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A Clinical Guide to Psychodynamic Psychotherapy

What is psychodynamic psychotherapy?The core competences of psychodynamic psychotherapy Aim and outline of the book Notes on terminology and use of clinical material Theory and research An overview of psychoanalytic theory Freud’s structural and developmental theories The topographical model of the mind The structural model of the mind Stages of psychosexual development Anxiety and psychopathology Anna Freud’s concept of developmental lines The beginnings of Object Relations theory: Melanie Klein and Wilfred Bion Unconscious phantasy and internalised objects The Paranoid-Schizoid Position Wilfred Bion: on containment and thinking Object Relations Theory: the British independents Fairbairn and object-seeking motivation Winnicott: the holding environment and the ‘good enough mother’Winnicott: the development of the true self or false self North American developments: a greater focus on the Self Object-relational models: Kohut and Kernberg Interpersonal-relational models: Sullivan and Mitchell Related theoretical developments Attachment theory Mentalisation theory Neuropsychoanalysis Thinking about theory and practice Efficacy and outcome research The rise of evidence-based practice The efficacy of psychodynamic psychotherapy The ‘active ingredients’ of therapy Research on patient experience of therapy Distinctive features of psychodynamic psychotherapy Neuroscientific evidence for the benefits of psychotherapy Working with outcome measures Competences The setting and the analytic frame Assessment and formulation What is a psychodynamic assessment?The purpose of a psychodynamic assessment What works for whom?The referral route The different roles of assessor and therapist in organisational settings Conducting an assessment When to consider the role for psychotropic medication Developing a psychodynamic formulation Structuring a psychodynamic formulation An illustrative psychodynamic formulation Assessing suitability for psychodynamic psychotherapy Key areas around suitability for psychodynamic psychotherapy Realistic aims for psychotherapy Anxiety and defences “Why are you being so defensive?” Understanding anxiety and defences Are defences necessary?Types of defences Destructive defensive behaviour Defences and attachment styles The false self Working with defences in therapy Resistance in psychotherapy Mentalising What is mentalisation?A brief history of mentalisation How do we develop the capacity to mentalise?Recognising impaired mentalising Restoring good mentalising Managing ruptures in the therapeutic relationship Monitoring our own mentalising capacities as therapists Unconscious communications Listening for unconscious communication Types of unconscious communication Free association, manifest and latent content Patterns of verbal and non-verbal communication Dreams as unconscious communication Unconscious communication through the transference and countertransference Making an interpretation Transference and countertransference Transference What is transference?Different types of transference Transference neurosis Self object transferences The cautionary tale Working in the transference Making transference interpretations Countertransference Role responsiveness and countertransference How to recognise and monitor your countertransference Particular types of transference-countertransference dynamics Projective identification and countertransference Acting out and acting in Endings Termination vs ending Developmental perspectives on endings When to end?Endings, recapitulated losses and resistance Endings from the therapist’s perspective Adaptations and practicalities Brief applications of psychodynamic work What do we mean by brief?Selection criteria for brief psychodynamic therapy Trajectory of brief psychodynamic therapy Why offer brief psycho dynamic therapy?Challenging situations and clinical dilemmas Challenges to the analytic frame Challenges in the therapeutic relationship Ruptures in the therapeutic alliance Erotic transference and countertransference Patients who ask questions and request advice Patients who challenge therapeutic boundaries The ‘good patient’ and/or the idealised therapist Risks in the clinical setting Suicide and safeguarding risks Regression in psychotherapy Working with difference Sexuality and gender diversity Racialised and classed identities Disability and ableism Working with differences Technology and social media The therapist’s online presence Privacy, confidentiality and data protection Patient’s use of technology in the setting and the transference Online communication: emails and texts Online banking Distance psychotherapy Appendix 1: Specimen terms and conditions Appendix 2: Specimen referral/pre-assessment questionnaire Appendix 3: Specimen end of therapy report Appendix 4: Specimen social media contract Appendix 5: Specimen privacy notice for website

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The clinical method in time-limited psychodynamic psychotherapy with children, young people and parents
In this chapter, three core elements of the approach to time-limited psychodynamic therapy with children, parents and young people are described. These are: 1 Asserting the legitimacy of the psychodynamic method and the making of meaning. 2 Attending to the developmental scaffold and the core developmental...
