Psychodynamic Psychotherapy
Feeling Unreal June 22, 2023 DOI: 10.1093/oso/9780197622445.003.0013 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Key points | The chapter argues that depersonalization/derealization disorder can be understood and treated through psychodynamic psychotherapy, linking un-reality experiences to early development, childhood emotional maltreatment, fearful attachment, fear of knowing, alexithymia, and affect phobia, and proposes an integrated psychodynamic treatment model that also addresses adolescent identity struggles, depersonalization-related worrying and obsessing, and drug-induced presentations. |
Abstract
Abstract The chapter elaborates psychodynamic psychotherapy approaches to the treatment of depersonalization/derealization disorder (DDD), intertwined with illustrative case examples. The chapter starts with more classic psychoanalytic reflections on the nature and treatment of depersonalization/derealization, including the often-assumed chronicity and refractoriness of the condition, the use of the couch, and the implications of different levels of personality organization. Compromised self-experiencing, escape from reality, and loss of genuine personhood are explored as phenomena underlying experiences of un-reality and de-personalization, starting with early development. The impacts of childhood trauma, in particular emotional maltreatment, as well as fearful attachment, are discussed, along with psychic processes organized around the fear of knowing and diminished emotional processing. The ways in which alexithymia and affect phobia unfold, and are worked with, in dynamic psychotherapy are laid out. Identity struggles of adolescence and early adulthood, commonly encountered in DDD, are elaborated. Depersonalization-related worrying and obsessing may have dynamic functions and meanings that are worth psychotherapeutic exploration. Psychodynamic entry points to tackling drug-induced presentations are put forth. The chapter concludes with an integrated model for the psychodynamic therapy of DDD.