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Psychodynamic (Psy 758) > Class 7: Core Psychodynamic Problems > Flashcards

Class 7: Core Psychodynamic Problems Flashcards

1
Q

Nomothetic vs. Idiographic Knowledge

A
  • then on next page without header
    • We can recognize patterns
    • We can identify problems
    • There are common problems that fit well with a psychodynamic approach
  • Nomothetic..bigger
  • idiographic…more to individual
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2
Q

Core Conflictual Relationship Theme

A
  • Core Conflictual Relationship Theme (CCRT)
    • Luborsky and Crits-Cristoph
    • CCRT
      • What the patient wanted from the other person (wish)
      • How the other people reacted (response of other/RO)
      • How the patient/”self” reacted to their reactions (response of self/RS)
    • CCRT recurs across relationships, form a pattern or schema
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3
Q

Core Psychodynamic Problems

(list them)

A
  • Depression
  • Obsessionality
  • Fear of abandonment
  • Low self-esteem
  • Panic anxiety
  • Trauma
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4
Q

Typical CCRTs

(depression)

(Summers and Barber, 2010, pp 96-97)

A
  • Wish to be loved—>rejected by others—>feel depressed/angry
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5
Q

Typical CCRTs

(Obsessionality)

(Summers and Barber, 2010, pp 96-97)

A

Wish to be in control of emotions & impulses —>others are controlling me—>feel angry/anxious

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6
Q

Typical CCRTs

(Fear of abandonment)

(Summers and Barber, 2010, pp 96-97)

A

Wish to merge/be close —>people are abandoning me—>feel alone, angry

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7
Q

Typical CCRTs

(Low self-esteem)

(Summers and Barber, 2010, pp 96-97)

A

Wish to be taken care of, love, respected, admired

—->not given enough respect, love, admiration —>feel empty and not admired

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8
Q

Typical CCRTs

(Panic anxiety)

(Summers and Barber, 2010, pp 96-97)

A

Wish to be close and loved —>people leave me —>feel loss, fear, anger

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9
Q

Typical CCRTs

(Trauma)

(Summers and Barber, 2010, pp 96-97)

A

Want to trust and be safe —>others violate my trust —->feel afraid and not trusting

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10
Q

Depression

(May present as)

A
  • sadness
  • loss
  • melancholy
  • boredom
  • frustration
  • irritability
  • fear, abandonment
  • hopelessness
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11
Q

Depression

(Subjective experience)

A
  • Feelings of self-criticism
  • negativity
    • hopelessness
  • loss
    • death….relationship like divorce…a move
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12
Q

Depression

(Theoretical considerations)

A
  • Freud’s “Mourning and Melancholia”
    • go from grief to melancholia..which is pathological….loose internal self
  • Klein’s Depressive Position (love and hate/frustration co-exist)
    • schizoid position
      • mom is all good or all bad
      • love and hate split….cant bring them together which results in loss of one or other
  • Kohut’s poor self-object
    • poor idea of self object
    • limited attachment results in feeling of sadness loss depression
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13
Q

Depression Formulation

A
  • Frustration with early attachment leads to anger and guilt
    • instead of expressing anger outward…gets expressed inward…as self criticsm
  • Response is to try to connect with idealized others
    • constantly comparing to best parts of others “like facebook”
  • Idealized others disappoint
  • Strengths sabbotaged
    • Courage (lack of energy), humanity (ability to engage…social withdrawl), transcendence(apprechiation of beuty in life)
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14
Q

Depression Treatment Goals

A
  • Decrease patient’s vulnerability to abandonment
    • “Ride out” natural ups and downs of relationships
  • Decrease tendency for harsh self-criticism
    • Hold on to a more positive sense of self
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15
Q

Depression Treatment Techniques

(Phases)

A
  • Phase 1
    • Supportive environment + education about depression
    • Behavioral activation
  • Phase 2
    • Identifying the key themes of (a) abandonment and loss, (b) resentment
    • Increased self-awareness, changing perceptions, trying new behaviors
  • Phase 3
    • Maintenance, deepening, working through
  • Phase 4
    • Termination
    • Fear of recurrence
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16
Q

Depression: Transference & Countertransference

A
  • Anaclitic (abandonment) depression
    • Transference = feeling abandoned
    • Idealize therapist, develop feelings of dependency
    • CT: rescue fantasy (I alone can help the patient through my care and interest
  • Introjective (guilty) depression
    • Transference tends to take the form of disappointment and anger toward therapist r/t past losses
    • CT: feelings of incompetence (in response to patients’ anger) or feeling sucked dry
17
Q

