Treatment Cont. - Lecture 18

Psychoanalytic / Psychodynamic Therapy

Traditional Psychoanalysis:

• a form of therapy originally developed by Sigmund Freud in the early 1900s

• based on the assumption that early childhood experiences provide the foundation for later development

• this impact of early experiences on our current functioning is unconscious

• these unconscious patterns exert influence over us that we are not aware of, especially in our interpersonal relationships

(Some) Therapeutic Techniques

Free Association

• the patient repeats thoughts, feelings, and memories/dreams while lying on a couch

  • anything that comes to mind without filler

  • idea that speaking freely would reveal aspects of their unconscious that the analyst could then interpret

  • traditionally, psychoanalyst would sit out of view

Defense Mechanisms

• Denial - blocking external events from awareness

• Projection - individuals attributing their own unacceptable thoughts/feelings/motives onto another

• Displacement - satisfying an impulse with a substitute object (ex: aggression, then taking it out on another person)

• Regressions - a movement back in psychological time when one is stressed

• Sublimation - satisfying an impulse with a substitute object in a socially acceptable way ( ex: aggression, but instead of taking it out on another person, put the negative impulse into something more socially acceptable, such as going to the gym, focusing on career, etc.)

Transference

• occurs in the relationship between patient and psychoanalyst

• occurs when the patient unconsciously responds to the therapist as if the therapist were a significant person in their life, such as a parent/other early life figure

  • ex: patient worries that therapist is judging them because parents were highly critical

• Traditional psychoanalysts encouraged transference by purposely remaining neutral

  • most modern therapists do not, taking a more active, collaborative approach

• the way a patient reacts to the therapist can be indicative of how they react to other people in their life

Modern Adaptations

• traditional psychoanalysis was a long process

• modern, typically shorter-term approaches that developed from psychoanalytic theory are termed psychodynamic therapies

• Key differences:

  • modern psychodynamic therapists are typically more collaborative with clients, more active in the therapy process, and demonstrate warmth and empathy

Acceptance and Commitment Therapy (ACT)

• a third wave cognitive-behavioral therapy

  • 1st wave: behavioral therapy

  • 2nd wave: cognitive behavioral therapy

  • 3rd wave: ACT, DBT, etc

• focused not just on changing behaviors and thoughts, but incorporating mindfulness and acceptance

• acceptance does not mean liking something, it means seeing it as what it is

• cognitive delusion is one specific ACT skill

Thoughts on Thoughts

• brains are thought-generating machines — which can be helpful

• but, thoughts can be “sticky” in our minds

• thoughts can also pull us towards avoidance

• your internal dialogue — or thoughts — may change in different situations

Cognitive Fusion

• when our thoughts feel like they are our reality (when thoughts aren’t just thoughts)

  • ex: “I am a disgusting person” vs. “ I am having the thought that I am a disgusting person.”

    • places distance

Avoidance of Thoughts

• it can be very overwhelming when we fuse with our thoughts

• we might try to ignore/run away

• turn to substance abuse, shopping, eating, etc

• we might avoid bigger issues in our life as a result

Cognitive Delusion

• a skill used to detach ourselves from our thoughts

• call a thought a thought —> acknowledge it

• acknowledge your thoughts and keep moving on, instead of fusing with them or avoiding them