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Psychodynamic Treatment of Depression


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Table of Contents

PART I: Introduction and OverviewChapter 1. IntroductionChapter 2. Development of a Psychodynamic Model of DepressionChapter 3. Overview of Psychodynamic Psychotherapy for DepressionPART II: Techniques in Psychodynamic Treatment of DepressionChapter 4. Getting Started With Psychodynamic Treatment of DepressionChapter 5. The Middle Phase of TreatmentChapter 6. Addressing Narcissistic VulnerabilityChapter 7. Addressing Angry Reactions to Narcissistic InjuryChapter 8. The Severe Superego and GuiltChapter 9. Idealization and DevaluationChapter 10. Defense Mechanisms in Depressed PatientsChapter 11. The Termination PhasePART III: Special TopicsChapter 12. Psychodynamic Approaches to Depression With Comorbid Personality DisorderChapter 13. Managing Impasses and Negative Reactions to TreatmentChapter 14. Psychodynamic Approaches to SuicidalityChapter 15. Use of Psychodynamic Psychotherapy With Other Treatment ApproachesIndex

Promotional Information

Depression is the most common cause of referral to psychodynamic therapy, and this book remains the best guide therapists have to effectively address this pernicious problem. It stands alone as a clear, technical, research-informed guide for experts as well as beginning therapists. It should be on the shelf of all clinicians practicing psychotherapy of any modality. Peter Fonagy, Freud Memorial Professor of Psychoanalysis and Head of Research Department of Clinical, Educational and Health Psychology, University College London; Chief Executive, Anna Freud Centre

About the Author

Fredric N. Busch, M.D., is Clinical Professor of Psychiatry at Weill Medical College of Cornell University and on the faculty at the Columbia University Center for Psychoanalytic Training and Research in New York, New York. Marie Rudden, M.D., is Clinical Assistant Professor of Psychiatry at Weill Medical College of Cornell University, Training and Supervising Analyst at the Berkshire Psychoanalytic Institute. Theodore Shapiro, M.D., is Emeritus Professor of Psychiatry in Pediatrics at Weill Medical College of Cornell University and Training and Supervising Analyst at the New York Psychoanalytic Institute in New York, New York.


As you know, depression is one of the most widespread sources of psychological and existential malaise, and one of the most complex challenges facing the clinician, psychologist-psychotherapist or doctor-psychiatrist. But over the last few decades there has been considerable progress in the treatment of depressive conditions, including the so-called "major" ones, that is, more severe: on the one hand psychopharmacology and, on the other, the development of psychotherapies, allowed to consider these situations with a certain optimism. The triad consisting of dynamic, cognitive-behavioral and interpersonal psychotherapies has been shown to be effective in the treatment of depression, but this book written by three prominent psychiatrists is, in particular, a single form of therapy, the one considered until recently less incisive: psychodynamic psychotherapy. Reading the text we realize that the psychodynamic approach emerges as a methodology of interest for numerous reasons. First of all it reduces the possibility of relapses and, in general, it allows to work by delimiting the patient's vulnerability - something that other therapies cannot guarantee -. It then allows you to work at a greater level of depth and analytics than CBT - Cognitive-Behavioral Therapy; from this point of view it should be noted that the cognitive-behavioral approach has been (and still is today) considered by many to be "the first choice" of therapy for a number of mental disorders, a belief that has spread even to doctors of base and which has numerous causes, but which today shows its limit more and more often. Finally, the dynamic approach allows to treat also the comorbid frameworks that, as every good clinician knows, constitute a relevant part of the patient's problem. But even compared to the typically medical, ie pharmacological, choice, the psychodynamic approach and, in general, psychotherapeutic, is emerging in a new light. In fact, the antidepressant drug therapies - as has been noticed recently and from several parts - can provoke a sort of drug dependence which, in turn, leads the patient to seek higher doses or other more effective drugs, essentially leading the subject to remain in the dysfunctional state. This is the so-called "iatrogenic" effect of drugs that, combined with addiction, can lead to a final paradoxical effect, that is to the chronicity of the state (anxious and / or depressive), rather than to its resolution. This observation is considerably resizing the efficacy of psychopharmacology in depression (and in other psychopathological situations), while certainly not neglecting the advantage that the patient can have, especially in the acute phases, to alleviate mental suffering and contain the heaviest manifestations of the morbid condition. What Fredric Busch, Marie Rudden and Theodore Shapiro propose takes on the identity of Focused Psychodynamic Psychotherapy, an approach based on illustrious historical precedents; in fact, in the first pages of the text are recalled the classic contributions of Sigmund Freud and Karl Abraham, and then many others - one for all: Sandor Rado, "The Problem of Melancholia". International Journal of Psychoanalysis, IX, 420-438, 1928 - to compose the lines of development of what can be called the evolutionary and dynamic model of depression considered from the visual angle of psychoanalysis. Thus the first part of the book introduces the reader to the topic and proposes a global vision of the therapeutic process. The second part, composed of eight chapters, examines step by step all the phases of the therapy, from the construction of the therapeutic alliance to the conclusion of the process, addressing issues such as the management of the patient's narcissistic vulnerability, the severity of the Super Ego, the processes idealization and devaluation, and the defense mechanisms characteristic of depressed subjects. The third and final part deals with special issues such as the aforementioned problem of co-morbidity - on the treatment of obsessive and compulsive forms and similar conditions, see the recent book edited by Katharine A. Phillips, Dan J. Stein, Handbook on Obsessive-Compulsive and Related Disorders (American Psychiatric Publishing, 2015) - but also negative reactions to therapy that can occur at certain stages of treatment. The analysis continues to consider the problem-prince of the depressed patient, ie the risk of suicide. The last of the fifteen chapters of which the text is composed includes psychodynamic psychotherapy in the context of other therapeutic, pharmacological and psychological approaches. To underline the wealth of clinical examples that are a counterpoint to all the issues addressed by the three authors, who are all psychiatric doctors of psychoanalytic training. Fredric N. Busch, is a Clinical Professor of Psychiatry at Cornell University's Weill Medical College, and holds other psychoanalytic positions at the Columbia University Center for Psychoanalytic Training and Research in New York. Marie Rudden, has the title of Clinical Assistant Professor of Psychiatry at the Weill Medical College of Cornell University, and is a training analyst and supervisor at the Berkshire Psychoanalytic Institute. Theodore Shapiro, is professor emeritus of Psychiatry in Pediatrics at the Weill Medical College of Cornell University, and serves as a training analyst and supervisor at the prestigious New York Psychoanalytic Institute. -- Andrea Castiello d'Antonio , psychologist and psychotherapist, an extraordinary professor at the European University of Rome * NO. 55 *

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