Brief psychodynamic psychotherapy in adolescent depression: Two case studies

In this paper the authors outline the basic principles of a manualized, brief psychodynamic approach that was evaluated as part of an outcome study within the National Health Service researching the effectiveness of two different forms of psychotherapy for major depression in childhood/adolescence: Focused Individual Psychodynamic Psychotherapy and Systems Integrative Family Therapy. As well as describing some of the difficulties encountered in short-term dynamic psychotherapy with adolescents, the authors present therapeutic work with two adolescents with major depressive disorder who were both seen as part of the research study. The authors depict some of the challenges and unavoidable difficulties which emerged during the therapy, arising from the needs of the research programme.     

Childhood depression: A place for psychotherapy

Pharmacotherapy and psychotherapy are the two dominant mental health treatment modalities, but they are often taught and practised very separately leading to polarisation which may fragment treatment delivery. This paper presents results from a small qualitative study of interfaces between these modalities as described by medical and non-medical professionals practising in the National Health Service (NHS) and explores whether this polarisation maps to the Kleinian ‘P/S’ (paranoid/schizoid) and ‘D’ (depressive) positions, the ‘P/S’ position of omnipotence and dominance of one model over the other shifting the attention away from a more realistic ‘D’ position of integration and concern for the patient. The challenges to the integration of pharmacology and psychotherapy are examined in reference to cultural, organisational, relational and intrapsychic issues. Finally, clinical implications of an integrative approach are considered.     

Is three a crowd? A perspective on countertransference challenges in psychoanalytic couple psychotherapy

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference.     

A systematic review of the evidence-based psychosocial risk factors for understanding of borderline personality disorder

Borderline personality disorder (BPD) is a serious personality disorder characterized by affective instability, impulsivity and interpersonal disturbance. Currently, intensive research is being conducted concerning the aetiology of BPD, including research on neurobiological, temperamental, psychosocial and cultural risk factors. This study focuses on psychosocial risk factors while other risk factors are taken into account in the discussion of the development of BPD. To our knowledge, no systematic review of the evidence-based medicine literature concerning this theme has been made thus far. However, understanding psychosocial risk factors of BPD is important in order to develop psychotherapeutic treatment models and methods. We provide a systematic review of the literature focusing on psychosocial risk factors for BPD. Utilizing this knowledge, we discuss how these data may be used when studying the development of borderline personality disorder and the treatment of borderline personality disorder.     

The Embodied Self. Movement and psychoanalysis

Increasing numbers of patients presenting problems with internet pornography have led to changes in the culture and practice of group analytic therapy at the Portman Clinic. The addictive element of this new form of artificial, sexual stimulation has to be recognised as part of the harm it produces. Group members spontaneously develop some of the principles and practice of established methods of addiction treatment, especially the 12-step programme, by helping each other manage their compulsion. This self-help function of the group coexists alongside the psychodynamic perspective, in which the meaning of harmful sexual behaviour is explored and understood. Certain individuals are more vulnerable to excessive use of pornography because of early developmental problems and current difficulties in their sexual relationships, resulting from internal conflicts about their sexuality. The group provides intimacy without sexualisation, primarily through a sibling transference. The therapist embodies an ability to think about the complexity of the sexual abuse that the pornography portrays. He or she works towards a truer perception of reality for group members, in which the false solutions of compulsive sexual behaviour are seen to be what they are: impediments to healthy development.     

SETTING UP A COUNSELLING SERVICE FOR PARENTS,INFANTS AND YOUNG CHILDREN

In this paper a brief model of working psychotherapeutically with children under 5 years of age and parents is explored. The psychoanalytic principles that guide the work are looked at and the practical aspects of setting up a service within NHS clinics is considered. The authors trace the history of this model, its aims, technique and the use of telephone counselling for parents. They discuss referrals, the setting, the structure and content of this counselling using clinical vignettes.     

The elephant tied up with string: a clinical case study showing the importance of NHS provision of intensive,time-limited psychoanalytic psychotherapy treatments

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments.     

Growing at the Hyphen: Female Friendships and Social Context

Although the psychological literature has focused more on immigrant women's roles in their families, women's friendships are important sources of support and identity development. This article explores the development of friendship in the context of immigration, cultural adaptation, becoming a template for identity and intimacy. Specifically, the author describes a personal friendship and a psychotherapy case vignette, integrating feminist, multicultural, and relational psychoanalytic perspectives, to illustrate the influence of female friendship in coping with loss, acculturative stress, discrimination, and the formation of bicultural identity. These examples highlight the ways in which personal friendships of the therapist and the client contribute to the psychotherapeutic relationship, growth in intimacy and authenticity, and the negotiation of a hyphenated identity.     

Special Issues in Psychotherapy with Minority Deaf Women

Abstract

Minority Deaf women have been traditionally underserved by mental health professionals, and specifically, therapists are unaware of issues unique to this population. It would be highly unlikely for a minority Deaf woman to have a therapist who matches her in racial background, hearing status, and communication mode. Therefore, the therapy process will be completely cross-cultural. Therapists who provide psychotherapy services to minority Deaf women need to be aware that their clients are members of a community where deafness is a culture and not a disability. Minority Deaf women are also likely to report feeling forced to choose between competing identities in order to get important needs met. In the following article, case examples are provided which illustrate some of the major issues that are likely to arise in therapy with minority Deaf women. These issues include: access to important information; communication, support and level of involvement with biological families; competing cultural demands; health concerns; and coping with chronic mental illness.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.