Revisiting psychoanalytic psychotherapy in the treatment of manic-depression: The case of an older adult woman with manic-depressive disorder

Since the proliferation of psychotropic medications, the usefulness of outpatient psychotherapy has been neglected in the treatment and research of persons suffering with manic-depressive disorders. High relapse rates, poor response, and persistent life problems of manic-depressive persons relying solely upon medication treatment calls for the adjunctive use of outpatient psychotherapy to augment stability in the lives of those who experience this disorder.;Literature reviewed outside the realm of medication treatment from cognitive-behavioral and contemporary psychoanalytic theories was sparse. However, literature reviewed from early psychoanalytic theory examines and applies the theory to outpatient treatment of manic-depressive patients. The author contends that psychoanalytically oriented psychotherapy with medication is an efficacious form of treatment, and presents the case of an older adult woman with manic-depressive disorder to demonstrate the benefits of this kind of combined treatment. Despite the patient's chronic history of manic-depression, three sources of data collected independently (former therapist, current therapist, past and follow-up psychological testing data) showed improvement in her psychosocial and intellectual functioning across two-and-a-half years of outpatient psychotherapy treatment with three different therapists.;The author analyzed the transcripts of therapy sessions, records, psychological testing results, and follow-up interviews with the patient and her current therapist. The analysis focused upon the patient's (1) perception of self, (2) perception of others and functioning within interpersonal relationships, (3) daily functioning, and (4) mental status. Transference-countertransference issues were also analyzed. The author connects these analyses with psychoanalytic theory and addresses the following questions: what function did psychotherapy play; how did it help the patient beyond her medication treatment; what role did psychoanalytic theory play in this case study; and what aspects of the theory best accounted for her improvement?;The findings showed that outpatient psychotherapy provided stability and evidence of some restructuring of the patient's personality. The author urges further research and attention to combined psychoanalytic therapy and medication treatment of manic-depressive disorders.