Important Questions for IGNOU PGDCFT MSCCFT MCFT003 Exam with Main Points for Answer - Unit 5 Psychodynamic Approaches

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Unit 5 Psychodynamic Approaches

1. Name the four main schools of psychoanalytic thought and their proponents, which have influenced the development of psychodynamic therapy.

Following are the four main schools of psychoanalytic thought and their proponents, which have influenced the development of psychodynamic therapy:

i) Freudian psychology by Sigmund Freud;

ii) Ego psychology by Heinz Hartmann, Anna Freud, Erik Erikson, Paul Gray and Fred Busch;

iii) Object relations psychology by Melanie Klein, W.R.D. Fairbairn, D.W. Winnicott, and Harry Guntrip; and

iv) Self psychology by Heinz Kohut.

2. Briefly describe the differences between short-term and long-term psychodynamic psychotherapy in terms of frequency and duration of therapy, therapeutic goals and the levels of therapist directiveness.

Following are the differences between short-term and long-term psychodynamic psychotherapy:

Frequency and duration of therapy: Short -term psychodynamic psychotherapy is usually time-limited, consisting of 16 to 30 sessions, conducted on once or twice-weekly basis. In long-term psychodynamic psychotherapy, sessions are usually 1 to 3 times a week and could extend over a few years.
Therapeutic goals: In long-term psychodynamic psychotherapy, the therapy goals include insight and personality reorganisation. In short-term psychodynamic approaches, the goals are more limited, focusing on specific conflicts and what might be achievable in the time available.
Levels of therapist directiveness: The therapist level of directiveness is relatively higher in short-term psychodynamic psychotherapy than in long-term psychodynamic psychotherapy.

3. Discuss the differences between psychoanalysis and psychodynamic psychotherapy.

The frequency of sessions in psychodynamic psychotherapy is lower (1 to 3 sessions per week) than in psychoanalysis (4 to 5 sessions per week).
The use of the couch for patient to lie on during sessions, with the patient out of the therapist's visual range, is characteristic of psychoanalysis whereas patient and therapist sit face to face in psychodynamic psychotherapy.
The goals of therapy tend to be more modest in psychodynamic psychotherapy, when compared with psychoanalysis. This may include symptom relief, only partial personality reorganisation and partial reconstruction of the past. The aim is a more select and focused understanding of problems and some conflict areas may be intentionally overlooked.
Psychodynamic psychotherapy focuses more on current dynamic conflicts and problems than on past issues.
There are some differences related to the therapeutic relationship. The adherence to therapeutic neutrality is less rigid in psychodynamic psychotherapy than in psychoanalysis. Psychodynamic psychotherapy also acknowledges the real personality and attitudes of the therapist. There is often more therapist activity in psychodynamic psychotherapy.
Although psychodynamic psychotherapy stresses the importance of transference within the treatment relationship, it does not promote the depth and intensity of the transference to the same extent as in psychoanalysis.
In terms of techniques, psychodynamic psychotherapy may integrate certain supportive and more directive techniques apart from the techniques like free association, clarification and interpretation derived from psychoanalysis.
While psychodynamic psychotherapy may not always vary in length from psychoanalysis, there are short-term variants of psychodynamic psychotherapy, upto about 20 sessions, which address focal conflicts.

4. Enumerate the indications and contraindications for patient selection in psychodynamic psychotherapy.

There are a number of factors that guide the selection of patients for psychodynamic psychotherapy. These include:

Psychological-mindedness: Psychological-mindedness refers to the capacity for insight and to understand problems in psychological terms.
Motivation for insight and change: Psychodynamic psychotherapy requires adequate motivation for introspection and change.
Average to above average intelligence.
Verbal capacity: Patients need to have a well-developed ability to verbalise internal experiences.
Adequate ego strength : Adequate ego strength includes the ability to sustain feelings and fantasies without impulsively acting upon them, being overwhelmed by anxiety, or losing the capacity to continue the dialogue.
Relatively mature superego development: Patients who commit criminal acts or have inadequate superego development are rarely suitable.
Ability to tolerate change and a degree of frustration, sadness and other painful emotion.
The capacity to distinguish between reality and fantasy.
Ability to form and sustain relationships: The capacity to relate well enough to form an effective working relationship with the analyst.

