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A clinical case study of a psychoanalytic psychotherapy monitored with functional neuroimaging

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Erstveröffentlichung
2013-10-23
DOI
10.18725/OPARU-33930
Wissenschaftlicher Artikel


Authors
Buchheim, Anna
Labek, Karin
Walter, Steffen
Viviani, Roberto
Institutions
UKU. Klinik für Psychosomatische Medizin und Psychotherapie
UKU. Klinik für Psychiatrie und Psychotherapie III
Published in
Frontiers in Human Neuroscience ; 7 (2013). - Art.-Nr. 677. - eISSN 1662-5161
Link to original publication
https://www.frontiersin.org/articles/10.3389/fnhum.2013.00677/full
Peer review
ja
Document version
publishedVersion
License
CC BY 3.0 International
Abstract
This case study describes 1 year of the psychoanalytic psychotherapy using clinical data, a standardized instrument of the psychotherapeutic process (Psychotherapy process Q-Set, PQS), and functional neuroimaging (fMRI). A female dysthymic patient with narcissistic traits was assessed at monthly intervals (12 sessions). In the fMRI scans, which took place immediately after therapy hours, the patient looked at pictures of attachment-relevant scenes (from the Adult Attachment Projective Picture System, AAP) divided into two groups: those accompanied by a neutral description, and those accompanied by a description tailored to core conflicts of the patient as assessed in the AAP. Clinically, this patient presented defense mechanisms that influenced the relationship with the therapist and that was characterized by fluctuations of mood that lasted whole days, following a pattern that remained stable during the year of the study. The two modes of functioning associated with the mood shifts strongly affected the interaction with the therapist, whose quality varied accordingly (“easy” and “difficult” hours). The PQS analysis showed the association of “easy” hours with the topic of the involvement in significant relationships and of “difficult hours” with self-distancing, a defensive maneuver common in narcissistic personality structures. In the fMRI data, the modes of functioning visible in the therapy hours were significantly associated with modulation of the signal elicited by personalized attachment-related scenes in the posterior cingulate (p = 0.017 cluster-level, whole-volume corrected). This region has been associated in previous studies to self-distancing from negatively valenced pictures presented during the scan. The present study may provide evidence of the possible involvement of this brain area in spontaneously enacted self-distancing defensive strategies, which may be of relevance in resistant reactions in the course of a psychoanalytic psychotherapy.
Funding information
Deutsche Psychoanalytische Vereinigung
Subject Headings
Funktionelle Kernspintomografie [GND]
Psychoanalyse [GND]
Affektive Bindung [GND]
Psychoanalysis [MeSH]
Magnetic resonance imaging [MeSH]
Single-case studies as topic [MeSH]
Object attachment [MeSH]
Keywords
fMRI; Psychotherapy Process Q-Set; Psychotherapie-Prozess-Q-Sort
Dewey Decimal Group
DDC 150 / Psychology

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Citation example

Buchheim, Anna et al. (2020): A clinical case study of a psychoanalytic psychotherapy monitored with functional neuroimaging. Open Access Repositorium der Universität Ulm. http://dx.doi.org/10.18725/OPARU-33930

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