Leon Hoffman

Defense Mechanisms and Implicit Emotion Regulation A Comparison of a Psychodynamic Construct with One from Contemporary Neuroscience

A growing interest in the neuroscience of emotion regulation, particularly the subfield of implicit emotion regulation, brings new opportunity for the psychodynamic treatment of neuropsychiatric disorders of childhood. At the same time, psychodynamic theorists have become more aware of the centrality of affects in mental life. This paper introduces a manualized psychodynamic approach called Regulation-Focused Dynamic Psychotherapy (RFP-C). Theoretically based on the domain construct of implicit emotion regulation (ER), this approach posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation. To illustrate this theoretical similarity, the literature connected with both concepts is reviewed. The implications of this idea, which could promote an interface between psychodynamics and contemporary academic psychiatry and psychology, are discussed.

Passions in Girls and Women: Toward a Bridge Between Critical Relational Theory of Gender and Modern Conflict Theory

This paper considers (1) some aspects of the lack of dialogue among psychoanalytic schools; (2) Brenners (1982) conception of drives and drive derivatives as inextricably linked to relationships, and some of its less-appreciated implications; (3) the debate over the importance of childhood sexuality in mental life; (4) the attempts by relational theorists to address and reintegrate the role of sexuality and gender, particularly in the study of feminine psychology; (5) the problematic role of aggression in psychoanalytic theories of women; (6) the avoidance by both men and women of womens passions and their anatomical loci, especially the clitoris, whose only function is the provision of pleasure; and (7) the suggestion that an integrated theory, including an understanding of the role of the body as well as of the passions and the defenses against them, results in the most effective clinical psychoanalytic approach. It then suggests that a bridge could be built between a relational point of view that takes into consideration the role of bodily experiences, and a classical point of view in which drive is seen as inextricably linked to relationships from birth on.

Mothers' Ambivalence With Their Babies and Toddlers: Manifestations of Conflicts With Aggression

In this paper the author continues his study of conflicts over aggression in women, discussing the implications for contemporary theories of feminine psychology of observations of mothers in parent/child groups with their infants and toddlers. Many mothers experience conflicts over aggression (both in themselves and in their children) and become intolerant of their ambivalence toward their children. The author suggests that this observation provides an avenue that allows an integration of psychoanalytic ideas about maternity and childrearing with psychoanalytic understandings of womens conflicts about achievement in the social realm outside the home. In both roles, difficulties mastering conflicts with aggression may cause women to struggle profoundly, and to experience problems, in successfully negotiating their important life goals, whether the goals refer to their roles as effective mothers or their roles as effective individuals in the social sphere outside the home. Some women may demonstrate these difficulties in one sphere or the other, some in both, and others in neither. The author suggests on the one hand that we need to eliminate the concept of normality when considering the activities of women, and on the other hand that we need to normalize the omnipresence of ambivalence in the psychology of women.

On the clinical utility of the concept of depressive affect as signal affect

The author reviews the scant literature relating to the concept of depressive affect as an affect parallel to anxiety. Then, through the presentation of detailed clinical psychoanalytic data, in particular the patients associations to interpretation, he demonstrates the value to the conduct of a psychoanalysis of an awareness of the role of depressive affect as a signal affect that triggers defense.

Treatment notes: objective measures of language style point to clinical insights.

Application of a computerized text analysis procedure is proposed that has the potential for use by psychoanalytic and psychodynamic clinicians: the systematic examination of linguistic style as reflected by clinicians in their ongoing process and case notes, which are ubiquitous in the mental health field. The studies reported here are, as far as is known, the first attempts to study treatment notes systematically using such procedures. Linguistic measures are used to track the trajectory of the clinical process throughout the treatment in two contrasting cases, one rated successful, the other not. The computerized linguistic analysis used here focuses on two analytically relevant linguistic variables: Mean High Referential Activity (MHW), a measure of the degree to which language is connected to emotional processing, and Reflection (REF), the use of words referring to logical functions. Changes in the relative position of these measures indicate nodal points in the treatment that might be analytically or therapeutically problematic, and that might be overlooked in a solely clinical reading. The analyst’s activity as reported in notes during such nodal periods is clinically examined to see how it may have affected the course of the analysis. This method has the potential for use in ongoing treatments, and may help clinicians refine their interventions.

