introduction to clinical psychology: science, practice and ethics chapter 11 psychodynamic...

Introduction to

Clinical Psychology:Science, Practice and Ethics

Chapter 11Chapter 11

Psychodynamic Psychodynamic PsychotherapyPsychotherapy

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PsychoanalysisPsychoanalysis

Goal – To make the unconscious Goal – To make the unconscious consciousconscious

InsightInsight IntellectuallyIntellectually EmotionallyEmotionally Working throughWorking through



Psychoanalysis: TechniquesPsychoanalysis: Techniques

Free AssociationFree Association DreamsDreams Everyday BehaviourEveryday Behaviour ResistanceResistance TransferenceTransference InterpretationInterpretation


Free AssociationFree Association

The “fundamental rule”The “fundamental rule” Patterns of associationPatterns of association


DreamsDreams

““The royal road to the unconscious”The royal road to the unconscious” The Interpretation of DreamsThe Interpretation of Dreams (Freud, (Freud,

1900)1900) Manifest ContentManifest Content Latent ContentLatent Content


Everyday or “inconsequential” Everyday or “inconsequential” behavioursbehaviours

The Psychopathology of Everyday The Psychopathology of Everyday LifeLife (Freud, 1901) (Freud, 1901)

Psychic determinismPsychic determinism Parapraxes – Freudian slipsParapraxes – Freudian slips ““Accidents”Accidents”


ResistanceResistance

Patient’s efforts to ward off efforts to Patient’s efforts to ward off efforts to dissolve neurotic methods of resolving dissolve neurotic methods of resolving problemsproblems

ExamplesExamples Talk lessTalk less Late for appointmentsLate for appointments Discuss trivial mattersDiscuss trivial matters Intensification of symptomsIntensification of symptoms Abatement of symptoms (“flights into health”)Abatement of symptoms (“flights into health”)


TransferenceTransference

Patients feelings toward and Patients feelings toward and relationship with the therapistrelationship with the therapist

Analysis of TransferenceAnalysis of Transference CountertransferenceCountertransference


Psychoanalytic Psychoanalytic interpretationinterpretation

Art – not scienceArt – not science Gradual – not all at onceGradual – not all at once


Psychoanalytic AlternativesPsychoanalytic Alternatives

Carl JungCarl Jung Alfred AdlerAlfred Adler Neo-FreudiansNeo-Freudians Ego PsychologistsEgo Psychologists Object RelationsObject Relations


Jung’s Analytic Jung’s Analytic PsychotherapyPsychotherapy

What Jung wrote about his method of What Jung wrote about his method of psychotherapy tended to be vague and imprecisepsychotherapy tended to be vague and imprecise

Some methods and concepts similar to Freud’s Some methods and concepts similar to Freud’s Free associationFree association Dreams Dreams TransferenceTransference

Theory diverged from Freud’s Theory diverged from Freud’s Less emphasis upon sexuality in understanding neurosesLess emphasis upon sexuality in understanding neuroses Less emphasis upon psychosexual stagesLess emphasis upon psychosexual stages Greater emphasis upon universal themesGreater emphasis upon universal themes


Jungian TheoryJungian Theory

Collective UnconsciousCollective Unconscious Universal unconscious Universal unconscious ArchetypesArchetypes (inborn dispositions to think, (inborn dispositions to think,

behave, and perceive in certain ways)behave, and perceive in certain ways) Introversion and extraversionIntroversion and extraversion

I = inward lookingI = inward looking E = outward lookingE = outward looking


Jungian Analytic Jungian Analytic PsychotherapyPsychotherapy

Goal: Goal: individuationindividuation To fully develop one’s unconscious To fully develop one’s unconscious

capacitycapacity Through insight freeing oneself to Through insight freeing oneself to

express one’s innate capacity for express one’s innate capacity for creativity and expressioncreativity and expression


Jungian Analytic Jungian Analytic PsychotherapyPsychotherapy

Not for everybodyNot for everybody Not for people with neuroses or other Not for people with neuroses or other

mental health problemsmental health problems Oriented toward generally healthy, Oriented toward generally healthy,

intellectually curious intellectually curious


Adlerian Psychotherapy: Adlerian Psychotherapy: AssumptionsAssumptions

Unconscious = not understood (not Unconscious = not understood (not an unconscious mind)an unconscious mind)

Emphasis upon social relationships Emphasis upon social relationships (particularly early family (particularly early family relationships) in developing relationships) in developing personalitypersonality

With With insightinsight client will chose to give client will chose to give up dysfunctional behaviour and up dysfunctional behaviour and choose healthier alternativeschoose healthier alternatives


Adlerian Psychotherapy: Adlerian Psychotherapy: CharacteristicsCharacteristics

Cooperative relationship between Cooperative relationship between therapist and clienttherapist and client

Clear goals established and agreed Clear goals established and agreed upon by therapist and clientupon by therapist and client

Therapists is overtly encouraging and Therapists is overtly encouraging and may give advicemay give advice


