Contemporary Psychodynamic Psychotherapy for Children and Adolescents: Integrating Intersubjectivity and Neuroscience

398 Pages·2015·6.15 MB·English

by  Sergio V. Delgado

Contemporary
Psychodynamic
Psychotherapy for
Children and Adolescents
Integrating Intersubjectivity
and Neuroscience
Sergio V. Delgado
Jeff rey R. Strawn
Ernest V. Pedapati
123
Contemporary Psychodynamic
Psychotherapy for Children and Adolescents

Sergio V. Delgado (cid:129) Jeffrey R. Strawn
Ernest V. Pedapati
Contemporary
Psychodynamic
Psychotherapy for
Children and Adolescents
Integrating Intersubjectivity
and Neuroscience
Sergio V. Delgado, MD Ernest V. Pedapati, MD, MS
Division of Psychiatry Division of Psychiatry
and Child Psychiatry and Child Psychiatry
Cincinnati Children’s Hospital Division of Child Neurology
Medical Center Cincinnati Children’s Hospital
Cincinnati , OH Medical Center
USA Cincinnati , OH
USA
Jeffrey R. Strawn, MD
Department of Psychiatry
and Behavioral Neuroscience
University of Cincinnati
Cincinnati , OH
USA
ISBN 978-3-642-40519-8 ISBN 978-3-642-40520-4 (eBook)
DOI 10.1007/978-3-642-40520-4
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014956865
© Springer-Verlag Berlin Heidelberg 2015
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To my patients and students
—SVD
To Elliott Nicole and Rachel Marie
—JRS
To Carolyn, Noah, and Harrison
—EVP
v

