W2

Question 1

Psychoanalysis

Answer 1

A distinctive form of psychological treatment and a model of psychological functioning, human development, and psychopathology; founded by Sigmund Freud

Question 2

Unconscious Motivation

Answer 2

Wishes, fantasies or tacit knowledge that are outside of awareness and motivate all human beings (in part)

Question 3

Why do Psychoanalysts seek to facilitate awareness of unconscious motivations?

Answer 3

To increase individual choice

Question 4

Freud’s Definition of the Unconscious

Answer 4

An area of psychic functioning in which impulses and wishes, as well as certain memories, are split off from awareness. This occurs because either the associated affects are too threatening or the content of the impulses and wishes themselves are learned by the individual to be unacceptable through cultural conditioning.

Question 5

A Modern Consensus on the Unconscious

Answer 5

Our experience and actions are influenced by psychological processes that are not part of our conscious awareness. These unconscious processes are kept out of awareness in order to avoid psychological pain.

Question 6

Primary Process

Answer 6

A raw or primitive form of psychic functioning. Operates unconsciously throughout the lifetime. Features no distinctions between past, present, and future. Hence, different feelings/experiences can be condensed together into one image/symbol; feelings can be expressed metaphorically, and the identities of different people can be merged. Infants operate in this mode as part of normal development. Operates throughout childhood (and adulthood in dreams and fantasy), as well as more consistently in individuals suffering from acute psychosis.

Question 7

Secondary Process

Answer 7

The style of psychic functioning associated with consciousness. Logical, sequential, and orderly. The foundation for rational, reflective thinking.

Question 8

Defenses

Answer 8

Intrapsychic processes that function to avoid emotional pain by pushing thoughts, wishes, feelings, or fantasies out of awareness. Methods in which the unconscious protects the conscious self (sometimes used by the ego to moderate id/superego). Usually involves some distortion of reality. Distinct from conscious coping mechanisms.

Question 9

Intellectualization as a Defense

Answer 9

Talking about something threatening while keeping an emotional distance from the feelings associated with it (i.e., focusing on facts over feelings, speaking practically)

Question 10

Projection as a Defense

Answer 10

Attributing a threatening feeling or motive one is experiencing to another person.

Question 11

Reaction Formation as a Defense

Answer 11

Denying a threatening feeling and proclaiming to feel the opposite.

Question 12

Splitting as a Defense

Answer 12

[Important to Kleinian Theory] - Avoiding one’s perception of another as good being contaminated by negative feelings through splitting the representation of the other into two different images; good and bad. Believed to be used by infants to preserve their feelings of safety with their mother. Can lead to dramatic fluctuations in one’s perceptions of others.

Question 13

Freud’s Definition of Transference

Answer 13

“Transferring” a template from the past onto the present dynamic with the therapist (i.e., a client with a violent father might begin to see the therapist as violent). First conceptualized by Freud as a barrier to treatment and a form of resistance. Later conceptualized as an opportunity to help the client understand how past relationships were influencing their experience of the present in an emotionally immediate way.

Question 14

The Distinction between One- Versus Two-Person Psychologies

Answer 14

One: Views the therapist as an objective/neutral observer who serves as a blank screen onto whom the client projects their transference.
Two: The therapist and client are co-participants who engage in an ongoing process of mutual influence at both conscious and unconscious levels. The therapist should be aware of their own ongoing contribution to the interaction (e.g., might play a role in the emergence of resistance).

Question 15

The Causes of Psychoanalysis’ Declining Fortune

Answer 15

The increasingly biological focus of psychiatry.
The rise of the cognitive-behavioral tradition.
The negative reaction to the arrogant/insular/elitist attitude that was associated with the psychoanalytic tradition.
The domain’s lack of receptiveness to valid criticism and empirical research.
The growing emphasis on evidence-based treatment.
The “quick-fix mentality”.

Question 16

Free Association

Answer 16

A technique in which clients are encouraged to suspend their self-critical function and verbalize thoughts, images, associations, and feelings that are on the edge of awareness (i.e., saying everything that comes to mind without censoring)

Question 17

The Influence of Josef Breuer on Psychoanalysis

Answer 17

“The Talking Cure” - Symptom relief through talking freely about traumatic experiences and recovering painful memories that had been dissociated.

Question 18

Seduction Theory/Psychosexual Theory

Answer 18

Freud’s early belief that sexual trauma/instinctual sexuality always lies at the root of psychological problems.

