Pub Date : 2023-11-27DOI: 10.1080/02668734.2023.2263509
Anna Croxford, Alan Baban, Sasha Kreel, Julian Stern
When it became clear that the COVID-19 pandemic would require significant shifts in working practice, staff in the Adult Complex Needs department at the Tavistock clinic designed a study to explore...
{"title":"Clinician experiences of remotely delivering psychodynamic and intensive psychoanalytic psychotherapy within an NHS institution during the COVID-19 pandemic, and possible implications for future clinical practice","authors":"Anna Croxford, Alan Baban, Sasha Kreel, Julian Stern","doi":"10.1080/02668734.2023.2263509","DOIUrl":"https://doi.org/10.1080/02668734.2023.2263509","url":null,"abstract":"When it became clear that the COVID-19 pandemic would require significant shifts in working practice, staff in the Adult Complex Needs department at the Tavistock clinic designed a study to explore...","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138513801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-23DOI: 10.1080/02668734.2023.2273444
Gemma Routledge
Psychotherapy has been practised via remote technology since the mid-1990s and has grown in mainstream popularity; yet, it remains controversial, particularly for psychoanalytically informed treatm...
{"title":"A virtual frame – how does forensic psychotherapy work remotely?","authors":"Gemma Routledge","doi":"10.1080/02668734.2023.2273444","DOIUrl":"https://doi.org/10.1080/02668734.2023.2273444","url":null,"abstract":"Psychotherapy has been practised via remote technology since the mid-1990s and has grown in mainstream popularity; yet, it remains controversial, particularly for psychoanalytically informed treatm...","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138513788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.1080/02668734.2023.2271969
Golan Shahar, Morgan Robison, Thomas E. Joiner
{"title":"Dissociation in suicidal depression: a Reformulated Object-Relations Theory (RORT) perspective","authors":"Golan Shahar, Morgan Robison, Thomas E. Joiner","doi":"10.1080/02668734.2023.2271969","DOIUrl":"https://doi.org/10.1080/02668734.2023.2271969","url":null,"abstract":"","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135291082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
AbstractThis article explores the relationship between developmental trauma, dissociation, and substance abuse within the framework of the self-medication hypothesis. By means of presenting a clinical vignette, the article illustrates how substance abuse can serve as a maladaptive coping strategy for managing overwhelming emotions that stem from traumatic experiences in attachment relationships during childhood. Individuals who have undergone developmental trauma may dissociate negative attachment memories and their related emotions, which consequently leads to compartmentalization of their internal states and hinders their self-regulation abilities. In such scenario, substances can act as external regulators of distressing emotions, distancing these individuals from their traumatic memories and facilitating the adoption of an omnipotent and self-reliant attitude. Hence, it is of utmost importance for clinicians to accurately identify and address the self-medication needs of these individuals. This is fundamental in facilitating these clients’ capacity to acknowledge, explore, and integrate their distressing memories as intrinsic elements of their identity, thereby fostering the development of a unified and cohesive self-concept.Keywords: addictiondissociationdevelopmental traumaself-medication hypothesis Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported that there is no funding associated with the work featured in this article
{"title":"Self-medication, traumatic reenactments, and dissociation: a psychoanalytic perspective on the relationship between childhood trauma and substance abuse","authors":"Antonino Costanzo, Gianluca Santoro, Adriano Schimmenti","doi":"10.1080/02668734.2023.2272761","DOIUrl":"https://doi.org/10.1080/02668734.2023.2272761","url":null,"abstract":"AbstractThis article explores the relationship between developmental trauma, dissociation, and substance abuse within the framework of the self-medication hypothesis. By means of presenting a clinical vignette, the article illustrates how substance abuse can serve as a maladaptive coping strategy for managing overwhelming emotions that stem from traumatic experiences in attachment relationships during childhood. Individuals who have undergone developmental trauma may dissociate negative attachment memories and their related emotions, which consequently leads to compartmentalization of their internal states and hinders their self-regulation abilities. In such scenario, substances can act as external regulators of distressing emotions, distancing these individuals from their traumatic memories and facilitating the adoption of an omnipotent and self-reliant attitude. Hence, it is of utmost importance for clinicians to accurately identify and address the self-medication needs of these individuals. This is fundamental in facilitating these clients’ capacity to acknowledge, explore, and integrate their distressing memories as intrinsic elements of their identity, thereby fostering the development of a unified and cohesive self-concept.Keywords: addictiondissociationdevelopmental traumaself-medication hypothesis Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported that there is no funding associated with the work featured in this article","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135242427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.1080/02668734.2023.2272765
E. Rüfenacht, L. Shaverin, J. Stubley, M. L. Smits, A. Bateman, P. Fonagy, P. Luyten
A significant number of individuals receiving mental health care exhibit a history of traumatic experiences. Accompanying dissociative symptoms often amplify the complexity of their required treatment. This article introduces a novel understanding and treatment approach for post-traumatic stress symptoms, inclusive of dissociation, derived from attachment and mentalization theories. Initially, we outline the different expressions of dissociation and the prevailing knowledge concerning their associations with diverse clinical manifestations and their role in trauma. We subsequently reinterpret these clinical symptoms through an attachment and mentalization lens, then proceed to elaborate on the new trauma-focused mentalization-based treatment and its therapeutic objectives. The article culminates with a case study that exemplifies the application of this approach in a clinical setting.