Adlerian Psychotherapy: Adlerian Psychotherapy: StagesStages

Establishment of good working relationshipEstablishment of good working relationship scriptsscripts

Understand the client’s lifestyles and goalsUnderstand the client’s lifestyles and goals Client’s place in family, client’s life storyClient’s place in family, client’s life story Explore client’s goalsExplore client’s goals

Achieve insight through interpretationAchieve insight through interpretation Insights that lead to action (not purely Insights that lead to action (not purely

historical)historical) Achieve Achieve reorientationreorientation

Choosing alternative ways of behaving Choosing alternative ways of behaving


Adlerian PsychotheapyAdlerian Psychotheapy

Strong influence on neo-Freudians such as Strong influence on neo-Freudians such as Karen Horney, Erich Fromm and Harry Karen Horney, Erich Fromm and Harry Stack SullivanStack Sullivan

Influenced existential and humanistic Influenced existential and humanistic therapists as well – the importance of therapists as well – the importance of people creating meanings for their livespeople creating meanings for their lives

Influenced cognitive therapists – idea that Influenced cognitive therapists – idea that people’s interpretations of significant people’s interpretations of significant events in their lives more important than events in their lives more important than events themselvesevents themselves


Neo FreudiansNeo Freudians

Erich FrommErich Fromm Karen HorneyKaren Horney Harry-Stack SullivanHarry-Stack Sullivan Accepted unconscious motivationAccepted unconscious motivation Focused upon contemporary Focused upon contemporary

interpersonal relationshipsinterpersonal relationships


Ego PsychologistsEgo Psychologists

Anna FreudAnna Freud Heintz HartmanHeintz Hartman Emphasized adaptation to current Emphasized adaptation to current

social environmentsocial environment


Object Relations TheoristsObject Relations Theorists

Karl AbrahamKarl Abraham Melanie KleinMelanie Klein


Contemporary Contemporary DevelopmentsDevelopments

Brief Psychodynamic PsychotherapyBrief Psychodynamic Psychotherapy Focal Psychotherapy (David Malan)Focal Psychotherapy (David Malan) Brief and Emergency Psychotherapy (Leopold Bellak)Brief and Emergency Psychotherapy (Leopold Bellak) Short-Term Anxiety-Provoking Therapy (Peter Sifneos)Short-Term Anxiety-Provoking Therapy (Peter Sifneos) Time-Limited Psychotherapy (James Mann)Time-Limited Psychotherapy (James Mann) Intensive Short-Term Dynamic Psychotherapy (Habib Intensive Short-Term Dynamic Psychotherapy (Habib

Davanloo)Davanloo) Supportive-Expressive Psychoanalytically Oriented Supportive-Expressive Psychoanalytically Oriented

Psychotherapy (Lester Luborsky)Psychotherapy (Lester Luborsky) Time-Limited Dynamic Psychotherapy (Hans Strupp)Time-Limited Dynamic Psychotherapy (Hans Strupp)


Contemporary Contemporary DevelopmentsDevelopments

Interpersonal Psychotherapy Interpersonal Psychotherapy (Klerman, Weissman, Rounsaville, & (Klerman, Weissman, Rounsaville, & Chevron, 1984)Chevron, 1984) Treatment for depression (originally)Treatment for depression (originally) Lasts 12 to 16 weeksLasts 12 to 16 weeks Three phasesThree phases

Initial - history formulate problemInitial - history formulate problem Second - active treatment focused on 1 or 2 Second - active treatment focused on 1 or 2

problemsproblems Third – recap and terminationThird – recap and termination


IPT- Problem areasIPT- Problem areas

Grief reactionGrief reaction Interpersonal role disputeInterpersonal role dispute Role transitionRole transition Interpersonal deficitsInterpersonal deficits


IPT EvaluationIPT Evaluation

As effective as CBT for depressionAs effective as CBT for depression Helpful for long-term maintenance of Helpful for long-term maintenance of

therapeutic gains in tx of depression therapeutic gains in tx of depression Helpful for post-partum depressionHelpful for post-partum depression As effective as CBT for bulimia As effective as CBT for bulimia

nervosa nervosa


Evaluation of Psychodynamic Evaluation of Psychodynamic TherapiesTherapies

Not particularly “psychological”Not particularly “psychological” Interesting and popularInteresting and popular Not much evidence of their efficacyNot much evidence of their efficacy Not listed among empirically Not listed among empirically

supported treatmentssupported treatments Exception is Interpersonal Exception is Interpersonal

PsychotherapyPsychotherapy


Psychodynamic EvaluationPsychodynamic Evaluation

Traditional psychoanalysis – Traditional psychoanalysis – economically not feasibleeconomically not feasible

Lack of emphasis upon behavior Lack of emphasis upon behavior change – frustrating to many change – frustrating to many consumersconsumers

Brief forms of psychodynamic therapy Brief forms of psychodynamic therapy are the futureare the future

Increasing pressure to empirically test Increasing pressure to empirically test psychodynamic therapiespsychodynamic therapies

introduction to clinical psychology: science, practice and ethics chapter 11 psychodynamic...

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