Exam 1 Terms

Question 1

Goals of Psychodynamic Treatment

Answer 1

• Seek to understand the meaning of the symptoms in the context of an overall picture of the patient
• Extend beyond symptom remission
• Success should be relieving symptoms & fostering a positive presence of psych capacities & resources (which will vary by person)

Question 2

Self and Object Constancy (Wellness)

Answer 2

Having the ability to feel ambivalent. (Good and Bad qualities)
Can talk about your dad saying both good and bad aspects about him.
People who lack this have no constancy either see all the good, or all the bad.
“Identity integration” – you feel like ‘yourself’ in different contexts, the same can be said for the way you experience others.
You have the ability to conceptualize multiplicities within self and others (can be simultaneously Good and Bad)

Question 3

Ego Strength/Resilience

Answer 3

Can you suffer some kind of stress and find a response to be adaptive? Be able to tolerate it & deal w/ it

Question 4

Affect/Thought Regulation

Answer 4

Move fluidly from 1 emotion to another. Can regulate your emotions, if someone does something bad you don’t explode and crash their car.
Being able to feel very strongly and not give into/ over to that. Maintain emotional regulation.

Question 5

Mentalization/Theory of Mind

Answer 5

Other people are separate subjects of subjectivity. People who lack this think that everything that happens to them is directed at them.
Example: “The baby knows how to push my buttons” → The baby is too young to know this concept of how to push your buttons

Question 6

Classical Psychoanalysis

Answer 6

Unearth root cause of neurosis by using free association and dream analysis. Exploration of fantasy life.

Question 7

Freud’s Theory of Infantile Sexuality

Answer 7

infants are sexual from birth; sexual impulse or desire and its conflict with society)
not things that actually happened
longed-for but felt guilty & repressed it
consequence/symptom b/c of the repression
infant sexual from the early stages, wish is in conflict w/ society
Symptoms result from conflict and repression on early (in born) sexual wishes/urges

Question 8

Freud’s Theory of Infantile Seduction

Answer 8

Seduction (adults or other people who are inducing children into sexual acts):
›The root cause of all neurosis is the premature introduction of sexuality into the experience of the child [before they’re sexual]
›Symptom reduction through:
Uncovering unpleasant experiences through dream analysis and free association
›Events that often occurred in childhood uncovered and worked through
And were often related to sexuality (his patients)
Later on he changed his theory to theory of infantile sexuality

Question 9

Topographical Model of Mind

Answer 9

Unconscious: unacceptable ideas and feelings
Preconscious: acceptable ideas and feelings that are capable of becoming conscious
Conscious: ideas and feelings in awareness at any particular time
Think of the iceberg analogy

Question 10

Structural Model of the Mind

Answer 10

Id, Ego, and Superego
Different Agencies
Id: cauldron full of seething excitations (unconscious)
Ego: collection of regulatory functions, keeping the id under control (partially conscious/unconscious)
•Superego: set of moral values and self-critical attitudes (internalized parental values).. Societal values (partially conscious/unconscious)

Question 11

Latent Content of Dreams

Answer 11

During dreams, defenses are deactivated and forbidden wishes come into consciousness.
TRUE MEANING OF A DREAM IS LATENT CONTENT OF DREAMS: unconscious material that is coming up
Underlying meaning of the symbol(s) in a dream (beyond the literal description of what happened in the dream)

Question 12

Manifest Content of Dreams

Answer 12

›Disguised Form of the forbidden material:
›Example: sister flying airplane and there’s a giraffe near her
The literal/actual subject matter of a dream

Question 13

Interpretation

Answer 13

The process by which the psychoanalyst brings the unconscious material into conscious awareness. It involves observation of the client’s conscious manifestation of unconscious thoughts and wishes and the hypothesis generation (development of hypothetical explanations linked to the underlying causal factors still in the unconscious)

Question 14

Transference

Answer 14

Repetition of past relationships in present relationship with your therapist – unconscious or conscious.
Apply old templates to therapeutic relationship
How to handle transference:
First make it conscious that they’re repeating old patterns, demonstrate why its an obstacle in treatment, trace it to its origin
How can you tell?
Overreaction, underreaction, or situation does not match emotional expression you just got
Transference can be both positive or negative.
Positive- you can do no wrong
Negative- strong dislike of the therapist

