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Similar to other therapeutic methods, the issue of patient dropout from psychoanalytic psychotherapy presents significant challenges for patients, therapists, and the overall mental health system. While quantitative studies in solution-focused therapies have often explored this issue, a more in-depth understanding can be gained by approaching it qualitatively within the framework of long-term, open-ended psychoanalytic psychotherapy. Eleven patients and four therapists with direct experience of dropout participated in twenty-six in-depth interviews, guided by Corbin and Strauss’s grounded theory methodology. The analysis identified the central theme of dropout as a ‘departure from the imbalanced binary system’, which includes contextual, action-interaction, and consequence categories. The conceptual model underscores key factors contributing to dropout, encompassing both cross-theoretical elements such as the therapeutic alliance and coping strategies, and more specific factors like perceptions of psychoanalytic therapy’s legitimacy in a specific culture and patients’ beliefs about its effectiveness as a therapeutic approach. These findings provide valuable insights into the complex nature of treatment dropout, offering important clinical and scientific implications. [ABSTRACT FROM AUTHOR]

Objective: To assess and compare the frequency of psychotherapeutic side effects in different psychotherapeutic approaches. Method: Side effects were assessed across 17 domains through structured interviews with 45 outpatients in cognitive-behavior, psychodynamic, and psychoanalytic psychotherapy. Results: Almost every patient (95.6%) reported at least one side effect, with a mean of 4.7 affected domains. Most frequent complaints were that problems were seen as more complex (60.0–80.0%), worsening of pre-existing symptoms (46.7–60%), occurrence of new symptoms (20.0–53.3%), feeling uncomfortable in treatment (33.3–40.0%), tensions with therapist (26.7–46.7%), as well as conflicts with current family and with family of origin (both 13.3–46.7%). Differences between therapeutic orientations were mostly non-significant. Conclusion: Psychotherapy is regularly accompanied by side effects, independent of different theoretical orientations. Psychotherapists need to be familiar with side effects in order to inform patients about treatment-associated risks and to recognize and manage side effects. [ABSTRACT FROM AUTHOR]

The use of social media by athletes can support them in difficult moments, but it can also become a source of negative emotions and psychological distress. This perspective critically examines psychoanalytic psychotherapy as a method for restoring athletes' psychological well-being after experiencing negative effects from social media use. The paper characterizes the key elements of psychoanalytic psychotherapy relevant to athletes, discusses the role of the psychoanalytic psychotherapist in working with athletes and describes the specifics of the psychoanalytic therapeutic process in this context. The potential advantages of psychoanalytic approaches over cognitive-behavioral methods are examined in treating the psychological impacts of problematic social media use among athletes. The analysis suggests that hate speech and negative online interactions can activate athletes' unprocessed life experiences rooted in early developmental stages. Psychoanalytic psychotherapy may offer a particularly effective method for restoring athletes' psychological wellbeing in such cases by addressing deep-rooted intrapsychic conflicts. However, a comprehensive approach integrating multiple therapeutic modalities is recommended to address the complex challenges athletes face in the digital age. This perspective acknowledges limitations in current research and suggest directions for future studies to develop and validate tailored interventions for athletes grappling with social media-related psychological distress. [ABSTRACT FROM AUTHOR]

This paper explores the psychotherapy process in a short-term psychoanalytic treatment (STPP) with a depressed adolescent. The empirical case study draws on both quantitative and qualitative data to examine the development of the psychotherapy process over time. 15 of the 29 audio recorded therapy sessions with a 16-year-old boy were sampled at intervals across the treatment. Session transcripts were coded using the Adolescent Psychotherapy Q-Set (APQ) and data analysed descriptively to compare characteristics of the process across the three treatment phases – beginning, middle, and ending. Descriptive statistics are supported with session extracts. Analysis of the APQ data suggests change in the patient's presentation across the therapy. In the early stages, he appeared withdrawn and made minimal responses to the therapist's attempts to work together; in the middle phase, he became more engaged, more able to talk about feelings, and more active in the sessions; and this was reflected in a less depressed presentation in the final phase. The therapist maintained a consistent therapeutic approach across all phases: supportive, non-judgemental, and working to make sense of the young person's experiences, looking for patterns and inviting curiosity about how things might be understood differently. Despite increased engagement in the therapy, depressive symptoms remained in the clinical range. [ABSTRACT FROM AUTHOR]

Despite the vast clinical and theoretical literature on what the analytic process should look like, we know very little empirically about the actual analytic process in long-term psychoanalytic treatments. In this study, we explored how much the therapeutic work in psychoanalytic treatments in naturalistic practice resembles an "ideal" psychoanalytic process. Using the Process Q-set expert prototype of an "ideal" psychoanalytic session (PQS-PA), we examined the course of treatment for 27 patients, and its relationship with treatment outcome using multilevel growth models. The treatments resembled the "ideal" analytic process to a moderate degree, regardless of treatment length and frequency of sessions per week. The level of "ideal" analytic process varied significantly between patients but not between analysts and was not affected by total number of sessions, or frequency of sessions. However, the session date might also have influenced the analytic process in that the resemblance to an "ideal" analytic session decreased over the 44 years of analytic practice. The extent to which the treatment resembled an "ideal" analytic process was not related to treatment outcome. The results may potentially speak to the patients' role in the therapeutic process and the changing emphases in analytic techniques over time. [ABSTRACT FROM AUTHOR]

Introduction: Short-term psychoanalytic psychotherapy (STPP) is an evidencebased treatment for adolescents with depression, but like all treatment approaches, not all patients benefit from it. Previous investigations of the process of STPP have mostly focused on successful cases, and only a few studies have included the perspectives of young people, their parents, and therapists in the understanding of treatment non-response. Methods: Semi-structured interviews were carried out with young people who were considered "non-responders" to STPP, as well as with their parents and therapists. These cases were analyzed using a descriptive-interpretative approach. Results: The data analysis revealed three themes: (1) Therapy as a safe space; (2) Can short-term psychotherapy ever be enough?; and (3) Therapists making links and connections that did not make sense to the young people. Discussion: This study's findings indicate that "poor outcome" psychotherapy does not necessarily equate to a "poor experience" of psychotherapy, with different stakeholders appreciating the treatment setting as a "safe space." However, they also suggest that some felt that a relatively short-term treatment could not lead to substantial change and that young people in STPP might have a more negative view of their outcomes compared to their parents and therapists. Finally, the findings indicate that some interventions made by clinicians in STPP feel wrong or do not make sense to young people, potentially affecting the therapy process. [ABSTRACT FROM AUTHOR]

