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Contemporary

Psychodynamic Psychotherapy for

Children

and Adolescents

Sergio V. Delgado Je rey R.Strawn Ernest V. Pedapati
Sergio V. Delgado
Je rey R.Strawn
Ernest V. Pedapati

Integrating Intersubjectivity and Neuroscience

123

Contemporary Psychodynamic Psychotherapy for Children and Adolescents

Sergio V. Delgado • Jeffrey R. Strawn Ernest V. Pedapati

Contemporary Psychodynamic Psychotherapy for Children and Adolescents

Integrating Intersubjectivity and Neuroscience

Contemporary Psychodynamic Psychotherapy for Children and Adolescents Integrating Intersubjectivity and Neuroscience

Sergio V . Delgado, MD Division of Psychiatry and Child Psychiatry Cincinnati Children’s Hospital Medical Center Cincinnati , OH USA

Jeffrey R. Strawn, MD Department of Psychiatry and Behavioral Neuroscience University of Cincinnati Cincinnati , OH USA

Ernest V . Pedapati, MD, MS Division of Psychiatry and Child Psychiatry Division of Child Neurology Cincinnati Children’s Hospital Medical Center Cincinnati , OH USA

ISBN 978-3-642-40519-8

DOI 10.1007/978-3-642-40520-4 Springer Heidelberg New York Dordrecht London

ISBN 978-3-642-40520-4

(eBook)

Library of Congress Control Number: 2014956865

© Springer-Verlag Berlin Heidelberg 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

To my patients and students

 

—SVD

To Elliott Nicole and Rachel Marie

 

JRS

To Carolyn, Noah, and Harrison

 

EVP

Foreword

Psychodynamic psychotherapy with children and adolescents is undergoing a tran- sition. With the advent of this carefully crafted and wise volume, the sea change unfolds before our eyes. Setting full sail, billowing out with the strong and refresh- ing wind afforded by the creativity and responsiveness of working intersubjectively in the here and now, the authors chart the metamorphosis from a one-person psy- chology to a two-person relational psychology. This is done in such fashion that we want to take the voyage with them that they collegially invite us on. Sea metaphors aside, the book explains, integrates, and summarizes an incredi- ble amount of information between two covers. Building on and furthering concepts cogently developed in Delgado and Strawn’s striking first volume, Difficult Psychiatric Consultations: An Integrated Approach, the present masterful volume, with an additional coauthor Pedapati, starts with a thorough grounding in the his- tory, evaluation, distinct characteristics, and vocabularies of the one-person and two-person models. Additionally, contributions of key pioneers from both ways of conceptualizing and working, including transitional figures and long-neglected trail blazers ousted by the orthodoxy, are respectfully examined evaluated and contrasted. The advances in attachment theory, systems theory, developmental psychology, genetics, and neu- roscience are synthesized and beautifully applied to the subject at hand. Case exam- ples covering all phases of development synergistically illustrate the two-person relational approach. The neurobiology of intersubjectivity, alongside research advances in meaning- making processes, relational schemas, implicit working memory, social reciprocity, cultural factors, temperament, and cognition are explained and their application to psychotherapy demonstrated. These concepts dance along in the narrative and are combined in interesting ways, building into a deconstructing force upon stale ideas and bounding toward a joyous rendering of contemporary thinking, buoyed by the wealth of recent knowledge. Moreover, all of these contemporary concepts are admirably clarified and explained and their therapeutic applications demonstrated, in the writing of these authors. When you put your own subjectivity firmly on the playing field, you are no longer in the stands observing the fray; you are in the fray. The mindfully solid cornerstone of the book is the explication of the four pillars of the contemporary diagnostic interview, namely, temperament, cognition, cogni- tive flexibility, and internal working models of attachment. As noted by the authors,

