Week 4: Psychodynamic Psychotherapy

Question 1

Overview of the Psychodynamic Approach (method) (5)

Answer 1

Psychodynamic psychotherapy is rooted in Freudian psychoanalysis*

Psychoanalysis, in its original format, involves the patient (known as the “analysand”) and the therapist(known as the “analyst”)

Couch and chair approach

This type of arrangement allows for free association and transference which are two central concepts in psychoanalysis

While there are psychiatrists who practice this way, it typically involves meeting 4x/week over several years*

Question 2

Overview of the Psychodynamic Approach (people) (3)

Answer 2

Leading figures include Freud (Sigmund and Anna), Melanie Klein, Alfred Adler, Carl Jung, along with the Object Relations theorists

Term psychodynamic psychotherapy captures breadth of theory and counselling that has derived from the original type of psychoanalysis developed by Freud

Note that most theorists of psychoanalytic perspectives were affluent, upper or middle class background* (Higdon, 2012)*

Question 3

Overview of the Psychodynamic Approach (Idealogy) (1+3)

Answer 3

One of the central features is belief that current concerns, issues, and challenges originated during childhood

• E.g., current relationship patterns and dynamics can be related to patterns in one’s family of origin.

Three important principles of this approach involve
- the influence of the past,
-the role of the unconscious,
- and the therapeutic relationship

Question 4

Psychodynamic Characteristics (Usher, 2013) (4)

Answer 4

1) Focus on affect and expression of emotion

2) Identification of recurring themes and patterns

3) Understanding of the effect of past experience on present problems

4) Focus on therapy relationship

Question 5

Psychodynamic: Terminology (Jacobs, 1988) (4)

Answer 5

The term psychodynamic comes from “psyche” which refers to thought, feeling, and spirit

Three aspects: the mind, feelings, and spirit/self are active, rather than static

This activity occurs within relationship, the enviornment, and also within oneself

Focusing on such dynamic processes is a way to capture the various aspects of self, such as:
- Freud: Id, Ego, Superego

Question 6

Psychodynamic: Relationships (Jacobs (1988)) (4)

Answer 6

Interested in the types of feelings that occur within relationships

• E.g., parent and child, between spouses, within a family, or in various groups

Also interest in the feelings that occur amidst the different aspects of a person’s psyche

For Freud, the map of internal relations within the psyche was explained by the id, ego, superego, also known as the Structural Approach

Question 7

Freud’s Personality Theory/Structural Approach (Seligman and Reichenberg, 2010) (3+3)

Answer 7

Id
- From birth, instinct related, body connection*, uses reflexive action and primary processes to relieve discomfort

Superego
- Opposite of ID, internalized rules and guidelines, rigid in nature, develops as child develops

Ego
- Develops as child develops, “the balancer,” rational, and self-conscious

Question 8

The Unconscious
(Jacobs (1988)) (6)
(Psychodynamic)

Answer 8

Freud’s use of hypnosis allowed him to better understand the influence of one’s unconscious

He noticed that under hypnosis, patients were better able to access certain memories and experiences*

• The goal of all psychodynamic work is to make the unconscious conscious
• Thus, a person is capable of acting with more conscious control and awareness

This is important because the unconscious, by definition, is unknowable until it becomes uncovered or exposed in some way

Freud used the terms conscious, preconscious and unconscious, also known as the Topographical Approach

Question 9

Psychodynamic: Topographical Approach (3+3)

Answer 9

Conscious
– ideas/feelings in awareness at any given time

Preconscious
– a memory, feeling, fact, or event that can become easily conscious

Unconscious
– unacceptable feelings and ideas or mental processes/material that are not easily accessible

Question 10

Psychodynamic: Layers of Understanding (Jacobs 1988) (3)

Answer 10

When a patient begins to tell their story, various details will become apparent to the psychodynamic psychotherapist

Ways of referring others, oneself, or assumptions about the therapist can all provide clues to the patient’s past experiences

While links to the past and present are not always clearly obvious, patterns and themes can emerge that can offer insight into how life experiences have shaped ones’ thoughts, feelings, and ways of interacting with others

Question 11

Psychodynamic: The Therapeutic Relationship (Jacobs (1988)) (4)

Answer 11

Of interest:

• The links between internal and external worlds of the client
• The links between past and present
• The links between what is talked about in counselling and what takes place between counsellor and client
• Note: the immediacy within the relationship is of great interest in psychodynamic therapy*

Question 12

Psychodynamic: Transference (Jacobs (1988)) (4)

Answer 12

Described as the repetition of childlike patterns of relating to others and these patterns occur within the therapeutic relationship

Also, transference phenomena occur in every human relationship

• Exploring this within the therapeutic relationship allows for insight, growth, awareness of relational patterns (both adaptive and dysfunctional), and allows for corrective experiences in therapy

Gaining such insight can allow for more effective and healthy relationships for the client*

