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Psychoanalytic Psychology - Vol 34, Iss 4

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Psychoanalytic Psychology Psychoanalytic Psychology serves as a resource for original contributions that reflect and broaden the interaction between psychoanalysis and psychology.
Copyright 2017 American Psychological Association
  • Transference-focused psychotherapy (TFP) for narcissistic personality: Engaging patients in the early treatment process.
    The authors outline the application of Transference-Focused Psychotherapy (TFP), a structured, twice-weekly psychoanalytic psychotherapy, to patients with narcissistic pathology. The operation of splitting-based defenses in the maintenance of the pathological grandiose self that is characteristic of individuals with narcissistic personality disorders is described, as are the obstacles posed by this structure to therapists attempting to establish a viable treatment frame and engage patients in the early treatment process. The narcissistic patient’s difficulty tolerating the interpretive process in psychoanalytic psychotherapy is formulated based on the ideas of several writers in the modern Kleinian tradition as well as contemporary object relations theory. An extended case discussion illuminates the foregoing, and several modifications related to tact and timing, drawn from various analytic sources, are outlined to enhance the interpretive process in TFP. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Transference focused psychotherapy and the language of action.
    Transference focused psychotherapy (TFP) is a psychoanalytic psychotherapy for individuals with personality disorders that is evidence based (Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Clarkin, Yeomans, & Kernberg, 2006; Doering et al., 2010; Giesen-Bloo et al., 2006). An important component of the treatment is examining the transference in the moment-to- moment interactions between the patient and therapist, in order to draw the patient’s attention to her thinking and assumptions, and to the emotional conclusions she makes that are outside her awareness. Roy Schafer, in A New Language for Psychoanalysis (Schafer, 1976) describes how people can actively choose to think and act while simultaneously hiding elements of the truth about these actions from themselves, and proposes the use of action language in our thinking about our work. In this article, clinical examples show how TFP allows for clarification and interpretation of a patient’s activity in a session. The article illustrates how the language of action supports and enhances the TFP psychotherapist’s way of talking to patients. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Reflective functioning and adolescent psychological adaptation: The validity of the Reflective Functioning Scale–Adolescent Version.
    Adolescence is a critical period of rapid biological and social development and early signs of adult mental disorders emerge during this life stage. Previous studies suggest that mentalizing failures, specifically difficulties in reflective functioning (RF) are linked with psychological symptoms. However, relatively little is known about the association between RF and psychological adaptation in typical development. In this study, the relationship between RF, internalizing and externalizing symptoms were investigated in 95 adolescents using the revised Reflective Functioning Scale–Adolescent version. Results indicate that RF is associated with more self-reported internalizing symptoms. Moreover, the relationship between RF and externalizing symptoms are accounted for by the co-occurrence of internalizing and externalizing symptoms in typically developing adolescents. The implications of these findings are discussed and suggestions for future studies are presented. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Reflective functioning in postpartum depressed women with and without comorbid personality disorder.
    Mentalization or Reflective Functioning (RF), that is, the ability to reflect upon ones’ own and others behavior in terms of underlying mental states, plays an important role in parenting behavior and children’s socioemotional development. RF has been suggested to be impaired in psychopathology, and thus maternal psychopathology after birth, such as postpartum depression (PPD) and Personality Disorder (PD), may not only affect the mother’s socioemotional functioning but also the development of the child. However, little is known about mentalizing abilities of PPD mothers, and mothers with PPD and comorbid PD. Therefore, the aim of this study was to evaluate RF in women presenting symptoms of PPD (n = 13), and women with PPD symptoms and comorbid PD (n = 14) compared with a nonclinical group (n = 52). Women were interviewed with the Adult Attachment Interview (AAI) before birth (nonclinical group), and 9–12 weeks after birth (clinical groups), and RF was assessed with the Reflective Functioning Scale applied to the AAI. ANCOVA results revealed no significant differences in mean RF abilities among the 3 groups. Possible reasons for the lack of differences in RF between the 3 diagnostic groups are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Between verbalization and reflection: Referential activity and narrative processes in borderline personality organization.
