Chap 9 - Psychodynamics

Question 1

Psychodynamic began…?

Answer 1

1950’s

Question 2

Psychodynamic Family Therapy is based on…?

Answer 2

Psychoanalytic Theory but encompasses more than traditional psychoanalytic theory; based on the work of Freud but interpreted, modified and applied to family life

Question 3

Major Theorists

Answer 3

Nathan Ackerman, 
Ivan Boszormenyi-Nagy, 
James Framo, 
Theodore Lidz, 
Norman Paul, 
Donald Williamson, 
Robin Skynner, 
and Lyman Wynne

Question 4

Nathan Ackerman

Answer 4

(1908-1971)-credited as the founder and most influential advocate of this approach to family therapy

Question 5

In the 1930’s Ackerman…

Answer 5

became interested in families and their influence on mental health and illness. This interest was sparked by his observations about the effect of unemployment on men and their families in a mining town in western Pennsylvania and about how families seemed to change more rapidly when all members were interviewed together. In his initial clinical work at the Menninger Clinic in Topeka, Kansas, he began treating whole families and sending his staff on home visits. He was especially interested in the psychosocial dynamics of family life and in applying psychoanalytic principles to family units.

Question 6

In 1957 Ackerman…

Answer 6

He opened the Family Mental Health Clinic at Jewish Family Services in New York

Question 7

In the 1960 Ackerman…

Answer 7

established the Family Institute in New York (Now called the Ackerman Institute for the Family)

Question 8

In 1961 Ackerman…

Answer 8

became the co-founder of Family Process, the first journal in family therapy.

Question 9

Ackerman’s personality

Answer 9

had a strong, charismatic personality, which helped attract interest in what he was doing. He was a fighter for what he believed in. Overall, he has been described as feisty, brilliant, charming, a gadfly, and a “sturdy, cigar-chomping little man who did not waste his time on useless politeness”.

Question 10

American Academy of Psychoanalysis

Answer 10

Ackerman also helped open the field of psychoanalysis to nonmedical specialists by establishing the American Academy of Psychoanalysis in 1955

Question 11

Emphasized strategies of the scapegoat, “Tickling of the Defenses”, complementarity, focusing on strengths, and interlocking pathology

Answer 11

Nathan Ackerman

Question 12

As a psychodynamically oriented therapist, Ackerman…

Answer 12

initiated a new way of thinking about individuals and families and advocated that an accurate understanding of an individual’s unconscious requires an understanding of its context.

Question 13

Ackerman influenced many psychodynamically oriented practitioners by…

Answer 13

hypothesizing that underneath the apparent unity of families “there existed a layer of intrapsychic conflict that divided family members into factions”.

Question 14

Ackerman took liberties in applying Freud’s theory to families and…

Answer 14

stressed the development of interpersonal as well as intrapersonal relationships.

Question 15

At the heart of psychodynamic family treatment

Answer 15

is a belief that changes in families and their members occur best when the family is examined in the context of its history and development. Conscious and unconscious processes are collectively and individually the focus of therapeutic interventions.

Question 16

Psychodynamic terms

Answer 16

marital schism, marital skew, pseudomutuality, relational ethics, invisible loyalties, family ledger, good enough mother, projective identification, and introjects to describe dynamics relationships within families.

Question 17

Psychodynamic emphasis

Answer 17

“the past is active in the present”

Question 18

Psychodynamic theory Stress the importance of social and historical data in the lives of families. T/F?

Answer 18

True

Question 19

reality of family interactions

Answer 19

one of the primary contexts of Psychoanalytic Family theory

Question 20

interlocking pathology

Answer 20

Ackerman connected family context and the unconscious in interlocking pathology, which explains how families and certain of their members stay dysfunctional. In an interlocking pathology, an unconscious process takes place between family members that keeps them together. If members violate the unwritten family rules, then the members either make a conscious decision to leave the family and become healthier, or they are drawn into the familiar family pattern by other members and continue to function in a less than ideal manner.

