Dynamic Psychotherapy

 

Began with Freud. Important concepts include:

mind is divided into ego (conscious), superego (conscious and unconscious) and id (unconscious). The id contains powerful drives such as aggression and libido

the unconscious

• include the pre-conscious (accessible with effort) and the unconscious proper, which is censored by the conscious mind because it contains unacceptable wishes, instincts, and drives and a can be accessed byfree association, dreams and parapraxes (Freudian slips)
• unconscious conflict arises when components of self are at odds with each other, with the aggressive impulse of the id inhibited by the superego
• anxiety arises because of the unconscious conflict and gives rise to defense mechanisms

how it works

premise is that we are always working towards emotional homeostasis. Feeling angry with a parent will be balanced with the need/desire that goes along with this, leading towards unconscious conflict.

 

want patient's to transfer their previous thoughts onto the therapist, such that it can be seen, brought up in adulthood, and then addressed

 

create the freedom to allow unconscious thoughts and impulses to come out into the conscious such that they can resolve. Sometimes people can't process things as a children; wait until adulthood to bring it up.

you want to reflect back to patients that a portion of their present feeling is from the past.

psychic determininsm

• asserts....

past is prologue

• who you are today is the result of life experiences, especially in childhood
• trauma in childhood leads to problems in adulthood

transference

• patient transfers feelings toward figures from the past onto the therapist, ie "you sound just like my mother"
• feelings are a repetition of the past and are not appropriate
• every relationship is a misture of real and transference

counter-transference

• includes all feelings the therapist has towards the patient
• the feelings are not unprofessional; by becoming aware of our negative feelings toward patients, we can reflect on them and avoid acting unprofessionally

resistance

force within psyche that fights against change

can be conscious or unconscious

can appear as non-adherence, or more sublty (showing up late, etc)

 

 

Intensive Sort-Term Dynamic Therapy

 

• how does ISTDP work?
• indiciations for ISTDP
• trial therapy
• interpretation of results
• resources and references

 

How Does ISTDP Work?

ISTDP appears to work by getting the emotions out: mobilizing and experiencing unconscious emotions

palpate the emotions.

put the focus on the emotions and monitor the anxiety reponse. clarify defenses..

 

as awareness increases, the threshold for somatization increases. they learn how to talk about and experience

 

Emotions

• bond with parents
• trauma to this leads to chemical withdrawal

 

Indications for ISTDP

• somatization in any system
• defensive, anxious, and avoidant patient
• patients who know they turn rage into the body (neurotic patients)
• patients who have self sabotage and defeat
• patients who wish to explore emotional forces involved in their somatic problems

Reasons not to use ISTDP

• Crohn's, ulcerative colitis, MS
• actively suicidal
• bipolar disorder (relative contraindication), psychotic disorder
• patients with prominent projection, cognitive-perceptual projection, or highly resisitant patients need supervision

 

Trial Therapy

Average 1.5 hours

 

over 2/3 have partial or major breakthrough in unconscious feelings

 

 

 

Interpretation of Test Results

• no change in symptoms - look for medical factors
• symptoms fluctuate in response to anxiety - possible role
• symptoms removed by emotional experience - likely somatizaion
• no unconscious anxiety mobilized - no anxiety is present, or therapy is not doing well