Week 7 Psychodynamic Therapy

Question 1

Describe how psychodynamic therapy deals with the past and present.

Answer 1

Past: You seek to understand the unconscious, so you look into the past. But at which point do you stop?

You then draw links between the past and the present, and see how the past affected the present. and how it can affect the future.

Question 2

PDT gets the client to have a deep understanding of ______.

Answer 2

self.

Doesn’t teach you problem-solving skills, but more of teaching you about things you don’t know about yourself. You then use these things to solve problems.

Question 3

Why is it that the skill of the therapist and client-therapist rapport are much more important in PDT than for other therapies?

Answer 3

Because PDT is very unstructured, but this is necessary because this allow the therapist to come up with more radical conclusions/suggestions. Hence, this requires strong therapeutic alliance. Good also anyway because you’re dealing with painful, core stuff in an unstructured way which means that you really have to trust the therapist.

Question 4

What kind of issues does PDT deal with?

Answer 4

Attachment

Question 5

Which part of Freudian theory is still used today?

Answer 5

biological explanations for the content of dreams- air that is breathed in is misinterpreted by the brain because it is not fully awake. Therefore, the brain interprets it as us falling. However, the challenge is to find out whether dreams have biological or unconscious meanings.

Question 6

Psychodynamic is unscientific. True or false?

Answer 6

False. Empirically supported before!

Just that some concepts cannot be proven - e.g id, ego, superego

Question 7

What are some hallmarks of a good PDT therapist?

Answer 7

1. Let client talk more to understand them better, but must be opportune in finding out when to talk
2. Reaffirm client first, don’t straightaway talk about painful staff
3. Need to juggle a lot of info at one time, but if you don’t get a complete pic today don’t rush it either

Question 8

What must be done when you do dream analysis?

Answer 8

Must do a lot of homework - what is biological and what can hint more about certain things?

Use of bookmarks when they mention content of dreams each time, this allows you to connect the dots and form a picture

Must know a lot about the person first!

Question 9

What are defense mechanisms?

Answer 9

Ways in which a person reconciles conflicting energy or come to terms with the problem that he/she has.

Question 10

Are defence mechanisms really that archaic?

Answer 10

NO because they are ways that can help ppl reconcile conflicting things - how is this outdated.

Meant to help person come to terms with whatever problems they have

Question 11

What is the concept that modern PDT is driven by?

Answer 11

Psychological determinism: everything has an explanation from a psychodynamic point of view.

Question 12

According to modern PDT, how does psychopathology come about?

Answer 12

When you have conflicting psychic energy, which will eventually manifest itself.

Symptoms will show multiple causes and functions.

Question 13

What is the goal of PDT then?

Answer 13

Loosen bonds of past experiences to create new life possibilities

Your old solutions are not helping!

Question 14

List 3 components of modern PDT.

Answer 14

1. Awareness building: highlighting conflicts, dualities, maladaptive old ways of interactions.
2. Utilize transference and countertransference
3. Free association.

Question 15

How to utilize transference and countertransference?

Answer 15

using the present interaction in therapy to illustrate to the client how maladaptive their interactions are with people around them). E.g. telling the client that the way they are interacting with you is eliciting a very dependent relationship. They could have elicited this in their previous partners which resulted in an unhealthy form of relationship, eventually causing the relationship to breakdown.

Question 16

How long does therapy take?

Answer 16

Hard to determine the exact amount of sessions that is truly needed. Only the therapist will know because it is based on the dynamic of the client and therapist. But is usually long-term e.g. 3-4 years

Question 17

Evaluate the efficacy of PDT in Singapore.

Answer 17

Less suitable when the client wants results fast or if they feel that it is just a chat
Could be suitable when you feel repressed and need to unleash your emotions
Ultimate need is to understand yourself and feel heard - could be done through talking out to friends

Question 18

____________ are best suited for PDT.

Answer 18

Personality disorders. personality develops from childhood!

Question 19

What else must be considered when deciding if PDT is effective for a client?

Answer 19

Resources: Client wants to know how to go about doing or not? Do they want to take committed action?

Which stage of therapy? If early state/pre-contemplative stage when they are not ready to do anything yet, then just provide them with the awareness by letting them know about themselves. But if they want change then provide them with resources for that .

If client is vocal maybe this is easier.

Question 20

Give 4 caveats to the effectiveness of PDT.

Answer 20

1. Meta-analyses based only on a small number of studies.
2. Diverse client populations.
3. Highly selective and unrepresentative of client samples.
4. Overlaps with ingredients with other therapies.

Question 21

List 2 approaches that PDT can take

Answer 21

1) Attachment focused therapy

2) Transference focused therapy

Question 22

What does attachment theory posit about PDT?

Answer 22

Repeated interactions with caregivers lead to internal working models of interactions with others.

Internal working models guide one’s thoughts, emotions, and behaviours towards others.

Question 23

How does AFA work in PDT?

Answer 23

Therapist as secure base

Transference and other client relationships as representations of internal working models

Internal working models as originating from caregiver relationships

sense of self as impacted by interactions with others

Question 24

Described transference focused therapy

Answer 24

Focus on client’s transference to the therapist.

Focuses on the here and now, not interpreting the past.

Everything that comes from what the client and therapist feels from the session. Assumes that patterns from the past are being replayed repeatedly

Client can develop a distorted perception of therapist, based on past experiences.

Combines PD approach with structure, limited setting and secondary gain.

Question 25

Differentiate between psychodynamic, psychoanalytic and psychoanalytic therapy.

