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Sadness and Loss: Toward a Neurobiopsychosocial Model

American Journal of Psychiatry , Volume 164 (1): 28 – Jan 1, 2007


Am Psychiatric Assoc
Copyright © 2007 American Psychiatric Association. All rights reserved.
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Sadness and Loss: Toward a Neurobiopsychosocial Model


A previously untreated 25-year-old female graduate student with masochistic traits but no axis I or II disorder entered twice-weekly psychodynamic psychotherapy with a stated goal of ending an abusive romantic relationship with a colleague. In the early months, sessions were filled with the patient’s childhood memories of emotional mistreatment by her parents, whose constant fighting left her feeling abandoned and terrified. She contrasted these memories with loving memories of her grandmother, in whose nearby house she recalled afternoons of calm play, cookies, and attentive nurturance. The patient’s grandmother was elderly when treatment began, and in the fourth month of treatment she became unexpectedly ill. The patient visited her daily and was with her when she died. The patient then entered a period of grief, spending much of each day thinking about her grandmother. However, she continued to be productive at work, did not develop a major depressive episode, and retained the capacity for pleasure and socialization. Therapy sessions followed a pattern: the patient would arrive in a euthymic state and begin to talk about her grandmother. The therapist responded with supportive clarification and mirroring, using phrases such as "you really loved her" or "she was the one who
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