Addicts to artists: The ‘good enough mother’ in the substance abuse clinic

Psychodynamic psychotherapy has had a bad reputation in substance abuse circles. Despite widespread use of behavioral interventions, outcomes remain relatively poor. The emerging trend is to incorporate relational and other psychodynamic approaches into addiction treatment. The article describes use of Winnicott's concepts of the ‘good enough mother’ and ‘play space’ in an outpatient ‘art group’.     

A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Training service providers working with traumatized children in South Africa: The navigations of a trainer

In South Africa, counselling training poses two related difficulties: working in a situation of ubiquitous, ongoing violence, and offering training to people who have minimal or no qualifications and are often overwhelmed by enormous workload. In this context, there is a temptation either to give up hope in the face of the enormity of the task, or defensively to package counselling as a set of techniques which can be taught without much self-reflection. In this article we discuss, by contrast, an intervention which used psychodynamic principles to develop learner-centred training drawing on trainees' own experiences. We consider the benefits of this approach even in a context of violence and meagre resources.     

Psychodynamic counselling for the borderline personality disordered client: A case study

Psychodynamic counselling for clients with borderline personality disorder is difficult and challenging because there are problems with the validity of the concept, diagnosing the disorder, managing disturbed behaviour and maintaining the treatment to successful completion. Nevertheless, counsellors are frequently called upon to provide assessment, management and treatment for this group. This article explores the application of psychodynamic principles of counselling to clients with borderline personality disorder, examines the history of the concept, the diagnostic process, and employs a case presentation to help describe aspects of character structure and treatment.     

On Targeting Emotion Regulation Deficits in Eating Disorders through Defense Analysis

ABSTRACT

Psychodynamic approaches to the treatment of individuals with eating disorders are underrepresented in research and in academia. This will increasingly deprive patients of a viable therapeutic alternate to the dominant behavioral family-based models. As psychodynamic approaches may have unique benefits, there is value in resolving this loss. Recent models of dynamic therapies for eating disorders within modern, empirically derived theory show promise for future psychodynamic viability. An attachment-focused approach targeting disordered attachment patterns that are common in individuals with eating disorders has recently been introduced. To complement this model, this article proposes an approach for individuals with eating disorders that is hypothesized to target emotion regulation deficits that are also commonly found in individuals with eating disorders. Observed parallels between the implicit branch of the emotion regulation system and that of contemporary constructs of defense mechanisms guide this proposal. Developmental considerations reveal important connections between this biologically based model and a two-person model based in attachment theory. In this way, this proposal offers a flexible psychodynamic approach that integrates with the existing literature. Further development of this approach could one day help patients to have a greater range of therapeutic options for recovery from eating disorders.     

Student essay competition prize winner a study of the breaking and remaking of affectional bonds

Abstract

This essay was originally presented as the author's final clinical essay for the Advanced Diploma in Psychodynamic Counselling run by the WPF (North) in conjunction with the Tuke Centre, York. It is a reflection on a year's counselling undertaken with a young man struggling with angry and violent impulses which threatened to wreck his relationship with his partner and their children. The work draws on psychoanalytic and attachment theories and examines the process involving client and counsellor as two men working together on issues of loss, relationship and intimacy.     

Anger - the hidden destroyer A psychodynamic approach with the physically disabled

Abstract

A basic challenge in the psychodynamic counselling of the physically disabled is the engagement of anger in relation to the patient's disability. Regardless of a patient's age at the onset of disability, they will exhibit anger, resentment and frustration for losses they may have, or perceive themselves to have, endured. Healthy physical and psychological adaptation requires the disabled patient to ‘cope’ with their anger. Feelings of anger may impede, obstruct or even derail the impetus towards healthy psychological and behavioural functioning. The manner in which we learn to negotiate the vicissitudes of daily life is linked to our selfobject development. This development does not end when we become adolescents or young adults, but continues throughout our life span. The normative, healthy psychological maturation required for adaptive behaviour is vulnerable to a wide range of impediments acquired at any point along the individual's developmental continuum. As clinicians we need to keep in mind that the self-regulation of internalized emotional states is transacted through a complex set of characterological and personality traits that may be impaired, or wanting, eventually leading to maladjusted psychopathological states. The therapeutic function of the clinician is to redress those ego deficits that stand in the way of a fully creative and productive life. The intended aim of this paper is to illustrate the manner in which I engage with those physically disabled persons presenting anger. I shall consider the use of counter-transference responses as behavioural in modifying various forms of anger formation manifested by disabled clients. It is my position that a positive shift in a disabled person's ego ideal through empathic transference will help to alleviate their underlying hostility and other forms of anger. The paper commences with a brief review of the experience of the disabled in Western society. I shall then turn to an examination of the psychotherapeutic approach underpinning my work with disabled clients. The third section will describe and illustrate, through case material, the clinician's use of self in the dyadic transaction with disabled clients.

