Introduction to Psychotherapy

1. Introduction to Psychotherapy

2. Introduction to psychotherapy Müge Alkan, PhD mugealkan8@hotmail.com, muge.alkan@ege.edu.tr 0 532 385 9299 6 October - Introduction 13 October – Key concepts of psychotherapy 20 October – Assessment and Therapeutic interventions 27 October –Introduction to Psychodynamic psychotherapy 3 November – Psychodynamic psychotherapy 10 November - Psychodynamic psychotherapy 17 November - Cognitive behavioral psychotherapy 24 November - Cognitive behavioral psychotherapy 1 December – Midterm and Group therapy 8 December - Group therapy 15 December -Interpersonal psychotherapy 22 December – Transactional analysis 29 December - Family therapy 5 January - General overview Midterm % 30 Presentation and paper % 30 Final exam % 40

3. Who are the patients? • Patients suffer from problems that interfere with their attaining life goals • Maximize potentials • Lead happy lives • Problems stem from unconscious conflicts • Presented as symptoms or personality traits and patterns • Either bothersome to patients or just interference with life of patients

4. Can patients be placed in diagnostic groups? • Yes, in many ways.. Differences in ego functioning • Normal-neurotic • Narcissistic • Borderline • Psychotic

5. Assessment of ego functioning • Reality testing • Sense of reality • Adaptation to reality • Impulse control and frustration tolerance • Object relations • Thought processes • Defensive functioning

6. Normal-neurotic group • Good ego functioning • Intact reality testing • Good interpersonal relations • Good adaptation to reality • Good impulse control • Stable identity • Affective stability • Mature defenses

7. Normal-neurotic group • Object relations; integrated, coherent and stable sense of self and objects. • Others are viewed as individuals of their having needs and desires of their own. • There may be some slippage in all areas, though rarely in reality testing. • All “normal“ people use numerous neurotic defenses, may have episodic difficulties.

8. Borderline group • Relative (may easily break) intact reality testing/thought processes/ interpersonal relations/adaptation to reality • Poor impulse control • Primitive ego defenses • Identity diffusion • Affective instability

9. Narcissistic group • Integrated but pathological identity based on grandiose self. • Labile self-esteem, sensitive to rejects, disappointments, failures.

10. Psychotic group • Poor ego functioning • Weak reality testing • Problems in almost all ego functions

11. Who are the therapists? • Psychiatrists, psychologists, clinical social workers, nurses, counselors. • Some –unconsciously- enter the field to solve their own problems.

12. What are some problems inherent in psychotherapy? • Psychotherapy is fascinating, intellectually stimulating when done well. • Can be exhausting, demanding, • Challenge of facing own problems and those of patients. • Projecting one’s problems onto patients • Taking own anger at them • Treating them as one wished to be treated • Using them for one’s own gratification • Boundary violations and sexual acting. • Can be isolating..

13. How important is one’s personal therapy or psychoanalysis? • Crucial.. • To understand one’s own problems and minimize their influence in the therapy process.

14. Which personal characteristics and experiences help to make a good therapist? • Some stability • Concern • Dedication • Integrity • Conscientiousness • Competence • High intelligence • Psychological mindedness • Empathy

15. Which personal characteristics and experiences help to make a good therapist? • Certain amount of suffering, depression and neurotic conflict. • A reflective, thoughtful person on the pessimistic, realistic side • Too much optimism is associated with denial. • Ability to listen • To be able to bear criticism and hostility without the need to retaliate • Intuition and creativity • Some life experience

16. How long does it take to become an effective psychotherapist? • Years..... • 10 years is mentioned.. • Psychotherapy is a continual and neverending learning. • Understanding oneself through personal analysis • Life experience • Learn theory and technique through reading • Supervision

17. Psychotherapy <--------------------------------------------------------------> Explorative therapies Supportive psychotherapy Insight oriented • Psychoanalysis • Analytically oriented psychotherapy • Dynamically oriented psychotherapy • Supportive psychotherapy • Cognitive psychotherapy

18. Psychoanalysis • 4-5 times a week on the couch • Free association • Resistance • Gradual process of unconscious becoming conscious • Context of transference • Neutral position

19. Psychoanalysis • Intense transference, in a regressed state • Feelings, thoughts (and defenses) originally directed toward important people in childhood • Actual and fantasized past as experienced by patient • Current relationships, past relationships

20. Issues in psychotherapy Stable therapeutic environment • Therapy is carried out in a stable, consistent and caring way in a safe, nonthreatening and nonintrusive environment. • Expectations of treatment should be clearly spelled out, discussed and always followed. • Good-enough mothering (Winnicott, 1958) • Holding environment (Winnicott, 1958) • Therapeutic alliance

21. Issues in psychotherapy Neutral therapist • Equal distance from id, ego and superego • Important in analytic therapies • Transference “blank screen” for displacement of feelings • Clarity of judgement and criticism

22. Issues in psychotherapy Flexible therapist • Need to oscillate methods with more troubled patients • Be ready for unpredictable and new challanges

23. Issues in psychotherapy Countertransference • Therapist’s conscious and unconscious reactions to the patient’s transference • Borderline patients: guilt, rescue fantasies, rage, hatred, helplessness, worthlessness, anxiety, terror. What is your response to such feelings ? !!!!! • Narcissistic patients: idealization, devaluation (acting as if the therapist does not exist) • Psychotic patients: passive, dependent and unable to change: helplessness may lead to taking over patient’s life.

24. Issues in psychotherapy Empathy • 1. Understanding • Building trust • “Empathy is not a cure itself” • 2. Explaining; gain insight

25. Issues in psychotherapy Action • Active in listening • More passive at first, but active later

26. What is the mechanism of change in psychotherapy? • Change via insight: (insight oriented interventions) “healthier patients” • Change via the relationship: (identification and internalization) “more troubled patients”

27. What are the basic strategies for psychotherapy? • Reexperiencing and working through the conflicts. • Strategy: maximize development and resolution of transference • Comment on resistance to the formation of transference • Help patient understand himself through transference with current and childhood relationships

28. What are the basic strategies for psychotherapy? Second strategy: • Focusing on present day interactions and relationships • Downplay transference Third strategy: • Supportive therapy • Supporting and enhancing ego functions • Blocking regression