He later modified this belief to allow for the fact that memory is reconstructive; and that early repressed sexual desires could result in false, recovered memories of sexual trauma - with similar psychological consequences.

Question 19

Libido

Answer 19

A type of psychic energy that is linked in a complex way to sexuality. Can be activated by both external and internal stimuli, which in turn produce an organismic sense of tension or “unpleasure.” Maintaining psychic energy at a constant level is a biological imperative, so this activated energy subsequently needs to be discharged to restore equilibrium (pleasurable tension reduction).

Question 20

The Pleasure Principle

Answer 20

A psychobiological push to repeat experiences that have become associated with tension reduction. Underlined by the model of motivation/drive theory; wherein individuals are motivated to satisfy these urges to maintain homeostasis

Question 21

Jung’s Definition of Emotional Complexes

Answer 21

Affectively charged ideas that are repressed because they are emotionally threatening.

Question 22

Primary Theoretical Disagreements between Jung and Freud

Answer 22

Jung believed Freud was mistaken in viewing sexuality as the most important motivational principle, and that Freud’s view of the unconscious was one-sided and failed to recognize the more creative and growth-oriented aspects of unconscious processes. He also felt that Freud failed to recognize the importance of the spiritual and transpersonal aspects of the human psyche. [Subsequently founded Analytical/Jungian psychology as his own school of psychotherapy]

Question 23

Freud’s Definition of the Id

Answer 23

The aspect of the psyche that is instinctually based and present from birth.

Question 24

Freud’s Definition of the Ego

Answer 24

A psychic agency that keeps aspects of experience deriving from the more primitive, instinctually based aspect of the psyche (the id) out of awareness.

Gradually emerges out of the id and functions to represent the concerns of reality. While the id presses for immediate sexual gratification, the ego evaluates the suitability of the situation for satisfying one’s instinctual desires, and it allows the individual to delay instinctual gratification or find other ways of channeling instinctual needs in a socially acceptable fashion. One important function of the ego is to mediate between the demands of the id and the superego.

Question 25

Freud’s Definition of the Superego

Answer 25

The psychic agency that emerges due to the internalization of social values and norms. Some aspects are conscious, others are not. Often becomes overly harsh and demanding, and can lead to self-destructive feelings of guilt and the rejection of one’s own instinctual needs and wishes. One goal of analysis has been to help individuals become more aware of the overly harsh nature of their superegos, so they become less self-punitive.

Question 26

Object Relations Theory

Answer 26

A theory concerned with the way in which we develop internal representations of our relationships with significant others. Stems primarily from the work of Melanie Klein.

Question 27

Ideals of the British Independents/Middle Group

Answer 27

Highlighted the value of providing clients with a supportive and nurturing environment. Emphasized the importance of spontaneity, creativity, and therapist flexibility (client by client). Featured names like Winnicott, Fairbairn and Bowlby.

Question 28

Ego Psychology – Classical Psychoanalysis.

Answer 28

A psychoanalytic tradition refined by Anna Freud and colleagues, and popular in the U.S. Later characterized characterized by an adherence to certain core theoretical premises (e.g., Freud’s drive theory of motivation and his psychosexual model of development) as well as specific technical guidelines. Views transference as a projection of the client’s unconscious dynamics and purported that therapists who had mastered their own unconscious conflicts could function as blank screens for clients. The key mechanism of change was theorized to involve the gaining of insight into one’s own unconscious conflicts.

Question 29

Interpersonal Psychoanalysis

Answer 29

Founded by Sullivan, Thompson and Fromm. Theorizes that the need for human relatedness is the most fundamental human motivation, that it is impossible to understand the individual without the context of their relationships with others, and that the therapeutic relationship needs to be understood in terms of both the client’s and therapist’s contributions.

Question 30

Kohut’s Primary Emphasis

Answer 30

The role of the therapist’s empathic stance as a mechanism of change.

Question 31

Relational Psychoanalysis

Answer 31

Arose from critiques of “problematic” aspects of classical psychoanalytic theory; spearheaded by Mitchell. Places greater emphasis on the need for human relatedness (rejecting drive theory), believes it is impossible for the therapist to be a blank screen and that the therapeutic relationship is one of mutual influence where the therapist cannot observe the client objectively, the therapist is fallible, and the authentic/human nature of the therapeutic relationship is a key ingredient in the change process.

