An investigation into the therapeutic dynamic of depressive states

Abstract

Through a historical survey of the psychoanalytical reflection on depression the author shows how, after the first works by Freud and Abraham on the topic, it has developed (at least at an implicit level) according to two basic explanatory orientations. By separative orientation, the therapeutic evolution of depression aims at the substantial abandonment of the investment (already impaired by affective ambivalence) in certain objects, or their internal representatives/derivatives, having high narcissistic value. According to restorative orientation, the overcoming of depression is connected, instead, to the possibility of maintaining or re-establishing that investment, at least at a level of internal derivatives. By referring to one of his clinical treatments, the author underlines the greater significance of the separative orientation, together with the necessity of considering the restorative dimension only as a partial and secondary function of the therapeutic dynamic of depression.

Keywords:

• research
• depression
• therapy
• mourning
• identification

Notes

¹The presence of a conflict due to ambivalence in the mourning leads to pathological mourning (with obsessional self-reproaches), which remains distinct from the melancholic state, connected with narcissistic regression.

²I think that it would have been very difficult in any case for the patient to cope, in a single lapse of time, with a radical internal reassessment of the two most important relationships of her life.

³We can refer in this regard to the considerations by Ferenczi (1930) on the relaxation principle.