Psychodynamic Therapy (Shapiro Ch. 5)

Question 1

What are the three main constructs in Freud’s structural model?

Answer 1

The Id
The Ego
The Superego

Question 2

What is the ID?

Answer 2

the aspect of mind concerned with what we want

Question 3

What is the SUPER EGO?

Answer 3

the aspect of mind concerned with what is right

Question 4

What is the EGO?

Answer 4

the aspect of mind concerned with what will work, which includes resolving conflicts between the id and superego

Question 5

What is object relations theory?

Answer 5

It emphasizes self-concept and relationships with other people as the foundation of personality. The word object, here, means other people, as opposed to the self (as in subject versus object)

Question 6

What are the three components of object relations?

Answer 6

1. The self.
2. Other people.
3. The relation between the two.

Question 7

What does object relations mean?

Answer 7

Internal images or schemas of the self’s relationships with other people, based on past experiences.

Object relations structure and color people’s interpersonal experiences by determining what is expected, desired, and feared

To some extent, however, object relations generalize and show consistencies across relationships

Question 8

What are defense mechanisms used for?

Answer 8

When the need to avoid anxiety outweighs the need for reality-based adaptation, people use defense mechanisms to avoid being conscious of some painful aspect of their internal or external world.

Question 9

Are defense mechanisms effective?

Answer 9

No, they are ineffective and maladaptive because they distort the person’s awareness of either the world or the self.

Question 10

What do defense mechanisms accomplish?

Answer 10

Defenses protect people from anxiety and pain. Thus, defenses represent the best the person has been able to do in her effort to pursue her desires while satisfying her conscience and her effort to see the world realistically while maintaining a sense that life is okay

Question 11

What is neurosis?

Answer 11

Psychological disturbance in people who have the ego capabilities for effective functioning

In neurosis, the person’s mature ego has the capability to rethink and resolve old conflicts, but it cannot gain access to those conflicts because they are unconscious.

For young children and seriously disturbed older clients who lack effective ego functioning, psychopathology is less a problem of access than of capability.

Question 12

What are the 2 forms of maladaptive ego functioning?

Answer 12

1. The superego can be too harsh and strict, and
2. The superego can be too lax

Generally, harsh superego functioning produces internalizing disorders, and weak superego functioning results in externalizing disorders.

Question 13

What is resistance?

Answer 13

the operation of unconscious defenses in the context of therapy

Question 14

What is transference?

Answer 14

occurs when the client has feelings about the therapist that result from their emotional dynamics and past experiences, not the present, external reality of the therapist themselves. In positive transferences, the client idealizes the therapist and has unrealistic hopes for a gratifying relationship with them.

Question 15

What is countertransference?

Answer 15

the mirror image of transference, is the effects of the therapist’s own issues and dynamics on his experience of the client

Question 16

How do dynamic therapists make inferences between observed behaviors and underlying processes?

Answer 16

By entering the child’s world of magical, fantasy-based thinking and, for example, asking them to describe the witch, say where she comes from and why she is so mean, draw a picture of the witch, and engage in imaginative play about her with dolls and puppets. In time, this type of work might enable you to trace the fantasy fear back to its source.

Question 17

What are discrepancies?

Answer 17

Incongruities. They occur when client statements or behaviors are inconsistent with each other.

Question 18

What are omissions?

Answer 18

noteworthy absences of thoughts or feelings that are “talked around” and never addressed directly.

Question 19

What are excesses?

Answer 19

extreme behaviors or expressions of emotion; they are too much of something.

Question 20

What are the objectives of dynamic therapy?

Answer 20

1. Increased self-understanding
2. Increased acceptance of feelings and wishes
3. Replacement of (unconscious) defense mechanisms with (conscious) coping strategies
4. Development of realistically complex and positive schemas for relationships between self and others

Question 21

What is ventilation (AKA catharsis)?

Answer 21

the emotions associated with traumatic events come to the surface

Question 22

What is emotion-focused therapy?

