The Role of Psychoeducation in Psychodynamic Psychotherapy

Psychoanalysts have generally avoided discussion of psychoeducational interventions in the context of psychodynamic psychotherapy, despite education being a component of many psychoanalytic techniques. This wariness stems from Freud's early concerns about interventions that could be deemed "suggestion," and a misunderstanding of various aspects of neutrality, including viewing psychoeducational comments as over-gratifying or siding with the ego. Although potential pitfalls exist, the authors review clinical evidence and research that indicate the value of psychoeducational approaches for engaging patients in psychodynamic psychotherapy, considering alternative treatments, providing a psychodynamic formulation, and enhancing the therapeutic alliance. In this context there has been increasing inclusion of psychoeducational interventions in clinical descriptions and manuals of psychodynamic psychotherapy. Various aspects of psychoeducation are described, including education about the patient's problems, how the treatment works, how the mind works, relevant information from other areas of psychology and neuroscience, and how the world works. A case example is provided that further demonstrates the value of psychoeducation in the clinical setting.

The Solving Problems in Everyday Living Model: Toward a Demedicalized, Education-Based Approach to “Mental Health”

We argue that human existential pain and threat may usefully be helped by a noncoercive educational approach that also resonates with many interpersonally focused psychological approaches, rather than by the widely touted current medical model of “mental health” treatment (using psychoactive drugs and supportive psychotherapy). First, the “progress” leading to the latest Diagnostic and Statistical Manual of Mental Disorders is briefly reviewed, highlighting the scientific limitations of the medical model. Next, an educational model of self-understanding and change, based on Popper’s fallibilism, Freire’s critical pedagogy, and Miller’s feedback-informed treatment is explicated. Finally, some options for funding and testing the model are discussed. We hope this offers mental health clinicians another important alternative to conceptualize the helping encounter to ameliorate personal problems in living.

On men crying: Lear's agony

King Lear vowed that because he was a man he would rather go mad or die than weep. Many adult male patients in psychoanalysis have just such an internal prohibition against crying, learned individually and often culturally encouraged, a prohibition that affects their ability to process loss, maintain intimacy, and accept vulnerability. It is suggested that the appropriate psychoanalytic role with these patients is to recognize and actively address this culturally supported prohibition. In addition, it is proposed that the prohibition against men crying may be a consequence of male envy of maternal traits and other feminine characteristics. Further, it is suggested that the developmental theory that the male child must "disidentify" with the mother memorializes a phallicism that often invokes the prohibition against crying in men and is itself mistaken.

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.