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Psychodynamic Approaches to Behavioral Change

Fredric N. Busch, M.D.

  • ISBN 978-1-61537-130-3
  • Item #37130

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Psychoanalytic psychotherapies have traditionally considered behavioral change as a secondary outcome, a beneficial byproduct of gaining insight and making the unconscious conscious.

Though clinical evidence suggests that an increasing number of psychoanalysts are targeting behavioral change, strategic frameworks remain scarce. Psychodynamic Approaches to Behavioral Change addresses this deficiency.

This guide demonstrates how, rather than being at odds with psychoanalytic treatments, targeting behavioral change can be part of the development and employment of psychodynamic therapy and can be used to enhance self-understanding. To that end, it offers readers a framework for behavioral change interventions, including:

  • Identifying problematic behaviors
  • Examining the context, affects, and meanings of problematic behaviors
  • Formulating contributing intrapsychic conflicts, defenses, and developmental factors
  • Identifying alternative behaviors
  • Elaborating feelings and fantasies about performing alternative behaviors
  • Addressing factors that interfere with alternative behaviors
  • Working with the impact of behavioral change
  • The use of homework

Clinicians will also find a frank discussion of potential pitfalls in efforts to change behaviors and a description of interventions for sustaining behavioral change, which will help them avoid some of the complex challenges that targeting behavioral change can present, as well as aid them as they work with their patients to maintain new behavior.

Throughout the book, vignettes illustrate how to apply these psychodynamic techniques in the clinical setting as clinician and patient collaborate to make practical changes in the patient's life. And because of its jargon-free tone, Psychodynamic Approaches to Behavioral Change will enable a broad range of mental health professionals—whether psychiatrists, psychologists, social workers, psychiatric nurses, or others—who use a variety of treatments to be more effective in their approach.


  • Preface
  • Chapter 1. Understanding Behavioral Change in Psychoanalytic Treatments
  • Chapter 2. Psychodynamic Understanding of Factors That Impede Behavioral Change
  • Chapter 3. Identifying and Addressing Risks in Targeting Behavioral Change
  • Chapter 4. Using Psychodynamic Techniques in Addressing Behavioral Change
  • Chapter 5. A Framework for Targeting Behavioral Change
  • Chapter 6. Identifying Dynamic Contributors to Problematic Behaviors
  • Chapter 7. Identifying Alternative Behaviors
  • Chapter 8. Identifying Interfering Factors in Performing Alternative Behaviors
  • Chapter 9. Working With Sustaining Behavioral Change and the Response of Others
  • Chapter 10. Engaging the Patient in Addressing Specific Behavioral Problems
  • Chapter 11. Addressing Behavioral Problems Related to Adverse Developmental Experiences and Trauma
  • Index

About the Authors

Fredric N. Busch, M.D., is Clinical Professor of Psychiatry at Weill Cornell Medical College and Lecturer in Psychiatry at the Columbia University Center for Psychoanalytic Training and Research in New York, New York.

This book is terrific! In it, the author addresses the very important issue of how behavioral change, and more specifically, therapist's activities to bring about this behavioral change, is often seen as incompatible with psychodynamic psychotherapy. In his argument that they are NOT incompatible at all, Busch includes: arguments often given by therapists about why this activity is thought be unacceptable; psychodynamic understanding of failures on the part of the patient to bring about behavioral change; special instances difficulties achieving this change (and how to deal with these difficulties); and, specific examples of therapist-patient interactions. This book should be required reading by all students and practitioners of psychodynamic psychotherapy, (indeed, of any kind of psychotherapy) both young and old.—Elizabeth L. Auchincloss, M.D., Vice chair, Education, Department of Psychiatry, Cornell University Medical College, Training and Supervising Psychoanalyst, Columbia University Center for Psychoanalytic Training and Research

Fredric Busch discusses the tension between attempts to change behavior and psychodynamic approaches to understanding and treating its psychologic underpinnings. Historically, psychodynamic treatments aimed at insight, while direct attempts to modify behavior were seen as inconsistent and even contradictory. Busch challenges this view, and demonstrates the many possibilities for synergistic interaction between the approaches. He illustrates his views with clinical vignettes, and offers rich guidance for practicing psychotherapists.—Robert Michels, M.D., Walsh McDermott University Professor of Medicine and Psychiatry, Cornell University

It takes courage to bring opposites together. It takes a remarkable intellect to align them. It takes brilliance to make such integration an entertaining as well a scholarly read. Fredric Busch's tour de force represents a substantial creative enlargement of our field—one which will be considered a seminal contribution to the broadening vision of the contemporary psychoanalytic process.—Peter Fonagy, OBE, FMedSci, FBA, FAcSS, Ph.D., Dip.Psy., Professor of Contemporary Psychoanalysis and Developmental Science and Head of the Division of Psychology and Language Sciences, University College, London; Director, UCLPartners Integrated Mental Health Programme; Chief Executive, Anna Freud National Centre for Children & Families

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