Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a (...) narrative synthesis of these new studies with those identified in the earlier reviews. The updated search identified 37 papers. When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers. The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations, and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people. (shrink)

This manual presents a carefully researched, detailed psychodynamic treatment program for the alleviation of a transdiagnostic range of primary Axis I anxiety disorders, including panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, and related psychological problems. First exploring the principles of psychodynamic theory and formulation, the authors then present a three-phased process of Panic Focused Psychodynamic Psychotherapy-Extended Range : initial evaluation, interpretation of central conflicts and defense mechanisms, and termination. Each phase is discussed (...) in depth and relies on central case illustrations to demonstrate techniques and results. A subsequent chapter explores how to address complex issues that may arise during the course of treatment. Altogether, this manual not only provides a demonstrated, adaptable approach for anxiety disorders, but also clearly embodies a spirit of research and empiricism heretofore rare in psychodynamic psychotherapies, with an eye toward future development. (shrink)

This commentary serves as a reply to Hoffart and Johnson’s article contending that psychodynamic psychotherapy (PDT) models cannot be examined with regard to mechanism of change or represent within-person causal relationships. Hoffart and Johnson cite purportedly paradigmatic examples of PDT and cognitive therapy and examine them with respect to Kazdin’s requirements for investigation of mechanisms of change. We highlight inaccuracies in Hoffart and Johnson’s representation of PDT and, in doing so, provide reasoning in support of the empirical examinability (...) of PDT. We conclude by recommending a metatheoretical system (i.e., functionalism) and empirical methodologies that clinical scientists may consider when investigating mechanisms of PDT in the future. (shrink)

The case of Xiang as described by Jane Carroll is indeed disconcerting well beyond the immediately apparent factors contained within the article. While Xiang’s direct medical expenses are excessive and his inability to pay for those expenses and further support his noncustodial family seem to be the main issues up for debate, Xiang, however, is likely going to need much more psychosocial support if he is to regain his previous independent functionality or retain any aspect of a quality of life (...) whilst continuing his indefinitely isolated treatment. In this response, I briefly outline the probable effects of Xiang’s current situation on his social identity and mental health as well as a potential way that we can minimize these adverse effects. (shrink)

A recurrent theme that is addressed in psychotherapies is the client’s conflicting emotions. This article discusses discursive practices of working on conflicting emotions during psychodynamic psychotherapy. We focus on a phenomenon that we refer to as a ‘delayed response’ and analyze the client’s uses of interactional means, such as a display of negative experience, to invite affiliation or empathy from the therapist. The therapist, however, does not take a turn in the first possible place after the client’s turn. (...) Recurrently, the therapist’s silence is followed by the client’s new turn that backs down from the emotional experience under discussion. After these retractions, the therapists respond with a turn that is responsive both to the retraction and to the initial display of negative experience that occurred prior to it. We argue that the timing of the therapist’s response in these sequences is in the service of psychotherapeutic work on conflicting emotions. (shrink)

The Therapeutic Process presents an informative, sequential, well-defined, and clinically rich guide to the process of psychodynamic psychotherapy. Specifically designed to have broad appeal and value for the beginning clinician as well as the more experienced clinician, this book includes many illustrative examples and well-defined terms.

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons "wise." Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle's intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and (...) psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom. (shrink)

To precisely define wisdom has been an ongoing task of philosophers for millennia. Investigations into the psychological dimensions of wisdom have revealed several features that make exemplary persons “wise.” Contemporary bioethicists took up this concept as they retrieved and adapted Aristotle’s intellectual virtue of phronesis for applications in medical contexts. In this article, we build on scholarship in both psychology and medical ethics by providing an account of clinical wisdom qua phronesis in the context of the practice of psychoanalysis and (...) psychodynamic psychotherapy. With the support of qualitative data, we argue that the concept of clinical wisdom in mental healthcare shares several of the key ethical dimensions offered by standard models of phronesis in medical ethics and serves as a useful, albeit overlooked, reference point for a broader development of virtue-based medical ethics. We propose that the features of clinical wisdom are pragmatic skills that include, but are not limited to, an awareness of balance, the acceptance of paradox, and a particular clinical manner that maintains a deep regard for the Other. We offer several suggestions for refining training programs and redoubling efforts to provide long-term mentorship opportunities for trainees in clinical mental healthcare in order to cultivate clinical wisdom. (shrink)