(Time-limited Psychodynamic Psychotherapy with Children and Adolescents: An interactive approach)
The clinical technique in time-limited psychodynamic psychotherapy with children, young people and parents
Setting up the conceptual frame for the therapeutic process It will be clear from the previous chapters that focused time-limited psychodynamic psychotherapy is dependent on the creation of a distinctive therapeutic frame. The essential components of the therapeutic frame are as follows: • Being...
(Time-limited Psychodynamic Psychotherapy with Children and Adolescents: An interactive approach)
The evidence base for psychodynamic psychotherapy for adults with depression
The evidence for both long-term and short-term psychodynamic psychotherapy in the treatment of adults has been mounting during the last decade (Leichsenring, Rabung, & Leibing, 2004; Leichsenring, 2005; Abbass, Hancock, Henderson, & Kisely, 2006; Leichsenring & Rabung, 2008; de Maat, de Jonghe, Schoevers,...
(Short-term Psychoanalytic Psychotherapy for Adolescents with Depression: A Treatment Manual)
The evidence base for child and adolescent psychodynamic psychotherapy
A systematic review of the evidence base for child and adolescent psychodynamic psychotherapy (Midgley & Kennedy, 2011) identified 34 distinct research studies, including 9 RCTs. Almost half of these (15 studies) had been reported on between 2004 and 2011, suggesting that there had been an exponential...
(Short-term Psychoanalytic Psychotherapy for Adolescents with Depression: A Treatment Manual)
Suitability for psychodynamic psychotherapy: the evidence
In their systematic review of psychodynamic psychotherapy for children and young people, Midgley and Kennedy (2011) note that there is some evidence to suggest that children with emotional or internalizing disorders respond better than those with disruptive or externalizing disorders (p. 248) but that...
(Short-term Psychoanalytic Psychotherapy for Adolescents with Depression: A Treatment Manual)
Clinical uses of psychodynamic formulation
A psychodynamic formulation has several uses in clinical practice. Its use is not confined to the psychotherapist but may help all psychiatrists and other professionals involved in clinical work in understanding what their patients are thinking and feeling, and understanding why. Exploring the patient’s...
(Medical psychotherapy)
Psychodynamic psychotherapy
(See Psychoanalytic psychotherapy in Chapter 2, pp. 20-30, and in Chapter 5, pp. 163-72.) Psychodynamic psychotherapy (insight-orientated psychotherapy) for addiction is a modified form of therapy that utilizes psychodynamic techniques aimed at increasing self-awareness, growth, and the working through...
(Medical psychotherapy)
A contextual analysis of time-limited psychodynamic psychotherapy with children, young people and parents
Page Intentionally Left Blank The 21st century presents us with challenges with respect to the way in which we disseminate information, particularly in the area of mental health. A post-modern perspective asserts that we cannot isolate a particular treatment such as time-limited psychodynamic...
(Time-limited Psychodynamic Psychotherapy with Children and Adolescents: An interactive approach)
Introducing an interactive model to time-limited psychodynamic psychotherapy
The underpinning argument presented in this book, is that time-limited psychotherapy for children and young people is not, and cannot be considered as a shorter or watered-down version of traditional child psychotherapy. Instead, time-limited psychotherapy views the problems presented by the child and...
(Time-limited Psychodynamic Psychotherapy with Children and Adolescents: An interactive approach)
A short history of time-limited psychodynamic psychotherapy with adults
Time-limited psychodynamic psychotherapy has a well-established theoretical and research base both in the UK and the US over more than 50 years. Whilst adults have been the primary focus of this therapeutic work, there are nevertheless elements of this work that can be usefully applied in developing...
(Time-limited Psychodynamic Psychotherapy with Children and Adolescents: An interactive approach)