Phase 2

This chapter provides an overview of the central psychodynamic techniques of the middle phase of TFPP. Core intrapsychic conflicts that contribute to PTSD symptoms are identified and actively addressed. Interpretation of defenses aids in the elucidation of conflicts. A prominent defense in PTSD, identification with the aggressor, is described in more depth. Exploration of the transference is discussed with attention to the ways in which core conflicts emerge with the therapist. Patients with PTSD trigger particularly intense countertransference reactions, knowledge of which furthers the therapeutic process. The technique of working through is articulated, in which the therapist and patient elucidate how various conflicts and defenses emerge across a range of symptoms, contexts, and relationships. Case vignettes are used to illustrate these approaches.

Core Psychodynamic Factors in PTSD

After briefly reviewing the psychoanalytic view of mental life, including the influence of the unconscious on mental life and symptoms, this chapter describes the impact of trauma from the psychodynamic viewpoint. Disruptions in narrative coherence, repetition and re-experiencing, intrapsychic conflicts, dissociation, defenses, intense negative affects, and disruptions in trust that result from trauma are described. Clinical examples are presented to illuminate these factors. In addition, the relevance of the patient’s pretrauma history, their attachment style and mentalization skills, and the specific nature of traumatic experience on the impact of trauma and associated symptoms is elaborated.

Somatoform and conversion disorders as psychological defences

Conversion disorder is the clinical situation in which one or more symptoms can present deficits that affect motor or sensory function and suggest a neurological or organic condition. Psychological factors are decisive, and they usually include a major anxiety generated by intrapsychic conflicts, which are converted by unconscious defense mechanism into symptoms. The symptoms are not intentionally provoked or simulated nor are explained by organic suffering or substance consumption. They affect the quality of life of the person who presents significant deficits such as motor, sensory, convulsive or mixed. It may also occur a lack of coordination, ataxia, paralysis, tremor, aphonia, difficulties at swallowing, loss of sensitivity, anesthesia that does not follow anatomical nervous trajectories, blindness or mental deafness. Consciousness is not altered, but a condition of "la belle indifference" appears which is rather associated with histrionic personality disorders and what the patients imagine about their own illness or suffering. This condition is unstable and changing. The primary gain is the expression of an unconscious psychological conflict through a somatic symptom by reducing anxiety and keeping conflict out of consciousness. The secondary gain is external and includes attention and care from caregivers or others.

PSYCHOANALYTIC VIEW ON THE UNCONSCIOUS MEANINGS OF ASSISTED REPRODUCTIVE TECHNOLOGIES

The article analyzes the internal mental dynamics of people involved in the processes of assisted reproductive technologies (ART). According to psychoanalytic theory, unconscious fantasies and meanings play an important role in these dynamics. The sources of these fantasies could be traced down to both intrapsychic conflicts and deficits of the individual and pressure of society. When working with patients in a psychodynamic way, it is important to take into account the socio-economic context, which in the modern world is largely set by the global economy of neoliberalism. Ignoring this context, as well as ignoring the significance of important events in the patient’s life history, usually leads to the collusion between the analyst and the patient in a «perverse» pact. Biomedicine of fertility has become a constitutive part of the neoliberal ethos. Within the framework of the global economy, conditions have been created for the commodification and fragmentation of the female and male reproductive bodies. However, despite the inclusion of gametes in the free exchange of goods, they are not stripped from personal meaning or affectively neutral. Tissue exchanges during ART procedures, in addition to the fact that they act as an element of technological chains, carry relational and social meanings. Gamete donation, even with the conscious acceptance of new social structures of reproduction and parenthood in adulthood, can activate the unconscious fantasy of an illegal «triple alliance» and the unconscious conflicts associated with it. Egg donation, in addition to an ethical dilemma, is fraught with confusion of parental identity and a sense of belonging to a social group. Myths rank high in the psychoanalytic theory of development among its other core constructs. They are considered as an important element of learning through experience. The article discusses the plots of myths about childbirth in the context of ART practices.

