Chapter 12: Psychodynamic - Psychotherapy
Mentalization-Based Treatment
1. Focus: Enhances the ability to identify and understand one's own feelings and those of others. 2. Background: Originates from the idea that early childhood experiences, particularly insecure attachments, impact emotional functioning. Application: Initially for borderline personality disorder, it is now also used for PTSD, substance use problems, and eating disorders. Techniques: Involves helping clients recognize and moderate feelings in real-time and understand assumptions about others' feelings
Other Contemporary Forms of Psychodynamic Psychotherapy transference-focused therapy
1. Focus: Strong emphasis on the unconscious transference of feelings from client to therapist. 2. Method: Interpretations of the client's transference to increase awareness of these tendencies. 3. Application: Primarily used for clients with borderline personality disorder and other personality disorders. Goal: To help clients understand and manage their relationship patterns.
Brief psychodynamic psychotherapy
A more efficient and increasingly common version of psychodynamic psychotherapy, typically lasting about 6 months or less
insight
A primary goal of psychodynamic psychotherapy is making the unconscious conscious.
Interpersonal Therapy (IPT)
A specific, manualized, contemporary form of psychodynamic psychotherapy that emphasizes interpersonal relationships and has received empirical support for the treatment of depression ***Developed in the 1980s by Gerald Klerman, Myrna Weissman It is designed to last about 14 to 20 sessions gathered a sizable amount of empirical evidence interpersonal and social rhythm therapy (IPSRT) specifically designed for clients with bipolar disorder
Object Relations:
A variation of psychodynamic psychotherapy deemphasizing internal conflict (id vs. superego), and instead emphasizing relationships between internalized "objects" (essentially, important people from the client's life) school
Self -Psychology
A variation of psychodynamic psychotherapy emphasizing parental roles in the child's development of self, with special attention paid to the meaning of narcissism at various points, including in therapy school of Hans Kohut
Ego -Psychology
A variation of psychodynamic psychotherapy emphasizing the adaptive tendencies of the ego over the pleasure-based drive of the id.
Psychodynamic Psychotherapy
An approach to psychotherapy deriving from the theories of Sigmund Freud, the primary goal of which is to make the unconscious conscious
Working Through
An often lengthy component of psychodynamic therapy in which interpretations are reconsidered and reevaluated again and again ***Часто длительный компонент психодинамической терапии, в ходе которого интерпретации пересматриваются и переоцениваются снова и снова.
How Well Does It Work?
Challenges in Measuring Psychodynamic Psychotherapy Outcomes: Difficult to define and measure core concepts like the unconscious, transference, insight, and defense mechanisms. Questions on measuring therapy effectiveness and isolating therapy as the cause of change. Empirical Research on Psychodynamic Therapy: Despite challenges, recent studies, especially in brief psychodynamic therapy, show favorable results. Meta-analyses indicate psychodynamic therapy can be as effective as cognitive-behavior therapy for various disorders. Specific Psychodynamic Therapies with Empirical Support: Include interpersonal therapy, short-term psychodynamic therapy, transference-focused therapy, and mentalization-based treatment for disorders like depression, personality disorders, and anxiety.
Free Association
Clients are encouraged to speak freely without censoring their thoughts, revealing underlying unconscious processes.
Resistance
Clients often show reluctance or avoidance when unconscious material surfaces, indicating areas of significant unconscious conflict.
Dream Analysis:
Dreams are considered a communication of unconscious material, with therapists helping clients interpret the latent content behind the manifest content of dreams.
More Contemporary Forms of Psychodynamic Psychotherapy
Ego Psychology: Erik Erikson's eight-stage theory focuses on social relationships and the adaptive roles of the ego. Object Relations Theory: Led by figures like Melanie Klein and Otto Kernberg, this school focuses on relationships between internalized "objects" or significant people in a client's life. Self-Psychology: Hans Kohut's approach emphasizes parental roles in developing self and examines narcissism. Feminist Critiques: Karen Horney, Nancy Chodorow, and Carol Gilligan challenged Freud's views on female development, proposing more gender-sensitive theories. Shift to Efficiency: Contemporary psychodynamic psychotherapy has adapted to societal demands for quicker, less expensive therapy. Brief psychodynamic therapy, often lasting fewer than 24 sessions, focuses on specific problems, a more active therapist role, and a primary focus on the present. Comparison with Long-Term Therapy: Brief therapy differs from long-term therapy in several ways, including a faster formation of the therapeutic alliance, focusing on less severe psychopathologies, and emphasizing current issues over past experiences.
