Psychodynamic Psychotherapy

History of Psychodynamic Approach

• The psychodynamic approach came first historically — for the first half of the 1900s, the psychodynamic approach and psychotherapy were practically synonymous

• Many therapies that arose later were reactions against the psychodynamic approach (humanistic, behavioral, cognitive)

• Many of the pioneers of non-psychodynamic theories were trained in psychodynamic programs but pivoted into something different later

Psychotherapy in present times

• despite its decline, psychotherapy remains relevant and widely used

• It influences clinical psychology through adaptations of its traditional methods into novel approaches that better suit contemporary culture

Sigmund Freud

pioneer of the psychodynamic approach to clinical psychology

Psychodynamic psychotherapy

An approach to psychotherapy deriving fro the theories of Sigmund Freud

• includes all efforts of revision and expansion and includes Freud’s original approach to therapy, known classically as psychoanalysis

The term psychoanalysis

• term was replaced by other terms at various points in the evolution of his theory by others — in this class we will use psychodynamic psychotherapy to represent them all

Primary goal of psychodynamic psychotherapy

To make the unconscious conscious

• use of insight - looking inside oneself and noticing something that had previously gone unseen

• Once we become aware of unconscious processes we can make efforts to control them deliberately rather than controlling us

Unconscious

Mental activity occurring outside of our awareness

• Freud’s most important and enduring contributions to clinical psychology

Freud and his followers on the unconscious

• the unconscious exists and exerts a powerful influence on our day to day and minute to minute lives

• Unconscious processes underlie all forms of psychopathology that clinical psychologists treat

How do psychodynamic psychotherapists access the unconscious ?

Through inference, deduction, and conjecture (not empirical or factual)

Free association

Technique in which the psychodynamic psychotherapist ask clients to say whatever comes to mind without censoring themselves at all

• client’s task is to verbalize any thought that occurs (hard task)

• The idea is that the words of people in such states of mind can be revealing of their innermost thoughts and feelings

Freudian Slips

• Verbal or behavioral mistakes determined by unconscious motivations

• According to psychodynamic psychotherapists

  • All behavior is determined and there is no such thing as a mistake, accident, or slip

Dreams

Psychodynamic psychotherapists believe that our dreams communicate unconscious material

Dream work

• when we sleep our minds convert latent content (raw thoughts and feelings of the unconscious) into manifest content (the actual plot of the dream as we remember it)

How do psychodynamic psychotherapists analyze dreams ?

By attempting to uncover the unconscious meaning behind them — essentially undoing the dream work

• dream interpretations are inferential rather than factual

Resistance

Client behavior that impedes discussion or conscious awareness of selected topics or emotions

• According to psychodynamic psychotherapists clients feel anxious when thoughts and feelings are being laid bare or too extensively or too quickly

  • This anxiety motivates them to create distractions or obstacles that impeded the exploration of those thoughts/feelings

Defense Mechanisms

• Techniques used by the ego to manage conflict between the id and the superego

• Psychodynamic psychotherapists believe that identifying clients’ unconscious defense mechanisms and bringing tech into the clients awareness can improve their quality of life

Freud’s Structural Model of the Mind

Id, Ego, Superego

• interaction of these 3 forces occur largely outside of awareness

Id

• Part of our mind that generates all the pleasure seeking, selfish, indulgent, and animalistic impulses

• Seeks immediate satisfaction of its wishes

• Freud believed the id was inborn

Superego

• Part of the mind that establishes rules, restrictions, and prohibitions

• Tells us what we should do — Uses guilt to discourage overindulgence in immediate pleasure

• Directly opposes the id

• Stands as an internalization of rules and morals taught to us

• Freud believes it became part of the mind through authority figures

Id vs superego

According to Freud our unconscious mental processes involve a constant battle between an id demanding instant gratification and a superego demanding constant restraint

Ego

A mediator between the id and superego

• faces 2 challenges

  • Partially satisfying both of these forces and eating the demands of reality

Types of defense mechanisms

Repression, projection, reaction formation, displacement, sublimation

Repression

• When the id has an impulse and the superego rejects it, the ego can repress conscious awareness of the impulse and the id/superego conflict around it

