Psychoanalytic Psychology

Treatment-resistant depression and personality disorders: An update on conceptualization, assessment, and evidence-based psychodynamic approaches.
When an individual diagnosed with major depressive disorder does not respond sufficiently even after multiple adequate trials of otherwise effective treatments, the label treatment-resistant depression (TRD) is often used to describe the patient’s condition. Personality disorders are among the most prevalent comorbid psychiatric conditions in major depressive disorder and, when undiagnosed or untreated, can contribute to the development of treatment resistance. This article provides an update on conceptualization and assessment of comorbid TRD and personality disorders and introduces three available evidence-based psychodynamic approaches to treatment: good psychiatric management, transference-focused psychotherapy, and mentalization-based treatment. This lead article for the special section on TRD and personality disorders is followed by companion articles on transference-focused psychotherapy, mentalization-based treatment, and mentalization more broadly. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Transference-focused psychotherapy for treatment-resistant depression and comorbid personality disorders.
Research indicates that treatment-resistant depression is common in clinical practice. Although there are several reasons why depression can be difficult to ameliorate, one common reason stems from comorbid personality disorders. Research has shown that not only are personality disorders commonly comorbid among those with depression, but their presence negatively affects the course and outcome in the treatment of depression. This implies that careful assessment of comorbid personality pathology is of critical importance in the case conceptualization of treatment-resistant depression and may be essential for planning treatments that most benefit patients. In the following article, we illustrate the value of transference-focused psychotherapy (TFP), an evidence-based approach for treatment of personality disorders, in addressing treatment-resistant depression when there is a comorbid personality disorder. To do this, we discuss the evidence regarding the comorbidity of treatment-resistant depression and personality disorders and the implications for treatment approaches. We make an argument for treatments such as TFP. We then explicate the TFP model of treatment, including TFP’s model of personality pathology in the development of treatment-resistant depression. In doing so, we also describe the evidence base behind TFP and its mechanisms of change. Clinical vignettes are also used to give clear examples of how TFP assesses and treats treatment-resistant depression in the context of personality pathology. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Mentalization-based approaches to comorbid personality pathology and treatment-resistant depression.
In recent decades, the evidence base for psychodynamic psychotherapy has expanded considerably, allowing for the application of treatments like transference-focused and mentalization-based therapies to a host of psychiatric concerns across a variety of contexts (Bateman & Fonagy, 2004, 2008, 2015, 2016; Constantinides & Dauphin, 2023; Griffiths et al., 2019; Yeomans et al., 2015). As that evidence base expands, we find that these therapies are particularly applicable to individuals with comorbid personality disorders and treatment-resistant depression. We aim in this special section to review the ways this is supported by research, with particular focus on mentalization-based treatment. This section will begin by stating the relevance of mentalizing to good mental health and, further, how comorbid personality pathology and treatment-resistant depression present distinct challenges to mentalizing. Then we elaborate on imbalances in mentalizing, how these difficulties underpin personality pathology, amplify depression, and manifest differently across personality types. This leads to a review of mentalization-based approaches, namely the more structured treatment model and the informal application of a mentalizing framework. To illustrate the effect of a treatment using the mentalizing framework, a case example is offered using a novel method of mentalizing assessment (incomplete sentence task). The use of three regularly administered sentence completion tasks at the beginning, middle, and end of treatment observed linguistic and qualitative changes in the patient’s mentalizing. We close with conclusions about this novel method and the potential for mentalization-based approaches for those with comorbid personality pathology and treatment-resistant depression, with ideas for future directions. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Depression, personality disorders, and metacognition: Intersections between psychoanalysis, research, and the clinic.
People seek treatment at the Austen Riggs Center in the context of profound difficulties in adaptation that are marked diagnostically by mood disorders and personality disorders. Although mood and personality disorders have different diagnostic criteria, they cannot entirely be disentangled, each linked to dysfunctional parenting in childhood. Treatments that focus primarily on the depressive symptoms may miss the underlying difficulties with affect regulation linked to character pathology. I will link research and theory to clinical evidence to illustrate ways in which psychoanalytic therapy can be useful in enhancing mentalization in individuals with complex symptom pictures. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Dreams in psychotherapy: An empirically supported model of the relations of dreams to the course of psychotherapy.