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Foreword

“The four pillars are the synergy of innate and environmental processes that become the blueprint of how a child learns to develop and maintain self-regulation abilities and unique implicit relational patterns to successfully interact with others.” How this approach is applied and the variables involved in the application pave the way toward understanding how one arrives at accurate diagnostic formulations and how these are used in developing sequential treatment plans, tailored for each individual patient and their family, that have the best chance of a successful outcome. Useful tables, wise suggestions, and rich case vignettes give immediacy to the concepts that come alive in the here and now for the reader now fully absorbed in the material. This was my experience as a reader. Also, I experienced something very interest- ing when going through the four pillars chapter and indeed with the reading experi- ence of the book overall. The book is put together and flows in such a way that a sense of safety and security becomes present in the reader. Even more importantly the book engenders a “space of vitality” that frees the mind as one experiences the welcoming and accepting atmosphere that pervades the book. In reflecting on my personal “voyage” with the authors, with some surprise I perceived that I was learn- ing the material at an implicit level. My recall had a clarity and substance that gave a conviction that I was prepared and ready to use these concepts without feeling the need to go back over things, reread paragraphs, or laboriously memorize anything. My reading experience was so attuned to the intentions of the authors that the mate- rial was entering into my implicit nondeclarative memory system. Extraordinary. In conclusion, I feel it is important to note that the lead author, Sergio V. Delgado, MD, was my supervisor and teacher throughout my child and adolescent psychiatry training at the Menninger Clinic as well as for the duration of my training in child and adolescent psychoanalysis through the Topeka Institute for Psychoanalysis. In addition he was vitally important in preparing me for my last position at Menninger as Director of the Child and Adolescent Psychiatry training program in the Karl Menninger School of Psychiatry. He also ensured that I graduated “under the wire,” so to speak, as the last child and adolescent psychoanalyst graduating from the Topeka Institute of Psychoanalysis. I never stop learning from him, and these pre- liminary remarks reflect that. May the reader’s learning experience from this book be equally gratifying.

Topeka , KS , USA

Kirby Pope , MD

Pref ace

This book is written with several audiences and several goals in mind. First, we aim to expand, synthesize, and contextualize the contemporary two-person relational psychodynamic psychotherapy literature as it relates to children and adolescents. Second, we seek to integrate the contributions from developmental research, neuro- science, and intersubjectivity with regard to the clinical work of the two-person relational psychotherapist. These important contributions have historically been considered as having limited value by those of the traditional one-person model. Third, we hope to guide child and adolescent psychiatry trainees, as well as newly minted and experienced child and adolescent psychotherapists, to discover the advantages of a multidimensional, four-pillared contemporary diagnostic interview (CDI) in order to carefully develop well-informed diagnostic formulations. These formulations will allow the psychotherapist to identify those children and adoles- cents for whom a psychodynamic psychotherapeutic approach will be most helpful, as well as those for whom this approach may not be ideal. Here, we would also note that the CDI facilitates observing and participating in the interactions of patients and their parents or caregivers, which will ultimately capture a spectrum of informa- tion not accessed in a standard diagnostic interview that is based solely on criteria from the Diagnostic and Statistical Manual of Mental Disorders , 5th Edition ( DSM - 5). In addition, the information obtained through a CDI (e.g., temperament, cogni- tion, cognitive flexibility, and internal working models of attachment) enhances the relevance of the clinical signs and symptoms that are obtained through the “standard interview,” thus facilitating a comprehensive two-person relational psychodynamic formulation. Moreover, we include a CDI tool that will help guide the clinician to choose the interventions needed (e.g., psychodynamic, behavioral, or pharmaco- logical). Further, we provide real-world cases that allow the reader to intimately follow the thought processes of the two-person relational psychotherapist in his work with children and adolescent. We recognize that, as with any approach, there will be skeptics about our think- ing and way of working. The notion of a two-person, relationally based psychody- namic model of psychotherapy may not be well received by some clinicians, including those who may be anchored in traditional one-person psychoanalytic cir- cles, as it challenges a key tenet of the one-person model: the archaeological approach of unearthing an unconscious and conflicted past. However, we would argue that the traditional one-person model must accept the relevance of two-person