Obsessionality: Controlling Feelings

A
  • Strong emotions, viewed as inconvenient or even threatening
  • OCPD; not OCD
  • Theoretical Considerations
    • Freud’s Anal stage:
      • value in order
        • thought over emotion (no evidence)…buy into thoughts will weaken you
      • fixation with ability to let go
      • Id wants relief by dischage and libido stuck….dont let go
    • Ego Psychology: Id/aggression/anger is bad, must be controlled
      • internalized superego…
        • anger is bad and must be under control
        • desire to control feeling…leads to obsessionality
18
Q

Obsessionality Formulation

A
  • Defenses control feelings/aggression
    • Intellectualization
      • reliance on cognitive processes
      • control anger and dont get mad at abuser…that they love you and it was their way of showing it….
    • Isolation of affect
      • _​_separating thoughts and feelings
        • you can feel one way but you have to do whats right
    • Reaction formation
      • _​_substituting positive feeling for negative
      • mom who feels agressive impulse to child for loss of freedom and then reacts to extra feeling of love to kid
    • Displacement
      • _​_shifting feelings/conflicts from one situation to another
      • kick dog because mad
    • Doing and Undoing
      • _​_express something, then take it back—”Just kidding.”
      • think passive agressive….dont really mean that…slipping through of control mechanisms
  • Conflict over aggression—guilt
    • would much rather not have agression but when do feel guilt
  • Control protects against strong negative feelings
  • Strengths
    • impaired by rigidity and constant control
    • wisdom, knowledge, and humanity (love, kindness….which makes sense bc they are unpredictable)
      • in order to be wise…have to be open to curiosity…feeling…cant be curious if have to be worried about what is coming up and having to control it
19
Q

Obsessionality Treatment Goals

A
  • Goals:
  1. help patience experience a wider range of emotions
  2. increase tolerance and acceptance of range of emotions
  3. decrease guilt
  • Challenges
    • Patient fears loss of control associated with negative emotions, fear of retaliation
    • Patient can experience anger and loss in the treatment relationship
20
Q

Obsessionality: Treatment Techniques

A
  • Therapeutic alliance: bookend interpretations with empathy
    • encourage them to conceptualize their prob to give them sense of control
  • Psychoeducation: lay out the “rules”
  • Help patient recognize and identify feelings
    • Mirroring, empathizing, active acceptance (to counter harsh superego
    • Circle back, going just a bit deeper each time
  • use empathy
21
Q

Obsessionality: Transference & Countertransference

A
  • Transference
    • Patient feels the need to control the therapy and the therapist
    • (in order to manage the negative feelings)
  • CT
    • Frustration, impatience, boredom (they ruminate), disconnection
22
Q

Fear of Abandonment

A
  • Insecure attachment
  • Feelings of vulnerability to separation, abandonment
  • Will use desperate strategies to stay connected
  • Subjective experience
    • Intense feelings of abandonment, chronic anger, physical and psychiatric sxs, alternating good and bad internal representations of others and self, no engaging activities, feelings of emptiness, impulsivity
    • Defenses:
      • splitting
        • all good or all bad
      • projective identification
        • youre just like…
        • de-realization
          • loose contact with what is real…they loose touch with that there is also good…
23
Q

Fear of Abandonment: Formulation

A
  • Theoretical Foundation
    • Bowlby’s insecure attachment
    • Mahler’s problems in rapprochement phase
      • inabliity to adjust
    • Kernberg’s attention to subjective experience of aggression and rage
      • Recommended confronting the rage in the transference
    • Patient protects against abandonment by controlling relationships and feelings, keeps others bound to them
    • Splitting allows a sense of goodness to survive
    • May manifest as clinging behavior or rejecting
  • Strengths impaired
    • humanity
      • ability to build relationships, love and kidnness
    • justice
24
Q

Fear of Abandonment: Treatment Goals

A
  • More stable, integrated image of self and other
    • Ability to be effective and active
    • Show them you have both good and bad
  • Decreased emotional reactivity
    • Contain destructive emotions
    • emotions are reactive in nature…with impulsivity..teach to decrease emotion reactivity
  • More stable relationships
25
Q

Fear of Abandonment: Techniques

A
  • Therapeutic Alliance
    • Calmness, patience, consistency
    • Tolerance of strong affect
  • Gunderson’s use other relationship to try out new self-perceptions and perceptions of others
  • Patient to verbalize feelings of loss and anger
  • Encourage self-soothing
  • DBT
  • Coaching support to help with fear of abandonment, help build repertoire of success
  • Treatment contract re: (un)acceptable behaviors, with clear contingencies
  • Flexibiilty, availability, responsiveness, within limits
26
Q

Fear of Abandonment: Transference and Countertransference

A
  • Transference
    • Split
    • Dependency
  • CT: helplessness, hostility, detachment
    • Needs to be closely monitored

Psychodynamic (Psy 758) (11 decks)

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