Psychodynamic Therapies

1. Psychodynamic Therapies

2. Freudian Psychoanalysis • Psychic determinism • Unconscious motivation • Early experiences • ★ The Instincts • libido • life instinct (Eros) • death instinct (Thanatos)

3. ★ The Structure • Id : Pleasure principle, primary process • Ego : Reality principle, secondary process • Superego : 1). Ego ideal • 2). Conscience

4. ★The psychosexual stages (Freud) vs. • psychosocial stages (Erikson, 1963) • 1). Oral stage : 0-1 yr. • Trust vs. Mistrust • 2). Anal stage : 1-3 yr. • Autonomy vs. Shame & Doubt • 3). Phallic stage : 4-5 yr. • Initiative vs. Guilt

5. 4). Latency stage : 6-11 yr. • Industry vs. Inferiority • 5). Genital stage : 12-20 yr. • Ego identity vs. Role confusion • 6). Intimacy vs. Isolation 20-24 yr. • 7). Generativity vs. Stagnation 25-65 yr. • 8). Ego Integrity vs. Despair 65 yr.

6. ★ Anxiety • 1). Reality anxiety : • real danger from the outside world • 2). Neurotic anxiety : • ego vs. id impulse • 3). Moral anxiety : • ego vs. standards of the conscience (superego)

7. ★ Mechanisms of Defense • the ego attempts to keep these conflicts and their discomfort from reaching consciousness by employing a variety of defense mechanisms, usually at an unconscious level • Repression 壓抑 (Suppression) • Denial 否定 • Reaction Formation 反向作用 • Projection 投射

8. Displacement 轉移 • Rationalization 合理化 • Sublimation 昇華 • Regression 退化 • Introjection 內射 • Identification 認同 • Compensation 補償 • Rituals & Undoing 儀式與消除

9. Goals of Psychoanalysis • 1). Intellectual and emotional insight into the underlying causes of the client’s problems • 2). Working through or fully exploring the implications of those insight • 3). Strengthening the ego’s control over the id and the superego

10. Psychoanalytic treatment techniques • Free association • The use of dreams • Analysis of everyday behavior • Analysis of resistance • Analysis of the transference • Making analytic interpretation

11. Variations on Classical Psychoanalysis • ★ Early Alternatives to Freudian Psychoanalysis • Individual Psychology (Alfred Adler) • Analytical Psychology (Carl Jung) • Will Therapy (Otto Rank) • Interpersonal Relations School (Harry Stack Sullivan)

12. ★ Contemporary Psychodynamic Approaches • Ego Psychology : (Anna Freud, Heinz Hartman, David Rappaport) • Object Relations Theory : (Melanie Klein, Otto Kernberg, David Winnicott, W. R. D. Fairbairn, & the “British School”) • Self Psychology : (Heinz Kohut) • Short-term Psychodynamic Approaches : (Wilhelm Stekel, Hans Strupp) • Postmodern Approaches : (Robert Stolorow, George Atwood)

13. Humanistic Therapies

14. The Humanistic Approach • Phenomenological approach • behavior of each human being at any given moment is determined primarily by the person’s unique perception of the world • Assumptions • 1). Human being are , thinking people who are individually responsible for what they do and fully capable of making choices about their behavior

15. 2). No one can understand another person’s behavior without perceiving the world through that person’s eyes • A reaction against Freud • Existentialist philosophers • Heidegger, Kierkeggard, Sartre…. • Gestalt school • North America • each person possesses a potential for growth

16. Kelly’s Personal Construct Theory • George Kelly(1955) • Fundamental assumption • human behavior is determined by personal constructs, or ways of anticipating the world • Like Scientists • the major goal of human beings is to validate their personal constructs, and thus to make sense of the world as they perceived it

17. Rogers’s Self Theory • Carl Rogers(1942, 1951,1961,1970) • The actualizing tendency • innate motive toward growth • Organismic vs. Self experiences • Incongruity • Conditions of worth • Distort reality in problematic ways

18. Maslow and Humanistic Psychology • Abraham Maslow(1954, 1962, 1971) • Self-Actualization • Need Hierarchy • Satisfaction of needs • Deficiency vs. growth motivation • Peak experiences

19. Perls and Gestalt Psychology • Fritz Perls(1947) • An instinct or tendency toward self-preservation and self-actualization • Ego as facilitating people’s growth and self-preservation by mediating conflicts between internal needs and environmental pressure • Awareness

20. Common Features in Humanistic Therapies • 1). Their clients’ lives can be understood only when viewed from the point of view of those clients (phenomenological world) • 2). View human beings not as instinct-driven creatures but as naturally good people who are able to make choices about their lives and determine their own destinies (self-actualization)

21. 3). View the therapeutic relationship as the primary vehicle • 4). Clients are regarded as equals • treat client as responsible individuals • 5). Emphasize the importance of experiencing and exploring emotions that are confusing or painful

22. Client-Centered Therapy • Carl Rogers • Nondirective Counseling • Conditions of worth force people to distort their real feeling, symptoms of disorder appear • “If … therapist (created what) … then … client (potential growth)…” • Growth-enhancing Relationship

23. Unconditional positive regard • Convey three messages • 1). Cares about the client • Nonpossessive caring • Willingness to listen is an important manifestation • patient, warm, interested • Don’t interrupt, change the subject, give other sign

24. 2). Accepts the client • ‘Unconditional’ : accept clients as they are without judging them • Separate a client’s worth as a person from the worth of the client’s behavior • 3). Trusts the client’s ability to change • ‘Positive’ : is reflected in the therapist’s trust in the client’s potential for growth and problem-solving

25. Empathy • Accurate empathy or empathic understanding • React to client’s external or internal frame of reference (Table 7.4 p.262) • Reflection, dual purpose • 1). Communicating the therapist’s desire for emotional understanding • 2). Making clients more aware of their own feelings • Distilling and “playing back” the client’s feeling

26. Congruence • Genuineness • The therapist’s feelings and actions should be congruent • Promote trust

27. Gestalt therapy • Fritz Perls • Aim at enhancing clients’ awareness • Assimilate or re-own the genuine aspects of self • Taking Responsibility • Experience • More active and dramatic than client-centered treatment

28. Focus on the Here and Now • “now=experience=awareness=reality” • Role-playing or part-taking • explore inner conflicts & experience the symptoms, interpersonal games, & psychological defenses • Frustrating the client • method of self exploration • help clients give up their maladaptive interpersonal roles & games • “hot seat”

29. Use of nonverbal cues • pay special attention to what clients say and what they do • The use of dreams • are seen as messages from the client to him- or herself

30. Other methods • Force clients to take responsibility for their feelings • convert indirect questions into direct statements • Topdog-underdog dialogue • Empty chair technique • Unmailed letter technique • Role played reversals

31. Other Humanistic Therapies • Logotherapy : Viktor Frankl • 1). Take responsibility for their feelings and actions • 2). Find meaning and purpose in their lives • Postmodern Approaches • postmodernism : constructionist, intersubjectivist, or narrative approaches • therapist-as-collaborator • vs. therapist-as-erpert