Question 13

Psychodynamic: Countertransference (3)

Answer 13

Countertransference is described as the same process but from the therapist to the client

• The various schools of psychodynamic thought conceptualize countertransference in different ways

A central feature is that therapists need to be mindful and self-reflective on their own feelings towards clients

Question 14

Defences Mechanisms
(Seligman and Reichenberg, 2010)

Answer 14

40 different types of defense mechanisms

Some are viewed as adaptive others potentially maladaptive

Examples
Humour
Suppression
Sublimation
Affiliation*
Anticipation

Question 15

Defences Mechanisms examples

Answer 15

Avoidance
Denial
Displacement
Dissociation
Idealization
Passive aggression
Projection
Reaction formation
Somatization
Repression

Question 16

Therapeutic Action: How does Psychodynamic psychotherapy work? (6)

Answer 16

Within psychodynamic work, work to:

• Make the unconscious conscious
• Supporting weakened ego functions*

Reactivation of development

• Reactive mental and emotional development in order to foster new, healthier growth
• Unlearn previous destructive patterns and replace with new adaptive one
• Relationship with therapist is reparative base*

Question 17

Facilitating Change (Summers & Barber, 2015) (1+3+1)

Answer 17

Psychodynamic perspective looks to reduce negative symptoms and improve mental health and functioning*

Techniques to bring about change:

1) guiding emotional exploration
2) Searching for new accurate perceptions
3) encouraging and testing of new behavioural responses

Affect, cognitions, and behaviour of equal importance

Question 18

The Therapeutic Relationship (4)

Answer 18

Establishing trust, rapport, and safety is particularly important in psychodynamic approaches

• The therapeutic relationship is viewed as being the central feature in facilitating change

The therapist also brings the transference into awareness – this is informed by sound theoretical knowledge and good clinical skill

The therapist is curious about who the person is, which creates acceptance and minimizes judgement

Question 19

Why did Nancy McWilliams create a list to Understanding Well-Being? (4)

Answer 19

Nancy McWilliams, author of several books on psychoanalytic psychotherapy, has created a list of 16 factors that comprise well-being

• This was done, in part, because the DSM characterizes “mental illness” yet does not contribute to a conceptualization of health and wellness

Additionally, there is a distinction between qualities that define good research, and qualities that define good clinical practice

Also, diagnoses such as depression or anxiety are experienced by each person in a unique way based on many other factors (personality, life experiences, social support, family history, employment, physical health, etc)

Question 20

Nancy McWilliams 16 Factors that Characterize Well-Being (16)

Answer 20

Capacity to work

Capacity to love

Capacity to play

Capacity to develop secure attachment

Sense of agency

Self and object constancy

Ego strength

Realistic and reliable self-esteem

Abiding values

Affect tolerance and regulation

Insight

Capacity to mentalize about others

Flexibility of defenses

Balance between relatedness and separateness

Sense of vitality

Acceptance

Question 21

Capacity to work

Answer 21

– can the person contribute in a meaningful way

Question 22

Capacity to love

Answer 22

– as an adult, to have intimate relationships with at least one person; as a parent, to be devoted to a child, placing his/her interests first

Question 23

Capacity to play

Answer 23

– enjoy life, experience pleasure (note: to truly experience it first hand, not watch it on social media)

Question 24

Capacity to develop secure attachment

Answer 24

does this person feel adequately secure in the world?

Question 25

Sense of agency

Answer 25

– self-efficacy, go after what you want; healthy autonomy, have say in own life

Question 26

Self and object constancy

Answer 26

– have a consistency sense of oneself; can feel ambivalence, aware of both positive and negative aspects of oneself

Question 27

Ego strength

Answer 27

– resilience – can you experience stress with an adaptive response?

Question 28

Realistic and reliable self-esteem

Answer 28

– finding balance between being overly harsh with oneself (unrealistic expectations) versus a false self (everything I do is fabulous)

Question 29

Abiding values

Answer 29

– some sense of ethics, morals, integrity

Question 30

Affect tolerance and regulation

Answer 30

– healthy people can feel a broad range of affect and can move fluidly from one to the other

Question 31

Insight

Answer 31

– do people have an understanding of what is happening, a sense of how long it might take to address it

Question 32

Capacity to mentalize about others

Answer 32

– separating own self from others e.g., a child who begins to realize that parents have other adults relationships that are not about the child

Question 33

Flexibility of defenses

Answer 33

– don’t automatically resort to same defenses in a rigid way (e.g., denial) – can use various defenses over different experiences

Question 34

Balance between relatedness and separateness

Answer 34

– can be deeply connected to others and also be comfortable alone with oneself

Question 35

Sense of vitality

Answer 35

– to experience enthusiasm, passion, feeling “alive”

Question 36

Acceptance

Answer 36

– mental health is not just about solving problems but accepting what cannot be changed and finding an adaptive way to move forward