Pub Date : 2022-07-03DOI: 10.1080/02668734.2022.2078997
A. Howe, Merryn Jones, Chris Bowden, Kevin Lu
Relationships are central to therapeutic community treatments and the process of change that is facilitated. In this paper, we present a systematic critical case study of a service user who undertook a course of treatment at a now closed therapeutic community day service in south London. Using the contents of electronic patient notes, outcome measures, review letters, staff reflections, and a post-treatment interview, we show the importance of relationships within TC care. While literature regarding the efficacy of TCs does exist, there is less research concerning in-depth case studies of treatment. The importance of relationships within the TC model has been theoretically explored but not clinically demonstrated in the literature. Our case study supports findings from a recent RCT concerning TC care versus ‘treatment as usual’ for borderline personality disorder. Our research further supports an approach emphasising the importance of relationships to TC work with personality disorder beyond any specific therapeutic modality.
{"title":"The importance of relationships in therapeutic communities: a systematic critical case study","authors":"A. Howe, Merryn Jones, Chris Bowden, Kevin Lu","doi":"10.1080/02668734.2022.2078997","DOIUrl":"https://doi.org/10.1080/02668734.2022.2078997","url":null,"abstract":"Relationships are central to therapeutic community treatments and the process of change that is facilitated. In this paper, we present a systematic critical case study of a service user who undertook a course of treatment at a now closed therapeutic community day service in south London. Using the contents of electronic patient notes, outcome measures, review letters, staff reflections, and a post-treatment interview, we show the importance of relationships within TC care. While literature regarding the efficacy of TCs does exist, there is less research concerning in-depth case studies of treatment. The importance of relationships within the TC model has been theoretically explored but not clinically demonstrated in the literature. Our case study supports findings from a recent RCT concerning TC care versus ‘treatment as usual’ for borderline personality disorder. Our research further supports an approach emphasising the importance of relationships to TC work with personality disorder beyond any specific therapeutic modality.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47107543","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 : 2022-05-18DOI: 10.1080/02668734.2022.2058988
Katrin Ahlström, Camilla von Below, David Forsström, A. Werbart
The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.
{"title":"Therapeutic encounters at the onset of the COVID-19 pandemic: psychodynamic therapists’ experiences of transition to remote psychotherapy","authors":"Katrin Ahlström, Camilla von Below, David Forsström, A. Werbart","doi":"10.1080/02668734.2022.2058988","DOIUrl":"https://doi.org/10.1080/02668734.2022.2058988","url":null,"abstract":"The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46215675","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 : 2022-04-07DOI: 10.1080/02668734.2022.2048882
Mattia Beggi, J. Gordon
The Interpersonal Dynamics (ID) consultation is a structured method of group reflective practice which helps staff mentalize transference and countertransference dynamics with patients. We present a detailed ID consultation of a female patient in an inpatient therapeutic community for people with severe personality disorders and demonstrate how this method sheds light on this patient’s internal world as externalised interpersonally with staff in the treatment setting. The resulting enactments are discussed in relation to several psychoanalytic theories and concepts, including Bion’s theory of containment and Ogden’s interpersonal definition of projective identification. We conceptualise our population of patients based on their use of primitive psychological defences such as splitting and projective identification and on the idea that they live at the border between what Klein described as the paranoid-schizoid and the depressive positions. We argue that the ID consultation functions as a container for staff and patients by bringing together and integrating the parts of the patient which are split off and projected into different staff members. Furthermore, the ID consultation is an invaluable triangular space that facilitates the move from difficult dyadic subjective experiences with patients to triadic objective perspectives and from passive reactions to responsive thinking and understanding.
