chapter 28 psychotherapies Flashcards
frequency
psychoanalytic
psychodynamic expressive
psychodynamic supportive
analytic: 4-5 week,50 min
expressive: 1-3/w, 1/2-1 hr
supportive: flexible
comparison of therapies- duration
analytic
expressive
supportive
analytic: long term, 3-5 years
expressive: short or long (several to years)
supportive: single to lifetime
comparison of therapies-setting
analytic
expressive
supportive
analytic:couch
expressive: face to face, sometimes couch
supportive: couch contraindicated
comparison of therapies- modus operandi:
analytic
expressive
supportive
- analytic:
- full analysis
- transference focused on alalyst,
- intrasession events,
- regression and transference neurosis
- expressive:
- partial analysis of dynamics and defenses
- focus on current events
- transference to others
- analysis of positive but not negative transference (unless impedes progress)
- limited regression
- supportive:
- therapeutic alliance and real object relations
- analysis of transference contraindicated
- regression discouraged
- focus on external events
comparison of therapies- therapist role
analytic
expressive
supportive
- analytic:
- neutrality
- frustrations
- mirroring
- expressive:
- modified neutrality
- implicit gratification
- greater activity
- supportive:
- neutrality suspended
- limited explicit gratification
- directing and disclosure
comparison of therapies- mutative change agents
analytic
expressive
supportive
- analytic:
insight with relatively deprived environment
- expressive:
- insight with more empathic invironment
- identification with benevolent object
- supportive
- surrogate ego as temporary substitude
- holding environment
- insight to degree possible
comparison of therapies-population
analytic
expressive
supportive
analytic:neuroses and mild personality pathology
expressive:neuroses, mild to moderate personality pathologies e.g. nacissitic, bordeline
supportive: severe character disorder, psychosis, crises, physical illness
comparison of therapies- patient requisites
analytic
expressive
supportive
- analytic:
- motivation,
- psychological mindedness
- good previous object relations
- ability to maintain transference neurosis
- frustration tolerance
- expressive:
- moderate to high motivation
- psychlogical mindedness
- can form alliance
- some frustration tolerance
- supportive:
- some motivation
- can form alliance
goals
analytic
expressive
supportive
- analytic:
- structural organnization of personality
- insight into events
- resolution of unconcsious conflicts
- symptom relief an indirect result
- expressive:
- partial reorganization
- resolution of conscious and preconscious conflicts
- improved object relations
- symptom relief is a goal or prelude to further exploration
- supportive:
- reintegration of self
- coping
- stabilization
- strengthening of defenses
- adjustment and acceptance of pathology
- symptom relief
- environmental restructuring
comparison of therapies- major techniques
analytic
expressive
supportive
- analytaic:
- free association
- full dynamic interpretatin (confrontaion, clarification, working through)
- emphasis on genetic reconstruction
- expressive:
- limited free association.
- confrontation,clarification and partial interpretation with emphasis on here and now predominate
- minimal genetic intepretations.
- supportive:
- free associations- contraindicated
- suggestion(advise) predominates
- abreaction- useful
- genetic interpretation- contraindicated
- confronation ,clarfication and interpretation in the here and now -secondary
comparison of therapies-adjunct treatments:
analytic
expressive
supportive
- analytic:
- primarily avoided
- if used- analyze all positive and negative implications.
- expressive:
- may be necessary (e.g. medications)
- negative implications explored
- supportive:
- often necessary(medication,family rehabilitative therapy,hospitalization, etc.)
- emphasize positive implications
what is classic psychoanalysis based on ?
based on theory of sexual repression, unfulfilled libidinal wishes in the unconscious, discover meaning and motivation of behavior
what are the methods of psychoanalysis
bringing up repressed memories reexperienced in transeferrence
reconstructed by analyst and resolved through:
understanding
recollection (remembering)
repetition(reliving)
working through(gaining insight)
indications for psychoanalysis:
- neurosis with significant suffering
- higly motivated but not desperate
- ability to form relationship:
- relatively stable relationships in past
- can withstande frustrating and regressive transference.
