Chapter 2 Psychodynamic Psychotherapies

Question 1

psychoanalysis=

Answer 1

= a form of psychological treatment and a model of psychological functioning and psychopathology.
Sigmund Freud (1856-1939) is known as the founding father of psychoanalysis, but it now consists of many different theories and treatment models that have developed over time.

Question 2

6 basic principles of psychoanalysis

Answer 2

1. unconscious motivation: all human beings are partly motivated by wishes, fantasies or implicit knowledge that is outside of awareness
2. awareness: facilitating awareness of unconscious motivations, thereby increasing individual choice
3. defenses: exploring ways in which we avoid painful or threatening fealings, fantasies and thoughts
4. ambivalence: humans are ambivalent about changing and exploring this ambivalence is most important
5. therapeutic relationship: the therapeutic relationship is important for exploring clients’ selfdefeating psychological processes and actions (both conscious and unconscious) and for change.
6. understanding: helping clients to understand the way in which their own construction of their past and present plays a role in perpetuating their self-defeating patterns.

Question 3

1- vs. 2 person psychologies

Answer 3

Across a range of different psychoanalytic schools there has been a shift from Freud’s classical one-person psychology to a two-person psychology.

• One-person psychology = the idea that it is possible to understand the client’s defense processes without consideration for the therapist’s own ongoing contributions to the interaction.
• Two-person psychology = the idea that assumes that both the therapist and client contribute to everything that takes place in a therapeutic relationship.

Question 4

free association =

Answer 4

= a technique in which clients are encouraged to attempt to verbalize thoughts, images, associations, and feelings without being self-critical and censoring. Because of problems he saw with the reliability of hypnosis, Freud began to encourage patients to say everything that came to mind without censoring.

Question 5

seduction theory=

Answer 5

the idea that sexual trauma always lies at the root of psychological problems. Freud started from this belief but gradually abandoned it as he began to focus more on the role of sexual instincts in the developmental process, emphasizing the role of fantasy and instinctual drive. This became known as drive theory.

Question 6

drive theory=

Answer 6

the idea that organisms are born with certain psychological needs (drives) and that a negative state of tension is created when these needs are not satisfied. When satisfied, drive is reduced and there is homeostasis. There is a push to repeat experiences that have become associated with tension reduction (pleasure principle).

Question 7

invloed bleuer and jung:

Answer 7

Bleuler and Jung began to use word-association tests to investigate response-times to emotionally charged words in psychiatric patients. They began to account for their findings using Freud’s theories about the nature of unconscious processes and argued that delayed response times reflected unconscious functioning of complexes.

Question 8

Complexes =

Answer 8

affectively charged ideas that are repressed because they are emotionally threatening.

Question 9

Zurich Psychoanalytic Society (1907)

Answer 9

Many colleagues of Bleuler and Jung (at the Burghölzli Clinic in Zurich) began to show growing interest in Freud’s work, spreading his ideas in the medical community around the world. Jung met with Freud personally and together with Bleuler established the Zurich Psychoanalytic Society.

Question 10

jung and freud relatie

Answer 10

Freud hoped that Jung would become his successor, leading the psychoanalytic movement. However, there were theoretical tensions that grew over time and led to the end of their collaboration: Jung believed that Freud was mistaken in viewing sexuality as the most important motivational principle and that he failed to recognize the importance of the spiritual and transpersonal aspects of the mind.

Question 11

Structural theory (ego psychology) = the idea that there are 3 agencies of the mind:

Answer 11

1. Id: instinctually based (immediate sexual gratification) and present from birth.
2. Ego: central controlling core that mediates between the id and the superego. It evaluates suitability of satisfying instinctual desires and allows for a delay in gratification or for findings other ways of satisfaction in socially acceptable ways.
3. Superego: embraces moral and social values and regulates drives, self-image, self-esteem, and drive discharge. It can be overly harsh and demanding, leading to feelings of guilt and rejection towards instinctual needs and wishes.

Question 12

object relations theory =

Answer 12

the idea that the basic human motive is to satisfy object (person) relationships. It developed in Britain from the work of Melanie Klein and colleagues. Note that objects are the things to which a person relates, which can be all kinds of things (people, places, things).

According to object relations theory, internal representations (internal objects) influence the way in which people perceive others, choose the people to establish relationships with, and shape their own relationships. A famous model of object relations is known as attachment theory.

The way people relate to others and situations in their adult life is shaped by family experiences during infancy.

Question 13

British Independents/Middle group

Answer 13

Next to Freudian and Kleinian groups, the British Independents/Middle Group started to appear. They were influenced by both Freudian and Kleinian ideas but did not align politically with either of them. The Middle Group specifically emphasized the importance of spontaneity, creativity, therapist flexibility, and providing clients with a supportive and nurturing environment.

Question 14

Unlike the British system embracing 3 different psychoanalytic traditions, the US was centered around ego psychology only.

Answer 14

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Question 15

Interpersonal (relational) psychoanalysis

Answer 15

the idea that the need for human relatedness is the most fundamental human motivation, instead of sexuality. It was founded by Harry Sullivan, who diverged too much from traditional ego psychology. The rise of relational psychoanalysis included critiquing aspects of classical psychoanalysis, which was around the same time of other important changes in society (behaviorism).

