Asian Trauma Survivors: Immigration, Identity, Loss, and Recovery

Psychological trauma in Asian American communities has been increasingly visible in recent years. This paper examines the impact of several variables, including migration, interdependence of the Asian family structure, and acculturation on the experience of trauma. Case illustrations are discussed to illustrate the interplay of cultural ideology, family dynamics, and intrapsychic experiences in the lives of many Asian and Asian American trauma survivors. Psychotherapeutic issues are explored from cultural and psychodynamic perspectives.     

Trauma,personality disorders and chronic depression – the role of the conversational model of psychodynamic psychotherapy in treatment resistant depression

Objective: To report preliminary data describing the interim treatment outcome of 44 patients referred with treatment-resistant depression (TRD), comorbid personality disorders and histories of early childhood trauma using the Conversational Model (CM) of psychodynamic psychotherapy. Method: Patients (N = 44), 13 males and 31 females with long histories of depression ranging from 2 to 30 years, resistant to multiple trials of treatment, were referred by mental health practitioners, including psychiatrists. They were treated with twice weekly CM psychotherapy by multidisciplinary trainees and supervised by experienced trained clinicians. Questionnaires were administered at assessment and at 12 months to assess symptoms, functioning, self-esteem, history of trauma, personality functioning and suicidality. In this preliminary study, there was no separate control group, and patients served as their own controls. Results: Patients with TRD were found to have comorbid severe personality disorders and histories of early childhood trauma. Significant improvement in symptoms, self-esteem, functioning and suicidality was noted after 12 months. Conclusion: Patients responded with symptomatic and functional improvement to twice weekly CM therapy.     

A Girl's Loyalty to her Mother

This paper explores the alliance between the analytic couple and the analytic process. The patient doesn't ally only with the analyst, but also with the unfolding of an experiential world. The developmental origins of this alliance are described in terms of infant and child being inside a forming intelligence; womb, mother and family—transforming the mental state of the subject. The structure of the experience is pictured by the resemblance to a simple—experiencing—self being inside a dream, and a rhetoric “I” speaking in an internal dialogue to an unanswering, but present, “you”. The writer describes the negative therapeutic reaction as an attempt to break into this forming intelligence; as an attempt to see who is the creator of the experiential universe. Staying inside the unfolding process is further investigated through the experiences of aloneness and presential immediateness.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

Time's wingèd chariot: Short-term psychotherapy in later life

Abstract

This paper is concerned with the appropriateness of short-term psychodynamic psychotherapy with older adults, a client group which has historically been neglected in psychotherapeutic practice. Drawing on the case study of a fourteen-session therapy with a woman in her seventies, it is argued that brief exploratory work can be of particular value to people nearing the end of their lives. The nearness of death gives a special urgency and motivation to the work and a time-limited therapeutic contract mirrors the reality of having only a short time left. Making psychotherapy available to older people also represents an important valuing and validation of their experience.     

THE ‘OTHER 23 HOURS’: SPECIAL PROBLEMS OF PSYCHOTHERAPY IN A ‘SPECIAL’ HOSPITAL

In this paper, I describe and discuss the complexities of being a therapist in a maximum security forensic psychiatric hospital, working with patients who have committed acts of serious violence, and who also suffer from severe mental illness and personality disorders. I suggest that profound disturbances in the patient's inner world get played out in triangular disputes between the patient, the therapist and other professionals working in the hospital. I also describe how real events in the life of the institution impact on the therapeutic process, and the importance for the therapist of reflection on the ‘other 23 hours’ that the patient lives outside of therapy. Finally, I raise some ethical dilemmas that arise for therapists working in such settings, where the stated therapeutic aim is not only treatment but also the containment and prevention of future violence.     

The advantages of formulation over categorical diagnosis in explorative psychotherapy and psychodynamic management

In neurosis and personality disorder, formulation is a clearer guide to aetiology, prognosis and treatment than is categorical diagnosis. Diagnosis and formulation have different and complementary functions. The formulation is an essential component in explorative psychotherapy but also has wide application in psychodynamic management. The content and the making of a formulation are described. the value of a psychodynamic approach in decision making, and in choosing between explorative psychotherapy and psychodynamic management, is illustrated by case examples.     

Influence of personal therapy on learning and development of psychotherapeutic skills

The aim of the present study was to investigate psychodynamic psychotherapists’ experience of the influence of personal therapy on professional growth during training with a focus on the acquisition of knowledge and the development of psychotherapeutic skills. Thematic analysis was conducted on interviews with former students (N=10) at two training institutes for psychoanalytic psychotherapy. The resulting theme “professional subjectivity” indicated that personal therapy was experienced as having a positive effect on learning and growth of professional skill by facilitating the development of a theory- and knowledge-based professional subjectivity, a personally founded, professional attitude. Important elements of this development are “shared experience,” “personal influence,” and “knowledge integration.” The emergence of professional subjectivity proved to be an important factor in terms of professional advancement for future psychotherapists. Finding and relating to their own subjectivity was crucial in the process of developing a personally founded, professional attitude in the clinical work.     

A Relational Psychodynamic Perspective on Assimilative Integration

In this paper we discuss recent advances in relational psychoanalytic thinking, and demonstrate how an assimilative approach to integration can be based on this theoretical and clinical model. We describe 3 instances in which active interventions may be used to enhance relationally oriented, psychoanalytic work: by impacting on relationships outside of therapy that maintain pathological patterns, by filling in intrapsychic deficits, and by supporting the patient's active efforts at change. We provide clinical examples to illustrate each of these points.     

Meeting Them “Where They're At”

Abstract

Child maltreatment is associated with serious psycho-social difficulties and enormous direct and indirect societal costs. As such, it is an area for which new and promising interventions are highly important. The purpose of this exploratory research is to examine intensive school-based psychodynamic therapy for severely maltreated children experiencing significant difficulties, by obtaining perceptions of therapeutic effectiveness by the children's parents, teachers and therapists. Themes include: therapists', parents', and teachers' perceptions of child's changes; parental perceptions of therapy and relationship with the therapist; therapists' perception of relationship with parents; school as the location of therapy; teacher-therapist relationship; and the child's academic status.