The COVID-19-pandemic brought massive changes in the provision of psychotherapy. To contain the pandemic, many therapists switched from face-to-face sessions in personal contact to remote settings. This study focused on psychodynamic therapists practicing Guided Affective Imagery, Hypnosis and Autogenous Relaxation and their subjective experiences with psychotherapy via telephone and videoconferencing during the first COVID-19 related lockdown period in March 2020 in Austria. An online survey completed by 161 therapists produced both quantitative and qualitative data with the latter (...) being subject to a qualitative content analysis. Our research suggests that telephone and videoconferencing are considered valuable treatment formats to deliver psychodynamic psychotherapy. However, therapists’ experiences with remote psychotherapy are multifaceted and ambiguous. In particular, the findings raise questions concerning the maintenance of the therapeutic alliance, the development of the analytic process, the sensitivity to unconscious communication, and the indication for certain types of patients that still need further investigation. Our research indicates that the long-standing reticence toward remote treatments offers among psychodynamic therapists is becoming more differentiated and partially dissolves as therapists gain experiences in their use. Attitudes are becoming more open. At the same time, the way is being prepared to take a closer look at the specific processes and dynamics of remote psychotherapy and to examine them critically in future studies. (shrink)

_Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach_ offers a new, short term psychotherapeutic approach to working dynamically with children who suffer from irritability, oppositional defiance and disruptiveness. _RFP-C_ enables clinicians to help by addressing and detailing how the child’s externalizing behaviors have meaning which they can convey to the child. Using clinical examples throughout, Hoffman, Rice and Prout demonstrate that in many dysregulated children, _RFP-C_ can: Achieve symptomatic improvement and developmental maturation as a (...) result of gains in the ability to tolerate and metabolize painful emotions, by addressing the crucial underlying emotional component. Diminish the child’s use of aggression as the main coping device by allowing painful emotions to be mastered more effectively. Help to systematically address avoidance mechanisms, talking to the child about how their disruptive behavior helps them avoid painful emotions. Facilitate development of an awareness that painful emotions do not have to be so vigorously warded off, allowing the child to reach this implicit awareness within the relationship with the clinician, which can then be expanded to life situations at home and at school. This handbook is the first to provide a manualized, short-term dynamic approach to the externalizing behaviors of childhood, offering organizing framework and detailed descriptions of the processes involved in _RFP-C_. Supplying clinicians with a systematic individual psychotherapy as an alternative or complement to PMT, CBT and psychotropic medication, it also shifts focus away from simply helping parents manage their children’s misbehaviors. Significantly, the approach shows that clinical work with these children is compatible with understanding the children’s brain functioning, and posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation, promoting an interface between psychodynamics and contemporary academic psychiatry and psychology. Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach is a comprehensive tool capable of application at all levels of professional training, offering a new approach for psychoanalysts, child and adolescent counselors, psychotherapists and mental health clinicians in fields including social work, psychology and psychiatry. (shrink)

_What is psychotherapy about?_ _What are the similarities and differences of its many forms?_ _What are the most recent developments in the field?_ _Introduction to Psychotherapy_ has been an essential reference book since its publication in 1979, and is regularly included in reading lists for trainee psychotherapists, psychiatrists and other professionals. It is often recommended to interested lay people and prospective patients. This third edition takes into account recent changes in psychotherapy theory, practice and research. The authors are (...) all psychoanalysts. The first edition arose from the experiences of Dennis Brown and Jonathan Pedder working and teaching together as Consultant Psychotherapists at St Mary's Hospital and Medical School, London. (shrink)

This fourth edition of _Introduction to Psychotherapy_ builds on the success of the previous three editions and remains an essential purchase for trainee psychotherapists, psychiatrists and other professionals. It has been revised and extended to capture some of the current themes, controversies and issues relevant to psychotherapy as it is practised today. Bateman has added new chapters on attachment theory and personality disorder and has developed further the research sections on selection and outcome. His new chapter on further therapies (...) covers a variety of therapeutic movements and establishes links between these and classical psychoanalytical therapies. _Introduction to Psychotherapy_ is a classic text that has been successfully updated to provide a relevant and essential introduction for anyone interested in psychotherapy. (shrink)