Question 16

conflict theory

Answer 16

the view that emphasizes the centrality of human experience and intrapsychic conflict.
Contemporary ego psychology has evolved into this view over time, and currently a variety of different traditions are embraced in America.

According to conflict theory, intrapsychic conflict plays a central role in the development of one’s personality: it arises from the compromise between core wishes and characteristic styles of defense that are used to manage them. Someone with narcissistic personality defends against dependency wishes and fears of abandonment by projections of grandiosity.

Question 17

Intrapsychic conflict =

Answer 17

ongoing conflict between unconscious wishes and defenses against them.

Question 18

criticism on psychoanalysis=

Answer 18

While psychoanalysis has been very popular for a period of time, its popularity has declined over the years. This has many causes, including the increasing emphasis on biological factors in psychiatry, the rise of cognitive-behaviorism, and growing emphasis on evidence-based treatment. Another factor influencing the decreasing popularity of psychoanalysis has been a negative public reaction to the attitude of arrogance, insularity, and elitism that became associated with it. Furthermore, psychoanalysis have lacked receptiveness of valid criticism and empirical research.

Question 19

hoe populair is psychoanalysis nu

Answer 19

Throughout the years, psychoanalysis has become:
- more flexible,
- less authoritarian,
- more practical,
- more responsive to the needs of a wider range of diverse clients.
- a growing body of empirical evidence.

In short, many problems have diminished. However, many people are unaware of these changes and still have a stereotypical view of psychoanalysis.

Question 20

attachment theory =

Answer 20

(john Bowlby)

the idea that all humans have an innate tendency to develop strong affectional bonds and that threats to these bonds result in psychopathology. To maintain proximity to attachment figures, infants develop internal working models. The internal models of threatening actions influence one’s susceptibility for dissociating experiences and feelings (aggression, anger, vulnerability) linked to them.

Question 21

internal working models=

Answer 21

representations of one’s interactions with attachment figures that allow for prediction of what type of actions will increase the possibility of maintaining proximity vs. of what types will threaten the relationship.

Question 22

internalization =

Answer 22

the process of developing internal representations of relationships with others that shape our ngoing experience and actions.

Question 23

Object relations theory and attachment theory have different ideas of the process of internalization:

Answer 23

• Attachment theory: internalization (internal working models) is based on actual interactions that have taken place.
• Object relations theory: internalization is based on both actual experiences as well as unconscious wishes and fantasies and other intrapsychic processes.

Question 24

developmental arrest models =

Answer 24

models that theorize that psychological problems emerge as a result of the failure of caregivers to provide a sufficient or optimal environment. This leads to the normal developmental process to become ‘arrested’. To develop a cohesive sense of self, the child requires caregivers that can adequately attune to his/her needs.

Question 25

hoe denkt psychoanalyse over unconscious

Answer 25

Traditionally, psychoanalysts have distinguished between psychoanalysis and psychodynamic (or psychoanalytic) psychotherapy. However, there has been a lot of debate about what the defining characteristics of psychoanalysis are and today, psychoanalysts usually do not make rigid distinctions anymore: they are more often based on politics than on theoretically justifiable criteria.

Question 26

primary vs secondary processes

Answer 26

• Primary process: a primitive form of psychic functioning that begins at birth and continues to operate unconsciously throughout the lifetime. It operates in dreams and fantasy and contains no distinction between past, present, and future.
• Secondary process: psychic functioning associated with consciousness. It is logical, sequential, and orderly and the basis of rational, reflective thinking.

Question 27

fantasies in psychoanalysis

Answer 27

Fantasies play an important role in the way in which people relate to external experiences, especially interpersonal relationships. Fantasy has several psychic functions, including the need for regulation of self-esteem, feeling of safety, regulating affect, and the need to master trauma.

Question 28

defense=

Answer 28

an intrapsychic process that functions to avoid emotional pain by pushing thoughts, wishes, feelings, or fantasies out of awareness.

Question 29

defense mechanisms=

Answer 29

• Intellectualization: talking about something threatening while keeping an emotional distance from the feelings associated with it.
• Projection: attributing a threatening feeling or motive that one experiences to another person.
• Reaction formation: denying a threatening feeling and proclaiming that one feels the opposite.
• Splitting: splitting the representation of another person into 2 different images to avoid the perception of that person as good from being contaminated by negative feelings.

Question 30

transferance=

Answer 30

when a patient responds to the therapist as though he/she were a significant figure in the patient’s past (usually a parent).

A client with a tyrannical father might begin to see and react to the therapist as tyrannical.

Question 31

According to Edward Bordin, the strength of the therapeutic alliance depends on …

Answer 31

• how much the client and therapist agree on tasks and goals
• the quality of the relational bond between them.

Question 32

countertransferance=

Answer 32

the therapist’s own feelings and reactions to the client’s transference that are a function of one’s own unresolved conflicts. According to Freud, countertransference was an obstacle to therapy, and the therapist should analyze or work thorough it in personal supervision, in therapy, or through self-analysis.

