Techniques of Psychotherapy II Midterm Rreview

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Techniques of Psychotherapy II Midterm Rreview
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Techniques Psychotherapy II Dr Behbahani
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Techniques of Psychotherapy II Midterm Rreview
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  1. Why is it important to diagnose?
    • 1. For treatment planning
    • 2. Prognostic implications: understanding complexity of the person
    • 3. Consumer Protection: be ethical know their history
    • 4. Communication of empathy: putting yourself in the shoes of the
    • client, feeling with them their pain.
    • 5. Forestalling flights from Tx: how different personalities differ from
    • each other.
  2. Best preduictor of therapy is
    the relationship. The relationship is everything.
  3. Major Players in PSYCHOANALYTIC THEORY
    • 1. Freud
    • 2. Kohut
    • 3. Fairbairn
    • 4. Klein
    • 5. Mahler
    • 6. Kernberg
  4. Sigmund Freud:
    • 1. Classic Psychoanalysis:
    • 2. Drive Theory:
    • 3. Id, ego, and Superego:
    • 4. Oedipal Complex:
    • 5. Electra Complex: “become like mommy to get someone like daddy”6. Stages of Psychosexual Development
  5. Sex, Aggression, Food (Avoid Pain – Gain Pleasure)
    Drive Theory
  6. a. Structural Model
    b. preverbal and infantile. No sense of time or who they are/ “what I
    feel is what mommy needs to feel.” It is self centered and selfish
    ID
  7. a. Structural Model
    b. Moral part of the brain. ____ Strength understands right from
    wrong. It’s about knowing how to appropriately satisfy your needs.
    EGO
  8. a. Structural Model
    b. Strict.
    SUPEREGO
  9. “become like daddy to get someone like mommy”
    Oedipal Complex:
  10. “become like mommy to get someone like daddy”
    Electra Complex:
  11. a. Oral stage:
    b. Anal Stage: Toilet Training
    c. Phallic Stage: They realize they have privates.
    d. Latent Stage:
    e. Genital Stage:
    Stages of Psychosexual Development
  12. 1. Mother exists for the child before child is born
    2. Mother determines the way the child responds to the external
    world and all other relationships.
    3. Development of the child’s death instinct is responsible for the
    child’s view of the world as GOOD or EVIL.
    4. EVIL VIEW IS PROJECTED ONTO OBJECTS IN THEIR WORLD. (i.e.,
    malevolent people)
    5. GOOD LIBINAL ENERGY IS PROJECTED ONTO GOOD OBJECTS.
    6. Split world between destructive and benevolent objects.
    7. Mom can be either GOOD or BAD. We will be in the depressive
    position.
    Melanie Klein:
  13. Child is afraid of dying and they generalize everything.
    Most important, Mother-Child Relationship
  14. motive force from his perspective.
    • W.R.D Fairbairn
    • Desire for relatedness
  15. Focused on operation of dependency in the relationship rather than the destructive fantasies.
    W.R.D Fairbairn:
  16. W.R.D Fairbairn:

    Three Phases:
    • a. Early infantile dependency
    • b. Transitional Periods
    • c. Mature dependence
  17. Mechanism of splitting
    to understand dependency needs.
  18. used to describe how the child deals with an inconsistent unsatisfactory world; which is an inconsistent and ungratifying mother. By ______ the mother, the child is able to maintain his dependent ties without constantly feeling threatened.
    Splitting:
  19. 1. MOTHER-CHILD RELATIONSHIP as KEY in UNDERSTANDING the
    PSYCHOLOGICAL GROWTH of a CHILD!!!
    2. Bipolar intrapsychic representations:
    a. Image of Self
    b. Image of Other
    c. Affective Coloring: What affect is at play here?!?!
    3. Introjection: taking the view point of others
    4. Identification: replaces introjections- its appreciation of others.
    5. EGO IDENTITY: Most mature form of functioning
    Otto Kernberg: OBJECT RELATIONS
  20. a. Image of Self
    b. Image of Other
    c. Affective Coloring: What affect is at play here?!?!
    • Otto Kernberg: OBJECT RELATIONS
    • Bipolar intrapsychic representations:
  21. taking the view point of others
    Otto Kernberg: OBJECT RELATIONS

    Introjection:
  22. replaces introjections- its appreciation of others.
    Otto Kernberg: OBJECT RELATIONS

    Identification:
  23. Most mature form of functioning
    Otto Kernberg: OBJECT RELATIONS

