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Psychodynamic psychotherapy does not feature in current treatment guidelines for attention‐deficit hyperactivity disorder (ADHD) in the United Kingdom. However, there is some psychoanalytic understanding of the disorder, which is corroborated in current neuroscientific theory, and supports clinicians in thinking beyond the behaviourally biased diagnosis and treatment models. One of the core features of ADHD is distortions in chronoception. This clinical paper therefore explores the psychoanalytic and neuroscientific theories of time perception as a way of exploring a discrete element of the complex idea of executive functioning more generally. It supports therapists approaching such executive dysfunction and to reconsider the treatment guidelines. A case example is used to explore how a transference‐, affect‐ and relationally‐focussed therapy can effect lasting change for people with ADHD in a way that behavioural and medication approaches do not. It is argued that such an intervention can improve oscillatory attention between subjective‐ and objective‐time and increase the capacity to self‐contain emotions. This brings patients into alignment with reality and restarts their psychic development towards themselves, others, the parental couple and grieving, which stalled in infancy. The internalised schema of the 50‐minute therapy session also provides a frame of reference for future tasks. [ABSTRACT FROM AUTHOR]

This paper attempts to summarize the evolution of interest in the concept of mentalization which has been researched and enriched by the linking of many disciplines alongside that of psychoanalysis and attachment theory. Taking into account the work of Professors Fonagy and Target and many others, the paper describes factors that enable the development of the capacity to mentalize and those that interfere. It will consider how the quality of attachment affects the transformation of pre-mentalized modes of experience to the recognition of psychic reality of self and other. While mentalizing is part and parcel of all therapies, a mentalization-based therapy was developed in the context of treatment of borderline personality disorder patients by Professors Bateman and Fonagy. The paper will illustrate key concepts in the theory of mentalization with the vignette taken from clinical practice. [ABSTRACT FROM AUTHOR]

Through one clinical example involving complex post-traumatic stress disorder, this paper explores the ways in which the psychoanalytic psychotherapist may need to find creative ways of working which incorporate findings from neuroscience whilst holding the basic frame and methods of the traditional psychoanalytic approach. This entails bringing knowledge of how the body (including the brain) works into the consulting room. In particular, the author describes ways of accompanying the patient during florid flashbacks to chronic and severe childhood abuse and of using grounding techniques afterwards, so that anxiety levels can be sufficiently contained for the necessary therapeutic work to take place. The role of supervision is also explored in terms of how the dynamic of rescuer/victim/persecutor may be played out in the supervisory relationship. Unusually, some of the patient's own reflections, written at the end of the therapy, have been incorporated into the paper. Consideration is given to whether departures from standard psychoanalytic technique constitute boundary violations or useful enactments, which can be seen as a form of creativity which enables the work to move on. [ABSTRACT FROM AUTHOR]

This paper describes the process of couple therapy with two couples that used blame as the currency of exchange in their relationship. Both couples struggled with managing three‐person relationships. The triangular setting of couple psychotherapy provoked and triggered primitive anxieties around exclusion, rejection and abandonment in both cases. I draw upon clinical work with two such couples to illustrate how one repeatedly collapsed the triangular space whereas the other gradually became more able to bear it. I refer to scientific evidence of the brain's ability to continue to change in response to new learning by forming fresh neural connections throughout life. I suggest that the repetitive occurrence of new experiences within couple psychotherapy can generate new neural pathways thereby biologically influencing new ways of how partners might respond to each other. I conclude by highlighting the therapeutic potential of the framework within which couple psychotherapy takes place, a triangular configuration which offers a developmental opportunity for navigating primitive anxieties related to triangular relationships. [ABSTRACT FROM AUTHOR]

Imagining people is crucial to the work of psychotherapists and fiction writers. By analysing how practitioners of both crafts use the word 'concrete', however, I find that writing and therapy diverge widely in their modes of imagining others. Therapists apply concrete to patients who are thought unable to symbolize, hard to treat, and lacking in imaginative capacity, whilst writers use concrete to denote quite the opposite: symbolic potency and meaning‐making. By analysing this use of concrete, and exploring the rich history of the word – including the introduction of material concrete into the modern world, and the alchemists' use of the word in their search for the philosophers' stone – I find that the current application of concrete by therapists denies a great wealth of potential which is much‐needed in our demanding work. Driven by research in sensory neuroscience, I suggest we consider mind, brain, and person to encompass both polarities of concrete, and thus two different forms of imagination. By using both forms with 'concrete' patients, we may discover new ways of imagining others and responding to them, going beyond the concrete fixities of our own theories to pay due reverence to the concrete realities of another person. [ABSTRACT FROM AUTHOR]

A good therapeutic alliance has been found to be the best predictor of outcome in psychotherapy, but psychotherapists also need to develop an understanding of the mechanisms by which that alliance is created and the factors that may damage that alliance and contribute to harmful effects of psychotherapy. I explore these factors in three contexts: the nature of the therapy itself, the characteristics of the therapist, and the dynamics of the patient–therapist relationship. I discuss the research that suggests that potentially harmful processes can be avoided by a dynamic‐agentive systems model, which views psychotherapy as a conversation, in which turn‐taking, rupture and repair, and perspective‐taking are the intersubjective tools that help to build the therapeutic alliance and that can be the focus for further study into the mechanisms by which psychotherapy is helpful or harmful. The neuroscience research that supports this model is summarized. [ABSTRACT FROM AUTHOR]