Lecture 3 psychotherapy

hysteria

unexplained physical symptoms, especially in women

Applied psychoanalysis

Adresses broader domain of development of normal personality funcitoning

Psychodynamic or psychoanalytic psychotherapy refers to a range of treatments based on psychoanlaytic concepts and methods that involve … frequent meetings and may be considerably … than psychoanalysis.

less, briefer

Psychic determinism

all thoughts, emotions and behaviours are caused by prior (often unconscious) mental processes

Drive theory

Our lives are shaped by 2 fundamental biological drivers: the life instinct (eros) and death instinct (thanatos), these drivers create internal tension that seeks expression

What is the other word for life instinct and what is the definition of life instinct?

Eros, drivers towards survival growth, reproduction and pleasure

What is the other word for death instinct and what is the definition

Thanatos, drives toward agression, self-destruction and a return to a lifeless state

Drive-defense model

Freud’s theory that people seek to gratify their wishes (drives) while simultaneously using mental defenses (like repression) to keep unacceptable or anxiety-provoking wishes out of conscious awareness

Freud’s topographical model of the mind (3 components)

Conscious

preconscious

Unconscious

Freuds structural model of the mind (3 components)

ID (biological component)

Superego (social component)

Ego (psychological component)

Match the following 2 terms to ID or to Ego or to Superego: reality principle, pleasure principle

ID: pleasure principle

Ego: reality principle

What does de reality principle do?

Seeks to satisfy ID’s desires in realistic and socially appropriate ways

What does the pleasure principle do?

Seeks immediate gratification

What do defense mechanisms do according to freud?

When the ego struggle to balance demands of the id and superego it relies on defense mechanisms

Repression

Unconscious blocking/forgetting of distressing thoughts, memories or feelings

Denial

refusing to accept reality or facts to avoid emotional pain or distressing consequences, often used to protect against anxiety, guilt or loss

Projection

Attributing one’s own unacceptable thoughts, feelings, or motives onto another person

A way to externalize internal conflict by perceving it in others instead of oneself

Displacement

Source of the impulse is externalized

Intellectualization

Attempt to distance oneself from feeling

Isolation of affect

Seperate ideas from feelings, disturbing things but no emotions

Reaction formation

Person expresses the opposite of the underlying unconscious reaction in order to gain as much distance as possible from the unacceptable reaction

Undoing

cancel or nullify a previous action or thought by doing or thinking the opposite

Regression

revert to an earlier mode of functioning as a way of avoiding certain feelings or anxieties

Splitting

motivated tendency to see things in black and white, all good or all bad

Rationalization

Fooling oneself by giving an apparently socially reasonable explanation that conceals one’s underlying unacceptable motive or painful feeling

Sublimation

(healthiest defense) rechanneling of unacceptable sexual, aggressive or other wishes into socially useful, acceptable adaptive ends

fixation (freuds theory of psychosexual dev)

When needs are under-or over gratified it can lead to a particular characteristic of a stage staying longer than its appropriate

Regression (freuds theory of psychosexual development)

The birth of a sibling leaving the older sibling feeling unloved can lead to going back to old behaviour

Opening phase psychoanalytic therapy

establishing the therapeutic relationship and clinical assessment (working alliance)

Analytic neutrality

The sense of indifference to the patient but in the sense of not taking sides in the patient’s conflicts

Free association (psychoanalytic technique)

Verbalize thoughts, feelings and memories without censorship, its aim is to bring unconscious material into awareness that is often linked to symptoms or relational patterns

Adressing resistance (psychoanalytic technique)

Seen as a sign that unconscious material is close to awareness, therapist helps identify and work through defense mechanisms that are blocking progress

Transference interpretation (psychoanalytic technique)

Patient projects feelings/expectations from early relationships onto the therapists, therapist helps the patient recognize and explore these projections to gain insight and resolve past conflicts

Dream analaysis (psychoanalytic technique)

Therapist and patient explore symbolic meanings of dream content to uncover repressed desires and conflicts

Interpretation

interpreation of patients behaviour and experience, particularly at unconscious aspects

YAVIS-syndrome, what does it stand for and why is it problematic?

Young, affluent, verbal, intelligent, succesful. Mental health professionals often unintentionally favor clients like these.