The contribution of psychoanalytic psychotherapy to the curative education and developmental promotion of children with socio-emotional deficits An inclusive school, as intended by the curriculum 21 in Switzerland and Liechtenstein, has often to deal with children with developmental deficits in the socio-emotional field. How can these be integrated in the class-group? This article outlines a proceeding of psychoanalytic-psychotherapeutic treatment of a child with behavior disturbancy in school. By means of a case-study it is shown how a pupil in a first class of primary school who had angry tantrums is brought to speak about his younger brother and to remember his own early childhood by doing this. As a psychoanalyticpsychotherapeutic approach the autor presents the method of dialogues with Squiggle-drawings (Winnicott), followed by a »Story by four pictures« (Zulliger). The text relates chosen steps of the psychotherapeutic treatment. The tantrums became more seldom and less violent as a result of the conversations and they could be smoothed by the teachers. It is explained which conditions are needed to allow the school-psychologist to do this kind of psychotherapeutic work in cooperation with the other experts in duty to promote the socio-emotional development of children (teacher, special education teacher, class-group, director, parents, psychomotricity therapeut). [ABSTRACT FROM AUTHOR]

Objective: One in six young adults presents with at least one mental health problem. However, so far, little attention has been directed to the mental health needs and the efficacy of therapeutic interventions for young adults. We conducted a systematic review and meta-analysis of the type, quality and efficacy of psychoanalytic psychotherapy for young people. Method: We searched the PsycInfo, PubMed, Embase, and Cochrane databases to identify all the published randomized controlled trials (RCT), and naturalistic and observational studies of psychodynamic or psychoanalytic psychotherapies. We calculated the standardized mean difference in scores of psychodynamic interventions versus control conditions, adopting a random effects model (Hedges' g). Results: We identified 22 eligible studies, including 14 RCTs, and 8 naturalistic studies. Statistical analyses showed no significant difference between psychodynamic psychotherapy and other comparison treatments (psychotherapy or pharmacological interventions) for young adults (Hedges'g - 0.34 [95% CI: -0.991;-0.309], p = 0.304). Nevertheless, there was a significant effect of psychodynamic psychotherapy when compared with control conditions (waiting list or treatment as usual) for target symptoms (Hedges'g - 1.24 [95% CI: -1.97;-0.51], p < 0.001). Conclusion: Our systematic review highlights important clinical implications in identifying the efficacy of psychoanalytic interventions for specific at-risk groups and suggests developing prevention strategies for mental health problems in young adulthood across cultures and context. [ABSTRACT FROM AUTHOR]

Objective: To identify and describe in-session interaction patterns between psychoanalytic therapists and adolescents diagnosed with major depressive disorder, comparing good and poor outcome cases. Method: Audio recordings for 100 psychotherapy sessions from 10 Short-Term Psychoanalytic Psychotherapies were analysed using the Adolescent Psychotherapy Q-Set (APQ). The cases and sessions were evenly divided into two groups (poor outcome and good outcome, 5 patients and 50 sessions per group). Interaction patterns were analysed with an Exploratory Factor Analysis (EFA), while group differences were assessed through t-tests. Results: The EFA revealed three factors: (1) "Open, engaged young person working collaboratively with a therapist to make sense of their experiences", (2) "Directive therapist with a young person fluctuating in emotional state and unwilling to explore", (3) "Young person expressing anger and irritation and challenging the therapist". Factor 1 was significantly more prominent in the good outcome cases, while factor 3, on the contrary, was more significantly related to the poor outcome cases. Factor 2 was equally present in both groups. Conclusion: Besides reinforcing to researchers and clinicians the association between a collaborative psychotherapy process with good outcomes, our findings also provide empirical data regarding the role of anger in adolescent depression and the psychotherapy process. [ABSTRACT FROM AUTHOR]

The use of social media by athletes can support them in difficult moments, but it can also become a source of negative emotions and psychological distress. This perspective critically examines psychoanalytic psychotherapy as a method for restoring athletes' psychological well-being after experiencing negative effects from social media use. The paper characterizes the key elements of psychoanalytic psychotherapy relevant to athletes, discusses the role of the psychoanalytic psychotherapist in working with athletes and describes the specifics of the psychoanalytic therapeutic process in this context. The potential advantages of psychoanalytic approaches over cognitive-behavioral methods are examined in treating the psychological impacts of problematic social media use among athletes. The analysis suggests that hate speech and negative online interactions can activate athletes' unprocessed life experiences rooted in early developmental stages. Psychoanalytic psychotherapy may offer a particularly effective method for restoring athletes' psychological wellbeing in such cases by addressing deep-rooted intrapsychic conflicts. However, a comprehensive approach integrating multiple therapeutic modalities is recommended to address the complex challenges athletes face in the digital age. This perspective acknowledges limitations in current research and suggest directions for future studies to develop and validate tailored interventions for athletes grappling with social media-related psychological distress.

Dropout from psychotherapy among adolescents is a common occurrence. Adolescents' need for independence can be in direct conflict with therapeutic relationships, particularly in open-ended psychotherapy where endings need to be negotiated. The present study was a service evaluation, which aimed to identify how open-ended once-weekly psychoanalytic psychotherapy ends with adolescents, and whether dropout could be predicted from a range of adolescent and treatment factors. The sample comprised 443 adolescents, aged 14–24, who had received psychoanalytic psychotherapy in a community-based clinic. Logistic regression was used to estimate the effects of predictors on the odds of dropout. Adolescents were categorised based on how treatment ended: adolescents' unilateral decision (43%), mutually agreed between adolescent and therapist (27%), initiated by changed external circumstances such as relocation (23%) or a referral to another service (6%). Younger adolescents and those from more disadvantaged backgrounds were most at risk of dropout. Missed sessions early in treatment were also predictive of dropout. Neither therapist change nor the number of services was significantly associated with dropout. This study shows that dropout is a frequent occurrence in open-ended psychoanalytic psychotherapy. Further research is needed to explore how young people at risk of dropout can be better supported to attend treatment to ensure they receive the maximum benefits. Moreover, research is required to identify how therapists can optimally respond to missed sessions, to avoid subsequent dropout and to facilitate positive and appropriate treatment endings. [ABSTRACT FROM AUTHOR]

