Class 9: just extra cpp of obsessionally

Question 1

Obsessionality: Controlling Feelings

Answer 1

• Strong emotions, viewed as inconvenient or even threatening
• Related to OCPD

Question 2

Obsessionality Formulation

Answer 2

• Defenses control feelings/aggression
  
  • Intellectualization (reliance on cognitive processes)
  • Isolation of affect (separating thoughts and feelings)
  • Reaction formation (substituting positive feeling for negative)
  • Displacement (shifting feelings/conflicts from one situation to another)
  • Doing and Undoing (express something, then take it back—”Just kidding.”)
• Conflict over aggression—guilt
• Control protects against strong negative feelings
• Strengths: impaired by rigidity and constant control

Question 3

Obsessionality Treatment Goals

Answer 3

• 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

Question 4

Obsessionality: Transference & Countertransference

Answer 4

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

Question 5

Case Formulation (Summers & Barber, 2010)

(parts)

Answer 5

1. Summarizing Statement
2. Description of Nondynamic Factors
3. Psychodynamic Explanation of Central Conflicts (one problem)
4. Predicting Responses to the Therapeutic Situation

Question 6

Obsessionality: Treatment Techniques

Answer 6

• Therapeutic alliance: bookend interpretations with empathy
• 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

Question 7

Case Formulation: Summers & Barber, 2010

(consider)

Answer 7

• Grounded in the patient’s history
• Consider
  
  • Seminal life events (across developmental trajectory)
  • Key subjective experiences, psychiatric sxs
  • Neurobiological factors, syndromal pathology
  • Psychodynamic themes
  • Treatments and response