Core conflictual relationship theme (CCRT)

central pattern or theme in relationship with others, reflecting underlying conflicts

What are the 3 components of CCRT

Wish

response from others

response from self

Wish CCRT

Desires or motivations in relationships

REsponse from other

perceived or expected reaction to wish

Response from self

perceived or expected reaction to response from other

What are the main 3 therapeutic interventions in intensive short-term dynamic psychotherapy (ISTDP)

• pressure

• challenge

• head-on collision

What is the treatment goal of ISTDP

experience and process unconscious attachment-trauma-related emotions

Pressure (ISTDP)

encourage patient to recognize and focus on avoided emotions

Challenge (ISTDP)

Point out defense patient is using and help overcome it

Head-on collision (ISTDP)

Attack on the entire defensive structure of patient

explain consequences of maintaining defensive barriers, emphasizes patien’ts role in either faciliatating or hindering therapeutic process

Supportive-expressive psychotherapy (SEP)

Combines elements of support and exploration and aims to uncover unconscious conflict

3 types of interventions (SEP)

• supportive

• expressive

• terminating

4 expressive interventions (SEP)

• exploration

• confrontation

• classification

• interpretation

Exploration SEP

identifying relationship themes (CCRT)

Confrontation SEP

highlighting defenses

Classification SEP

restating what patient already (unconsciously) knows

Interpretation

linking different elements of CCRT (also of past and present)

What does Affect Phobia Therapy (APT) tie psychopathology to?

Fears about feelings that are deemed consciously objectionable (affect phobias).

What are the three steps in APT's restructuring process?

Systematic activation of feared affect (exposure), inhibiting habitual defenses (response prevention), and providing support to regulate anxiety (habituation).

Which therapy uses emotional experience as a change catalyst?

Accelerated Experiential Dynamic Psychotherapy (AEDP).

In AEDP, what are "green-signal affects"?

Positive emotions that result from a favorable experience and temper anxiety.

In AEDP, what are "red-signal affects"?

Affects that mobilize defenses and create barriers to emotional processing.

What are the three tasks of AEDP?

Relational techniques, Restructuring techniques, and Experiential-affective techniques.

What do relational dynamic approaches primarily focus on?

Exploring internal experiences and representations of self in relation to objects and interpersonal relational modes.

How does Supportive-Expressive Psychotherapy (SEP) view symptoms?

As efforts to solve interpersonal problems in maladaptive ways.

What does Dynamic Interpersonal Therapy (DIT) aim to promote awareness of?

An unconscious core relational pattern that is linked to clinical symptoms.

What does IPAF stand for in DIT?

Interpersonal-affective focus.

What concept in Time-Limited Dynamic Psychotherapy (TLDP) characterizes a patient's basic relational suppositions?

The Clinical Maladaptive Pattern (CMP).

What are the original categories of the CMP in TLDP?

Acts of self, expectations of others' reactions, perceived acts of others toward self, and acts of self toward self.

What is a key step in recognizing diversity in psychotherapy regarding history?

Recognize historical trauma and cultural context.

Through what lens should a therapist understand language use and emotional expression?

A contextual lens.

What can influence the therapy dyad, process, and outcome?

Both the patient's and psychotherapist's experiences of oppression and stereotypes of the other.

Is there more empirical research on Brief Dynamic Psychotherapy (BDP) or psychoanalysis?

BDP.

How many RCTs on BDP were found in Lillengren's 2023 study?

229 RCTs.

How efficacious is BDP compared to other treatments?

More efficacious than inactive controls, and generally no difference compared with active treatments.

What is the "Dodo bird verdict"?

The finding that outcomes for different therapies are surprisingly equivalent ("everybody has won, and all must have prizes").

Aside from alleviating symptoms, what is a broader benefit of psychodynamic therapy?

It develops inner capacities and resources for a richer life, such as increased empathy and ability to self-soothe.

According to Driessen et al. (2016), for which patients is STPP more efficacious than CBT?

Moderately depressed patients with low baseline anxiety, and severely depressed patients on antidepressants with an episode longer than one year.

According to Driessen et al. (2016), when is CBT more efficacious than STPP?

For severely depressed patients who also took antidepressants and had a depressive episode shorter than one year.

What causes a lack of moderator findings in conventional meta-analyses?

Limited sample sizes in RCTs and only having access to study-level information.

What is the benefit of Individual Participant Data (IPD) meta-analyses?

They combine data from all trials to get larger sample sizes and look at the patient-level.

In the IPD-MA comparing STPP vs. Antidepressant Medications (ADM), which was more efficacious for patients with higher baseline depression severity?

Antidepressant medications (ADM).