PSZICHOTERÁPIA
A professional journal of practice based on psychotherapeutic methods
A quarterly publication
33rd year, issue 2, May 2024.
Content
Editorial
Henrietta Benkő, Dániel Vattay
STUDIES
Methodological study
Krisztina Csáky-Pallavicini: Self and object on the same stage – perspectives and characteristics of transference-focused psychodrama psychotherapy
Case study
Eszter Hanvay: Broken tiny windows – Details of a therapeutic process with a patient characterized by secondary structural dissociation
Case study
Richárd Flach: Possibilities and limits. Presentation and analysis of the role of an institutional psychologist in the suicide crisis management of an adult student in a dormitory
WORKSHOP
Workshop study
István Ormay: On the international and Hungarian history of active analysis
Comment
Judit Lendvay: A Hungarian psychoanalyst living in the USA visits Psytopia – comment on András Holló’s essay
András Holló: Short reflection on the comments
Zsanett Kepics: Wondering in Psytopia – the end of the road
PROFESSIONAL LIFE
Back to school
Psychotherapy training program in Tündérhegy – Dániel Eörsi, Krisztina Pál
Debates, comments
Ethical dilemmas in therapeutic practice 44.: Márta Kreidl ♦ József Krékits ♦ Ádám Borbély
News
Summary of the Psychotherapy Council Association’s delegates meeting
Changes in the Professional Colleges
Reviews
Conferences – Zsanett Kepics ♦ Zsanett Kepics ♦ Marita Ardai-Punczman
Book reviews – Kinga Farkas
List of professional books and periodicals
Professional programs
Editorial announcements
STUDIES
METHODOLOGICAL STUDY
Krisztina Csáky-Pallavicini
Self and object on the same stage – perspectives and characteristics of transference-focused psychodrama psychotherapy
Transference-focused psychodrama integrates psychodrama with the concept of dyads and primitive coping mechanisms. It works with scenes of therapeutic relationship on the stage of shared imagination: with dyads and patterns of object-relations – relationships to internal object-representations that are manifested in external relationships and in the transference to the therapist. In this paper, the author summarizes some of the concepts underlying TFP-oriented psychodrama. It uses case studies to illustrate how psychodrama works and compares the concepts and working methods of psychodrama and TFP. It shows how conflicting representations of self and object can be used on the psychodramatic stage. How working with dyads on the stage – a feature of transference-focused psychodrama – is achieved. This technique enables the therapist to set the content projected onto him on stage. The study points out the differences in working with borderline and neurotic personality disorder patients in terms of the possibilities of using each technique. In the case of patients with identity diffusion, scene building, doubling, and mirroring techniques – rather than role reversal – play a significant role. Psychodrama can be combined well with TFP both in group settings and in individual therapy. The paper also discusses, through case examples, how transference-focused psychodrama helps to understand group processes, which can also be staged and managed. We’re given a taste of working with dyads, how active and averted dyads can be juxtaposed on stage. Keeping up with the rapid alternation of dyads is a challenge in scene building. Yet the advantage of psychodramatic work is that the alternating active self and object parts are present on stage at the same time – thus the avoidance of splitting is systematically resolved. The patient’s „reality” is completed, expanded.
Keywords: psychodrama – transference-focused therapy – object relations – borderline – diad
CASE STUDY
Eszter Hanvay
Broken tiny windows – Details of a therapeutic process with a patient characterized by secondary structural dissociation
This paper presents some important moments of the four-year therapy of a female patient who experienced complex childhood traumatization. The treatment was conducted in the framework of Van der Hart’s structural dissociation model. Trauma survivors often do not show the classic symptoms of PTSD, which, together with the frequent amnestic barrier, makes it difficult to diagnose and treat. Due to the heterogeneity of the symptomatic picture, patients often receive a diagnosis that does not express – in fact, rather hides – the origin of the trauma, or several seemingly independent comorbid diagnoses dominate the symptom picture. Anna suffers from secondary structural dissociation. Her symptoms, initially presenting mainly as phobic and generalized anxiety, became etiologically and diagnostically meaningful with the exploration of her life history, and by the realization that her symptoms stem from the unprocessed traumatic past and the unintegrated functioning of the parts of the personality. We worked in altered states of consciousness, with integrative psychotherapy methods: mainly with KIP and ego-state techniques, in accordance with the professional guidelines for the therapy of complex traumatization. The case study is introduced by a brief description of the trauma-related structural dissociation model.
Keywords: complex trauma – structural dissociation – integrative psychotherapy – KIP – ego-state
CASE STUDY
Richárd Flach
Possibilities and limits. Presentation and analysis of the role of an institutional psychologist in the suicide crisis management of an adult student in a dormitory
This methodological study presents the details of school psychology counseling with an adult, student client, taking place within the framework of a dormitory, with an emphasis on the prevention of suicidal behavior and the role of institutional psychology in suicide prevention. Among the intervention areas of school psychologists, the treatment of suicidal cases stands out. These are events associated with significant emotional stress, which present the specialist with many dilemmas, since despite the abundant prevention background material, there is no protocol developed for the school situation that also would assign the related responsibilities to the appropriate professionals. The study presents the epidemiological aspects of self-destruction in adolescence and young adulthood, the main characteristics and competence limits related to working as a school psychology counsellor in such cases, and considerations related to suicide prevention. Later, I describe a case of suicidal case from a school psychologist’s practice, focusing on the circumstances of referral, condition recognition, relationship building and suicide prevention steps. Initially, the focus of counselling with the client was the development of individual coping strategies, career choice, time management, stress management, and the development of an agenda that would support learning, which are well-defined competencies in school psychology practice. At the same time, the client’s increasing self-harm, emotional lability and fear of abandonment were prioritized for crisis intervention and psychiatric examination. In connection with this, I bring up the difficulties of loneliness, uncertainty and workload of a school psychologist in a dormitory, emphasizing the professional dilemmas caused by the practice of school psychology counseling and suicide crisis management. Despite the challenges, I try to enforce the principle of expected care in the case of the client, since I manage to delegate them to an appropriate level of care. At the end of the study, you can read recommendations and suggestions for the elements of a possible suicide prevention model adapted for the work of school psychologists.
Keywords: suicide crisis – school psychology – school counseling – suicide prevention – school mental health
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