Psychodynamic Treatment of a Case of Grief Superimposed on Melancholia

Abstract

In this case study, a chronically depressed, middle-aged woman is widowed, exacerbating her depression and anxiety. The case is treated from a psychodynamic perspective, with the classical psychoanalytic conceptualization of complicated mourning and melancholia accounting for the patient's symptom profile. Therapy itself involves the extensive provision of empathy and attunement as well as exploration of feelings in the transference and countertransference. Deeply entrenched and refractory symptoms justify the provision of 2 years of psychotherapy, which allowed the patient the time to uncover unacceptable emotions, learn about how she disowned them, and reintegrate them so as to strengthen ego functioning. The process of self-understanding and reexperiencing in the transference enabled the patient to regain energy and enjoyment in her activities and set her on the path to resuming former functioning.

Keywords

grief melancholy mourning (in adults)depressive position reactive depression endogenous depression.

Get full access to this article

View all access options for this article.

References

Abraham, K. (1927). Notes on the psycho-analytic investigation and treatment of manic-depressive insanity and allied conditions. In Selected papers on psychoanalysis (pp. 137-156). London: Hogarth Press and the Institute of Psychoanalysis. (Original work published 1911)

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .

Bibring, E. (1953). The mechanism of depression. In P. Greenacre (Ed.), Affective disorders. New York: International Universities Press.

Bromberg, P. (1989). The mirror and the mask: On narcissism and psychoanalytic growth. In A. P. Morrison (Ed.), Essential papers on narcissism. New York: New York Universities Press.

Chessick, R.D. (1991). The technique and practice of intensive psychotherapy . Northvale, NJ: Jason Aronson.

Freud, S. (1913). Remembering, repeating and working through (further recommendations on the technique of psychoanalysis). Standard Edition, 12, 145-156.

Freud, S. (1917). Mourning and melancholia. Standard Edition, 14, 237-260.

Freud, S. (1933). New introductory lectures on psychoanalysis, XXXII: Anxiety and instinctual life. Standard Edition, 22, 81-112.

Fromm-Reichman, F. (1950). Principles of intensive psychotherapy. Chicago: University of Chicago Press.

10.

Greenson, R. (1959). Phobia, anxiety, and depression. Journal of American Psychoanalytic Association, 7, 663-674.

11.

Kernberg, O. (1989). Factors in the psychoanalytic treatment of narcissistic personalities. In A. P. Morrison (Ed.), Essential papers on narcissism. New York : New York Universities Press.

12.

Klein, M. (1975). A contribution to the psychogenesis of manic-depressive states. In Writings: Love, guilt and reparation and other works (Vol. 1). London: Hogarth Press. (Original work published 1934)

13.

Rado, S. (1928). The problem of melancholia. International Journal of Psycho-analysis, 9, 420-438.

14.

Schafer, R. (1954). Psychoanalytic interpretation in rorschach testing . New York: Grune & Stratton .

15.

Winnicott, D.W. (1965). The maturational processes and the facilitating environment. New York: International Universities Press.