Class 6: Short-term Psychodynamic Therapy and Models of Change and The Therapeutic Alliance

Question 1

Short-term Psychodynamic Psychotherapy

Answer 1

• Dates back to the early theorists (since 1920s)
• Took shape in the 1970s and 1980s
  
  • Time-Limited Psychotherapy (TLP): Mann
  • Time-Limited Dynamic Psychotherapy (TLDP): Strupp, Binder and Levenson
  • Short-Term Dynamic Psychotherapy (STDP): Davanloo, Malan and Sifneos

Question 2

Short-Term Dynamic Psychotherapy (STDP)

(does what two things)

Answer 2

• Expose hidden feelings
  
  • driving pateint behaviors and motivation
  • hidden feelings cause anxiety
    
    • we become aware of…once experinced we activate defense mech. to make anxiety go away….which allows us to continue to hide from feeling
• Recognize relational patterns

Question 3

Short-Term Dynamic Psychotherapy (STDP)

(Expose hidden feelings)

Answer 3

Question 4

Short-Term Dynamic Psychotherapy (STDP)

(Recognize relational patterns)

Answer 4

Question 5

Models of Change

Answer 5

• Cognitive-Behavioral Therapy
  
  • Change in Cognitions Ø Change in Feelings and Behavior
  • Focus: core beliefs, automatic thoughts, schemas, symptoms, beliefs about others
  • Therapeutic relationship is means to end
  • More structured and transparent
• Psychodynamic Therapy
  • Change in Affect Ø Change in Behavior and Thoughts
  • Focus: feelings, motivations, wishes, fears, fantasies, relationship patterns
  • Therapeutic relationship may be a focal point
  • Less structured, relationship unfolds

Question 6

The Therapeutic Alliance

(building blocks)

Answer 6

• Building Blocks: trans-theoretical
  
  • Emotional intelligence
  • Capacity for empathy

Question 7

The Therapeutic Alliance

(Psychodynamic model)

Answer 7

• Psychodynamic model
  
  • Ability to balance
    
    • Closeness and separation
    • Nurturance and reflectiveness
    • Ambition and acceptance

Question 8

The Therapeutic Alliance

(Three components)

Answer 8

• Goal: patient and therapist agree on goals of treatment
• Task: each person’s role
  
  • Patient shows up, shares honestly and only, work on implementing new understanding
  • Therapist listens carefully, without bias, develops understanding, offers new ways of thinking and acting
• Bond: attachment between patient and therapist
  
  • Safety, warmth, empathy, emotional engagement

Question 9

The Therapeutic Alliance

(The Alliance in Psychodynamic Psychotherapy)

Answer 9

• The Alliance in Psychodynamic Psychotherapy (Greenson, 1967)
  
  • Three dimensions
    
    • The therapeutic Alliance
    • Transference
    • Real Relationship
  • Obstacles
    
    • “Resistance”: unconscious, past experiences get in the way
    • “Enactment”: therapist responds (CT) to patient’s transference

Question 10

The Therapeutic Alliance

(Per Summers & Barber)

Answer 10

• Positive Emotions foster the alliance
  
  • Encouraging comments
  • Shared humor
  • Direct praise
  • Recognition of patient strengths
  • Expressions of optimism
• (I would argue that these nurture the alliance because they are the activities of a healthy self-object)

Question 11

The Therapeutic Alliance

(How to facilitate therapeutic alliance skills)

Answer 11

• Discuss patient non-verbal communication (vs. empathy alone)
• Correctly identifying core conflict early
• Ability to repair alliance ruptures

Question 12

Strategies for Facilitating the Therapeutic Alliance

Answer 12

• Give a brief explanation of what will happen
• Be curious and self-aware (it’s contagious!)
• Approach patient’s behaviors with warmth, enthusiasm, support, interest
• Attend to the patient’s likeable qualities
• Nurture positive emotions
• Be faithful to your tasks (and engage the patient in her/his tasks)
• Try to understand the patient’s goals
• Pay attention to what is alliance and what is transference or resistance; transference and resistance are natural and shouldn’t be judged
• Frame comments in supportive way
• Monitor patient’s anxiety and pleasure (signs of enactment)
• Pay attention to ruptures; explore, and don’t be afraid to apologize
• Have empathy, but encourage change (be a “bridge”)
• Monitor your own manner