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Preface

relational psychotherapeutic interventions within the context of accrued knowledge from attachment and temperament theories, contemporary neuroscience, develop- mental research, as well as cognitive and social psychology. Knowledge of the two- person relational approach to psychotherapy will allow for a more comprehensive understanding of the complexity of the human mind and how it works. A two-person relational model relies on an understanding of the bidirectional communication that is inherent in the here-and-now experiences between the patient and the psycho- therapist. This bidirectional influence depends on continuous work with their mutual intersubjectivities (i.e., the participating in and understanding of the subjective experiences of another that occur in the psychological field between the two partici- pants) and involves an intimacy with the patient and his or her parents or caregivers that some may challenge as compromising the “true objectivity of the transference manifestations.” To this, we respond that “true objectivity” as a construct fails to take advantage of recent contributions from neuroscience, developmental research, attachment theory, and intersubjectivity. Additionally, our hope is that the reader may appreciate some of the persistent dilemmas that have evolved in the two-person relational model and that this book will provide the student, in the broader sense of the term, with a clear, relevant, and practical approach to the young patient, as well as an understanding of when a psychodynamic psychotherapy approach is deemed to be beneficial. Ultimately, this book will have day-to-day clinical relevance to the practicing child and adolescent psychiatrist or psychotherapist. The seeds from which this book grew were sown by the lead author’s years of practicing and teaching in both the traditional one-person and two-person relational psychoanalytic psychodynamic theories. The lead author, as he has taught child and adolescent psychiatry trainees, as well as candidates in adult and child psychoanaly- sis, recognized that the traditional one-person model of conceptualizing the psycho- logical difficulties of the child and adolescent limited clinicians. Disenchanted by the prevailing explanations of unconscious drives, ego defenses, object relations, and self-psychological constructs for his patients’ struggles, he recognized that these approaches often fell short. He felt these formulations did not account for the psychotherapist’s here-and-now experience. Moreover, the experience of teaching two-person relational psychology to child and adolescent trainees and psychoana- lytic candidates revealed the need for understanding the four pillars of a contempo- rary diagnostic formulation of patients’ difficulties (i.e., an understanding of temperament, cognition, cognitive flexibility, and the internal working models of attachment). There is an urgent need for a practical and clinically relevant approach to help trainees tease out their patients’ strengths and weaknesses and to help the trainees tailor treatment interventions. This is particularly relevant in the current era in which trainees now evaluate and treat more psychologically ill patients and increasingly struggle to “find good psychodynamic psychotherapy cases.” Moreover, trainees now more than ever are treating children who need help learning how to survive and how to grow in their disruptive and unpredictable environments. Thus, the decision to write this book began with a number of active discussions among the authors, despite generational differences. The authors also became increasingly aware of a

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disconnect between teaching and supervision in the contemporary model. This dys- synchrony occurs in the context of the traditional one-person psychology model, wherein the relevant and practical concepts from the contemporary relational and intersubjective theories are neither taught nor integrated into clinical practice. Importantly, this happens despite the increasing acceptance of two-person relational psychology in many psychodynamic venues, and it is perpetuated by a dearth of user-friendly material in the standard psychiatric texts and journals that are fre- quented by trainees. In fact, most articles regarding contemporary two-person rela- tional psychotherapy are found in psychoanalytic journals and publications for psychologists and social workers, thus limiting its dissemination to the child and adolescent psychiatry trainee. The junior author began to nudge the lead author by asking, “Why don’t you start a relational advanced psychotherapy program or, even better, write a book about two-person relational psychotherapy in children and ado- lescents? The last book about relational child psychotherapy was published in 2002.” We are happy to say that what started as a collection of ideas has become a real- ity. The Relational Advanced Psychotherapy Program (RAPP) is in its second year with ten members—some being trainees and others faculty. We are also happy to say that we completed our book with the hope that it will become a “go-to” resource for child and adolescent psychiatry trainees and clinicians who may wish to learn about the captivating and rewarding contemporary two-person relational approach. Although the authors’ paths in learning about the two-person relational psychol- ogy were different, our destination has been the same: to share with our colleagues what we have learned and what has shaped us. Therefore, in this book, we have made efforts to represent the views of both the expert in the two-person relational model and the skeptic of the two-person relational model in order to help readers arrive at their own conclusions.

The Authors’ Journeys

Sergio V. Delgado

I was fortunate to train in child and adolescent psychiatry and child psychoanalysis at the Menninger Clinic in Topeka, Kansas, more than 20 years ago. This helped me be thoroughly emerged in traditional one-person psychology and also exposed me, in readings and in person, to the early pioneers of the two-person relational discov- eries. At the Menninger Clinic, the faculty and supervisors were predominantly psychoanalysts who taught in a pluralistic and eclectic manner. Some were Freudian, others were skilled in teaching Kleinian object relations theory and ego psychology, and some adhered to self-psychology. In tandem with the psychoanalytic teachings, family therapy was a requirement for trainees and was taught by skilled social work- ers who favored understanding patients within the context of their family system. The skilled family therapy supervisors were instrumental in requiring exposure to the readings of the works of such well-regarded family therapy theorists and clini- cians as Minuchin, Haley, the Milan group, Satir, and Bowen.

