PSY219 Exam #2

psychotherapy

a general term for ‘talk therapy,’ e.g., psychodynamic, CBT, EMDR, DBT, feminist

psychoanalytic, psychodynamic, & dynamic

synonyms for therapy approaches that focus on unconscious conflict and processes

psychoanalysis

a form of intensive psychoanalytic therapy involving 3-5 sessions per week, often with the patient lying on a couch (therapist not sitting in their view)

brief & time limited therapy

models of therapy have had a set number of sessions and/or pay attention to the duration of therapy, e.g., brief dynamic therapy

open-ended therapy

therapy of no set duration

psychoanalytic view of life (main objectives)

freud wrote, “psychoanalysis trans neurotic misery into ordinary unhappiness”; psychotherapy restores viality, not happiness— helping people live more freely + authentically (often brings a greater capacity for joy)

helps people manage the inevitable difficulties of life; there are different ways of being in the world, there is no one right way to be

life involves various forms of suffering (psychoanaltic view of life)

existential suffering is unavoidable; normal facts of human existence

neurotic suffering is avoidable and can be lessened through therapy

psychoanalytic values

humans are complex creatures shaped by multiple & conflicting conscious + unconscious forces; ambiguity/uncertainty in life + therapy is unavoidable & should be tolerated

psa values: complexity, depth, nuance, patience, acceptance, curiosity (opposes values of dominant us culture)

psychoanalytic values can lead to long treatments with no clear endpoint

honesty + psychoanalytic therapy

ethic of honesty; a goal of therapy is to shed illusions, including self-deception— we are all strangers to ourselves at some level; knowing ourselves is difficult (+ always partial) bc everyone has an unconscious

being a psychoanalytic therapist involves ongoing self-discovery + personal growth; includes becoming skilled at seeing the role of your own unconscious)

freudian (classical) psychoanalysis

focus→ conflict between the id, ego, and superego (internal conflict)

goal→ rationality

approach→ analysis

contemporary psychoanalysis

focus→ both internal conflict and conflict between self-states or between self and other

goal→ authenticity

approach→ spontaneity

treatment manuals

a guide for conducting a particular form of therapy; may be general or detailed; were developed to use in research

most people don’t use treatment manuals beyond developing for research bc you never know what’s going to happen (spontaneity)

psychoanalytic rejection of treatment manuals

therapy involves spontaneity + authenticity

each dyad is unique, each moment is unique

reflection-in-action→ experts solve problems holistically and in the moment, not in a prescribed stepwise fashion (not technical rationality)

freudian psa + consciousness

a secondary process

rational, reflective thinking, logical, sequential

part of the ego is conscious + part is unconscious

freudian psa + unconsciousness

the primary process

dreams + fantasies (wishes)

id – “sex and aggression” → drive toward pleasure, has to do with where in the body is desiring pleasure and wanting that feeling to continue; aggression has to do w saying no and setting boundaries

repression

primary defense mechanism that keeps conflict + id impulses in the unconscious & out of consciousness

unacceptable wishes are kept out of consciousness

unconsciousness in freudian psa

therapist helps bring the unconscious into consciousness→ where id (it– separating from things like sex + aggression) was, there ego (I– part of your being) shall be; expands the ‘I’ and diminishes the power of the ‘it’

“one person psychology” → focus on the patient’s unconscious

unconscious in contempoary psa

multiple self-states may be in conflict with each other + self-states may be dissociated or split off from each other — dissociation is the defense mechanism that keeps self-states separated (thinking ‘sometimes I’m like this, sometimes I’m like that’); or, self-states may be un-symbolized

no central controlling function – ego

therapist is a “partner in thought”; “two-person psychology” → the unconscious of both people affect the therapy process; “we are not masters of our house”→ we are all motivated by forces outside of our awareness

psychoanalytic therapy + fantasy

plays an important role in people’s psychic functioning; ranges from conscious to deeply unconscious

freud linked fantasies to the instinctual wishes of the id

also recognized other psychic funcitons (self-esteem, safety, emotional regulation, mastery)

transference (psychoanalytic therapy)