Foreword
Psychodynamic psychotherapy with children and adolescents is undergoing a tran-
sition. With the advent of this carefully crafted and wise volume, the sea change
unfolds before our eyes. Setting full sail, billowing out with the strong and refresh-
ing wind afforded by the creativity and responsiveness of working intersubjectively
in the here and now, the authors chart the metamorphosis from a one-person psy-
chology to a two-person relational psychology. This is done in such fashion that we
want to take the voyage with them that they collegially invite us on.
Sea metaphors aside, the book explains, integrates, and summarizes an incredi-
ble amount of information between two covers. Building on and furthering concepts
cogently developed in Delgado and Strawn’s striking fi rst volume, D iffi cult
Psychiatric Consultations : An Integrated Approach , the present masterful volume,
with an additional coauthor Pedapati, starts with a thorough grounding in the his-
tory, evaluation, distinct characteristics, and vocabularies of the one-person and
two-person models.
A dditionally, contributions of key pioneers from both ways of conceptualizing
and working, including transitional fi gures and long-neglected trail blazers ousted
by the orthodoxy, are respectfully examined evaluated and contrasted. The advances
in attachment theory, systems theory, developmental psychology, genetics, and neu-
roscience are synthesized and beautifully applied to the subject at hand. Case exam-
ples covering all phases of development synergistically illustrate the two-person
relational approach.
T he neurobiology of intersubjectivity, alongside research advances in meaning-
making processes, relational schemas, implicit working memory, social reciprocity,
cultural factors, temperament, and cognition are explained and their application to
psychotherapy demonstrated. These concepts dance along in the narrative and are
combined in interesting ways, building into a deconstructing force upon stale ideas
and bounding toward a joyous rendering of contemporary thinking, buoyed by the
wealth of recent knowledge. Moreover, all of these contemporary concepts are
admirably clarifi ed and explained and their therapeutic applications demonstrated,
in the writing of these authors. When you put your own subjectivity fi rmly on the
playing fi eld, you are no longer in the stands observing the fray; you are in the fray.
The mindfully solid cornerstone of the book is the explication of the four pillars
of the contemporary diagnostic interview, namely, temperament, cognition, cogni-
tive fl exibility, and internal working models of attachment. As noted by the authors,
vii
viii Foreword
“The four pillars are the synergy of innate and environmental processes that become
the blueprint of how a child learns to develop and maintain self-regulation abilities
and unique implicit relational patterns to successfully interact with others.” How
this approach is applied and the variables involved in the application pave the way
toward understanding how one arrives at accurate diagnostic formulations and how
these are used in developing sequential treatment plans, tailored for each individual
patient and their family, that have the best chance of a successful outcome. Useful
tables, wise suggestions, and rich case vignettes give immediacy to the concepts
that come alive in the here and now for the reader now fully absorbed in the
material.
This was my experience as a reader. Also, I experienced something very interest-
ing when going through the four pillars chapter and indeed with the reading experi-
ence of the book overall. The book is put together and fl ows in such a way that a
sense of safety and security becomes present in the reader. Even more importantly
the book engenders a “space of vitality” that frees the mind as one experiences the
welcoming and accepting atmosphere that pervades the book. In refl ecting on my
personal “voyage” with the authors, with some surprise I perceived that I was learn-
ing the material at an implicit level. My recall had a clarity and substance that gave
a conviction that I was prepared and ready to use these concepts without feeling the
need to go back over things, reread paragraphs, or laboriously memorize anything.
My reading experience was so attuned to the intentions of the authors that the mate-
rial was entering into my implicit nondeclarative memory system. Extraordinary.
I n conclusion, I feel it is important to note that the lead author, Sergio V. Delgado,
MD, was my supervisor and teacher throughout my child and adolescent psychiatry
training at the Menninger Clinic as well as for the duration of my training in child
and adolescent psychoanalysis through the Topeka Institute for Psychoanalysis. In
addition he was vitally important in preparing me for my last position at Menninger
as Director of the Child and Adolescent Psychiatry training program in the Karl
Menninger School of Psychiatry. He also ensured that I graduated “under the wire,”
so to speak, as the last child and adolescent psychoanalyst graduating from the
Topeka Institute of Psychoanalysis. I never stop learning from him, and these pre-
liminary remarks refl ect that. May the reader’s learning experience from this book
be equally gratifying.
Topeka , KS , USA Kirby Pope , MD
Pref ace
T his book is written with several audiences and several goals in mind. First, we aim
to expand, synthesize, and contextualize the contemporary two-person relational
psychodynamic psychotherapy literature as it relates to children and adolescents.
Second, we seek to integrate the contributions from developmental research, neuro-
science, and intersubjectivity with regard to the clinical work of the two-person
relational psychotherapist. These important contributions have historically been
considered as having limited value by those of the traditional one-person model.
Third, we hope to guide child and adolescent psychiatry trainees, as well as newly
minted and experienced child and adolescent psychotherapists, to discover the
advantages of a multidimensional, four-pillared contemporary diagnostic interview
(CDI) in order to carefully develop well-informed diagnostic formulations. These
formulations will allow the psychotherapist to identify those children and adoles-
cents for whom a psychodynamic psychotherapeutic approach will be most helpful,
as well as those for whom this approach may not be ideal. Here, we would also note
that the CDI facilitates observing and participating in the interactions of patients
and their parents or caregivers, which will ultimately capture a spectrum of informa-
tion not accessed in a standard diagnostic interview that is based solely on criteria
from the Diagnostic and Statistical Manual of Mental Disorders , 5 th Edition (D SM -
5) . In addition, the information obtained through a CDI (e.g., temperament, cogni-
tion, cognitive fl exibility, and internal working models of attachment) enhances the
relevance of the clinical signs and symptoms that are obtained through the “standard
interview,” thus facilitating a comprehensive two-person relational psychodynamic
formulation. Moreover, we include a CDI tool that will help guide the clinician to
choose the interventions needed (e.g., psychodynamic, behavioral, or pharmaco-
logical). Further, we provide real-world cases that allow the reader to intimately
follow the thought processes of the two-person relational psychotherapist in his
work with children and adolescent.
We recognize that, as with any approach, there will be skeptics about our think-
ing and way of working. The notion of a two-person, relationally based psychody-
namic model of psychotherapy may not be well received by some clinicians,
including those who may be anchored in traditional one-person psychoanalytic cir-
cles, as it challenges a key tenet of the one-person model: the archaeological
approach of unearthing an unconscious and confl icted past. However, we would
argue that the traditional one-person model must accept the relevance of two-person
ix