The development of evidence-based practice guidelines for psychotherapy is based primarily on the findings from randomised controlled trials, but there is also a need to understand and learn from the experience of those who attend therapy. Some studies have begun to examine the experience of children and adolescents who have been in psychoanalytic psychotherapy. However, no investigations to date have synthesised this body of work and drawn clinical implications from this research. Therefore, this study aimed to provide the first qualitative meta-synthesis of empirical studies examining children and young people's experiences of psychoanalytic psychotherapy. Articles meeting the inclusion criteria (n = 11) addressed treatments taking place in the UK, Scandinavia and Western Europe, and most of them focused on those who were in therapy as adolescents. The overall methodological quality of the studies was high. Based on the qualitative meta-synthesis, four over-arching themes were identified: (1) Children and adolescents learn to navigate their role during therapy; (2) The importance of the therapeutic relationship; (3) Psychoanalytic psychotherapy as a 'painful' process; and (4) Perceived impact of psychotherapy varies and is difficult to gauge. Some of the findings were consistent with the literature on adults' experiences of psychoanalytic therapy, as well as young people's experiences of other types of therapy. However, the findings also point to certain unique features of psychoanalytic psychotherapy for children and adolescents. The clinical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

There is a paucity of literature demonstrating the efficacy of psychoanalytic psychotherapy for patients with Alzheimer's or other dementias. This paper examines the challenges and richness of this kind of treatment for both patients and analyst through the use of a narrative case study. [ABSTRACT FROM AUTHOR]

ObjectiveOne in six young adults presents with at least one mental health problem. However, so far, little attention has been directed to the mental health needs and the efficacy of therapeutic interventions for young adults. We conducted a systematic review and meta-analysis of the type, quality and efficacy of psychoanalytic psychotherapy for young people.MethodWe searched the PsycInfo, PubMed, Embase, and Cochrane databases to identify all the published randomized controlled trials (RCT), and naturalistic and observational studies of psychodynamic or psychoanalytic psychotherapies. We calculated the standardized mean difference in scores of psychodynamic interventions versus control conditions, adopting a random effects model (Hedges’ g).ResultsWe identified 22 eligible studies, including 14 RCTs, and 8 naturalistic studies. Statistical analyses showed no significant difference between psychodynamic psychotherapy and other comparison treatments (psychotherapy or pharmacological interventions) for young adults (Hedges’g − 0.34 [95% CI: −0.991;-0.309], p = 0.304). Nevertheless, there was a significant effect of psychodynamic psychotherapy when compared with control conditions (waiting list or treatment as usual) for target symptoms (Hedges’g − 1.24 [95% CI: −1.97;-0.51], p

IntroductionShort-term psychoanalytic psychotherapy (STPP) is an evidence-based treatment for adolescents with depression, but like all treatment approaches, not all patients benefit from it. Previous investigations of the process of STPP have mostly focused on successful cases, and only a few studies have included the perspectives of young people, their parents, and therapists in the understanding of treatment non-response.MethodsSemi-structured interviews were carried out with young people who were considered “non-responders” to STPP, as well as with their parents and therapists. These cases were analyzed using a descriptive-interpretative approach.ResultsThe data analysis revealed three themes: (1) Therapy as a safe space; (2) Can short-term psychotherapy ever be enough?; and (3) Therapists making links and connections that did not make sense to the young people.DiscussionThis study’s findings indicate that “poor outcome” psychotherapy does not necessarily equate to a “poor experience” of psychotherapy, with different stakeholders appreciating the treatment setting as a “safe space.” However, they also suggest that some felt that a relatively short-term treatment could not lead to substantial change and that young people in STPP might have a more negative view of their outcomes compared to their parents and therapists. Finally, the findings indicate that some interventions made by clinicians in STPP feel wrong or do not make sense to young people, potentially affecting the therapy process.

Copyright of Revista CES Psicologia is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Using the country house poetry of the English Civil War as a metaphor, this article traces some of the key debates in child and adolescent psychoanalytic psychotherapy (CAPPT) research over the last 25 years. It identifies three main trends: initial confidence that child and adolescent psychoanalytic psychotherapists (CAPPTs) could apply their existing theoretical methods to empirical research; recognition of the need to use qualitative methodology and to engage with quantitative approaches; and a period of retrenchment, with particular questioning of the use of randomised controlled trial (RCT) methodology. The article also reports the results of a service evaluation undertaken subsequent to the feasibility Trial on Inter-Generational Attachment and Children Undergoing Behaviour problems (TIGA-CUB) to determine whether to proceed to a large-scale, definitive trial, and the inclusion of TIGA-CUB in an on-going, innovative research project on RCT methodology. The article concludes that, if CAPPTs want RCT methodology more appropriate to their ways of working, the profession and the Association of Child Psychotherapists (ACP) will need to develop a more pro-research environment, as well as career pathways which combine clinical work and publicly funded research. [ABSTRACT FROM AUTHOR]

No systematic review has been conducted to provide an overview of the effectiveness of psychoanalysis for treatment outcomes in bipolar depression and mania. The present study undertakes a scoping review of the effectiveness of psychoanalysis for bipolar disorder (BD), provides a summary of the evidence base, and identifies issues for future research in this area. A thorough search of journal articles in MEDLINE, PEP-Web, PsycINFO, Scopus, and the Web of Science was carried out to obtain available studies on psychoanalytic treatment for BD published from 1990 to 2021. We searched for either quantitative or single-case studies. Twenty-six single-case reports from 21 articles and no quantitative studies met the inclusion criteria. A qualitative analysis suggests efficacy and cost-effectiveness but thus far there is no scientific evidence in support of psychoanalysis. Although these pilot findings suggest that psychoanalysis may impact symptoms and global functioning in individuals with BD, the underlying evidence is poor and should be confirmed by experimental studies. [ABSTRACT FROM AUTHOR]

