This is the Chapter 3 of the book The Individual (de Bruin, E., 1st Edition). Which is content for the exam of the Theory component of Module 4 (The Individual) of the University of Twente, in the Netherlands.

Chapter 3:

The psychodynamic tradition

Psychodynamic therapy: emphasis therapist’s ability use relationship client/ therapist to explore feelings/ relationship dilemmas --> helps clients achive inshight/ understanding how their problems developed/ how they are maintained, and transform this inshight into mature capacity to cope current/ future difficulties.

Origins of psychodynamic therapy: Freud

• Free association: patient lie relaxed position and say whatever comes to mind --> Freud reported many patients remembered unpleasant sexual experiences in childhood --> concluded root problems child’s own sexual (emotional energy) needs
• Features psychoanalysis/ psychodynamic approach:

• Difficulties client origin childhood
• Not consciously aware motive/ impulses actions
• Interpretation transference relationship

• Stages:

1. Oral Stage: [1^st year life] - Erotic pleasure from oral region (mouth)
2. Anal stage: [2 to 4 years] - Pleasure from defecating (anal region)
3. Phallic Stage: [5 to 8 years] – Immature genital longing, directed members opposite sex --> most significant effects later life, because forced repress sexual feeligns
4. Latency stage: child’s sexuality becomes less important

• Good enough mother: caretaker/ responds quickly enough without being over-protective/ smothering
• Importance of unconscious:

• Id: ultimate motives for our behaviour. Core drives: Eros (life/ love/ sex)/ Thanatos (death/ hate/ aggression)
• Ego: conscious/ rational part mind, makes decisions/ deals reality
• SuperEgo: “conscience”. Store-house rules/ taboos about should/ shouldn’t --> mainly internalisation of parents attitudes
• Defense mechanisms: developed by mind to protect ego from pressure from constant conflict id/ superego

• Transference: fundamental cornerstone psychodynamic theory/ practice --> form free association, Freud discovered patients view of him was not objective/ rational response to his actual behaviour --> patients perceived him lens/ filter constructed previous relationships

• Task of the therapist: behave differently from original characters in patients life --> client aware new different possibilities around relationships with others
• Aim therapist: where id was, let ego be

• Catharsis: when person truly understands issue, experience release of emotional tension associated with repressed/ buried memories of the issue
• Mechanisms of defence:

• Repression (motivated forgetting): removal from awareness any threatening impulse/ idea/ memory
• Denial (motivated negation): blocking external events/ info from awareness
• Projection (displacement outwards): attribute other own unacceptable desires/ thoughts
• Displacement (redirection of impulses): channelling impulses to different target
• Reaction formation (asserting the opposite): defending against unacceptable impulses by turning them into the opposite
• Sublimination (finding an acceptable substitute): transforming impulses into more socially acceptable form of behaviour
• Regression (developmental retreat): response internal feelings triggered by external threat, by reverting behaviour form earlier stage of development

• Techniques/ strategies used in psychodynamic/ psychoanalytic therapy:

1. Therapist self-awareness: use feelings/ fantasies/ action tendencies therapist experience in response to client --> valuable information everyday way of being with others of client
2. Interpretation: important to consider timing/ correctness of interpretation/ understandability interpretation
3. Expression/ projective technique: as means of exploring past/ present circumstances

Psychodynamic tradition:

• Early pioneers:

• Jungian approach (analytic psychology): diverged sexual development of Freud

• Collective unconscious:

• Archetypes: symbolic representations universal facets human experience
• Shadow: aspects of self denied to conscious awareness

• Individualisation: human development --> lifelong quest for fulfilment.

• Object relations (Melanie Klein): relationship-oriented therapy, direct observations behaviour babies and mothers-infant interaction

• Objects: can be the mother. Composed internalised image/ memory of person, with all the parts of that person
• Part-object: breast --> good/ bad object, depending if baby needs are being met
• Paranoid-schizoid period: baby feels little security world because recovering from trauma birth
• Depressive reaction: deep sense disappointment/ anger when realise loved person can be good and bad
• Self-centeredness: grandiose/ narcissistic patterns of relating to others --> underlying cause problems adult life

• Projective identification: when person whom feelings/ impulses are being projected is manipulated into believing that they have these feelings/ impulses

• Dependency: actively seeking assistance from other --> need of assistance motivates by projective fantasy (sense of self-in-relationship originating in disturbed object relations in early childhood)

• The real relationship: beyond transference and countertransference

• Inner worlds: closed systems, psychoanalysis aims to break through, to allow patient to become accessible to the influence of outer reality
• Countertransference: reaction to the client or client's transference

• American post-Freudian tradition:

• Self-theory: set of perceptions individual has for himself/ relationships/ other aspects of life
• Narcissism: other people experienced as “self-objects”, extensions of the self
• Optimal frustration: therapist can never achieve complete empathy and acceptance (same for parents)

• European tradition:

• Jacques Lacan: consciousness in apprehending the world categorized into 3 models: imaginary/ symbolic/ real (non-linguistic realms).

• Lacanian theory: limits of understanding based on language

• Attachment theory: therapist make use of therapist relationship to become an internalized “secure base” for client

• John Bowlby: humans basic need form of attachment, will not function well unless such attachment is available
• Internal working model: internal representation of social world --> main attachment figures/ themselves/ links between these elements
• Strange situation: infants systematically observed while mother leaves/ returns

• Secure: missing parent --> seeks contact when she returns, and then back to play normally
• Insecure-avoidant: few signs missing parent, avoid her in reunion
• Insecure-ambivalent: distressed/ angry parent leaves, cannot settled she returns
• Insecure-disoriented

• Adult Attachment interview: means assessing patterns of attachment later in life --> aim to surprise the unconscious, then person will find themselves saying things beyond conscious control

• Secure/autonomous: story coherent/ consistent/ objective
• Dismissive: not coherent, dismissive of attachment-related experiences and relationships
• Preoccupied: incoherent, angry, preoccupied with past experiences
• Unresolves/disorganised: similar dismissive + preoccupied, but include long silences or erroneous statements (talking as though someone who died still alive)

• Metacognitive monitoring: people step back form situation and reflect what they are saying --> characteristic securely attached
• Mentalisation: capacity to learn how to reflect on experience
• Reflective function: ability think about/ talk about painful past events --> helps protect themselves from raw emotional impact without use defences

• The concept of the “third”: authoritative figures from earlier periods

• Triangular relationship: transference interpretation

Brief psychodynamic therapy:

Commences with assessment interview (explores readiness/ capability of client to engage productively in therapy)

Transference neurosis: strong transference reaction, encouraged in long-term analysis, allow evidence of childhood relationship patterns to emerge

• Psychodynamic-interpersonal therapy: meaning and role of language. Core approach is that people need to be able to talk about their feelings --> dissolves loneliness associated with holding feelings to oneself

1. Start identification core problem that underpins depression
2. This is explored as to enable client to mentalise/ reflect productively on their experience, then client helped to consider other ways of feeling/ thinking in situation that evoke depression
3. Written statement by therapist, summarising work together, preventing future relapse

• Other forms of brief psychodynamic therapy:

• Intensive short-term dynamic psychotherapy: unlocking the unconscious by challenging ways in which client defend himself against difficult emotions
• Affect phobia therapy: attention to the ways repressed emotions are expressed in non-verbal behaviour/ body awareness