patient’s experience of the therapist/therapy relationship that connects to the unconscious and/or to relationships outside the therapy

countertransference (psychoanalytic therapy)

ditto for therapist; this term is also used more broadly (totality of therapist emotional experience of the patient)— a potential source of information about the patient’s internal world, as long as the therapist reflects on it instead of acting it out

enactment (psychoanalytic therapy)

when the therapist + patient are interacting according to unconscious dynamics

ex. a patient who fear abandonment starts missing sessions, testing whether the therapist will “give up” on them; therapist starts feeling distant + strict ab attendance — unconsciously re-enacting the rejecting parent dynamic the patient expects

→ when they realize this together (“It feels like we’re repeating the pattern you described with your mother”), it becomes a powerful moment of insight — an enactment that is now being analyzed instead of repeated

interpretation (psychoanalytic therapy)

a statement that identifies unconscious motivation, thought, or conflict

3 types→ transference, non-transference, + genentic; most psychoanalysts don’t care much ab the differences in type

empathic statements are also important, as we see in brief dynamic therapy

transference interpretation (psychoanalytic therapy)

explanation of unconscious dynamics in a current moment w the therapist (ex. “you beleive i will reject you as your mother did”

grounded in the here + now; immediate + experiential quality; experientially fresh + immediate

less likely to be intellectualized or theoretical; collaborative exploration or meta communication

non-transference or extra-transference interpretation (psychoanalytic therapy)

about a relationship outside the therapy (ex. “your image of god mirrors your image of your own father”

can help the patient see something new ab the situation; should facilitate exploration; can be experienced as therapist defensiveness if therapist similarities are not addressed 

genetic interpretation (psychoanalytic therapy)

explanation of a current dynamic in terms of past/childhood dynamics (ex. “you believe you are wrong to have hope bc your father disappointed your hopes so often when you were young”)

can help patients understand the origins of their ways of being; current problems are understandable given past situations; goal is to help patients develop new ways of being

dreams + psychoanalytic therapy

royal road to the unconscious; freud considered them to be disguised wishes; can be useful to consider the dreamer to be each of the characters in a dream; not a major part of psychoanalysis today but can be useful in some cases

manifest content→ reportable content of the dream (ex. “i dreamt my father was still alive”)

latent content→ hidden meaning of the dream

3 theoretical foundations of brief dynamic therapy

attachment theory→ why do people behave as they do? why is this client experiencing things/doing things as they are?

interpersonal-relational theory→ what is the medium in which therapeutic change occurs?; the therapeutic relationship is the medium of change

experiential-affective component→ what needs to change?; focus of change is on emotion/affect

john bowlby + attachment theory

infant-mother bond is rooted in evolution + necessary for infant survival; attachment needs + behaviors continue throughout the cycle of life— adults turn to other adults esp in times of stress

not based in drive for pleasure (freud) or need for food (classical conditioning, behaviorists)

attachment figure provides a secure base for the infant to explore the world; both security + support for exploration are important functions of attachment (note: culture specific, not universal)

internal working models (attachment theory)

iwm develop over time from early childhood experiences with attachment figure; schema of self + other; foundations of the person’s relationships throughout life

iwm are positive or negative expectations of self (valued? seen? neglected? criticized?) & other (nurturing? supportive? judgmental?)

mary ainsworth + attachment [buddies w bowlby]

developed the strange situation, an experimental procedure for studying attachment patterns in babies

identitified 3 attachment types (secure, avoidant, anxious ambivalent)— anxious + avoidant aren’t abnormal (attachment disorders are much more extreme)

insecurely attached children have negative iwm of self and/or other that affect their relationships throughout life

secure attachment

positive working models of self + other; feels comforted; feels supported exploring the world

avoidant attachment

minimize the importance of relationships, even as babies; gives the appearance of independence; they’re avoiding their need of the caretaker

anxious ambivalent attachment

seeks comfort but does not feel comforted

attachment-based therapy goal

explore and change internal working models

attachment-based therapy overarching therapist tasks

provide a secure base to examine painful aspects of life; assist exploration or expectations + biases; encourage consideration of how childhood experiences w parents relate to current life; help the patiet imagine healthier ways of acting + thinking (what’s possible for them now); examine the therapeutic relationship for iwm (focus on transference-countertransference in the here + now)