{"title":"The interpersonal dynamics consultation in a therapeutic community for borderline patients: containing relationships at the coal face","authors":"Mattia Beggi, J. Gordon","doi":"10.1080/02668734.2022.2048882","DOIUrl":"https://doi.org/10.1080/02668734.2022.2048882","url":null,"abstract":"The Interpersonal Dynamics (ID) consultation is a structured method of group reflective practice which helps staff mentalize transference and countertransference dynamics with patients. We present a detailed ID consultation of a female patient in an inpatient therapeutic community for people with severe personality disorders and demonstrate how this method sheds light on this patient’s internal world as externalised interpersonally with staff in the treatment setting. The resulting enactments are discussed in relation to several psychoanalytic theories and concepts, including Bion’s theory of containment and Ogden’s interpersonal definition of projective identification. We conceptualise our population of patients based on their use of primitive psychological defences such as splitting and projective identification and on the idea that they live at the border between what Klein described as the paranoid-schizoid and the depressive positions. We argue that the ID consultation functions as a container for staff and patients by bringing together and integrating the parts of the patient which are split off and projected into different staff members. Furthermore, the ID consultation is an invaluable triangular space that facilitates the move from difficult dyadic subjective experiences with patients to triadic objective perspectives and from passive reactions to responsive thinking and understanding.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41940602","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 : 2022-04-03DOI: 10.1080/02668734.2022.2057575
J. Alderdice
{"title":"Psychoanalysis and Covidian life – common distress, individual experience","authors":"J. Alderdice","doi":"10.1080/02668734.2022.2057575","DOIUrl":"https://doi.org/10.1080/02668734.2022.2057575","url":null,"abstract":"","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45929698","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 : 2022-04-03DOI: 10.1080/02668734.2022.2101730
P. Cundy
There have been several changes at the journal recently. I am sad to report that our editor, Jessica Yakeley, left her post at the end of 2021. Jessica took up the role of editor in 2012, writing her first editorial in 26–04 which was published in December that year. Over the ensuing period she has published three books based on special issues of the journal: ‘Forensic Psychotherapy’ (Yakeley & McGauley, 2018), ‘Psychoanalytic Perspectives on Fundamentalism, Radicalisation and Terrorism’ (Yakeley & Cundy, 2019) and ‘The Social and Interpersonal Origins of Depression Today’ (Clarke et al., 2020). Jessica has been an inspirational leader for the journal, overseeing its ongoing development for a decade. On a personal note Jessica has been a positive and supportive colleague, initially helping me to settle into my role as assistant editor, and then encouraging me to expand and develop the tasks for which I have been responsible. Jessica will be greatly missed, and all involved in the journal are immensely grateful for her work here. Also leaving us is Arabella Kurtz, Book Reviews Editor, who has recently taken up a role in Northamptonshire as lead of a new NHS Staff Health and Wellbeing Service. The book reviews section has flourished under Arabella’s guidance. A particularly significant development was the ‘book review essay’, a new category that enables authors to reflect on their own personal and clinical experiences in the context of two or more books on a specific subject. I am pleased that this issue includes a review of Arabella’s recently published book ‘How to run reflective practice groups’ (Kurtz, 2020). I am delighted to welcome Rachel Hodgins into the role of Book Reviews Editor. Rachel is a Clinical Psychologist in Psychoanalytic Psychotherapy currently working at the Tavistock & Portman NHS Foundation Trust. Like Arabella, Rachel’s first degree was in English. She has previously peer reviewed articles for the journal, and also contributed a book review essay. Rachel has already begun commissioning reviews, and hopes to implement some exciting developments in our relatively new social media profiles. Rachel is a friend and former colleague and I look forward to a fruitful working relationship here at the journal. This very full issue begins with a focus on the psychosomatic. In the first of our articles Elias Seidl, Dirk Schwerthoffer and Otmar Seidl report on a study conducted in Munich which explored the role of psychodynamic factors in tinnitus aurium. Tinnitus is the conscious perception of an acoustic sensation in the absence of a corresponding external stimulus. It is experienced relatively commonly (10–15% of the population) but causes significant distress to 1–2%. In this study 99 outpatients at an ENT clinic completed a psychodynamic Psychoanalytic Psychotherapy, 2022 Vol. 36, No. 2, 59–63, https://doi.org/10.1080/02668734.2022.2101730