Currently, countertransference is more broadly defined as the totality of the therapist’s reactions to the client.

Question 33

resistance=

Answer 33

the tendency for an individual to resist change or act in a way that undermines the therapeutic process (consistently coming late to sessions). It is often considered as a manifestation of a defense mechanism and should be seen not as an obstacle but as a mode of the client’s functioning that needs to be explored and understood.

Question 34

intersubjectivity =

Answer 34

the ability to hold onto one’s own experience while at the same time beginning to experience the other as an independent center of subjectivity. The patient and therapist can both share their view of the situation and can accept each other’s view or respond with counterbid in an ongoing negotiation.

Question 35

enactment=

Answer 35

an interaction between the client and therapist that is shaped by both of their unconscious contributions.

Non-verbal interactions between both parties, with unconscious meaning for both.

Both parties, and their working models, are influencing each other. Exploring and working through enactments can help with modifying a patient’s relational schemas/working models.

Question 36

therapy layout: 4 concepts

Answer 36

• empathy
• interpretation
• support and advice
• termination

Question 37

support & advice=

Answer 37

Ideally, one wishes to promote a clients’ self-efficacy. However, the therapist should also recognize that a genuine word of reassurance or advice can be very important.

Question 38

termination=

Answer 38

Psychoanalysis considers termination to be one of the most important phases of treatment. When it is done right, it can play a vital role in helping clients consolidate the gains that have been made.

However, when it is done wrong, it can negatively affect the treatment process. The therapist should find a balance between respecting the patient’s decision to terminate but also to explore the client’s underlying motivations for terminating (feeling too dependent on the therapist).

Ideally, termination should be decided upon collaboratively by the client and therapist.

Question 39

The most basic mechanism of change involves…

Answer 39

making the unconscious conscious by using interpretations. In psychoanalysis, change involves becoming aware of our instinctual impulses and related unconscious wishes and then learning to deal with them in a rational way. There is also an emphasis on the importance of emotional insight.

Question 40

creating meaning=

Answer 40

Psychoanalysis also works by providing culturally normative explanations for symptoms and emotional pain. By providing an account of the role of childhood experiences, a patient’s experiences of self-blame can be reduced and the process of developing adaptive coping strategies can begin.

Question 41

containment=

Answer 41

the process of attending to our own emotions when working with clients and tolerating and
processing painful or disturbing feelings non-defensively. A therapist should process and manage feelings that the client evokes so that their responses can help regulate the patient’s emotions.

Question 42

alliance rupture and repair=

Answer 42

the change process of strain and repair of the therapeutic alliance.

Psychoanalytic theory proposes that the therapist will inevitably fail the client by not being adequately attuned to his/her needs. The client will be retraumatized and this has to be worked through again.

Question 43

No treatment is effective for all individuals, and this is especially true for certain specific psychoanalytic interventions (emphasizing interpretation will not do much for clients with limited self-reflection). If conceptualized in a flexible, more broad way, psychoanalysis can be useful for a wide range of clients.

Answer 43

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Question 44

Psychoanalysis may not be the best therapy for clients that have little interest, time, or financial resources to be in long-term treatment. The same goes for going to treatment once a week, or even more.

Answer 44

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Question 45

wat voor evidence is er wel voor psychodynamic theories

Answer 45

• Short-term therapy: meta-analyses of RCTs have found substantial effect sizes for short-term dynamic psychotherapies that are as large or even larger than those for cognitive therapies.
• Long-term therapy: meta-analyses found that longer-term psychoanalytic therapy is particularly effective for complex mental disorders (personality disorders), chronic disorders and in cases of multiple disorders.
• Follow-up: most notably, the effectiveness of psychoanalytic therapy increases after termination, which has not emerged to the same extent for cognitive-behavioral interventions.

Question 46

6 questions you can think about in psychoanalysis

Answer 46

1. where is the anxiety, resistance, or defense?
2. with what words and images does the patient identify?
3. where does our desire appear?
4. where does the unconscious speak?
5. how does the transferance develop?
6. what is being repeated?

Question 47

Where is the anxiety, resistance, or defense? voorbeelden

Answer 47

Where is something left out or talked over? What does the patient not want to hear? Where does it seem that anxiety is avoided (by laughing it away)?

Question 48

With what words and images does the patient identify? voorbeelden

Answer 48

What words and images of the self-recur? How did the patient come to identify with them? Are they in conflict with desires or fantasies?

Question 49

Where does desire appear?

Answer 49

Is there an (unconscious) desire speaking? Is desire being cast aside out of fear or by not fitting with demands?

Question 50

Where does the unconscious speak?

Answer 50

It is assumed that the patient aims to structure speech on the demands of ego and the other person and when he/she fails to do so, slips may occur. These ‘errors’ reveal hidden desires and usually evoke defenses and resistances.

Question 51

How does the transference develop? voorbeelden

Answer 51

How does the patient and therapist position themselves and the other? It is assumed that the patient and therapist shape the relation on the basis of fantasies.

Question 52

What is being repeated?

Answer 52

Are there repetitions of certain words or phrases? Can you recognize something that is being repeated in interpersonal situations or the therapeutic relation?