Psychodynamic Understanding Research Articles

Psychodynamic understanding of the worlds of experience and motives in conspiracy beliefs

Psychodynamic understanding of the worlds of experience and motives in conspiracy beliefs

Internet-Delivered Affect-Focused Psychodynamic Therapy for Adolescent Depression: Treatment Principles and Clinical Application in the ERiCA Project

ABSTRACT Internet-delivered, therapist-guided, self-help programs are novel ways to deliver psychotherapeutic interventions adapted from established therapy models. Such programs can be easily accessed online and may offer an important treatment option for patients who struggle with barriers to seeking out and engaging in face-to-face psychotherapy, including depressed adolescents. While there are evidence-based Internet-delivered self-help programs based on cognitive-behavioral therapies (i.e. ICBT) for adolescent depression, a program based on psychodynamic principles (i.e. IPDT) has so far been lacking. In this article we describe the IPDT program developed within the ERiCA project, which has so far been evaluated in two randomized controlled trials (RCTs). We further provide a case example from one of the trials to illustrate the treatment process and therapeutic interaction in detail. Given the novelty of the approach, we will particularly highlight and discuss how a psychodynamic understanding of adolescent development and depressive dynamics as well as affect-focused treatment principles inform the treatment, including the therapist’s role, tasks, and choice of interventions. The potential implications and utility of IPDT for regular clinical practice are elaborated as well as potential research directions for the future.

The superego in supervision. censor, persecutor or protector

Key to psychodynamic and psychoanalytic work is an observing ego and the capacity to reflect on conscious and unconscious dynamics. Supervision frequently requires us to think the unthinkable and consider and reflect on material that might be shame inducing or provoke anxiety. However, this requires the ego to allow unconscious thoughts and feelings to surface and not be inhibited by the superego. The superego affects us in many ways. It sometimes acts as a censor determining what can be consciously thought in order to manage anxiety and inhibit unwanted thoughts and affects entering consciousness. It can persecute us with shoulds and oughts but it can also protect through consideration of what is appropriate and ethical. In this paper I explore the impact of the superego on supervisory and clinical work in terms of being a censor, a persecutor and protector. The paper interweaves theory with clinical examples and examines how the superego can inhibit the exploration of clinical material and the development of a reflective and psychodynamic understanding of the client’s internal world. In addition I consider how the superego is a factor that ensures good practice and that the work of the clinician is fit for purpose.

The ‘wave-particle’ child: reconnecting the disconnect in the concept of latency

ABSTRACT The aim of this paper is to re-examine psychodynamic understanding of middle childhood towards a conceptual reformulation of this critical developmental stage. We believe such a reformulation is necessary in the light of contemporary psychoanalytic thought and developmental findings outside of the psychoanalytic field. This is intended as a preliminary stage in the direction of a recalibration of the technique and language of child analytic treatment to fit the particular psychological challenges and needs of middle childhood. Historically, middle childhood (or latency) has been regarded as a period of psychosexual dormancy and psychic rigidity. We review contemporary developmental findings and suggest a shift in emphasis in psychodynamic thinking towards the psychic growth, developmental challenges and emotional fragility that also characterise middle childhood. We propose that the psyche of the school-aged child is at once wave and particle, constantly growing and evolving and yet simultaneously stable and structured. We also emphasise the complexity of psychosocial development in middle childhood beyond the triangular, into what we term the polygonal psychic space. The familiar structured games of middle childhood – card games, ball games, board games and today’s console games – reflect this complex and paradoxical developmental picture, but the traditional child psychotherapy paradigm remains biased towards the toys and make-believe games of early childhood. Adaptation of technique and clinical theory to middle childhood is critical, particularly given the recent steep rise in referrals of school-aged children to mental health clinics across the globe, and the relatively high treatment drop-out rate commonly seen, especially in boys. We suggest the game-play typical of middle childhood offers a safe and developmentally appropriate medium of play, through which the child can express and explore their intrapsychic and interpsychic world in a psychotherapeutic setting.

