Class 1

Question 1

Sigmund Freud (1856 -1939)

(1. Theory based on?)
(2. Nerosis derives from?)
(3. Talking cure based on?)

Answer 1

1. Case studies
   
   • Specifically his studies on Meloncony in women
2. Unconscious conflicts in childhood
   
   • neurotic feelings and behaviors came out of unconscious conflicts that were going on within a person
3. therapist interpretation
   
   • talk therapy…you talk about it and its catharthic

Question 2

Main Criticisms of Psychodynamic Theory

Answer 2

1. Unscientific
   
   • Psychodynamic theories cannot be empirically tested
   • Interpretations are subjective
2. Deterministic
   
   • Childhood events determine behavior
3. Eurocentric/Androcentric/Heterocentric
   
   • Derived from European/American middle- and upper-middle class, heterosexual, cisgender male experience and values (that founded these theories)

Question 3

Evolution of Psychodynamic Theories (picture)

Answer 3

• Drive theory is where you find Freud…you would be hard pressed to find a therpy/thery that is not based on Freud…even CBT
• It went from a Drive…Ego psychology to
  
  • object relations to
    
    • which is the internal drives that you may have but also to the relationships that you form objects around you…with you being one of the object…and as an object you have drives…you have an ego
  • self psychology to
  • Relational and intersubjective
• somewhere as all of this going on…behavior therapy….and cognitive therapy were talking off

Question 4

Response to Critique of Psychodynamic theory
#2: Deterministic

Answer 4

• Every theorist since Freud has reconceptualized and expanded psychodynamic theory to include later development and social/environmental interactions from
  
  • Anna Freud’s (1936) understanding of the primacy of the Ego to…
  • Erik Erikson’s Epigenetic Stages (1964, 1968) to…
  • intersubjective theories of Stephen Mitchell (1988, 2003), Thomas Ogden (1994) and Paul Wachtel (2008).
• (her note on slide)
  
  • inside oriented work
    
    • talking about the client therapist relationship…transference and CT

Question 5

Research on Effectiveness of Psychodynamic Psychotherapy

Answer 5

• “Effectiveness” may not be the same as an absence of symptoms.
• “psychological health is also the presence of inner capacities and resources that allow people to live life with a greater sense of freedom and possibilities” - shedler

Question 6

Biopsychosocial Model of
Health and Disease

Answer 6

• Use of biological/medical, psychological and social lenses to understand patient’s behavior and distress allows for complementary foci
• pic of flower and girl…focus on flower or foucs on girl
  
  • might not be all about the flower…or all about the girl…but will help you notice the pattens
  • the girl might be unconscious and they bring it into focus

Question 7

The Essence of Psychodynamic Therapy

Answer 7

The Sensibility of the Therapist

• An attitude of Curiosity and Awe
• Respect for Complexity
• Tendency toward Identification and Empathy
• Capacity for Faith

Question 8

Essential Features of Psychodynamic Psychotherapy

Answer 8

1. Use of exploratory (curious), interpretive (more like observations), and supportive interventions as appropriate
2. Frequent sessions
   • cant express empathy with a deadline of 6 sessions
   • need to build caring (close) relationship (theraputic alliance)
3. Emphasis on uncovering painful affects, understanding past painful experiences
   
   • this is the heart of psychodynamic
4. Goal is to facilitate emotional experience and increase understanding
5. Focus on the therapeutic relationship, including attention to transference and countertransference
   
   • noticing transference and bringing attention to it
     
     • another reason for freq. sessions….client cant be on best behavior for long
6. Use of a wide range of techniques, with variability in application by different practitioners

Question 9

Distinctive Features of Psychodynamic Therapy

(list 1-7)

Answer 9

1. Focus on affect and expression of emotion.
2. Exploration of attempts to avoid distressing thoughts and feelings.
3. Identification of recurring themes and patterns.
4. Discussion of past experience (developmental focus).
5. Focus on interpersonal relations.
6. Focus on the therapy relationship.
7. Exploration of fantasy life.

Question 10

Distinctive Features of Psychodynamic Therapy

(1. Focus on affect and expression of emotion)

Answer 10

• Feelings play a central role in shaping people’s behaviors.
  
  • There is a distinction between intellectual understanding and emotional insight.
• when in doubt go to the feelings….

Question 11

Distinctive Features of Psychodynamic Therapy

(2. Exploration of attempts to avoid distressing thoughts and feelings)

Answer 11

• Patients (like all people) are invested in avoiding painful or troubling feelings. They may do this intentionally or without awareness.
• Psychodynamic techniques include noticing when patients miss sessions, arrive late, change topic, or shift focus away from feelings.

Question 12

Distinctive Features of Psychodynamic Therapy

(3. Identification of recurring themes and patterns)

Answer 12

• Hallmark of psychodynamic therapy…noticing patterns
• People have patterns or themes in their thoughts, feelings, self-concept, relationships, and life experiences, and may or may not be aware of them.
• e.g.: an attraction to controlling people when choosing a romantic partner, a perception of self as a failure, etc.
• Psychodynamic techniques include identifying these themes or patterns, and helping patients recognize them.