Question 21

object relations theory

Answer 21

A more recent focus of psychodynamic theory is object relations theory which is the bridge between classical Freudian theory, with its emphasis on individual drives, and family therapy, with its emphasis on social relationships. An object is something that is loved, usually a person. The term object relations mean “relations between persons involved in ardent emotional attachments. These attachments can exist in our outer world reality or as residues of the past- that is inner presences, often unconscious, that remain vigorous and very much alive within us”. Through object relations theory, relationships across generations can be explained. (pg. 205)

Question 22

splitting

Answer 22

This process of evaluation occurs at its lowest level through an unconscious procedure known as splitting. In splitting, object representations are either all good or all bad. Through splitting people are able to control their anxiety and even the objects (persons within their environment) by making them predictable. The problem with splitting is that it distorts reality. Individuals who operate in this way have trouble dealing with the complexity of human relationships and may be immature in their reactions. (pg. 205)

Question 23

The importance of object relations theory in family therapy is

Answer 23

it provides a way for psychodynamic clinicians to explain reasons for marital choices and family interaction patterns. It stresses the value of working with unconscious forces in individuals and families beyond Freud’s metaphorical concepts of id, ego, and superego. Unconscious and unresolved early object relations that adults may bring into their marriage relationships can result in the development of dysfunctional patterns in which persons cling to each other desperately and dependently. These patterns keep repeating until one or both spouses (or in some cases their children) become more aware, take actions to differentiate themselves from past objects, and learn to act in new and productive ways.

Question 24

Treatment Techniques

Answer 24

In psychodynamic family therapy, considerable emphasis is on the unconscious, early memories, and object relations. The therapeutic techniques used include transference, dream and daydream analysis, confrontation, focusing on strengths, life history, and complementarity

Question 25

Transference

Answer 25

is the projection of feelings, attitudes, or desires onto a therapist. It is used in family therapy in order to understand dominant feelings within a family unit and delineate what emotions are being directed toward which people. Benefits for using this include the expression of pent-up emotion (catharsis), self-discovery, insight, and the learning of new ways to interact.

Question 26

Dream and Dream Analysis

Answer 26

The objective of having family members discuss their dreams or daydreams is to analyze what needs within the family are not being met. Strategies are then developed to meet deficits. Can be difficult to handle if the number of family members participating is large.

Question 27

Confrontation

Answer 27

In confrontation procedures, the therapist points out to families how their behaviors contradict or conflict with their expressed wishes. The idea behind confrontation is to help family members become more aware of what they are doing and to change their strategies for coping and becoming functional.

Question 28

Focusing on Strengths

Answer 28

By concentrating on strengths, family therapists help change the families focus. As a consequence of focusing on strengths, structured activities can be designed to promote cooperation and break dysfunctional patterns of behaving. For example, a family can be asked to plan an event that will utilize the abilities of all family members.

Question 29

Life History

Answer 29

By taking and assessing a family’s life history, psychodynamic family therapist can report present and past patterns of interaction within the family. This process also affirms to family members that they are valued and accepted regardless of their backgrounds. Taking a family life history promotes tryst in the therapist and also provides family members with insight. The history can be written in a narrative or an abbreviated form.

Question 30

Complementarity

Answer 30

This is the degree of harmony in the meshing of family roles. For example, if a husband and wife agree that her role should be planning the family budget and his to balancing the check book, they have established a complementarity relationship in regards to financial roles. A task of the therapist may be to ask the members what they want and what they are willing to do in return.

Question 31

Interpretation

Answer 31

Interpretation involves bringing unconscious conflicts between family members into consciousness. While interpretation may not completely resolved conflicts, its takes the covert nature out of the discord and allows family therapy to progress in a more straightforward way by increasing members of the family’s insight into how the past is continuing to affect the present.

