is only intensified. A supervisor should have specific goals in mind, and they differ according to the level of experience of the supervisee. These may or may not match the goals of the neophyte therapist, though, as Moga and Cabaniss (2014) state, they need to be made clear to the supervisee. An initial supervisory goal is to help the supervisee become able to bear strong affect without having to act. Affect, certainly in the psychodynamic tradition, is a main avenue of change, and it is imperative that therapists become comfortable with a wide range of emotions and a wide level of intensity of those emotions. For example, some young therapists are made very anxious when their patients express sexual feelings toward them. A supervisor can helpfully point out that most feelings 54 rutan in therapy are often addressed to “Dear Occupant,” meaning that they are transference feelings invited by the role of the therapist. Another early goal is to help the supervisee understand and use theory to guide in technique. Early in the process, this will likely be helping the supervisee use the supervisor’s preferred theory. It is hoped that in later stages, the supervisor will help supervisees learn the theories that most naturally fit with them. In the psychodynamic tradition, helping the supervisee hear “process” and believe in the unconscious are two of the most important skills to impart. Then the task is to learn how to feed back to the patients what has been heard in a way that maximizes patient growth. The supervisory relationship is an intimate and complicated one. Supervisees are in a vulnerable position, often encountering painful aspects of their own personalities . In addition, most of the time, supervisor and supervisee work in the same setting and have multiple types of connections, including personal. The supervisor must be acutely aware of the boundaries of the supervisory relationship. Often the supervisory relationship is even more complicated, as when the supervisor is new in the role, or when there are personality conflicts, or when supervision occurs across professional disciplines. There are many types of supervision. There is supervision of specific modalities, for example, supervision of individual therapy, couple therapy, family therapy, or group therapy. There are different configurations for supervision. Much supervision of individual therapy occurs in dyadic settings, whereas often, supervision of group therapy occurs in groups. There are even peer supervisory groups (Kassan, 2010). Good supervision provides the supervisee with a cognitive frame by which to understand the patient, an ability to elicit and allow the full emotions of the patient, an ability to value the patient no matter how distasteful his or her defenses might be, a keen sense of professional ethics, the ability to “hear” the unconscious themes in each hour, and, finally, an ability to maintain a professional boundary that protects both patient and therapist. REFERENCES Alonso, A. (1985). The quiet profession: Supervisors of psychotherapy. New York: Macmillan. Kassan, L. D. (2010). Peer supervision groups: How they work...

Looking at the gap between social psychological and psychodynamic perspectives on group dynamics historically

Purpose – The paper aims to describe and understand the gap between the psychodynamic literature on groups and the social psychological perspective on group dynamics. Design/methodology/approach – As Wilfred Bion is the most influential group dynamics representative of the psychodynamic tradition the authors performed a citation analysis of Bion's work to find out whether it influenced the social psychological research on group dynamics. They compared three domains of literature: therapy/clinical, management/organization studies and social psychology. Moreover, they depict (by drawing on interviews with European pioneers in social psychology) the historical context in which European social psychology developed to explain the gap between the psychodynamic and social psychological approaches in the study of group dynamics. Findings – The results clearly indicate the existence of a gap between the social psychological and psychodynamic perspectives on group dynamics. Moreover, the authors show that Bion did influence scholars studying or working with real-life groups and is cited more by American than European scholars. The attempt to build a legitimate scientific identity for social psychology provides a context for understanding of the neglect of the psychodynamic tradition. Research limitations/implications – The authors conclude by exploring ways in which the psychodynamic tradition may fertilize the social psychological tradition in studying groups. Originality/value – The paper is one of the first to address the discrepancy between the social psychological and psychodynamic perspectives in the study of group dynamics.

Revisiting Balint's innovation: enhancing capacity in collaborative mental health care

Interprofessional collaboration is increasingly recognized as a key response to the challenges associated with complex mental health issues in community primary-care settings. Relatively few practice models, however, provide an orientation and a structure that combines quality patient care, professional development, and the building of community capacity. A psychodynamic tradition of supervision and collaboration, an approach known as the Balint model, holds considerable potential to bring this orientation to collaborative primary care and mental health teams. As a consultation group, the Balint approach brings participants' attention to subtle emotional–interpersonal phenomena such as the provider–patient relationship, the presentation of illness, and the experiences of patients and team members. We introduce and provide an overview of the Balint group model, including several concepts proposed by Balint to illuminate the emotional and relational complexities of providing mental health care in a collaborative primary-care setting. The context of our discussion is the implementation of a modified Balint group approach within a Canadian collaborative mental health Care (CMHC) program. We also discuss how an interprofessional application of this approach can enhance patient care, contribute to care providers' professional development, and build community capacity.

Chapter 6. The New Story: On the Possibility of Liberating Oneself From the Drug Self

This chapter explores the meaning(s) of “treatment effect” within the psychodynamic tradition. The conventional wisdom is that a successful treatment presupposes a transformation of unconscious “material” to a conscious level. The “treatment effect” is reinterpreted as being better understood as changing an old (and detrimental) story into a new tale—an alternative narrative about the self. New possibilities following this conceptual change are introduced with the aid of some concrete examples.

