Beyond the impasse : reflections on dissociative identity disorder from a Freudian–Lacanian perspective

Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID

Countertransference in relation to client interpersonal functioning: a qualitative study.

Psychotherapists frequently experience strong thoughts and feelings in working with clients. This is traditionally referred to as countertransference. Countertransference phenomena are omnipresent in everyday ambulant and institutional psychotherapeutic practice. Although different therapeutic movements have distinct views on how to handle this matter, they more or less agree to the idea that the nature of countertransference reveals something about client dynamics. Over the past decade, there has been growing interest within the field of empirical research in the relationship between countertransference and client characteristics. However, this research is mainly quantitative in nature, which allows generalizations across groups but leaves conclusions largely superficial. Moreover, it bases client characteristics exclusively on descriptive diagnostics of psychopathology, leaving them isolated and static, instead of viewing them dynamically in their interpersonal context. To truly understand the development and evolution of countertransference in relation to client characteristics throughout treatment, this phenomenon will be studied within a qualitative, multi-case research design. Client characteristics will be approached from a psychodynamic structural viewpoint, placing them in a complex reciprocal relationship with the therapist. An overview of the used methodology will be presented, as well as some initial findings

Core interpersonal patterns in complex trauma and the process of change in psychodynamic therapy : a case comparison study

We performed a case comparison study to investigate the nature of interpersonal patterns in childhood trauma and the process of change therein. We analyzed three matching cases of childhood trauma that followed a psychodynamic treatment via a mixed-methods design. We found that (1) the core tendency to avoid negative reactions from others through passive behaviors emerged in all three cases, both in childhood and adulthood, (2) core interpersonal patterns transpired in the interaction between patient and therapist and thereby affected the therapeutic relationship, and (3) change ensued when a repetition of core interpersonal patterns was avoided and a new relational experience occurred. The accumulated findings across cases further resulted in several clinical implications and recommendations, such as the importance of the assessment of patients' (covert) conditions, responsiveness, supervision and facilitating patients' agency, and provided several avenues for further research

How do time limits affect our psychotherapies? A literature review

The application of time limits (i.e. restricting the amount of sessions before the beginning of psychotherapy) has become ingrained in psychotherapy research and in the context of managed care, mostly due to pragmatic and economic reasons. However, little is know on how this technique interferes with the psychotherapeutic process. Although several theorists have considered the possible advantages and drawbacks of the technique, research explaining these mechanisms is scattered. By conducting this review, we strived to answer two questions: (1) Does a time limit alter the psychotherapeutic process? And (2) In what way? In doing so, this study aspires to grant more insight into the mechanisms of time limited psychotherapy and aimes to contribute to a first understanding of the dynamics of a time restricted therapy process. We searched for articles in the databases of Web of Science and Pubmed. Our review identified 28 studies that provide empirical grounds to explain processes involved when applying a time limit to psychotherapy. Qualitative research suggests that a time limit exerts pressure on the therapy process and creates an expectancy effect, which can have both positive and negative consequences. Additionally, time limits can be associated to therapists taking on a more directive role in therapy. Results show that a time limit is anything but a neutral intervention; it is a technique that complexly interacts with therapy processes on multiple grounds. Further research is vital to determine which environment is appropriate for its application

Understanding long-term outcome from the patients’ perspective : a mixed methods naturalistic study on inpatient psychotherapy

Objective: The complex phenomenon of psychotherapy outcome requires further conceptual and methodological developments that facilitate clinically meaningful research findings. In this study, we rely on an idiosyncratic and process-oriented understanding of treatment effects in order to investigate long-term outcome. A conceptual model of long-term outcome is presented that comprises both a taxonomy of change and explanatory factors. Method: A mixed methods naturalistic study was conducted in an inpatient psychotherapy setting. Long-term quantitative outcome data are complemented with a data-driven thematic analysis of interviews with 22 participants, five to six years after ending inpatient psychotherapy. Results: Long-term outcome findings show improved well-being for the majority of former patients and this until five to six years after treatment. From the patients’ perspectives, long-term changes can be situated on different interrelated existential levels: reconnection to others and (the meaning of) life, a revelation, an altered self, life changes, and altered expectations and ideas about recovery and treatment. The complex interplay of the person, the therapy centre, the outside world and the evolution over time helped explain the experienced changes and individual differences. Conclusion: The findings support the value of an idiosyncratic and process-oriented understanding of outcome and recovery as well as substantiate the importance of multiple methods and perspectives when studying the effects of psychotherapy