When it became clear that the COVID-19 pandemic would require significant shifts in working practice, staff in the Adult Complex Needs department at the Tavistock clinic designed a study to explore the emotional impact of remote working on clinicians and patients, and to consider related clinical implications both individually and collectively. A set of semi-structured questions were designed to tap into experiences of working remotely, and clinicians were interviewed. The material arising from these interviews has been summarised into themes. The predominant theme was clinicians' awareness of the importance of their own emotional milieu in delivering psychoanalytic psychotherapy, especially at a time of crisis, in their initial emotional responses and as they gathered further remote experience. They raised challenges around maintaining an analytic frame amid therapeutic uncertainties, and in the context of the many physical losses of a remote frame: blurred clinical boundaries, altered emotional experiences and resonance, and important impacts on holding, patient attendance, and worsening distress and risks for patients who struggled remotely. Strategies to adapt were key, particularly remaining emotionally consistent and observant amidst uncertainty, and support was paramount to do so. These experiences assist in informing clinicians about the limitations and uses of remote clinical work. [ABSTRACT FROM AUTHOR]

Access to one's healthy aggression is critical for both patient and therapist. On the patient's end, the ability to access and modulate aggression is fundamental to the establishment of healthy self-esteem and the capacity to sustain relationships and pursue life goals. On the therapist's end, access to aggression allows for the setting of a secure therapeutic frame and the subsequent conduct of the deep work of therapy. Conversely, lack of access to aggression creates burdensome and problematic situations that may subvert the treatment. Beginning therapists have a particular susceptibility to minimize their own aggression given certain factors in their choice of profession. Supervisors' modeling of the experience of aggression, as well as the provision of a safe atmosphere in which new clinicians become comfortably aware of their own and their patients' aggression, will help fortify beginning therapists' capacity to harness their aggression in the service of the work. [ABSTRACT FROM AUTHOR]

Abstract Background Whether and how psychotherapies change brain structure and function is unknown. Its study is of great importance for contemporary psychotherapy, as it may lead to discovery of neurobiological mechanisms that predict and mediate lasting changes in psychotherapy, particularly in severely mentally ill patients, such as those with chronic depression. Previous studies have shown that psychoanalytic psychotherapies produce robust and enduring improvements in not only symptom severity but also personality organization in patients who have chronic depression and early life trauma, especially if therapy is delivered at a high weekly frequency. Methods/design Patients with chronic major depression and a history of early life trauma will be recruited, assessed, and treated across 3 international sites: Germany, Switzerland, and the United States. They will be randomized to one of two treatment arms: either (1) once weekly psychoanalytic psychotherapies, or (2) 3–4 times weekly psychoanalytic psychotherapies. They will have full clinical characterization as well as undergo MRI scanning at study baseline prior to randomization and again one year later. A group of matched healthy controls will undergo similar assessments and MRI scanning at the same time points to help discern whether study treatments induce brain changes toward or away from normal values. Primary study outcomes will include anatomical MRI, functional MRI, and Diffusion Tensor Imaging measures. Study hypotheses will be tested using the treatment-by-time interaction assessed in multiple general linear models with repeated measures analyses in an intent-to-treat analysis. Discussion MODE may allow the identification of brain-based biomarkers that may be more sensitive than traditional behavioral and clinical measures in discriminating, predicting, and mediating treatment response. These findings could help to personalize care for patients who have chronic depression patients and early life trauma, and they will provide new therapeutic targets for both psychological and biological treatments for major depressive illness.

Psychotherapy dropout is a common phenomenon in youth mental health, often due to dissatisfaction with treatment. However, little is known about the therapeutic processes that precede dropout due to dissatisfaction. This mixed-methods empirical case study aimed to explore the therapeutic process of a 12-session, prematurely ended therapy with a young person with depression in short-term psychoanalytic psychotherapy (STPP). The Adolescent Psychotherapy Q-set (APQ), an empirically validated process measure, was used as a framework for qualitative analysis exploring the therapy process over time. Analysis of APQ ratings of the 12 sessions found a productive patient-therapy dyad working collaboratively to understand the young person's experiences and emotions. Following an initial phase of the young person presenting as emotional and vulnerable, she became increasingly ambivalent about continuing in psychotherapy. A lively and argumentative period exploring the young person's ambivalence and increased sense of well-being culminated in eventual dropout. This study suggests that even in a strong, collaborative working relationship with an engaged young person, ambivalence around dependency and vulnerability can threaten treatment completion. Therapists' enhanced sensitivity to relevant processes that precede therapy dropout have the potential to improve engagement of young people in psychotherapy, which may optimise outcomes. [ABSTRACT FROM AUTHOR]

Indonesia, a country with a vast population of approximately 275 million people on over 17,000 islands, currently has 1,221 psychiatrists nationwide. Psychodynamic psychiatry and psychoanalysis are integral to the practice of psychiatry in Indonesia, primarily because of the charismatic influence of Bachtiar Lubis, who trained in Canada in the early 1960s. Upon his return to Indonesia, Bachtiar Lubis supervised a generation of psychiatrists, including two of this article's authors, who carried on his pedagogical work. The psychodynamic model and treatments have faced obstacles limiting their acceptance in Indonesia, including importing a Western model that has not been culturally adapted to treat patients in the East, the stigma of mental illness in local communities, and the complex comorbidities of persons who seek psychiatric care. Psychodynamic psychotherapy in Indonesia is presently taught in university-based residency programs for eight semesters. A psychodynamic psychotherapy competency-based curriculum was adopted nationwide. The dissemination of psychotherapy knowledge and skills is greatly assisted by an active psychiatric professional association—the Indonesian Psychiatric Association Psychotherapy Section, a member society of the World Federation for Psychotherapy. The authors propose international and regional academic collaborations to maintain enthusiasm among trainees and improve quality of care. [ABSTRACT FROM AUTHOR]

