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Contemporary Psychodynamic Psychotherapy for Children and Adolescents Contemporary Psychodynamic Psychotherapy for Children and Adolescents Integrating Intersubjectivity and Neuroscience Sergio V. Delgado Je rey R. Strawn Ernest V. Pedapati 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 Sergio V. Delgado, MD Ernest V. Pedapati, MD, MS Division of Psychiatry Division of Psychiatry and Child Psychiatry and Child Psychiatry Cincinnati Children’s Hospital Division of Child Neurology Medical Center Cincinnati Children’s Hospital Cincinnati , OH Medical Center USA Cincinnati , OH USA Jeffrey R. Strawn, MD Department of Psychiatry and Behavioral Neuroscience University of Cincinnati Cincinnati , OH USA ISBN 978-3-642-40519-8 ISBN 978-3-642-40520-4 (eBook) DOI 10.1007/978-3-642-40520-4 Springer Heidelberg New York Dordrecht London 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, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms 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 specifi cally 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 specifi c 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 Springer is part of Springer Science+Business Media (www.springer.com) To my patients and students —SVD To Elliott Nicole and Rachel Marie — JRS To Carolyn, Noah, and Harrison — EVP v 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 fi rst volume, Diffi cult 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 fi gures 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 clarifi ed and explained and their therapeutic applications demonstrated, in the writing of these authors. When you put your own subjectivity fi rmly on the playing fi eld, 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 fl exibility, and internal working models of attachment. As noted by the authors, vii viii 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 fl ows 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 refl ecting 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 refl ect 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
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