When Freud invented/discovered psychoanalysis, he devised not just a theory of mind but also a tool that enabled him to observe the "mind." And with the tool of psychoanalysis, he was able to observe the workings of the default mode network (DMN) some hundred years before anyone knew of its existence. Since then, various operations of the DMN have been identified. One is the integration of perception into memory through the process of functional connectivity. In posttraumatic stress disorder (PTSD) there is significant pathology in functional connectivity involving multiple brain networks-especially the DMN and the intrinsic alarm system. This article addresses the causes and consequences of this pathophysiology as it relates to the sense of time, safety, and story in PTSD.
Recent clinical trials have suggested the safety and efficacy of psychedelic therapy for treatment-resistant depression, posttraumatic stress disorder, addiction, and end-of-life distress. While neurobiological mechanisms such as 5-HT2A receptor activation, increased neural entropy, and default mode network modulation have been well-characterized, significantly less attention has been given to the emergence of unconscious material within psychedelic states. This article introduces a psychodynamically informed framework for understanding and working with such material in clinical contexts. Drawing on psychoanalytic theory, we explore how psychedelic compounds may facilitate access to preverbal, dissociated, and developmentally embedded psychic content, often expressed through somatic experience, symbolic imagery, and unconstrained affect. Using the four standard phases of psychedelic screening, preparation, psychedelic treatment session, and follow-up or integration, we present a structured psychodynamic lens, integrating conceptual theory with illustrative clinical vignettes. These fictional composites, informed by publicly funded clinical research programs, highlight how unspoken experience, affective intensity, and shifts in psychic structure may unfold within the psychedelic experience. We argue that consideration of unconscious communication, symbolic processes, and defensive functioning can foster greater clinical depth. This article advances the position that psychoanalytic models, though underrepresented in current psychedelic research, offer valuable tools for conceptualizing mechanisms of change beyond symptom reduction. As psychedelic treatments approach regulatory approval and broader clinical use, such perspectives may play an important role in future research, training, supervision, and individualized care models.
Maternal-infant early bonding, a robust precursor for later healthy infant development, may be jeopardized by maternal early exposures to adverse experiences (ACEs). Both psychological and biological aspects of maternal functioning have been identified as potential putative mechanisms for the deleterious effects of ACEs on maternal-infant bonding, but research has rarely included both in mediation testing, limiting our understanding of the relative contributions of each. We prospectively evaluated the direct and indirect effects of maternal report of ACEs on mother-infant bonding using pregnancy maternal mental health (depression, anxiety, and posttraumatic stress symptoms) and cortisol levels, a marker of HPA-axis functioning. Participants were 446 women recruited from the community; poverty and intimate partner violence (IPV) were overrepresented in our sample. Women completed self-report surveys during their pregnancy and at 1 month postpartum. Baseline cortisol levels were assessed in the laboratory during late pregnancy. A structural equation model to test sequential mediation was estimated and included relevant covariates (race, IPV, traumatic birth). There was a significant indirect effect of ACEs on maternal-infant postpartum bonding via late-pregnancy mental health, but not through maternal late-pregnancy baseline cortisol levels. Our findings underscore the potential for screening and therapeutic intervention addressing depression, anxiety, and PTSD symptoms during pregnancy among women with ACEs history, with benefits that may span two generations and set the stage for a healthy mother-child relationship.
Much has been elucidated about the neurobiological effects of early childhood trauma and its transgenerational transmission, although its integration into psychodynamic therapy has been challenging. Here we focus on a common area of interest to both areas-emotion and cognition rooted in past trauma experiences and how these experiences produce maladaptive behaviors transmitted to the next generation through parenting behaviors. We explore two mammalian research paradigms of early-life trauma explicitly within attachment, and transmission of transgenerational pathology through the caregiver to the offspring. We suggest that understanding the neurobiology through this mammalian nonhuman research can provide, in part, an understanding for the complex psychodynamic thought processes seen in adulthood, particularly as the mother begins to raise her own child. Specifically, while cognition and complex conscious and unconscious thoughts are characteristic of the human condition following early-life trauma, the mother-infant attachment system is a phylogenetically preserved system with some basic characteristics seen across species. We outline how embracing both the cognition and preserved trauma neural programing within attachment may provide some insight into cases, especially for the parent-child social interactions well documented to program the brain. Using mother-infant attachment, we suggest there is an area of convergence between clinical psychodynamic focus and basic research in brain function and mechanisms. Focusing on this convergence may provide a unique viewpoint to psychodynamics to supplement diagnosis and treatment.