Operationalizing and Visualizing Psychodynamics in Positive Psychotherapy (PPT)

This article presents a novel conflict model for operationalizing and visualizing psychodynamics within the context of Positive Psychotherapy (PPT). The model builds upon the traditional approach of N. Peseschkian and M. Goncharov’s model from 2014, further enhanced by the basic needs of love, security, and autonomy as outlined by G. v. Witzleben (2014), and the emotions delineated by P. Ekman and Traditional Chinese Medicine (TCM). The model affords an in-depth understanding of a patient’s motivations and psychodynamic responses in various situations. It expands upon previous models that focused on conflicts rooted in the connection between primary and secondary capabilities. By considering the simultaneous or sequential existence of different inner conflicts, the model allows for a comprehensive view of a patient’s psychodynamics. While this article only provides an excerpt of the ideas from the author’s recent book, it offers general guidelines for operationalizing and visualizing psychodynamics within PPT, encouraging further exploration and understanding of individual psychodynamics.

Operationalized Psychodynamic Diagnostic of Adolescents in Light of the New ICD-11 Model of Personality Functioning: Personality Structure, Psychodynamic Conflicts, and Mental Health Problems.

The International Classification of Diseases and Related Health Problems, 11th Revision introduced a fully dimensional approach to personality disorders which conceptionally converges with the long-standing psychodynamic understanding of psychopathology through underlying intra- and interpersonal impairments. In this study, the diagnostic contributions of the two psychodynamic concepts of personality structure and psychodynamic conflicts were investigated through the comparison of self-report data of 189 adolescents with mental health problems and 321 mentally healthy controls. The study results reveal that adolescents with mental health problems show significantly higher impairments in all four domains of personality structure and significantly higher levels of several psychodynamic conflicts. Further, adolescents with different mental health problems significantly differ regarding the impairments in the personality structure domains and several levels of psychodynamic conflicts. While higher structural impairments are shown in adolescents with eating and anxiety disorders, higher levels of the passive self-worth conflict persist in adolescents with depressive disorders, and higher levels of the passive identity conflict are affecting adolescents with eating disorders. The findings suggest that a standardized diagnostic assessment of personality structure and psychodynamic conflicts in adolescent patients could contribute to a deeper understanding of mental health problems and appropriate treatment planning through the detection of underlying intra- and interpersonal impairments.

Interrater Reliability of the Psychological Mindedness Assessment Procedure, Extended (Dutch) Version, in a Clinical Patient Population

The Psychological Mindedness Assessment Procedure, Extended Dutch Version (PMAP-plus), was developed to assess psychological mindedness in mental health care. Psychological Mindedness represents the ability to understand self and others through mental representations of internal psychodynamic states. In patients, deficits in psychological mindedness capacity can cause problems in self- and interpersonal functioning. This brief report describes interrater reliability of four PMAP-plus scenarios for evaluating psychological mindedness capacity among patients. Patients with personality disorders (N = 194) were asked to respond to four enacted videotaped PMAP-plus scenarios presenting a person talking about a personal experience. The videotaped scenarios varied in their emotional impact. All verbatim responses were scored by two clinically experienced raters on a hierarchical scale with gradually increasing complexity of psychodynamic understanding. Clinicians achieved acceptable interrater reliability on PMAP-plus in this patient population. Two scenarios with low emotional impact evoked significantly higher interrater agreement as compared to two scenarios with high emotional impact. Our results suggest that mental health professionals can reliably distinguish levels of psychological mindedness by assessing PMAP-plus in a patient population. Scenarios differ in potency to reveal psychological mindedness capacity. The variation in emotional impact in subsequent scenarios makes it a promising instrument measuring psychodynamic capacities for psychotherapeutic treatment.

Is it safe outside? Tales from a home visiting service for families during the COVID pandemic

AbstractA description of a mentalization informed home‐based project, an adaptation of the ECID project (Equipo Clínico de Intervención a Domicilio), into a time‐limited first aid mental health team in response to heightened mental health needs during the COVID Pandemic in Barcelona, Spain is offered. ECID is a project with a developmental psychodynamic understanding of psychopathology and relational dynamics informing a highly flexible treatment approach. This paper describes a focus on the need for clinicians to take an active role whilst adapting to the specific needs and situation of each child and family, instead of continuing to ask them to adapt to what services can or are prepared to offer. Clinical examples are given to illustrate the value of an integrative community approach informed by both systemic and psychodynamic lenses. Specifically, we reflect on the benefits of a mentalization informed approach to working with families during high levels of psychosocial stress for both families and practitioners. We illustrate how of a mentalization informed clinical service can promote and support the development of a therapeutic alliance when internal safety is impacted by a very real external threat. Finally, preliminary data is presented regarding the impact of parental stress and trauma on children and adolescents' adaptation to a potentially traumatic situation as well as their capacity for returning to a progressive development pathway.