    Both empirical and theoretical data would seem to suggest that patients with borderline personality organization (BPO; e.g., O. F. Kernberg, 2004b) show severe problems with emotional regulation that arise due to dysfunctions in intrapsychic representation and emotional–relational processing. The research presented here examines emotional–relational processing from 2 points of view—from that of referential activity (RA) and through the process of narrative processing. A major goal of the 2 presented studies was to explore the referential and narrative processes in BPO. Study 1 compares BPO with a general group of higher personality organization, Study 2 with specified groups (neurotic personality organization [NPO] and integrated personality organization [IPO]). We hypothesized that people with BPO (in their utterances) would show lower emotional–relational processing that might manifest in higher RA processes. The RA indices (concreteness, specificity, and imagery) were significantly higher in the BPO group for narratives about negative emotional–relational situations. No intergroup differences were observed for narratives about positive emotional–relational conditions (Study 1). Moreover, when lexical indices were used, the concreteness index was higher in a statistically significant way for BPO, in comparison with NPO, and the imagery index was significantly higher in BPO than in the IPO group (Study 2). From the experience-processing point of view, results in the BPO group revealed verbal access to emotional experiences but without the reflection stage, where arousal would have connected to meaning. Taking the structure of the representation into account, the disturbance in emotional–relational processing might be explained by a splitting within the intrapsychic representation. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Change in personality functioning during psychotherapy for depression predicts long-term outcome.
    Because depression is a recurrent disorder, the therapeutic aim for it should be the prevention of relapse or recurrence. Practitioners of psychoanalytic (PA), psychodynamic (PD) and cognitive–behavioral therapy (CBT) claim to achieve stable results by improving patients’ personality functioning (e.g., self- and object representations, capacity to regulate affect and self-esteem). This hypothesis was tested using data from a subsample of 67 patients of the Munich Psychotherapy Study. In addition, we tested a diathesis–stress model, assuming that a failure to improve personality functioning during therapy may represent a vulnerability factor, especially for people confronted with adverse life events after therapy. Depressive symptoms and general psychiatric distress were assessed using the German versions of the Beck Depression Inventory (Hautzinger, Bailer, Worall, & Keller, 1995) and the Global Severity Index of the Symptom Checklist 90–Revised (Franke, 1995) at pretreatment, posttreatment, and 3-year follow-up. Personality functioning was assessed pre- and posttreatment using the Scales of Psychological Capacities (Wallerstein, 1991; Wallerstein, DeWitt, Hartley, Rosenberg, & Zilberg, 1989). Patients were interviewed at 1-year follow-up to detect negative life events in the intervening time. Regression analyses revealed that depressive symptoms and general psychiatric distress at 3-year follow-up were significantly predicted by pre- to posttreatment changes in personality functioning. When controlling for pre- to posttreatment changes in outcome measures, the effects of change in personality functioning were no longer significant. However, we found evidence for an interaction effect between pre- to posttreatment changes in personality functioning and the number of negative life events on general psychiatric symptoms, partially supporting the assumed diathesis–stress model. This suggests that, irrespective of treatment modality, therapists should focus on changes in personality functioning to obtain stable benefits. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Interactions between obsessional symptoms and interpersonal dynamics: An empirical single case study.