4.psychological mindedness and capacity for insight.
- at least average IQ
- can think abstractly
- ego strength:
- mature superego
- can reflect and become dependent and passive
- can accept analytic rules .integrate interpretations,shift perspectives and become an observer of own processes
6.Honesty
contraindication for psychoanalysis
- no suffering
- cant tolerate frustration
- poor impulse control
- low motivation
- dishonesty,antisocial
- concrete
- major life crisis
- severe physical illness(cant invest long term)
- low intelligence
- close relationship with analyst
Difference between Freuds psychoanalysis and modern days (frequency and time?)
Freud- 6 per week, full hour.
modern- 3-5 per week, 50 min
couch in psychoanalysis-advantages
- relaxation,eases patient’s conscious control of thoughts
- avoids analyst influence
- permits observation of analyst without interruption
- symbolic value for freudian legacy.
note: couch can be introduced gradually and suspended when necessary (if countertherapsutic or regression unnecessary)
the fundamental rule
- pure free associations-requires patient to say every thing that come to head.
- analyst examines diminshed flow
- prohibit action in favor of verbalization
- postone major changes in life if not dicussed and analyzed(like marriage).
rule of abstinance
avoid any satisfaction of emotional needs and wishes toward analyst
what is psychoanalytic psychotherapy?
- Broader than classis psychoanalysis.
- Mainly use of insight-oriented methods.
- A blend of uncovering and suppressive measured
- mainly face to face
- can deal with short term conflicts
what are 2 types of psychoanalytic psychotherapy, and how do they differ?
expressive:
- insight oriented
- uncovering
- evocative
- interpretive
supportive:
- relationship-oriented
- suggestive
- supressive or repressive
couch in psychoanalytic psychotherapy?
- rarely used since limited free association method - used when need to access fantasy or dreams to enlighten a specific issue
limitations of expressive etherapy?
some may not tolerate emotional integration of cognitive awareness. may decompensate from frequent interpretation
supportive therapy
Foundation in 18th century
Treatment with empathic and humane environment
Used in genral practice and rehabilitation.
Places major etiological emphasis on external events
contraindications for supportive therapy?
- no absolute contraindications!
- not suited for those capable of more in depth approach-not because they may be harmed, but because they may not be ufficiently benefited by it
- Nevertheless, individuals who are sychologically minded but not highly motivated ,may benefit from supportive therapy.
Corrective emotional experiance
- Franz Alexander
- Elemants of both psychoanalysis and psychoanalytic psychotherapy
- Therapist plays opposite role than destructive parents., to reverse their paren’s mistakesqcrrect traumatic past events
who identified the basic charateristics of brief therapy?
franz alexander and thomas french
Brief Focal Psychotherapy (Malan-Tavistock) indications and contraindications
Indication
- high motivation- correlates with successful outcome
- not dangerous
- capably to consider problems in emotional terms
- capable to face disturbing material
- capable to respond to interpretations
- capable to endure sress of treatment
contraindications:
- serious suicide attempts.
- alcoholism /substance dependence
- incapacitating obsessions
- incapacitating phobic symptoms
- destructive acting out
brief focal psychotherapy requirements and techniques (Malan)
- identify and interpret transference early(inc. negative)
- link transference to parent relationship
- Both patients and therpist should be willing to become deeply involved and to bear ensuing tension
- formulate a focus and termination date in advance
- patients should work through grief and anger about termination
brief focal psychotherapy (Malan) length of treatment
experienced: 20 sessions
in average trainee: 30
Malan did not exceed 40
Time limited psychotherapy (Boston university- Mann) indications and contraindications
no clear cut indications.
contraindications:
- Major depressive disorder that interferes with treatment agreement
- acute psychosis
- desperate patients who need but cannot tolerate object relations.