Answer 22

makes extensive use of self-expression as a mechanism of change

Question 23

What is an interpretation?

Answer 23

is a therapeutic technique that brings an UCS process to the client’s attention

Question 24

What is dynamic psychoeducation?

Answer 24

Teaching the client about the emotional, relationship, and life issues involved in her difficulties. Involves information about general human functioning.

Question 25

What is a holding environment?

Answer 25

a refuge where all thoughts, wishes, and fears, no matter how embarrassing they might be in other settings, can be voiced without eliciting disapproval. The counselor reserves only one prerogative: She comments on what the client says and does.

Question 26

What is the general style of a dynamic therapist?

Answer 26

reflective, inquisitive style, with a calm curiosity about all human experiences. In the current understanding of “neutrality,” the therapist is fully and equally accepting of all of the client’s impulses, emotions, thoughts, and all aspects of self. However, this does not preclude the expression of human responses to the client’s experiences

Question 27

What is an interpretation?

Answer 27

causal explanations; they attempt to explain why the client feels, thinks, or behaves in some way

Question 28

What is a clarification?

Answer 28

means asking questions about client statements or behaviors to ascertain what the child meant by his words or actions.

Question 29

What is a confrontation?

Answer 29

drawing the client’s attention to some inconsistency or contradiction within her own beliefs, emotions, and behaviors.

Question 30

What is the process of “working through?”

Answer 30

The therapist helps the client apply an insight to the variety of experiences and behaviors to which the insight pertains

Question 31

What does the term dynamic mean?

Answer 31

refers to interactions between different parts or aspects of the mind. According to analytic theory, the mind is not a unified whole, and mental structures differ in their aims, content, and manner of operation. As a result, people often experience internal conflict

Question 32

What contributes to maladaptive functioning?

Answer 32

Traditional formulations derive from the idea that the unconscious does not mature—and it influences our current functioning As a result, people have difficulties that their mature ego would be capable of resolving if it could gain conscious access to the problems These difficulties involve ineffective, unrealistic defense mechanisms and object relations

Question 33

What do dynamic therapists use to make assessments?

Answer 33

the focus is on the symbolic meaning of behaviors. These can be inferred from: play, especially with figures like dolls and puppets, artwork, pictures, transference, resistance, imaginative material, and patterns of behavior

Question 34

What is the change agent for dynamic therapy?

Answer 34

Insight!!!

Therapists provide an unstructured, inquisitive, accepting environment that facilitates the emergence of deep-level material from clients’ spontaneous talk and play. Therapists provide interpretations that illuminate previously misunderstood elements of the client’s functioning. If the client’s mature ego is capable of understanding and resolving the problems, the unit of therapeutic work is done

Question 35

What if insight is not enough?

Answer 35

These clients need ACTIVE INPUT from their counselors, which can take two main forms: psychoeducation and corrective emotional experience

Psychoeducation is different from insight because it pertains, not just to the client, but to life and people in general. Clients without strong ego functioning are unlikely to gain these understandings on their own.

The question for the therapist is: What does the client misunderstand about life that is contributing to her problems?

Question 36

What are corrective emotional experiences?

Answer 36

This work involves emotional relearning through the therapeutic relationship and should involve more than generic acceptance: When maladaptive learning about self and others is revealed in the transference, counselors can create interpersonal experiences that specifically counter this learning. Client expressions of interpersonal pessimism, fear, or shame are opportunities for this type of intervention. The client internalizes the therapist’s view of him

Question 37

What is insight-based child management?

Answer 37

therapists work with caregivers to provide corrective experiences without necessarily interpreting the dynamics for the child

Question 38

What is the etiology of problems within a psychodynamic perspective?

Answer 38

Traditional formulations derive from the idea that the unconscious does not mature
and it influences our current functioning. As a result, people have difficulties that their mature ego would be capable of resolving if it could gain conscious access to the problems. These difficulties involve ineffective, unrealistic defense mechanisms and object relations, both of which generate maladaptive functioning