Psychodynamic Considerations in the Treatment of a Young Person with Autistic Spectrum Disorder: A Case Report

That psychodynamic concepts can be utilized in the multimodal treatment of children with autistic spectrum disorders (ASD) almost seems to be an oxymoron in the contemporary general mental health community. It may be that the mother-blaming/refrigerator-mother conceptions of the 1940s and 1950s have turned the mental health community, as well as parents, away from psychodynamic considerations in the treatment of ASD to treatments other than dynamic ones. This is a report of a patient with ASD who was interviewed on video by his therapist/analyst at the age of 19 after obtaining informed consent. The interview reviews their work together, which had begun when the patient was three and a half and who was not really talking well past his sixth birthday. We conjecture that the addition of a psychodynamic approach contributed to the developmental gains.

Adolescent mass shootings: developmental considerations in light of the Sandy Hook shooting

Abstract Adolescent mass shootings are a special subset of mass killings, which continue despite significant preventative public health efforts. It is often held that these individuals have few salient warning signs that could have been identified. This piece proposes that mass shootings committed by adolescent and post-adolescent young males must be understood from a developmental perspective. The hypothesis proposed in this paper is that such killings occur as the result of the adolescent’s frustrated effort to progress along normative development. The goal of normative separation from maternal figures by the boy is presented as a potential risk factor when this goal is thwarted. Childhood case material from the perpetrator of a recent adolescent mass shooting, the Sandy Hook shooting, is discussed as an illustration of this hypothesis. Implications for public health measures and for individualized treatment are presented and developed.

Evidence-Based Psychodynamic Psychotherapy: HANDBOOK OF EVIDENCE-BASED PSYCHODYNAMIC PSYCHOTHERAPY: BRIDGING THE GAP BETWEEN SCIENCE AND PRACTICE. Edited by Raymond A. Levy and J. Stuart Ablon. Totowa, NJ: Humana Press, 2009, xxii + 399 pp.,

Psychodynamic therapy (PDT) is a widely practiced form of psychotherapy for a variety of different problems and disorders. Nevertheless, the concepts and techniques used in PDT are often taught in a way that obscures rather than clarifies their nature. In addition, a gap remains between the theoretical, clinical, and empirical literature of PDT. This seminar presents a series of evidence-based psychodynamic techniques and processes, grounded in coherent theoretical formulations, systematic research, and applied clinical examples. You will also learn about metaanalytic research on the overall efficacy and effectiveness of PDT.

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Violence prevention programs can help children cope with trauma if effective strategies are developed to address youth victimization and childrens exposure to domestic violence and trauma. Psychoanalysts are in a unique position to develop such primary and secondary prevention programs for children for whom violence is part of everyday life. An intense long-term relationship is an essential treatment ingredient for these profoundly troubled youngsters. In such a relationship, the therapist/analyst cannot react automatically to the inevitable hostile, destructive aggression that emerges in the treatment of severely traumatized children. A particularly key contribution by Osofsky is her discussion of the ubiquity of “countertransference every day in people who work with traumatized children.” Here I provide a clinical example of a failure that resulted from my own countertransference.

A Psychoanalytically Oriented Approach as Primary and Secondary Prevention: Discussion of Joy Osofsky's “Psychoanalytically Based Treatment for Traumatized Children and Families”

Two psychodynamic treatments for children with externalizing behaviors are compared: Regulation-Focused Psychotherapy for Children with Externalizing Behaviors (RFP-C) and Mentalization Based Psychotherapy for Children (MBT-C). Although these two treatments encompass a variety of similar interventions, the treatments differ as follows: MBT-C primarily addresses the child’s subjective sense of self (social cognition system) whereas RFP-C primarily targets the child’s defenses against unpleasant emotions (implicit emotion regulation system). With both approaches, clinicians can manage their countertransference by using an active psychotherapeutic technique when working with children who exhibit externalizing behaviors.