Interpersonal/Psychodynamic Psychotherapy, Definitions, Models and Key Concepts Flashcards
Key features of psychodynamic-interpersonal psychotherapy
A focus on the relationship between client and therapist
A focus on interpersonal relations
A focus on affect and expression of emotions
The exploration of fantasy life
Explores attempts to avoid distressing thoughts and feelings
Identifies recurring themes and patterns
Recognises that past experiences affect our relation to, and experience of the present
Formulating and evaluating hypotheses in psychodynamic psychotherapy (Smith, 1987)
Data gathering Re-contextulising Pre-validation Consider spoken form, order and timing Interpretation Post-validation
Data gathering
Engaging the client in conversation about why they are there Free association Problem focused Assimilation model Accounts of the person by others Verbal communication Non-verbal communications Therapist's countertransference
Assimilation model
Stiles et al. (1990)
- Mastery
- Problem solution
- Application/working through
- Understanding insight
- Problem statement
- Vague awareness
- Unwanted thoughts
- Warded off
Re-contextualising
Unconscious meaning
Making sense of what is conscious and unconscious from what the client has said
Pre-validation
How can I put this information together to help them make sense of it?
Developing a hypothesis
Formal completeness (particular key elements are organised in a specific way)
Synthesis
Consistency
Spoken form, order and timing
Ensure that you do not upset the client
Spoken form - use clear, open and non-demanding language
Order - resistance before content, here and now before current and past
Timing - the nature of transference, the client’s free associations, consider when the client does not know, needs to know and is capable of knowing
Interpretation
Help the client make sense of and understand feelings
Post-validation
Are we doing any good?
Are we helping them to recover?
What is psychic equilibrium?
The mental state which the client presents with when they are referred
What is the problem with psychic equilibrium?
Their equilibrium is dysfunctional or precarious
The client directs their efforts to maintain this equilibrium
What does the meeting with a therapist do to psychic equilibrium?
Disturbs it
This may result in them pushing you away to hold onto it
What does psychodynamic theory presuppose?
The existence of latent unconscious meanings
Transference
Freud (1912)
When psychological experiences are revived and instead of being located in the past are applied to dealings with a person in the present
Often transferred into the therapeutic relationship
The client unconsciously interacts with the therapist as they would with another or others in the past
Freud’s structural theory (1923)
Id
Ego
Superego
Id
Natural drives/instincts
Primitive part with drives for life (sex) and death (aggression)
Impulsive and infantile
Ego
Controls the drives of the Id by mediating the drives in the external world
Works out realistic ways to satisfy the Id
Superego
Incorporated the values and morals of society
Controls the Id’s impulses, especially those which society prohibits such as sex and aggression
Hierarchical Listing of Defence Mechanisms (Perry)
Mature defences Obsessional defences Other neurotic defences Minor image-distorting defences (narcissistic) Disavowel defences Major image distorting defences Action defences
Mature defences
Affiliation Altruism Anticipation Humour Self-assertion Self-observation Sublimation Suppression
Obsessional defences
Isolation
Intellectualisation
Undoing
Other neurotic defences
Repression
Dissociation
Reaction formation
Displacement
Minor image-distorting defences
Omnipotence
Idealisation
Devaluation
Disavowel defences
Denial
Projection
Rationalisation
Fantasy
Major image distorting defences
Splitting
Projective identification
Splitting
Hold onto the good
Project out the bad
Projective identification
Fantasy of projecting a part of oneself into another person and of that part taking over the person from within
There is a pressure exerted via the interpersonal interaction such that the recipient of the projection experiences pressure to think, feel and behave in a manner congruent with the projection
Project onto the therapist
Action defences
Acting out
Passive-aggression
Hypochondriasis
Object Relations Theory (Klein)
The effect of internalised relations with primary caregivers during infancy, and their unconscious influence on the nature of future relationships
Children do not only internalise the object itself, but the entire relationship
Infants internalise two sets of object relations, both positive and negative
Representations in Object Relations Theory
Representations of…
The self
The object
The emotion that links the two
Unconscious Fantasy