From an intrapsychic to an interpersonal symptom: Relations Training in Action

This article proposes a conceptualization of symptoms from an interpersonal perspective and advocates group analysis as an appropriate medium for treatment. Psychoanalytic theory has traditionally conceptualized symptoms using the language of intrapsychic conflicts in the individual’s mind. In this article, drawing on ideas from group analysis and contemporary psychoanalytic theories, I propose an interpersonal conceptualization of symptomatic phenomenology. In addition, I introduce a concept that describes a treatment process based on this perspective: Relations Training in Action1. I will argue that a symptom occurring in one person symbolizes an inadequate interpersonal relations pattern, and that recognition of the pathological relations pattern in therapy enables a process which paddles the creation of healthier communication. Furthermore, I suggest group therapy as a space which offers a rich set of opportunities for the repetition and reparation of relations disorder (Friedman, 2007), and that the transition from the language of intrapsychic symptoms to the language of relationships plays a significant role in broadening the areas of interpersonal communication (Foulkes, 1964). Therapy based on an interpersonal perspective regarding symptoms will facilitate participation in a meaningful and significant relationship with the other, improve the mental health of patients and decrease their need to cling to the symptom.

Jacob Levy Moreno’s Psychodrama As a Work Technique For Treating Patients in Group and Individual Psychotherapy

Introduction. The basic purpose of this article is to present Jacob Levy Moreno’s psychodrama method as the psychotherapeutic technique useful in work with patients during individual and group psychotherapy. Material and Method: The author presents the analysis of case studies of patients treated in individual and group psychotherapy. He instances the examples of psychodramatic work on the stage as well as monodramatic and reports their importance in the process of patient psychotherapy. He discusses the effects of these act ivities in the context of changes in the emotional and interpersonal functioning of patients. Results: The given examples of monodrama and psychodramatic works illustrate the mechanisms of the changes offered by the method, e.g. insight, abreaction, acceptance of internal impulses, confrontation with the feelings of other people, training of alternative behaviors. In the article one can follow each subsequent step of analyzing intrapsychic conflicts of patients, which, thanks to the play on the stage, can be named and experienced by them. Conclusions: Psychodrama, used in the psychotherapeutic work of the group and in individual work with the patient (in the form of a monodrama), gives great opportunities to broaden the insight of the patient into very complicated internal mechanisms of conflicts and deficits. Psychotherapist - leader encourages patients to be creative and to spontaneous development of their blocked personality elements. The specificity of psychodrama is a relatively quick resolution of many years of ongoing conflict and permanent reparation of traumatic experiences, even from early childhood.

Interaction Structure and Transferential Patterns in Brief Psychotherapy: A Single-case Study

Nowadays it is sufficiently accepted that the therapeutic action of psychotherapy is expected to lie at the interface between two dimensions: identification and interpretation of the patient's dysfunctional relationship patterns arising in the relationship with the clinician. This can only happen, however, if there is a temporal space where the transference-countertransference reactions to be explored and understood can emerge (Jones, 2000). The limited number of sessions characterizing short-term psychotherapy does not seem to allow the unfolding of these dynamics, thus suggesting that the therapeutic action of this approach lies outside the patient-therapist relationship. The aim of this study is to investigate the possibility that, even within the few sessions that characterize short-term psychotherapy, the dynamics of transferencecountertransference typical of the patient's dysfunctional relationship patterns do in fact emerge. For this purpose, a study has been made of the patterns of patient-therapist interaction, measured by the Psychotherapy Process Q-set. The patterns identified are related to the change found in the Core Conflictual Relationship Theme, allowing reflection on the role played by alternating interaction patterns in the variation of the patient's intrapsychic conflicts in this psychotherapy model.

Anger and depression

SummaryA series of psychoanalytic theorists and clinicians have suggested that conflicts about anger play a central role in the development of depression. Research data have supported the notion that patients struggle with the experience and expression of angry feelings. Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships. These conflicts lead to anger being directed inwards, further lowering self-esteem, creating a vicious cycle. Defence mechanisms that are triggered, including passive aggression, reaction formation, denial and identification with the aggressor, are ineffective at managing these conflicts and further prevent the appropriate expression of anger. This article discusses how to identify and detoxify angry feelings and fantasies using a psychodynamic approach.