Introduction to Clinical Psychology: Science, Practice and Ethics Chapter 11 Psychodynamic Psychotherapy This multimedia product and its contents are protected under copyright law. The following are prohibited by law: Any public performance or display, including transmission of any image over a network; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Any rental, lease, or lending of the program Copyright ©Allyn & Bacon 2005

Psychoanalysis Goal – To make the unconscious conscious Goal – To make the unconscious conscious Insight Insight Intellectually Intellectually Emotionally Emotionally Working through Working through Copyright ©Allyn & Bacon 2005

Psychoanalysis: Techniques Free Association Free Association Dreams Dreams Everyday Behaviour Everyday Behaviour Resistance Resistance Transference Transference Interpretation Interpretation

Copyright ©Allyn & Bacon 2005 Free Association The “fundamental rule” The “fundamental rule” Patterns of association Patterns of association

Copyright ©Allyn & Bacon 2005 Dreams “The royal road to the unconscious” “The royal road to the unconscious” The Interpretation of Dreams (Freud, 1900) The Interpretation of Dreams (Freud, 1900) Manifest Content Manifest Content Latent Content Latent Content

Copyright ©Allyn & Bacon 2005 Everyday or “inconsequential” behaviours The Psychopathology of Everyday Life (Freud, 1901) The Psychopathology of Everyday Life (Freud, 1901) Psychic determinism Psychic determinism Parapraxes – Freudian slips Parapraxes – Freudian slips “Accidents” “Accidents”

Copyright ©Allyn & Bacon 2005 Resistance Patient’s efforts to ward off efforts to dissolve neurotic methods of resolving problems Patient’s efforts to ward off efforts to dissolve neurotic methods of resolving problems Examples Examples Talk less Talk less Late for appointments Late for appointments Discuss trivial matters Discuss trivial matters Intensification of symptoms Intensification of symptoms Abatement of symptoms (“flights into health”) Abatement of symptoms (“flights into health”)

Copyright ©Allyn & Bacon 2005 Transference Patients feelings toward and relationship with the therapist Patients feelings toward and relationship with the therapist Analysis of Transference Analysis of Transference Countertransference Countertransference

Copyright ©Allyn & Bacon 2005 Psychoanalytic interpretation Art – not science Art – not science Gradual – not all at once Gradual – not all at once

Copyright ©Allyn & Bacon 2005 Psychoanalytic Alternatives Carl Jung Carl Jung Alfred Adler Alfred Adler Neo-Freudians Neo-Freudians Ego Psychologists Ego Psychologists Object Relations Object Relations

Copyright ©Allyn & Bacon 2005 Jung’s Analytic Psychotherapy What Jung wrote about his method of psychotherapy tended to be vague and imprecise What Jung wrote about his method of psychotherapy tended to be vague and imprecise Some methods and concepts similar to Freud’s Some methods and concepts similar to Freud’s Free association Free association Dreams Dreams Transference Transference Theory diverged from Freud’s Theory diverged from Freud’s Less emphasis upon sexuality in understanding neuroses Less emphasis upon sexuality in understanding neuroses Less emphasis upon psychosexual stages Less emphasis upon psychosexual stages Greater emphasis upon universal themes Greater emphasis upon universal themes

Copyright ©Allyn & Bacon 2005 Jungian Theory Collective Unconscious Collective Unconscious Universal unconscious Universal unconscious Archetypes (inborn dispositions to think, behave, and perceive in certain ways) Archetypes (inborn dispositions to think, behave, and perceive in certain ways) Introversion and extraversion Introversion and extraversion I = inward looking I = inward looking E = outward looking E = outward looking

Copyright ©Allyn & Bacon 2005 Jungian Analytic Psychotherapy Goal: individuation Goal: individuation To fully develop one’s unconscious capacity To fully develop one’s unconscious capacity Through insight freeing oneself to express one’s innate capacity for creativity and expression Through insight freeing oneself to express one’s innate capacity for creativity and expression

Copyright ©Allyn & Bacon 2005 Jungian Analytic Psychotherapy Not for everybody Not for everybody Not for people with neuroses or other mental health problems Not for people with neuroses or other mental health problems Oriented toward generally healthy, intellectually curious Oriented toward generally healthy, intellectually curious

Copyright ©Allyn & Bacon 2005 Adlerian Psychotherapy: Assumptions Unconscious = not understood (not an unconscious mind) Unconscious = not understood (not an unconscious mind) Emphasis upon social relationships (particularly early family relationships) in developing personality Emphasis upon social relationships (particularly early family relationships) in developing personality With insight client will chose to give up dysfunctional behaviour and choose healthier alternatives With insight client will chose to give up dysfunctional behaviour and choose healthier alternatives