Background: Whether and how psychotherapies change brain structure and function is unknown. Its study is of great importance for contemporary psychotherapy, as it may lead to discovery of neurobiological mechanisms that predict and mediate lasting changes in psychotherapy, particularly in severely mentally ill patients, such as those with chronic depression. Previous studies have shown that psychoanalytic psychotherapies produce robust and enduring improvements in not only symptom severity but also personality organization in patients who have chronic depression and early life trauma, especially if therapy is delivered at a high weekly frequency. Methods/design: Patients with chronic major depression and a history of early life trauma will be recruited, assessed, and treated across 3 international sites: Germany, Switzerland, and the United States. They will be randomized to one of two treatment arms: either (1) once weekly psychoanalytic psychotherapies, or (2) 3–4 times weekly psychoanalytic psychotherapies. They will have full clinical characterization as well as undergo MRI scanning at study baseline prior to randomization and again one year later. A group of matched healthy controls will undergo similar assessments and MRI scanning at the same time points to help discern whether study treatments induce brain changes toward or away from normal values. Primary study outcomes will include anatomical MRI, functional MRI, and Diffusion Tensor Imaging measures. Study hypotheses will be tested using the treatment-by-time interaction assessed in multiple general linear models with repeated measures analyses in an intent-to-treat analysis. Discussion: MODE may allow the identification of brain-based biomarkers that may be more sensitive than traditional behavioral and clinical measures in discriminating, predicting, and mediating treatment response. These findings could help to personalize care for patients who have chronic depression patients and early life trauma, and they will provide new therapeutic targets for both psychological and biological treatments for major depressive illness. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify and describe trajectories of change in distress among highly challenging patients who had received long and intensive psychoanalytic psychotherapy. Methods: The longitudinal version of the K‐means algorithm was applied to the outcome measures data of 74 patients treated in four public mental health centers. The patients were measured five times at 6‐month intervals for three outcome measures. Results: For the OQ45 and Symptom Checklist‐90, one trajectory was marked by a lower initial distress level. In this trajectory, the improvement occurred in the first half of the measurements, with a plateau thereafter. A second trajectory was characterized by higher initial severity and an improvement, mainly in the second part of the measurements. For the Beck Depression Inventory, one trajectory was marked by lower initial distress. In this group, the improvement occurred throughout the entire period. The remaining patients were characterized by higher initial distress and a decreased level of distress in the last part of treatment. They began to improve only during the third year of therapy. Conclusion: The response to treatment is not uniform in long‐term treatment for highly challenging patients. A significant number of patients require a longer period of therapy to ignite improvement. [ABSTRACT FROM AUTHOR]

Objective: To provide a review of journal articles discussing clinical cases or vignettes of psychoanalysis or psychoanalytic psychotherapy of patients affected by bipolar disorder. Methods: A thorough search of journal articles was performed in five databases to identify studies published from 1990-2021. Results: Twenty-four articles were included in this review, comprising a total of 29 case reports. The most common theoretical approach adopted by the authors was “object relations.” Two main sets of clinical-theoretical considerations and recommendations emerge: the applicability of analytic treatment to patients with bipolar disorder – taking into account their analyzability and practical arrangements for conducting therapy – and theoretical speculations on the nature and development of the illness, as well as on the conceptualization of its different phases. Conclusion: Our findings reveal that there is some psychoanalytic literature providing insight into the psychological dynamics and treatment of patients with bipolar disorder. Elaboration of this literature may help improve our understanding and provide more accurate and comprehensive descriptions of the intrapsychic and interpersonal dynamics of these patients, yielding potentially valuable information for clinical and research purposes, particularly with regard to reducing interpersonal conflict, and increasing insight and engagement with lifestyle changes and other behaviors likely to promote health and stability.

Treatment-resistant depression (TRD) accounts for a large fraction of the burden of depression. The interventions currently used are mostly pharmacological and short-term psychotherapies, but their effectiveness is limited. The Tavistock Adult Depression Study found evidence for the effectiveness of long-term psychoanalytic psychotherapy (LTPP) plus treatment as usual (TAU), versus TAU alone, for TRD. Even after a 2-year follow-up, moderate effect sizes were sustained. This study assessed the cost-effectiveness of this LTPP + TAU. We conducted a within-trial economic evaluation using a Bayesian framework. Quality-adjusted life years (QALYs) were 0.16 higher in the LTPP + TAU group compared with TAU. The direct cost of LTPP was £5500, with no substantial compensating savings elsewhere. Overall, average health and social care costs in the LTPP + TAU group were £5000 more than in the TAU group, employment rates were unchanged, and effects on other non-healthcare costs were uncertain. Accordingly, the incremental cost-effectiveness ratio was ≈£33,000/QALY; the probability that LTPP + TAU was cost-effective at a willingness to pay of £20,000/QALY was 18 %. The sample size of this study was relatively small, and the fraction of missing service-use data was approximately 50 % at all time points. The study was conducted at a single site, potentially reducing generalizability. Although LTPP + TAU was found to be clinically effective for treating TRD, it was not found to be cost-effective compared with TAU. However, given the sustained effects over the follow-up period it is likely that the time horizon of this study was too short to capture all benefits of LTPP augmentation. • Quality-adjusted life years were 0.16 higher in the intervention group. • The direct costs of the intervention were approximately £5500. • These intervention costs were not offset by savings elsewhere. • The intervention was not cost-effective, but underestimation of benefits is likely. [ABSTRACT FROM AUTHOR]

In this pilot study, we followed 22 patients during their psychoanalytic psychotherapy to monitor changes in the quality of their object representations (father, mother, partner/best friend, self) and level of psychopathology (OQ45). The Differentiation-Relatedness Scale (DR-S) was used in two semi-structured interviews: Object Relation Inventory (ORI) and two questions of the Adult Attachment Interview (AAI). Results showed that the DR-S ratings are comparable in both interviews for father and mother, with significant changes during therapy for father using the ORI and mother using the AAI. The level of psychopathology also changed significantly during treatment. Despite some shortcomings, the DR-S in combination with the ORI and AAI-questions seems a useful instrument for clinicians to monitor structural change in personality functioning during psychoanalytic psychotherapy. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Psicología Universidad de Antioquia is the property of Universidad de Antioquia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The authors, both professors of psychiatry, trained as psychoanalysts according to the standards of the International Psychoanalytic Association (IPA), recount 30 years of conceptual and empirical research work for the construction of a model of brief and adaptive psychodynamic psychotherapy applicable at the Primary Health Care level. The many milestones of this journey are reviewed, starting with the difficulties and obstacles encountered when pursuing this task within IPA institutions. Once the authors decided to conduct the task outside the analytic institution, they created two training programs for psychodynamic therapists and a research group in psychotherapy, all of which have attained excellence. This effort gave birth to several institutions that are still in operation, such as the Chilean and Latin American chapters of the Society for Psychotherapy Research, the Chilean Congress of Psychotherapy, the PhD Program in Psychotherapy, and finally the Millennium Institute for Research and Personality (MIDAP). In its 8 years of existence, MIDAP has become a national and Latin American reference center for research in Mental Health, aimed at implementing preventive and psychotherapeutic interventions in vulnerable populations at the primary health care and community level. The article ends with a description of the main components and the final process of the construction of the Protocol of Psychotherapeutic Competences for the Treatment of Depression in Primary Health Care level. [ABSTRACT FROM AUTHOR]