Question 32

Role of the Therapist (in all roles)

Answer 32

In all roles the therapist must be careful to emphasize family as well as individual reactions. It is crucial that family members have extensive and free flowing interchanges and that the therapist does not become overly involved or central in the process.

Question 33

Psychodynamic therapist role of a teacher

Answer 33

Role of a teacher - It is essential that family members learn basic psychoanalytic terms and how these terms apply on a personal and interpersonal basis.

Question 34

Psychodynamic therapist role “good enough mother”

Answer 34

good enough mother” is one whose infant feels loved and cared for and is able to develop trust and a true sense of self. This role might call for the therapist to actually nurture the family member by providing encouraging behaviors that were absent at earlier developmental stages. This behavior could take the form of anything from pats on the back to the giving of compliments.

Question 35

Psychodynamic therapist role of a catalyst

Answer 35

a catalyst who moves into the “living space” of the family and stirs up interactions. Ackerman was a master of engaging families in this manner. The result was that families in treatment would often have a meaningful emotional exchange. In the role of a catalyst, the therapist activates challenges, confronts, sometimes interprets, and helps integrate family processes. Such a role requires high energy and stamina.

Question 36

Psychodynamic Process & Outcome

Answer 36

o A major goal of psychodynamic family therapy is to free family members of unconscious restrictions. This outcome is sometimes achieved through the therapist’s interpretation of events and insight on the part of family members regarding events. Interpretation is best offered by the therapist at a preconscious level, that is, on material that family members are almost aware of. When insights are achieved in such an endeavor, they must be worked through, that is, translated into new and more productive ways of behaving and interacting.
o Once unconscious restrictions are worked through, family members are able to interact with one another as whole, healthy persons on the basis of current realities rather than unconscious images of the past

Question 37

Differentiation

Answer 37

When this goal is achieved, the results are usually manifested in changes that are described by the term DIFFERENTIATION. The idea behind differentiation is that individuals have reached a level of maturity in which they can balance their rational cognitive and emotional selves and they can separate themselves from others in a non-anxious way.

Question 38

Crisis Resolution

Answer 38

Sometimes the achievement of differentiation is not possible. Professionals can then opt for crisis resolution, which is similar to that of other treatment modalities and basically involves a reduction in symptoms. Therapists focus more on supporting defenses and clarifying communication than on analyzing defenses and uncovering repressed needs and impulses.

Question 39

Unique Aspects of Psychodynamic Family Therapy

Answer 39

o A major emphasis of psychodynamic family therapy is that it concentrates on the potency of the unconscious in influencing human behavior.
o The psychodynamic approach examines basic defense mechanisms and the part they play in family relationships. (table 9.1 pg. 210)
o A third novel aspect is its emphasis on historical origins of dysfunctions and the treatment of persons and families so affected.
o Finally, this theory, especially object relations, helps examine how persons form attachments and how family members function as a result.

Question 40

Comparison with Other Theories

Answer 40

o Psychoanalytic is more linear than not-it focuses on cause and effect interactions. Too often this type of treatment is either limited to an individual or not broadened to family life.
o This theory is demanding in time and money because of the depth of exploration in toots of their difficulties. Most cannot afford to take the time or pay the price.
o Psychodynamic treatment generally requires higher than average intellectual ability. This theory may not be appropriate for families that are concrete in handling situations or become impatient with the abstract. These families want immediate results and cannot cope well with abstract concepts, such as the unconscious.

Question 41

Similarities between Psychodynamic and Bowen Therapies

Answer 41

Both psychodynamic and Bowen family treatments are based on conceptual models that are comprehensive in scope. They also apply techniques that have developed from both research and practice.
They also share the belief that in family therapy an emphasis should be placed on the fact that “the past is active in the present”
Both have a focus on how intrapersonal and interpersonal aspects of life affect each other. (The way people relate to themselves influences how they interact with others and the way in which people have been reacted to by others in the past affects how they perceive and treat themselves)
Also share their view that change is usually gradual and requires hard work with a heavy investment of time and resources.