Useful Servants: Psychodynamic Approaches to Clinical Practice provides a simple but not simplistic overview of nine major approaches to psychodynamic theory and psychotherapeutic practice. Each chapter includes clinical vignettes as well as an extensive case illustration of how theories may be used in the consulting room. For beginners in the field, Useful Servants makes accessible the central ideas that have shaped the discourse of psychotherapy. The advanced clinician will find this book an invaluable review and reference tool; (...) in particular, the chapter on Lacan offers a fresh and digestible summary of the clinical application of this immensely complex thinker. (shrink)

This article is a discourse analysis of two historical inquiries into what clinici-ans today call attention deficit hyperactivity disorder . Of primary con-cern in this regard are psychodynamic perspectives towards ADHD symptoms, championed by psychoanalysts and psychologists, and neurological perspectives towards ADHD, which continue to favor a purely physiological approach to understanding the disorder. Those within the psychodynamic camp are inclined to view ADHD as an interactional difficulty between self and social environment - a condition best remedied by (...) psychotherapy. Those within the neurological camp see ADHD as a specific brain process, whose effective treatment depends upon adequate psychopharmacology. This essay argues that both psychodynamic and neurological perspectives towards ADHD have strategized to legitimate one perspective through the expulsion of the other. Within the current era of ADHD nomenclature and treatment it is clear that neurological perspectives dominate the debate. However, neurological perspectives continue to be haunted by a considerable amount of skepticism, both nationally and internationally. Because of this it would be difficult to assert that neurological perspectives, though winning the “legitimation race” in contemporary understandings of ADHD, are entirely monolithic sources of ADHD knowledge. (shrink)

Background: The classical symptom specificity hypothesis (Blatt, 1974) links obsessional symptoms to autonomous interpersonal behavior. Inconsistent findings from cross-sectional group studies on symptom specificity have previously been associated with several conceptual and methodological limitations intrinsic to nomothetic research. Previous empirical case research reported ambivalences between autonomous and dependent interpersonal behavior in obsessional pathology. Aim and Method: The present ‘theory-building’ case study specifically aims at further refinement of the classical symptom specificity hypothesis by testing specific operationalizations within an empirical single case (...) design. Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of a psychodynamic therapy. Interpersonal functioning is assessed by means of the Core Conflictual Relationship Theme method. The classical symptom specificity hypothesis is contrasted to an alternative hypothesis of interpersonal ambivalences as determinants of obsessional symptoms. Results: Close associations between obsessions and interpersonal dynamics are observed. Findings predominantly affirm the ambivalence hypothesis rather than the classical symptom specificity hypothesis. Psychodynamic interventions focusing on interpersonal conflicts are related to symptomatic changes. Conceptual and methodological considerations, limitations and future research indications are discussed. (shrink)

Currently there are several psychotherapy modalities utilising theory and research from neuroscience in treatment frameworks for mental health and recovery from trauma. In Australia this includes: the Conversational Model of Psychodynamic Psychotherapy, a contemporary psychodynamic approach used for treating Borderline Personality Disorder and other trauma-related disorders; Electroencephalogram Neurofeedback, a brain training therapy which has been used as an adjunct to counselling/psychotherapy in traumatic stress and developmental trauma; and Somatic Experiencing, an integrative mind-body approach based on (...) body responses to threat and fear, especially thwarted attempts to enact fight or flight in the face of threat. These modalities have a promising but still-limited evidence base. This paper explores the role of different types of evidence to frame a descriptive review of the current evidence base available for clinicians practicing in these three modalities. While large clinical trials can provide evidence of comparative effectiveness, case studies, observational, qualitative and practice-based enquiry can assist in discovering other aspects of therapy important for individual clients and practitioners. Existing frameworks of evidence- and ethics-informed health and clinical decision-making suggest an ethical approach can incorporate new, developing and evidence-building therapies. Recommendations include careful consideration of informed consent for therapy including disclosure of efficacy and safety, and specific to psychotherapies incorporating neuroscience, a need for practitioners to reflectively assess their own knowledge, competence, heuristic approaches and biases. (shrink)

This volume explores how conceptions of pragmatism set forth in American philosophy serve as orienting perspectives in psychotherapy. Drawing on the influential contributions of William James and John Dewey, the author demonstrates how realistic, comparative approaches to understanding strengthen everyday therapeutic practice. He also examines recent developments in neuroscience that shape training and practice in the broader field of psychotherapy, encompassing psychodynamic, behavioral, cognitive and humanistic traditions. By following a clinical pragmatism, psychotherapy can be viewed as (...) an instrumental project that is governed by _results_ rather than a commitment to particular theoretical perspectives, empirical findings, or technical strategies. Through a variety of case studies, this volume emphasizes the crucial role of experiential learning in change and growth, and the recognition of the person as an individual. (shrink)

