Mental health articles

Psychodynamic Interventions
Whatever techniques one uses, the treatment of anxious and depressed students
benefi ts from psychodynamic insights, as we’ve already seen in connection with
analyzing transference and countertransference phenomena. Another key psychodynamic
insight is the importance of identifying and resolving patients’
resistance to change (Greenson, 1967), and in a larger sense taking into account
patients’ personality style. (In a similar vein, recent CBT writings focus on
“maximizing readiness for change” [Sperry, 1999] and the importance of treating
comorbid personality disorders [Beck, 2005].) And so, before we reassign
homework tasks that a student hasn’t completed, fi rst we should explore what
may be getting in the way, or why he or she isn’t complying. Does the student
equate the therapist’s involvement with smothering, hectoring, or impossible-toplease
parents? Does the student sit back and wait for the therapist to magically
wave a wand? Does the student mistrust the therapist? Is the student afraid of
change and of giving up the miserable safety of the status quo? Th e possibilities are many. Once the reasons for resistance are discovered and brought out into
the open, the student may respond to behavioral and cognitive interventions.
Th e psychodynamic perspective also sensitizes us to the “how” of resistance,
which is closely associated with personality style. Does a student
“Forget” assignments?
Get too easily discouraged?
Argue and nitpick?
Make a joke of problems?
Get lost in confusing details?
Shift the focus of attention?
Prefer to blame others?
Prefer to wallow in self-blame?
Come late or miss sessions?
Here too, it oft en helps to point out the pattern: “Have you noticed that
whenever I ask about your actions during the week, you bring up some other
topic, like right now when you started to criticize your roommate? For some
reason it seems diffi cult for you to focus on your own behavior.”
Of course, students won’t necessarily like hearing about their opposition
to change. A nonjudgmental, sensitive manner when pointing out resistances
protects the therapeutic relationship and makes it clear that we’re not blaming
or grading our patients: “I’m sure there are reasons why you keep coming
late, and it would be good for us to discover them.” Sometimes it’s wise not to
mention resistances at all, since doing so may only elicit more resistance. But
even when we say nothing about it, gauging the strength of resistance helps us
determine when to press ahead with interventions and when to ease up with
them. In the face of strong opposition to change, the best course may be to sit
back and empathically listen for a while, leaving it to the student to later take
the lead in altering behaviors and ways of thinking.
Beyond exploring the hidden sources of resistance, the various psychodynamic
perspectives also mine unacknowledged feelings and motives in general.
Th is emphasis is of particular relevance to depressed and anxious students, who
oft en give the impression of not knowing their inner lives, and not wanting to
know. Th us, deferential and exaggeratedly nice students may be out of touch
with their forceful and aggressive impulses; hypermasculine students may be
out of touch with either tender or homoerotic feelings; and hyperrational students
may be out of touch with feelings of any stripe. For all such self-deceivers,
stifl ing taboo feelings is a no-win proposition, leaving them feeling depleted
when their defenses work well and anxious when their defenses threaten to
break down. It follows that helping students recognize and accept underlying
feelings is central to the treatment of depression and anxiety. And while all
therapies strive to accomplish this goal, the psychodynamic approach, with
its historical stress on unconscious phenomena, especially tunes into missingaspects in patients’ presentations, what they can’t or won’t allow themselves to
say or fully experience.
Finally, the psychodynamic approach, especially traditional psychoanalysis,
famously looks to the past and especially early family relationships to understand
current mood and anxiety symptoms. Here college clinicians need to
exercise their judgment. On the one hand, the short-term model used at most
campus clinics precludes taking a painstaking history, and delving deep into
early life events is probably developmentally inappropriate for present- and
future-oriented young people. On the other hand, many depressed and anxious
students have been damaged by earlier experiences—neglect or loss;
emotional, physical, or sexual abuse; parental substance abuse or emotional
illness; teasing or bullying at school—and with this pain oft en comes a strong
need to tell their story. Disclosing hurtful experiences to an accepting and
affi rming adult can bring catharsis, perspective, hope, and resolve. Without
an opportunity to unburden themselves and make sense of their pasts, some
students will feel held back from tackling current problems.