Introduction to Psychotherapy

Introduction to Psychotherapy

Introduction to psychotherapyMüge Alkan, PhD

[email protected], [email protected] 532 385 9299

6 October - Introduction13 October – Key concepts of psychotherapy20 October – Assessment and Therapeutic interventions27 October –Introduction to Psychodynamic psychotherapy3 November – Psychodynamic psychotherapy10 November - Psychodynamic psychotherapy17 November - Cognitive behavioral psychotherapy24 November - Cognitive behavioral psychotherapy1 December – Midterm and Group therapy8 December - Group therapy15 December -Interpersonal psychotherapy22 December – Transactional analysis29 December - Family therapy5 January - General overview

Midterm % 30Presentation and paper % 30Final exam % 40

Who are the patients?

Patients suffer from problems that interfere with their attaining life goals Maximize potentials Lead happy lives

Problems stem from unconscious conflicts Presented as symptoms or personality traits

and patterns Either bothersome to patients or just

interference with life of patients

Can patients be placed in diagnostic groups?

Yes, in many ways..

Differences in ego functioning Normal-neurotic Narcissistic Borderline Psychotic

Assessment of ego functioning Reality testing Sense of reality Adaptation to reality Impulse control and frustration

tolerance Object relations Thought processes Defensive functioning

Normal-neurotic group

Good ego functioning Intact reality testing Good interpersonal relations Good adaptation to reality Good impulse control Stable identity Affective stability Mature defenses

Normal-neurotic group

Object relations; integrated, coherent and stable sense of self and objects.

Others are viewed as individuals of their having needs and desires of their own.

There may be some slippage in all areas, though rarely in reality testing.

All “normal“ people use numerous neurotic defenses, may have episodic difficulties.

Borderline group

Relative (may easily break) intact reality testing/thought processes/ interpersonal relations/adaptation to reality

Poor impulse control Primitive ego defenses Identity diffusion Affective instability

Narcissistic group

Integrated but pathological identity based on grandiose self.

Labile self-esteem, sensitive to rejects, disappointments, failures.

Psychotic group

Poor ego functioning Weak reality testing Problems in almost all ego functions

Who are the therapists?

Psychiatrists, psychologists, clinical social workers, nurses, counselors.

Some –unconsciously- enter the field to solve their own problems.

What are some problems inherent in psychotherapy?

Psychotherapy is fascinating, intellectually stimulating when done well.

Can be exhausting, demanding, Challenge of facing own problems and

those of patients. Projecting one’s problems onto patients Taking own anger at them Treating them as one wished to be treated Using them for one’s own gratification Boundary violations and sexual acting.

Can be isolating..

How important is one’s personal therapy or psychoanalysis?

Crucial.. To understand one’s own problems

and minimize their influence in the therapy process.

Which personal characteristics and experiences help to make a good

therapist? Some stability Concern Dedication Integrity Conscientiousness Competence High intelligence Psychological mindedness Empathy

Which personal characteristics and experiences help to make a good

therapist? Certain amount of suffering, depression and

neurotic conflict. A reflective, thoughtful person on the

pessimistic, realistic side Too much optimism is associated with

denial. Ability to listen To be able to bear criticism and hostility

without the need to retaliate Intuition and creativity Some life experience

How long does it take to become an effective psychotherapist?

Years..... 10 years is mentioned.. Psychotherapy is a continual and

neverending learning. Understanding oneself through personal

analysis Life experience Learn theory and technique through reading Supervision

Psychotherapy

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Explorative therapies Supportive psychotherapy

Insight oriented Psychoanalysis Analytically oriented psychotherapy Dynamically oriented psychotherapy Supportive psychotherapy Cognitive psychotherapy

Psychoanalysis

4-5 times a week on the couch Free association Resistance Gradual process of unconscious

becoming conscious Context of transference Neutral position

Psychoanalysis

Intense transference, in a regressed state

Feelings, thoughts (and defenses) originally directed toward important people in childhood

Actual and fantasized past as experienced by patient

Current relationships, past relationships

Issues in psychotherapy

Stable therapeutic environment Therapy is carried out in a stable, consistent

and caring way in a safe, nonthreatening and nonintrusive environment.

Expectations of treatment should be clearly spelled out, discussed and always followed.

Good-enough mothering (Winnicott, 1958) Holding environment (Winnicott, 1958) Therapeutic alliance


Neutral therapist Equal distance from id, ego and

superego Important in analytic therapies Transference “blank screen” for

displacement of feelings Clarity of judgement and criticism


Flexible therapist Need to oscillate methods with more troubled patients Be ready for unpredictable and new challanges


Countertransference Therapist’s conscious and unconscious reactions to

the patient’s transference Borderline patients: guilt, rescue fantasies, rage,

hatred, helplessness, worthlessness, anxiety, terror. What is your response to such feelings ? !!!!!

Narcissistic patients: idealization, devaluation (acting as if the therapist does not exist)

Psychotic patients: passive, dependent and unable to change: helplessness may lead to taking over patient’s life.


Empathy 1. Understanding Building trust “Empathy is not a cure itself” 2. Explaining; gain insight


Action Active in listening More passive at first, but active later

What is the mechanism of change in psychotherapy?

Change via insight: (insight oriented interventions) “healthier patients”

Change via the relationship: (identification and internalization) “more troubled patients”

What are the basic strategies for psychotherapy?

Reexperiencing and working through the conflicts.

Strategy: maximize development and resolution of transference

Comment on resistance to the formation of transference

Help patient understand himself through transference with current and childhood relationships

What are the basic strategies for psychotherapy?

Second strategy: Focusing on present day interactions and

relationships Downplay transference

Third strategy: Supportive therapy Supporting and enhancing ego functions Blocking regression

Documents

Introduction to Psychotherapy