I propose to demonstrate the clinical plausibility of the ‘psychotherapy scene’ of the Bacchae, which is subjected here to a purely psychiatric analysis: all my interpretations and conjectures are based on clinical data and psychiatric theory only. Euripides' objective and rational treatment of the irrational, the accuracy of his descriptions of abnormal behaviour, which are compatible, down to the last detail, with descriptions found in modern psychiatric texts, and his capacity to present not simply a partial list of symptoms, (...) but a coherent clinical picture are taken for granted and will not be discussed further in the present context. The focus of my enquiry is exclusively the psychiatric plausibility of Euripides' description of the psychotherapeutic process.It goes without saying that, since ‘instant cures’ are impossible, Euripides condensed a normally fairly long procedure into a single scene, selectively high-lighting only what would be the crucial moments of a real psychotherapy. His summary of the psychotherapy is as satisfactory as that of a modern psychiatrist. In fact, Euripides' masterly selectivity actually facilitates the understanding of the psychodynamics of Agave's recovery. This enables me to comment on the Euripidean text in exactly the same way as I commented on the verbatim transcript of the psychotherapy of one of my Plains Indian patients. (shrink)

In _Short-Term Psychodynamic Therapy with Children in Crisis, _Elisabeth Cleve presents the therapeutic stories of four children who have experienced trauma or are displaying dramatic clinical symptoms such as low self-esteem and anxiety. Exploring the situation between the individual child and the therapist, the therapeutic space and their experiences, each chapter follows the sessions and the progress made, concluding with a follow-up after the end of therapy. Cleve explores each case as it progresses, emphasising the inner strength of the (...) children and including the interactions between the therapist and the children’s parents. The focus of the psychotherapeutic encounter is in each case to help the child face the trauma, mourn what had been suffered and then move on in life with renewed strength. The final chapters explore the ethics of sharing case material and present Cleve’s reflections on working with traumatised children, and the book also includes forewords by Lars H. Gustafsson, paediatrician and associate professor of social medicine, and Björn Salomonsson, child psychoanalyst and researcher at Karolinska Institutet in Sweden. This warm and readable work will be insightful reading for child psychologists and psychotherapists and other clinicians working with children who have experienced trauma. It will also be of interest to readers wishing to learn more about the processes of psychotherapy with children. (shrink)

This study is part of a larger exploration of ‘talk and cure’ that combines the examination of talk-in-interaction, with nonverbal displays, and measurements of the client’s and therapist’s autonomic arousal during therapy sessions. A key assumption of the study is that psychotherapy entails processes of intersubjective meaning-making that occur across different modalities and take place in both verbal/explicit and nonverbal/implicit domains. A single session of a psychodynamic psychotherapy is analysed with a focus on the expression and management (...) of affect, with an aim to describe key interactive events that promote change in both semantic and procedural domains. The clinical dialogue is analysed discursively, with a focus on the conversational processes through which new meanings are jointly constructed and affective states shared; detailed attention is paid to nonverbal displays of affiliation and affect. Furthermore, we explore whether the interactional patterns implicated in joint meaning-making, as revealed by analysing the therapeutic conversation, have correlates in the autonomic arousal of the two protagonists, as reflected in their heart rates. Conversation analysis has still untapped potential to illuminate interactional patterns that underlie the practice of psychotherapy. In this exploratory study we suggest that discursive analyses of talk-in-interaction can be enriched through detailed focus on nonverbal displays as well as measures of physiological arousal. Drawing upon the analysis, we suggest that bringing the methodological strengths of language-based analysis into fertile dialogue with embodied quantitative data can help our explorations of what’s really going on in psychotherapy. (shrink)

Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about (...) therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components – autobiographical memories, semantic structures, and emotional responses – supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: reactivating old memories; engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed. (shrink)

