Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 3. Psychodynamic Therapies

2. Freud & His Descendants Psychoanalysis Psychodynamic Id → Ego Intrapsychic →Interpersonal Defenses → Mastery, adaptation Biological → Social

3. A Sketch of Alfred Adler • 1870-1937 • MD from Vienna University • Began as ophthalmologist • Colleague & early disciple of Freud • Freud & Alder had falling out in 1911 • Developed Individual Psychology • Moved to New York in 1935 • Died of heart attack while on tour

4. Theory of Personality Striving for superiority • Core motivation • Can be expressed in many ways • Reaction to inferiority We create fictional goals for living & ideal self Examples: • Peace & happiness throughout the land • Honesty is the best policy

5. Theory of Personality (cont.) • Feelings of inferiority are stimuli for dealing more effectively with world • Style of life • Influenced by feelings of inferiority • Effected by ordinal position (birth order) • Prime mover is creative self

6. Theory of Psychopathology • Pathological personalities are those discouraged from attaining superiority in a socially constructive style • Emerge from family atmospheres of • competition • mistrust • neglect • domination • abuse • pampering

7. 4 Selfish Goals for Attaining Superiority • Attention seeking • Power seeking • Revenge taking • Declaring deficiency or defeat

8. Therapeutic Processes Consciousness Raising • Identifying basic mistakes • Bibliotherapy • Lifestyle analysis Contingency Control • Weaken effects of present contingencies • Creating new, healthy images • Catching oneself Choosing • Acting as if • Push-button technique

9. Therapeutic Content Intrapersonal Conflicts • Anxieties & defenses • Self-esteem • Responsibility Interpersonal Conflicts • Intimacy & sexuality • Communication • Hostility • Control

10. Therapeutic Content (cont.) Individuo-Social Conflicts • Adjustment versus transcendence • Impulse control Beyond Conflict to Fulfillment • Meaning of life • Ideal individual • Gemeinschaftsgefühl: social interest that contributes to welfare of humanity

11. Therapeutic Relationship Classical values • Love • Faith • Hope for human condition Teacher-therapist model

12. Practicalities of Adlerian Therapy • Flexible & innovative • Varying formats • Conjoint family sessions • Multiple-therapist approach • Advocate time-limited, active treatment • Workshops for parenting & couples • Pro bono work

13. Alternatives to Conventional Psychodynamic Therapy • Ego psychology • Object relations (Kernberg) • Self psychology (Kohut) • Supportive therapy • Brief psychodynamic therapy • Mentalization treatment

14. Ego Psychology/Analysis • Established by Hartmann, Kris, Loewenstein, Erikson, Rappaport • Assumes ego is separate from the id • Postulates ego has conflict-free spheres (autonomous ego) • Psychosocial (not psychosexual) stages • 8 crisis periods • Later stages as important as early stages

15. Object Relations • Relationships between self and others are the major organizing principle in people’s lives • Are mental representations of self & others (not interpersonal events) • Partly energized by instincts, esp aggression • Prominent therapists include Fairbain, Kernberg, & Kohut

16. Self Psychology • Heinz Kohut • Ideal identity is an autonomous self (self-esteem & self-confidence) • Deemphasized id impulses in early relationships • Ideal situation: children receive mirroring & interaction from loving parents • Famous case of The Two Analyses of Mr. Z

17. Stages of Self-Development(Margaret Mahler) • Normal autism (first few months of life) • Normal symbiosis • Lasts 2 – 7 months • Attachment • Symbiotic psychosis • Integration stage • Splitting • Introjection

18. Supportive Therapy • Aims: strengthen coping, encourage & reassure, prevent regression • Therapist reinforces patient’s adaptive behaviors to reduce intrapsychic conflicts • Mixture of both exploratory/expressive and supportive interventions

19. Brief Psychodynamic Therapy • Time limits (12 to 40 sessions) • Targeting a focal interpersonal problem • Setting modest, achievable goals • Adopting a more active/less neutral stance • Establishing a rapid working alliance • Employing transference interpretations quickly • Emphasizing process of termination

20. Mentalization-Based Therapy • Peter Fonagy and Anthony Bateman • Mentalization: Understanding our own perspective and others’ to improve interactions + relationships • Designed for BPD, but now applied to others • Strengthens relationships & emotional regulation to reduce symptoms • Aim: development of mentalizing

21. Effectiveness of Adlerian Therapy • Little controlled empirical research • Four studies on Adlerian therapy • Results slightly better then placebo • Found as effective as client-centered therapy & psychoanalytic therapy

22. Effectiveness of Object Relations Therapies • Transference-Focused Psychotherapy (TFP) vs. treatment as usual • Randomized clinical trials of TFP vs. CBT • Specific, structured psychotherapies are superior to unstructured treatments as usual • TFB & CBT of comparable effectiveness in treatment of borderline patients

23. Effectiveness of Supportive Therapy • Proven effective for depression compared to control • Combined treatment (meds + psychotherapy) more effective than either alone

24. Effectiveness of Brief Psychodynamic Therapies • Extensively studied in controlled research • Cognitive-behavioral researchers find more impressive results for CBT • Psychodynamic researchers find more impressive results for psychodynamic therapy (allegiance effect)

25. Effectiveness of Mentalization Treatments • More effective than TAU for borderline patients at termination and 18 months later • MBT effect persisted 5 years post-treatment • Studies demonstrate success and cost-effectiveness of MBT

26. Criticisms of Psychodynamic Therapies • From a Psychoanalytic Perspective (rejects half of the personality, naïve, gimmicky) • From a Cognitive-Behavioral Perspective (certain concepts are untestable, questionable theories) • From a Cultural Perspective (sexist, ignore social factors, too individualistic) • From an Integrative Perspective (lack of evidence and systemization)

27. Future Directions of Adlerian Therapy • Future impact will probably be more indirect then direct • Represented in cognitive and behavioral therapies • Principal direction for Adlerians is to go “on beyond Adler”

28. Future Directions of Psychodynamic Therapy • Increase attention to disturbances in infancy & early childhood • Focus will shift from neuroses to personality disorders • Determine which works best for which patient • Time-limited psychodynamic therapy

29. Key Terms character analysis collective unconscious compensation compulsive lifestyle conflict-free spheres creative self drive theory effect size ego analysis ego psychology fictional finalism Gemeinschaftsgefühl (social interest) holding environment ideal self individual psychology inferiority complex acting “as if” aggression instinct allegiance effect analytical psychology anamnesis archetypes attachment styles autonomous ego autonomous self basic mistakes bibliotherapy birth order/ordinal position catching oneself

30. Key Terms (cont.) introjection lifestyle analysis masculine protest meta-analysis mentalization mentalization-based treatment mirroring narcissistic personality normal autism normal symbiosis object object relations organ inferiority psychodynamic therapies psychosocial stages of development push-button technique self-interest self psychology social interest splitting striving for superiority style of life/lifestyle supportive therapy symbiotic psychosis supportive-expressive therapy therapeutic, or working, alliance transference-focused psychotherapy (TFP) treatment manuals

31. Recommended Websites • Anna Freud National Centre for Children and Families: www.annafreud.org/ • APA Division of Psychoanalysis: www.apadivisions.org/division-39 • International Association for Psychoanalytic Self Psychology (Kohut): www.iapsp.org/ • International Society of Transference-Focused Psychotherapy www.istfp.org/ • North American Society of Adlerian Psychology: www.alfredadler.org • Society of Analytical Psychology (Jung): www.jungian-analysis.org/