{"title":"Editorial","authors":"P. Cundy","doi":"10.1080/02668734.2022.2101730","DOIUrl":"https://doi.org/10.1080/02668734.2022.2101730","url":null,"abstract":"There have been several changes at the journal recently. I am sad to report that our editor, Jessica Yakeley, left her post at the end of 2021. Jessica took up the role of editor in 2012, writing her first editorial in 26–04 which was published in December that year. Over the ensuing period she has published three books based on special issues of the journal: ‘Forensic Psychotherapy’ (Yakeley & McGauley, 2018), ‘Psychoanalytic Perspectives on Fundamentalism, Radicalisation and Terrorism’ (Yakeley & Cundy, 2019) and ‘The Social and Interpersonal Origins of Depression Today’ (Clarke et al., 2020). Jessica has been an inspirational leader for the journal, overseeing its ongoing development for a decade. On a personal note Jessica has been a positive and supportive colleague, initially helping me to settle into my role as assistant editor, and then encouraging me to expand and develop the tasks for which I have been responsible. Jessica will be greatly missed, and all involved in the journal are immensely grateful for her work here. Also leaving us is Arabella Kurtz, Book Reviews Editor, who has recently taken up a role in Northamptonshire as lead of a new NHS Staff Health and Wellbeing Service. The book reviews section has flourished under Arabella’s guidance. A particularly significant development was the ‘book review essay’, a new category that enables authors to reflect on their own personal and clinical experiences in the context of two or more books on a specific subject. I am pleased that this issue includes a review of Arabella’s recently published book ‘How to run reflective practice groups’ (Kurtz, 2020). I am delighted to welcome Rachel Hodgins into the role of Book Reviews Editor. Rachel is a Clinical Psychologist in Psychoanalytic Psychotherapy currently working at the Tavistock & Portman NHS Foundation Trust. Like Arabella, Rachel’s first degree was in English. She has previously peer reviewed articles for the journal, and also contributed a book review essay. Rachel has already begun commissioning reviews, and hopes to implement some exciting developments in our relatively new social media profiles. Rachel is a friend and former colleague and I look forward to a fruitful working relationship here at the journal. This very full issue begins with a focus on the psychosomatic. In the first of our articles Elias Seidl, Dirk Schwerthoffer and Otmar Seidl report on a study conducted in Munich which explored the role of psychodynamic factors in tinnitus aurium. Tinnitus is the conscious perception of an acoustic sensation in the absence of a corresponding external stimulus. It is experienced relatively commonly (10–15% of the population) but causes significant distress to 1–2%. In this study 99 outpatients at an ENT clinic completed a psychodynamic Psychoanalytic Psychotherapy, 2022 Vol. 36, No. 2, 59–63, https://doi.org/10.1080/02668734.2022.2101730","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45151275","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 : 2022-04-01DOI: 10.1080/02668734.2022.2058073
Chris Dawber
{"title":"How to run Reflective Practice Groups: a guide for healthcare professionals - 1st ed","authors":"Chris Dawber","doi":"10.1080/02668734.2022.2058073","DOIUrl":"https://doi.org/10.1080/02668734.2022.2058073","url":null,"abstract":"","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41850654","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 : 2022-03-28DOI: 10.1080/02668734.2022.2048057
Liam Bierschenk
This paper addresses theories pertaining to what could be said of the state of mind of the creator in the art-making phase of art therapy, by reference to the interchange with the looking/talking phase. I pursue this exploration of the interchange within the concept of the triangular relationship: creator-artwork-viewer, as well as the three ‘waves’ of art therapy theory and practice. I conclude by making use of mathematical abstraction to describe the recursive sequence of art-making and looking/talking about the art, to pose questions about what might be occurring during these processes and which it is hoped could serve as a framework for further investigations from various theoretical standpoints.
