Week 4) Psychodynamic approaches

Question 1

Trauma is the greek word for

Answer 1

wound

Question 2

Trauma is associated with

Answer 2

anxiety, depression, substance abuse

Question 3

PTSD is

Answer 3

an anxiety disorder caused by a distressing event outside normal range of experience (DSM-III; DSM-IV).

Question 4

Symptoms of PTSD

Answer 4

Involves: Intense fear, terror, helplessness

Main 3 symptoms:

1) re-experiencing trauma: nightmares, distressing thoughts, flashbacks
2) avoidance and numbing: avoiding places and situations, thoughts, detached and cut off from others.
3) Hyper-arousal: angry very easy, on edge, uptight, lack of sleeping, overly alert, irritable.

Question 5

It is PTSD or trauma if these symptoms persist for ….

Answer 5

> 1 month

Question 6

What are some examples of common traumata?

What is traumata?

Answer 6

Common traumata: threat to life/physical integrity (self/family); natural disasters; car accidents; war; rape; torture
Traumata: events that are severe enough to instigate a PTSD response

Question 7

What is collective vs personal trauma?

Answer 7

Collective: something thats happened on a national level

Personal trauma: more within one own’s life.

Question 8

What was only recently added into the DSM 5?

Answer 8

Child sexual abuse as a trauma. “Developmentally inappropriate experiences without violence or injury (added DSM-IV)”. Only recognised in 80s.

Question 9

What has the DSM 5 changed with reference to PTSD?

Answer 9

PTSD no longer an anxiety disorder. It’s own disorder.
Removed the need of “terror” or intense fear, because it was found that these dont actually predict PTSD.

Added: persistent negative alteration of mood & cognition

Also you need to have 1st hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related)’’. UNLESS it is work related, and then its 2nd hand trauma e.g. police officer, social worker.
(this is to avoid self-diagnosis e.g. ppl looking through newspaper and mild reaction only but self-diagnosing).

Question 10

What were the two strongest predictors of PTSD?

Answer 10

life stress

then lack of social support

Question 11

What is the difference between resilience and recovery?

What is hardiness?

Answer 11

Resilience: some people just to seem to cope better and have no life disruption after this trauma. Can be personal or collective resilience. Idea of hardiness: some more hardy than others. Refers to being able to be committed to finding meaning in life. A sense of self-efficacy.

VS

Recovery: people who have to recover and it disrupts their life.

Question 12

Resilience: What is repressive coping?

Answer 12

You dont deal with bad emotional events. Repressing all your shit. Women who were victims of child sexual abuse, the ones who didnt wanna talk about it actually had better day to day functioning than those who were preoccupied with it. So avoidance defence like this can have some kind of positive effect.

Question 13

Resilience: What is mature defences?

Answer 13

Dealing with things via humour. Also an element of resilience.

Question 14

What factors determine whether its likely for a traumatic event to turn into PTSD?
3 main ways.

Answer 14

Severity, duration, proximity:

Severity example: Single large event (eg. car accident); /several ‘smaller’ events (eg. witnessing abuse)

Duration: Multiple/prolonged traumatic events e.g. repeated sexual abuse.

Repeated & intrusive interpersonal trauma (eg. domestic violence)

Question 15

What is “complex trauma” . What is the nature of these severe stressors? (3)

Answer 15

children’s exposure to multiple traumatic events, often of an invasive, interpersonal nature with long-term impact of this exposure. e.g. abuse and profound neglect

Exposure to severe stressors that are:

a) repetitive or prolonged
b) involve harm or abandonment by caregivers (etc.)
c) occur at developmentally vulnerable times

Effects:

• Long term physical & mental negative effects
• Poor treatment outcomes/comorbidity (Cohen & Hien, 2006)

Question 16

What does complex trauma has that normal trauma doesnt?

Answer 16

potential Dissociative identity disorder.

Question 17

What is transgenerational trauma?

Answer 17

-Trauma effects transmitted across generations
eg. Children of Holocaust survivors.
↑vulnerability to stress/PTSD
-Coping difficulties
-Insecure attachment

Question 18

There has been a history of trauma in personality. Whats an example.

Answer 18

Hysteria for women in the 19th century.
Something physically wrong with them, with no physical cause. conversion of psychological stress into physical symptoms.

