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PSY348 - Clinical 2 > Interpersonal/Psychodynamic Psychotherapy, Definitions, Models and Key Concepts > Flashcards

Interpersonal/Psychodynamic Psychotherapy, Definitions, Models and Key Concepts Flashcards

1
Q

Key features of psychodynamic-interpersonal psychotherapy

A

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

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2
Q

Formulating and evaluating hypotheses in psychodynamic psychotherapy (Smith, 1987)

A 
Data gathering 
Re-contextulising 
Pre-validation 
Consider spoken form, order and timing 
Interpretation 
Post-validation
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3
Q

Data gathering

A 
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
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4
Q

Assimilation model

A

Stiles et al. (1990)

  1. Mastery
  2. Problem solution
  3. Application/working through
  4. Understanding insight
  5. Problem statement
  6. Vague awareness
  7. Unwanted thoughts
  8. Warded off
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5
Q

Re-contextualising

A

Unconscious meaning

Making sense of what is conscious and unconscious from what the client has said

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6
Q

Pre-validation

A

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

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7
Q

Spoken form, order and timing

A

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

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8
Q

Interpretation

A

Help the client make sense of and understand feelings

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9
Q

Post-validation

A

Are we doing any good?

Are we helping them to recover?

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10
Q

What is psychic equilibrium?

A

The mental state which the client presents with when they are referred

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11
Q

What is the problem with psychic equilibrium?

A

Their equilibrium is dysfunctional or precarious

The client directs their efforts to maintain this equilibrium

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12
Q

What does the meeting with a therapist do to psychic equilibrium?

A

Disturbs it

This may result in them pushing you away to hold onto it

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13
Q

What does psychodynamic theory presuppose?

A

The existence of latent unconscious meanings

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14
Q

Transference

A

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

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15
Q

Freud’s structural theory (1923)

A

Id
Ego
Superego

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16
Q

Id

A

Natural drives/instincts
Primitive part with drives for life (sex) and death (aggression)
Impulsive and infantile

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17
Q

Ego

A

Controls the drives of the Id by mediating the drives in the external world
Works out realistic ways to satisfy the Id

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18
Q

Superego

A

Incorporated the values and morals of society

Controls the Id’s impulses, especially those which society prohibits such as sex and aggression

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19
Q

Hierarchical Listing of Defence Mechanisms (Perry)

A 
Mature defences 
Obsessional defences 
Other neurotic defences 
Minor image-distorting defences (narcissistic) 
Disavowel defences 
Major image distorting defences 
Action defences
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20
Q

Mature defences

A 
Affiliation 
Altruism 
Anticipation 
Humour 
Self-assertion 
Self-observation 
Sublimation 
Suppression
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21
Q

Obsessional defences

A

Isolation
Intellectualisation
Undoing

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22
Q

Other neurotic defences

A

Repression
Dissociation
Reaction formation
Displacement

23
Q

Minor image-distorting defences

A

Omnipotence
Idealisation
Devaluation

24
Q

Disavowel defences

A

Denial
Projection
Rationalisation
Fantasy

25
Q

Major image distorting defences

A

Splitting

Projective identification

26
Q

Splitting

A

Hold onto the good

Project out the bad

27
Q

Projective identification

A

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

28
Q

Action defences

A

Acting out
Passive-aggression
Hypochondriasis

29
Q

Object Relations Theory (Klein)

A

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

30
Q

Representations in Object Relations Theory

A

Representations of…
The self
The object
The emotion that links the two

31
Q

Unconscious Fantasy

A

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

32
Q

Paranoid-schizoid position

A

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

33
Q

Splitting Object Relations Theory

A

Relationships are maintained with parts of objects (e.g. the breast rather than the mother) and split between good and bad

34
Q

Projection Object Relations Theory

A

Negative feelings are protected outward towards the mother

Positive feelings are internalised

35
Q

The depressive position (6 months +)

A

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

36
Q

The depressive position example

A

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

37
Q

Internal objects example

A

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

38
Q

Basic techniques used by therapists to explore the client’s difficulties

A 
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
39
Q

Information giving responses

A

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’

40
Q

Listening and observing

A 
Attend to factual content 
Words used 
What is not said 
Observation of a client's mood 
Therapist does not interrupt
41
Q

Monitoring of therapist’s own feelings

A

Feelings
Fantasies
Reactions
Help client to understand how they make other people feel

42
Q

Reflect back to the client

A

Shows that the therapist is listening

43
Q

Information seeking responses

A

Aimed at classification
Helps sort what is happening
Questioning
Rephrasing

44
Q

Exploratory responses

A

Attempts to draw out more information from the client

Generated from hypotheses about that the client may not be saying but be hinting at

45
Q

Confrontation

A

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’

46
Q

Linking responses

A

Words or actions are linked as a tentative interpretation to try and understand the nature of the client’s anxiety in the session

47
Q

Malan’s triangles (1979)

A

Triangle of conflict

Triangle of person

48
Q

Triangle of conflict

A

Defence
Anxiety
True feeling (often an impulse)

49
Q

Triangle of person

A

Other (usually current)
Transference (usually here-and-now)
Parent (usually distant past)

50
Q

What is an interpretation?

A

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

51
Q

Containment (Bion)

A

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

52
Q

Shedler (2010) how effective is psychodynamic-interpersonal psychotherapy

A

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

53
Q

Efficacy of psychodynamic-interpersonal psychotherapy

A

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

54
Q

Critique of psychodynamic psychotherapy

A

Evidence concerns short term psychodynamic psychotherapy
Some of the studies have been poorly described
Number of RCT is considerably fewer than for CBT

PSY348 - Clinical 2 (9 decks)

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