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Preface

My training included learning the value of using information obtained through cognitive psychological testing and of corroborating and expanding upon the infor- mation gathered from the clinical diagnostic interviews. This provided a wider base of understanding through adding clinical information on cognitive deficits and learning problems. In essence, during my training, I learned that the psychological landscape of the child and his or her family was best understood when approached from different theoretical perspectives and integrated in a coherent manner to tailor useful and practical treatment recommendations, including psychotherapy, family therapy, tutoring, and medication management. Additionally, during my training, developmental research had begun to emerge and gain momentum across the country. I was fortunate to have participated in video recordings of the stranger anxiety experiments involving infants and toddlers of unwed teenage mothers, which were used to learn about the quality of these moth- ers’ attachment to their children and were reassessed at 6 and 12 months. As a resident, I met Sir John Bowlby, who, in spite of recovering from painful shingles, had the energy to discuss with great fervor the importance of internal work- ing models of attachment between infant and caregivers necessary for survival. Several years later, I was exposed to Dr. Daniel Stern, who gave a Grand Rounds presentation at the Menninger Clinic. Stern had theoretically departed from Margaret Mahler’s work and discussed his research about the complex developmental strides of the child during the first 2 years of life when their mother provides the necessary affective attunement. Further, I was asked by my colleagues and friends, Kathryn Zerbe and Glen Gabbard, to present at a clinical case conference to Dr. Robert N. Emde, a psychoanalyst and mentee of René Spitz, who was to be the discussant. Dr. Emde was distinguished by his work in infant research, explicating the role that emotional availability, affective attunement, and social referencing had in the child’s attachment to their caregivers. The clinical case presentation led to the publication, with Drs. Emde and Pope as coauthors, of An atypical eating disorder in a 2-year-old female, which solidified my thirst to learn two-person relational psychology in depth and began my questioning of the “truths” of the traditional one-person model. This proved to be a more challenging task, as I had begun the time-demanding training in adult and child psychoanalysis at the Topeka Institute for Psychoanalysis (TIP). At the TIP, I was exposed to an eclectic curriculum, with readings from such prominent authors as Freud, Jung, Suttie, Erikson, Horney, Sullivan, Klein, Kohut, Rinsley, Fairbairn, Guntrip, Fonagy, Benjamin, and Hoffman. I later became a train- ing and supervising adult and child analyst and eventually the director of the child psychoanalytic training program. Becoming a training and supervising adult and child analyst in an eclectic institute permitted me to have a balanced and in-depth understanding of the pluralistic traditional one-person models and the two-person relational models, which is not common in all institutes. This gave me an advantage that allowed me to recognize the enchantment and limitations of the traditional one- person psychology with more clarity. In 2002, I moved to Cincinnati to join the department of child psychiatry at the Cincinnati Children’s Hospital Medical Center, with the goal of enhancing the child and adolescent psychiatry trainee’s psychotherapy courses. I also joined the

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Cincinnati Psychoanalytic Institute as a training and supervising adult and child analyst, which has had a tradition of adhering to the one-person model and shown more reluctance in accepting the contemporary two-person relational model. However, two-person relational articles have gradually made their way into the readings at the Cincinnati Psychoanalytic Institute’s Faculty Study Group. My launching of the Relational Advanced Psychotherapy Program (RAPP) has been slow to garner significant institute support but has been very gratifying nonetheless.

