This is the Chapter 3 of the book The Individual (de Bruin, E., 1st Edition). Which is content for the exam of the Theory component of Module 4 (The Individual) of the University of Twente, in the Netherlands.
Chapter 3:
The psychodynamic tradition
Psychodynamic therapy: emphasis therapist’s ability use relationship client/ therapist to explore feelings/ relationship dilemmas --> helps clients achive inshight/ understanding how their problems developed/ how they are maintained, and transform this inshight into mature capacity to cope current/ future difficulties.
Origins of psychodynamic therapy: Freud
- Free association: patient lie relaxed position and say whatever comes to mind --> Freud reported many patients remembered unpleasant sexual experiences in childhood --> concluded root problems child’s own sexual (emotional energy) needs
- Features psychoanalysis/ psychodynamic approach:
- Difficulties client origin childhood
- Not consciously aware motive/ impulses actions
- Interpretation transference relationship
- Oral Stage: [1st year life] - Erotic pleasure from oral region (mouth)
- Anal stage: [2 to 4 years] - Pleasure from defecating (anal region)
- Phallic Stage: [5 to 8 years] – Immature genital longing, directed members opposite sex --> most significant effects later life, because forced repress sexual feeligns
- Latency stage: child’s sexuality becomes less important
- Good enough mother: caretaker/ responds quickly enough without being over-protective/ smothering
- Importance of unconscious:
- Id: ultimate motives for our behaviour. Core drives: Eros (life/ love/ sex)/ Thanatos (death/ hate/ aggression)
- Ego: conscious/ rational part mind, makes decisions/ deals reality
- SuperEgo: “conscience”. Store-house rules/ taboos about should/ shouldn’t --> mainly internalisation of parents attitudes
- Defense mechanisms: developed by mind to protect ego from pressure from constant conflict id/ superego
- Transference: fundamental cornerstone psychodynamic theory/ practice --> form free association, Freud discovered patients view of him was not objective/ rational response to his actual behaviour --> patients perceived him lens/ filter constructed previous relationships
- Task of the therapist: behave differently from original characters in patients life --> client aware new different possibilities around relationships with others
- Aim therapist: where id was, let ego be
- Catharsis: when person truly understands issue, experience release of emotional tension associated with repressed/ buried memories of the issue
- Mechanisms of defence:
- Repression (motivated forgetting): removal from awareness any threatening impulse/ idea/ memory
- Denial (motivated negation): blocking external events/ info from awareness
- Projection (displacement outwards): attribute other own unacceptable desires/ thoughts
- Displacement (redirection of impulses): channelling impulses to different target
- Reaction formation (asserting the opposite): defending against unacceptable impulses by turning them into the opposite
- Sublimination (finding an acceptable substitute): transforming impulses into more socially acceptable form of behaviour
- Regression (developmental retreat): response internal feelings triggered by external threat, by reverting behaviour form earlier stage of development
- Techniques/ strategies used in psychodynamic/ psychoanalytic therapy:
- Therapist self-awareness: use feelings/ fantasies/ action tendencies therapist experience in response to client --> valuable information everyday way of being with others of client
- Interpretation: important to consider timing/ correctness of interpretation/ understandability interpretation
- Expression/ projective technique: as means of exploring past/ present circumstances
Psychodynamic tradition:
- Jungian approach (analytic psychology): diverged sexual development of Freud
- Archetypes: symbolic representations universal facets human experience
- Shadow: aspects of self denied to conscious awareness
- Individualisation: human development --> lifelong quest for fulfilment.
- Object relations (Melanie Klein): relationship-oriented therapy, direct observations behaviour babies and mothers-infant interaction
- Objects: can be the mother. Composed internalised image/ memory of person, with all the parts of that person
- Part-object: breast --> good/ bad object, depending if baby needs are being met
- Paranoid-schizoid period: baby feels little security world because recovering from trauma birth
- Depressive reaction: deep sense disappointment/ anger when realise loved person can be good and bad
- Self-centeredness: grandiose/ narcissistic patterns of relating to others --> underlying cause problems adult life
- Projective identification: when person whom feelings/ impulses are being projected is manipulated into believing that they have these feelings/ impulses
- Dependency: actively seeking assistance from other --> need of assistance motivates by projective fantasy (sense of self-in-relationship originating in disturbed object relations in early childhood)
- The real relationship: beyond transference and countertransference
- Inner worlds: closed systems, psychoanalysis aims to break through, to allow patient to become accessible to the influence of outer reality
- Countertransference: reaction to the client or client's transference
- American post-Freudian tradition:
- Self-theory: set of perceptions individual has for himself/ relationships/ other aspects of life
- Narcissism: other people experienced as “self-objects”, extensions of the self
- Optimal frustration: therapist can never achieve complete empathy and acceptance (same for parents)
- Jacques Lacan: consciousness in apprehending the world categorized into 3 models: imaginary/ symbolic/ real (non-linguistic realms).
- Lacanian theory: limits of understanding based on language
- Attachment theory: therapist make use of therapist relationship to become an internalized “secure base” for client
- John Bowlby: humans basic need form of attachment, will not function well unless such attachment is available
- Internal working model: internal representation of social world --> main attachment figures/ themselves/ links between these elements
- Strange situation: infants systematically observed while mother leaves/ returns
- Secure: missing parent --> seeks contact when she returns, and then back to play normally
- Insecure-avoidant: few signs missing parent, avoid her in reunion
- Insecure-ambivalent: distressed/ angry parent leaves, cannot settled she returns
- Insecure-disoriented
- Adult Attachment interview: means assessing patterns of attachment later in life --> aim to surprise the unconscious, then person will find themselves saying things beyond conscious control
- Secure/autonomous: story coherent/ consistent/ objective
- Dismissive: not coherent, dismissive of attachment-related experiences and relationships
- Preoccupied: incoherent, angry, preoccupied with past experiences
- Unresolves/disorganised: similar dismissive + preoccupied, but include long silences or erroneous statements (talking as though someone who died still alive)
- Metacognitive monitoring: people step back form situation and reflect what they are saying --> characteristic securely attached
- Mentalisation: capacity to learn how to reflect on experience
- Reflective function: ability think about/ talk about painful past events --> helps protect themselves from raw emotional impact without use defences
- The concept of the “third”: authoritative figures from earlier periods
- Triangular relationship: transference interpretation
Brief psychodynamic therapy:
Commences with assessment interview (explores readiness/ capability of client to engage productively in therapy)
Transference neurosis: strong transference reaction, encouraged in long-term analysis, allow evidence of childhood relationship patterns to emerge
- Psychodynamic-interpersonal therapy: meaning and role of language. Core approach is that people need to be able to talk about their feelings --> dissolves loneliness associated with holding feelings to oneself
- Start identification core problem that underpins depression
- This is explored as to enable client to mentalise/ reflect productively on their experience, then client helped to consider other ways of feeling/ thinking in situation that evoke depression
- Written statement by therapist, summarising work together, preventing future relapse
- Other forms of brief psychodynamic therapy:
- Intensive short-term dynamic psychotherapy: unlocking the unconscious by challenging ways in which client defend himself against difficult emotions
- Affect phobia therapy: attention to the ways repressed emotions are expressed in non-verbal behaviour/ body awareness
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