Question 15

Countertransference

Answer 15

Process by which the therapist (within a therapeutic relationship) displaces his or her feelings thoughts and behaviors associated with a past relationship onto the client.
Can also be any feelings (even current ones) about the client
Can be positive or negative
Destructive if left in the unconscious

Question 16

Working Alliance

Answer 16

Relatively non-neurotic rational rapport built between the analyst and the client which aids the healing process. It involves the client’s capacity to progress towards improvement through an interaction between the client’s rational ego and therapist’s analyst’s ego.
There together, working together on therapeutic goals
Creates a holding environment (creating a space that is safe enough to let down defenses & let whatever they’ve kept locked inside come out)

Question 17

Resistance

Answer 17

Defensive processes that emerge in therapy relationship that impede exploration and inquiry.
Unconscious/conscious
It is any force that works against therapy
We all have a fear of change, even if we do want help
Three areas that should be considered: If someone is resisting you it could be transference, or something that happened in last session, and outside life or relationship
Examples: Arriving late, not coming at all, not talking etc.

Question 18

Working Through

Answer 18

A process that is repetitive where someone gains some insight and it becomes integrated in their life
Intrapsychic Conflict
•Id (impulse) conflicting with ego or superego (what is regulating it)
An impulse & a regulation
Process of repeating, elaborating, and amplifying interpretations; necessary for successful therapy

Question 19

Repetition Compulsion

Answer 19

When a person repeats a traumatic event or its circumstances over and over
Reenacting an event or putting oneself in a situation where the event is likely to occur again
A type of “reliving”
Can take place in dreams or hallucinations where memories and feelings of what happened are repeated/re-experienced

Question 20

Free Association

Answer 20

Therapeutic tool used in psychoanalysis where the client is encouraged to engage in a process of free flow of emotional expression in an uncensored, transparent fashion. This involves letting go of the defenses which may hinder or restrict the expression of those unconscious, unacceptable thoughts, feelings and emotions.
Insight
the knowledge or understanding of emotional processes and feelings. it can take place at both intellectual and emotional levels, while the latter provides for more deeper processing

Question 21

Drive Theory

Answer 21

Freud- people are “driven” by internal forces (mainly sexuality) & that psych is a matter of tracing the ways in which these drives are expressed & satisfied
Threatening stimuli impinge (mechanical system) stimuli from envt and internal stimuli that can be threatening to person
›External (mom is not there)
›Internal
›The mind is structured to contain and discharge the energy (mind has to deal with it and decide what to do)
›Developmental model
›Sexuality: a pleasurable drive central to human experience
›Source: the part of the body where tension arises (very physical) Mouth is source
›Aim: the goal, the activity desired (food wanting to eat)
›Object: the target required for satisfaction (mother’s breast)
Inborn drive
›Example: Infant feeding
›Oral, Anal, Phallic, and Genital Phases (pleasure center changes)
›Socialization sets up inhibitions and restrictions especially as you go throughout life. Society sets what you can suck on and what you can’t

Question 22

Intrapsychic Conflict

Answer 22

Conflict between id, ego, or superego

Structural theory says id and superego are in conflict, and the ego modulates them

Question 23

Defense Mechanisms

Answer 23

›When anxiety occurs, the mind first responds by an increase in problem-solving thinking, seeking rational ways of escaping the situation. [ dealing with the current stress]
If this is not fruitful, a range of defense mechanisms may be triggered.
›These are tactics which the Ego develops to help deal with the Id and the Super Ego impulses
All Defense Mechanisms share two common properties:
They often appear unconsciously.
They tend to distort, transform, or otherwise falsify reality.
All defense mechanisms exist on a continuum from primitive to more advanced
How someone shows denial can show as psychotic or healthy

Question 24

Denial

Answer 24

Claiming/believing that what is true is actually false.

Example: A man refuses to believe that his wife is dead and still sets up the table for 2 people.

Question 25

Rationalization

Answer 25

This is a defense mechanism.
Creating false but credible justifications. When something you wanted fails to happen, deciding it wasn’t that desirable. Or if something bad happens, deciding it wasn’t so bad.

