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Methods of Intervention. Psychodynamic Approach ‘The Past in the Present’ presented by Ali Harrison. Social Work Theory and Interventions. Psycho (of the mind) dynamic (movement) Theory for understanding what is going on in a case

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Methods of Intervention


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methods of intervention

Methods of Intervention

Psychodynamic Approach

‘The Past in the Present’

presented by Ali Harrison

social work theory and interventions
Social Work Theory and Interventions
  • Psycho (of the mind) dynamic (movement)
  • Theory for understanding what is going on in a case

(ie Ego development -Freud, or strength of Attachment- Bowlby)

  • Methods of Intervention which come from that understanding

(i.e working with ego defences or life story work, play therapy, inner child work, exploring subpersonalities etc)

slide3

Aim of Psychodynamic workfor the service user to become a fully functioning person who has more control over what they do, and is not driven by unresolved, unconscious past events.

focuses on the inner world of the client and that which is hidden from consciousness
Focuses on the inner world of the client and that which is hidden from consciousness

‘Our behaviour, including what we say do and think, is caused by experiences memories and needs many of which, we are not consciously aware’

Freud

slide5

Psychodynamic Approach is used ..retrospectively to understand current problems in parenting and behaviour,proactively to prevent future damage, to make sense of the clients internal world, to give insight and to build self confidence and ego strength

slide6

Deals with the emotional inside of the clientUnderstands current behaviour in terms of past experiencesProblems in key relationships in childhood can effect development and lead to current problems in relationships or behaviour

slide7

Psychodynamic WritersSigmund and AnnaFreud/Melanie Klein, Margaret Mahler, Donald Winnicott, John Bowlby, Michael RutterJuliet Mitchell Alice Miller Virgina Axaline Micheal JacobsEric BurnEric Erikson

slide8

InterventionUsing the relationship workers meet emotional and developmental needs of the client through support, nurturing, re-parenting, containment and insight

slide9

Making sense allows people to gain control of the meaning of their experiences, changing the meaning, brings about changes in behaviour. This creates a more robust, mature and independent personality which will be more socially competent and able to handle relationships more effectively

slide10

The emphases is on the clients capacity for adaptation and problem solving within the personality.This development takes place within the central framework of the relationship between the client and the worker

slide11

FreudPersonality Theoryunderstanding ego developmentand Ego defencesworking in the relationship with transference and countertransference

slide14
Idinstinctual drives of the child for survival, wants, urges,needsimpulses for sex and aggressionlargely unconscious
slide15

Super egoInternalised voice of authority (parent, teachers, school, church etc)‘shoulds’, ‘ought to’, rules, guilt, moral principles, teachingCan be underdeveloped or too rigid

slide16

EgoThe ‘thinking’ reality centre which mediates between the unconscious tension between the id and superego, causing anxiety and dis-equilibrium in the psyche

slide17

Tension in Egofrom internal and external pressures from others and societyResulting anxiety is dealt with by employing defence mechanisms(Anna Freud)

the work involves helping a client find a way through to their true feelings that the defences mask
The work involves helping a client find a way through to their true feelings that the defences mask
slide20

Ego Defence MechanismsSplitting, Idealisation and Projection (primitive defences) Reaction Formation (defences originating in toddlerhood))Denial and Repression Sublimation, Rationalisation and Displacement Regression and Fixation

ego defence mechanisms
Ego Defence Mechanisms

Splitting and Denial

(a primitive defence formed in early infancy described by Klein.)

Anxiety in infant caused by baby's merged identity with mother, who is sometimes present and soothing other times absent and frustrating.

Good breast/bad breast and eventual object consistency

slide22

Ego Defence MechanismsRepressionthreatening or painful thoughts and feelings are pushed out of conscious awareness(i.e. early sexual abuse)

slide23

Ego Defence MechanismsDisplacementanxiety is discharged by shifting energy to a safer or closer target(i.e. intimidation of a meek father at work, can cause acting out at home in domestic violence and /or child abuse)

slide24
Ego Defence MechanismsSublimationredirecting aggressive or sexual energy into creative or athletic activity
slide25

Ego Defence MechanismsRegression and FixationReverting to a form of behaviour the client has ‘outgrown’, to an earlier stage of development when the demands were not so great.(i.e. thumb sucking and smoking are ‘oral phase’ activities)Or failing to move on in developmental stages (ie anorexia)

slide26

Ego Defence MechanismsReaction Formationexaggerated feelings are expressed, opposite to what is truly being felt(ie someone being extremely off hand when what they feel is affection they cannot risk expressing)

slide27

Exercises on Ego DefencesDiscuss with your partner times when you employ any of the ego defences described, what effect do they have in your life?