Traditionally, psychoanalytically oriented clinicians have eschewed a direct focus on symptoms, viewing it as superficial turning away from underlying psychopathology. But this assumption is an artifact of a dated classical approach; it should be reexamined in the light of contemporary relational thinking. So argues Mary Connors in _Symptom-Focused Dynamic Psychotherapy_, an integrative project that describes cognitive-behavioral techniques that have been demonstrated to be empirically effective and may be productively assimilated into dynamic psychotherapy. What is the warrant for symptom-focused interventions (...) in psychodynamic treatment? Connors argues that the deleterious impact of symptoms on the patient's physical and emotional well being often impedes psychodynamic engagement. Symptoms associated with addictive disorders, eating disorders, OCD, and posttraumatic stress receive special attention. With patients suffering from these and other symptoms, Connors finds, specific cognitive-behavior techniques may relieve symptomatic distress and facilitate a psychodynamic treatment process, with its attentiveness to the therapeutic relationship and the analysis of transference-countertransference. Connors' model of integrative psychotherapy, which makes cognitive-behavioral techniques responsive to a comprehensive understanding of symptom etiology, offers a balanced perspective that attends to the relational embeddedness of symptoms without skirting the therapeutic obligation to alleviate symptomatic distress. In fact, Connors shows, active techniques of symptom management are frequently facilitative of treatment goals formulated in terms of relational psychoanalysis, self psychology, intersubjectivity theory, and attachment research. A discerning effort to enrich psychodynamic treatment without subverting its conceptual ground, _Symptom-Focused Dynamic Psychotherapy_ is a bracing antidote to the timeworn mindset that makes a virtue of symptomatic suffering. (shrink)

This article examines how therapists and patients start building and managing relationships and pursue institutional goals at the same time. Based on a corpus of 6 audio-recorded therapies (client-centered therapy and psychodynamic therapy), I investigate first encounters between therapists and patients as the starting points of any therapeutical process and the place where a relationship between the interactants is established for the first time. Following a microlinguistic qualitative approach and applying methods from conversation analysis and discourse analysis, I show (...) how therapists, on the one hand, try to align with patients to build a positive working alliance and, on the other hand, work to fulfill specific interactive tasks of therapeutic discourse which demand disaligning with the patients’ communicative activity and their interactive expectations. Specific interactive “jobs” that need to be fulfilled in psychotherapy are identified, namely the performance of institutional roles by the interactants, the establishment of an interaction structure and the pursuit of helpful change in the patient. I show at which places in the interaction therapists (dis-)align with the patients’ projected communicative activity and how aligning and disaligning are related to the interactive process and the establishment and performance of these interactive jobs. The analysis shows that, at the beginning of therapy, alignment and disalignment are both important processes for the following reasons: Aligning with the patient contributes to a positive relationship, which has been shown to be vital for successful psychotherapy, while disaligning introduces the patient to the specific discursive mechanisms that characterize therapeutic discourse and constitute the basis for its effectiveness. Overall, the paper argues that reducing therapy to a dichotomy between relationship and “technique” seems overly simplistic, as both aspects need to be handled and managed at the same time. (shrink)

With the publication of this book psychotherapy finally arrives at the mainstream of mental health practice. This volume is an essential companion for every practising psychiatrist, clinical psychologist, psychotherapy counsellor, mental health nurse, psychotherapist, and mental health practitioner. It is integrative in spirit, with chapters written by an international panel of experts who combine theory and research with practical treatment guidelines and illustrative case examples to produce an invaluable book. Part One gives a comprehensive account of all the (...) major psychotherapeutic approaches. Parts Two and Three systematically describe psychotherapeutic approaches to the major psychiatric disorders and personality disorders. Many chapters are multi-authored and describe the psychodynamic, cognitive behavioural and other approaches for treating these illnesses. Part Four examines applications and modifications of psychotherapy across the lifecycle. Part Five describes psychotherapy with specific populations such as medical patients and those where gender is an issue, and finally Part Six tackles some of the special topics of concern to psychotherapists including ethics, legal issues, and psychotherapy and neuroscience. The first of its kind, this is a 'must have' volume for all trainee and practising psychological therapists, whatever their background - psychiatry, psychology, social work, or nursing. (shrink)