Question 26

Reaction Formation

Answer 26

Defense mechanism in which the individual displays or forms a behavior or reaction which is opposite to that of the unacceptable feelings and emotions he or she is actually holding in the unconscious.

Question 27

Intellectualization

Answer 27

taking an objective viewpoint. Talking about feelings without feeling them

Question 28

Repression

Answer 28

A defense mechanism.
Motivated forgetting or ignoring. Pushing uncomfortable thoughts into the subconscious, keeping them at a distance.
Example: A child who grew up in an abusive household later has no recollection of this violence.

Question 29

Sublimation

Answer 29

redirecting ‘wrong’ urges into socially acceptable actions

Question 30

Regression

Answer 30

going back a developmental stage. Development is not in a straight line
–Example: whining when tired.

Question 31

Introjection

Answer 31

Subject takes into itself, the behaviors, attributes, or other external objects, especially of other people. Common: a child introjects aspects of parents into his/her own persona. ›According to Freud, the ego and the superego are constructed by introjecting external behavior into the subject’s own persona.
›This can be a defense mechanism where one takes on attributes of a strong other person who is able to cope with the current threat. (Identification with the Aggressor)
Take in their way of being, swallowing the other person whole
Can also see it in grief, if you’re so linked to someone and they pass away, it’s as if a piece of you went with them

Question 32

Dual Instinct Theory

Answer 32

Aggression and Dual Instinct
1920: Dual Instinct Theory
Aggression (another basic instinct/energy) and Sexuality are the basic energies that motivate the mind
›Defenses (one way the mind manages threats from outside or inside) (cant have sex with anyone we want) and repression are not only harmful,
but also helpful to save people and society from themselves
· ›Sometimes aggression can be helpful if someone is hurting you
· ›Health: modulating repression (sometimes using it and sometimes not, only when its beneficial for you)

Question 33

Projective Identification

Answer 33

Bringing together Projection and Introjection
›Introduced by Klein in 1946
›“Not only does the patient view the therapist in a distorted way that is determined by the patient’s past object relations (stereotype plates); in addition, pressure is exerted on the therapist to experience himself in a way that is congruent with the patient’s unconscious fantasy” Ogden (1982)
›Can be thought of as 2 or 3 steps (3rd is technique/what to do)
1.Parts of the self are split off and projected into an external object (therapist)
2.The other/object (therapist) identifies with the split-off part and possessed/coerced/moved by it… might be super irritable
3.The therapist contains the projected parts of the patient’s self, metabolizes them, and then makes more healthy thoughts, feelings, or behaviors available to the patient
· ›Ex. Narcissism: depositing inferiority in the therapist (feel ashamed of attempts to help) or schizoid: depositing hope into the therapist (rescue fantasy)
›VERY helpful in recognizing countertransferential experiences
›Because it can lead to a self-fulfilling prophecy for clients (if you still are angry with her, she will think that everyone IS angry with her)

Question 34

Projection

Answer 34

attributing uncomfortable feelings to others. Lack of boundary between self and other; who is feeling what here? Where is origin of this feeling?
›-Taking an intolerable aspect of one’s internal world and projecting it onto others.
-›This can be a defense mechanism where it is used to expel and externalize uncomfortable inner thoughts and feelings.
-Ex. Paranoia – other people are angry at me, want to hurt me. When the individual is angry – but not consciously aware of his/her own anger

Question 35

Fantasy

Answer 35

I think this is supposed to technically be “phantasies”. Klein’s primary interests are the inner world of drives and unconscious fantasies. Drives are fundamental, biological entities for Klein. They are represented in the mind by phantasies. Focuses on death drives- destructiveness. Death drive finds its expression psychologically in envy; destructive urge to destroy all good in an object. Envy is moderated by gratitude. Balance depends on factors of infant and environment - (mother) A loving generous mother will ameliorate the infant’s envy, while a depressed one will aggravate it.
Another reading said - these are not conscious fantasies which are daydreams.
Phantasies- Arise from inner drives and their relationships with the objects to which they come attached.

