Class 11/12: Time-Limited Psychodynamic Psychotherapy Flashcards
1
Q
Time-Limited Dynamic Psychotherapy -Hanna Levenson
A
- Circumscribed Focus: Identify, track, maintain focus
- Limited Goals
- Time Management
- Selection Criteria
- Therapist Activity: ranging from supportive to exploratory interventions
- Therapeutic Alliance: affective, common goals, quick
- Rapid assessment and intervention
- Termination: explicit throughout
- Optimism: about achieving goals
- Contract: patient agrees to timeframe
2
Q
Time-Limited Dynamic Psychotherapy
(Characteristics)
(Commonalities)
A
- Importance of childhood experiences and development
- Role of the unconscious in behavior
- Role of conflict
- Transference-countertransference
- The therapeutic alliance
- Behavior patterns
3
Q
Time-Limited Dynamic Psychotherapy
(Characteristics)
(Differences from Traditional Theory)
A
- Does not embrace Freudian psychoanalytic concepts and techniques
- Does make use of other theoretical approaches
- More integrative in interventions
4
Q
History of Short-Term Psychotherapy
A
- Freud began with brief model
- Later shifted from catharsis to free association
- 1920s: Sandor Ferenczi and Otto Rank
- focused on more active role of therapist, briefer models
- 1940s: Franz Alexander and Thomas Morton French
- Adjusted length and frequency of sessions, emphasized corrective emotional experience
5
Q
History of Short-Term Psychotherapy
(1970s)
A
- David Malan (London)
- “Intensive Brief Psychotherapy” (IBP): Triangle of Conflict (impulse—anxiety—defense); Triangle of Persons
- Habib Davanloo (Montreal)
- Intensive Short-term Dynamic Psychotherapy (ISTDP): Confrontation
- Peter Sifneos (Boston)
- Short-term Anxiety-Provoking Psychotherapy (STAPP)focused on more active role of therapist, interpretations
- James Mann (Boston)
- 12 sessions, focused on separation and loss
6
Q
History of Short-Term Psychotherapy
(1980s)
A
- Relational models
- Hans Strupp and Jeffrey Binder
- Time-limited Dynamic Psychotherapy (TLDP)
- Focus on recurrent, maladaptive themes (expressed in the transference)
- Time-limited Dynamic Psychotherapy (TLDP)
- Lester Luborsky
- Supportive-Expressive Psychotherapy
- Core Conflictual Relationship Theme (CCRT)
- Supportive-Expressive Psychotherapy
- Joseph Weiss and Harold Sampson
- Control Mastery Theory
- Hans Strupp and Jeffrey Binder
7
Q
Time-Limited Dynamic Psychotherapy
(TLDP)
A
- Binder, Strupp, Levenson
- Grounded in
- Object Relations
- Attachment theory
- Interpersonal-relational theory (interactive dynamics)
- Experiential-affective Change
8
Q
Principles of TLDP Hanna Levenson (2010)
(1-9)
A
- Search for relatedness is innate
- Maladaptive relationship patterns form early, persist
- Patterns persist because people identify with them
- People are “stuck,” not “sick”
- Focus is on relationship patterns + their emotions
- Focus is on interactive processes rather than context
- Focuses on one (primary) problematic relationship pattern
- Therapist is both/and participant, observer
- Change continues after termination
9
Q
Goals of TLDP Hanna Levenson (2010)
(Providing new experiences for the client (with the therapist and with current relationships))
A
- Interpersonal experiences
- Intrapersonal (i.e., internal processes)—transforming affect
- Create positive emotional state (e.g., depression to anger)
- Shared implicit relationship (attunement; “holding” a client)
10
Q
Goals of TLDP Hanna Levenson (2010)
(Providing new understandings for the patient regarding emotional shifts within and relational shifts between (i.e., experiential learning))
A
- Intrapersonal
- Through use of countertransference
- Interpersonal
- Through reflection, interpretation, clarification, confrontation, talking about patterns within the therapeutic relationship
- Removes “blame” from the story, promotes compassion for all
11
Q
TLDP Formulation Hanna Levenson (2010)
A
- “Cyclical Maladaptive Pattern” (CMP)
- Basis of dynamic focus
- Organizing framework
