Use of a psychodynamic life narrative in the treatment of depression in the physically ill.

Overview

Depression, unlike grief, is a maladaptive response to the crisis of illness. This crisis has certain characteristics: (a) psychic disequilibrium with confusion and uncertainty; (b) regression with intensified transferences; and (c) a tendency to examine the trajectory of one's life. This situation makes the patient not only more vulnerable but also more responsive to intervention. These characteristic reactions of illness can be considered in designing a therapeutic maneuver to treat depression. Three cases are used for illustration. In each case a depressed patient was presented a statement that placed his physical illness in the context of his life trajectory and demonstrated the psychodynamic logic of his depression. We call this intervention a "psychodynamic life narrative." The therapeutic effect of such a narrative and the type of patient most likely to benefit from such an intervention are discussed.