{"title":"Addressing dissociation symptoms with trauma-focused mentalization-based treatment","authors":"E. Rüfenacht, L. Shaverin, J. Stubley, M. L. Smits, A. Bateman, P. Fonagy, P. Luyten","doi":"10.1080/02668734.2023.2272765","DOIUrl":"https://doi.org/10.1080/02668734.2023.2272765","url":null,"abstract":"A significant number of individuals receiving mental health care exhibit a history of traumatic experiences. Accompanying dissociative symptoms often amplify the complexity of their required treatment. This article introduces a novel understanding and treatment approach for post-traumatic stress symptoms, inclusive of dissociation, derived from attachment and mentalization theories. Initially, we outline the different expressions of dissociation and the prevailing knowledge concerning their associations with diverse clinical manifestations and their role in trauma. We subsequently reinterpret these clinical symptoms through an attachment and mentalization lens, then proceed to elaborate on the new trauma-focused mentalization-based treatment and its therapeutic objectives. The article culminates with a case study that exemplifies the application of this approach in a clinical setting.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135242597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-23DOI: 10.1080/02668734.2023.2246058
Richard A. Chefetz, Nirit Soffer-Dudek, Eli Somer
AbstractMaladaptive daydreaming (MD) is the excessive employment of immersive daydreaming characterized by highly absorbing fantasy experiences that become a preferred focus of consciousness at the expense of living in the real world. Active dissociative processes like depersonalization and derealization, including those also characteristic of dissociative identity disorder (DID): amnesia, identity confusion, and identity alteration, may be present and, like in DID, seem to be psychodynamically driven. Comorbidity with attention deficit disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and others is typical. Often associated with profound shame experience, it is, like DID, a condition that tends to be concealed and requires a clinician to be knowledgeable about its nature before a diagnosis can occur and effective treatment be initiated. We introduce the concept, explore its clinical associations and manifestations, and provide several case vignettes to illustrate the breadth and depth of this potentially debilitating variation on daydreaming.Keywords: dissociative absorptionmaladaptive daydreamingdissociative disorders Disclosure statementNo potential conflict of interest was reported by the author(s).
{"title":"When daydreaming becomes maladaptive: phenomenological and psychoanalytic perspectives","authors":"Richard A. Chefetz, Nirit Soffer-Dudek, Eli Somer","doi":"10.1080/02668734.2023.2246058","DOIUrl":"https://doi.org/10.1080/02668734.2023.2246058","url":null,"abstract":"AbstractMaladaptive daydreaming (MD) is the excessive employment of immersive daydreaming characterized by highly absorbing fantasy experiences that become a preferred focus of consciousness at the expense of living in the real world. Active dissociative processes like depersonalization and derealization, including those also characteristic of dissociative identity disorder (DID): amnesia, identity confusion, and identity alteration, may be present and, like in DID, seem to be psychodynamically driven. Comorbidity with attention deficit disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and others is typical. Often associated with profound shame experience, it is, like DID, a condition that tends to be concealed and requires a clinician to be knowledgeable about its nature before a diagnosis can occur and effective treatment be initiated. We introduce the concept, explore its clinical associations and manifestations, and provide several case vignettes to illustrate the breadth and depth of this potentially debilitating variation on daydreaming.Keywords: dissociative absorptionmaladaptive daydreamingdissociative disorders Disclosure statementNo potential conflict of interest was reported by the author(s).","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135412622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-23DOI: 10.1080/02668734.2023.2270658
Poul Rohleder
{"title":"Psychoanalysis and homosexuality: a contemporary introduction <b>Psychoanalysis and homosexuality: a contemporary introduction</b> , by Leezah Hertzmann and Juliet Newbigin, Abingdon, Routledge, 2023, 172 pp., £19.99 (pback), ISBN 9781032220987","authors":"Poul Rohleder","doi":"10.1080/02668734.2023.2270658","DOIUrl":"https://doi.org/10.1080/02668734.2023.2270658","url":null,"abstract":"","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135412633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-17DOI: 10.1080/02668734.2023.2254824
Vedat Şar
AbstractDissociative depression is a complex and chronic mood disorder characterized by a combination of persistent depressive symptoms and intermittent major depressive episodes. A key feature of dissociative depression is the existence of dissociative symptoms that are linked to prolonged stress experienced during childhood and infancy. Disturbances of sense of self and agency are core indicators of the disorder. Common symptoms include thoughts of guilt and worthlessness, difficulties with concentration and decision-making, changes in appetite and sleep, and suicidal ideation. Additionally, individuals may exhibit various expressive patterns such as borderline phenomena, psychoticism, trauma-related enactments, and attempts at control through somatization, compensatory narcissism, and obsessions. One challenge is that dissociative depression often does not respond well to biological treatments alone. Psychotherapeutic interventions that do not specifically address the dissociative aspect may also be ineffective. The required comprehensive approach involves working through layers of therapeutic reality to reverse the process that led to the status quo. An intensive psychodynamic practice with a renewed theoretical understanding (Dialectical Dynamic Therapy-DDT) is necessary to identify the leverage points that can bring about radical inner change. The aim is to alleviate the barriers that prevent individuals from realizing their full potential assigned in the beginning of life.Keywords: depressiondissociationtraumadynamicsreality AcknowledgementsThe author wish thank to Görkem Ayas, MD for their valuable comments on evolving versions of the manuscript.Disclosure statementNo potential conflict of interest was reported by the author(s).
