A psychodynamic approach to anxiety is not disorder specific; anxiety can and usually is present to varying degrees in all patients that are seen for psychodynamic psychotherapy. This chapter aims to shed some light on some psychodynamic approaches to thinking about anxieties. Using theory and clinical examples we think about how difficulties in containing processes between caregiver and infant early in the infant’s life may predispose to the persistence of archaic anxieties. We go on to explore the nature of separation and loss in relation to anxiety and finally, we reflect on how internal conflict and the role of a critical internal object can bring about anxiety. The clinical examples illustrate how wider variation in anxieties may present in therapy and the last section focuses on how the therapist may experience and respond to these different anxieties.

The consultation is likely to be the first experience the patient has of a psychodynamic way of thinking and it has the potential to be an experience of being deeply heard and understood. In the consultation period the aim is for the therapist to have an experience of the internal world of the patient and the patient an experience of what the therapy will be like. A consultation over a series of meetings may even give the opportunity of developing a patient’s capacity to undertake therapeutic work. It is a complex process that often starts before the patient even enters the room. There are different approaches to the consultation process and some of these are discussed. Given that the psychodynamic consultation is an encounter which will, in all likelihood, create anxiety and a sense of vulnerability in the patient, we can expect to see defences emerging in the moment-by-moment interaction and these are considered. A tripartite structure of psychodynamic formulation is outlined as a helpful framework for picking out the relational dynamic

This chapter describes specific techniques employed in modern day psychodynamic psychotherapy. It commences with a brief outline of the core psychodynamic attitude consisting of relative restraint, ‘anonymity’, and ‘neutrality’ along with helpful tips for the psychotherapist at the start of their career. It then goes on to a section on the importance of unconscious communication which includes a brief instruction on dream interpretation. This is followed by a detailed description on the use of transference and countertransference to elicit relevant object relations; this section includes how to manage ruptures in therapy. There is a description of the spectrum of interventions and techniques used in psychodynamic psychotherapy ranging from the more supportive end of the spectrum through to the more expressive. The chapter concludes with the process of working through and managing resistance. Throughout there are suggestions for how to couch interventions when working with a patient and also clinical vignettes to illustrate key techniques.

This chapter provides an overview of current thinking regarding the supporting theory of psychodynamic psychotherapy. Rather than going through theoretical constructs in historical order of when each theory was proposed, they are presented as a composite of past and present thinking that the authors have found to be clinically relevant. It commences by describing theories on the early development of the infant and the creation of the internal world and object relations. The chapter them moves on to the issue of accommodating to the world as it is experienced by the infant, outlining circumstances leading to adaptive and less adaptive development. The chapter then outlines ‘core theory’ which covers more traditional psychodynamic concepts such as conflict, resistance, and defence mechanisms with an emphasis on projective identification. The role of this latter defence mechanism is linked with the theoretical constructs of transference and countertransference. There is a section on the narcissistic constellation in order to help the reader negotiate later sections in the book. Finally the chapter concludes with an introduction to theories as to how change is effected in psychodynamic psychotherapy.

Staff in the caring professions often have to contain troubling and unpredictable communications (projections) from those they work with. It is usual and expected for staff to have feelings in response to these communications – this is part of the process of emotional containment. If reflected on, the professional’s feelings and inner responses (countertransference) can be a vital source of information about the relational dynamics the service user carries with them and how the staff member is responding to these. However, if staff members do not reflect on and process their countertransference, there is the potential for increased stress for the staff member, and to inadvertently re-enact the patient’s relational difficulties rather than provide containment for them. A reflective practice (RP) group brings a whole clinical team together with the primary task being to reflect on and process staff-patient, teamm and organisational dynamics, to sustain caring relationships with patients and reduce the stresses of the work for staff. This chapter offers an introduction to psychodynamic RP groups, aimed at both participants and group facilitators. We discuss the theory of RP groups and their intended purpose, outline a process of starting a group, and consider what is expected for both participants and facilitators.

Counseling patients through their journey to conceive can be challenging. When a therapist becomes pregnant, the therapeutic alliance alters.This chapter explores the unique dynamics between the pregnant fertility counselor and reproductive clients. Questions around the “who, what, where, when, why and how” of pregnancy disclosure are used as a tool to help think about the various elements to the therapeutic alliance. Intense feelings can be triggered for a patient who is struggling with infertility or pregnancy loss, but can also trigger emotional reactions for the fertility counselor. The transference and countertransference that arises with the self-disclosure of a pregnancy is likely to unfold complicated dynamics and emotions. The positive and negative implications that a pregnancy disclosure can have from the patient’s point of view, as well as that of the therapist, are addressed. Additionally, the postpartum experience and the return back to work after parental leave are also discussed. While this chapter focuses on the pregnant therapist, the issues raised pertain to all pregnant reproductive medical staff treating infertility patients.

In this chapter, the author sets out a unitive way of thinking about the relationship between spirituality, psychiatry and psychotherapy. An introduction to spirituality in mental health care is followed by a discussion of the meaning of ‘spirit’, ‘soul’ and ‘ego’ and how these terms may be understood with reference to ongoing developmental tasks. The poem I AM, written by the nineteenth-century poet John Clare, who suffered from enduring mental illness, is considered in depth from both psychoanalytic and Jungian approaches in order to illustrate different perspectives on Clare’s anguish and spiritual yearning. The evolution of transpersonal psychology, in which Jung’s concepts play an important part, is traced historically, with the increasing recognition of the value of spiritually orientated psychotherapy. The chapter concludes with several case studies by the author, illustrating how a range of soul-centred approaches can readily and helpfully engage with the spiritual reality of the patient.

Referencing the poem I AM by John Clare, who suffered from mental illness. Psychoanalytic and Jungian therapies are compared in order to illustrate different perspectives on Clare’s anguish and spiritual yearning. A brief history of the evolution of transpersonal theory and of spiritually oriented therapeutic approaches is provided, and the chapter concludes with case studies illustrating how soul-centred therapy can readily and helpfully engage with the spiritual reality of the patient.

The chapter describes how to manage ruptures in the therapeutic alliance. It opens by outlining a conceptual model to understand the ruptures and proceeds to consider the ways that ruptures may manifest at different points in psychotherapy. One way to respond to some ruptures in alliance in via enhancing motivation and therefore the technique of Motivational Interviewing is described in detail; outlining the steps of expressing empathy, developing discrepancies (between actual and desired outcomes), avoiding argumentation, rolling with resistance and supporting self-efficacy. The chapter reviews ways to manage the assignment and review of homework exercises so that they are a productive element in clinical psychology practice. The chapter concludes with a close examination of psychotherapeutic process; defining what “process” is, and how to work with transference and countertransference.

Janet Malcolm famously described psychoanalysis as “the impossible profession.” Writing about “The Varieties of Psychoanalytic Experience” is an equally impossible task. Although the discipline of psychoanalysis was founded by Freud, it has altered dramatically since. I have chosen to focus on the following key issues and concepts: transference, countertransference, and intersubjectivity; the shift from oedipal to preoedipal concerns; the transformations wrought by feminism, social and political studies, and continental theory. These converge on questions of psychoanalysis in relation to history and culture, especially in regard to theories of trauma and mourning. In this sense, psychoanalysis (like literature and literary studies) demonstrates its flexibility, variability, and relevance to contemporary life. The very instability of Freud’s narrative method, as demonstrated in his Dora case history, insures its significance and continuity over time.