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Psychodynamic Approaches

Psychodynamic Approaches

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Psychodynamic Approaches

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  1. Psychodynamic Approaches Object Relations Theory

  2. Psychodynamic Approaches • Neo-Freudian Tradition • Alfred Adler, Wilhelm Reich, Carl Jung, Otto Rank, and Sullivan • Ego-Analytic Tradition • Self-Psychology andObject Relations Theories • Originated with Anna Freud and Melanie Klein’s observation of infants in the 1930’sd 1940’s • Winicott, Erikson, Mahler, Fairbarn

  3. Neo-Freudian Tradition • Objected to Freud’s emphasis oninstinct theory, infantile sexualityand his view of theOedipus complex • More concerned than Freud with: • The nature of conscious experience: cognition and will– human’s ability to choose • Psychological health and normal development • Socio-cultural determinants of behavior

  4. Ego-Analytic Tradition • Based on work with young children • Interested in understanding severely disturbed adults (psychosis, narcissistic, borderline disorders) • Emphasizes • Ego’s functioning in adaptation, coping, and mastery • Interpersonal experiences

  5. Psychodynamic Approaches • Agree with Freud in • The importance of early life • The importance of the unconscious • The role of defense mechanisms • The use of transference, counter transference, interpretation, insight, resistance and catharsis in therapy • Abandon the couch and pay attention to the therapeutic alliance based on a real therapist – client relationship in the here and now

  6. Object Relations Theory • Concerned with the formation of the self before the Oedipal stage • Major drive of humans is thedrive to relate • Ego’s role is toseek relationshipsrather than to control an unruly ID (Fairbarn) • The self is formed in the context ofearly relationships

  7. Objects • Object Relations • Interpersonal relations • External Objects • Significant persons that are the target of a person’s feelings, desires, needs • Internal Objects • Internalized images of the external person, which may differ from the real person

  8. Inner and Outer World of Objects

  9. Psychological Function of Infants • Splitting (normal and defensive process) • Keeping apart contradictory feelings about others- good mother vs. frustrating mother • Internalization of “Others”– “Experiences” • An aspect of the external world* is introjected and becomes part of the child’s internal world • *Emotional experiences & characteristics of relationships • Internal objects carry out functions performed by the external object: trust, self-worth, condemnation. • Lead to the formation of self-representations

  10. Self-Representations • How the infant perceives him/herself in relation to significant others in their lives • Initially, external objects and self are not differentiated • Pleasurable feelings are internalized as “good me” • Frustration is internalized as “bad me” which is painful – and often repressed • Self-representations and internalized objects shape how one relates to oneself and to others

  11. Development of the Self • Crucial early development task : move from • a state offusion and dependence on care-giver to • a state ofincreased independence anddifferentiation (attachment-individuation processes) • Adequate, positive relations in the early stages lead to good feelings about self • Negative relations and neglect leave the child feeling empty, deficient, frustrated

  12. Development of the Self - Mahler • Normal Autism First 3 to 4 weeks • Objectless period of primary narcissism • Responses based on physiological tensions • Normal Symbiosis 2-3 to 8 months • Dim awareness of mother as separate • Differentiates pleasurable (bliss, reaching out) from frustrating experiences (aggression) • Investment in the relationship with caretaker is the crucial point from which all subsequent relationships form

  13. Harry Harlow: On the Nature of Love – American Psychologist -- 1958

  14. Harry Harlow • After 8 months of total isolation, damage to the ability to form bonds was permanent • Less than 3 months, damage was reversible • Food, cuddling, warmth, movement and few hours of play

  15. Development of the Self - Mahler • Separation Individuation10 months to 21/2 years • “No” period - disengagement from symbiotic relationship – emergence of the Ego • Caretaker: balance betweenletting go and being emotionally available • Neglect or enmeshmentwill hamper exploration of environment. • Neglect: child will focus energy on getting attention • May revert to earlier splitting mechanisms thatmay lead tonarcissistic or borderlinedisorders

  16. Attachment -- Autonomy

  17. Development of the Self - Mahler • Emotional Object Constancy and Individuality 3 years old on • Internalization of a positive image of caretaker • comforts child in caretaker’s absence and • allows for individuation • Ability integrate “good” and “bad” aspects of the internalized object (caretaker) • Development of a unified self-image: cohesive self • Development of complex cognitive functions & language • Increased reality testing and curbing of aggressive feelings

  18. Psychopathology • Deficits in the early relations: • Generate feelings of aggression and anger • Hinder the development of acohesive self • Result in disintegrated internalized objects or psychic structures- splitting • May lead to serious difficulties in adult relationships: • Narcissistic Personality Disorder • Borderline Personality Disorder

  19. Narcissistic Personality Disorder Grandiose sense of self-importance - Lacks empathy Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love Believes that he or she is “special” and unique Requires excessive admiration, praise Has a very strong sense of entitlement, e.g., unreasonable expectations or wants automatic compliance with expectations Exploitative of others -- hostility Often envious of others or believes others are envious of them Regularly shows arrogant, haughty behaviors or attitudes

  20. Borderline Personality Disorder Frantic efforts to avoid real or imagined abandonment A pattern of unstable and intense interpersonal relationshipsextremes idealization and devaluation Identity disturbance: unstable self-image or sense of self Impulsivity in at least two areas (e.g., spending, sex, substance abuse, reckless driving, binge eating) Recurrent suicidal behavior, threats, or self-mutilating beh. Emotional instability due to significant reactivity of mood Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger Transient, stress-related paranoid thoughts or severe dissociative symptoms

  21. ] Example Early Conflict • Client has difficulty relating to others: • Child receives inadequate, inconsistent care in infancy, experiences: • Frustration and anger • Perception of needs as bad, self as bad • Fear of abandonment from caretaker • To some extent the negative feelings will berepressed or denied

  22. In adulthood, situations that elicit desire to be close to others, to have others take care of her needs, elicit Anxiety related to the repressed feelings of: • Frustration and anger • Perception of needs as bad, self as bad • Fear of abandonment • Symptom: Difficulties in interpersonal relations – • Problem : Extensive use mechanisms of defense (e.g.denial, reaction formation, projection, displacement, sublimation) to avoid the anxiety generated by these negative feelings

  23. Psychodynamic Perspective • Potential Defense Mechanisms • Displacement: anger, frustration towards parental figures and self is directed towards significant others • Projection/Sublimation: projects on others repressed desires of being taken care of- becomes supreme caretaker • Reaction formation: develop a super-independent person • Conflict between consciousdesire (to be close to others, be taken care of) and repressed aspects of the Ego (sense of self as bad; fear of rejection/abandonment)

  24. Psychodynamic Therapy • Enable client to re-experience conflicts related to early stages of development: • Explore repressed negative experiences • Emotionally: Catharsis, Corrective Em. Exp. • Explore how current conflicts repeat patterns of behaviors and feelings about self and others established earlier • Cognitive: Interpretation-Insight • Parallel Process: In relation to therapist • Examination/Confrontation of defenses

  25. Therapy (continued) • to achieve a more positive level of functioning (object relations): • The therapist provides some of the functions that client lacked in childhood • Therapist serves as an auxiliary ego to help client cope with painful, overwhelming emotions • Modeling – positive intimacy • Foster process of integration and synthesis of self- cohesive self with less reliance on defenses

  26. Limitations Lack of direct attention to behavior change Limited number of specific interventions Reliance on exploring the past Does not lead to quick results