Psychodynamic Therapies

● Change occurs through insight and understanding of early, unresolved issues.

• ● The therapist assumes a nondirective role.
• ● Establishes a holding environment for the client and the opportunity to develop a secure
• attachment relationship.

• Past Influences the Present
• Underlying Conflicts
• Defense Mechanisms
• Transference
• Countertransference
• Interpretation

Early wounding relationships, or patterns from these relationships, are unconsciously replicated in current relationships.

• Infants and children all form attachment relationships with their
• caregivers (some are secure and healthy, some are insecure, avoidant, ambivalent, etc.).
• These patterns are repeated in adult relationships causing perpetual conflict, failed
• relationships, or an inability to enter into an intimate relationship with another adult.

• Unconscious techniques used by a person to strengthen their ego
• and protect themselves from negative thoughts and feelings that are associated with
• past experiences

• The process of the client transferring unresolved emotions associated
• with significant others in the client’s past onto the therapist.

The process of the therapist transferring unconscious emotional responses associated with individuals in their past onto their client.

A key technique used whereby the therapist verbally communicates their hypothesis regarding the effects of the client’s past on their presenting issues.

• Establish a holding environment. Build rapport and therapeutic alliance
• through listening, exploration of client’s experience, empathy, interpretation, and
• maintaining neutrality.

• Promote insight and growth; increase individuation; work through
• termination/abandonment issues.

Terminate therapy when the client is able to put new insights into action.

• ● Emphasis on early development as a decisive factor influencing later development.
• ○ The role of the past and unconscious is very important.
• ○ Clients are asked to identify thoughts and feelings regarding events in the past.

• ● Uncover and interpret unconscious impulses and defenses against them.
• ● Examine client’s self-awareness and understanding of the influence of the past on
• present behavior.
• ● Enhance clients’ ego strength and self-esteem.
• ● Decrease use of unhealthy defense mechanisms.
• ● Allow the client to access painful feelings in a safe environment, experience the true
• feelings, and resolve the inner conflict.
• ● Examine early relationships, attachments, and interactions to discover what issues from
• the family of origin might be projected in current relationships.

• ● Establish a holding environment for the client and the opportunity to develop a secure
• attachment relationship.
• ● Observe and reflect the ways in which a client projects previous object relationships into therapeutic interactions (projections).
• ● The therapist points out to the client patterns of distortion and manipulation used to establish and maintain relationships.
• ● Avoid being pulled into the client’s maladaptive patterns (countertransference).
• ○ The client should be compelled to seek new, healthier ways of relating to others.
• ● Identify and resolve the underlying causes of internal and relational conflict.
• ● Interpret transference.

Change occurs through both reparative experiences within the treatment relationship and from new insight into and modification of entrenched object relations pathology.

• ● Neutral
• ● Emphasis on transference and countertransference
• ● Therapist as a new and good object

• ● Providing reparative experiences and building new internal structures
• ● Gaining insight into how past relationships impact client’s functioning
• ● Improving relationships with self and others

• Objects
• Internalization
• Self- and Object-Representations
• Ego
• Splitting
• Projection
• Projective Identification *
• Introjection

• Refers to persons in the external world. Individuals seek objects (others) from
• birth.

• Early infant-caretaker interactions lead to the person internalizing basic
• attitudes toward self and other, characteristic relational patterns, and a repertoire of
• defenses and internal capacities.

• Infants form images of themselves and others. Once formed, they are fundamental internal structures that affect the ways in which
• individuals view themselves and others.

• The structure responsible for dealing with the world, for instituting defense
• mechanisms, for internalizing external objects, and for integrating and synthesizing self and object-representations.

• When two contradictory states, such as love and hate, are compartmentalized
• and not integrated.

• Involves projecting undesirable feelings or emotions onto someone else,
• rather than admitting to or dealing with the unwanted feelings.

• Refers to a psychological process in which a person will project
• a thought or belief that they have onto a second person. Then, in most common
• definitions of projective identification, there is another action in which the second person
• is changed by the projection and begins to behave as though they are, in fact, actually
• characterized by those thoughts or beliefs that have been projected.

• Where the subject replicates in themselves behaviors, attributes, or other
• fragments of the surrounding world, especially of other people.

• Establish a holding environment. Build rapport and therapeutic alliance through
• listening, exploration of client’s experience, empathy, and maintaining neutrality.

Promote insight and growth through interpretation. Confront resistance and primitive defense mechanisms. Focus on transference/countertransference dynamic. Identify and process projective identification.