Retaining Psychodynamic Thought in Contemporary Psychiatry

Back to table of contents Previous article Next article Psychiatry & PsychotherapyFull AccessRetaining Psychodynamic Thought in Contemporary PsychiatryRandon S. Welton, M.D.Randon S. WeltonSearch for more papers by this author, M.D.Published Online:30 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.11.30AbstractPsychodynamic psychotherapy was once a cornerstone of psychiatric training and practice. Historically, most psychiatrists would have felt comfortable exploring patients’ unconscious and interpersonal issues in weekly therapy sessions. In contemporary psychiatry, however, psychodynamic thought has lost its preeminence. Managed care’s preferential reimbursement of psychopharmacology and reliance on lower-cost therapists compounded by the mistaken belief that psychodynamic psychotherapy lacks empirical support led to a steady decline in psychiatrists providing psychodynamic psychotherapy. Ironically this occurred simultaneously with the emergence of a literature demonstrating the efficacy and cost-effectiveness of psychodynamic psychotherapy in managing personality disorders, chronic depression, and anxiety. What can psychiatry do to preserve the benefits engendered by a psychodynamic understanding of patients?In addition to promoting psychodynamic psychotherapy, psychiatric training should focus on the advantages of incorporating psychodynamic thought into a wider range of patient interactions. Psychodynamically informed psychiatrists can emphasize once commonly held beliefs such as these:Everyone has an active unconscious that in part dictates their desires, reactions, and behaviors.Past experiences shape one’s current relationships, emotions, and decisions.People tend to form recurring patterns of relationships often based on early childhood models.The relationship between the psychiatrist and patient contains both diagnostic and therapeutic potential.We must act quickly, however, if we want a psychodynamic orientation to remain a core feature of psychiatry; the last generation of psychiatrists who were steeped in psychodynamic thought are rapidly reaching retirement age. Some psychiatrists, especially those in private practice, are able to offer traditional psychodynamic psychotherapy, but all psychiatrists can still inculcate a psychodynamic understanding into routine clinical care. Consider the following example:A young man was seen in the ICU by the consultation/liaison team. He had cut his wrist and taken an overdose of acetaminophen. When the resident sat down with him, the patient was curt and dismissive. “Let’s get this over with. ... I was suicidal, but I am not anymore. I have seen the error of my ways. I promise.”Despite the aggressiveness of these remarks, the resident sensed the patient was more scared than angry. She asked why he was trying to push her away when she was trying to help him. He became suddenly tearful, “That is what they always say. You pretend to care, but when I need you, no one is there for me.” Recognizing that the intensity of his response came from previous disappointments, she tried to reassure him of her desire to help and said, “It sounds like people have let you down before. I wonder if that had something to do with you trying to kill yourself.” This led to a conversation about his chronic relationship struggles and the argument with a close friend that had precipitated the suicide attempt.A minimal psychiatric response to this situation would be to thoroughly document a risk assessment and make recommendations about psychopharmacology. A psychodynamic psychiatrist would reflect on what these interactions say about the patient’s past experiences and inner life and how those factors should guide her approach to the patient.The consultation/liaison resident encouraged the patient to discuss the relationship with his friend and their distressing conversation. She then asked him to consider a different perspective.“You two sound very close. You have felt rejected by many people in your life, but maybe his spending time with other people is not a rejection of you. I wonder if there are parts of his life that don’t involve you, just like there are parts of your life that don’t involve him.” The patient nodded. “Well, he was going over to play some stupid online game. He knows that I get bored with that stuff. He has asked me before, and I have always said ‘no.’ ” The resident suggested, “So maybe he didn’t invite you because he knew you wouldn’t want to go.”The resident’s understanding of the patient’s interpersonal vulnerabilities allowed her to strengthen their therapeutic alliance and to help the patient re-examine long-standing, unconscious beliefs about his relationships. She continued his current medications without change and arranged for a next-day appointment with his outpatient therapist.Retaining a psychodynamic orientation can deepen our understanding of patients and guide our interactions wherever we work. We should not settle for a reductionistic view of patients’ symptoms, as if their primary problem was a medication deficiency. Today’s psychiatrists can incorporate these practical psychodynamic principles into their everyday work and thereby provide the comprehensive care that patients need and deserve ■Randon S. Welton, M.D., is an associate professor of psychiatry and director of the psychiatry residency program at Wright State University School of Medicine. He is also a member of the Committee on Psychotherapy of the Group for the Advancement of Psychiatry (GAP). ISSUES NewArchived

