Marie Rudden

Panic disorder and depression: A psychodynamic exploration of comorbidity

Eight of twenty‐one patients presenting for treatment in an open trial of brief psychodynamic psychotherapy for panic disorder also carried the diagnosis of major depression. For the patients who completed the study, depression remitted as well as panic disorder. The authors highlight psychodynamic factors that they hypothesize may contribute to the significant overlap between panic disorder and depression, and describe three videotaped cases to illustrate these points.

Oedipal Dynamics in Panic Disorder

Both research and clinical work have revealed factors that can lead to the onset and persistence of panic disorder. Preoedipal conflicts intensify the danger of oedipal longings for panic patients. Competition with the same-sex parent is linked with angry preoedipal fantasies and associated fears of disruption in attachments. Fantasied or actual successes can thus trigger panic episodes. Regression to a helpless, dependent state such as panic defends against the danger of aggressive, competitive fantasies and actual achievements. However, the regressive state can also be experienced as dangerous, and can be linked with frightening homosexual fantasies. A reactive aggressive oedipal stance can sometimes result, triggering escalating turmoil. The panic episode serves a series of compromise formations in dealing with these conflicted wishes.

Leadership and regressive group processes: A pilot study

Various perspectives on leadership within the psychoanalytic, organizational and socio‐biological literature are reviewed, with particular attention to research studies in these areas. Hypotheses are offered about what makes an effective leader: her ability to structure tasks well in order to avoid destructive regressions, to make constructive use of the omnipresent regressive energies in group life, and to redirect regressions when they occur. Systematic qualitative observations of three videotaped sessions each from N = 18 medical staff work groups at an urban medical center are discussed, as is the utility of a scale, the Leadership and Group Regressions Scale (LGRS), that attempts to operationalize the hypotheses. Analyzing the tapes qualitatively, it was noteworthy that at times (in N = 6 groups), the nominal leader of the group did not prove to be the actual, working leader. Quantitatively, a significant correlation was seen between leaders’ LGRS scores and the group’s satisfactory completion of their quantitative goals (p = 0.007) and ability to sustain the goals (p = 0.04), when the score of the person who met criteria for group leadership was used.

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

Objective: To identify variables predicting psychotherapy outcome for panic disorder or indicating which of 2 very different forms of psychotherapy—panic-focused psychodynamic psychotherapy (PFPP) or cognitive-behavioral therapy (CBT)—would be more effective for particular patients. Method: Data were from 161 adults participating in a randomized controlled trial (RCT) including these psychotherapies. Patients included 104 women; 118 patients were White, 33 were Black, and 10 were of other races; 24 were Latino(a). Predictors/moderators measured at baseline or by Session 2 of treatment were used to predict change on the Panic Disorder Severity Scale (PDSS). Results: Higher expectancy for treatment gains (Credibility/Expectancy Questionnaire d = −1.05, CI95% [−1.50, −0.60]), and later age of onset (d = −0.65, CI95% [−0.98, −0.32]) were predictive of greater change. Both variables were also significant moderators: patients with low expectancy of improvement improved significantly less in PFPP than their counterparts in CBT, whereas this was not the case for patients with average or high levels of expectancy. When patients had an onset of panic disorder later in life (≥27.5 years old), they fared as well in PFPP as CBT. In contrast, at low and mean levels of onset age, CBT was the more effective treatment. Conclusions: Predictive variables suggest possibly fruitful foci for improvement of treatment outcome. In terms of moderation, CBT was the more consistently effective treatment, but moderators identified some patients who would do as well in PFPP as in CBT, thereby widening empirically supported options for treatment of this disorder.

Leadership and Regressive Small Group Processes: A Case Study

The psychoanalytic literature of regressive group and intergroup processes is reviewed briefly and selectively to derive principles of effective, working group leadership. These principles are applied to a case study of the leadership provided by Terje Larsen to the unique work group of Palestinians, Israelis, and Norwegians who produced the 1993 Oslo Peace Accords.

The 'secret cocoon': Fantasies about the private self in the absence of consensual reality

Clinical material is presented from an analysand whose defense of withdrawal to ‘a private internal space’ was mobilized when she became confused, within her relationships and within the transference, about whose understanding of a shared event was ‘real.’ Analysis of the defense as resistance revealed a disrupted sense of connection to others and to the analyst in the face of the difficulty in determining a consensual reality. This was accompanied by emotional withdrawal, with a complex fantasy of retreat to a protective inner hiding place, or cocoon. The phenomenology and functions of such withdrawals, the fantasies accompanying them, and the ways in which they changed during the analysis are discussed in this paper. For the patient described, the analysis of her shifting ‘cocoon’ states and of the fantasies connected with them eventually enabled her to access her creative ‘private self’ more freely and with less conflict.

Transferencia, relación y el analista como objeto: Hallazgos del Grupo de Trabajo Norteamericano sobre Métodos Clínicos Comparados

Se utilizan los datos del Grupo de Trabajo Norteamericano sobre Métodos Clínicos Comparados (MCC) con el fin de 1) explorar cómo los psicoanalistas norteamericanos conciben y abordan la transferencia y la relación entre el analista y el analizado y 2) estudiar en qué tipo de ‘objetos’ se convierten los analistas, de manera explícita e implícita, dentro de los tratamientos psicoanalíticos. El Grupo de Trabajo Norteamericano sobre Métodos Clínicos Comparados estudió detenidamente 17 casos clínicos presentados por psicoanalistas norteamericanos en varios encuentros de un amplio espectro de escuelas analíticas. Hallamos que los 17 analistas podían dividirse en tres grupos, según la coherencia interna de sus métodos y su abordaje de la transferencia, la relación analista-analizado y la situación del analista como objeto. También descubrimos que el trabajo individual de los analistas, aunque muy influenciado por sus escuelas de pensamiento, también incluía singulares interpretaciones de sus paradigmas particulares.

What You Don't Know You Know: Our Hidden Motives in Life, Business and Everything Else

patient-centred interpretations which are then experienced as projections of the analyst can lead to problems and hence demand analyst-centred interpretations; on the other hand, in other situations analyst-centred interpretations can be felt to confirm the projections of the patient, which can make patient-centred interpretations necessary. This book does offer the reader solid background knowledge of psychoanalytic theory, especially object relations theory. However, too much specialist knowledge is already assumed in the reader for it to become, as John Steiner writes in his foreword, ‘‘essential reading for anyone wishing to extend their clinical technique, be it psychoanalyst, psychotherapist, psychiatrist or researcher in the field of medicine or social sciences’’ (p. 9). It would be highly desirable if the important progress in the understanding of personality disorders that is contained in this book could be made available in less hermetic terms to non-psychoanalysts, which could in turn enhance the impact of psychoanalysis as a clinical therapeutic method. On a practical clinical level, new psychoanalytically oriented, manual-based new directions in treatment followed by the working groups, MentalizationBased Treatment (MBT) led by the London psychoanalysts Bateman and Fonagy and the New York Transference Focused Psychotherapy (TFP) centred round Otto F. Kernberg, have contributed much in recent years, through accurate diagnosis, the contract-setting phase of therapy or the use of behavioural techniques, to making borderline disorders more controllable today than they were 20 years ago. It is all the more important, however, that theoretical work on the central dynamics of interpersonal relationships and unconscious processes should be continued alongside the practical work carried out in longstanding regular therapeutic sessions. This book offers a wealth of suggestions towards this end.

Wounded by Reality: Understanding and Treating Adult Onset Trauma

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