• Work through termination and abandonment issues. Consolidate interpretations. Review
• insights gained in therapy.

• Change occurs through empathetic attunement and strengthening the self structures through
• optimal responsiveness.

• ● Emphasis on empathetic understanding and optimal responsiveness
• ● Allows emergence of self-object transferences and the repair of disruptions

• ● Developing self-cohesion and self-esteem.
• ● Locating better self objects

• Self-Objects
• Self-Object Needs
• Mirroring
• Optimal Frustration
• Mirroring Transference
• Twinship Transference
• Idealizing Transference
• Adversarial Transference
• Experience-Near Empathy

• Early self-objects are those empathetic or attuned caretakers who perform
• vital functions for the infant that it cannot carry out itself

Mirroring, idealization of others, twin/alter ego

Approving and confirming responses

• When a self-object is needed, but not accessible, this will create a
• potential problem for the self, referred to as a "frustration"

The patient seeks acceptance and confirmation of the self

The patient experiences the therapist as someone like himself

The patient looks up to and admires the therapist

The need for a supportive relationship that the patient can oppose in order to grow

When therapist steps into client’s shoes and imagines what it is like to be the client

• Establish a therapeutic holding environment. Demonstrate that the therapist is able to
• provide containment. Provide “experience-near” empathy. Explore the client's problem and history.

• Repair disruptions of the self-object transference. Addressing enactments. Empathizing
• with losses and blows to self. Mourning loss of self objects. Mourning ambitions and fantasies.
• Identify alternative self-objects.

Reflect on the treatment process. Acknowledge and process issues related to termination.

Change occurs through exploration of past and current relational attachments and trauma in the environment of a healing, secure, and reliable relationship.

• ● Provide a sufficiently secure base to enable a person to explore emotional experiences
• of the past and the present.
• ● Create a secure, accepting, caring, non-judgmental, and reliable environment where the patient can feel comfortable sharing their most traumatic experiences and exploring the
• nature of the client’s attachment pattern.

• ● Raise awareness of client’s problematic behavioral and emotional patterns, formed in
• early childhood as attempts to maintain attachment to primary caregivers.
• ● Repair the capacity to regulate affects.
• ● Resolve any emotional or social disruptions within the patient’s life.
• ● Improve quality of attachment with others.

• Attachment Behavior System
• Secure Attachment
• Preoccupied/Anxious Attachment
• Dismissive/Avoidant Attachment
• Fearful/Avoidant Attachment

• The process in which infants and caregivers have an organized pattern of signals and responses that leads to the development of a
• protecting and trusting relationship. The emotional bond that develops between adult
• romantic partners is partly a function of the same motivational system - the attachment
• behavioral system.

• The person has easy access to a wide range of feelings and memories, positive and negative. Has a balanced view of parents and has worked through hurt and anger from the past. Has developed a strong sense of self and
• empathy for others.

• The person is still embroiled with anger and hurt at parents. They sometimes value intimacy to such an extent that they become overly dependent on the attachment figure both past and present. They often recall role
• reversal in childhood and have a hard time seeing their own responsibility in
• relationships. They dread abandonment.

• The person dismisses the importance of love and connection – and the value of emotions in general. Often idealizes parents, but actual
• memories don’t corroborate. They dislike looking inward and often have a shallow, if any, self-reflection. They often are very independent, dismissive of their own emotionality, and have difficulty tolerating the heightened emotions of others.

• The person usually has a history of trauma and or loss. Similar to Dismissive/Avoidant, they dismiss the importance of love and connection but usually out of fear or a belief that they are unworthy of love. They have difficulty trusting
• others and may feel uncomfortable with emotional closeness.

• Attunement is the key intervention in the early stage and consists of forging a
• personal relationship between the therapist and the patient. The therapist provides a secure base by reliably demonstrating empathy and care. Collaboratively identifying client’s
• “attachment style," that is, problematic behavioral and emotional patterns, formed in early childhood as attempts to maintain attachment to primary caregivers.

• Disruptions are explored in the middle phase. Disruptions include those in the early life
• of the client as well as those in current relationships, including the relationship with the therapist. Support client’s ability to regulate and express emotions in relationally difficult situations, teaching clients to have a reflective stance toward themselves.

• Repair occurs during the late middle phase and the end of treatment. Repair stage of the
• therapy aims to alter the patient’s current reactions to the events that cause them emotional distress by sharing their own interpretations of the event. By sharing their own subjective
• interpretation, the therapist helps create a new reality of the painful events for the patient in
• order to get rid of unwanted emotions and reactions.