slide28

Exercises in Ego DefencesThink about a client you are working with, what are the primary defences being used by this client, how is that impacting on their ability to function?Is it useful to challenge this ego defence or is ego strengthening work required?

slide29

Human Growth and Development Theory (understanding Regression and Fixation)Freud-Psychosexual developmentErikson -Lifespan Development PsychologyKlein, Mahler and Winnicott-Object RelationsBowlby- Attachment Theory

slide30

Linear and nested personality developmentFreud and Eriksonlinear developmentbirth--------------------------------death developmental stages

slide31

Freud’s Psychosexual Stagesmaturity dependant on successful completion of the one before, regression to earlier stages in times of stressOralAnalPhallic (Oedipal)LatencyGenital

slide32

Eric Erikson Life span development stages Whole life cycle as a series of tasks in which opposing tensions must be brought into some sort of equilibrium.Erikson places individual development in family, social and cultural context

slide35
Autonomy versus Shame and Guilt 1-6 yearsEstablishing autonomy and self control without a loss of self esteem
slide36

Initiative versus Guilt 6-10yearshaving the initiative to strive for goals which will fulfil personal potential and give a sense of purpose

slide37
Industry versus Inferiority 10-14 yearsCompetence - acquisition of skills needed for full and productive involvement in society
slide38
Identity versus Role Confusion 14-20 yearsIdentity- developing an integrated self consept and a coherent set of values and beliefs
slide39
Intimacy versus Isolation20-35 yearsIntimacy the establishment of close committed relationships with others
slide40
Generativity versus Stagnation 35-65 yearsGenerativity - the creation of a lasting contribution that will extend beyond ones own lifetime
slide41

Integrity versus Despair 65+Integrity- acceptance and satisfaction with ones life, and an understanding of its place as part of a wider humanity

slide42
References Joyce Lishman ‘A handbook of theory for Practice Teachers in Social Work’ Chapter 2and Micheal Jacobs’The Presenting Past’
slide43

Nested or layered developmental stagesinner infantinner child inner adolescentinner young adultetcReference Firman and Gila ‘Psychosynthesis Psychology of Spirit’

slide44

We carry the wounds of earlier stages which can unconsciously impact on relationships in the presenti.e issues of dependency and trust………Object Relations how the infant constructs his internal world

slide46

The ‘Maternal care system’ acts as the External Unifying Centre for the baby, being responsive, empathic, soothing, holding and stroking thereby ‘transforming his environment’

as the social worker acts for the chaotic and disorganised client
as the social worker acts for the chaotic and disorganised client
  • By providing empathic listening, responding appropriately to need, holding the client psychologically in times of distress, building self esteem and a sense of personal effectiveness and worth….
  • The relationship is the main tool of intervention in Psycho-dynamic casework
early childhood development revision
Early Childhood Development Revision
  • The Jurassic Park World of the new born baby…..
  • No boundaries
  • no concept of time
  • fragmented experiences
  • instinctual drives to survive
melanie klein
Melanie Klein
  • Breasts good and bad
margaret mahler
Margaret Mahler
  • 0-2 Autism
  • 2-6 months Symbiosis
  • 6-10 Hatching
  • 10-16 months Practising
  • 16-24 months Reappoachment
  • 24-36 Object Consistancy
donald and claire winnicott
Donald and Claire Winnicott
  • Transitional Love Object
  • The Holding environment
  • Direct work with Children
slide53

Bowlby and Ainsworth attachment Theory secure / insecure attachments and resilienceKlein Paranoid Schizoid and Depressive positionsMahler Separation and Individuation from the maternal care systemImportance of external unifying centre to process anxiety and need for transitional objects in process of separation

slide54
‘Strange Situation Test’ Mary Ainsworth building on the observational work of John BowlbyMaternal Deprivation and the Growth of Love
secure attachment
Secure attachment
  • Cry when mum leaves, happy and greet her on return,
  • use her as secure base from which to explore, returning occasionally for reassurance
  • Co-operative and generally free from anger
aviodant anxious or insecure attachment
Aviodant (anxious or insecure attachment)

rarely cry when mum leaves,

and avoid her when she comes back

dislike being held,

dislike being put down more

tend to be angry and

do not reach out in time of need

slide57

Ambivalent or Resistant attachmentbecome anxious even before mum leaves and are very upset when she goes outwhen she returns they show ambivalence by seeking contact, but resisting and squirming or kickingThey do little exploration and are hard to comfort

slide58

Disorganised or Disorientated AttachmentMain and Solomon 1986)Babies show contradictory behavioursGreet mum on return then turn away or approach her without lookingseem confused and afriadmost likely to happen when mumis insensitve, intrusive or abusive

slide59

Intergenerational Transmission of Attachment PatternsThe way a mother remembers her attachment to her parents seems to predict the way her children attach to her. Parents who can clearly, coherently and consistently describe their own early experiences (favourable or unfavourable) tend to have babies that become securely attached to them (Main and Cassidy 1985)If there are no memories, the mother may consider herself unlovable, and insensitive to the babies signals

slide60

A mother who was securely attached, or understands why she wasn’t can accurately recognise their babies attachment behaviour, respond encouragingly and help the baby make strong attachments to her (Brotherton 1990)

slide62

Understanding how past impacts on presentLife - lines and Genogramshow might you creatively work with these tools in the case study?…….. In a case you are currently working with?

