Psychodynamic Theory and Approaches to Depression

Over the last 30 years, several disorder-focused psychodynamic psychotherapies have been developed to directly address specific problem areas. This chapter will describe depression-focused psychodynamic psychotherapy as one form of these interventions. Consistent with these approaches, the chapter will describe a core psychodynamic formulation for depression, including particular self and other representations, intrapsychic conflicts, and defenses. The formulation posits a core vulnerability that can lead to vicious cycles involving (1) angry reactions to narcissistic injury and (2) a compensatory idealization that then triggers subsequent intense disappointment in self and others. The chapter will then provide an overview of how to address these vulnerabilities using psychodynamic techniques modified for treatment of depressive symptoms.