How Well Does It Work?2 Empirical Evidence on Therapy Components:
Empirical Evidence on Therapy Components: Studies show that greater insight, effective transference interpretation, and well-managed countertransference reactions correlate with better therapy outcomes.
Psychodynamic Psychotherapy Overview
Historical Importance: Psychodynamic therapy was once central to psychotherapy, especially in the early 20th century. Influence on Other Therapies: It influenced the development of therapies like humanistic, behavioral, and cognitive therapies. Decline in Popularity: Its popularity has declined due to criticisms about its scientific validity and effectiveness compared to approaches like cognitive-behavioral therapy. Ongoing Use and Adaptation: Despite criticisms, psychodynamic therapy remains relevant and has adapted to contemporary needs in clinical psychology. Evidence of Efficacy: Recent research supports the efficacy of psychodynamic therapy, highlighting its ongoing significance in the field
Defense Mechanisms: Displacement
In psychodynamic psychotherapy, a defense mechanism in which the ego displaces an id impulse toward a safer target
Defense Mechanisms: Reaction Formation
In psychodynamic psychotherapy, a defense mechanism in which the ego forms a reaction against the id impulse, resulting in a behavior opposite of the original id impulse.
Defense Mechanisms: Sublimation
In psychodynamic psychotherapy, a defense mechanism in which the ego redirects the id |impulse in such a way that the resulting behavior actually benefits others
Defense Mechanisms: Repression
In psychodynamic psychotherapy, a defense mechanism in which the ego represses conscious awareness of the conflict between id and superego.
Transference
In psychodynamic psychotherapy, the tendency of clients to form relationships with therapists in which they unconsciously and unrealistically expect the therapist to behave like important people from the clients' past.
Freudian Slips:
Mistakes or slips of the tongue are viewed as expressions of unconscious wishes or conflict
Defense Mechanisms: Projection
Projection. In psychodynamic psychotherapy, a defense mechanism in which the ego projects an id impulse onto other people
Accessing the Unconscious:
Psychodynamic therapists use inferential methods to access clients' unconscious thoughts and feelings, relying on deduction and conjecture rather than empirical facts. ***Психодинамические терапевты используют методы умозаключений для доступа к бессознательным мыслям и чувствам клиентов, полагаясь на дедукцию и предположения, а не на эмпирические факты.
How Well Does It Work? The Allegiance Effect in Psychotherapy Research:
The Allegiance Effect in Psychotherapy Research: Researchers' biases towards certain therapies can influence study outcomes. Studies have found a strong relationship between researchers' preferences and their ratings of therapy effectiveness. Calls for more transparency and diversity in researchers' orientations to mitigate bias. Comparative Studies and Allegiance Effects: Mixed findings on the impact of allegiance effects, with some studies supporting its influence and others refuting it. Suggestions for reducing bias include collaborative research groups with diverse orientations and greater transparency about researchers' preferences.
Goal of Therapy:
The aim is to make clients aware of their unconscious processes and defense mechanisms, enabling more mature handling of internal conflicts.
The "blank screen" role
The therapist role in which little personal information is revealed to facilitate transference Роль терапевта, при которой раскрывается мало личной информации для облегчения переноса.
Phallic Stage
The third of the psychosexual developmental stages, and the stage from which issues of self-worth may emerge Age Range: The phallic stage occurs from about 3 to 6 years old. Controversial Concepts: Original Freudian ideas tied to gender and sex in this stage are largely disputed and disregarded in modern psychodynamic therapy. Key Concepts: Focus on the desire for a special, close relationship with parents (related to Oedipus and Electra complexes). Parental Response Importance: The way parents respond to these desires crucially shapes a child's self-view and self-worth. Positive Parental Response: Ideally, parents should positively respond to children's desires for closeness without overindulgence. Overly Positive Response: Can lead to inflated self-worth in children, resulting in adults who may appear arrogant or egotistical. Negative Parental Response: Rejection of these desires can harm a child's self-esteem, leading to adults who are insecure and self-doubting. Clinical Implications: Issues from this stage often manifest in psychotherapy, including depression, dysthymia, anxiety, relationship problems, and other self-worth related issues.