brief dynamic therapy process

bc therapy is time-limited or brief, the therapist uses particular strategies & focuses

there are 25 specific strategies (do NOT need to know)

maintaining the therapeutic relationship in bdt

take a respectful/non-judgmental stance; listen receptively; assess, use, + comment on client strengths; identify obstacles + opportunities in the therapy process

accessing + processing emotion in bdt

relate to clients in the here/now from a deeply empathic place; encourage clients to process emotion + experience & express emotion in the session (cyclical maladaaptive pattern— “you must arrive at a place before you can leave it”); help clients become aware of emotions out of awareness + deepen experience of emotions they are aware of

label emotions + understand their significance; focus specifically on attachment-related feelings

ask open-ended questions; explore clients’ words

maintain focus on relationships in bdt

focus on relationships in client’s life (relationship w therapist is used to understand those relationships in vivo)

therapist may self-disclose their feelings (but rarely their personal experiences)

advise against using transference interpretation 

identify + explore cyclical maladaptive pattern in bdt

when people have negative expectations, they behave in ways that align, then they receive a reinforcement of those expectations

cmp-formulation that identifies iwm of self + other in current relational problems; specific + grounded in client experience

serves as a focus for therapy; therapist may connect cmp to clients’ early experiences to depathologize

promoting change directly in bdt

use in-session experiences to actively disconfirm client’s iwm, negative schemas, + expectations 

encourage clients to try new behaviors outside of the session, even if risky

consider giving homework (this is uncommon in psychoanalytic approaches)

when to end bdt

growth continues after the therapy ends (true for psychoanalytic therapies in general)

therapy ends when the client has made sufficient gains, rather than when the client has fully acheived all their goals— people learn how to do for themselves what the therapist has been doing for them)

race/ethnicity in psychoanalytic therapy — overview/purpose of the article

describes psychoanalytic perspectives on the roots of xenophobia + defense mechanisms used in relation to race; presents psychoanalytic understanding of the experiences of immigrants to the u.s. from marginalized communities, esp bipoc

shows how upstream structural forces + oppression can be considered with a psychoanalytic lens

explores clinical implications— how do these processes manifest in therapy?; how do therapists work w both internalized (unconscious) + overt expressions of racism?; how do psychoanalysts think ab therapist-patient differences in identity + privilege?

xenophobia

fear + hatred of strangers or foreigners, or of anything that appear strange or foreign

ethnocentrism

belief that a certain nation, state, culture, or community is superior to others; everyone has ethnoentric beliefs 

link between xenophobia + immigration

xenophobia is lower among people who have more contact w immigrants, BUT xenophobia increases when immigration rises at a soceital level

xenophobia is “experienced in conscious + uconscious life & embedded in early object relations & structural privilege + oppression”

early object relations→ the ways early childhood experiences with parents/caretakers have been internalized; very similar to iwm in attachment theory (what i’ve learned ab self, world, + others, & how i internalize them)

this model considers both downstream (individual, intrapsychic) + upstream (structural) forces in xenophobia

xenophobia and racism

xenophobia + racism are “mutually supporting forms of oppression”; immigrants of color experience both forms of oppression; xenophobia takes both internal (intrapsychic) + external (interpersonal) forms

internal xenophobia→ attitudes + beliefs about self and other

external xenophobia→ interpersonal actions fueled by prejudice

psychoanalytic theories of experiences of immigrants

experience of immigration is complex + multi-layered; applies to both clients + therapists who are immigrants; bc xenophobia + racism are parts of everyone’s reality + identity, they should be explored in psychotherapy (similar to wilcox argument + basis of multicultural competence)

immigrants desire the privileges of whiteness, including protection from racism— this may seem to mean disowning one’s ethnic identity (which is often a source of strength)

being a “minority” means having less power (i.e., being marginalized)