Copyright ©Allyn & Bacon 2005 Adlerian Psychotherapy: Characteristics Cooperative relationship between therapist and client Cooperative relationship between therapist and client Clear goals established and agreed upon by therapist and client Clear goals established and agreed upon by therapist and client Therapists is overtly encouraging and may give advice Therapists is overtly encouraging and may give advice

Copyright ©Allyn & Bacon 2005 Adlerian Psychotherapy: Stages Establishment of good working relationship Establishment of good working relationship scripts scripts Understand the client’s lifestyles and goals Understand the client’s lifestyles and goals Client’s place in family, client’s life story Client’s place in family, client’s life story Explore client’s goals Explore client’s goals Achieve insight through interpretation Achieve insight through interpretation Insights that lead to action (not purely historical) Insights that lead to action (not purely historical) Achieve reorientation Achieve reorientation Choosing alternative ways of behaving Choosing alternative ways of behaving

Copyright ©Allyn & Bacon 2005 Adlerian Psychotheapy Strong influence on neo-Freudians such as Karen Horney, Erich Fromm and Harry Stack Sullivan Strong influence on neo-Freudians such as Karen Horney, Erich Fromm and Harry Stack Sullivan Influenced existential and humanistic therapists as well – the importance of people creating meanings for their lives Influenced existential and humanistic therapists as well – the importance of people creating meanings for their lives Influenced cognitive therapists – idea that people’s interpretations of significant events in their lives more important than events themselves Influenced cognitive therapists – idea that people’s interpretations of significant events in their lives more important than events themselves

Copyright ©Allyn & Bacon 2005 Neo Freudians Erich Fromm Erich Fromm Karen Horney Karen Horney Harry-Stack Sullivan Harry-Stack Sullivan Accepted unconscious motivation Accepted unconscious motivation Focused upon contemporary interpersonal relationships Focused upon contemporary interpersonal relationships

Copyright ©Allyn & Bacon 2005 Ego Psychologists Anna Freud Anna Freud Heintz Hartman Heintz Hartman Emphasized adaptation to current social environment Emphasized adaptation to current social environment

Copyright ©Allyn & Bacon 2005 Object Relations Theorists Karl Abraham Karl Abraham Melanie Klein Melanie Klein

Copyright ©Allyn & Bacon 2005 Contemporary Developments Brief Psychodynamic Psychotherapy Brief 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 Davanloo) Intensive Short-Term Dynamic Psychotherapy (Habib Davanloo) Supportive-Expressive Psychoanalytically Oriented Psychotherapy (Lester Luborsky) Supportive-Expressive Psychoanalytically Oriented Psychotherapy (Lester Luborsky) Time-Limited Dynamic Psychotherapy (Hans Strupp) Time-Limited Dynamic Psychotherapy (Hans Strupp)

Copyright ©Allyn & Bacon 2005 Contemporary Developments Interpersonal Psychotherapy (Klerman, Weissman, Rounsaville, & Chevron, 1984) Interpersonal Psychotherapy (Klerman, Weissman, Rounsaville, & Chevron, 1984) Treatment for depression (originally) Treatment for depression (originally) Lasts 12 to 16 weeks Lasts 12 to 16 weeks Three phases Three phases Initial - history formulate problem Initial - history formulate problem Second - active treatment focused on 1 or 2 problems Second - active treatment focused on 1 or 2 problems Third – recap and termination Third – recap and termination

Copyright ©Allyn & Bacon 2005 IPT- Problem areas Grief reaction Grief reaction Interpersonal role dispute Interpersonal role dispute Role transition Role transition Interpersonal deficits Interpersonal deficits

Copyright ©Allyn & Bacon 2005 IPT Evaluation As effective as CBT for depression As effective as CBT for depression Helpful for long-term maintenance of therapeutic gains in tx of depression Helpful for long-term maintenance of therapeutic gains in tx of depression Helpful for post-partum depression Helpful for post-partum depression As effective as CBT for bulimia nervosa As effective as CBT for bulimia nervosa

Copyright ©Allyn & Bacon 2005 Evaluation of Psychodynamic Therapies Not particularly “psychological” Not particularly “psychological” Interesting and popular Interesting and popular Not much evidence of their efficacy Not much evidence of their efficacy Not listed among empirically supported treatments Not listed among empirically supported treatments Exception is Interpersonal Psychotherapy Exception is Interpersonal Psychotherapy

Copyright ©Allyn & Bacon 2005 Psychodynamic Evaluation Traditional psychoanalysis – economically not feasible Traditional psychoanalysis – economically not feasible Lack of emphasis upon behavior change – frustrating to many consumers Lack of emphasis upon behavior change – frustrating to many consumers Brief forms of psychodynamic therapy are the future Brief forms of psychodynamic therapy are the future Increasing pressure to empirically test psychodynamic therapies Increasing pressure to empirically test psychodynamic therapies