O USO DE INSTRUMENTOS PSICOLÓGICOS PARA A ORIENTAÇÃO PROFISSIONAL NA PRÁTICA CLÍNICA

This article aimed to carry out a descriptive and exploratory bibliographical research on the importance of vocational guidance for young people and which psychological instruments can be used as clinical practice by psychology professionals. Based on the findings in the literature on professional choice, professional guidance and types of assessment, we sought to make a methodological proposal for a clinical intervention in professional guidance using instruments and psychological tests. The findings indicate the importance of using psychometric resources and techniques of self-report tests, expressive and projective personality tests for the understanding of psychodynamics, professional choices and preferences.

Treatment and Qualitative Research of Schizophrenia

IntroductionThe author demonstrates the psychodynamic understanding of schizophrenia and describes the ensuing personality-structural psychotherapy. Schizophrenia from a psychodynamic understanding is a disease in the core of the identity with disturbances of the personality functions of identity, ego-demarcation, aggression, fear, narcissism, perception, cognitive abilities and the body- ego. It is the concern of the author to investigate how schizophrenically structured patients and their family members experience the group dynamic field in which the patients grew up and its relations to the illness. The following five topics: contact and experiences within the family of childhood, body care and physical contact, kindergarden and school life, puberty, and contacts outside the family have been investigated.ObjectivesThe aim is to show how the family settings and backgrounds are conducive to developing schizophreniaMethodsThe author chosed for her investigation the method of biographical interviews, introduced by Witzel (1985). This method of interviewing is problem centered, object and process oriented. The analysis of the exhaustive tape-recorded interviews was made by using the method of qualitative analysis based on the grounded theory.ResultsSchizophrenia from psychodynamic understanding is a disease in the core of the identity with disturbances of the personality functions of identity, ego-demarcation, aggression, fear, narcissism, perception, cognitive abilities and the body- ego.ConclusionsIt is the concern of the author to investigate how schizophrenically structured patients and their family members experience the group dynamic social energetic field in which the patients grew up and its relations to the illnessDisclosureNo significant relationships.

Defense Mechanisms Reloaded in the Light of Impaired Personality Functioning: An Attempt of Clarification and Simplification Resulting in the DSQ-22-A for Adolescents.

With the upcoming ICD-11, the diagnostic guidelines for personality disorders will change fundamentally to a dimensional severity concept, including the evaluation of several domains of personality functioning. Moreover, the lifetime perspective will allow this diagnosis even in early adolescence, providing the opportunity for early detection and intervention. In psychodynamic understanding, defense mechanisms are considered to be a part of the “personality structure”, which is one axis in the related diagnostic system (OPD) and showed great similarities to the concept of personality functioning. The most common inventory to assess defense mechanisms is the Defense Style Questionnaire, especially the DSQ-40, which has unfortunately not been specifically adapted to younger ages yet. Using an age-adapted version of the DSQ-40 with simplified formulations, a thorough empirical item analyses and selection was performed, including a face-validity check of the items by experienced therapists and assessments for item correlations, factor structure, reliability, construct and clinical validity in a german clinical and school sample containing 396 adolescents. Though several improvements, similar problems as reported for the adult DSQ versions concerning face-validity and coherence of the item pairs (2-item-method) to represent the single defense mechanisms were obtained. Thus, not all item pairs could be kept and a shortened version DSQ-22-A for adolescents with good psychometric properties was build. The three resulting defense categories adaptive, neurotic and maladaptive showed acceptable scale reliabilities (0.63, 0.56, 0.68), sound factor structure and convincing convergent and clinical validity in terms of highly significant correlations with impaired personality structure according to the OPD-CA2-SQ as well as with PHQ-D depression and somatic symptoms, especially for the maladaptive defense category (0.75, 0.44, 0.34). Likewise, the maladaptive defense category differed highly significant (p = 0.000) and with a large effect size of d = 0.9 standard deviations between adolescents from the school and the clinical sample. The DSQ-22-A can be recommended for use in adolescents for research, diagnostics and therapy planning, especially with regard to personality functioning and structure. Possible fundamental changes concerning some basic operationalization's of the defense mechanisms and the 2-item-method were suggested for international discussion.