Question 32

Conflict Theory

Answer 32

Contemporary ego psychology; emphasizes the centrality in human experience, and the ongoing conflict between unconscious wishes and defenses against them. Features a greater emphasis on principles of technique and practice.

Question 33

Lacan’s Definition of a Lack

Answer 33

Our identity is forged out of a misidentification of ourselves with the desire of the other. There is not a true self waiting to be discovered, there is just emptiness—a fundamental sense of alienation from the self. This stems from the fact that experience cannot be communicated without language.; and that symbolizing experience through language results in a distortion of this experience.

Question 34

Conflict Theory (of Personality)

Answer 34

[Freud and colleagues] - Posits that intrapsychic conflict plays a central role in the development of personality. Differing personalities can be understood as resulting from the compromise between underlying core wishes and the styles of defense used to manage them.
An obsessive individual is involved in a conflict between obedience and defiance. Intellectualization is the defense used to manage threatening underlying emotions (by obscuring feelings with word/details).
The hysterical personality style wishes for emotional intimacy and defends that with superficial or dramatic emotionality and seductiveness.
The phobic personality displaces intrapsychic conflict onto external stimuli. Common defenses include displacement, projection, and behavioral avoidance. Unacceptable feelings of anger are often transformed into panic.
The narcissistic personality defends against underlying wishes for dependency and fear of abandonment through superficial projections of grandiosity and self-aggrandizing behaviors.

Question 35

Object Relations Theory (of Personality)

Answer 35

Theorizes that internal representations (e.g.., internal objects or internal object relations) influence the way in which people perceive others, choose the types of people with whom to establish relationships, and shapes their relationships in a continuous fashion through their own perceptions and actions. Much of the writing in this domain is conceptually ambiguous; different theorists have different definitions of an internal object.

Question 36

Internalization in Object Relations Theory

Answer 36

The process of establishing an internal object.

Question 37

Bowlby’s Model of Object Relations Theory

Answer 37

Attachment Theory: Humans have an instinctive need (a motivational system referred to as the attachment system) to maintain proximity to their primary caregivers (a.k.a. attachment figures). This is adaptive function as it increases the possibility that the infant will be able to obtain the caretaking/protection necessary for its survival. To achieve this, infants develop representations of their interactions with their attachment figures that allow them to predict which actions will increase the likelihood of maintaining proximity versus which actions threaten the relationship (internal working models). Those actions/ways of being that are learned to be threatening ways (i.e., aggression, anger, and vulnerability) are hence disassociated by the infant.

Question 38

Internal Working Models vs. Internal Object Relations

Answer 38

Representations of a relationship with another that allows one to predict the consequences of a given action.
Bowlby’s Perspective: These models are based on actual interactions that have taken place with significant others.
Classical Object Relations Perspective: These models are shaped by a combination of real experiences with unconscious wishes/fantasies/other intrapsychic processes that are not reality based. These unconscious fantasies exist before any human encounters and serve as the scaffolding for one’s perception of others.

Question 39

Klein’s Definition of Projective Identification

Answer 39

Infants experience their own aggression as intolerable and therefore fantasize that this aggression originates in the other (typically, the mother)

Question 40

Fairbairn’s Perspective on Internal Object Establishment

Answer 40

Internal objects are established when the individual withdraws from external reality because the caregiver is unavailable, frustrating, or traumatizing: so, the individual creates a substitute internal reality. These fantasized relationships become building blocks for one’s experience of the self (because the self is always experienced in relation to others). The traumatizing aspects of the significant other that motivate the development of the unconscious fantasy/internal object inevitably end up becoming part of the internal structure that is developed.
As adults we seek out others who resemble our parents as a type of loyalty to our internal objects. Or, we project our internal objects onto others, thereby increasing the possibility that we will perceive them in a given way and react in predictable manner to that projection/or act in a way that will elicit a response that resembles the way our parents would have responded because this is what feels most natural to us. The abusive relationship becomes the template for love. To give up this model of relating would mean to give up all hope of relating to others.

Question 41

What do Internal Object Relations and Internal Working Models help us to think about?

Answer 41

Both provide ways of thinking about the way in which our internal representations of relationships with others shape our ongoing relationships.