This article explores the history of ‘subordination-authority-relation’ psychotherapy, a brand of psychotherapy largely forgotten today that was introduced and practised in inter-war Vienna by the psychiatrist Erwin Stransky. I situate ‘SAR’ psychotherapy in the medical, cultural and political context of the inter-war period and argue that – although Stransky’s approach had little impact on historical and present-day debates and reached only a very limited number of patients – it provides a particularly clear example for the political dimensions (...) of psychotherapy. In the early 20th century, the emerging field of psychotherapy was largely dominated by Freudian psychoanalysis and its Adlerian and Jungian offshoots. Psychotherapists’ relations with academic psychiatry were often uneasy, but the psychodynamic schools succeeded in establishing independent institutions for training and treatment. However, as this article shows, the gulf between mainstream psychiatry and psychotherapy was not as wide as many histories of the psy-disciplines in the early 20th century suggest. In inter-war Vienna, where these conflicts raged most fiercely, Stransky’s ‘SAR’ psychotherapy was intended as an academic psychiatrist’s response to the challenge posed by the emerging competitors. Moreover, Stransky also proposed a political alternative to the existing psychotherapeutic schools. Whereas psychoanalysis was a liberal project, and Adlerian individual psychology was closely affiliated with the socialist movement, ‘SAR’ psychotherapy with its focus on authority, subordination and social hierarchy tried to translate a right-wing, authoritarian understanding of society into a treatment for nervous disorders. (shrink)

Summary The case of an anorectic patient is presented to demonstrate how well-known symptomatic phenomena such as a supposedly distorted body perception can be understood. Further theoretical suggestions are made to explain the motive to starve, without making complicated psychodynamic assumptions. To do so, genuine gestalttheoretical concepts such as ‘centring’ and ‘reference system’ are used. This leads to hints for a temporarily perception-focused formation of the therapeutic relationship.

Traditionally, there have been few legal actions brought against psychotherapists that allege negligent psychotherapy and negligent treatment of psychiatric disorders. However, in the case of Osheroff v. Chestnut Lodge, a patient-physician (Dr. OsheroE) sued Chestnut Lodge, a private psychiatric facility, for negligence based on the staff's decision to apply a psychodynamic model of treatment (through psychotherapy) and not a biological model. The case sparked a heated debate between adherents of the psychodynamic model and those of the (...) biological model. This article explores the implications of the Osheroff litigation for mental health professionals. It is proposed that an interactive informed consent process be used to protect psychotherapists against Osheroff-type litigation. (shrink)

According to Positioning Theory, participants in narrative interaction can position themselves on a representational level concerning the autobiographical, told self, and a performative level concerning the interactive and emotional self of the tellers. The performative self usually is much harder to pin down, because it is a non-propositional, enacted self. In contrast to everyday interaction, psychotherapists regularly topicalize the performative self explicitly. In our paper, we study how therapists respond to clients' narratives by interpretations of the client’s conduct, shifting from (...) the autobiographical identity of the told self, which is the focus of the client’s story, to the present performative self of the client. Drawing on video-recordings from three psychodynamic therapies (tiefenpsychologisch fundierte Psychotherapie) with 25 sessions each, we will analyze in detail five extracts of therapists‘ shifts from the representational to the performative self. We highlight four findings: • Whereas clients’ narratives often serve to support identity-claims in terms of personal psychological and moral characteristics, therapists rather tend to focus on clients’ feelings, motives, current behavior and ways of interacting. • In response to clients’ stories, therapists first show empathy and confirm clients’ accounts, before shifting to clients’ performative self. • Therapists ground the shift to clients’ performative self by references to clients’ observable behavior. • Therapists do not simply expect affiliation with their views on clients’ performative self. Rather they use such shifts to promote the clients’ self-exploration. Yet, if clients resists to explore their selves in more detail, therapists more explicitly ascribe motives and feelings that clients do not seem to be aware of. The shift in positioning levels thus seems to have a preparatory function for engendering therapeutic insights. (shrink)

In the background of this paper lies the idea that the developmental thinking characteristic of psychoanalysis and, more broadly, psychodynamic psychotherapy is all of a piece with a philosophical tradition going back to Plato and Aristotle, which focuses on the connections between human nature, human excellence and the good life for human beings. That is, psychoanalysis is to be understood in part as belonging to a Platonic-Aristotelian tradition in moral philosophy, or to what has become known—unfortunately - as (...) 'virtue ethics'.The aim of the paper is to explore one way in which this idea might be spelled out in detail. First, I... (shrink)

The point of psychotherapy has occasionally been associated with talk of ‘life’s meaning’. However, the literature on meaning in life written by contemporary philosophers has yet to be systematically applied to literature on the point of psychotherapy. My broad aim in this chapter is to indicate some plausible ways to merge these two tracks of material that have run in parallel up to now. More specifically, my hunch is that the connection between meaning as philosophers understand it and (...) therapy as psychotherapists ought to practice it is much closer than is suggested by the field of existential psychotherapy, which expressly addresses the topic of life’s meaning and appeals to ideas from classic philosophers such Søren Kierkegaard, Martin Heidegger, and the like. I instead proffer the claim that psychodynamic and humanistic therapy, clinical psychology, and counselling psychology as such, not a particular branch of them, are best understood as enterprises in search of meaning in life, in the way many present-day philosophers understand this phrase. In this chapter, I spell out what I mean by this bold hypothesis and provide some good reason to take it seriously. (shrink)

