Affective Change in Psychodynamic Psychotherapy: Theoretical Models and Clinical Approaches to Changing Emotions

Subič-Wrana, Claudia; Greenberg, Leslie S.; Lane, Richard D.; Michal, Matthias; Wiltink, Jörg; Beutel, Manfred E.

doi:10.13109/zptm.2016.62.3.207

Cited by 14 publications

(7 citation statements)

References 46 publications

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“…This lays the groundwork for future investigations of the question what determines the ability to maintain the ability to mentalize under attachment distress, which has important clinical implications. As Subic-Wrana and colleagues [ 91 ] stress, psychotherapeutic success requires the facilitation of affect-centered mentalizing by “the activation of emotional experiencing and of the cognitive processing of this experience by symbolizing and reflecting on the emotions in order to give them meaning” in the therapy session (p. 219). In order to best strike the balance between emotional experiencing and cognitive processing, it is useful to know as much as possible which factors and circumstances may enable or hinder affect-centered mentalization.…”

Section: Discussionmentioning

confidence: 99%

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

et al. 2018

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IntroductionWe investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress.MethodsThe sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ).ResultsWhile the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores.DiscussionOur findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.

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Section: Discussionmentioning

confidence: 99%

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

et al. 2018

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“…Psychodynamic frameworks conceptualize attempts to avoid affects and particular affectively charged contents as contributing to the emergence of psychiatric symptoms and psychosocial dysfunction (Subic-Wrana et al, 2016). Within these frameworks, defense mechanisms work to maintain lack of awareness (Perry & Bond, 2012), which occurs to protect the person from experiencing psychic danger yet precludes the individual’s ability to process and address the relevant conflicts or wishes.…”

Section: Emotions and Outcome In Psychodynamic Therapiesmentioning

confidence: 99%

In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in panic-focused psychodynamic psychotherapy.

Keefe¹,

Huque²,

DeRubeis³

et al. 2019

Psychotherapy

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In panic-focused psychodynamic psychotherapy (PFPP), exploration and interpretation of avoided and conflicted emotions and fantasies surrounding anxiety are thought to promote panic-specific reflective functioning (PSRF), which drives panic disorder improvements. Patient emotional expression within a session may be a marker of engaged processing and experiencing of affectively charged material. Degree of in-session expressed emotion, indicating both verbal and nonverbal emotions, was examined across three early therapy sessions for prediction of subsequent outcomes. We further investigated whether personality disorder traits, theorized to relate to constricted (obsessive-compulsive) or heightened (borderline) emotions, moderated this relationship. Emotional expression in Sessions 2, 5, and 10 of a 24-session PFPP protocol was assessed by blinded observers in 44 patients randomized to PFPP in a two-site randomized controlled trial of psychotherapies for panic disorder. Robust regressions were conducted to examine the relationship between average emotional expression across the measured sessions and symptom and PSRF changes subsequent to the sampled sessions, as well as moderation by personality disorder criteria, controlling for early outcomes. Higher levels of emotional expression across the early sessions predicted greater subsequent symptom and PSRF improvement. Elevations in expression of grief/sadness drove the symptomatic finding. Patients meeting more borderline criteria experienced a smaller and potentially negative relationship between emotional expression and symptom improvement. Emotional expression in PFPP may be an indicator of positive therapy process for patients without comorbid borderline personality traits, predicting prospective improvements in both a key mediator (PSRF) and symptoms. Clinical Impact StatementQuestion: Does patient in-session emotional expression in an anxiety-focused psychodynamic psychotherapy facilitate symptom relief and developing the capacity to understand the psychological meanings of symptoms? Findings: Degree of patient emotional expression across three early sessions of panicfocused psychodynamic therapy predicted higher panic symptom improvement and symptom-specific mentalizing improvements subsequent to those early sessions. Meaning: Therapeutically facilitating a patient's ability to affectively explore and engage with meanings and conflicts surrounding symptoms may be a part of a good process in panic-focused psychodynamic therapy. Next Steps: Emotional engagement at particular moments, such as exploration of attachment-related relationship episodes and fantasies, may be particularly important in this treatment.

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“…Emotion oriented orientations have both commonalities and differences in what is considered particularly important when working with emotions in session. For example, Psychodynamic therapies recognize indepth emotional exploration as essential (Diener et al, 2007;Subic-Wrana et al, 2016), contemporary third-wave Cognitivebehavioral therapies emphasize awareness and acceptance of emotions (Sloan and Kring, 2007), and Emotion-focused therapy (EFT) argues that clients need to get in touch with their core maladaptive emotional states to be able to transform them (Greenberg and Goldman, 2019).…”

Section: Introductionmentioning

confidence: 99%

Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy

et al. 2020

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ObjectiveTo explore how clients in clinical settings experience the process of opening up and sharing their inner experiences in the initial phase of therapy.MethodsTwo psychotherapy sessions of clients (N = 11) were videotaped and followed by interviews. Interpersonal process recall was used to obtain in-depth descriptions of clients’ immediate experiences in session. A follow-up interview was conducted 3 months later. The interviews were analyzed using thematic analysis.ResultsThe data revealed how and why clients distanced themselves from inner experiences in the initial phase of therapy. The overarching theme was “Holding back and struggling to open up,” which included four subthemes: (a) fearing the intensity and consequences of negative emotions; (b) experiences of being incapable and bodily stuck; (c) being insecure about one’s worthiness and right to share inner experiences with the therapist; and (d) struggling with feeling disloyal to loved ones.ConclusionThe participants held back because they feared different consequences of opening up. A range of concerns led participants to distance themselves from their inner experiences and/or to refrain from openly talking about them to the therapist. Concerns related to appropriate interpersonal conduct as client were especially important. This knowledge is highly relevant to clinicians when building safety for psychotherapeutic work.

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Affective Change in Psychodynamic Psychotherapy: Theoretical Models and Clinical Approaches to Changing Emotions

Abstract: Zusammenfassung Veränderung des Emotionserlebens in der psychodynamischen

Cited by 14 publications

References 46 publications

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in panic-focused psychodynamic psychotherapy.

Opening Up: Clients’ Inner Struggles in the Initial Phase of Therapy

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