Question 13

Distinctive Features of Psychodynamic Therapy

(4. Discussion of past experience (developmental focus))

Answer 13

• Early experiences of attachment figures affect present behavior. Understanding those early experiences helps people make different choices in current situations.
• Psychodynamic techniques include exploring early experiences in order to shed light on current experiences and difficulties.

Question 14

Distinctive Features of Psychodynamic Therapy

(5. Focus on interpersonal relations)

Answer 14

• People’s personality and sense of self (a.k.a. “ego”) evolve in relation to attachment figures; in these relationships, either their developmental needs are sufficiently satisfied, or they are not, and this has lasting consequences in later life.
• Psychodynamic techniques involve helping patients explore those early relationships, to recognize areas where needs were not satisfied.

Question 15

Distinctive Features of Psychodynamic Therapy

(6. Focus on the therapy relationship)

Answer 15

• The relationship between therapist and patient is an important element of therapy and can become a focus of attention, based on the belief that a patient’s relational patterns and themes will surface in the therapeutic relationship.
  
  • e.g. a person raised by ineffective caregivers may perceive the therapist as ineffective
• Psychodynamic techniques involve paying attention to the patient’s feelings toward the therapist (aka “transference”) and the therapist’s own feelings toward the patient (aka “countertransference”).

Question 16

Overview of
Psychodynamic Theories

Answer 16

1. Drive
   
   • Sigmund Freud
2. Ego
   
   • Anna Freud
   • Erik Erikson
3. Object Relations
   
   • Melanie Klein
   • John Bowlby
   • Otto Kernberg
   • Margaret Mahler)
4. Self-Psychology
   
   • Heinz Kohut
5. Relational and Intersubjective
   
   • Stephen Mitchell
   • Thomas Ogden

Question 17

Pragmatic Psychodynamic Psychotherapy (PPP)

Answer 17

• Unconscious Conflict shapes behavior
  
  • Drive vs. Drive
    
    • love vs. aggression
      
      • all have capacity for both…times when struggle with the two parts of self to address a certain behavior
  • Drive vs. Cultural value
    
    • intimacy vs. autonomy
      
      • want to be close but not dependent on someone
  • Drive s. Reality
    
    • intimacy vs. lack of partner
  • Leads to Compromise Formation (adaptive defense—a way to tolerate the conflict)
    
    • compromise formation is how you address these patterns/feelings
• drive used in Freud sense….internal drive within you

Question 18

Pragmatic Psychodynamic Psychotherapy (PPP)

Answer 18

• Each component is important; their relationship is multidirectiona
• Picture from top clock wise should be…Drive,Cognition, Behavior, Affect
  
  • drive…internal motivator
  • cognition….
  • behavior…
  • affect….
  • everything is connected…can start anywhere as long as you address them all

Question 19

P.P.P

(miscellaneous slide without title)

Answer 19

• Trauma shapes perception, and therefore gets replayed
  
  • going to get played with or without your knowledge…with your knowledge you actually own the story and have the ability to change it
• Psychodynamic factors interact with biological/medical and social/cultural factors (i.e., the Biopsychosocial Model)
  
  • dynamic is not independent of biopsychosocial
• Change occurs by the following pathway
  
  • The patient
    
    • develops awareness and insight, including re-experiencing painful affects, thoughts, memories
    • develops a safe, trusting, empathic relationship with the therapist (a different model of relationship)
    • finds new ways of perceiving past situations, and so can respond differently to new situations

Question 20

PPP Techniques

(list)

Answer 20

• free association
• theraputic relationship
• Three legged stool
• Core Psychodynamic Problem
• Treatment Planning
• Facilitating Change

Question 21

PPP Techniques

(“Free Association”)

Answer 21

• Open-ended questions
• Attention to here-and-now
• Therapist gently guides the patient; does not impose an agenda
• process vs content
  
  • content is when you are talking about the sitiation in terms of the details
  • process is when you take a step outside of the content and say here is what I am noticing

Question 22

PPP Techniques

(Three legged stool)

Answer 22

• Three legged stool
  
  • (past relationships, present relationships, therapeutic relationship)
    
    • but focus on present relationships….
      
      • focus on present relationships knowing that past relationship color it
      • focus on present relationship knowing that the theraputic relationship colors it

Question 23

PPP Techniques

(Core Psychodynamic Problem)

Answer 23

• serves as foundation for a comprehensive formulation, and guides the work
• Core Psychodynamic Problems (Summers & Barber, 2010)
  • Depression
  • Obsessionality
  • Fear of abandonment
    
    • heart of borderline PD
  • Low self-esteem
  • Panic anxiety
  • Trauma

Question 24

PPP Techniques

(Treatment Planning)

Answer 24

• Goal setting is collaborative
• Treatment can be multimodal (e.g., pharmacotherapy + psychotherapy)

Question 25

PPP Techniques | (Facilitating Change)

Answer 25

* Exploration of painful affects, memories, thoughts * Develop alternative perceptions * Collaborative * Involves speculation * Trying new behaviors * comes down to is it in the past....focus on present