Interpersonal/Psychodynamic Psychotherapy, Definitions, Models and Key Concepts

Question 1

Key features of psychodynamic-interpersonal psychotherapy

Answer 1

A focus on the relationship between client and therapist
A focus on interpersonal relations
A focus on affect and expression of emotions
The exploration of fantasy life
Explores attempts to avoid distressing thoughts and feelings
Identifies recurring themes and patterns
Recognises that past experiences affect our relation to, and experience of the present

Question 2

Formulating and evaluating hypotheses in psychodynamic psychotherapy (Smith, 1987)

Answer 2

Data gathering 
Re-contextulising 
Pre-validation 
Consider spoken form, order and timing 
Interpretation 
Post-validation

Question 3

Data gathering

Answer 3

Engaging the client in conversation about why they are there 
Free association 
Problem focused 
Assimilation model 
Accounts of the person by others 
Verbal communication 
Non-verbal communications 
Therapist's countertransference

Question 4

Assimilation model

Answer 4

Stiles et al. (1990)

7. Mastery
8. Problem solution
9. Application/working through
10. Understanding insight
11. Problem statement
12. Vague awareness
13. Unwanted thoughts
14. Warded off

Question 5

Re-contextualising

Answer 5

Unconscious meaning

Making sense of what is conscious and unconscious from what the client has said

Question 6

Pre-validation

Answer 6

How can I put this information together to help them make sense of it?
Developing a hypothesis
Formal completeness (particular key elements are organised in a specific way)
Synthesis
Consistency

Question 7

Spoken form, order and timing

Answer 7

Ensure that you do not upset the client
Spoken form - use clear, open and non-demanding language
Order - resistance before content, here and now before current and past
Timing - the nature of transference, the client’s free associations, consider when the client does not know, needs to know and is capable of knowing

Question 8

Interpretation

Answer 8

Help the client make sense of and understand feelings

Question 9

Post-validation

Answer 9

Are we doing any good?

Are we helping them to recover?

Question 10

What is psychic equilibrium?

Answer 10

The mental state which the client presents with when they are referred

Question 11

What is the problem with psychic equilibrium?

Answer 11

Their equilibrium is dysfunctional or precarious

The client directs their efforts to maintain this equilibrium

Question 12

What does the meeting with a therapist do to psychic equilibrium?

Answer 12

Disturbs it

This may result in them pushing you away to hold onto it

Question 13

What does psychodynamic theory presuppose?

Answer 13

The existence of latent unconscious meanings

Question 14

Transference

Answer 14

Freud (1912)
When psychological experiences are revived and instead of being located in the past are applied to dealings with a person in the present
Often transferred into the therapeutic relationship
The client unconsciously interacts with the therapist as they would with another or others in the past

Question 15

Freud’s structural theory (1923)

Answer 15

Id
Ego
Superego

Question 16

Id

Answer 16

Natural drives/instincts
Primitive part with drives for life (sex) and death (aggression)
Impulsive and infantile

Question 17

Ego

Answer 17

Controls the drives of the Id by mediating the drives in the external world
Works out realistic ways to satisfy the Id

Question 18

Superego

Answer 18

Incorporated the values and morals of society

Controls the Id’s impulses, especially those which society prohibits such as sex and aggression

Question 19

Hierarchical Listing of Defence Mechanisms (Perry)

Answer 19

Mature defences 
Obsessional defences 
Other neurotic defences 
Minor image-distorting defences (narcissistic) 
Disavowel defences 
Major image distorting defences 
Action defences

Question 20

Mature defences

Answer 20

Affiliation 
Altruism 
Anticipation 
Humour 
Self-assertion 
Self-observation 
Sublimation 
Suppression

Question 21

Obsessional defences

Answer 21

Isolation
Intellectualisation
Undoing

Question 22

Other neurotic defences

Answer 22

Repression
Dissociation
Reaction formation
Displacement

Question 23

Minor image-distorting defences

Answer 23

Omnipotence
Idealisation
Devaluation

Question 24

Disavowel defences

Answer 24

Denial
Projection
Rationalisation
Fantasy

Question 25

Major image distorting defences

Answer 25

Splitting | Projective identification

Question 26

Splitting

Answer 26

Hold onto the good | Project out the bad

Question 27

Projective identification

Answer 27

Fantasy of projecting a part of oneself into another person and of that part taking over the person from within There is a pressure exerted via the interpersonal interaction such that the recipient of the projection experiences pressure to think, feel and behave in a manner congruent with the projection Project onto the therapist

Question 28

Action defences

Answer 28

Acting out Passive-aggression Hypochondriasis

Question 29

Object Relations Theory (Klein)