Introduction: Psychotherapy added to usual hospital care is beneficial. This study reports on two contrasting cases, one responder and one nonresponder, from a randomized controlled trial on the effectiveness of intensive and brief psychodynamic psychotherapy (IBPP) for depressed inpatients, in which reduction in depressive severity was maintained for up to 1 year after completion of IBPP. We aimed to explore how the psychotherapist and patient interacted to work through the themes of focalization (described in the IBPP manual) and how their work was part of a potential process of change. Methods: This case study is part of the general framework of mixed methods in psychotherapy combining quantitative analysis of data collected in a randomized controlled trial with a qualitative case study. Results: Two general categories emerged--(1) becoming the subject of one's depression and (2) regaining a sense of suppor--which combine specific functions. In the first, the functions relate to interactions in line with the psychoanalytic work of mourning, which aims for an appropriation of depressive symptoms. In the second, interactions have as their functions the construction of a therapeutic space and the restoration of an epistemic trust by acknowledging the patient's melancholic state and maintaining emotional contact. Work related to regaining a sense of support was observed in both cases, whereas work related to becoming the subject of one's depression was more specific to the responder case. Discussion: These results highlight the importance of interventions that help generate a sense of support and mobilize the internal processes of symbolization, understanding, and appropriation, leading patients to develop the capacity to give meaning to their symptoms and to understand the personal psychological factors related to the depressive episode. [ABSTRACT FROM AUTHOR]

Engaging the silent adolescent is a major psychotherapeutic challenge. This article presents a comprehensive approach to this problem, illustrated with clinical material. This approach emphasizes a careful diagnostic assessment, including an assessment of the patient's level of personality organization and capacities to participate in psychodynamic psychotherapy. Three approaches to the silent teenager are explored in depth: a mostly supportive approach focused on containment of maladaptive behaviors; a psychodynamic approach with supportive elements focused on demonstrating safety through humor, play, normalization, and self-disclosure while exploring the patient's automatic relationship patterns; and a psychodynamic approach using transference-focused psychotherapy for adolescents (TFP-A), aimed at effecting long-lasting changes in the patient's views of self and others and their characteristic ways of managing conflict and stress, with gradual movement from a tendency for controlling, protective silence to vulnerable, cooperative sharing. [ABSTRACT FROM AUTHOR]

Deborah was referred to me for psychoanalytic psychotherapy following a suicide attempt and depression. We began a fascinating journey spanning more than 10 years. During therapy, many questions arose concerning the suicidal episode, which she could not register consciously. I tried to understand the reasons for her depression and the attempted suicide through the unconscious process in the therapeutic relationship and through the music and poetry that she brought to sessions. In this paper I describe the process of listening for the signifiers of semiotic and symbolic language, both metaphoric and metonymic, as revealed in poetry and music according to the theories of Kristeva and Lacan. The poetry enabled the patient to retrieve childhood memories, experience the movement from unconscious to conscious, and mourn through the experience of transference and countertransference in the therapeutic relationship. Also illustrated is the transition from singing the music to more symbolic language, turning the patient's sensory experience into language, and connecting her personal experience with the culture of her past. The patient's mourning and the lost love objects are discussed through the prism of classical and object relations theories. [ABSTRACT FROM AUTHOR]

Silence, as an element of the therapeutic encounter has been of interest in psychoanalytic theory from the early stages of its development. Theoretical views on the functions of silence have broadened considerably since the phenomenon was first examined, in line with developments of theory and technique. This literature review aims to explore silence in psychoanalytic theoretical literature and proposes three broad categories of silence in psychoanalytic psychotherapy, namely: silence as defence; silence as connection; and silence as withdrawal. From this review it appears that silences in psychoanalytic therapy may often be multidetermined in nature; it is suggested that there are limits to the extent to which these can, and possibly should, be understood. The implications of the theoretical understanding of silence for clinical practice are then explored, and the importance of each therapist finding their own way to incorporate silence into their work with each patient is acknowledged. Debate within the literature as well as research in this area are important to further understanding of this phenomenon. [ABSTRACT FROM AUTHOR]

National research studies report elevated suicide rates amongst gay men, particularly those under the age of 26. Much of the current health and psychiatric literature on suicide tends to focus on the external world impacting on the suicidal individual. Although valuable, it is not enough to understand the specific circumstances that could contribute to gay men's suicidality. This paper focuses on the relationship between the external and internal dynamics at play in the suicidality of gay men, with particular emphasis on the development, influences, and nature of a cruel and punishing superego. The author provides some contemporary psychoanalytic theories on same‐sex desire as a useful framework to understand minority sexuality. Some influential classic and contemporary psychoanalytic theories regarding suicidality and the development and character of a cruel and punishing superego are presented. The concept of internalized homophobia and the impact of heteronormative masculinity on the gay man's psyche are explored as drivers for suicidality. A composite case study from clinical experience with suicidal gay men in an NHS setting is presented to illuminate the discussion. This paper could add new perspectives and important dialogue for psychoanalytic psychotherapists working with this patient population. [ABSTRACT FROM AUTHOR]

In this article, the author describes an adolescent's complex conflict both with his father and with his own changing body. The psychoanalytical analysis of an adolescent, Marco, 16 years old, offers us an opportunity to reflect on the Oedipal conflict, its present-day importance, and how, when it reaches particularly high levels of emotional intensity, can be transformed into a physical symptom which nullifies both the body and mental functioning. This case enables us to investigate the importance of identification with the parent of the same sex, a process which promotes the organization of the Self. This case demonstrates that the difficult path toward the "becoming-a-subject" in adolescence (R. Cahn 1999) needs to work through the subject's conflict with a father unable to escape his own narcissism, and who has not succeded in managing his defenses regarding his role as a parent, and overcome his own Oedipus complex. For Marco, fainting has represented a situation of functional compromise, an efficient symptom which enabled him to "switch off" and has represent an apt solution for his psychological well-being. Marco projected onto his body something that for him was intolerable, as a way to deal with his anger. In this way, not only did he make himself more available and managed to mobilise further resources, he succeeded in not losing control of his impulses, and in protecting himself from a psychological breakdown. Psychotherapy has helped Marco to stay in touch with himself and continue to grow and develop. [ABSTRACT FROM AUTHOR]