influence of premigration context on immigrants

racial/ethnic/social class hierarchies – immigrants may try to distance themselves from “typical” immigrants by remaining connected to these hierarchies

ambivalence

we always also hate the ones we love; simultaneous experience of love + hate towards one person

if you allow yourself to love, they will inevitably piss you off SO MUCH

identification

children identify (unconsciously) with their parents as part of their development; they become like their parents by adopting characteristics, desires, + values they understand their parents to hold

when children identify with their parents, they may take on their parents’ prejudiced beliefs & societal racism; a person may feel that questioning or rejecting a parent’s beliefs means rejecting or losing the parent

defense mechanisms used bc hating someone we love feels bad so try to keep hate out of awareness

ways to protect ourselves from feeling negative emotions:

projection→ perceiving hated aspects of self (or another person) as part of someone else (i.e., someone perceived as different; less than), not the loved one (or self); unconscious scapegoating; model minority myth

dissociation→ keeping hated + loved aspects segregated

splitting→ seeing people (including self) as all good or all bad

case vignette #1 — john’s view of immigrants was…

an attempt to regain a sense of power by identifying with powerful people + whiteness, & by dissociating from powerless people (certain immigrants)

mirrored in the therapist’s countertransference (there are good + bad white people)

a tie to his parents, whom he loved + hated & did not want to lose

case vignette #2 — anika’s view of immigrants was…

an attempt to protect herself from being marginalized (making friends with white people, avoiding other Indian immigrants)

an attempt to distance herself from internalized colorism from her mother + caste bias from her father

goals of emotion-focused therapy

to help clients experience mastery in re-experiencing emotions they could not handle in the past

accomplished through corrective emotional experiences within the therapy relationship + specific emotion-focused techniques

key concepts of emotion (eft)

emotions are: fundamentally adaptive, a basic mode of information processing, & provide access to needs, wishes, or goals + the action tendencies are associated with them

2 pathways for emotion: fast & slow

emotion schemes

cognitive, affective, motivational, and behavioral structures; activated outside our awareness + influence cognitive processing

they involve visceral, physiological, imagistic, action-potential, + possibly cognitive features; & represents both the situation as construed and its emotional effect on the individual

based in evolution + personal history!

primary adaptive emotion

a direct response that is consistent with the situation; ex. loss—> sadness

primary maladaptive emotion

a direct response, but the situation is misconstrued; ex. closeness—> fear

secondary reactive emotion

response to one’s own emotion; anger ab feeling hurt

often defend against a primary emotion — “i’m not hurt i’m PISSED”

might be a response to an intervening thought — i feel sad, but sadness is weakness so i will feel anger instead; process is not conscious

instrumental emotion

expressed to influence or control others, not genuine; manipulative

two major tasks in EFT processes

help people with too little emotion access more + help people with too much emotion contain their emotions

therapeutic relationship plays a key role in both tasks: therapist provides affect attunement, emotion regulation/soothing, & new emotional experiences

awareness (1st principle of emotion change)

3 steps:

1) awareness of past emotion + the reason for it (trigger), reflecting; 2) reduce time between emotion + awareness; 3) become able to recognize emotions as they occur

expression (2nd principle of emotion change)

overcoming avoidance of emotional experience (clients must be encouraged to do bc people avoid uncomfy emotions); rejects the idea that emotions aren’t natural

being able to express previously constricted primary emotions in words (tolerate being in contact w emotion); both adaptive + maladaptive emotions need expression

NOT venting a secondary reactive emotions; not helpful bc it’s not real!

regulation (3rd principle of emotion change)

what emotions should be regulated (which are primary emotions?)+ how should they be regulated?

provide safe space; support self-regulation + self-soothing; offer compassion for painful emotions

reflection (4th principle of emotion change)

make narrative sense of emotions; integrate emotional experience into self-narrative; create new meaning; enhance understanding of self

transformation (5th principle of emotion change)

transformation of primary maladaptive emotions; fully feel + accpet the maladaptive emotion

undo the emotion by activating more adaptive emotions that are incompatible with it; withdrawal emotions are replaced w activation emotions; undoing changes the emotion schemes

techniques of transformation (5th principle of emotion change)

explore adaptive feelings that were present in the original situation or currently (ex. anger at a person who did harm which replaces fear or shame)

enactment; imagery; recalling past experience of the adaptive emotion

the emotion experience itslf, rather than understanding, is the key; the past can be changed!

