Relational Psychoanalytic Perspective on Couples Psychotherapy

ABSTRACT

This places Relational Psychoanalysis within the pantheon of models of couples psychotherapy in psychoanalysis including those from Freudian, Object Relational, Self Psychology, and Intersubjective Systems Theory. Following a brief overview of key ideas pertinent to Relational Psychoanalysis, the article discusses the author’s Six-Step version of a relational psychoanalytic approach to couples psychotherapy.     

The Psychoanalytic Psychotherapy of Dissociative Identity Disorder in the Context of Trauma Therapy

Homosexuality is most probably variable in its pathway of origin. Reports of instances of when it has been possible to follow its development from childhood into adulthood are lacking in the literature. In this paper, the author describes his experience of treating two nine-year-old girls who had had serious problems in their relationships with their parents and who developed lesbian relationships when they became adults. In each instance, there were extremely traumatic experiences with the girl's father and failure of the mother to intercede on the girl's behalf. One patient was treated up into adolescence, with a follow-up later on, and the other was treated well into adulthood. Psychological factors that seem to have contributed to the eventual development of a lesbian sexual orientation are discussed in this paper.     

A Relational Psychoanalytic Model for Case Management: A Literature Review

Abstract

Relationship building is critical in case management with the seriously mentally ill. A theoretical framework, such as relational psychoanalytic theory, with a strong integrative emphasis provides a structure for the complex interplay of internal and external factors/forces in case management. The purpose of this paper is to provide a literature review in the area of case management: relational psychoanalytic theory, relationship building and psychodynamic theory. The review concludes outlining the appropriateness of this theoretical framework for case management.     

Individual Multimodal Therapy for Weight Loss: A Case Example

Individual multimodal therapy provides a comprehensive approach to the treatment of overeating. The multimodal treatment plan helps to target social and emotional issues related to eating disorders as well as the eating behaviors themselves. The authors present a case study highlighting a treatment model based on a multimodal conceptualization.     

What Abandoned Children Construe as Stressful Experiences: Implications for Psychoanalytic Relational Theory and Child Psychotherapy

As part of psychological evaluations to determine whether interventions were needed, 106 abandoned children (aged 5 to 19 years) residing in SOS-Kinderdorf International Children's Villages in Spain were individually administered a structured interview to learn what each child construed as upsetting. Before admission, each child had been exposed to one of three traumatic, interpersonal experiences: excessive neglect; physical abuse; and parents who were prostitutes, abusing drugs, or both. In an unexpected finding, the events these children discussed most often as having upset them did not focus on abandonment or on traumatic conditions they had endured. Rather, converging with reports of public school children residing with their families in the United States, the events they discussed concerned harm to loved ones (e.g., accident, illness, hospitalization). In addition, children who had been visiting relatives while residing in a Children's Village differed from those who had not visited relatives in what they experienced as traumatic. The results are examined in terms of implications for psychoanalytic-relational theory and for planning treatment programs for children who have been abandoned or are living in institutions.     

The Experience of the Holy: A Relational Psychoanalytic Analysis

The title of this paper, The Experience of the Holy is a direct reference to Rudolf Otto's book Das Heilige. The paper begins with Otto because he lays out many of the important issues involved in a psychological investigation of the experience of the holy, especially the question of whether the sacred is a unique object of experience, or a characteristic of our experience of ordinary objects. The paper then discusses three contemporary relational psychoanalysts (D.W. Winnicott, Hans Loewald, and Christopher Bollas), and the ways in which their theorizing illuminates the psychology of the sacred.     

Technical Considerations in the Psychotherapy of Traumatized Individuals: A Psychoanalytic Perspective

This paper addresses two specific aspects of clinical technique in the treatment of traumatized individuals. The first aspect involves the creation of a safe holding environment as an essential step for the emergence of trauma-related memories and the containment of the affects accompanying them. Such scenarios may appear in the clinical material only through the workings of "procedural memory." It is therefore important to contain and gradually decipher repetitive patterns of behavior and feelings of shame, guilt and rage that go with them. The second aspect examines the challenges such work poses to the analyst's containing capacities, credulousness and even his or her reality testing within a clinical situation. The resulting instability of the analyst's work ego can make it hard for him or her to remain vigilant yet empathic, and emotionally attuned but analytically skeptical. The analyst's flexibility to be utilized as a transference object, developmental object and self-object remains a critical determinant of the treatment outcome under such circumstances. The paper provides clinical material to illustrate these two aspects of clinical technique.     