Females with Eating Disorders and Urinary Incontinence: A Psychoanalytic Perspective.

Eating disorders (EDs) are complicated mental illnesses with significant treatment resistance and dropout rates. For successful treatment, it is important for clinicians to better understand the patients’ narrative and their lived experiences. A thorough psychodynamic understanding of patients’ childhood attachment and primary relationships, personality traits and mental processes is, therefore, crucial for managing patients with ED. Interestingly, several studies have observed an association between functional urinary symptoms and individuals with ED. EDs such as anorexia nervosa are associated with an increased risk of all urinary symptoms, and functional incontinence was also more common in extreme female athletes with low energy availability and with disordered eating. There is, however, a dearth of literature describing this relationship, and the underlying mechanisms remain remote. In this paper, we present a psychoanalytic approach to the presence of urinary symptoms in females with EDs. We hypothesize that these symptoms are tied to specific traits or characteristics of ED patients, namely the overarching need for control, a pathological strive for perfection and the self-denial of basic bodily urges. This is discussed in relation to psychopathological processes, development and personality factors commonly seen in patients with ED.

Clinical wisdom, science and evidence: The neglected gifts of psychodynamic thinking.

We review five key areas of contemporary psychodynamic practice and research to highlight the contributions psychodynamic concepts can make to clinical psychiatry. These areas are as follows: (1) Contributions to understanding the development of subjectivity. (2) The psychodynamic understanding of the effects of early childhood trauma and their consequences in adult life. (3) The vital importance of the psychodynamic notion of the 'holding environment' based on an understanding of the dynamics of the development of subjectivity and trauma which, if applied, might improve the quality of psychiatric care in the public mental health system and enhance both the clinical competence and morale of clinicians in the system. (4) The emerging scientific disciplines of Neuropsychoanalysis and Affective Neuroscience, which illustrate the importance of seriously studying the mind as well as the brain. (5) A brief summary of some research into the clinical effectiveness and efficacy of psychoanalysis and its related psychodynamic therapies.

If Japan was a Person

The language memoir has informed a wealth of research on multilingualism. Polly Barton’s book 50 Sounds (2021), in which she narrates her experience of moving to Japan as part of the Japan Exchange and Teaching Programme, is another example of autobiographical writing with rich insight into LX learning. The article examines Barton’s exploration of relationships in and with an LX and reflects on the importance of transferential phenomena in LX acquisition. Parallels between LX and L1 learning during infancy are also investigated. The findings seem relevant for a psychodynamic understanding of LX learning that takes object relations into account and will hopefully result in more research.

65.1 PSYCHODYNAMIC PSYCHOPHARMACOLOGY CURRICULUM FOR CHILD AND ADOLESCENT PSYCHIATRY

The phenomenon of polypharmacy or inadequate treatment with psychotropic medication is not an uncommon issue in child and adolescent clinical practice. Using psychodynamic theory can guide psychopharmacology treatment, especially when dealing with treatment-resistant patients or when the formulations are very complex. This raised questions about the best way to integrate psychodynamic concepts into psychopharmacology. Through the AACAP Psychodynamic Faculty Training and Mentorship Initiative (PFTMI), the presenter collaborated with his mentor, Horacio Hojman, MD, MBA, Associate Professor at Alpert Medical School at Brown University, Faculty at Boston Psychoanalytic Society and Institute, to develop a psychodynamic psychopharmacology curriculum for children and adolescent psychiatry residency training programs. This curriculum emphasizes the importance of establishing a therapeutic alliance and recognizing the meanings, both conscious and symbolic, of medication to everyone in the system of prescribing medications. Applying psychodynamic understanding and techniques can help child and adolescent psychiatry residents become effective prescribers; the residents will maintain their self-esteem and may experience less burnout. In this way, they can become increasingly motivated to learn psychodynamics and to apply this psychodynamic knowledge in their daily practice in a variety of clinical settings, especially in psychopharmacology. A psychodynamic approach to psychopharmacology can enhance the comprehensive biopsychosocial formulation and may result in better clinical outcomes for children and families.

