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The current article focuses on client’s perspectives of the mechanisms of change in Dynamic Interpersonal Therapy (DIT), a brief psychodynamic therapy developed for the treatment of depression. Five participants were interviewed and the transcripts were analysed using Interpretative Phenomenological Analysis (IPA). The results point out four subthemes, capturing different active ingredients of DIT: therapy shedding light on previously sealed aspects of self; the relational exchange with the therapist challenging intimate fears; moving towards an interpersonal understanding of their difficulties; and putting the pieces of their lives together into a coherent narrative. Overall participants described an interplay between relational and insight-oriented mechanisms taking place. As part of the former mechanisms, participants reported the development of a secure attachment to their therapist and the provision of a new relational experience, partly via mechanisms corresponding to the concept of transference. Participants reported an increase in insight to have been achieved via an understanding of an interpersonal and emotional pattern as well as via the restoration of a coherent life-story. Processes that theoretically map onto the concept of mentalisation were also reported. The findings are discussed in relation to the DIT and psychodynamic theory about change and to relevant research literature. [ABSTRACT FROM AUTHOR]

An NHS Mental Health Trust Medical Psychotherapy Consultation Service using psychoanalytic psychiatry to help the patient and professional is described. The Consultation Service established in 2000 is offered to secondary acute and community mental health teams and primary care. The service was evaluated as a basis for regional and national development. Between 2006 and 2013, 87 consultations from 210 were sampled to ascertain demographic and diagnostic profiles and outcomes of the consultation process. We conducted an online survey of local consultant psychiatrists' views about the service, and undertook a thematic analysis of the free text comments. We also conducted a survey of members of the Royal College of Psychiatrists' Medical Psychotherapy Faculty to ascertain whether similar consultation services existed elsewhere in the UK and had been evaluated. The Leeds model of psychoanalytic consultation – a 'consultation sandwich' – is described. From a psychoanalytic perspective, the work of consultation is seen as an extension of the dynamic field of the analytic situation. This paper develops the concept of a bastion – an omnipotent reserve in and between the patient and professional derived from adhesive identifications leading to stuck relationships. The adhesive identification in the patient and professional acts like a 'grievance glue' – a mutual manifestation in a last bastion of painful limitations not faced, losses not grieved. [ABSTRACT FROM AUTHOR]

Two seemingly unrelated characteristics of psychoanalytic couple psychotherapy may be better understood when juxtaposed. First, countertransference in psychoanalytic couple psychotherapy holds particularly strong intensity. Second, format decisions are central to couple psychotherapy. The use of conjoint and concurrent formats, or variations thereof, has been key in the historical development of couple psychotherapy and remains an area of much debate. Some couple psychotherapists use the format of couple psychotherapy flexibly, using variations of conjoint or concurrent couple psychotherapy, while others adhere strictly to working conjointly. Decisions regarding whether to undertake concurrent or conjoint therapy are not generally linked to countertransference; this article demonstrates that reading decisions regarding format through consideration of countertransference offers a needed perspective for the therapist. Case studies published by psychoanalytic couple therapists are analysed through this prism to demonstrate that changing the format may serve to dilute countertransference. One particular manifestation of countertransference, linked to oedipal dynamics, is explored: countertransferential intensity for couple psychotherapists potentially relates to being faced with their internal parental couple and their unresolved Oedipal strivings. Possible unconscious motivations to change the format of couple psychotherapy need to be carefully considered, as format changes may mask an avoidance of bearing the countertransference. [ABSTRACT FROM AUTHOR]

The popularity of mindfulness and mindfulness-based interventions (MBIs) has seen authors from various psychotherapeutic orientations proclaiming the mindfulness status of their respective approaches. Despite a long tradition exploring the parallels between psychoanalysis and Buddhism, few authors have critically examined the relationship between contemporary psychoanalytic therapy and MBI. Those who have addressed this issue tend to be integrative psychotherapists who promote active mindful interventions in psychoanalytic therapy at the expense of identifying those features that distinguish psychoanalytic treatment from mindfulness-based orientations. In this article, I argue that the analytic attitude is inherently and necessarily mindful insofar as it invites psychotherapy patients to observe and tolerate defensively avoided experience. However, psychoanalytic therapy goes beyond this by emphasizing the interpretive elaboration of experience in the context of the transference relationship and resistance to exploring this. The analytic attitude also runs counter to the prescription or teaching of meditative techniques, which may function in the service of the therapist's counter-resistance. A psychotherapy vignette is used to illustrate that while psychoanalytic therapy certainly includes a mindfulness component, understanding the unconscious significance of mindfully tolerated experience is the hallmark of the psychoanalytic process. This makes psychoanalytic therapy mindfulness-inclusive, rather than mindfulness-based. [ABSTRACT FROM AUTHOR]

Although the treatment of suicidal adolescents is complex and may be daunting to many clinicians, it continues to play an important role in suicide prevention. In this paper, we use case material to address questions that arise in psychotherapy, including the contending priorities of understanding the suicidal act in order to prevent repetition, versus connecting emotionally with the patient in the therapeutic relationship; and the use of an evolving understanding of the complexity of suicide that develops over time as patient and therapist engage in a deepening relationship which fosters life-sustaining development and psychic change. We present a case description of a patient in later adolescence, who began intensive psychoanalytic psychotherapy after a suicide attempt and explore key components of therapeutic action. From this discussion we emphasise the relational aspects of the transference and countertransference that enables interpretation and increased therapeutic receptivity through collaborative interaction. We conclude that collaborative interaction is foundational for therapeutic action with suicidal adolescents. [ABSTRACT FROM PUBLISHER]