{"title":"The interchange in art-psychotherapy","authors":"Liam Bierschenk","doi":"10.1080/02668734.2022.2048057","DOIUrl":"https://doi.org/10.1080/02668734.2022.2048057","url":null,"abstract":"This paper addresses theories pertaining to what could be said of the state of mind of the creator in the art-making phase of art therapy, by reference to the interchange with the looking/talking phase. I pursue this exploration of the interchange within the concept of the triangular relationship: creator-artwork-viewer, as well as the three ‘waves’ of art therapy theory and practice. I conclude by making use of mathematical abstraction to describe the recursive sequence of art-making and looking/talking about the art, to pose questions about what might be occurring during these processes and which it is hoped could serve as a framework for further investigations from various theoretical standpoints.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49141722","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 : 2022-03-14DOI: 10.1080/02668734.2022.2040047
C. Clesse, Th. Rabeyron, M. Botbol
Even if psychoanalysis no longer prevails with the extraordinary enthusiasm it inspired after World War II, it still retains an important place for many in the mental health field. This paper’s objective is to describe the current situation of psychoanalysis and psychoanalytic therapies in the French health system, showing how, in our country, it has developed to this unique position. So far, influenced by the evolution of psychoanalysis in France, historical, cultural, and societal factors added with a strong lobby from psychodynamic scholars and strong support offered by clinical psychology, psychoanalysis and psychoanalytic psychotherapies have maintained a significant practice framework in France. Despite being challenged by the dominant global position of DSM psychiatry and cognitive psychology, psychoanalysis’ influence remains strong as it does not affect only psychology and psychiatry but also extends to the humanities and social sciences. New practice types and future directions for psychoanalysis and psychoanalytic therapies are then discussed.
{"title":"Contemporary situation of psychoanalysis and psychoanalytical therapies in France","authors":"C. Clesse, Th. Rabeyron, M. Botbol","doi":"10.1080/02668734.2022.2040047","DOIUrl":"https://doi.org/10.1080/02668734.2022.2040047","url":null,"abstract":"Even if psychoanalysis no longer prevails with the extraordinary enthusiasm it inspired after World War II, it still retains an important place for many in the mental health field. This paper’s objective is to describe the current situation of psychoanalysis and psychoanalytic therapies in the French health system, showing how, in our country, it has developed to this unique position. So far, influenced by the evolution of psychoanalysis in France, historical, cultural, and societal factors added with a strong lobby from psychodynamic scholars and strong support offered by clinical psychology, psychoanalysis and psychoanalytic psychotherapies have maintained a significant practice framework in France. Despite being challenged by the dominant global position of DSM psychiatry and cognitive psychology, psychoanalysis’ influence remains strong as it does not affect only psychology and psychiatry but also extends to the humanities and social sciences. New practice types and future directions for psychoanalysis and psychoanalytic therapies are then discussed.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42662223","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 : 2022-03-10DOI: 10.1080/02668734.2022.2037691
Lauren R Ahlquist, Brandon C Yarns
The COVID-19 pandemic and ensuing social distancing requirements resulted in an abrupt transition in the provision of most mental healthcare to telehealth; yet it was, at first, unclear whether patients' emotional expressions - of great import to the success of many psychodynamic therapies - could be facilitated using teletherapy. This article first presents a targeted literature review focused on emotional expressions in psychotherapy and implementing psychodynamic therapy over telehealth and then describes our clinical experience transitioning a psychodynamically-informed, evidence-based, and experiential group treatment for chronic pain, emotional awareness and expression therapy (EAET), to video telehealth at VA Greater Los Angeles Healthcare System. We discuss barriers we encountered in our implementation of EAET over video telehealth but also illustrate the ultimate success of the approach using verbatim excerpts from our therapeutic work, which aim to demonstrate the potential to facilitate powerful emotional expressions over video telehealth when conducting a psychodynamically-informed treatment. We examine the possible applications for video telehealth to maintain emotionally focused, psychodynamic psychotherapy administration and enhance its teaching and training. Although we describe limitations of our specific approach, ultimately, our experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies in a telehealth setting.