Psychodynamics of imagination failures: Reflections on the 20th anniversary of 9/11

This article aims to advance the psychodynamic understanding of imagination failures by studying lessons learned in the US government’s public inquiry into September 11th, 2001 (9/11). Analyzing the findings of The 9/11 Report, I theorize that two forms of macro-level hubris—America’s “hubris of empire-building” and Al Qaeda’s “hubris-nemesis complex”—amalgamated in a uniquely generative manner leading to events on 9/11. Previous studies of public inquiries often demonstrate that inquiry reports are monological story-telling performances used to create sense-making narratives that function hegemonically to impose a simplified version of reality to assign blame and depoliticize events in order to facilitate closure after shocking events. In contrast, findings here suggest that by constructing a critical narrative, The 9/11 Report may serve as a new type of public inquiry report that invites learning about the complex factors that underpin crisis. The article concludes by identifying fruitful areas of future research and ways to theorize further about the collective psychodynamics of macro-level hubris and the psychodynamic factors that hinder learning and contribute to imagination failures.

Understanding Panic Buying Through an Integrated Psychodynamic Lens.

Previous literature has identified panic buying as often being a response to environmental stressors. In early 2020, we saw an increase in panic buying as a response to a real and/or perceived lack of resources due to COVID-19. Although panic buying has a long history, there is a lack of literature to provide a psychological understanding of the phenomenon. During the early days of COVID-19 clients presented with fear and uncertainty. These negative emotions were, in part, a response to a real shortage of basic supplies. However, the panic response led to behaviors that, for some individuals, resulted in atypical buying patterns. From a therapeutic perspective, one can consider behavioral and psychodynamic explanations and interventions, and how this impacts the associated behaviors. This article will focus on psychodynamic understandings of panic buying as a response to events that result in negative emotions. By providing a psychodynamic understanding of panic buying, authors hope to contribute to the therapy of clients presenting with related behaviors and their associated negative affect.

UMA COMPREENSÃO PSICODINÂMICA DA OBESIDADE EM PACIENTES PÓS-BARIÁTRICOS

UMA COMPREENSÃO PSICODINÂMICA DA OBESIDADE EM PACIENTES PÓS-BARIÁTRICOS

Аналіз причин суїцидальної поведінки в контексті психоаналітичної теорії

The article examines the views of scientists on the causes of suicide and suicidal behavior in the psychoanalytic tradition context. The research presents a retrospective vision of psychoanalysts of the suicide phenomenon. Based on the theoretical analysis, the authors try to generalize the understanding of the causes and motives of suicidal behavior in psychoanalytic theory. The desire to solve certain life problems motivates people to overcome their inferiority. The article raises issues related to the psychodynamic understanding of the mechanisms of suicidal decision, through the struggle of the instincts of Eros (instinct of life) and Thanatos (instinct of death), the struggle of “I” with the “Super- I”, or through the unconscious metaphorical desire to return to the womb, symbolic acceleration degeneration. There is no unity in the issue of suicide; representatives of different scientific fields, followers of many psychological schools consider it from different angles. Some individuals fail to do so; they begin to feel the need to destroy others. The desire to solve certain life problems motivates people to overcome their inferiority. But if some individuals fail to do so, they begin to feel the need to destroy others. Suicide in this context becomes a covert attack on other people. Through self-destruction, a person seeks to evoke compassion for himself and condemnation of those responsible for his low self-esteem. Psychoanalytic approach primarily tries to explain the phenomenon of suicide by internal unconscious processes, the struggle of “Me” with “Super-Me”. Considering the psychoanalysts’ views, it is concluded that suicide in the psychoanalytic concept is primarily seen as an internal urge arising in the psyche and over time is stimulated by external factors, the struggle between instincts of self-preservation and self-destruction is at the heart of the process. Based on the theoretical analysis, the authors try to generalize the understanding of the causes and motives of suicidal behavior in psychoanalytic theory. Based on the views of psychoanalysts, it is concluded that suicide in the psychoanalytic concept is primarily seen as an internal motivation that arises in the psyche and over time is stimulated by external factors, at the heart of this process is the struggle between instincts and self-destruction. Thus, the authors conclude that the psychoanalytic approach, which considers suicide as an act of self-destructive tendencies of the individual, autoaggressive behavior, which is an unconscious way to punish himself and tries to explain the phenomenon of suicide, primarily internal unconscious processes, struggle “I” and “Super-I”. Key words: psychoanalysis, suicide, suicidal behavior, autoaggression.