For three decades Jeremy Holmes has been a leading figure in psychodynamic psychiatry in the UK and across the world. He has played a central role in promoting the ideas of John Bowlby and in developing the clinical applications - psychiatric and psychotherapeutic - of Attachment Theory in working with adults. Drawing on both psychoanalytic and attachment ideas, Holmes has been able to encompass a truly biopsychosocialperspective. As a psychotherapist Holmes brings together psychodynamic, systemic and cognitive models, alert (...) to vital differences, but also keenly sensitive to overlaps and parallels. This volume of selected papers brings together the astonishing range of Holmes' interests and contributions. The various sections in the book cover: An extended interview - covering Holmes' career and philosophy as a psychodynamic psychiatrist 'Juvenilia' - sibling relationships, the psychology of nuclear weapons, and the psychodynamics of surgical intervention. Psychodynamic psychiatry: Integrative and Attachment-Informed A psychotherapy section inwhich he develops his model of psychotherapeutic change 'Heroes' - biographical pieces about the major influences including, John Bowlby, Michael Balint, David Malan, Jonathan Pedder and Charles Rycroft. 'Ephemera' - brief pieces covering such topics as frequency of psychodynamic sessions and fees. Attachments: Psychiatry, Psychotherapy, Psychoanalysis - The Selected Works of Jeremy Holmeswill be essential and illuminating reading for practitioners and students of psychiatry and psychotherapy in all its guises. (shrink)

Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post (...) outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patients’ perspectives. Methods: The study took place in the context of a Randomized Controlled Trial evaluating time-limited psychodynamic and cognitive behavioural therapy for major depression. A mixed methods study was conducted including patients’ pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients’ interviews. Findings: From the patients’ perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients’ resistance and impossibility and the context as a source of distress. “No change” in outcome scores therefore seems to involve a “partial change” when considering the patients’ perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed. (shrink)

Use of the imagination is a key aspect of successful psychotherapeutic treatments. Psychotherapy helps clients get in touch with, awaken, and learn to trust their creative inner life, while therapists use their imaginations to mentalise the suffering other and to trace the unconscious stirrings evoked by the intimacy of the consulting room. Working from this premise, in _The Therapeutic Imagination_ _Jeremy Holmes_ argues unashamedly that literate therapists make better therapists. Drawing on psychoanalytic and literary traditions both classical and contemporary, (...) Part I shows how poetry and novels help foster therapists’ understanding of their own imagination-in-action, anatomised into five phases: attachment, reverie, logos, action and reflection. Part II uses the contrast between secure and insecure narrative styles in attachment theory and relates these to literary storytelling and the transformational aspects of therapy. Part III uses literary accounts to illuminate the psychiatric conditions of narcissism, anxiety, splitting and bereavement. Based on Forster’s motto, ‘Only Connect’, Part IV argues, with the help of poetic examples, that a psychiatry shorn of psychodynamic creativity is impoverished and fails to serve its patients. Clearly and elegantly written, and drawing on the author’s deep knowledge of psychoanalysis and attachment theory and a lifetime of clinical experience, _Holmes _convincingly links the literary and psychoanalytic canon. _The Therapeutic Imagination _is a compelling and insightful work that will strike chords for therapists, counsellors, psychoanalysts, psychiatrists and psychologists. (shrink)

A subject’s relationship with work is by no means “neutral” as regards selfdevelopment. What becomes of the psychical relationship with work does not depend solely on the individual’s particular characteristics as a person, in particular their gender; it depends also on the nature and organization of work. In order to analyse the importance of work in the development of the psychic erotic economics, I refer to the psychotherapy of a young woman that took place towards the end of her (...) adolescence. This will enable me to show how work can have a positive impact on mental development. Then, in order to illustrate how work may destroy mental functioning, I briefly analyse examples taken from investigations I undertook in France in companies where several workplace suicides had taken place. (shrink)

Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion (...) and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence can retroactively become part of a topic closure sequence, can become shaped as an intra-topic silence, and can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels. (shrink)

Guides the practicing clinician or student therapist toward practical applications of imagery in a range of psychodynamic, cognitive, and behavioral therapies.