Answer 29

The effect of internalised relations with primary caregivers during infancy, and their unconscious influence on the nature of future relationships Children do not only internalise the object itself, but the entire relationship Infants internalise two sets of object relations, both positive and negative

Question 30

Representations in Object Relations Theory

Answer 30

Representations of... The self The object The emotion that links the two

Question 31

Unconscious Fantasy

Answer 31

Serve as the basis for all future mental mechanisms Primitive internalised mental images of instincts and drives The mental and emotional capacities of an individual result from the interaction of these fantasies with actual experience, and the resulting emotion that ensues

Question 32

Paranoid-schizoid position

Answer 32

Newborn - 4-6 months First few months of life, infant is in a state of anxiety and so uses four mechanisms to cope Splitting Projection Identification Introjection

Question 33

Splitting Object Relations Theory

Answer 33

Relationships are maintained with parts of objects (e.g. the breast rather than the mother) and split between good and bad

Question 34

Projection Object Relations Theory

Answer 34

Negative feelings are protected outward towards the mother Positive feelings are internalised

Question 35

The depressive position (6 months +)

Answer 35

Cycles of projection and introjection continue until the infant comes to the understanding that the good mother and the bad mother are one Fragmented view of partial objects develops into an awareness of the object as a single entity Developing capacity to view the self and objects as including both good and bad - forming the basis of an integrated ego

Question 36

The depressive position example

Answer 36

Realises that the same mother whom there were fantasies of destroying is the same mother they love Causes feelings of guilt and mourning of lost omnipotence The infant thus engages in reparation in an effort to restore and fix objects they fantasised about destroying

Question 37

Internal objects example

Answer 37

If you were out at the weekend and got very drunk, hit a friend and got arrested You think, oh no what would my mum and dad say? You have these thoughts because they are internal objects

Question 38

Basic techniques used by therapists to explore the client's difficulties

Answer 38

``` Information giving responses Listening and observing Monitoring of therapist's own feelings (counter-transference) Reflect back to client Information seeking responses Exploratory responses Confrontation Linking responses ```

Question 39

Information giving responses

Answer 39

May concern information about their treatment Reason for referral Matters such as time left in the session No advice or instruction can be given by therapist such as 'if I were you, I would do this'

Question 40

Listening and observing

Answer 40

``` Attend to factual content Words used What is not said Observation of a client's mood Therapist does not interrupt ```

Question 41

Monitoring of therapist's own feelings

Answer 41

Feelings Fantasies Reactions Help client to understand how they make other people feel

Question 42

Reflect back to the client

Answer 42

Shows that the therapist is listening

Question 43

Information seeking responses

Answer 43

Aimed at classification Helps sort what is happening Questioning Rephrasing

Question 44

Exploratory responses

Answer 44

Attempts to draw out more information from the client | Generated from hypotheses about that the client may not be saying but be hinting at

Question 45

Confrontation

Answer 45

Draw attention to what the client is avoiding 'You keep telling me this but not how you feel about it' 'Whenever I ask you about X, you change the subject'

Question 46

Linking responses

Answer 46

Words or actions are linked as a tentative interpretation to try and understand the nature of the client's anxiety in the session

Question 47

Malan's triangles (1979)

Answer 47

Triangle of conflict | Triangle of person

Question 48

Triangle of conflict

Answer 48

Defence Anxiety True feeling (often an impulse)

Question 49

Triangle of person

Answer 49

Other (usually current) Transference (usually here-and-now) Parent (usually distant past)

Question 50

What is an interpretation?

Answer 50

Once the hypothesis has been formulated, pre-validated and examined with respect to spoken form, order and timing, the next step is to voice it as an interpretation All comments and other verbal interventions which have the aim of making the client aware of some aspect of their psychological functioning of which they were not previously conscious

Question 51

Containment (Bion)

Answer 51

The therapist acts as a container of the client's intolerable experiences Through this process, the client may come to see that the projected split off part of the self is not as malevolent as thought The client is enabled to re-integrate the aspect of themselves that they could not contain

Question 52

Shedler (2010) how effective is psychodynamic-interpersonal psychotherapy

Answer 52

Review of 8 meta-analyses Post treatment effect sizes range from 0.69 to 1.8 Control group studies, group of people have treatment and group that don't, effect sizes moderate to very good Pre-post effect sizes 0.78 to 1.46 Start of treatment to end of treatment, good effect sizes

Question 53

Efficacy of psychodynamic-interpersonal psychotherapy

Answer 53

Studies suggest the benefits of psychodynamic psychotherapy are enduring, more than CBT Studies comparing CBT with psychodynamic therapy fail to show difference in efficacy, dodo bird effect

Question 54

Critique of psychodynamic psychotherapy

Answer 54

Evidence concerns short term psychodynamic psychotherapy Some of the studies have been poorly described Number of RCT is considerably fewer than for CBT