• The ego takes the impulse and the internal conflict and “sweeps them under the rug”

• Most similar to denial which usually refers to events that happen to us rather than impulses that come from within us

Projection

• When the id has an impulse and the superego rejects in, the ego can project the id impulse onto others around us

• We convince ourselves that the unacceptable impulse belongs to someone else and not ourselves

• We attribute out more objectionable qualities to others and cast ourselves as possible recipients of other’s unacceptable behavior

Reaction Formation

• When the id has an impulse and the superego rejects it, the ego can form a reaction against the is impulse — essentially do the exact opposite

• Ex: when the id urges us to do something selfish we do something selfless instead

Displacement

• When the id has an impulse and the superego rejects it, the ego can displace the id impulse to a safer target

• Rather than aiming the id’s desired action to whom or what it wants, we redirect the impulse towards another person or object to minimize repercussions

• “Kicking the dog”

Sublimation

• When the id has an impulse and the superego rejects its the ego can sublimate it —— this is to redirect it in such a. Way that the resulting behavior benefits others

• Allows the id to do what it wants

Maturity of defense mechanisms

Some psychodynamic psychotherapists believe that some defense mechanisms are more mature/healthier than others

• denial and repression — immature

• Sublimation — mature

Id translated to “it”

The part of you that is animalistic rather than human

Superego translated to “over-me”

An internalization of the rules and demands that came from authority figures (especially parents)

Ego translated to “me”

The person negotiating between the demands for instant pleasure and the demands to follow rules

Translations of Freudian terms

Characterize the whole person instead of an abstract component of the mind

Transference

• Client’s tendency to form relationships with therapists in which they unconsciously and unrealistically expect the therapist to behave like important people from the client’s past

• May be the most essential means for the psychodynamic therapist to access a client’s unconscious material

Countertransference

• transference by therapists onto clients

• Psychodynamic psychotherapists generally strive to minimize it because it involves a reaction to the client that is unconsciously distorted by the therapist’s own personal experiences

• This is one reason why many psychodynamic training programs require trainees to be clients in psychodynamic psychotherapy —- so they’re aware of their own unconscious issues

Freud’s psychosexual stages

oral, anal, phallic, latency, and genital

• among the most widely known aspects of his theory

Fixation

Unsuccessful resolution of the psychological tasks of a particular developmental stage

• a child may become stuck at any stage which can cause problems related to that stage for many years

• Fixation most often occurs when parents do “too much” or “too little” in response yo the child’s needs at a certain developmental point

Oral stage

First of the psychosexual stages and the stage from which dependency issues may emerge

• occurs roughly during the first year and a half of a child’s life

• During this time the child experiences pleasurable sensations through the mouth — feeding (breast or bottle) is the focal issue

• Children whose parents mismanage this stage ay display blatantly “oral” behaviors in life

  • Smoking, overeating, drinking, nail biting, etc

Oral Stage — dependency

• primary issue of the oral state is dependency

• Overindulgence - children learn that depending on others always work out and others solely exists to meet their needs; children become overly trusting, naive and unrealistically optimistic as adults

• under-indulgence (not responsive) - child learns to never depend on others and others have no interest in helping you; children may be mistrusting, suspicious, and unrealistically pessimistic

Anal stage

Second stage of psychosexual development in which issues of control may emerge

• age: 1.5 - 3 years old

• During this stage children are learning to control themselves — main issue is toilet training

• Adults (especially parents) place demands on children regarding their speech and behavior

Anal Stage — Control

primary issue of this stage is control

• too demanding — children can be over inserted with getting everything just right; children often grow ti become adults who think obsessively or behave compulsively in order to stay in control

• too lenient — children can become lax about organization; can continue into adulthood (messy desk, sloppy schedules, etc)

Phallic Stage

Third psychosexual stage which issues of self worth may emerge

• age: 3-6 years old

• Most controversial stage

• During this time children want to have a special/close relationship with parents — parents response shapes the child’s view of themselves

Phallic Stage - self worth

Self worth is the key consequence of this stage

• too positive — overinflated child’s sense of self; children grow into adults who have unrealistically high opinions of themselves; strike others as egotistical

• Rejection — wounded self worth; children may grow to devalue themselves and become overly insecure and self doubting