    Both classical and contemporary psychoanalytic theories stress the importance of interpersonal dynamics in treating neurotic symptoms. Associations between the symptomatic and interpersonal level were formally represented in the symptom specificity hypothesis (Blatt, 1974, 2004), which linked obsessional symptoms to an autonomous interpersonal stance. Findings from cross-sectional group studies on symptom specificity, however, do not converge, possibly indicating that the complexity of associations is underestimated. This article presents a theory-building case study specifically aiming at refinement of the classical symptom specificity hypothesis by quantitatively and qualitatively describing the longitudinal clinical interplay between obsessional symptoms and interpersonal dynamics throughout a psychodynamic psychotherapy. Interpersonal functioning was assessed by means of the core conflictual relationship theme method (Luborsky & Crits-Cristoph, 1998). Findings affirm a close association between symptoms and interpersonal dynamics. However, obsessional symptoms proved to be determined by profound ambivalences—manifesting both within and between relationships—between dependent and autonomous interpersonal behavior. Psychodynamic interventions focusing on interpersonal conflicts were associated with symptomatic alterations. Conceptual and methodological considerations, limitations and future research indications are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Beyond the statistics: A case comparison study of Victor and Tim.
    The 2 treatments, in this case comparison study, are strategically chosen to illustrate one of many or a result from a randomized controlled study on the long-term effect of transference work (Høglend et al., 2006). Namely, the interaction between transference work, therapists’ self-reported parental countertransference, and patients’ personality pathology that were reported by Dahl et al. (2014). Their findings indicated that transference work in the context of relatively strong parental countertransference was positive for patients meeting criteria for high levels of personality pathology but negative for patients with low levels of personality pathology. To shed light on these results, 2 patients with different levels of personality pathology and divergent long-term results, treated by the same therapist who reported high levels of parental feelings while using transference work in this time-limited dynamic psychotherapy were chosen. Victor and Tim’s treatments fulfilled these conditions and will be presented using interviews and questionnaires from before, during, and after therapy, until 3 years follow-up. The therapeutic interaction is examined with finer grained process analyses, and session transcripts are included to demonstrate how transference work is delivered in this study. This article illustrates treatments behind the statistical analysis. More explicitly it exemplifies how parental countertransference may color transference work for better or worse due to interactions between therapist and patient. The self-reported parental countertransference may be seen as an empathic response leading to new relational experiences and long-term positive change or an enactment leading to repetitions of earlier interpersonal patterns and no change in the long run. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Psychodynamic case formulation: A roadmap to protocol adaptation in CBT.
    Cognitive–behavioral approaches are considered the treatment of choice for traumatic stress reactions in childhood. In spite of documented effectiveness of these approaches in reducing traumatic reactions, criticism has been raised regarding difficulties in implementing these treatments effectively in community-based clinical settings. In these settings many of the children suffer from complex and multiple traumatic experiences, live in chaotic households, and have parents that are often traumatized themselves and struggle to provide the support expected in those treatment approaches. Using a case study of a patient with complex trauma, this paper will demonstrate the challenges involved in implementing short-term, evidence-based cognitive–behavioral treatment in the community. It will offer a model for psychodynamically informed protocol adaptation, and demonstrate ways in which integrating psychodynamic case formulation can enable effective implementation of cognitive–behavioral treatment protocols with complex cases. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The therapeutic process of a child diagnosed with disruptive mood dysregulation disorder.
    It has been recognized that there is a need to make psychotherapy more effective for children with disruptive symptoms. Many studies on child psychodynamic psychotherapy have indicated its effectiveness, but do not explain how this treatment works. It is not only necessary to understand how it works, but also for which therapist—patient dyads. The Child Psychotherapy Q-Set was designed to describe the therapeutic process with children, and makes it possible to identify interaction structures (i.e., repetitive patterns of interaction) and how they change in the course of a treatment. Based on these assumptions, the aim of this study was to analyze the psychotherapeutic process of a school-aged boy who presented with disruptive behavior disorder, identifying the interaction structures in his treatment. A total of 123 sessions of his treatments were analyzed and 4 interaction structures were identified: 2 became more characteristic over the course of treatment, and 2 became less characteristic. They also varied in magnitude. The therapeutic process showed characteristics consistent with the models described as ideal for psychodynamic psychotherapy, the reflective functioning process, and cognitive–behavioral therapy, in this order of significance. The study highlighted the importance of supportive interventions alongside expressive ones in the treatment of children with disruptive behavior disorders. The results also suggested the integrationist nature of most psychotherapies, and the importance of acknowledging and understanding the effective elements, rather than treatment types that can be present within any therapeutic modality. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The application of psychodynamic psychotherapy within a preexisting primary care assessment and treatment approach.