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists, consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was (...) employed to assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed. (shrink)

Altruistic behavior and motivation has traditionally been regarded as a defense mechanism defined by the vicissitudes of instinctual gratification. In this article, we suggest that there exists a substantial body of evidence from the fields of ethology, infant research, and experimental psychology to support the existence of an independently motivated altruism that is nondefensive in nature. We attempt to show how the view of altruism as a universal motivational system stems from the recent developments in evolutionary theory and contributes to (...) our understanding of intrapsychic factors influencing human behavior in general and the process of psychotherapy in particular. It is not our goal to prove the existence of "pure altruism" that can never be derived from selfish motives. Rather, our thesis is that self-oriented and altruistic motivations are equal and essential partners in human evolution and development. It is the optimal balance of these two forces that is necessary for evolutionary advancement and for psychological health. (shrink)

What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in _Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis_, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings and endings" that permeate one another throughout (...) the course of therapy. For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment; ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals and supervene when therapy stagnates. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation. By linking beginning and ending phases not to the chronology of treatment but to the patient’s experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts. Nor does he shy away from a trenchant critique of the instrumental “medical model” of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. Schlesinger's exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these inquiries are gems of pragmatic clinical wisdom. _Endings and Beginnings_ distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession. (shrink)

From the Couch to the Circle: Group-Analytic Psychotherapy in Practice is a handbook of group therapy and a guide to the group-analytic model - the prevailing form of group therapy in Europe. The book draws on both John Schlapobersky’s engagement as a practitioner and the words and experience of people in groups as they face psychotherapy’s key challenges - understanding and change. This book provides a manual of practice for therapists’ use that includes detailed descriptions of groups at (...) work; accounts of therapists’ own experience and the issues they face in themselves and in their groups. The book is devoted to the Group-Analytic model but the other principally psychodynamic models of group therapy - the Tavistock, Interpersonal, Psychodynamic, Modern Analytic and Structural/Systemic models - are brought into a comparative discussion and drawn upon to create an integrated and coherent approach. The book is divided into three sections: Foundations – aimed at practitioners using groups of any kind and working at every level, including those providing supportive psychotherapy and providing groups for psychosis, trauma, the elderly, people at risk, the elderly and children; The Group-Analytic Model – defines the group-analytic model at a basic and advanced level; The Dynamics of Change – aimed at group analysts, psychotherapists and psychologists providing short-term psychotherapy and long-term group analysis The book is illustrated with clinical vignettes including incisive, instructive commentaries to explain the concepts in use. It is intended for those seeking psychotherapy, whether to resolve personal problems or to find new sources of meaning in their lives. It is also intended for policy-makers in mental health, students of different models of psychotherapy and the psychosocial field. The comparative discussion running through the text about methods and models of practice will likely be of interest to the wider mental health and psychotherapy fields. The author draws together the inherited wisdom of group analysis since Foulkes’ time and makes his own lasting contribution. From the Couch to the Circle will be an invaluable, accessible resource for psychotherapists, psychoanalysts, psychologists, family therapists, academics, psychologists, mental health practitioners, academics and teachers in psychotherapy. (shrink)

_Winner of the 2010 Goethe Award for Psychoanalytic and Psychodynamic Scholarship!_ This book builds a key clinical bridge between attachment theory and psychoanalysis, deploying Holmes' unique capacity to weld empirical evidence, psychoanalytic theory and consulting room experience into a coherent and convincing whole. Starting from the theory–practice gap in psychoanalytic psychotherapy, the book demonstrates how attachment theory can help practitioners better understand what they intuitively do in the consulting room, how this benefits clients, and informs evidence-based practice. Divided (...) into two sections, theory and practice, _Exploring in Security_ discusses the concept of mentalising and considers three components of effective therapy – the therapeutic relationship, meaning making and change promotion – from both attachment and psychoanalytic perspectives. The second part of the book applies attachment theory to a number of clinical situations including: working with borderline clients suicide and deliberate self-harm sex and sexuality dreams ending therapy. Throughout the book theoretical discussion is vividly illustrated with clinical material, personal experience and examples from literature and film, making this an accessible yet authoritative text for psychotherapy practitioners at all levels, including psychoanalysts, psychiatrists, clinical psychologists, mental health nurses and counsellors. (shrink)