Unassimilated traumatic memories
Repression & substitute outlets. But if you didnt deal with psychological trauma then it would reexpress itself say as pain in the limb or something.
Unconscious mental life

Question 19

Psychodynamic approach?

Answer 19

Puts emphasis on motivational states (e.g. drives; object relations/our relationships ) & affects.
We use a lot of defense mechanisms to repress these drives or thoughts and push them out of your mind.

There is a lot of evidence about unconscious thoughts etc, ppl are influenced by things they dont know.

Question 20

What is a defence mechanism?

Answer 20

Unconscious/automatic responses to impulses, ego-threats

Question 21

What is reaction formation as a defence mechanism?

Answer 21

e.g. someone intensely homophobic but defending

against their own homosexuality by being a renowned homophobic.

Question 22

What did the study on homophobia as reaction formation find?

Answer 22

Homophobic males show increased levels of sexual arousal to homosexual stimuli compared to non-homophobic males (Adams, Wright & Lohr, 1996)

Question 23

There are many varieties of psychodynamic perspectives

Answer 23

Attachment theory
Object relations (imp of relationships with ppl).
Neuropsychoanalysis.

What we look at is a combination of Object relations, attachment, & mentalisation theory (Fonagy, 2000)

Question 24

Bowlby looked at what in attachment theory?

Answer 24

Maternal deprivation, and the effects of this.

Later reanalysed by someone else to just be the effect of any caregiver (male or female).

Question 25

What is the universality hypothesis with regards to attachment theory?

Answer 25

Attachment theory has a univserality claim. It is a universal need.

Question 26

What is the Ethological approach in attachment theory?

Answer 26

Survival advantage with bonding to caregiver. Children cant look after themselves, so certain benefit in developing an attachment. This is a species wide behaviour.

Question 27

What is the competency hypothesis?

Answer 27

Competency hypothesis: that attachment relationships is necessary to be a competent person, your psychological and emotional development as well.
It’s needed for “Socio-emotional development”.
Impact upon personality & later relationships

Question 28

What is alloparenting?

How does alloparenting question the universality of attachment notion?

Answer 28

Attachment to networks of multiple caregivers.
Suggests that the universality hypothesis is a very westernised notion, based on typical nuclear family. However studies on alloparenting, suggest that alloparenting is quite popular.

Therefore:
“cross-cultural evidence indicates that in most societies, nonparental caretaking is either the norm or a common form”

Question 29

What’s an example of a place that engages in alloparenting ?

Answer 29

Efé (Zambia): infants have on average 14 caregivers in first 18 weeks of life

Question 30

What is a disorganised/unresolved attachment style?

Answer 30

approach avoidance approach to caregivers, where caregivers are meant to be source of security but are actually source of danger.

Question 31

What is the defensive exclusion hypothesis in attachment?

Answer 31

Defence as a means of affect regulation.

Insecurely attached individuals will filter out all information related to his or her attachment figure, as this is associated with psychological pain.

Question 32

What is Attachment trauma?

Answer 32

Traumatic loss, physical/sexual abuse
Unresolved/disorganised attachment
Dissociated self states (Blizard, 2003)
Disruption of metacognition (not being able to reflect)
Failures in emotional regulation
Negative impact on relationships (during our development we need healthy relationships, but attachment trauma leads to long-term right brain dysregulation).

“Attachment bonding is central to development of the right brain system in processing emotions. Modulation of stress, self-regulation & the early origin of the bodily-based implicit self”

Question 33

What is Mentalisation? Why is it important in attachment?

Answer 33

Mentalisation: the capacity to understand ourselves & others in terms of mental states. Relationships are essential for learning about one’s own & others minds.

Question 34

Why is mirroring important btn parent and child?

Answer 34

Development of subjectivity (other ppl have thoughts and feelings).

Development of the affective self (getting child to understand their emotions e.g. your scared).

Development of self-object differentiation

Question 35

What is containment in mentalisation theory?

Answer 35

“involves the presence of another being who not only reflects the infant’s internal state, but re-presents it as a manageable image, as something that is bearable & can be understood”

IMP for self regulation.

Question 36

What does secure attachment depend on ?

Answer 36

• caregiver’s mentalising/reflective capacity

“Secure attachment experiences are based on having been mentalized or FELT understood”

Question 37

What impairs mentalisation?

Answer 37

Trauma e.g. fear/abandonment impairs mentalisation

Question 38

Parents high on reflectiveness were …. - …. times more likely to have secure children than parents whose reflective capacity was poor

Answer 38

3-4 times more likely.