In this paper, I describe how my painting practice restored and sustained a more coherent and vitalized sense of self during the isolation, loneliness and sense of unrealness, dislocation, and lost world order brought about by Covid. I describe how the intersubjective and physical process of painting, and the nonverbal, embodied experience of creating art re-situated me in a world that felt real and allowed me to know and reflect on emotional experiences not available verbally until represented in visual, concrete form. I present a brief clinical example to illustrate how my artistic practice during Covid decisively informed an appreciation of the importance of a co-constructed selfobject experience that recognized how essential a patient's own affirmed creativity was for enhancing her sense of vitality, agency, and possibility of positive change. [ABSTRACT FROM AUTHOR]

In surfing the waves of COVID-19 and the current socio-political culture of alarm, uncertainty, and anxiety, I describe how exploring works by Mark Rothko, the Rolling Stones, and Henri Matisse helped me find grounded experiential footing during the pandemic. Rothko's multiform and later paintings encouraged exploration of the soul, experiences of the ineffable, of life-and-death. In contrast, the Rolling Stones inspired me to feel my heart, my beat, my connectedness to rhythm and knowledge that presence rests on interpersonal connection. Finally, as seen in The Red Studio, Matisse and his use of color re-vivify the experience of living, and provided a roadmap back to optimism. [ABSTRACT FROM AUTHOR]

Even if psychoanalysis no longer prevails with the extraordinary enthusiasm it inspired after World War II, it still retains an important place for many in the mental health field. This paper's objective is to describe the current situation of psychoanalysis and psychoanalytic therapies in the French health system, showing how, in our country, it has developed to this unique position. So far, influenced by the evolution of psychoanalysis in France, historical, cultural, and societal factors added with a strong lobby from psychodynamic scholars and strong support offered by clinical psychology, psychoanalysis and psychoanalytic psychotherapies have maintained a significant practice framework in France. Despite being challenged by the dominant global position of DSM psychiatry and cognitive psychology, psychoanalysis' influence remains strong as it does not affect only psychology and psychiatry but also extends to the humanities and social sciences. New practice types and future directions for psychoanalysis and psychoanalytic therapies are then discussed. [ABSTRACT FROM AUTHOR]

In 1988, the APP hosted a conference on psychoanalytic psychotherapy (PP) in the public sector in other European countries. This taught us that Britain had much to learn from other countries as well as much to share. The APP realised the need for a European Federation of PP in the public sector (EFPP) to represent and facilitate the field. The APP therefore joined with representatives from the Association of Child Psychotherapy and the Institute of Group Analysis and in 1991 formally created such an organisation by linking with similar representatives from European Union countries. This article takes an overview of PP in European countries, comparing the situation now in 2022 with the time of the founding of the EFPP in 1991. Despite significant setbacks in some countries, the indications are that PP has made very significant process in most countries in terms of the number of training organisations and practitioners in all four EFPP sections. The impact on public mental health provision is impressive in some countries but remains limited if not very limited in many. The article reviews some of the factors that have led to progress and setbacks, pinpointing 'lessons' and warning signs. [ABSTRACT FROM AUTHOR]

Psychoanalysis has been around in India for over a century now, beginning with the works of G.S. Bose in 1910s. However, the popularity, acceptability and accessibility of Psychoanalytic Psychotherapy has had a fluctuating course in the mental health arena of the country. The initial enthusiasm seems to have been circumscribed within the academic community and appears to have taken objections with its 'foreign origin and roots'. This approach to psychotherapy was seen as alien to the Indian culture and was not welcome warmly as a treatment strategy. However, there have been some recent attempts in making this style of thought and school popular and accessible in clinical settings and there seems to be a slow but gradual increase in the usage of Psychoanalytic thinking in both clinical and non-clinical settings. The paper reviews the history and describes the current state of Psychoanalytic Psychotherapy in India and highlights the difficulties in accessing the therapy within the national health schemes. [ABSTRACT FROM AUTHOR]

Despite increasing recognition of the importance of multicultural sensitivity in psychotherapy, studies offering in‐depth exploration of client experiences are relatively rare, and studies exploring both client and therapist perspectives even less common. This paper explores how clients and therapists experience the presence of racial identity in psychotherapy. Eleven client–trainee therapist pairs attending a free clinic in Johannesburg, South Africa, were interviewed and transcripts were qualitatively analyzed utilizing psychoanalytic research methods. This paper explores three core themes: the difficulty of talking about racial/ethnic identity; the uneasy relationship between psychotherapy and culture; and the struggle for understanding between client and therapist. This paper concludes with an invitation to embrace ambivalence, uncertainty, and partial understanding in the face of racial trauma. [ABSTRACT FROM AUTHOR]

The conference 'Life and death of psychoanalytic societies: lessons from history and new prospects for unions' was held on 23-24th January 2021 online via Zoom with the main location in Kyiv, Ukraine. It was the Ist conference initiated by the Division 'Psychoanalytic Psychology and Psychotherapy' of the National Psychological Association of Ukraine, a new valid member of the European Federation of Psychologists' Associations (EFPA). The organisers of the conference managed to involve 62 colleagues from different psychoanalytic societies from Ukraine, Italy, Japan, and Armenia. 6 institutions became the co-organizers of the conference. The conference created a place for psychoanalysts to reflect fruitfully on the history and the present functioning of psychoanalytic societies and to discuss current challenges and future prospects for the unions. The generous exchange of thoughts and the atmosphere of acceptance of otherness established a favourable platform for psychic investment in the future of psychoanalytic societies in Ukraine. [ABSTRACT FROM AUTHOR]

There has been a comprehensive development over the last few years of low intensity intervention programs that are implemented within a user context and that are made up of everyday life activities, and it has been necessary to adapt the necessary methodological channels in order to guarantee an adequate resolution pathway. The mixed method perspective offers a suitable framework, and observational methodology -- in itself considered mixed method -- is appropriate for studying the implementation and evaluation of low intensity intervention programs, allowing the development of the QUAL-QUAN-QUAL stages that correspond to the connect integration pathway of mixed methods. In this work it was applied to a single case, in a low intensity intervention, retrieving valuable information obtained, but systematizing it and applying quantitizing to the qualitative data that was treated quantitatively in a rigorous manner. The aim was to analyze the psychotherapist-patient interaction in psychoanalytic psychotherapy, in which we sought to identify which of the therapist's techniques stimulated actions of reciprocal social interaction in the child, and which techniques inhibited non reciprocal social interactions. The observational design was nomothetic, follow-up, and multidimensional. The patient was a 4-year-old boy with a diagnosis of severe autism spectrum disorder. We used an ad hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen's kappa using the free QSEQ5 software program. Polar coordinate analysis was carried out using the free program HOISAN 2.0. Polar coordinate analysis allows us to obtain an inter-relational map of the connections detected between focal behavior established in each case and the different categories. The results provide objective evidence -- backed up by the application of polar-coordinate-based data analysis -- that within a framework of psychoanalytic psychotherapy, the techniques of "verbalization" and "vocalization" significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors in a child with severe autism spectrum disorder with no language. On the other hand, direct gaze promotes the child's withdrawal. The results are of key importance as they show the therapist behaviors most useful for promoting social interaction in a child with severe autism. [ABSTRACT FROM AUTHOR]