Question 42

Developmental Arrest Models

Answer 42

[Winnicott’s developmental theory, Kohut’s self-psychology] – Psychological problems emerge as a result of the failure of caregivers to provide a “good enough” or optimal environment. Hence, the normal developmental process becomes arrested.

The infant begins in a state of subjective omnipotence; believing that their wishes make things happen and that their mother will satisfy all of their needs. The mother fails; the infant loses omnipotence and experiences the distinction between their fantasies and reality. If the mother is unresponsive/her needs obstruct the infant’s — the infant becomes over-adapted to the needs of the other and develops a false self. By defining themselves in regard to the needs of others, the infant may grow up to feel alienated from themselves. To develop a cohesive sense of self, the developing child requires caregivers who can provide adequate mirroring/are attuned to their needs, and who work through their inevitable failings.

Question 43

Optimal Disillusionment

Answer 43

A gradual process of challenging an infant’s fantasies about their caregiver which enables them to accept the limitations of the mother without being traumatized. Can be an important mechanism in therapy as well.

Question 44

The Traditional Defining Characteristics of Psychoanalysis

Answer 44

Long term (e.g., four years or more), intensive (e.g., four or more sessions per week), and open ended (no fixed termination date or number of sessions).
The therapist was expected to: help clients become aware of their unconscious motivation, refraining from giving advice, avoid influencing the client through sharing personal beliefs/values, maintaining anonymity through minimal sharing of personal details/feelings, maintaining a neutral and objective stance, and sit upright/out of view of the client. [no single right way to do psychoanalytic therapy now]

Question 45

The Therapeutic Alliance

Answer 45

The relationship between the client and therapist based on the client’s undistorted perception of the therapist and on a feeling of genuine linking/trust. Bordin suggested that the strength of the alliance depends on the level of agreement between client and therapist as to the tasks/goals of therapy and the quality of their bond (degree of trust/extent to which the client feels understood).

Question 46

Transference in Modern Psychodynamic Therapies

Answer 46

The client’s tendency to view the therapist in terms that are shaped by their experiences with important caregivers and other significant figures who played important roles during the developmental process. Early experiences establish templates or schemas that shape the perception of people in the present.

Question 47

Countertransference according to Freud vs. Now

Answer 47

The therapist’s counterpart to the client’s transference. Freud conceptualized it as the therapist’s feelings/reactions to the client’s transference that are a function of their own unresolved conflicts. He considered it an obstacle to therapy.
Now, countertransference tends to be defined more broadly as the totality of the therapist’s reactions to the client (including feeling, associations, fantasies, and fleeting images). Seen as a potentially valuable source of information for the therapist; although not an infallible source of information about the client’s unconscious.

Question 48

Resistance

Answer 48

The tendency for an individual to resist change or act in a way that undermines the therapeutic process. The way in which defensive processes manifest in the therapy session and interfere with the therapist’s goals or agenda.
Resistance is no longer conceptualized as the client doing something wrong by “refusing to co-operate”, but instead as a response that needs to be understood rather than simply bypassed.

Question 49

The Analytic Dyad

Answer 49

The new product that emerges as a result of the meeting of the minds between the therapist and the client.

Question 50

Intersubjectivity

Answer 50

The ability to hold onto one’s own experience while at the same time recognizing that another individual has their own subjective experience; recognizing the validity of another person’s perspective without one’s own being invalidated. From this perspective, transference can be understood as the client’s initial bid at defining reality in the midst of the therapeutic relationship (who is doing what, and what each are really experiencing)

Question 51

Enactments

Answer 51

The therapist and client playing complementary roles in relational scenarios; of which neither is fully aware. Provides clients with an opportunity to see how their relational schemas contribute to their interactions with others. Can give the therapist insight into dissociated aspects of the client’s internal experience.

Question 52

Interventions and Processes within (Modern) Psychotherapy

Answer 52

[T.I.E - C.S.A]
Empathy (most fundamental intervention, critical to establishing an alliance)
Interpretation (therapist’s attempt to help the client become aware of their intrapsychic unconscious patterns: client must be able to use the insights so they should be empathetic, well-timed, and of suitable depth - strong therapeutic alliance can also make threatening interpretations more palatable)
Clarification, Support, and Advice (“what do you mean by that?” - transparency, honesty, support, and well-timed advice can be critical interventions)
Termination (well-handled termination can consolidate gains made, while a poorly handled one can negatively affect treatment; terminations should review changes made and the client’s role in that change)

Question 53

Mechanisms of Change in Psychotherapy

Answer 53

U.C E.I H.R A.L C R.R (6)

Understanding Callie’s Every Insight Has Really Amazing Long-term Consequences, Right Rachel?