Jeffrey R. Strawn

I completed my residency training in general psychiatry at the University of Cincinnati. Following my general psychiatry training, I completed a fellowship in child and adolescent psychiatry at Cincinnati Children’s Hospital. My training at the University of Cincinnati, a program with strong foundations in traditional one- person psychodynamic psychotherapy, and my early psychotherapeutic work were strongly influenced by Freud’s drive theory, object relations, and self-psychology, with an emphasis on neutrality and boundaries. However, I began to notice limita- tions of the “archaeological” approach to patients’ problems, which emphasized the unearthing of conflicts and felt, at times, limited by an emphasis on therapeutic neutrality and interpretation as the primary vehicle of change in the context of tra- ditional psychotherapeutic treatments. As I began my child and adolescent psychi- atric training, I was exposed to the two-person relational approach by the lead author of this book. I quickly began to recognize the importance of alternative intersubjectivity-based approaches. In parallel with this increasing exposure to and practice of two-person relational psychotherapy, I directed the Pediatric Anxiety Disorders Clinic and Research Program, wherein I was using functional magnetic resonance imaging (fMRI) to examine the neurofunctional basis of anxiety disor- ders in children and adolescents and working to understand the neurophysiology of emotional processing in youths. As I conducted these research studies with various fMRI paradigms (i.e., tasks), I began to observe activation in a number of structures and regions that subserve self-other processing. The findings of this neuroimaging research reverberated with my contemporary two-person relational psychothera- peutic work with children and adolescents. I enjoy teaching the two-person rela- tional approach to psychotherapy to medical students, general psychiatry residents, and child and adolescent psychiatry fellows at the University of Cincinnati and Cincinnati Children’s Hospital Medical Center.

Ernest V. Pedapati

In my final year of medical school at the University of Massachusetts, I still could not decide between the body and the mind. Instead, I embraced my ambivalence and pursued the Triple Board Residency at the University of Cincinnati and Cincinnati

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Children’s Hospital Medical Center. Unlike conventional child psychiatry training, the Triple Board emphasizes pediatric medicine with later specialization in psychia- try and child psychiatry. Rather than distance myself from mental health, my train- ing in pediatrics inspired a curiosity for childhood development and gave me a new lens to pediatric psychopathology. I struggled with understanding why a child rav- aged with bone cancer struggled so vigorously to live or why a child caught in the depths of depression would so earnestly wish for death. Although my early supervi- sors helped me understand children psychologically through a traditional one- person lens, over time I found common ground with my pediatric training as I began to deepen my understanding of attachment theory, neuroscience, and social cogni- tion. This inevitably led me to wholeheartedly embrace two-person relational psy- chotherapy, and I am grateful for the lead author’s invitation to collaborate in writing this book, which will enhance my colleagues’ psychotherapeutic experience.

Cincinnati , OH , USA

Sergio V . Delgado, MD Jeffrey R. Strawn, MD Ernest V . Pedapati , MD

Acknowledgments

We wish to credit our respected and admired colleagues Robert Emde, MD; Paul Wachtel, PhD; and Neil Altman, PhD, who laid the foundation for our journey to two- person relational psychotherapy through their eloquent and clinically masterful writ- ings. We are forever appreciative of the time and effort that they took to read selected chapters and to make insightful comments that have greatly improved this book. We also are indebted to our close friend Kirby Pope, MD, who read the first drafts of this manuscript, as well as subsequent revisions, and was gentle in sharing comments that helped shape the flow of the content of this book. The editorial comments of Drs. Emde, Wachtel, Altman, and Pope were mindful that, in many respects, two-person relational psychology has evolved from what was a one-person psychology. We would like to express our heartfelt gratitude to our young patients, who unknowingly contributed intersubjectively to this book in remarkable ways. They provided the clinical material through their subjectivities in here-and-now moments with us as psychotherapists. We also wish to thank our mentors and teachers, who provided the foundation for our appreciation of the multiple theories and complexi- ties that must be considered if we are to understand and help our patients and their families. Additionally, we are indebted to our students, who helped us appreciate the pressures of trying to “fit in” learning about the evolution of two-person rela- tional psychology and psychotherapy, due to the prevailing pressures by colleagues and supervisors loyal to the traditional one-person psychology and those loyal to solely psychopharmacological interventions. Our students were also pivotal in encouraging the authors to “put it in writing,” not only the tenets of two-person relational psychology but, more importantly, specific case examples discussed from both a traditional one-person model and a two-person relational model, which we realized was very much needed. We want to express our warm thanks to Corina Schaefer, associate editor of clini- cal medicine at Springer Publishing. We are grateful for her steadfast support when we requested Springer to sponsor our book. She has provided the energy behind these pages and both believed in us and supported this project. Also, we give a heartfelt thank you to Greg Ford for his masterful and sensitive editorial assistance, with attention to detail, and his ability to make clearer our sometimes muddled sen- timents with his skillful use of the written word and grammatical prowess. We are grateful to the colleagues and students who took the time to read selected chapters and generously provided constructive criticism. They were kind enough to

