Table of Contents
Preface ix
Acknowledgments xii
Introduction: A Historical Context of ADHD: From Moral Indictment to Compassion xv
Chapter Highlights xxix
1 A Psychodynamic Understanding of ADHD Symptoms: Engendering Compassion 1
Neurological Perspectives on ADHD 3
Neurological Determinants 4
Neurological and Neurocognitive Models of ADHD Etiology 10
Psychodynamic Views on Neurological Determinants 12
The Psychodynamic Perspective on ADHD 13
Psychodynamic Determinants 15
Environmental Determinants 15
Intrapsychic Determinants 20
Summary 30
Chapter Highlights 31
Neurological Perspective on ADHD 31
The Psychodynamic Perspective on ADHD 32
2 Psychodynamic Psychotherapy: A Compassionate Treatment Approach 35
The Ego Developmental Model 37
Ego Psychology 37
Relational Models of Self-Development 43
The Interpersonal Approach 43
The Work of Melanie Klein 47
The Work of Donald Winnicott 51
The Work of Wilfred Bion 53
Summary 55
Chapter Highlights 56
The Ego Developmental Model 57
Relational Models of Self Development 58
3 Psychodynamic Psychotherapy Interventions 59
The Psychoanalytic Framework 59
The Psychodynamic Therapist's Disposition 60
Ego Psychology Interventions 62
Ego Defense 63
Integration of Immature Wishes into Ego Functions 65
The Therapist as an Auxiliary Ego 68
Relational Interventions 69
Understanding and Developing a Relationship with the Child 69
Holding and Containing Difficult Affective Experiences 70
Countertransference 71
The Narrative Approach 72
Joint Attention 72
Play Therapy: Psychodynamic Supportive Expressive Play Psychotherapy 74
Other Psychodynamic Techniques 74
An Integrative Model for Addressing Ego-Id and Ego-Superego Difficulties 75
Technique: Developing the Child's Capacity to Mentalize/Self-Reflect 78
Case Vignettes: A Note on Methodology 80
A Psychodynamic Theoretical Perspective on Change 83
Summary 91
Chapter Highlights 91
4 Psychodynamic Psychotherapy of ADHD: Treatment Guidelines 95
An Integrated Psychodynamic Model of Treatment 96
Initial Phase Of Treatment 99
Developing a Therapeutic Relationship 99
Emergence 101
Inter subjective Space (The Coming Together) 102
The Use of Empathy to Develop a Therapeutic Alliance 103
When to Talk about the Child's Presenting Problems 104
Engaging with Parents and Teachers 104
Treatment Formulation 105
Understanding the Child's Difficulties 105
Identifying Dynamic Issues 105
Treatment Phase 106
Interventions for Ego-Id Problems 106
Interventions for Ego-Superego Problems 109
Chapter Highlights 115
5 Behavioral and Other Approaches: Behavioral Therapy, Cognitive Behavioral Therapy, and Parent and School Interventions 117
Behavioral and Cognitive Behavioral Perspectives on ADHD 118
Cognitive Behavioral Therapy 118
Behavioral Approaches 121
What Do Psychodynamic Psychoanalysts Think about Behavioral Approaches? 125
A Psychodynamic Approach to Parenting and School Interventions 126
Parenting and Family Dynamics 126
Parent intervention 128
School Intervention 134
Summary 135
Chapter Highlights 136
Cognitive Behavioral Approach (CBT) 136
Behavioral Approaches 137
Psychodynamic Approach to Parenting and School Interventions 137
Epilogue 139
The Moral Indictment of ADHD Children 140
Economic Factors 140
Cultural Factors 141
Cultivating Compassion for the ADHD Child 145
A Social Construction View 145
A Vision for All Children 148
Conclusion 149
Bibliography 151
Index 169
About the Author 177