Introduction to Psychotherapy

Introduction to psychotherapy Müge Alkan, PhD October - Introduction 13 October – Key concepts of psychotherapy 20 October – Assessment and Therapeutic interventions 27 October –Introduction to Psychodynamic psychotherapy 3 November – Psychodynamic psychotherapy 10 November - Psychodynamic psychotherapy 17 November - Cognitive behavioral psychotherapy 24 November - Cognitive behavioral psychotherapy 1 December – Midterm and Group therapy 8 December - Group therapy 15 December -Interpersonal psychotherapy 22 December – Transactional analysis 29 December - Family therapy 5 January - General overview Midterm % 30 Presentation and paper % 30 Final exam % 40

Who are the patients? Patients suffer from problems that interfere with their attaining life goals Maximize potentials Lead happy lives Problems stem from unconscious conflicts Presented as symptoms or personality traits and patterns Either bothersome to patients or just interference with life of patients

Can patients be placed in diagnostic groups? Yes, in many ways.. Differences in ego functioning Normal-neurotic Narcissistic Borderline Psychotic

Assessment of ego functioning Reality testing Sense of reality Adaptation to reality Impulse control and frustration tolerance Object relations Thought processes Defensive functioning

Normal-neurotic group Good ego functioning Intact reality testing Good interpersonal relations Good adaptation to reality Good impulse control Stable identity Affective stability Mature defenses

Normal-neurotic group Object relations; integrated, coherent and stable sense of self and objects. Others are viewed as individuals of their having needs and desires of their own. There may be some slippage in all areas, though rarely in reality testing. All “normal“ people use numerous neurotic defenses, may have episodic difficulties.

Borderline group Relative (may easily break) intact reality testing/thought processes/ interpersonal relations/adaptation to reality Poor impulse control Primitive ego defenses Identity diffusion Affective instability

Narcissistic group Integrated but pathological identity based on grandiose self. Labile self-esteem, sensitive to rejects, disappointments, failures.

Psychotic group Poor ego functioning Weak reality testing Problems in almost all ego functions

Who are the therapists? Psychiatrists, psychologists, clinical social workers, nurses, counselors. Some –unconsciously- enter the field to solve their own problems.

What are some problems inherent in psychotherapy? Psychotherapy is fascinating, intellectually stimulating when done well. Can be exhausting, demanding, Challenge of facing own problems and those of patients. Projecting one’s problems onto patients Taking own anger at them Treating them as one wished to be treated Using them for one’s own gratification Boundary violations and sexual acting. Can be isolating..

How important is one’s personal therapy or psychoanalysis? Crucial.. To understand one’s own problems and minimize their influence in the therapy process.

Which personal characteristics and experiences help to make a good therapist? Some stability Concern Dedication Integrity Conscientiousness Competence High intelligence Psychological mindedness Empathy

Which personal characteristics and experiences help to make a good therapist? Certain amount of suffering, depression and neurotic conflict. A reflective, thoughtful person on the pessimistic, realistic side Too much optimism is associated with denial. Ability to listen To be able to bear criticism and hostility without the need to retaliate Intuition and creativity Some life experience

How long does it take to become an effective psychotherapist? Years years is mentioned.. Psychotherapy is a continual and neverending learning. Understanding oneself through personal analysis Life experience Learn theory and technique through reading Supervision

Psychotherapy Explorative therapies Supportive psychotherapy Insight oriented Psychoanalysis Analytically oriented psychotherapy Dynamically oriented psychotherapy Supportive psychotherapy Cognitive psychotherapy

Psychoanalysis 4-5 times a week on the couch Free association Resistance Gradual process of unconscious becoming conscious Context of transference Neutral position

Psychoanalysis Intense transference, in a regressed state Feelings, thoughts (and defenses) originally directed toward important people in childhood Actual and fantasized past as experienced by patient Current relationships, past relationships

Issues in psychotherapy Stable therapeutic environment Therapy is carried out in a stable, consistent and caring way in a safe, nonthreatening and nonintrusive environment. Expectations of treatment should be clearly spelled out, discussed and always followed. Good-enough mothering (Winnicott, 1958) Holding environment (Winnicott, 1958) Therapeutic alliance

Issues in psychotherapy Neutral therapist Equal distance from id, ego and superego Important in analytic therapies Transference “blank screen” for displacement of feelings Clarity of judgement and criticism

Issues in psychotherapy Flexible therapist Need to oscillate methods with more troubled patients Be ready for unpredictable and new challanges

Issues in psychotherapy Countertransference Therapist’s conscious and unconscious reactions to the patient’s transference Borderline patients: guilt, rescue fantasies, rage, hatred, helplessness, worthlessness, anxiety, terror. What is your response to such feelings ? !!!!! Narcissistic patients: idealization, devaluation (acting as if the therapist does not exist) Psychotic patients: passive, dependent and unable to change: helplessness may lead to taking over patient’s life.

Issues in psychotherapy Empathy 1. Understanding Building trust “Empathy is not a cure itself” 2. Explaining; gain insight

Issues in psychotherapy Action Active in listening More passive at first, but active later

What is the mechanism of change in psychotherapy? Change via insight: (insight oriented interventions) “healthier patients” Change via the relationship: (identification and internalization) “more troubled patients”

What are the basic strategies for psychotherapy? Reexperiencing and working through the conflicts. Strategy: maximize development and resolution of transference Comment on resistance to the formation of transference Help patient understand himself through transference with current and childhood relationships

What are the basic strategies for psychotherapy? Second strategy: Focusing on present day interactions and relationships Downplay transference Third strategy: Supportive therapy Supporting and enhancing ego functions Blocking regression