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point out what was not clear, what was confusing, what required further elaboration, and what we had omitted. Among these colleagues are: Mary Ahn, MD; Mary Singeltary, DO; Amanda Jones, OTR/L; Chris Marrett, MD; Heather Adams, DO; John Vraciu, DO; Yesie Yoon, MD; Deborah Reynolds, LISW-S; and Kellie Ryan, LISW. We also express our gratitude to Michael Sorter, MD and John Kerechek, MAS, who provided the enthusiasm and support for our work to become a reality. To all we say, thank you! I am indebted to Erin, my true love and muse, for providing the inspiration and patience to complete this book. She provided the challenging and clarifying com- ments due to her expertise in traditional one-person psychology. I will always remember her sharp and “loving” comments—“it sounds too much like gobbledy- gook”—when the manuscript needed help clarifying the complexities of two-person relational psychology, which proved to be useful “unedited” critiques that improved the readability of this book. Finally, I want to thank my friends and coauthors, Jeff and Ernie, who tolerated my Hispanic grammar and my strong views about the limi- tations of a traditional one-person approach, which they at times felt needed to be softened. We were able to maintain our close and intersubjective friendship despite our not-so-subtle disagreements. Finally, I apologize to the readers who may feel more could have been written to further clarify two-person relational clinical concepts or that may have wished for more clinical cases with lengthier and more detailed explanations. To them I say, our work is incomplete; we all have much to learn and we could have easily taken more time and energy without being able to capture all the nuances of a two-person relational model. Therefore I kindly encourage the reader to make use of this book as a springboard to further read the many eloquent books and papers referenced throughout the book. —SVD This work would not have been possible without the loving support of my wife, Lara, who from the beginning helped me to balance our life with the writing of this book, although she may still not agree that we reached equilibrium. Also, I thank my daughters, Elliott Nicole and Rachel Marie, for their daily lessons in intersub- jectivity and attachment theory. My regular reminders of implicit relational know- ing and development ultimately made the writing of this book possible. Finally, I thank my friends and coauthors, Sergio and Ernie, whose encouragement and always-present enthusiasm were the driving force for this work.

—JRS The efforts placed on this book were greatly inspired by my own desire to relate and be in relation with my dear wife, Carolyn, and my two young and rambunctious sons, Noah and Harrison. I also recognize the implicit imprints left upon me by the careful care of my father, Francis, mother, Elsie, and my sister, Sheila. Though many of my contributions were informed by my clinical work, much was crafted in the cauldron of the messiness of real life, learning how to be a good therapist, a loving husband, and a caring and inexperienced new father. I am truly grateful for the encour- agement and wisdom of my great friend and mentor Bob Turner, who over the course of two decades, continues to inspire in me a passion to be curious. As we conclude this project, I am thankful for Sergio and Jeff, who began as my mentors and continue as my friends and to whom I feel deep admiration for their tenacity and creativity. —EVP

Contents

1 Introduction

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1.1 Making the Case for Two-Person Relational Psychodynamic

 

Psychotherapy: A Neurodevelopmentally Informed Treatment

 

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Introduction to Two-Person Relational Psychology

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1.2 Context and Key Concepts in Two-Person

 

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1.4 How to Use This Book

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2 Traditional One-Person Psychology

 

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2.1 Traditional One-Person Psychology

 

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2.2 Historical Background of Traditional One-Person Model of Child and Adolescent Psychoanalysis and Psychodynamic Psychotherapy

 

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2.3 Freud and Classic Psychoanalytic Theories

 

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Sigmund Freud (1856–1939): Drive

 

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First Child in Psychoanalysis: Little Hans

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Freud’s Colleagues

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Carl Gustav Jung (1875–1961)

 

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Hermine von Hug-Hellmuth (1871–1924)

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Berta Bornstein (1899–1971)

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Heinz Hartman (1894–1970) Autonomous Ego Erik Erikson (1902–1994) Theory

 

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Two-Person Relational Psychology View: Ego Psychology

 

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2.6 Object Relations Theory

 

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Melanie Klein (1882–1960)

 

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Donald Winnicott

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Margaret Mahler (1897–1985)

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Contents

Peter Blos (1904–1997) The Second Individuation

. Personality Disorders in Children and Adolescents

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2.7 Self-Psychology Heinz Kohut

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31

31

Anna Ornstein (1927–)

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31

Two-Person Relational Psychology View:

 

33

2.8 .