Serve as the basis for all future mental mechanisms
Primitive internalised mental images of instincts and drives
The mental and emotional capacities of an individual result from the interaction of these fantasies with actual experience, and the resulting emotion that ensues
Paranoid-schizoid position
Newborn - 4-6 months
First few months of life, infant is in a state of anxiety and so uses four mechanisms to cope
Splitting
Projection
Identification
Introjection
Splitting Object Relations Theory
Relationships are maintained with parts of objects (e.g. the breast rather than the mother) and split between good and bad
Projection Object Relations Theory
Negative feelings are protected outward towards the mother
Positive feelings are internalised
The depressive position (6 months +)
Cycles of projection and introjection continue until the infant comes to the understanding that the good mother and the bad mother are one
Fragmented view of partial objects develops into an awareness of the object as a single entity
Developing capacity to view the self and objects as including both good and bad - forming the basis of an integrated ego
The depressive position example
Realises that the same mother whom there were fantasies of destroying is the same mother they love
Causes feelings of guilt and mourning of lost omnipotence
The infant thus engages in reparation in an effort to restore and fix objects they fantasised about destroying
Internal objects example
If you were out at the weekend and got very drunk, hit a friend and got arrested
You think, oh no what would my mum and dad say?
You have these thoughts because they are internal objects
Basic techniques used by therapists to explore the client’s difficulties
Information giving responses Listening and observing Monitoring of therapist's own feelings (counter-transference) Reflect back to client Information seeking responses Exploratory responses Confrontation Linking responses
Information giving responses
May concern information about their treatment
Reason for referral
Matters such as time left in the session
No advice or instruction can be given by therapist such as ‘if I were you, I would do this’
Listening and observing
Attend to factual content Words used What is not said Observation of a client's mood Therapist does not interrupt
Monitoring of therapist’s own feelings
Feelings
Fantasies
Reactions
Help client to understand how they make other people feel
Reflect back to the client
Shows that the therapist is listening
Information seeking responses
Aimed at classification
Helps sort what is happening
Questioning
Rephrasing
Exploratory responses
Attempts to draw out more information from the client
Generated from hypotheses about that the client may not be saying but be hinting at
Confrontation
Draw attention to what the client is avoiding
‘You keep telling me this but not how you feel about it’
‘Whenever I ask you about X, you change the subject’
Linking responses
Words or actions are linked as a tentative interpretation to try and understand the nature of the client’s anxiety in the session
Malan’s triangles (1979)
Triangle of conflict
Triangle of person
Triangle of conflict
Defence
Anxiety
True feeling (often an impulse)
Triangle of person
Other (usually current)
Transference (usually here-and-now)
Parent (usually distant past)
What is an interpretation?
Once the hypothesis has been formulated, pre-validated and examined with respect to spoken form, order and timing, the next step is to voice it as an interpretation
All comments and other verbal interventions which have the aim of making the client aware of some aspect of their psychological functioning of which they were not previously conscious
Containment (Bion)
The therapist acts as a container of the client’s intolerable experiences
Through this process, the client may come to see that the projected split off part of the self is not as malevolent as thought
The client is enabled to re-integrate the aspect of themselves that they could not contain
Shedler (2010) how effective is psychodynamic-interpersonal psychotherapy
Review of 8 meta-analyses
Post treatment effect sizes range from 0.69 to 1.8
Control group studies, group of people have treatment and group that don’t, effect sizes moderate to very good
Pre-post effect sizes 0.78 to 1.46
Start of treatment to end of treatment, good effect sizes
Efficacy of psychodynamic-interpersonal psychotherapy
Studies suggest the benefits of psychodynamic psychotherapy are enduring, more than CBT
Studies comparing CBT with psychodynamic therapy fail to show difference in efficacy, dodo bird effect
Critique of psychodynamic psychotherapy
Evidence concerns short term psychodynamic psychotherapy
Some of the studies have been poorly described
Number of RCT is considerably fewer than for CBT