Question 36

Internal Objects

Answer 36

Internally formed mental representations of actual external objects or the fantasies and experiences of it. This was first conceptualized by Klein who viewed infants as perceiving the world in terms of these internal objects and not the actual external relationships.
•’Internal object’ is a term used commonly in Kleinian theory to denote an inner mental and emotional image of an external figure, also known as an external object, together with the experience of that figure.
•The inner world is seen to be populated with internal objects.
Mental representation that has a thought component, emotional component, & experiential component

Question 37

Kleinian Psychoanalysis

Answer 37

Recognized the centrality of the infant’s first relationships
•She elucidated the early mental processes that build up a person’s inner emotional world
•By analyzing children’s play Klein explored the uncharted territory of the mind of the infant
•Explored the roots of the superego (conscious, societal values) (predating 3, when Freud suggested)
•Klein’s offered a description of:
•the child’s deepest fears (children do have deep fears at a very early age and they have to deal with them)
•the defenses against them
•This enabled her to make original theoretical contributions to psychoanalysis, most notably the ‘paranoid-schizoid position’ and the ‘depressive position’. You’re either one or the other
•She showed how these primitive mental states impact the adult (like attachment theory- early relationships create mental experiences and we take it into adulthood)

Question 38

Depressive Position

Answer 38

Involves the child’s realization that the good and the bad can co-exist in the same object. Mother is viewed as having both the good and bad breast. This threatens the safety feelings of the infant, due to it’s fear of contaminating and destroying the good breast with it’s aggressive demeanor with the bad breast. This is characterized by depressive anxiety, which is overcome by efforts of reparation to make up for the destructive behavior.
•Mental State “There must be room in love for hate” -Peacock
•Follows the paranoid-schizoid
•Understood to begin in the second six months of life
•The baby, gaining in physical and emotional maturity, begins to integrate its fragmented perceptions of its parent and has a more integrated sense of self
•Bringing together conflicted feelings of love and hate, realizing the hated person and the loved person are one and the same leads to the most anguished sense of guilt and, in time, a wish to repair.
•It is repeatedly revisited and refined throughout early childhood, and intermittently throughout life.

Question 39

Envy

Answer 39

According to Klein is the position in which the child realizes that the good breast possesses and hoards all the good resources and in that way has power over the infant. The infant therefore attempts to destroy the good breast in an attempt to gain position of those resources. This is different from the paranoid-schizoid position since it involves attempts of destruction of the good and not the bad.
•The definition of envy used by Klein is the angry feeling that another person possesses and enjoys something else desirable, often accompanied by an impulse to take it away or spoil it.
Has a destructive nature

Question 40

Paranoid-Schizoid Position

Answer 40

Proposed by Klein who says that infants possess a sense of distinction between the good and bad within their internal objects. The good and the bad are therefore effectively split in the mind of the child and the child experiences a sense of safety. The child clearly demarcates the good attributes as completely separate and uncontaminated by the bad object (most often expressed as good and bad breast). The good breast is approached with feelings of nourishment, warmth and joy whereas the bad breast is approached with a fear of poisoning due to painful experiences experienced in the presence of it. This is marked by persecutory anxiety.

Question 41

Holding Environment

Answer 41

Physical hold but also emotional/mental holding when the baby feels that someone is holding them in their mind and doing things to be good for them
Winnicott

Question 42

Impingement

Answer 42

Winnicott
Part of not good enough mothering. Too much impingement (external demands of mother that interrupt infant’s going on being) will hurt development of the self of the baby. However, need some impingement because need some sense of reality and disappointment.
In case forgot what going on being is it’s:
Moment to moment they have a wish come up and it happens. Floating, not really thinking about how things are happening. Wishes emerge and are met and it cycles

Question 43

Winnicottian Psychoanalysis

Answer 43

Part of the object relations theorists. Believed there is no such thing as a baby- because the mother is always by it’s side. Roots of psychopathology can be found as early as infancy in mother-infant relationships. Did not pay much attention to the role of fathers. We were wired for growth and development, in the right environment this happens, but if not then psychopathology develops.
Focuses on the “real mother”
Differs from Klein in that: Personhood emerges from earliest experiences - from development within the environment the mother provides, not conflictual instinctual pressures arising from within the baby