Making the Unconscious Conscious (by becoming aware of our unconscious wishes and our defenses against them, we increase the degree of choice available to us and decrease the influence they have on us)
Emotional Insights (client’s understandings should not be relegated to the realm of intellectual understanding so their emotional quality should be increased to ensure their impact on daily functioning - this can be done via transference interpretations; as the client reflects on immediate experience rather than abstract formulations)
Historical Reconstructions (understanding one’s psychological coping strategies as adaptive in the context of a dysfunctional childhood situation—but maladaptive in the present—the client can become more tolerant and begin the process of developing coping strategies that are adaptive for the present)
Increasing/Appreciating the Limits of Agency (as clients gain an appreciation of the connections between their symptoms, their ways of being, and their own contributions to conflictual patterns, they come to experience a greater degree of choice in their lives and view themselves more as agents than victims.)
Containment (the therapist attends to their own emotions when working with clients; and cultivates the ability to tolerate and process painful or disturbing feelings in a non-defensive fashion)
Rupture and Repair (ruptures in the therapeutic relationship may result in retraumatization for the client; but working through it constructively can help the client to recognize their capacity to work through disruptions in relatedness/relationship misunderstandings)

Question 54

Psychoanalytic Psychotherapies

Answer 54

A group of treatments, some with greater specification than others, that focus on human subjectivity and its interplay with both the external and internal environments. Psychoanalysis can be considered an umbrella term for these treatments; which are rooted in the same theoretical background.

Question 55

What is MBT?

Answer 55

Mentalization Based Treatment; a psychotherapy pioneered by Fonagy. Recognized treatment for personality disorders in the Netherlands.

Question 56

What is TFP?

Answer 56

Transference Focused Psychotherapy.

Question 57

Distinctions between Classical and Contemporary Practice

Answer 57

Classic Psychoanalysis [high frequency, long-term; 4-5 times a week, 5+ years]
Contemporary Psychoanalysis [medium to low frequency, medium long to short; a fortnight/twice a week, a year or so]

Question 58

Repression vs. Suppression

Answer 58

Repression involves the unconscious forcing of a distressing memory out of the conscious; whereas Suppression is a conscious attempt to achieve the same result.

Question 59

Denial and Displacement as Defences

Answer 59

Denial – refusing to acknowledge some aspect of reality (e.g., alcoholic denying a drinking problem)
Displacement – redirecting one’s feelings to another target; not expressed to who they really want to express it to.

Question 60

Mature vs. Immature Personality Organization

Answer 60

A continuum on which to conceptualize personality. A more immature organization involves splitting and keeping things apart as a defense (i.e., if one thing is present, something else cannot be). This internal fragmentation could be conceptualized as a house with many rooms but no corridors. You can only be in one room at once, and that room is determined by the environment/context. In therapy you seek to construct those corridors and enable an individual to recognize that “you are not only A, you are also B”.

Question 61

What is PDM-2?

Answer 61

The second edition Psychodynamic Diagnostic Manual. It features some tests. but not many (i.e., interview formats, projective tests, questionnaires)

Question 62

The Continuum of Defenses

Answer 62

Mature (healthy defense) –> neurotic –> primitive (least healthy).
Note that one affect/symptom can serve as a defense against another (i.e., panic attacks defending from a fear of releasing anger)

Question 63

Why might you choose CBT over a Psychotherapy?

Answer 63

If a symptom is causing immense day-to-day suffering; as psychotherapy’s focus is not on symptom reduction so it may take longer to dissipate. Instead, one of its focuses is authenticity and a greater understanding of the self/what underlies the symptoms.

Question 64

Marked Mirroring

Answer 64

A mechanism of change in psychotherapy; receiving the client’s emotion as a therapist but not allowing yourself to be overwhelmed by it.
“Yes, this is a heavy emotion but I can bear it, which means you can bear it, and we will persevere.”

Question 65

Reasons to Prescribe Psychodynamic Therapy

Answer 65

Applicable to a variety of circumstances (anxiety, depression, sexual/relational problems etc.). Prescribed when one is suffering from a pattern that is repeated over time, or when a symptom focused therapy did not bring enough relief.