Summary .

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33

References

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34

3 Two-Person Relational Psychology for the Child and Adolescent Relational

 

37

Two-Person Relational Psychology

3.1 .

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38

Making the Case for a New Paradigm

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38

3.2 Historical Background of Two-Person Relational

Psychology

in Adults.

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41

. Freud’s Dissenting Colleagues

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42

British Relational

44

American Relational Theorists

45

3.3 Historical Background of Two-Person Relational

 

Psychology in Child and Adolescent Psychotherapy American Two-Person Relational Child

 

46

and Adolescent Psychotherapists

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47

Other Two-Person Relational Child

and Adolescent Psychotherapists

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50

3.4 Two-Person Relational Psychodynamic Psychotherapy

 

50

Basic Principles of a Two-Person Relational Psychodynamic Psychotherapy Process

51

3.5 Two-Person Relational Experiences Are Contextual Realities in the Environment That Trigger

 

53

a Person’s Anxiety.

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53

Interactions with Another Person That Implicitly

 

. The Patient Unknowingly and Implicitly is Trying to Engage the Psychotherapist into a Relational Pattern that is Contextually

Trigger Anxiety

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55

56

Uncertainty in Two-Person Relational Psychotherapy

 

57

Anxiety in the Two-Person Relational Psychotherapist

58

3.6 Critiques of the Two-Person Relational

59

3.7 Summary

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60

References

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60

4 Key Pioneers of Two-Person Relational Psychology

 

63

4.1

Developmental Psychology Researchers

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63

René Spitz (1887–1974)

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63

Robert Emde (1935–)

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64

Contents

xix

Daniel Stern

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The Boston Change Process Study Group (BCPSG)

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66

L. Alan

Sroufe

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67

Edward Tronick

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68

Andrew Meltzoff (1950–)

 

69

Colwyn Trevarthen (1931–)

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Peter Fonagy (1952–)

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70

4.2 Developmental Psychology Synthesizers

 

70

Allan Schore (1943–)

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70

Daniel

Siegel

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71

4.3 Developmental Theory and Theorist’s

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71

Attachment Theory

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71

John Bowlby (1907–1990)

 

73

Mary Ainsworth

73

Mary

Main

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73

Lev Vygotsky

74

Adoption Policies

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74

4.4 Temperament

74

4.5 Summary .

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75

References

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75

5

Key Concepts in Two-Person Relational Psychology

 

79

5.1 Meaning-Making Processes

 

81

5.2 Affective Attunement

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83

5.3 Emotional Availability and Social Referencing

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84

5.4 Temperament.

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86

5.5 Internal Working Models of Attachment (IWMA)

Secure Attachment

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88

Attachment Patterns: Secure, Insecure-Ambivalent/Anxious, Insecure-Avoidant/Dismissive, and Insecure-Disorganized

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89

. Insecure-Ambivalent/Anxious Attachment

 

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89

Insecure-Avoidant/Dismissive Attachment

 

90

Insecure-Disorganized Attachment

90

5.6 The Contextual Nature of Attachment

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91

5.7 Fundamental Principals of Two-Person Relational Psychotherapy: Implicit Relational Knowing

 

and Intersubjectivity

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93

Implicit Relational

 

93

Intersubjectivity.

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94

5.8 Real Relationship, Present Moments, Now Moments,

 

and Moments of Meeting

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96

. Present Moment, Now Moments, and Moment of Meeting

Real Relationship

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96

96

Fuzzy Intentions and

 

100

Mentalization and

101

xx

Contents

 

5.9 Corrective Emotional Experience

 

102

5.10 Key Concepts: Implications for Two-Person Relational Psychotherapy

 

103

Andrew: A Securely Attached Child

103

 

Implications for Two-Person Relational Psychodynamic

 

Psychotherapy .

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