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Smolar, A.I. (2020). Epilogue: Psychoanalysis Combined with Other Modalities. Psychoanal. Inq., 40(6):461-462.

(2020). Psychoanalytic Inquiry, 40(6):461-462

Epilogue: Psychoanalysis Combined with Other Modalities

Andrew I. Smolar, M. D.

We would all agree, I think, that there is some variation in stance among the different psychoanalytic perspectives represented in this issue. Some of the authors work relationally, while some work more classically. However, notwithstanding this range of stances, and the diversity of clinical circumstances that are described, all of the authors take up instances in which their customary dyadic stance proves to be insufficient to move their patients forward. It seems that there are two common threads that move therapists toward the use of “non-traditional” modalities to supplement their psychodynamic scaffolding. One factor is the consideration of the body, through which many of the patients feel hyper-stimulated, restricted, dysregulated, or tortured; the other is the source of their psychic injuries, which under the nuanced eye of the dynamic therapist, turns out to be early in their psychological developments. Sometimes, however, it turns out to be so early in development that it precedes the child’s elaborate use of words but is encoded in her body (Van der Kolk, 2014), or has so influenced the child’s primary attachment relationship (usually with mother) that it encroaches on the feeling of safety (with the therapist) necessary for the establishment of the therapeutic alliance.

The implications for technique are serious. For one, the seemingly trusting, verbal, motivated patient may seem appropriate for in-depth treatment, when she actually may have been coerced into compliance by early injurious caretakers, setting up a dangerous alliance.

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