Psychodynamic Family Therapy

1. Psychodynamic Family Therapy • EPSY 6393 -- Dr. Sparrow 1

2. Original Concepts • Basis of unconscious drives were sexual and aggressive; therapy was reductionistic • Clients labored under intrapsychic conflicts stemming from childhood, having to do with whether they could express their impulses. • Anxiety, expectation of punishment • Depression, calamity has already happened 2

3. Original Concepts • Family was the source of the problem, but did not sustain it in the present. Relationship with analyst was sufficient to reawaken all of the conflict associated with the original parents. The focus was the resolution of transference. • Therapy was retrospective • Therapy was individual, and not interpersonal beyond the analyst-patient relationships 3

4. Treatment • Uncovering and interpreting unconscious impulses and defenses against them. • Either finding a way to relax defenses against the expression of healthy impulses, or • Strengthening defenses against excessive gratification 4

5. Modern Developments • Self Psychology -- Kohut • Every human being longs to be appreciated • If our desire is frustrated at an early age, the way we go about gaining appreciation is tied to that period of our lives. 5

6. Modern Developments • Object Relations -- Klein • Bridge between individual theory and family theory • Internal “objects,” that is, images of self and others forged in early fantasy and experiences, and internalized. • The ego was not so much driven by impulses as motivated to find an outside match for the internal object • Love, and the desire to connect, was more important than instincts 6

7. Attachment theory -- Spitz and Bowlby • A child has a profound need for a stable and constant object • If frustrated in their search, then children will later suffer anacliticdepression, and an extreme sensitivity to a lack of support • This sensitivity gives rise to enmeshed and disengaged relationships (Bowen) 7

8. Separation-IndividuationMahler, Winnicott • After the child experiences a period of total unconscious immersion in, and identification with the mother, she begins a process of separation (differentiation) at about 6 mos. • Average expectable environment facilitates individuation • “Good enough” mother • Devotes herself to child sufficiently to establish security • Shifts to self interest as child needs her less • Transitional object as a symbol of the mother 8

9. Separation-Individuationcontinued • Self-objects are not quite separate in the child’s experience, so nurturance is taken into the self more easily. Whatever a mother does or says translates into an experience of self love. • Two qualities of parenting are thought to be essential to a secure self: • Mirroring = Understanding + Acceptance • Idealization • Kohut’s primary narcissism and formation of the Narcissistic Personality Disorder • Grandiosity normally gives way to self esteem and idealization forms the basis for personal values • Rage when frustrated 9

10. Interpersonal Psychiatry --Sullivan • warm nurturing mother creates good feelings • frustrating mother leads to child disociating in order to avoid anxiety • good me • bad me • not me 10

11. Interpersonal Psychiatry --Sullivan • Parataxic distortions • the perception of others, based not on actual experience with the individual but from a projected fantasy personality • “Falling in love” can create the atmosphere where parataxic distortion is primarily involved in the perception of the object of affection. 11

12. Marriage • A blur of reality and fantasy • We fall for someone who is a substitute for our unattained ideals. • We want out mates to conform to an internalized unrealistic model of fulfillment. • Conscious and unconscious contracts • Projective identification -- an interactional process in which a person behaves according to our projections of anxiety-arousing aspects of ourselves. 12

13. Marriage • The individual and marital “shadow” -- the repressed aspects of each person which are kept repressed by tacit understandings (Jung, Sparrow) • Original attraction may be to someone who will permit the repression of the individual shadow. • Example: A woman represses her urge to express herself openly for fear of being unlovable, so she become attracted to a man who is willing to “wear the pants” in the family, who is repressing his own shadow of tenderness and vulnerability. • Problems emerge in midlife when repressed issues surface. I want to “find my own voice,” so I am no longer attracted to my husband’s assertiveness. 13

14. More concepts • Delineations -- when parents project their fantasies upon their children, rather than letting them be themselves. • The presenting problem (symptom bearer) is often symbolic of the parent’s own denied emotion or wish. • Invisible loyalties -- when a child take on a symptom to unite their parents in concern. 14

15. Goals of Psychoanalytic Family Therapy • To free family members from the power of unconscious constraints so they can relate in a healthy way. • Separation-individuation or differentiation (similar to Bowen’s concept) • To let go of one another in a way that frees the other to become more independent 15

16. Conditions for Change • Insight is necessary but not sufficient • Insights have to be “worked through” to the point where new ways of interacting emerge. • The therapist has to interrupt to get couples to get in touch with what they are feeling and avoiding (similar to Bowen’s process questions). 16

17. Therapeutic Interventions • Listening • Empathy • Interpretations • Analytic Neutrality 17

18. What the Therapist is Looking For • Emotion to signal the presence of unconscious conflict • Internal experience and its history • How partner triggers the experience • How therapist plays into the interaction (transference) 18

19. Scenario One • Couple comes for counseling. Presenting problem is that husband was caught text messaging an old girlfriend “Happy Birthday-Juan.” Wife has been jealous and insecure, and now she knows without a doubt that he is, or will soon, cheat on her. He angrily claims that he has been loyal, but that she is always controlling him, and he’s not free to show respect and friendship toward men or women he has known. He insists on having more freedom, while she insists that he cut off his relationships with old girlfriends and men who are “bad influences.” 19

20. Scenario Two • Couple comes for counseling. They have been married for six years, and have three young children. Mom works and juggles parenting duties with a bank job. Dad is a coach, and is away at night a lot during football and basketball season. Kids are doing well at school, but parents have begun arguing over little things. Every time they talk, they get into an argument, and lately have been using a lot of foul language. He thinks she needs to quit work because she doesn’t have any time for him, and she thinks he needs to spend more time at home with the kids. 20