{"id":1240,"date":"2017-04-29T16:46:11","date_gmt":"2017-04-29T23:46:11","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1240"},"modified":"2023-09-07T09:45:49","modified_gmt":"2023-09-07T16:45:49","slug":"psychodynamically-informed-clinical-work","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1240","title":{"rendered":"Psychodynamically informed clinical work"},"content":{"rendered":"

\"\"<\/a>In a world of diverse\u00a0mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost\u00a0their former\u00a0prominence. \u00a0Only a small fraction of patients have\u00a0the time, money, and interest to engage in long-term, open-ended mental exploration \u2014 even if doing so\u00a0would get to the root of their\u00a0problems and lead to lasting improvement. \u00a0More commonly, emotional\u00a0distress is\u00a0dealt with in emergency departments, in crisis clinics, on the medical and surgical floors of hospitals, in short-stay psychiatric inpatient units, and in non-clinical settings such as\u00a0schools and prisons. \u00a0These settings permit\u00a0only limited\u00a0assessment and clinical intervention. \u00a0Partly as a result,\u00a0nearly all have embraced medication and cognitive behavioral techniques. \u00a0These treatments\u00a0are seen as “evidence based” because they empirically\u00a0decrease, as designed, the discrete signs and symptoms that make up\u00a0psychiatric diagnostic criteria. \u00a0They are, in other words, very good for treating most psychiatric diagnoses.<\/p>\n

Treating the person\u00a0so\u00a0diagnosed is another matter, though. \u00a0No two depressions, psychoses, or traumatic reactions are the same. \u00a0An\u00a0individualized perspective recognizes\u00a0the person behind the symptoms \u2014 and even the person behind the persona. \u00a0Knowing patients in depth\u00a0may uncover\u00a0why one gratefully accepts care while another resists; why one is consolable while\u00a0another is not; why one prefers\u00a0inpatient care\u00a0while another opts for yoga and herbs. \u00a0Two patients may meet criteria for “major depressive disorder, recurrent,\u00a0moderate,” yet look and act very differently from one another. \u00a0Attention to these differences\u00a0is the strength of psychodynamic treatment, and exactly what is lost as we turn away from it.<\/p>\n

Fortunately, psychodynamic\u00a0understanding is\u00a0not limited to dynamic psychotherapy per se. \u00a0Psychodynamics are everywhere if we look for them. \u00a0The way people handle stress, their typical defenses\u00a0or\u00a0coping strategies, distinguish one personality from another. \u00a0 By acting on\u00a0plausible hypotheses about another person’s conscious and unconscious motivations, we align our efforts to his or her\u00a0emotional reality, feel more\u00a0empathy, and help that person meet his or her\u00a0true needs.<\/p>\n

Psychodynamically informed clinical thinking starts with\u00a0staying awake and paying attention. \u00a0\u00a0It takes no formal training to appreciate\u00a0that, faced with the same threat, one person laughs it off, another counter-punches, while still another retreats and concedes. \u00a0Observing and acting on these personality differences can improve one’s skills as a trial lawyer, a salesperson, or an elementary school teacher.\u00a0 \u00a0If attorneys, salespeople, and teachers can enhance their work in this way, surely mental health professionals, and clinicians\u00a0in general, can as well. \u00a0How does the patient relate to the clinician and to treatment recommendations? \u00a0How much motivation is there to get well? \u00a0How fearful is the patient? \u00a0Is it fulfilling\u00a0to work with this person, or is he or she\u00a0antagonistic, self-sabotaging, or working at cross-purposes?<\/p>\n

The next step\u00a0is curiosity: why<\/em> is\u00a0the patient this way? \u00a0 From childhood we hear and apply informal explanations\u00a0for what motivates others. \u00a0Psychodynamic theory refines this\u00a0natural\u00a0inclination. \u00a0It\u00a0offers\u00a0principles based in the\u00a0dynamic unconscious to explain and predict human behavior, and to recognize\u00a0emotions the patient may not have articulated or even been conscious of. \u00a0A prescription can feel generous and caring to one patient, and a brush-off to another; knowing something about the personalities of these\u00a0patients can guide effective treatment. \u00a0The agitated\u00a0patient in the emergency room may be an assault risk, or just frightened. \u00a0Knowing the difference can mean calling Security versus having a calming conversation. \u00a0In any setting the clinician\u00a0can still prescribe the same medications, order the same lab tests, or conduct (or refer the patient for) the same CBT, just with a deeper sense of what the patient seeks, and what is most apt to help.<\/p>\n

The final, optional step is to share psychodynamic wonder\u00a0with patients, i.e., to encourage their own curiosity about themselves. \u00a0This is where clinicians differ from attorneys and salespeople: besides providing a service, we also strive\u00a0to help patients\u00a0feel and stay well.\u00a0 Dynamic insight may help a patient better understand herself or himself (“know thyself”), tie together apparently disparate symptoms, and lay out\u00a0a path to emotional healing. \u00a0It doesn’t take\u00a0a mental health professional with psychodynamic expertise to imbue this curiosity and self-reflection \u2014 although it may help. \u00a0Minimally, it takes a psychodynamically informed<\/em> clinician who is willing and able, even when providing other types of assessment and treatment, to see the patient as an individual with unique\u00a0emotional reactions, a characteristic way of dealing with stress, and a subtle depth of personality that is meaningful and important.\u00a0 While this perspective would enhance any clinical practice, its absence in any area of clinical psychiatry or psychology is a particularly glaring omission.<\/p>\n","protected":false},"excerpt":{"rendered":"

In a world of diverse mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost their former prominence. Only a small fraction of patients have the time, money, and interest to engage in long-term, open-ended mental exploration \u2014 even if doing so would get to the root of their problems and lead to […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[67,7,51,8],"tags":[31,53],"class_list":["post-1240","post","type-post","status-publish","format-standard","hentry","category-medical-practice","category-psychiatric-diagnosis","category-psychiatry-in-general","category-psychotherapy","tag-insight","tag-psychodynamics","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1240","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1240"}],"version-history":[{"count":7,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1240\/revisions"}],"predecessor-version":[{"id":1663,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1240\/revisions\/1663"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1240"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1240"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1240"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}