The power of a positive therapeutic outcome lies in the clinician's ability to engage with the client despite emotional content, clinical aptitude or specific approach. Empathic attunement brings into operation those mechanisms underpinning the dynamic process integral to the approach used in the above cases. Countertransference issues sometimes intervene in the unconstrained flow of therapy. Regardless, those issues that are salient to the client and are incorrectly handled by the clinician will appear recurrently until satisfactorily addressed. Further, even when errors are made in sessions, outcomes may be positive.

Whatever the initial purpose that brings a physically disabled person to therapy there will eventually be a need to address issues around their condition. It is not enough to ignore or accept a client's earliest statement that their disability Ms not a problem'. They may initially not have come into therapy for problems concerning their disability; however, the particular disability will ultimately play an important role as to how and what the person feels, thinks and believes about him or herself. In general, psychodynamic counselling with the physically disabled requires knowledge of disability issues as well as of counselling procedures. Those working with the disabled need to understand their own personal issues through analytic work and continued supervision. Working with the physically disabled can be overwhelming, frustrating and exhausting, but in the end is most rewarding.     

Marital counselling: Teaching an eclectic approach

Limited opportunities for training combined with misperceptions about the nature of marital counselling lead to many professionals conducting consultations with couples without training. Where training exists, generally a specific ‘pure’ approach, or a definite brand of eclecticism is taught. The Sheffield Marital and Sexual Difficulties Clinic training course currently aims to give trainees the building blocks for evolving their own brand of eclecticism, or the opportunity to follow a particular approach. Psychodynamic, behavioural and systems theories are highlighted, and the various ways to which these (and other theories) can be used together are examined.     

Offering a ‘therapeutic presence’ in schools and education settings

Abstract

In this essay I present the clinical work with a client that I have been working with for 9 months now. The essay is divided into sections, each one indicative of one phase of the counselling relationship. In each of them I present the therapeutic process (my client's and myself) by highlighting some newly-acquired psychodynamic concepts, sharing some difficulties encountered, the learning gained though supervision and the progress of the client.     

Applying psychodynamic insights in brief counselling

Abstract

After a review of the place of brief work in the psycho-dynamic tradition, this paper explores how three psychodynamic insights may be of use in brief counselling. Using case examples drawn from work with employment problems, the paper discusses the activation of healing/developmental processes through brief counselling. The ‘significant emotional experience’ which is seen as important is analysed in terms of work with the transference and the punitive superego.     

Bridging the Divide Between Psychodynamic and Behavioral Approaches for Children with Oppositional Defiant Disorder

ABSTRACT

Oppositional defiant disorder (ODD) is one of the primary reasons youth are referred to mental health services. Disruptive behavior disorders such as ODD are heterogeneous in their presentation, developmental trajectories, and treatment needs. Given the high attrition rates in child psychotherapy in general, there is a need for a range of interventions tailored to meet the unique needs of each family to help increase familial engagement and positive outcomes for children with ODD.

This article outlines composite clinical case material of a child with ODD who was treated with Regulation Focused Psychotherapy for Children (RFP-C), a manualized, psychodynamic intervention for ODD. The case presented is then reconceptualized from a behavioral parent training perspective. This approach uses parent training to encourage positive parenting practices and reduce coercive reinforcement cycles. The case material and its reconceptualization are followed by a discussion of the distinctions between psychodynamic and behavioral approaches to children with ODD. An integrated psychotherapy approach is proposed, and the benefits and challenges of psychotherapy integration are discussed.     

Supportive and interpretative interventions in fostering mentalisation during counselling

ABSTRACT

This work analysed which profiles of counsellors’ supportive and interpretative actions emerged in two group counselling interventions designed to promote mentalisation in underachieving university students. The Psychodynamic Intervention Rating Scale was used to analyse this and the level of depth of defence interpretations. Two outcome measures were administered to analyse student mentalisation and their academic achievements. Process findings showed that supportive actions were used for the most part in both counselling interventions; however, only one group improved in terms of mentalisation and academic performance. In the good-outcome group, there were more defence interpretations, especially during the early sessions, and with a deeper level of elaboration. The innovative relevance of these findings and their implications for practice among counsellors are discussed.     

