This summary includes the Psychodynamic approach lecture, which took place at the University of Twente on 28-04-2023. The lecture covered Chapters 3 and 5 of The Individual Book (de Bruin, E., 1st Edition)

Psychodynamic Approach:

Chapters 3 and 5, The Individual

Psychological suffering

7 characteristics of abnormal behaviour/psychological disorder (Seligman et al., 2001):

1. Personal suffering
2. The (dis)functional aspects of behaviour
3. Irrational and incomprehensible behaviour
4. Unpredictability & loss of control
5. Outstanding and conventional behaviour
6. Behaviour that brings about uneasiness in others
7. Transgression of moral norms

The ‘Three P’s’: characteristics of a personality disorder:

1. Pathological
2. Pervasive
3. Persistent

Borderline personality disorder (BPD)

“an instable sense of self (psychologically) & emotion regulation difficulties (behaviourally)”

• Continuous fear of being abandoned
• Pattern unstable relations (idealizing versus devaluation)
• Unstable self-image
• Impulsivity in at least two domains (sex, eating, drug-abuse, …)
• Suicidal behaviour
• Strong mood changes
• Chronic feelings of emptiness
• Intense anger/difficulty controlling anger
• Severe dissociative symptoms/stress-related paranoid

How BPD develops?

• Psychodynamic perspective: development of the personality structure
  • Baby-stage:
    • Good --> sleep, milk, …
    • Bad -->  hunger, wet diaper, …
• First years of life
  
  • Babies potentially highly disordered
    
    • No right or wrong
    • No (coherent) cognitions
    • Completely dependent
    • I hate you or I love you
    • Explosive raw emotions
  • 5 year Olds, healthy neurotic
    
    • Defence mechanisms
    • Autonomy
    • Self-conscious / Mentalizing (ego) + Ego-functions
    • Conscience (super-ego) --> Internalized moral standards

Broad psychodynamic disorder

• Psychotic Personality Organization (PPO):
  • Baby-stage: all id --> expressions of sexual/aggressive instincts
• Narcissism (Kernberg):
  
  • Subtype BPD, since it shows same personality organisation
  • Pathological Grandiose self:
    
    • Defence mechanism --> Combine ideal-self + ideal-other + ideal-aspirations
    • Need of others denied/devalued
    • Abnormal love of the self/incapacity love others
    • Show self-satisfaction
    • Need to be admired, without mutuality of relationship
• Defence mechanisms: psyche’s solution for dealing with two incompatible wishes
  
  • From Primitive --> Mature defence mechanisms
• Vertical lines: illustrates primitive defences (completely outside of conscious awareness)
  
  • The psyche ignores one of the hemispheres --> “It’s as if part of you - your thoughts, feelings and experiences - doesn’t exist”
    
    • E.g. my life is nothing but pain; it always has
• Horizontal lines (solid): allows for (temporary) repression of impulses/guilty conscience
  
  • E.g. you would like to yell at your teacher for making the exam so hard, but you reason he just has high expectations of you (rationalization) and you count to ten and again set your mind again on answering the questions on the test (suppression)
  • E.g. your superego tells you to stop drinking and go home, since you have class tomorrow.. but hey, the professor wouldn’t mind if you showed up after the break. Besides, there are still 10 more lectures during this course. Even skipping one shouldn’t be a problem
• Dotted horizontal lines: indicates when there is no real separation of the Id, Superego and Ego
  
  • Can result in:
    
    • Impulsive action (Id cannot be controlled)
    • Personal high standards perceived as absolute laws (=the superego cannot be separated from the ego)

Defence and emotion regulation

• Too much defence --> emotions suppressed
• Too little defence + ego-functioning --> overwhelmed with emotions

Psychoanalytic and Psychodynamic treatment

Therapy:

Classical psychoanalysis

• Transference neurosis: reveals particular meanings that client has given to infantile relationships and events, which generate internal conflicts between wishes and particular defences formed to strive against them
• Oedipal conflicts: relate to attachment to the parent of opposite sex, accompanied by envious/aggressive feelings toward parent same sex

Brief psychodynamic therapy

• Experiencing emotions in here and now
  • E.g. expressions of suppressed emotions and fantasies
• Amplifying awareness (cognitive integration --> create a mental connection between different types of knowledge)
• Challenging the defences
• Unlocking (open unconsciousness): deep sorrow/conflicts towards parents

Clinical treatment of BPD

Transference Focused Therapy:

Transference: process in which thoughts, beliefs and feelings which were formed in other (early) relationships are activated by the mind when in contact with another person

• Developed specifically for patients with borderline personality disorder
• Client’s defence mechanisms used as the key ingredients for treatment