    This article aims to demonstrate the utility of psychodynamic treatment approaches within primary care medical settings. First, I provide an overview of the basic integrative care principles, followed by a discussion of a widely used primary care assessment and intervention method (The 5 As: assess, advise, agree, assist, and arrange). I then review specific psychoanalytic perspectives and techniques that are effective in dealing with shorter term, circumscribed conditions. Next, I offer a discussion of the value of a psychoanalytic framework within primary care settings, with a specific focus on the integration of psychodynamic techniques within the 5As approach. This article concludes with a clinical vignette demonstrating the applicability of psychodynamic techniques for a patient presenting in a medical setting. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Reconsidering parallel process in psychotherapy supervision: On parsimony, rival hypotheses, and alternate explanations.
    A much hallowed concept, parallel process has been referred to as supervision’s signature phenomenon, having now been a part of psychoanalytic and psychotherapy supervision for over 60 years. But I propose that much of parallel process is a fiction, and in what follows, I consider why I believe that to be so. Though promising, parallel process research is still in embryonic form (Tracey, Bludworth, & Glidden-Tracey, 2012; Watkins, 2015c), and the primary “evidence” for parallel process remains the clinical case report, case example, or anecdote. But how much real evidence do such reports, examples, and anecdotes provide? I consider that question subsequently, selectively examining parallel process case examples and anecdotes across the last 6 decades. On the basis of that examination, the following problems were identified: (a) case examples involving highly conflicted supervision relationships and questionable interpretations (e.g., where the supervisor instigated the very conflict that she/he then interpreted as a patient–therapist parallel process issue bubbling up into supervision), (b) case examples being far more easily explained by rival hypotheses and alternate explanations, and (c) mismatches between parallel process definitions and case examples. In constructing clear and usable parallel process case examples, 3 intertwined recommendations are proposed: (a) provide a clear definition of parallel process, (b) provide a definition-consistent case example, and (c) provide case commentary that makes clear how the interpreter arrived at her/his interpretations (i.e., showing the thought process involved). (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Inhibition in the dissertation writing process: Barrier, block, and impasse.
    In this paper, I explore the kinds of difficulties arising during the writing process as seen in students embarking on, engaged in the midst of, and at the stage of completion of a dissertation. I am specifically concerned with the dissertation completed as a part of a humanities-based program in contrast to an empirical piece of work based in a scientifically oriented program. Contained in this process can be the experience of a terror of what the dissertation represents, a breakdown in the relationship to the dissertation, the sometimes shattering or at least wounding of an illusion around one’s abilities and a loss of the capacity to think about the subject matter of the dissertation, and a violent emergence of a painful object relation. Here, and in characterizing such a process in general terms in relation to inhibition, I differentiate between barriers (largely to do with practical limits, the nonnegotiable inabilities and disabilities), blocks (related to processes of defense against anxiety, where anxiety is evaded or eradicated), and impasses (where both student/author and supervisor are caught in a collusive dynamic, conscious and/or unconscious, that adversely affects progress), emphasizing that these are not distinct aspects of the process, but act as intersecting and overlapping, indeed connected, contributors to the process of struggling with the task. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Review of Screen relations: The limits of computer-mediated psychoanalysis and psychotherapy.
    Reviews the book, Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy by Gillian Isaacs Russell (see record 2015-21745-000). This is a book about the strengths and limitations of screen-mediated treatments—the name which Isaacs Russell gives to the practice of using video-conferencing software to conduct psychoanalytic sessions at a distance. Much of the book is devoted to consideration of how screen-mediated treatment is calling for both major and minor adaptations in analytic process and technique. This book offers a template and foundation for attending to the intricacies of computer-mediated treatment as we attempt to engage in deep analytic work through a new medium. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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