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Psychoanalytic Therapies 2 (Psychodynamic Concepts (Mechanisms of Defence …
Psychoanalytic Therapies 2
British Institute Psychoanalysis
Training consists of:
Personal analysis
reading and clinical seminars
monther-infant observations
2 training patients plus supervision
Psychodynamic Concepts
Conflict (e.g. between patient and partners, internal conflicts - tensions)
Unconscious Processes
Some manifestations
Anxiety and Psychic Pain (how the patient copes with it; traumatic memories)
Motivational Drives/Instincts (relationships...)
Developmental Phases
Mechanisms of Defence
Conflict between wish and reality
Conflict between life and death instincts (controversial)
Conflict between different aspects of the mind
Adaptation is via defences
"Hierachy" of defences from primitive (child-like) to mature
Repression
Pushing back of unacceptable wishes from consciousness - primary mechanism of defence - classical
Development of true self (delayed, suppressed)
Return of the repressed (if they are not dealt with)
Controversial in recent times - recovered memories - repressed traumatic memories
Not the same as "suppression" - conscious process
Analysts originally accused of ignoring child sexual abuse
Psychotherapists then accusedd of inventing it
Repression being an unconscious process
Projective Identification
Primitive defence
Unconscious process in which parts of the self is projected onto another
More complex than projection - communicative aspect - recipient induced to feel or act in ways that originate with the projector
Can be more mutal
Externalised affects and impulses can boomerang back
Splitting
Division of an object into all good or all bad (black and white thinking)
Avoids ambivalence
Seen in many working environments
NEUROTIC MECHANISMS
Repression - not as the primary defence but a conscious pushing away of painful aspects of emotional life
Dissociation - disconnection or separating from reality ("I feel like I'm not in my own skin right now")
Denial and disavowal - deals with external reality (e.g. "unknown pregnancy)
Reaction formation - attitude and behaviour opposite to conscious wish or desire (e.g. homophobia)
Identification with the aggressor (Anna Freud) (e.g. Stockhom Syndrome) - submission to adult aggression in child (important in understanding child abuse effects)
Isolation - affect and idea are conscious but not linked e.g. recounting painful events (e.g. inappropriate affect - laughing at a traumatic event that has happened)
Undoing - an attempt to manage psychic pain via magic thinking e.g. in OCD (Washing away the badness) - e.g. in therapy, rather than dealing with the suppressed experiences "undoing" the pregress made in therpay; common in offenders when recounting "remorse" (not showing remorse directly, but trying to "undo" the bad they have done through other rituals)
Mental State and Defence Mechanisms
Hysteria (related to borderline personality, not a good defence mechanism, since it allows for extreme outbursts)
Obsessional Conditions
Paranoid (in therapy trying to work through this paranoia, and where it comes from)
Depression (in therapy trying to get to the defence, why this has happened, where it comes from)
Intellectualisation and Rationalisation
Common in medicine; law; poltics and business
e.g. something bad has happened to me, but this happens to many people, so I shouldn't feel depressed about it
or: I'm not a sexist, men are biologically predisposed to be superior to women (finding a rational, interlectual, more broad argument to overcome something
Internalisation and Incorperation
Taking in and modifying the external world (new parents finally identify with introjected paternal attitudes) - making our external world fit with out internal world
MAUTURE MECHANISMS
Sublimation and humor (e.g. gallows humour) - finding a social acceptable way of dealing with things, e.g. joining a boxing club to control anger; humor - making the best of the situation
Partial expression of unconscious wishes and desires in a socially acceptable and creative way
Techniques in Psychoanalysis/Psychodynamic Psychotherapy
Therapeutic or Working Alliance - relationship between the therapist and the client, clients often attack the therapeutic relationship (e.g. in undoing)
Free Association
Interpretation - "When you say that, what I think you mean is..." (e.g. in dream analysis)
Confrontation - "I am confused, because I don't understand how that fits with what you said last session..." (challenging the client, trying to lead the client to a different understanding, getting them to reflect on their own words)
Clarification - "Maybe we need to slow down a bit. What do you mean when you say..."
Transference - "I find myself feeling quite uncomfortable here, and I wonder why..." (don't go too deep, but see how the client reacts to it)
Working through - "I know you find this hard, but I want to return to the discussion about..." (working through resistance)
Transference
We work out what others think of us both consciously and unconsciously
People quickly notice signs which confirm their "blueprint" of how they expect others will treat them (Depending on our previous experiences; looking for signs that confirm the blueprint - mostly of others close to us)
Transferring feelings, and behaviours we know from one person, onto another
Bateman and Fonagy
Intersubjectivity - Child's innate drive to take part in dialogue (not necessarily verbal)
Organising activity
Reproduced in relationship with analyst/therapist
Initially seen as contaminating
Past and/or present (reconstruction vs. here and now) - how past interactions influence the current ones
Transference - classic conception
Classic transfer onto analyst past experiences and strong feelings (e.g. jealousy, frustration, rivalry, hatred...)
Analyst seen as a "blank screen"
Transference - modern conception
Emergence of latent meanings linked to intensity of analytic relationship
Medium through which an individual's drama is played out with the analyst becoming a player
A new experience that is influenced by tha past, remains as the "here and now"
not necessarily expressed or conscious
Distortion of history
History always a construction
Not only in analytic situations but hard to disentangle from the environment without a container that specifically observes it
Debate transference vs. reals life interpretations
Not about the truth, but about what is important to the client
Types of Transference
Psychotic, intense, primitive, transitory
PD-borderline; nacissistic; paranoid
Idealised/denigratory
Erotic transference - loving and affectionate strivings. Can be managed with effective boundaries but erotised transference can be extreme and destructive
Countertransference
"no analyst goes further than his own complexes and internal resistances permit" (Freud saying that everyone has limits, and that countertransference is a "dangerous method" - have to be careful lwith it)
Conceptualisation changed over the years
Thoughts and feelings experienced by the analyst
.
2 Parts
What belongs to the analyst. sometimes difficult to distinguish what comes from the patient and what the analyst brings with them; important to havev own therapy as analysts
A form of communication relevant to the patient''s internal world - helpful in understanding the patiet