slide64
Preparation for transitions, loss and attachment issues Life-story-work, crisis intervention, loss and bereavement stages
slide65

Life Story WorkLife Story WorkAuthor: Tony Ryan and Rodger Walker A practical guide to helping children understand their past. Life Story Work is an attempt to give back the past to children separated from their birth families. It can help children begin to accept their past and move forwards positively into the future, giving them a structured and understandable way of talking about themselves. It also enables adults working with children to listen to them and respect their views and wishes.The Child's Own Story: Life Story Work with Traumatised Children Richard Rose, Terry Philpot

slide66
Interventions for accessing issues from the past that are affecting the present…Psychodynamic Counselling
slide67

The ‘Triangle of Insight’ (Jacob 1991)The psychodynamic counselling approach uses the processes of the relationship between the worker and the service user. Within the relationship there is the experience of patterns, emotions and reactions of past relationships – this re-enactment of the past in the present can offer insight and understanding, and new ways of dealing with problems involving past, present and worker/service user relationshipsthe service-user experiences a caring relationship (i.e. the ‘good parent’) and this helps to work through painful experiences, whilst being held and contained

slide68
Transference and Counter-transference in the client worker relationshipHow does the client make me Feel and React?What's being Projected?
slide69

TRANSFERENCE can be positive or negative. The feelings a service user may have about a significant other person in their past are transferred into the present and onto the social worker

slide70

COUNTERTRANSFERENCEfeelings that are stirred up in the social worker in response to the service user’s behaviour or story .It is important that the worker involved is clear about what feelings are personal to them and what is not their own, if not social workers can end up responding to their counter-transferal feelings

slide71

Exercise in working with transferenceThink of a client or someone you know that brings up strong feelings in you. What transference or counter-transference reactions might be at play?What insight might this give you about the persons relationship with dependency, aggression, grief etc..

slide72

Creative ways of working PsychodynamicallyUnderstanding and working with internal conflict/parts transactional analysis,subpersonality work, inner child work, play therapy

slide78

We all have, with in us, an Inner Child, and yet for those of us who have been abused in childhood, that inner child is very often a hurt and frightened inner child. Inner Child work, and inner child therapy, are a means by which we can start to learn to love ourselves, feel safer within and reduce the nightmares in order to recover from childhood sexual abuse abuse, and other forms of childhood abuse. Inner Child therapy and inner-child work, is growing in popularity as the therapy is both less invasive of exactly what happened and helps survivors to understand their own behaviours. Inner Child work can also help us understand any disassociative tendencies that we may have as well, no matter where we are on the disassociative scale. Becoming a friend to your inner child can also help with self harm tendencies, comfort eating etc

slide80

Working with PartsInner Child ‘Healing the inner child’ Penny ParkesEgo States Eric BurnsTransactional AnalysisPlay Therapy ‘Dibs’ Virginia Axaline Using Puppets, symbols, letters, toys etcWorking with Subpersonalities John RowenEmpty Chair Perles

slide81

using transference and counter-transference played out in the social work relationshipWorking with Ego Defences

slide82

Assessment of Ego Strengthsa service user’s ego needs to be assessed in terms of its strength to tolerate self-scrutiny. What are the stresses on the functioning of the service user’s ego?Crisis Intervention- When the clients personality isoverwhelmed , use ego sustaining and supporting skills building self esteem If the clients ego defences are too strong ego use direct work to modifying and challenge defences (Coulshed and Orme 1998, Hollis 1964)

slide83

Limitations of using a Psychodynamic Approach for social workers by focusing on the inner world of the client it fits client back into status quo doesn’t change structural problemsSometimes behaviour needs changing quickly, Psychodynamic theory may give useful insights but it does not guarantee changing behaviourSocial workers may not have time, expertise or adequate supervision to use the methodology

slide84

Recent developments from Psychodynamic theoryPsycho-social approach (see article),working with inner and outer world of client (Hollis and Woods) casework is about people, their environment and the relationship between them CAT cognitive analytic therapy combining psychodynamic with cognitive approaches to provide brief interventions (Ryle and Kerr)