Treatment for drug-induced depression usually consists of cessation or reduction of the causative agent and psychopharmacologic management. In addition, psychotherapy can be useful as an adjunctive treatment. The author presents case material related to a young woman with an inborn physical illness, who became depressed during the course of interferon treatment for a medical complication, hepatitis virus infection. In addition to the cessation of interferon and pharmacologic management, supportive psychotherapy of a psychodynamic orientation was started in order to address the patient's low self-esteem and anxiety about her future. During the course of psychotherapy, it was understood that the premature cessation of interferon was, to her, a narcissistic injury. It was also important to explore the meanings of her inborn illness and her guilty feelings. After reviewing various formulations of depression, the author discusses the case material from an integrative perspective, which describes vicious cycles of depression.
The relationship between psychoanalytic theory and psychoanalytic practice is highly complicated. In this paper, the author presents case material from the psychoanalysis of a man with social anxiety. In the process, the analyst came to be perceived as a version of a blank screen. At the same time, the analyst noted a discrepancy between the patient's attitude on and off the couch. Further work revealed that this splitting in his attitude had its root in the patient's relationship with his parents during his childhood. It was crucially important that the analyst did not take his perceived blankness as a technical success but that he understood the patient's reaction contextually, taking his past relationships with his parents into consideration. The author then discusses theoretical issues related to the blank screen concept. Finally, the author discusses the importance of understanding the two aspects of analytic theorizing, that is, the prescriptive and descriptive aspects.
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