Answer 25

Psychodynamic = refer to a range of treatments based on psychoanalytic concepts and methods
Psychoanalysis - treatment takes 3-5 days per week and it is an interpersonal process and involves more frequent meetings
Psychoanalytic psychotherapy - sessions take place once or twice a week and the client sits in a chair

Question 26

According to PDT, most psychological difficulties were once _________________.

Answer 26

Adaptive solutions to life challenges.

Question 27

Define conflict.

Answer 27

Contradiction or dissonance within our own minds. we may resolve it by disavowing one or another aspect of our feelings. Push them out of conscious awareness but it will come back and BITE YOU IN THE ASS one day.

Question 28

Conflict takes place around intimacy.

What does intimacy mean in this context?

Answer 28

You desire emotional closeness and warmth, but you are afraid to receive it for fear of it being a sign of weakness and dependence. So you reject warmth even when you want it.

Question 29

What does it mean when conflict revolves around anger?

Answer 29

fearing retribution, retaliation and feelings of anger are inconsistent with our image as a loving person.

don’t allow ourselves to feel angry, but it’s unhealthy!

Question 30

_______ creates psychological difficulties.

Answer 30

Inner conflict

Question 31

How does transference allow a client to get better?

Answer 31

Clients view you from the lenses of their past, hence each client will see you very differently
Transference occurs when past expectations, templates or scripts have been activated in the context of a therapeutic relationship
Relieving and reworking relationship patterns that has arisen out of transference is central to recovery. This can be done by pointing/highlighting to the client to bring to his awareness of what he is subconsciously behaving (through gently summarising and reflecting)
Use therapeutic setting as a way to form a new and different kind of relationship with the client so that they have new evidence that not all relationships conform to their expectations shaped by their past. This allows them to view relationships through different lenses and relationships will become more fulfilling for them.
Transference is greatly welcomed and the more salient it is, the better - utilise the problematic relationship patterns from transference and countertransference as a means of understanding the patient and effecting change
Better therapeutic outcomes occurred when therapists are mindful towards client’s emotional responses to them and draw links between the responses and their behaviour towards other people.

Question 32

What does resistance refer to?

Answer 32

Refers to defensive processes that emerge within the therapy relationship itself which is causing avoidance towards uncomfortable thoughts and feelings
Arises out of conflict or discord within the patient (can be manifested when patient comes late, misses appointments etc. or does things that delay or impede therapy)
The best approach towards resistant behaviour is for the therapist to develop a sense of curiosity regarding these behaviour and view them non-judgmentally. Can bring them to patient’s awareness.

Question 33

What is the unconscious?

Answer 33

Defense, conflict and unconscious mental life are intertwined
Referring to thoughts, feelings and behaviours that we disavow or defend against
Our unconscious thoughts and feelings are not dormant or inactive but actively seek expression by influencing our conscious thoughts, feelings and actions in indirect ways

Question 34

What is psychological causation?

Answer 34

Psychoanalytic therapy aims to guide the patient to recognise connections that exist between thoughts, feelings, actions and events so that they can better identify reasons behind their behaviour
In therapy, patients are guided to understand themselves better first so that their experiences do not seem so foreign to them

Question 35

What is the aim of psychological causation?

Answer 35

The aim is to expand their scope of awareness so that the symptoms do not appear to happen randomly
When their awareness increases, finding new solutions to old problems becomes much easier to achieve

Question 36

What can be done to achieve psychological causation?

Answer 36

The therapist can guide patients to examine what happened before the behaviour or guide patients to think deeper about the thoughts, emotions that came along with it when they are engaging in the behaviour (whether or not it made sense) that was causing problems
The sequence of the client’s thoughts is mapped out, the corresponding hypotheses are drawn by forming associations between the patient’s thoughts and behaviours. This allows us to see how their unconscious thoughts are influencing their behaviour.

Question 37

What is overdetermination?

Answer 37

a symptom/behaviour can have multiple causes.

Question 38

What is multiple function?

Answer 38

symptom or behaviour got multiple functions.

Question 39

Psychoanalytic therapy relies on ______________ into the most private, personal and deeply subjective aspects of inner experience

Answer 39

empathically attuned inquiry

Question 40

What are psychological symptoms caused by? are due to complex network of thoughts, feelings, perceptions and memories that contextualise and give them meaning

Associative pathways tend to lead to what is emotionally charged or problematic - our mental pathways are mostly organised along feelings and if we observe our thought process without editing or censoring them, they will lead to troubling outcomes

Answer 40

complex network of thoughts, feelings, perceptions and memories that contextualise and give them meaning

Question 41

_____________ tend to lead to what is emotionally charged or problematic - our mental pathways are mostly organised along feelings and if we observe our thought process without editing or censoring them, they will lead to troubling outcomes

Answer 41

associative pathways

Question 42

What are free associations useful for?

Answer 42

Making implicit associative linkages explicit.

Question 43

When is free association not suitable?

Answer 43

if client is someone who normally like to feel composed, socially desirable and in control

Question 44

What is psychic determinism?

Answer 44

Thoughts, feelings, behaviour and symptoms are not random or accidental, but are influenced or determined by the mental events preceding them
It can be understood as how there is continuity from one thought to another and that the thoughts are chained in meaningful associative sequences

Question 45

Psychoanalytic therapy advocates for _____ and _____ once we identify the links that are causing problematic behaviours that need to be changed.

Answer 45

change growth

Question 46

What is required from the psychodynamist therapist?

Answer 46

Psychoanalytic therapy - requires a degree of intelligence, professional knowledge, skills, a capacity for empathic attunement with another person, a willingness to immerse ourselves in another person’s private subjective world and willingness to examine ourselves

Psychoanalytic therapy is done WITH the patient - collaborative, shared effort between 2 people who struggle to make sense together