Therapeutic Interaction and Dropout: Measuring Relational Communication in Solution-focused Therapy

The relational communication of sixteen dropout versus sixteen continuation sessions of solution-focused therapy was studied using two different coding schemes. On the Topic Initiation/Topic Following coding scheme (Tracey, 1986) no differences were found between dropout and continuation sessions, whereas the Family-Relational Communication Control Coding Scheme (Heatherington and Friedlander, 1987) yielded a number of significant findings. Both in 'successful' and in 'unsuccessful' dropout sessions, therapeutic interaction was found to be more conflictive than in continuation cases, with clients showing more domineering behaviour in dropout than in continuation sessions. Markovian and lag sequential analysis are used to clarify some of these findings, and their implications are discussed.     

Structure with Engagement: Toward an Integration of Trauma and Relational Psychoanalytic Models in the Treatment of Dissociative Disorders

Trauma model approaches to the treatment of dissociative disorders may provide containment and direction and yet, these same approaches may be constricting and limit exploration. However, relational psychoanalytic approaches may allow for engagement and exploration while potentially failing to provide containment and structure. This article provides an overview of key elements of both models and considers the question of whether it is possible to creatively resolve theoretical and clinical tensions between trauma model and relational psychoanalytic responses to dissociation. A review of the history of the study of dissociation in the field of psychoanalysis and concerns about psychoanalytic practice in the context of dissociation is followed by comparing contrasting conceptualizations of the assumptions of normality, definitions of dissociation, theories of etiology, goals of treatment, and theorized mechanisms of action. The review ends with a discussion of potential possibilities for clinical integration.     

Working With Fathers in Psychoanalytic Parent-Infant Psychotherapy edited by Tessa Baradon,Routledge, Abingdon and New York, 2019, 191 pp.

The American Journal of Psychoanalysis -     

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.     

How Psychoanalytic Thinking Lost its Way in the Hands of Men: The Case for Feminist Psychotherapy

A feminist stance is adopted to challenge the androcentric nature of many of the concepts which lie within the tradition of male psychoanalytical thinking. Such thinking steadfastly refused, and largely still refuses, to acknowledge the social reality and consequences of women's experience of living in a patriarchal society. It is argued that psychoanalytical theory has construed women as inferior and is wholly revealing of what men expect and want women to be. Any psychotherapy based solely within that tradition thus plays its part in the oppression of women. Two concepts from analytical psychotherapy, transference and counter-transference, are used as specific examples, and some contrasting researches advanced by feminist psychotherapy are outlined.     

Psychoanalytic Training: The Absence of Thirdness: A Review of Impossible Training: A Relational View of Psychoanalytic Education by Emanuel Berman

This paper suggests that the concept of “thirdness” has been essential in the evolution of our thinking about the complexity of the clinical process in psychoanalysis. However, the way psychoanalysis has been, and in most places continues to be, taught and organized remains mired in older, binary, and concrete dichotomies—as Emanuel Berman''s recent volume on the subject demonstrates—an “absence of thirdness” that seems to reinforce and enshrine the marginalization of psychoanalysis from the broad quest for the advancement of human knowledge in the western tradition. In the course of developing these ideas, the paper discusses other aspects of Berman's stimulating and, in some respects, controversial, work.     

Dynamic Relational Group Psychotherapy: A Neurobiologically Informed Model of Change

In this article, we introduce a preliminary, neurobiologically informed model of group therapy that links the timing and nature of specific group interventions with hypothesized changing neurobiological needs of the group. We suggest that the observed phases of group development reflect an underlying reorganization of neuronal circuitry that occurs as members progress through a hierarchically organized treatment, and that this reorganization involves the integration and homeostatic rebalancing of subcortical and neural networks. Our preliminary Dynamic Relational Model suggests that an understanding of the neurobiological processes involved in group development may help inform and direct effective group-based psychotherapy interventions.     

The Value of Integration: Psychoanalytic Psychotherapy Meets Ego Psychology in a Psychotherapy Group for Children

ABSTRACT

Psychotherapy integration requires us to look beyond the confines of a particular theoretical or technical approach towards other perspectives. Integrative work with children, in particular, meets the socio-emotional needs of the child while simultaneously modeling behaviors and skills. This paper presents an explicitly integrative approach to child group psychotherapy: Relationships. Individuals. Skills. Engagement (RISE) Group. We begin with an in-depth discussion of the RISE group structure illustrated by clinical examples (the “what”) followed by a review of the theory and treatment modalities that inform the approach (the “why” and “how”). The RISE group is grounded in two theoretical perspectives (psychoanalytic principles and ego psychology) and draws upon clinical techniques from multiple treatment modalities (including cognitive behavior therapy, psychodynamic play therapy and dialectical behavior therapy). Combined, the merger of these perspectives results in a multilevel intervention that forges pathways to mastery and competence within the child. Finally, we discuss the value and limitations of integration as applied to group psychotherapy for children.