Note: Expectant parents’ levels of reflectiveness functioning predicted child’s attachment security in the 2nd year of life

Note: its also about the psychological functioning of the parent.

Question 39

Describe the state of indigenous australians pre European settlement, with regards to…

physical health
mental health

How long have they been in Australia for like this?
How many Indig Aust were there originally?

Answer 39

European arrival 1788
Estimated 750,000 Indigenous Australians
Here approx 40- to 60,000 years
Anthropological/archaeological evidence: prior to arrival of Europeans, indigenous people appear to have had:

Good physical health
Low levels of mental health problems
Anxiety, depression, suicide very rare (Parker, 2010)

Question 40

Indigenous Australians were individualist or collectivist?

Answer 40

Deeply collectivist; self & wellbeing tied to family, land, culture & spirituality

Question 41

Describe the Traditional child rearing practices of Indig Australians.

Answer 41

Tightly woven kinship system
Any child had a number of nurturing kinship mothers or “aunties” who could take over caregiver role when needed (Parker, 2010)
Children developed sense of self & security via multiple attachment bonds

Question 42

Describe how things have changed for Indigenous Australians since European settlement ?

hint: 
population 
diseases
life expectancy 
mental health

Answer 42

After 50 years of European settlement

Indigenous pop’n declines to approx. 40,000

Exotic diseases, Massacres, Displacement

Present time:
Indigenous life expectancy 10 years lower than non-Ind./much poorer physical health
Higher anxiety, depression, psychosis, substance abuse, suicide compared to non-Indigenous

Question 43

What was the stolen generation about?

Answer 43

Government policy of enforced assimilation (the process of taking in and fully understanding information or ideas).

Children of mixed Aboriginal descent forcibly removed from their Indigenous families & placed into Western foster settings eg. large group homes

Approx. 1 in 3 Indigenous children forcibly removed

1910s-1960s: explicitly to advance assimilation into dominant White culture

Question 44

Compared to non-Stolen counterparts, what have been the effects on those stolen?

hint: 
education
alcohol 
criminal behaviour
health

Answer 44

Stolen people typically have poorer levels of education & poorer employment outcomes (Majchrzak-Hamilton & Hamilton, 1997)
Alcohol abuse is higher for Stolen persons
Stolen persons twice as likely to have been arrested
Stolen persons typically have worse physical & mental health
Indigenous health generally poorer compared to non-Indigenous

Question 45

In terms of aboriginal australians seeking aboriginal legal services/ arrested, ……% of clients seeking help were stolen.

Answer 45

90%

Question 46

The whole reason we refer to stolen generations here is to further understand attachment theory. Attachment theory used as theoretical basis

Answer 46

good ! no one cares!

Question 47

What is intergenerational trauma?

Answer 47

the transmission of historical oppression and its negative consequences across generations.

Involves: Demoralisation, disorientation, loss of connection. Disruption of role of family & culture for guiding upbringing. Cycle of distress

Question 48

Compared to non-Indigenous children, Indigenous children are:

…. times as likely as non-Indigenous children to be hospitalised for assault

….. times as likely to be the subject of substantiated child abuse or neglect

….. times as likely to be under juvenile justice supervision

Answer 48

5.4 times as likely as non-Indigenous children to be hospitalised for assault

8 times as likely to be the subject of substantiated child abuse or neglect

15 times as likely to be under juvenile justice supervision

Question 49

What has been done about this trauma for the indigenous?

Answer 49

Story workshops: workshops that allow indig aust to express their story etc.

Minding the baby intervention: where vulnerable mothers, for 2 yrs they have social workers helping that mother with reflective functioning and mentalisation.

Question 50

Essay q: Critically evaluate whether attachment theory accounts for the impact of the Stolen Generations

Answer 50

What are the key terms: attachment theory
The relationships with mentalisation and attachment
What are the stolen gen and how does it relate to attachment.

Well attachment theory predicts that their would be attachment trauma associated with stolen gen. But in terms of this impact, a lot of things occur in ppls life, attachment might be part of the reasons for the effects, but what about the extensions of it say substance abuse, sexual assault etc.

There are a lot of other factors e.g. abuse, complex PTSD, culture taken away (not covered by attachment), connection and spirituality with land is imp for them, not covered here. They have profound connection with land.