Integrative Psychotherapy and Coping With Psychopathological Syndromes: Dilemmas Around the Treatment of a Patient With Resistant Trichotillomania

The clinical case presented herein addresses the following 2 key issues: (1) the meaning and consequences of bypassing a major symptom or syndrome in a patient’s treatment to facilitate development and growth in other dimensions of her life that were being hindered due to their interrelations with the symptom; and (2) the therapeutic impact of incorporating strategic, cognitive, and behavioral interventions into a relational psychodynamic psychotherapy modeled on Wachtel’s (1997) cyclical psychodynamics theory. The primary distress, symptoms, personal, and family background of the patient are outlined, followed by a description of the psychodynamic formulation and detailed clinical considerations lying behind the adoption of a cyclical integrative therapeutic plan. The treatment plan comprised strategic intervention, interpretative work around the psychodynamic formulation, cognitive challenging, augmenting self-esteem, reinforcing active and independent behaviors, with a focus on the therapeutic effects of therapeutic alliance, and corrective experiences. The discussion, outcomes, and conclusions sections demonstrate the importance of adopting creative, flexible, and integrative attitudes when working with patients suffering from defined complex symptoms among other complaints and distresses.