    EGO IDENTITY
  24. 1. Worked with autistic and psychotic children.
    2. Separation-Individuation marked by three phases:
    a. Autistic Phase: first few weeks of child’s life. If they feel
    something then so should you. They need to feel connection
    (i.e., by touch)
    b. Symbiotic Phase: Understanding that others exist in the world.
    c. Separation-Individuation: knowing you are separate from others.
    3. Separation-Individuation: Autonomy vs staying fused with
    mother.
    4. Completion of phases results in child being able to internalize
    the mother and maintain a stable inner vision of her in her
    absence.
    Margaret Mahler: OBEJECT RELATIONS
  25. a. Autistic Phase: first few weeks of child’s life. If they feel
    something then so should you. They need to feel connection
    (i.e., by touch)
    b. Symbiotic Phase: Understanding that others exist in the world.
    c. Separation-Individuation: knowing you are separate from others.
    Margaret Mahler: OBEJECT RELATIONS

    Separation-Individuation marked by three phases:
  26. Autonomy vs staying fused with mother.
    Margaret Mahler: OBEJECT RELATIONS

    Separation-Individuation:
  27. 1. Children need their parents to satisfy their needs.
    2. Psychopathology occurs when the need of a child are not met.
    3. FOCUSED ON NARCISSISTIC INDIVIDUALS
    4. Concrete and Empathic Communication
    5. TWO NARCISSITIC NEEDS a CHILD SEEKS through OBJECT
    RELATIONS
    6. PATHOLOGY: Inability to transcend the narcissistic
    internalization of infancy
    7. Mirroring and Idealizing needs
    Heinz Kohut: FOUNDER OF SELF PSYCHOLOGY
  28. 1. IMPERFECT ATTENTIVE MOM makes a better mom than a PERFECT INATTENTIVE MOM
    2. Holding Environment: All children need to be held and feel supported
    3. Transitional Object: security objects (i.e., blanket, bear) Symbol from Mom and/or DAD. Helps with separation anxiety.
    4. All about DEPENDENCE!!!
    D.W. Winnicott: OBEJCT RELATIONS THEORIST
  29. All children need to be held and feel supported
    D.W. Winnicott: OBEJCT RELATIONS THEORIST

    Holding Environment:
  30. security objects (i.e., blanket, bear) Symbol from Mom and/or DAD. Helps with separation anxiety.
    D.W. Winnicott: OBEJCT RELATIONS THEORIST

    Transitional Object:
  31. something I don’t like about me
    Ego Distonic:
  32. Anxiety that motivates me is an example
    Ego Syntonic:
  33. We are driven to seek pleasure, We seek relationships because they satisfy us.
    Basic Assumptions of Psychodynamic motivation:
  34. mental events are determined and set in motion by prior mental events.
    Regulatory Principles, pain principle
    Psychic Determinism:
  35. getting stuck in a Stage

    Ex: stuck in anal phase- anal retentive
    Regression:
    FIXATION:
  36. Focused on the aspect that if the child was ________ or ________. He/she would be fixated at specific stages. We see these in pathological behaviors.
    Overfrustration & Overgratification:
  37. psychological stages of development we develop our personality through our life
    Erik Erikson:
  38. psychological stages of development we develop our personality through our life.
    Erik Erikson:

    Trust vs Mistrust:
  39. “Stage we are in”
    Erik Erikson:

    Intimacy vs Isolation:
  40. things that play a role in our development
    Harry Stuck Sullivan

    Speech, play-
  41. Autistic Phase
    Symbiotic Stage
    Interdependence: child is separated and this is healthy
    Margaret Mahler: Object relatedness
  42. 1. ID: Primary Process
    2. Primitive Drives, impulses, fantasies
    3. Operates under the Pleasure Principle SOLELY
    4. It’s Preverbal and Prelogica: Primary Process Thought
    5. It’s unconscious but its existanse can be derived from thoughts,
    acts, and emotions
    6. Psychotic patients function under the ID-PRIMARY PROCESS.
    EGO PSYCHOLOGY:
  43. 1. Mediator/ finds ways to adapt and handle ID’s Striving
    2. Develops continuously through life
    3. Secondary Process Thought
    4. Ranges from fully conscious to fully unconscious
    5. Therapeutic Split in the EGO: necessary condition of effective
    analytic therapy
    6. EGO STRENGTH: Ability to deal with things
    7. Emotional Flexibility: people with mature defenses tend to have
    emotional flexibility
    EGO: Rational part of the system
  44. 1. Formed mainly during Oedipal Complex through identification and
    parental values
    2. Psychic agency
    SUPEREGO: Moral Perspective
  45. 1. Importance of Caretaker
    2. Severe psychopathology demonstrated the disturbance of internal
    objects
    3. Client-therapist relationship appeared to mirror the child-parent
    relationship
    4. Allow us to be empathetic with our patients
    5. Parallel Process: You can take in your patients roles and feelings
    6. Counter transference: Therapist projects onto client his or her
    emotions.
    Object Relations:

    How do we relate to other people or avoid relationships
  46. 1. Individuals are void of objects
    2. Need for mirroring was essential in the conceptualization
    3. Mirroring parents and their actions
    4. Who do we want to be like???
    5. Objectives:
    6. Symptom relief usually appears once therapeutic relationship is
    secure.
    7. Insight:
    8. Agency:
    9. Empowerment:
    10. Identity:
    11. Self-Esteem:
  47. Self-Psychology:
  48. a. Increase insight
    b. Sense of identity
    c. Increase self esteem
    d. Improve ability to identify feelings
    e. The lower the function the more physical aggressive
    f. Inability to use words
    g. Withdraw
    h. Enhance Ego strengths: ability to cope
    i. Increase their pleasure
    j. Work on treating your patients
    Self-Psychology:

    Objectives:
  49. key to healing, make unconscious-conscious. What Drives your behavior?
    • Self-Psychology:
    • Insight:
  50. increasing sense of agency
    • Self-Psychology:
    • Empowerment:
  51. recent theoretical construct
    Self-Psychology:

    Identity:
  52. develop a more cohesive self- feel less scared and understand who they are.
    Self-Psychology:

    Erikson and The Identity Crisis:
  53. can be very fragile. Client must see therapist as NOT perfect. Be HONEST WITH YOUR PATIENT
    • Self-Psychology:
    • Self-Esteem:
  54. Emotional Maturity
    Emotional Intelligence:
  55. ability to cope and handle stress. Helps adapt to reality
    EGO STRENGTHS:
  56. They begin as healthy, creative adaptations and they continue to work adaptively throughout life.
    When they are operating to defend the self against threat, they are discernible as defenses.
  57. Primary/ Primitive Defense Mechanisms:
  58. process whereas what is inside is misunderstood as coming from the outside. This is the basis for empathy
    Primary/ Primitive Defense Mechanisms:

    Projection:
  59. process whereby what is outside is misunderstood as coming from inside. Can be very destructive process just like projection. For example identification with all aggressor, mourning and its relation to depression.
    • Primary/ Primitive Defense Mechanisms:
    • Introjections:
  60. A quality of Projective identification- a natural consequence of a person being disturbed enough to have primitive ways of perceiving reality. Short of psychosis.
    MELANIE KLEIN: PROJECTIVE IDENTIFICATION

    Self-fulfilling prophecy:
  61. a boundary b/w self and outer world
    Primary defenses:
  62. internal boundaries. More mature. They have already individuated. They differentiate between what coming from the inside vs what’s coming from the outside.
    Secondary defenses:
  63. take the self out of the situation (autistic nature).

    1. Understanding the world by withdrawing from reality into fantasy.
    2. Seen with schizoid characterAutistic fantasy: they understand their
    world by withdrawing from reality into fantasy
    Primitive Withdrawal:
  64. first reaction to catastrophe in all individuals. (if I don’t acknowledge it, it doesn’t exist)
  65. Denial:
  66. Avoids issues: everything will be ok.
    Pollyana:
  67. 1. They and the world are one experience.
    2. They feel others have their same needs.
  68. Omnipotent Control: Preverbal.
  69. Primitave Idealization:
    • 1. Primitive Fantasy.
    • 2. Idealizing occurs at different levels throughout life.
    • 3. Fusion with a benevolent other translates to SAFETY!
    • 4. Hope to be free of Shame.
    • 5. Fusion with an Idealized object frees one of imperfections. Normal Idealization
  70. 1. Narcissistic personalities need constant reassurance of their
    attractiveness and perfection.
    2. Results from the condition of dependence of this defense.
    3. Since self-esteem strivings in people who are organized around idealizing
  71. Primitive Idealization/ Devaluation:
  72. 1. Lack of psychological boundries b/w the self and the world.
    2. No differentiation
    3. Projection and Introjection = Projective Identification
  73. Projection and Introjection:

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