Psychodynamic psychotherapy has historically been among the longest and most expensive forms of therapy. True False
True
Defense Mechanisms: (Id, superego, ego)
Unconscious mechanisms like repression, projection, reaction formation, displacement, and sublimation help manage internal conflicts between the id, ego, and superego. ***In psychodynamic psychotherapy, techniques used by the ego to manage conflict between the id and superego The id -In psychodynamic psychotherapy, the part of the mind that generates and seeks immediate satisfaction for all the pleasure-seeking, selfish, indulgent, animalistic impulses Superego - In psychodynamic psychotherapy, the part of the mind that establishes rules, restrictions, and prohibitions The ego in psychodynamic psychotherapy is the part of the mind that manages conflict between the id and the superego and also meets the demands of reality; the part of the mind that generates defense mechanisms.
Juan has formed a psychotherapy relationship with his clinical psychologist in which Juan unconsciously and unrealistically expects the psychologist to behave like Juan's mother. Juan's situation best illustrates ______. a) transference b) reflection c) resistance d) allegiance effects
a) transference
According to psychodynamic psychotherapists, unconscious motivations manifest when someone makes verbal or behavioral missteps, or ______. a) dreams b) manifest content c) Freudian slips d) resistance
c) Freudian slips
According to psychodynamic psychotherapists, fixation at the oral stage can result in problems related to ______ later in life, fixation at the anal stage can result in problems related to ______ later in life, and fixation at the phallic stage can result in problems related to ______ later in life. a) dependency; self-worth; control b) control; dependency; self-worth c) self-worth; control; dependency d) dependency; control; self-worth
d) dependency; control; self-worth
One of Freud's most enduring contributions to the field is the ______. the notion that everyone has psychological disorders importance of parental influence existence of the unconscious idea that talk therapy is the way to approach problems
existence of the unconscious
The process in which clients say whatever comes to mind without censoring themselves at all is known as ______. a Freudian slip sublimation free association transference
free association
Brief psychodynamic psychotherapy tends to work best when clients ______. have problems that are mild and narrowly defined have been through therapy before have the support of friends and family members are intrinsically motivated
have problems that are mild and narrowly defined
During Interpersonal Therapy (IPT), the last few sessions are designed to teach the client about depression categorize the client's problems into one of four categories review the client's accomplishments associate the client's problems with particular emotional reactions
review the client's accomplishments
Ego psychology highlights ______. social relationships the allegiance effect insights object relations
social relationships
Oral Stage
the first of the psychosexual developmental stages, and the stage from which issues of dependency may emerge The oral stage, a concept in psychodynamic theory, occurs in the first 1.5 years of a child's life, where pleasure and comfort are primarily experienced through the mouth. Key activities like feeding become central. This stage is crucial for developing attitudes towards dependency. Overindulgence in this stage can lead to adults who are overly trusting and dependent, expecting others to meet their needs. Conversely, neglect or unresponsiveness can result in adults who are mistrustful and pessimistic, reluctant to rely on others. These early experiences, particularly in their extreme forms, can significantly influence an individual's personality and relationship patterns and are often a focus in psychodynamic psychotherapy.
Anal Stage
the second of the psychosexual developmental stage, and the stage from which issues of control may emerge follows Age Range: The anal stage occurs from approximately 1.5 to 3 years old. Primary Task: Toilet training is a key focus, but the broader theme is learning self-control. Parental Influence: How parents manage demands on speech, behavior, and other areas significantly impacts development. Overly Demanding Parents: Can lead to children becoming adults who are overly meticulous and controlling, showing obsessive and compulsive behaviors. Too Lenient Parents: May result in children growing into adults who are disorganized and lax, with messy habits and haphazard routines. Clinical Implications: Extremes in behavior due to experiences in this stage can contribute to anxiety disorders like obsessive-compulsive disorder and challenges in relationships due to incompatible living styles.
interpretation
the therapist's attempts to formulate and discuss with the client a hypothesized connection between unconscious material and client's behavior
Countertransference
transference by the therapist toward the client ***One reason why many psychodynamic training programs have required their students to be clients in psychodynamic psychotherapy themselves is to become aware of their own unconscious issues so they will not arise as countertransference toward their own clients
Fixation
unsuccessful resolution of the psychological tasks of a particular developmental stage ***неудачное решение психологических задач определенного этапа развития
Psychosexual Stages:
—oral, -anal, -phallic, - latency -genital