The current study examines the psychotherapeutic treatment of an early-20s Caucasian male diagnosed with narcissistic personality disorder. The patient was treated with 56 sessions of psychoanalytic psychotherapy utilizing an object relations approach. Treatment aimed at decreasing the patient's anger, anxiety, depression, and improving emotion regulation. Another focus of this patient's treatment was helping him gain insight into the nature of his unconscious predictions and interpretations of others' behavior in the hope that he may begin to experience relationships with greater emotional connection and less conflict. Treatment outcomes were measured using Reliable Change Index analyses, which indicated a significant reduction in anxiety, depression, anger, and emotion regulation difficulty between the beginning of treatment and the most recent session. The patient also demonstrated increased mentalization abilities and fewer anger outbursts throughout the course of treatment. During the sessions surrounding a therapeutic rupture, the patient's emotion regulation abilities worsened temporarily; therapy shifted during this time to a more supportive analytic framework. An object relations-focused theoretical background and clinical treatment implications are discussed in relation to this case. [ABSTRACT FROM AUTHOR]

There has been a comprehensive development over the last few years of low intensity intervention programs that are implemented within a user context and that are made up of everyday life activities, and it has been necessary to adapt the necessary methodological channels in order to guarantee an adequate resolution pathway. The mixed method perspective offers a suitable framework, and observational methodology – in itself considered mixed method – is appropriate for studying the implementation and evaluation of low intensity intervention programs, allowing the development of the QUAL-QUAN-QUAL stages that correspond to the connect integration pathway of mixed methods. In this work it was applied to a single case, in a low intensity intervention, retrieving valuable information obtained, but systematizing it and applying quantitizing to the qualitative data that was treated quantitatively in a rigorous manner. The aim was to analyze the psychotherapist-patient interaction in psychoanalytic psychotherapy, in which we sought to identify which of the therapist’s techniques stimulated actions of reciprocal social interaction in the child, and which techniques inhibited non reciprocal social interactions. The observational design was nomothetic, follow-up, and multidimensional. The patient was a 4-year-old boy with a diagnosis of severe autism spectrum disorder. We used an ad hoc observation instrument combining a field format and a category system. Interobserver agreement was analyzed quantitatively by Cohen’s kappa using the free QSEQ5 software program. Polar coordinate analysis was carried out using the free program HOISAN 2.0. Polar coordinate analysis allows us to obtain an inter-relational map of the connections detected between focal behavior established in each case and the different categories. The results provide objective evidence – backed up by the application of polar-coordinate-based data analysis – that within a framework of psychoanalytic psychotherapy, the techniques of “verbalization” and “vocalization” significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors in a child with severe autism spectrum disorder with no language. On the other hand, direct gaze promotes the child’s withdrawal. The results are of key importance as they show the therapist behaviors most useful for promoting social interaction in a child with severe autism.

This paper presents defense-oriented psychoanalytic psychotherapy as a tailored treatment for boys through a neurophysiological hypothesis. Male central nervous system development is reviewed, with a focus on the development of the emotion regulation system. The organizational effects of pre- and post-natal androgens delay central nervous system development in males relative to females, following a caudal to rostral phylogenetic framework. Ventromedial prefrontal structures mature at an earlier developmental age than dorsolateral prefrontal structures, creating less of a gender gap in the available underlying neural architecture for responsivity to targeted therapeutic intervention. The hypothesized operation of defense analysis upon ventromedial prefrontal cortical structures and corticolimbic connectivity therefore positions boys to benefit from psychotherapy equally as girls. In this study, we explored gender differences in presentation and response to a short-term, manualized defense-oriented psychoanalytic psychotherapy named regulation-focused psychotherapy for children. In a sample size of 43 school-aged children, consisting of 32 boys and 11 girls, with oppositional defiant disorder, we found no statistically significant differences in participant characteristics upon entry nor in treatment response, as measured by changes in scores on the Oppositional Defiant Disorder Rating Scale, the oppositional defiant problems subscale of the Child Behavior Checklist, the suppression and reappraisal subscales of the Emotion Regulation Questionnaire for Children and Adolescents, and the lability and negativity subscale of the Emotion Regulation Checklist. The findings were comparable with the gendered findings of preexisting studies of play therapy, where boys and girls improve equally, but not of behaviorally predominant psychotherapy, where girls appear to have superior responses. Our findings suggest that the treatment as a general play therapy, but with a focus on the implicit emotion regulation system, was successful in meeting boys' gendered treatment needs. Conclusions are drawn with implications for further study. [ABSTRACT FROM AUTHOR]

In this paper we present the main features of a 10‐year, twice‐weekly psychoanalytic psychotherapy with a female subject (Clare) who presented with severe depression, self‐harm and suicidality. Serious traumatic events in her upbringing led to the formation of a pathological defensive structure based on a rigid identification with the aggressor, used as a dysfunctional means of protecting her against the threat of severe anxiety and psychic annihilation. Although the prognosis appeared bleak, her motivation for greater self‐understanding, her resilience and her therapist's commitment to analytic work allowed for a strengthening of the therapeutic alliance. Gradually and painfully, Clare succeeded in recognizing the difference between her cruel primary figures and the figure of a caring and containing psychotherapist, which in turn allowed her a more robust internalization of a benign object. The change in the nature of the transference towards greater trust coincided with improvements in her life, in the quality of her interpersonal relationship and external functioning. Psychiatric medication was gradually withdrawn and Clare found a part‐time job. Improvements were maintained by follow‐up consultations. The positive outcome confirms that long‐term psychoanalytically oriented therapy is an effective approach for the treatment of subjects presenting with severe emotional difficulties. [ABSTRACT FROM AUTHOR]