What harm can it do?: A discussion of the potential for harm inherent in psychodynamic work

Abstract

This paper examines some of the ethical issues raised by the nature of psychodynamic work. It suggests that both the aims and the process of psychodynamic therapy raise ethical issues which we cannot responsibly ignore, but that if the work is to be effective it cannot be made wholly safe. That, however, does not absolve us from the requirement for taking care, and for thinking about what we are doing and what we are risking.     

Time-limited counselling

Abstract

This paper introduces a new synthesis of approaches to time-limited psychodynamic counselling, giving an account of some of its antecedents and of some of the values which underlie therapeutic effectiveness.

It offers a discussion of the impetus which may be obtained by facilitating the client in working towards a positive outcome which is clearly identifiable. Two time-limited counsellings are then described, in which the underlying conflicts, surrounding loss in the first and impaired trust in the second, are seen to emerge. Finally, some ethical issues are raised and the effects of the planned ending on the client's unconscious process are described.

Mental health, in the humanistic sense, is characterized by the ability to love and to create, by the emergence from the incestuous ties to family and to nature, by a sense of identity based on one's experience of self as the subject and agent of one's powers, by the grasp of reality inside and outside of ourselves, that is by the development of objectivity and reason.     

Psychodynamic counselling in an educational setting: Containing,transference and clientele

Abstract

The concepts of containing and transference, as well as the specific nature of the clientele, may, on a first approach, be used to differentiate psychodynamic counselling in an educational setting (PES) from the ‘pure gold’ of psychoanalysis. Further, it is argued that a realistic understanding of PES, given the constraints in which it operates, demands that the psychodynamic practitioner be prepared to cut her procedural cloth in accordance with the demands her clients place upon her. This makes PES a pragmatical practice rather than some lesser cousin of ‘orthodox’ psychoanalysis.     

Well Children Living with Diabetic Siblings

Abstract

This article examines the psychological adjustment of well children who live with diabetic siblings. A sample of 28 well siblings between the ages of 8 and 12 were studied, utilizing standard tests and a semi-structured interview. Standard tests demonstrated that well siblings had adjustment difficulties manifested by internal stressors that originated from anxiety and low self-concept. This report emphasized the qualitative results of well siblings living with diabetic siblings. The findings conclude that well siblings have difficulties negotiating emotions, communications, and activities with their diabetic siblings. The report interprets sibling issues from a psychodynamic orientation, suggesting that many of the healthy psychological functions performed by the sibling relationship are interrupted by the introduction of a chronic illness. Recommendations based on the findings are offered to professionals who work with diabetic children and their families.     

The stresses of learning counselling: Six recent graduates comment on their personal experience of learning counselling and what can be done to reduce associated harm

This paper presents research that examines the negative and stressful aspects of learning counselling and methods for harm reduction. Using an in-depth semi-structured interviewing approach, six people who recently graduated from a UK university counselling programme have commented on their negative experiences of learning counselling and what helped or would have helped to reduce the harmful effects. This research has produced information which indicates that counselling trainees experience significant disruptions in their relationships with their family and friends; that a sizeable number of trainees report feelings of depression and or stress; and that counselling trainers have not addressed these issues effectively. The study concludes with a suggestion that an extra training component could be built into existing training frameworks that focus on the process of 'becoming a counsellor'.     

Towards an understanding of the psychodynamic processes of the body

Abstract

Counselling clients frequently mention bodily symptoms, yet, within the therapy world, the body largely remains off-limits. This, in some part, is undoubtedly due to the prevailing issues around the touch taboo. However, the symptoms emanating from the body may well have profound psychodynamic meaning. This paper sets out to describe a psychodynamic perspective for how these symptoms may arise. Notions such as libido and preverbal theories, along with primal defence mechanisms, are used to show how the body becomes involved in unconscious processes. A case study is presented as illustrative of some of the psychodynamic concepts that may be implicated. It is argued that bodywork may help in providing a preverbal supportive environment from which a therapeutic alliance may develop, thus allowing for a verbalization of unconscious conflict.