{"title":"Dissociative depression: a psychodynamic view","authors":"Vedat Şar","doi":"10.1080/02668734.2023.2254824","DOIUrl":"https://doi.org/10.1080/02668734.2023.2254824","url":null,"abstract":"AbstractDissociative depression is a complex and chronic mood disorder characterized by a combination of persistent depressive symptoms and intermittent major depressive episodes. A key feature of dissociative depression is the existence of dissociative symptoms that are linked to prolonged stress experienced during childhood and infancy. Disturbances of sense of self and agency are core indicators of the disorder. Common symptoms include thoughts of guilt and worthlessness, difficulties with concentration and decision-making, changes in appetite and sleep, and suicidal ideation. Additionally, individuals may exhibit various expressive patterns such as borderline phenomena, psychoticism, trauma-related enactments, and attempts at control through somatization, compensatory narcissism, and obsessions. One challenge is that dissociative depression often does not respond well to biological treatments alone. Psychotherapeutic interventions that do not specifically address the dissociative aspect may also be ineffective. The required comprehensive approach involves working through layers of therapeutic reality to reverse the process that led to the status quo. An intensive psychodynamic practice with a renewed theoretical understanding (Dialectical Dynamic Therapy-DDT) is necessary to identify the leverage points that can bring about radical inner change. The aim is to alleviate the barriers that prevent individuals from realizing their full potential assigned in the beginning of life.Keywords: depressiondissociationtraumadynamicsreality AcknowledgementsThe author wish thank to Görkem Ayas, MD for their valuable comments on evolving versions of the manuscript.Disclosure statementNo potential conflict of interest was reported by the author(s).","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135994582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-17DOI: 10.1080/02668734.2023.2251552
Dana Amir
The present paper seeks to propose, using a combination of psychoanalytic and linguistic thinking, a distinction between three degrees of symbolicity across the somatoform dissociative continuum: the metaphorical, in which there is a symbolic connection between the somatoform phenomenon and the traumatic content, the metonymic, which constitutes a revival of the traumatic experience without the ability to reflect on it, and the psychotic, in which the somatoform phenomenon is experienced as ego-syntonic, thus neither causes distress nor evokes thinking. Three clinical vignettes demonstrate how the higher the degree of symbolization, the more effective the therapeutic process. Finally, a fourth vignette demonstrates how acoustic association in the therapist's countertransference can constitute an antidote to the patient's acoustic dissociation, allowing the reclaiming of the capacity for linking.
{"title":"Metaphoric, metonymic and psychotic somatoform dissociation","authors":"Dana Amir","doi":"10.1080/02668734.2023.2251552","DOIUrl":"https://doi.org/10.1080/02668734.2023.2251552","url":null,"abstract":"The present paper seeks to propose, using a combination of psychoanalytic and linguistic thinking, a distinction between three degrees of symbolicity across the somatoform dissociative continuum: the metaphorical, in which there is a symbolic connection between the somatoform phenomenon and the traumatic content, the metonymic, which constitutes a revival of the traumatic experience without the ability to reflect on it, and the psychotic, in which the somatoform phenomenon is experienced as ego-syntonic, thus neither causes distress nor evokes thinking. Three clinical vignettes demonstrate how the higher the degree of symbolization, the more effective the therapeutic process. Finally, a fourth vignette demonstrates how acoustic association in the therapist's countertransference can constitute an antidote to the patient's acoustic dissociation, allowing the reclaiming of the capacity for linking.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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