Question 44

Subjective Omnipotence

Answer 44

the illusion that the baby’s moment to moment desires/needs actually create the desired objects and gratifications. Whatever they want they can make happen. When they want something they get it. Hungry -> get breast

Question 45

Objective Reality

Answer 45

The world in which, as the baby learns very gradually, s/he is not omnipotent—that others have subjectivities too, and where s/he is dependent on others

Question 46

Transitional Space

Answer 46

Play is now a wand- mixing real with magical … called transitional space – mixing the two, dealing with reality while bring magical things also

Question 47

Transitional Object

Answer 47

stuffed animal or blanket, brings it everywhere. Blanket makes you think mom is with you when she isn’t. Helps you feel connected. Helps people with internalization process

Question 48

Good Enough Mother

Answer 48

A baby needs to develop some reality that there’s things that are painful.
Starts off with an almost complete adaptation to the infant’s needs, and as time proceeds she adapts less and less completely, according to the infant’s capabilities to deal with her failure.

Question 49

True Self

Answer 49

distinct personhood with spontaneously arising wishes and feelings that are experienced as real and important—“requires the preservation of the experience of subjective omnipotence as a deeply private, never fully revealed, core of experience” (M&B, p. 127)

Question 50

False Self

Answer 50

a self completely oriented to others’ expectations—living entirely in objective reality

Question 51

One Person Psychology

Answer 51

Classical theory is considered to be a one person psychology, whereas relational theory is considered to be a two person psychology. Therapist takes a neutral stance and acts as a participant observer. The therapist does not bring him/herself into the therapy. Rather, assumes a relatively distant stance from the client’s expressions during therapy. Transference is not an interpersonal event but a process occurring within the analysand. Point is to minimize external stimuli to allow unfolding of free associations.

Question 52

Two Person Psychology

Answer 52

Two person psychology is that who the analyst is, not only how he or she works but his or her very character makes a real difference to the patient. The analyst’s personality affects not only the therapeutic alliance or so called real relationship but also the nature of the transference itself.
Two person impinges on these?: Traditional notions of anonymity and neutrality were intended to enable the transference, free associations and other aspects in patient’s psychological life to make their appearance in analysis without interference

Question 53

Relational Psychoanalysis

Answer 53

NOT a unified theoretical system
Instead – it is a community of analysts who share common clinical and theoretical sensibility –relational, eclectic
Most influential theorist: Stephen Mitchell (Relational-conflict model)
Borrows from Mahler, Winnnicott, Loewald, Sullivan, Fairbairn
Integrated relational approach (takes relational ideas from any theory)
Relational theory is both respectful of traditional analytic theories and is a sharp break from the classical tradition
especially rejects dual-drive theory
Focus on similarities among the diff schools & bringing them together to a community
Anyone who sees the relationship as primary are included
•Greenberg and Mitchell (1983) used the term Relational to bridge the traditions of interpersonal relations (interpersonal psychoanalysis) and object relations (as developed within the British school)
•Intersubjectivity theory
•Social constructivism
•Gender theorizing
•Radical Alternative to classical analysis
•Rejection of drive theory – replace with relationships as the center of the theoretical system
•“two person” psychology - just like there is no mother without the baby
•Deconstruction of dichotomies and polarizations
•Emphasis on holding the tensions of extremes, ambiguity, dialogue, and paradox
•Also Evolutionary within psychoanalysis
•Eclectic theory - synthesis
•Balances continuity with discontinuity

Question 54

Self States

Answer 54

Each self-state has a specific function in real and fantasized relationships and is activated in particular contexts
Humans are biologically predisposed to activate certain self-states to match the demands of their social environment (evolutionarily it’s a good things)
This multiplicity of self-states is therefore adaptive, and psychological health is seen as the product of flexibility in moving within and between multiple self-states
Each self has multiple self-states, and different env bring out diff ones and health is integration