From the beginning, interpretation of dreams has been an integral part of psychoanalytic psychotherapy. Nevertheless, it is still not clear how exactly dreams are related to psychopathology of the patient and the topics and course of therapy. This article aims at providing an empirically supported theoretical model of how dreams are specifically related to psychopathology, the topics that are focused on in psychotherapy, and the general course and results of psychotherapy. On the background of the findings of empirical and clinical dream research, the methodology of Structural Dream Analysis is presented which has reached the point of formulating a theoretical model which explains the relations between dreams and improvement gained in the course of psychotherapy. The core concept that was found is a hierarchical typology of dream patterns which are characterized by different levels of agency of the dream ego representing the extent of ego strength of the person. The central hypothesis contained in the theoretical model of a correlation between a rise in dream ego agency parallel to improvement in psychotherapy is statistically tested and found to be confirmed. The methodology of Structural Dream Analysis has the potential to inform future research but can also be used in assessment and clinical practice in the field of psychotherapeutic dream work. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Exploring object relations and self-structure in men with substance use disorders: A qualitative study.
Psychoanalytic perspectives consider that object relations and deficits of self-structure play a significant role in the etiology of substance use disorders. However, despite the rich psychoanalytic literature addressing this issue, there is only a limited amount of research supportive of these approaches. This study aimed to illustrate a comprehensive picture of object-relational patterns and deficits affecting the self-structure of substance abusers. The research was conducted based on a qualitative method and the content analysis method of Graneheim and Lundman’s approach, and 23 patients with substance use disorder participated in it. Finally, four themes were identified as follows: relational patterns, quality of representations, defense mechanisms, and filling an inner void. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Review of Complex depression: The role of personality dynamics and social ecology.
Reviews the book Complex Depression: The Role of Personality Dynamics and Social Ecology, by Golan Shahar (see record 2024-14831-000). My comments here are intended not as a critique of Shahar but to inform a psychoanalytic readership that may have lost awareness of how revolutionary Stern’s (1985) The Interpersonal World of the Infant was in reformulating psychoanalytic developmental psychology when that book was first published 40 years ago. The real issue, for purposes of this review, is how Shahar characterizes his reformulated depressive position because it differs in significant respects from Klein’s theory and is, I believe, a much more adequate empirical account of the psychodynamics involved. Shahar has given us a worthy contribution, one that I have discussed at considerable length, partly because I now know that he and I share much more than a Blattian intellectual lineage but mainly because of his thoroughgoing effort (a) to bring psychoanalytic ideas to nonpsychoanalytic clinicians in the treatment of depression and (b) to modify and psychodynamic thinking about depression in light of current research, often conducted by nonpsychoanalytic investigators, on this complex, challenging clinical problem. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Review of Exigent psychoanalysis: The interventions of Jean Laplanche.
Reviews the book, Exigent Psychoanalysis: The Interventions of Jean Laplanche by Gila Ashtor (see record 2021-80657-000). Gila Ashtor, PhD, LP, is a psychoanalyst, writer, and critic on the faculty at Columbia University. In writing about the work of Jean Laplanche, she joins a small group of psychoanalysts in the avantgarde of theory here in North America where Laplanche’s work has only reached an English-speaking audience in the past 2 decades or so thanks, mainly, to the translations of John Fletcher and Jonathan House and his associates at Unconscious in Translation Press. Dr. Ashtor is a careful and thorough scholar of psychoanalysis whose project in this book is to stage “an encounter between Laplanche and the field of Contemporary Anglo-American psychoanalysis as it exists today” (p. 34). The book is structured around four major concepts and areas of conflict in the field: the mytho-symbolic and metapsychology, sexuality and the unconscious, seduction and psychic structure, and translation and motivation. Ashtor has done us a great service by writing this book, clearly demonstrating the theoretical impasses in both the classical and progressive schools of psychoanalysis and pointing the way toward Laplanche’s interventions in these debates. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Psychoanalytic Psychology - Vol 42, Iss 1