Psychodynamic psychotherapy Flashcards

Question

explain the notion of interpreting defenses as a therapeutic tool

Answer 1

-Depends on what the therapist views defences as (as ways to resist/avoid things, as indicators of pathology, or as means of protection). -The above techniques are used to generate material for interpretation of defences, resistance, symptoms and other patterns of behaviour. -Interpretation of the defences and their meanings are used to help clients understand origins of their problems -They can thus gain more control over them and more freedom to behave differently. Interpreting defences is a difficult skill, and it can be threatening for the patient, so the therapist must keep some issues in mind: - Timing: a good relationship must already be in place. - Resonance for patient: must feel truthful and meaningful.

Answer 2

1. gender+ sexuality 2. ignoring context 3.lack of evidence

Answer 3

> Original Freudian psychoanalytic model pathologised women. It favoured men and saw women as second-class citizens. E.g. hysteria; the concept of ‘penis envy’. This was also emblematic of the time Freud lived in. Memories of sexual abuse were eventually interpreted as children’s symbolic, repressed fantasies (seduction theory). Original conceptualisations of pathology were often considered ‘mother-blaming’. Children’s problems seen as the responsibility of the other e.g. over-controlling mother leads to anorexia in her daughter. Alternative sexuality was also conceived of as pathological or deviant. Much of the developmental research in the 1950s and ‘60s was only done with boys (e.g. Erikson’s stages of development). - Therefore ideas of normal development were based on male standards. But, feminists like Juliet Mitchell argue that Freudian theory offers an analysis of Freud’s sociocultural context, in the Victorian era. - Argues that Freud was attempting to make sense of the problematic values of his time, although many of his ideas ended up being problematic themselves. - E.g. penis envy represents the desire of women to hold the power that men have in society

Answer 4

> One of the biggest criticisms of classical psychoanalysis is that it disregards context. Traditional models hold views of the ‘isolated mind’, independent of social values, relationships, culture etc. Very little attention was thus given to culture or social issues such as class. Promotes essentialist ideas of what it means to be ‘human’ – that there’s a prototypical human and one type of development we should all follow. But what it means to be human, how we think about others and the world etc differs around the world. We are also products of our contexts. Another big problem is that it was viewed as elitist and inaccessible to people who can’t afford it (analysis sessions can be 3-4 times/week, and are very expensive). - This is still true to a certain extent. Also criticised for its long-term approach. Another reason why it’s more expensive. Applicability to other cultural contexts has been questioned. Ideas are based in Western/Eurocentric thought. Some models still position the analyst/therapist as an expert – they know exactly what’s happening with the patient and what to do. Their ideas take prominence in the therapy. BUT contemporary psychoanalytic models like Intersubjectivity Systems Theory consider context central to understanding a person. Also insists on the therapists being reflexive.“ Psychoanalysis has changed this traditional doctor-patient relationship from one of authority to one of partnership (Rayner, 1991). - It is generally accepted that the doctor knows as much or as little as the patient and thus both patient and therapist are involved in an exploration of what is going on for the patient.” (Berg, 2014) But this uneven power dynamic is particularly evident in a context such as SA, where Western ideas and techniques are put on a pedestal and there are entrenched relationships of domination as a result of colonial and apartheid ideologies (Berg, 2014).

Answer 5

> Most common criticism is that psychodynamic theories are considered ‘unscientific’ i.e. not ‘evidence-based’. This is driven by some of the EB movement. If we were to use the APA’s definition of evidence-based we’d see that psychodynamic therapies are supported. Even RCTs provide evidence for psychodynamic therapies. However, they’re ill-suited to RCTs as they don’t use a manualised approach. “the (often unacknowledged) “active ingredients” of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment.” Concepts and constructs like the Unconscious or affect are difficult to measure and so there’s no proof that they exist. This criticism has been the most damaging to the perception of psychotherapies. It may be rooted in the perception of psychoanalytic community as elitist, exclusionary and snobbish. It is in fact an inaccurate criticism…

Answer 6

> Evidence for psychoanalytic constructs is rapidly accumulating (e.g. neuro-imaging studies that support claims for dynamic unconscious). Important to remember that successful treatment is not simply focused on the resolution of symptoms but also development of positive psychological capacities. So when studies are set up to compare therapies on degree of symptom-reduction only it will be an unfair comparison. general psychotherapy is effective, and has large effect sizes. CBT and related therapies are also effective but the effect sizes are generally smaller. Antidepressant medicationis significantly less effective than any type of therapy. - Lastly, Psychodynamic therapy has a wide body of evidence showing large effect sizes. -“Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” -“In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends”. - “In contrast, the benefits of other (nonpsychodynamic) empirically supportedtherapies tend to decay over time for the most common disorders”. Abbass, Hancock, et al. (2006): meta-analysis of 23 RCTs of 1431 patients receiving psychodynamic psychotherapy.

Answer 7

> The patient’s improved general psychological/intrapsychic abilities may lead to increased positive outcomes even after therapy has ceased. Thus, there is in fact considerable evidence to show that psychodynamic psychotherapy is effective

Answer 8

> Much of Freudian psychoanalysis has been transformed or left behind. Most contemporary schools of thought recognise the primacy of relationships and not drives as motivators. - We organise our experiences and understanding around affect, and our strong feelings are often in relation to other people. Some schools of thought reject drive theory altogether. Therapists are no longer seen as objective ‘blank slates’. - Important to recognise the role of the therapist within the relationship. The therapist is also responsible for what they bring to the process. -Each therapist-patient dyad creates its own unique intersubjective field between them. Each person creates a unique interaction with someone else. -“What takes place in the clinical consulting room reflects the qualities and style of the individual therapist, the individual patient, and the unique patterns of interaction that develops between them.” -The Unconscious is not out there to be ‘discovered’, but rather meaning is co-created. - The meaning constructed varies according to context and to the people involved. - Releases us from the idea of an ‘objective and essential truth’ which must be discovered.

Answer 9

>But he didn’t find hypnosis effective for him as a treatment technique. >Developed ‘free association‘ (a technique that evolved from hypnosis) – letting patients talk freely without interruption. >Found that the material that often emerged included strong emotions, deeply buried memories and childhood sexual experiences. >Psychotherapy is still often called the talking cure today.

Answer 10

1. Oral phase (0-1 years) – sucking, biting, swallowing. Conflict = being weaned from mother. Individuation, separation from mother.

Answer 11

2. Anal (2-3) – learning to use a toilet. Resolution of the challenge leads to the ability to control themselves. Symbolic of other forms of control in adulthood.

Answer 12

3. Phallic (3-6): develop an awareness of their genitals. Start to negotiate their relationships with their opposite-sex parents.

Answer 13

4. Latencwhaty (6-puberty): energy is sublimated into working and developing. Not much is happening, there is no conflict to be resolved. A time of consolidation, learning, developing friendships etc.

Answer 14

5. Genital (puberty onwards): when teenagers have a sexual awakening, and become sexually attracted to others. People learned to love, and developed an understanding of social rules.

Answer 15

-Treatment involves making the unconscious conscious – becoming more and more aware. -A lot of this has been retained, but a lot has also been transformed. -There have been many other psychotherapists who have been influential. ---Each developed Freud’s theories in different ways.

Answer 16

Transference = the emergence of patterns of interacting that are shaped by fears and hopes about relationships. The therapist then uses those patterns to help you understand them better (emotional insight), and to have a different experience of oneself in relation to the therapist.

Answer 17

>Countertransference = therapist’s response to those feelings, behaviors, and expectations.