Question 55

Dissociation

Answer 55

•The separation and alternation of self-states, or the “separation of mental and experiential contents that would normally be connected” (Howell, 2005, p. 18)
•Many Relational therapists conceptualize dissociative processes on a continuum, ranging from dissociation as a healthy and adaptive psychic function that is relationship-pursuing to dissociation as a rigid, problematic, or pathological function that is disruptive to both intrapersonal and interpersonal relationships
important in trauma - they may manifest themselves in a wide variety of ways from severe to moderate to milder everyday dissociative phenomena
becomes a problem when the person is unable, in one state of mind, to maintain any real sense that at other times he thinks and acts differently or any connection with the other states of mind
researchers see the concept of dissociation shifts as a continuously fluctuating degree of accessibility and awareness for any particular thought, feeling or behavioral pattern, depending on the particular psychological configuration that is at the fore at the moment

Question 56

Overdetermination

Answer 56

significant psychological problems or tendencies have more than one cause – often complex

Question 57

Separation-Individuation

Answer 57

This is a theory proposed by Mahler. Within earliest months child breaks out of an autistic shell, entering human connections which is why maternal partner is important in evolving identity.
Subdivided this process in separation-individuation into subphases each with own onset, normal outcome, and risks.
1. Hatching- infant’s increased alertness, regular alteration in the gaze, more outwardly directed, checking back to mother as a point of orientation. It ends at 9 months when active locomotive capacities and physical developments carry to the practicing subphase.
2. Practicing- toddler launches himself into the world, despite moving away from mother he experiences himself, psychically, as still at one with her, sharing in her perceived omnipotence
3. Rapprochement- 15-24 months. Child experiences crucial psychic disequilibrium. Children move away from mother and come back for reassurance. Realization of helplessness and dependence, so the need for independence alternates with the need for closeness/realization of helplessness
a. feel unconnected to mom
· Psychological development catches up with physical maturation. Realizes psychic separation from the symbiotic union with the mother.
· Wants mother to be in sight so that through action and eye contact he can regulate this new experience of apartness.
· The risk is mother will misread this actually progressive need as regressive and respond with impatience or unavailability, precipitating an anxious fear of abandonment in toddler.
· Contributes to ongoing proclivity to depression
· Taught clinicals to understand and treat borderline patients, whose pathology fell between neurosis and psychosis

Question 58

Diagnosis using the PDM

Answer 58

intends to characterize a person’s full range of functioning - emotional, cognitive, and social patterns
Dimension I: Personality Patterns and Disorders - P Axis
the person’s general location on a continuum from healthier to more disordered functioning, and the nature of the characteristic way the individual organizes mental functioning and engages the world
Dimension II: Mental Functioning - M Axis
detailed description of emotional functioning - the capacities that contribute to an individual’s personality and overall level of psychological health or pathology
takes a more microscopic look at mental life, systematizing such capacities as info processing, and self-regulation; the forming and maintaining of relationships; experiencing, organizing, and expressing different levels of affects or emotions
Dimension III: Manifest Symptoms and concerns - S Axis
begins with the DSM IV TR categories and goes on to describe the affective states, cognitive processes, somatic experiences, and relational patterns most often associated with each one
approach symptom clusters as descriptors
trying not to overstep our knowledge base
presents symptom patterns in terms of the patient’s personal experience

Question 59

The Therapeutic Frame

Answer 59

It is the things that we do as therapists, the structure that we create for therapy, that demonstrates our beliefs about how therapy works. It includes expectations about how we, therapist and client, will interact with each other and contribute to the therapy process.

Question 60

The Couch Technique

Answer 60

The couch is used as a tool to facilitate free flow of emotions and feelings within the client by reducing the effect of extraneous variable which may confound it. In the psychodynamic setting, the client is often made to lie down on the couch while the therapist sits behind the couch in a position that restricts the view of both the therapist and client from each other. This has two benefits which include:
1. Allowing the therapist to assume a relaxed position, and supine position of the client allows them to relax as well and enter a different atmosphere of consciousness
2. Reduces the effect of therapist expressions and non verbal gestures on the client’s free associations and in that way the client expresses clearer images and pictures.
· The couch is not used by all psychodynamic psychotherapists. Some therapists think it restricts their ability to fully engage with the client and provide a sense of empathy and genuineness. Some clients think such a set up is unsafe. In some cases patients get too comfy with the couch and it may hinder their true emotional expression and engagement in the therapy.