Assessment of suitability for psychodynamic psychotherapy should also include some external life situations. Patients in midst of major life crisis, for example, loss of job or divorce, serious physical illness or inadequate financial resources may not be suitable for initiating psychodynamic psychotherapy

5. What are defense mechanisms? Describe some important defense mechanisms and their significance in psychodynamic psychotherapy.

Defense mechanisms are constructions of the ego that unconsciously operate to protect against conscious awareness of anxiety-provoking memories, wishes, fears or needs.
The major defense mechanism is repression, which induces "forgetting" of harsh realities. The psychoanalytical model also states that many of the unconscious conflicts develop in early childhood and may account for strong feelings, conflicts and symptoms later in life.

6. Describe the therapeutic techniques used predominantly in the middle phase of psychodynamic psychotherapy.

Transference/Countertransference
Confrontation
Clarification
Interpretation
Working Through

7. What is the importance of the termination phase in psychodynamic psychotherapy?

The final part of the treatment phase is the period in which changes are consolidated and new behaviours are solidified.
A major issue at the time of termination is to be able to explore issues related to separation, loss and change for both the patient and the therapist. It is an extremely important phase for the patient because it helps the patient review the experience, both emotionally and intellectually, and to be able to separate from a parent-like figure. The therapist also needs to become aware of possible countertransference responses of anger, thoughts about breaking boundaries or failure to terminate when indicated.

8. Briefly discuss the important models of short-term psychodynamic psychotherapy

Focal Psychotherapy: included the development of inclusion criteria for patient selection, identification of focal issues, emphasis on intense affect experienced by the patient, analysis of transference linked with childhood and the importance of working through "loss" of therapist during termination.
Mann's 12-session Time-limited Therapy (Mann, 1973), focused on separation-individuation issues that were stimulated by the quick, planned termination of therapy.
Short-term anxiety provoking therapy developed by Sifneos ( 1973, 1987), selected patients having conflicts related to the oedipal stage.
Intensive short-term dynamic psychotherapy developed by Davanloo (1979), even included a single-session treatment.
Contemporary versions of short-term psychodynamic psychotherapy include TimeLimited Psychotherapy (TLP; Strupp & Binder, 1984) and Short-term Supportive-Expressive Psychoanalytic Psychotherapy (Luborsky, 1 984). These models include training and supervision using treatment manuals and an emphasis on research of treatment processes and outcomes.

Important Points

i) Psychodynamic psychotherapy focuses on thoughts, feelings and behaviours that have unconscious roots.

ii) Psychodynamic psychotherapy explores past childhood experiences and relationships.

iii) Identification of negative automatic thoughts is not a hallmark of psychodynamic psychotherapy.

iv) One of the primary goals of psychodynamic psychotherapy is insight.

v) Therapeutic neutrality is strictly adhered to in psychoanalysis.

vi) Psychodynamic psychotherapy has a relatively greater focus on current conflicts than on past dynamic issues and problems.

vii) The use of the couch is characteristic of sessions in psychoanalysis.

viii) Psychodynamic psychotherapy emphasises partial interpretation of unconscious conflicts.

ix) The frequency of therapy sessions ranges from one to three sessions per week in psychodynamic psychotherapy.

x) The following patient characteristics are considered as indications for patient selection is psychodynamic psychotherapy:

Good verbal capacity

Psychological-mindedness

Adequate ego strength

xi) In psychodynamic psychotherapy, the analysis of transference is the process by which the therapist interprets the feelings expressed by the client toward the therapist as being indicative of the feelings typically expressed by the client toward important people in her or his personal life.

xii) The tentative statement of the patients' individual dynamics and conflicts is called psychodynamic formulation

xiii) All of the following are components of psychodynamic therapy:

interpretation

working through

clarification

xiv) Issues related to separation, loss and change are prominent in the termination stage of psychodynamic psychotherapy.

xv) In psychodynamic psychotherapy, working through is the process by which new insights are acquired and these are used to make changes in current life situations and functioning.

xvi) The defense mechanism in which an unacceptable thought or feeling is transformed into it's opposite is reaction formation

xvii) The men behind the theories:

Franz Alexander - Corrective emotional experience

Malan - Focal psychotherapy

Davanloo - Triangle of person

Mann - Separation-individuation conflicts

Sifneos - Oedipal conflict

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