Depression and grandiosity: Clinical and theoretical issues in the treatment of narcissistic disturbances

The literature on the interrelationship of grandiosity and depression is reviewed. A review of Alice Miller's theories here promotes the understanding of the narcissistic core of depression. Clinical vignettes serve to demonstrate the close links between grandiose ideation and melancholia in the form of masked grandiosity lurking behind the depressive manifest picture. Object loss, in line with the formulations suggested in this paper, is but one form of a narcissistic loss; recovery from a depressive episode, paradoxically, depends on the renovation of the narcissistic supplies and on the giving up, through the mourning process, of narcissistic elements.     

Systematic Integration of Clinical Techniques: An Inclusive Matrix for Guiding Assessment and Intervention

This paper discusses a framework consisting of a combined assessment and intervention model, based on a systematic integration of two existing behavioral-cognitive methods. The integration of these basic models creates an inclusive matrix that facilitates both initial diagnosis and the devising, in accordance with the diagnosis, of appropriate treatment strategies. Theoretical and clinical examples from the domain of post-traumatic stress disorder (PTSD) in general and combat reaction in particular, are presented to demonstrate the efficacy of this proposed combined model.     

The application of psychodynamic methods within the framework of behavior therapy

Behavior Modification has gone a long way since its start as a reaction to the traditional psychiatric and psychotherapeutic methods. It is no longer a monolithic term, as it includes a variety of theoretical and conceptual positions, different methodological approaches and many therapeutic techniques. It is the aim of this paper to demonstrate that due to the changes behaviorism has gone through, it is no longer an alien discipline to psychoanalysis as it has been in the early days of the movement. Therefore, an integration between the two approaches is currently possible in a relatively smooth and conflict- free manner. There are several varieties of integration between the two approaches. The suggested combination is an elaboration of Kaplan's method, which is behaviorally-oriented, but utilizes psychoanalytic concepts and techniques pragmatically at times when the behavioristic treatment program has come to a stalemate because of the patient's resistances. This approach seems to be especially coherent and efficient;it has proven to be successful in avoiding the pitfalls which were the cause of skepticism with respect to the integration of the two types of treatment — behavior therapy and psychodynamic therapy. Vignettes from behavioral-cognitive treatment of test anxiety and combat reaction (post-traumatic stress disorder) will be presented in order to demonstrate the suggested method.     

Repetition compulsion and self-psychology: Towards a reconciliation

The concept of repetition compulsion, which has never been fully acknowledged by Kohut and his followers, is re-evaluated in this article within the context of self-psychology. In line with the underlying principles of defensive contact-shunning on the one hand, and non-traumatic empathic failure on the other hand, the repetition can be seen as the twofold expression both of the wish for a new benign relationship and of the dread of traumatic, repeated disappointment. Therefore, early non-traumatic disappointments are initiated by the patient, and role-responded to by significant others. This way, the risk of disillusionment of full-blown expectations is avoided. The repetition compulsion, then, is a complex mechanism: preventive in one part, it protects the vulnerable self from potentially traumatising experiences; thus, it is operated in response to the danger signal of emotional cravings, once the latter are experienced as getting out of hand. Providing novel experiences, in its other part, it can lead to opening the road for change; such curative impact relies on lengthy working through in a safe, empathic, holding environment.