- A “plausible narrative”
- “describes the cycles or patterns people get into that involve inflexible, self-perpetuating behaviors, self-defeating expectations, and negative self-appraisals and that lead to dysfunctional and maladaptive interactions with others” (Levenson, 2010)
12
Q
CMP Categories
(1-5)
A
- Acts of the self ”)
- Thoughts, feelings, motives, perceptions and behaviors
- May be conscious or unconscious
- Expectations of Others’ Reactions
- Acts of Others Toward the Self
- Acts of the Self Toward the Self (Introject)
- How the client views him/herself
- Therapist’s Interactive Countertransference
13
Q
TLDP Case Formulation: Assessment
A
Therapist:
- Lets client tell own story
- Conducts an anchored history
- Attends to emotional elements of story
- Explores emotional-interpersonal context
- Uses CMP to gather, organize, guide questions
14
Q
TLDP Case Formulation:
Conceptualization
A
Therapist
- Listens for behaviors and emotions (in past, current, and therapeutic relationship)
- Is aware of own behaviors and emotions (countertransference)
- Watches of reenactments in the therapeutic relationship
- Develops a CMP story that describes the client’s pattern
15
Q
TLDP Case Formulation:
Treatment Planning
A
Therapist
- Uses CMP to formulate what new experiences might be therapeutic (intra- and interpersonally)
- Uses CMP to formulate what new understandings might be therapeutic (intra- and interpersonally)
- Continually revises and refines the CMP
- Considers influence of cultural factors throughout
16
Q
Form for the CMP
A
17
Q
TLDP Intervention Strategies:
Maintaining the Therapeutic Relationship
A
The Therapist
- Responds respectfully , collaboratively, nonjudgmentally
- Demonstrates listening receptively
- Recognizes client’s strengths, and communicates these
- Address clients obstacles (aka “resistance”) and opportunities
18
Q
TLDP Intervention Strategies:
Accessing and Processing Emotion
A
The Therapist
- Helps client stay emotionally regulated
- Encourages client to experience/express affect
- Facilitates client’s awareness of emotions, and depth of experience
- Helps client name emotional experience and recognize it’s significance (as it pertains to the therapeutic goal)
- Helps client access, experience, deepen attachment-related feelings andor primary emotions related to CMP
19
Q
TLDP Intervention Strategies:
Empathic Exploration + Focused Inquiry
A
The Therapist
- Uses open-ended questions
- Inquires into personal meanings of the client’s words
- Responds to the client’s statements by asking for concrete detail
___________________________________________________
1.Throughout, maintains a focused line of inquiry
20
Q
TLDP Intervention Strategies:
Relationship Focus
A
The Therapist
- Facilitates client’s expression, exploration of feelings, thoughts, and beliefs in relation to past, current, therapeutic relationship
- Encourages client to discuss how the therapist might feel/think about the client
- Discloses own reactions to aspects of client’s behavior generally and to CMP specifically
- Metacommunicates about interpersonal process within the therapeutic relationship
21
Q
TLDP Intervention Strategies:
Cyclical Patterns
A
The Therapist
- Asks about client’s introject
- Helps client link emotions and personal meanings to patterns of interpersonal behavior
- Deepens client’s emotional and conceptual understanding of impact of CMP on intra- and interpersonal functioning
- Links need for disowning emotions to early experiences with caregivers
- Helps client incorporate more adaptive feelings thoughts, and behaviors into a new narrative
22
Q
TLDP Intervention Strategies:
Promoting Change Directly
A
The Therapist
- Provides opportunities for client to have new experiences in interactions with therapist, others (consistent with tx goals)
- Gives process directives in session and outside of session (e.g., homework) to help client take steps toward new emotions/experiences/understandings
- Discusses time-limited nature of therapy