Assessing Clinician's Subjective Experience during Interaction with Patients

Background: While psychiatric literature has shown renewed interest in fine psychopathological investigation, little study has been devoted to the clinician's subjective experience with the patient, which is highly valued by the phenomenological and psychodynamic traditions. We aimed at developing a valid and reliable instrument to measure such experience. Sampling and Methods: First, 104 self-report items were developed, based on daily clinical practice and references from the literature on clinician's subjective experience. Of these, 46 were retained after pilot testing and exclusion of items with poor psychometric properties. Thirteen psychiatrists and 527 first-contact patients participated in the validation study. Psychiatrists completed the ‘Assessment of Clinician's Subjective Experience' (ACSE) instrument and the Brief Psychiatric Rating Scale (BPRS) after the visit and the Profile of Mood State (POMS) before and after it. The ACSE was completed again for 60 patients with stable BPRS scores over a short retest interval. Principal component analysis with orthogonal rotation was performed. The internal consistency and test-retest stability of ACSE factorially derived scales were calculated. Convergent validity was tested by examining the correlations between ACSE scores and change in POMS scores during the visit. Results: Five factors (interpreted as tension, difficulty of attunement, engagement, disconfirmation, impotence) accounting for 57% of total variance were extracted. All ACSE scales showed high internal consistency and stability, and correlated with conceptually related POMS scales. Conclusions: The pattern of subjective experience identified by the ACSE is consistent with classical psychopathological descriptions and previous related studies. Despite limitations such as the relatively small number of psychiatrists studied and the exclusively self-report nature of the instrument, this study supports the validity and reliability of the ACSE and suggests that it may be a valuable tool for training, research and possibly diagnostic purposes.

A Widened Scope on Therapist Development: Designing a Research Interview Informed by Psychoanalysis

This article presents a qualitative research interview method informed by psychoanalysis, which can collect data beyond the subjective report of the participants. The method has been used to study acquisition of psychodynamic understanding and therapy technique among student therapists in psychology. Within the psychodynamic tradition, the subjective report of every person is viewed as potentially distorted by defense processes. Moreover, relational patterns in an interaction are viewed as significant data about the intrapsychic object relations of a person provided that the person is placed in a projective situation. Since common qualitative interview methods focus primarily on verbal data, such psychodynamic assumptions represent a methodological challenge. To collect a wider scope of data than merely the subjective report, a research interview has been developed based on a certain degree of projection, a psychoanalytic listening perspective, and the use of emotional expression in the interview relation as data. Subsequently, relational scenarios and incidences of defense processes in the research participants are inferred.

The affective neuropsychology of confabulation and delusion

The paper reviews the history of the scientific understanding of the role of emotion in confabulation and delusion. I argue that the significance of emotion in the pathogenesis of these symptoms was obscured by academic polarisation between psychodynamic and neurocognitive traditions and was also often obfuscated by rigid distinctions between psychogenic and neurogenic explanations. This tradition of epistemic dualism was implicitly maintained in the fields of cognitive neuropsychology and cognitive neuropsychiatry. This paper focuses on memory-related confabulation following ventromedial frontal lobe lesions, awareness-related confabulation following right perisylvian lesions, and delusions of various aetiologies. Ambiguity regarding the definition and taxonomy of symptoms renders direct comparison difficult, but certain overriding principles are becoming discernible. Recent findings suggest that emotion and motivation influence both confabulation and delusion. These influences may be instigated directly by neural dysfunction or indirectly by life changes and altered social circumstances, or by a combination of these. Importantly, the rejection of epistemic dualism in the conceptualisation of both symptoms can allow us to study them in parallel and draw conclusions about the relation between cognition and emotion. Specifically, confabulation and delusion can be described as faulty attempts to balance the conflicting demands of accurate and self-serving reality representation.

Psychiatry and Politics in Pelotas, Brazil:

The world-wide emergence of categories for diagnosing mental health problems in children and youth such as conduct disorder is often attributed to the globalization of a highly biomedical form of psychiatry. In Brazil, a small group of therapists are resisting biomedicalization by keeping psychodynamic traditions alive and aiming to transform psychotherapy into a resource for politicized youth empowerment. Nevertheless, clinical practices demonstrate an increased use of biomedical diagnoses and therapeutic routines. On the basis of fieldwork with therapists and teachers, and a nine-year-long ethnography of young people, this article explores the localized effects of these potentially contradictory developments. Results show that the growth of biomedical practices alongside politicized therapeutic approaches is not indicative of underlying ambiguities but has, rather, emerged from the purposefully equivocal nature of Brazilian social, medical, and professional life. The article uses this Brazilian case study to critically debate theories of medicalization in the anthropology of psychiatry.

Self‐Soothing — A Recursive Intrapsychic and Relational Process: The Contribution of the Bowen Theory to the Process of Self‐Soothing

The concept of self‐soothing originating in the psychodynamic tradition has attracted interest from therapists as a key skill in the managing and regulating of strong affect and emotional discomfort. While a capacity for self‐soothing is implicit in, and a vital prerequisite to, the process of differentiation, Murray Bowen also predicted that the outcome of increased differentiation is improved emotional equilibrium and a capacity for self‐soothing, clearly a recursive process. The attention of Bowen family systems theory to both the relational and intrapsychic aspects of human functioning provides a useful framework through which to explore these aspects of the dynamics of self‐soothing. This article describes some of the key processes involved in developing a self‐soothing capacity within an effort to define a more autonomous self in significant relationships. The author contrasts Family Systems thinking with other theoretical perspectives that speak to the importance of self‐soothing. Finally, the role of the therapist as a facilitator of an environment in which the self‐soothing resources of clients can emerge is considered alongside suggestions and strategies for how a therapist may contribute to a client's own efforts.