A Clinical Guide to Psychodynamic Psychotherapy

340 Pages·2021·5.462 MB·English

by  Deborah Abrahams, Poul Rohleder

A Clinical Guide to Psychodynamic
Psychotherapy
A Clinical Guide to Psychodynamic Psychotherapy serves as an accessible and applied
introduction to psychodynamic psychotherapy.
The book is a resource for psychodynamic psychotherapy that gives helpful and
practical guidelines around a range of patient presentations and clinical dilemmas.
It focuses on contemporary issues facing psychodynamic psychotherapy practice,
including issues around research, neuroscience, mentalising, working with diversity
and difference, brief psychotherapy adaptations and the use of social media
and technology. The book is underpinned by the psychodynamic competence
framework that is implicit in best psychodynamic practice. The book includes a
forewordbyProf.PeterFonagythatoutlinestheuniquefeaturesofpsychodynamic
psychotherapythatmakeitstillsorelevanttoclinicalpracticetoday.
The book will be beneficial for students, trainees and qualified clinicians in
psychotherapy, psychology, counselling, psychiatry and other allied professions.
Deborah Abrahams is a psychoanalytic psychotherapist and chartered clinical
psychologist with over 25 years of clinical experience, including 15 years in the
NHS. She is a dynamic interpersonal therapy (DIT) practitioner, supervisor and
traineraswellasProgrammeDirectorofDITattheAnnaFreudCentre.Deborah
is a senior member of the British Psychotherapy Foundation and has a private
psychotherapy practice in North West London offering supervision, psychoanalytic
and psychodynamic psychotherapy.
Poul Rohleder is a psychoanalytic psychotherapist and chartered clinical
psychologist, as well as a dynamic interpersonal therapy practitioner. He has
over 15 years’ experience of working in public mental health care systems and
in private practice. He is a trustee of the British Psychoanalytic Council and
sits on several other professional committees and is currently a senior lecturer
at the Department of Psychosocial and Psychoanalytic Studies, University of
Essex, UK.

A Clinical Guide to
Psychodynamic
Psychotherapy
Deborah Abrahams and Poul Rohleder
Firstpublished2021
byRoutledge
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©2021DeborahAbrahamsandPoulRohleder
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ISBN:978-0-815-35266-2(pbk)
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Contents
List of illustrations vii
Acknowledgements viii
Foreword ix
1 Introduction 1
PART1
Theory and research 11
2 An overview of psychoanalytic theory 13
3 Efficacy and outcome research 43
PART2
Competences 57
4 The setting and the analytic frame 59
5 Assessment and formulation 88
6 Anxiety and defences 127
7 Mentalising 149
8 Unconscious communications 167
9 Transference and countertransference 183
10 Endings 207
vi Contents
PART3
Adaptations and practicalities 219
11 Brief applications of psychodynamic work 221
12 Challenging situations and clinical dilemmas 239
13 Working with difference 256
14 Technology and social media 273
Appendix 1: Specimen terms and conditions 294
Appendix 2: Specimen referral/pre-assessment questionnaire 296
Appendix 3: Specimen end of therapy report 299
Appendix 4: Specimen social media contract 301
Appendix 5: Specimen privacy notice for website 303
References 305
Index 319
Illustrations
Figures
1.1 The core competences for psychodynamic psychotherapy 4
2.1 Freud’s model of the mind 19
3.1 A diagrammatic representation of a randomised control trial 45
6.1 A diagrammatic representation of Freud’s model of anxiety and
defence 129
6.2 Adapted from Malan’s triangle of conflict 144
8.1 Therapist and patient position triangles 181
9.1 Adapted from the Triangle of Person or Insight 193
11.1 Two examples of an Interpersonal Affective Focus for DIT 230
14.1 Updated Maslow’s (1943) hierarchy of needs 273
Tables
3.1 Comparisons of meta-analysis studies on treatment effectiveness 46
6.1 Different types of defences 130
Acknowledgements
The authors would liketo dedicate the book to our patients, from whom we have
learned so much. We would like to thank our clinical supervisors for their wise
guidance over the years. We are grateful to our colleagues with whom we have
worked closely in the Camden & Islington NHS Foundation Trust, Anna Freud
Centre,TavistockClinicandpeersupervisiongroupsattheBritishPsychotherapy
Foundation. We are especially appreciative of the support and endorsements of
Peter Fonagy, Alessandra Lemma, Bob Hinshelwood and Maxine Dennis.
Foreword
When I pick up this excellent introduction by Abrahams and Rohleder, I
wonder what the secret ingredient might be that ensures the survival of the
ideas and practices stated with brilliant clarity in this book. In principle, no
scientific theory or clinical practice that is 125 years old has any right to be
describedasrelevanttocurrentpractice.So,whathashelpedpsychoanalysisandits
offspring,psychodynamicpsychotherapy,tosurvivealltheseyears.InthisForeword,
Iwouldliketoadvanceafewsuggestionsabouttheuniquefeaturesoftheapproach
whichareallexceptionallywellexemplifiedbyAbrahamsandRohleder’sbook.
First, the idea that the mind is capable of generating mental disorder, the
so-called principle of psychological causation, revolutionised psychiatry in the 19th
century. The term ‘dynamic’ was used in the late nineteenth century by
Leibniz, Herbart, Fechner, and Hughlings-Jackson to contrast with the word
‘static’ (Gabbard, 2000). As such, the word served to highlight the distinction
between a psychological and a fixed organic neurological impairment model
of mental disorder. Evidently, the approach continues to benefit from the
flexibility this bridging of the mind-body divide generates. More recently,
‘dynamic’ has come to be contrasted with descriptive phenomenological psy-
chiatry that has focused on categorising mental disorders in circumscribed
ways, rather than emphasising the way mental processes (thinking, feeling,
wishing, believing, desiring) interact to generate problems of subjective
experience and behaviour. Psychodynamic Theory, as outlined in the first
chapters of this book, is focused on understanding how we can meaningfully
conceive of mental disorders as specific organisations of an individual's con-
scious or unconscious beliefs, thoughts and feelings. The rich case studies
presented throughout illuminate the subtleties of this process and how the
psychodynamic clinician, charged with the task of investigating the specific
ideas and constructions, is able to elegantly explain a person’s suffering.
Second,psychodynamicpsychotherapyisuniqueindescribinghowpsychological
causation extends tothe non-conscious part of themind. Nagel, Wollheim,Hopkins and
otherphilosophersofthemind(Hopkins,1992;Nagel,1959;Wollheim,1995)have
allpointedtotheassumptionofunconsciousmentalisationasakeydiscoverywithin
the psychoanalytic model. Implicitly or explicitly, psychodynamic models assume
that non-conscious narrative-like experiences, analogous to conscious fantasies,