Mann length of treament
strictly 12 sessions
Mann -requirements and techniques
- positive transference predominates early
- specific adherence to central issue involving transference
- positive identification
- making separation a maturational event
- clarification of present and past experiances and resistances
- therapist active and supportive, education and encouragement,
Mann - Time limited psychotherapy- main conflicts
- independence vs dependence
- activity vs passivity
- unresolved or delayed grief
- adequate vs inadequate self esteem
Mann-time limited therapy- main emphasis
determine patients central conflict
explore maturational crises and many psychological and somatic complaints.
What is Short term dynamic psychotherapy (Mcgill university, Davanloo)?
encompasses nealy all varieties of brief therapies and crisis interventions
Patient’s classificaion of short term dynamic therapy (Davanloo)?
- primarily oedipal conflict
- primarily non oedipal conflict
- conflict with more than one focus
*Also devised a specific technique for severe OCD and phobias
Davanloo(Short term dynamic therapy) selection criteria?
The criteria empasize ego functions of primary importance to therpeutic focus:
- establishment of therapeutic focus
- formulation of problems
- ability to interact emotionally
- a history of give and take relatinship with significant person
- can tolerate anxiety,guilt,depression
- motivation
- psychological mindedness
- ability to respond to interpretations
- ability to line evaluators with people in past or present.
What do Davanlo and Malan have in common?
Both emphasize patient’s response to interpretation as an important selection and prognostic criterion.
Davanloo requirements and techniques
- flexibility-adapt technique to patient’s need
- control regressive tendencies
- active intervention to avoid dependence
- emotional experience is corrected through insight
Short term anxeity provoking psychotherapy- Sifneous- critera for short term anxiety provoking therapy (harvard universsity- sifneous)
- patient’s ability to select one of variety of problems
- desire to resolve problem, and motivation to change- not just symtomatic relief
- one meaningful give and take relationship during childhood
- can interact flexibly and express feelings appropriately
- above average psychological sophistication
- a specific psychodynamic formulation- centering in oedipal conflict
- contract to work on specific focus, with minimal expectation of outcomes.
what are the 4 stages of anxiety provoking therapy?
- patient-therapist encounter
- early therapy
- height of treatment
- evidence of change and termination
axiety provoking therapy- phase 1
- patient therapist encounter
- alliance
- closed and opened end questions
- specify minimal expectations.
axiety provoking therapy- phase 2
early therapy- transference to therapist are clarified as soon as they appear- establishes alliance
axiety provoking therapy- phase 3
- height of treatment
- active concentration on oedipal conflict chosen
- anxiety provoking questions and confrontations
- avoidance of pregenital issues used to avoid anxiety
- avoidance of transference neurosis
- concentratinon on anxiety-laden material even before clarifying defense mechanisms
- repeated demonstration of parent-transference links
- corrective emotional expereience
- encouragement and support when anxious while struggling to understand conflicts
- new learnig and problem solving
- repeated dynamics until defense mechanisms are understood
anxiety provoking therapy final phase
evidence of change and termination of therapy:
- demonstration of change in behavior outside therapy
- evidence that uses adaptive behavios
- initiation of talk of termination
what is comon among short term therapies?
- therapeutic alliance and dynamic interaction
- use of transference
- active interpretation of central issue
- link between parental and transference issues
- early termination
which therapies did the following develop?
Malan
Mann
Davanloo
Sifneos
- Malan- Brief focal psychotherapy
- Mann- Time limited psychotherapy
- Davanloo- Short term dynamic psychotherapy
- Sifneous- Anxiety provoking
Who developed the folowing short term therapies?
Brief focal
Time limited
Short term dynamic
Anxiety provoking
- Brief focal- Malan
- Time limited- Mann
- Short term dynaic- Davanloo
- Anxiety provoking-Sifneos
analyst as mirror
- the analyst in impenetrable to the patient, he only reflects what is shown
- neutral blank sceens
- therapist does not interact.
- allows analyst to accept without censure all forbidden or objectionable responses
