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Friedman, R.C. (2014). Editorial Comment on “Therapeutic Interaction with an Older Personality Disordered Patient”. Psychodyn. Psych., 42(2):173-174.

(2014). Psychodynamic Psychiatry, 42(2):173-174

Editorial Comment on “Therapeutic Interaction with an Older Personality Disordered Patient” Related Papers

Richard C. Friedman, M.D.

The psychodynamically oriented community is indebted to this research group for carrying out a labor intensive “n of 1” prospective investigation of an older woman with multiple diagnoses. Most clinicians do not do research and might be somewhat startled to learn how much effort was put into this investigation. A segment of intensive psychotherapy lasting for eight years was tape-recorded and transcribed. Transcription is arduous and the labor was provided by valiant graduate students as is so often the case. Time-series analysis is a sophisticated assessment approach and a team consisting of an advanced graduate student and supervisor were necessary to carry out this effort.

Clinical work in itself is demanding and requires a high level of skill and substantial experience. Whole programs at a graduate and postgraduate level are devoted primarily to the theory and practice of clinical therapeutics and other programs to research. Integrating both in a single article involves conceptual complexity and seamless teamwork.

A few points about the clinical and research issues discussed in this article require commentary. The patient Ms. Q falls into a category well known to psychotherapists, but as the authors note, little researched: an older woman who is not psychotic, does not live in an institution, works, but has suffered from chronic mental illness and has required intensive psychodynamic psychotherapy for much of her adult life. Ms. Q therefore is unlike patients who profit from manual-based short-term interventions such as Cognitive Behavior Therapy (CBT), for example. Interestingly patients with similar cross-sectional psychopathological profiles may in fact do well (for a time) as a result of such focused interventions. It is clear however, that what might be called “Ms. Q's total self-circumstances,” her personality, the sum and substance of everything that contributed to her unique self-identity, made a “quick fix” approach impossible.

[This is a summary excerpt from the full text of the journal article. The full text of the document is available to journal subscribers on the publisher's website here.]

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