{"title":"Eliciting emotional expressions in psychodynamic psychotherapies using telehealth: a clinical review and single case study using emotional awareness and expression therapy.","authors":"Lauren R Ahlquist, Brandon C Yarns","doi":"10.1080/02668734.2022.2037691","DOIUrl":"https://doi.org/10.1080/02668734.2022.2037691","url":null,"abstract":"<p><p>The COVID-19 pandemic and ensuing social distancing requirements resulted in an abrupt transition in the provision of most mental healthcare to telehealth; yet it was, at first, unclear whether patients' emotional expressions - of great import to the success of many psychodynamic therapies - could be facilitated using teletherapy. This article first presents a targeted literature review focused on emotional expressions in psychotherapy and implementing psychodynamic therapy over telehealth and then describes our clinical experience transitioning a psychodynamically-informed, evidence-based, and experiential group treatment for chronic pain, emotional awareness and expression therapy (EAET), to video telehealth at VA Greater Los Angeles Healthcare System. We discuss barriers we encountered in our implementation of EAET over video telehealth but also illustrate the ultimate success of the approach using verbatim excerpts from our therapeutic work, which aim to demonstrate the potential to facilitate powerful emotional expressions over video telehealth when conducting a psychodynamically-informed treatment. We examine the possible applications for video telehealth to maintain emotionally focused, psychodynamic psychotherapy administration and enhance its teaching and training. Although we describe limitations of our specific approach, ultimately, our experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies in a telehealth setting.</p>","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9881109/pdf/nihms-1861762.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9157457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-16DOI: 10.1080/02668734.2021.2022744
Rebecca Philipp, Alexander Krüger, R. Lindner, A. Mehnert‐Theuerkauf, S. Vehling
Describing the course of a short-term supportive-expressive psychotherapy of a male patient with terminal cancer, this study aimed to illustrate the clinical presentation of avoidant attachment behavior and to identify potential challenges in treating these patients from a psychoanalytic perspective. We analyzed eight therapy sessions, recorded and transcribed as part of a randomized controlled trial, following the explication technique of qualitative content analysis. We analyzed a patient with high attachment avoidance as assessed by the Experiences in Close Relationships Scale measuring adult attachment. We found that ‘attachment avoidance’ subsumed different defense mechanisms, which helped the patient to reduce his fear associated with (1) feelings of dependency: denial, (2) overwhelming distress: isolation of affect, displacement, (3) feelings of guilt and shame: repression, (4) regulating his interpersonal relationships: projective identification. Adding psychoanalytic interpretations to the existing material helped to identify rigid defense mechanisms interfering with sharing his fears about death and dying. Still, the low intensity setting offered him a reliable and tolerable therapeutic relationship. Contributing to the understanding of the specific challenges in treating avoidant patients, our findings underline the importance and feasibility of establishing a holding environment and fostering a positive transference relationship to engage in a joint mourning process.
{"title":"Understanding avoidant attachment in a patient with terminal cancer: a psychoanalytic perspective","authors":"Rebecca Philipp, Alexander Krüger, R. Lindner, A. Mehnert‐Theuerkauf, S. Vehling","doi":"10.1080/02668734.2021.2022744","DOIUrl":"https://doi.org/10.1080/02668734.2021.2022744","url":null,"abstract":"Describing the course of a short-term supportive-expressive psychotherapy of a male patient with terminal cancer, this study aimed to illustrate the clinical presentation of avoidant attachment behavior and to identify potential challenges in treating these patients from a psychoanalytic perspective. We analyzed eight therapy sessions, recorded and transcribed as part of a randomized controlled trial, following the explication technique of qualitative content analysis. We analyzed a patient with high attachment avoidance as assessed by the Experiences in Close Relationships Scale measuring adult attachment. We found that ‘attachment avoidance’ subsumed different defense mechanisms, which helped the patient to reduce his fear associated with (1) feelings of dependency: denial, (2) overwhelming distress: isolation of affect, displacement, (3) feelings of guilt and shame: repression, (4) regulating his interpersonal relationships: projective identification. Adding psychoanalytic interpretations to the existing material helped to identify rigid defense mechanisms interfering with sharing his fears about death and dying. Still, the low intensity setting offered him a reliable and tolerable therapeutic relationship. Contributing to the understanding of the specific challenges in treating avoidant patients, our findings underline the importance and feasibility of establishing a holding environment and fostering a positive transference relationship to engage in a joint mourning process.","PeriodicalId":54122,"journal":{"name":"Psychoanalytic Psychotherapy","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43566795","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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