corrective emotional experience

therapy relationship provides new emotional experiences, e.g.: facing shame, having anger accepted, being soothed; the feelings that come up are accepted; focused on helping the person experience emotionality in different ways

allows clients to experience mastery in their emotional experiences

person-centered therapy therapeutic goals (as identified by carl rogers)

therapist attempts to create an optimal therapeutic relationship for the client; in this environment, the client can develop into their full self

therapist strives to: be congruent, genuine, & authentic; experience unconditional positive regard for the client

actualizing tendency (person-centered therapy)

inherent movement toward growth, wholeness, integration, autonomy, + effectiveness

basis of therapist’s trust and optimism

self (person-centered therapy)

organized i or me, consistent + also open to change

self-actualization (person-centered therapy)

process of expressing aspects of self in the world

we can live our lives as ourselves in the world; to accept + be accpeted as one’s full self

psychological adjustment (vs maladjustment) involves… (person-centered therapy)

congruence (vs incongruence) → aspects of self – thoughts, feelings, behavior – are in harmony; kinda the opposite of psychoanalytic  bc natural state is congruence, not internal conflict

openness to experience→ taking in information from internal + external sources without defensiveness; defensiveness isn’t inherent as it is in psychoanalysis

conditions of worth (person-centered therapy)

people place conditions on others based on what they find desireable or acceptable (i.e., people are good if/when…); limitations; people show or hide aspects of self based on the evaluation/response they expect from others; people who experience them (everyone) fear revealing their true/full selves + engage in “image management”

children’s views of themselves are shaped by their parents’ conditions of worth, e.g., love you if/when…; parents are conveying value; continues to impact us

also shaped by culture + may differ by identity (e.g., gender roles)

unconditional positive regard (person-centered therapy)

acceptance of another person’s experienc eor behavior without conditions; involves valuing the person not judging them based on behaviors; opposite of conditions of worth

when clients experience this, they can become moer tolerant + accepting of aspects of themselves

it is a universal need to be seen accurately + accepted— can’t be accepted if not seen

locus of evaluation (person-centered therapy

source of a person’s values

internal (self); external (others, esp persons or sources of authority)

organismic valuing process (person-centered therapy)

internal processes that guide people toward their self-interest

frame of reference (person-centered therapy)

locus of perspective on a person

internal (subjective experience of self); external (interpretation of a person from the outside)

person-centered therapy process: varieties of empathy

empathy is feeling the experience from the inside, not the outside

silent listening (active process, comforting); empathic understanding (basic form of empathy— encourages further exploration + expression); clarification (therapist articulates lenient ideas more clearly) affective empathy (focuses on client’s emotion or bodily experience); explorative empathy (tentative, probing— assist client in reflecting/exploring experiences); evocative empathy (use of rich, vivid language/imagery— heightens client emotional experience); inferential empathy (infers meaning that is not fully expressed or known); affirmative empathy (validates client’s experience of self); empathic challenge (gently offer an alternative perspective); conjectural empathy (interpretation— client naturally recognizes the personal truth); observational empathy (articulate meaning of nonverbal expressions); self-disclosure (use of personal ex’s to demonstrate understanding); first-person empathy (use of ‘i’ to convey empathic statement); improvisational empathy (novel, unique responses— therapist feels inspired to say right then)

empathy and emotion (person-centered therapy)

emotion is central to most problems (like EFT); emotion is a source of information + a guide to living authentically; emotion is adaptive (rather than interfering or maladaptive); enhancing emotional experience is associated w positive responses to PCT

role of the client (person-centered therapy)

identify + discuss meaningful concerns; determine the direction of the therapy; participate fully by expressing feelings & engaging w the therapist; choose to change (use their actualizing tendency towards goodness); tolerate not receiving advice, direction, or guidance from therapist; therapist doesn’t drive the convo, the client does