Psychodynamic Psychotherapy (eBook)

A Clinical Manual

Deborah L. Cabaniss (Autor)

eBook Download: EPUB

2016 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-119-14199-0 (ISBN)

Infos

An updated and expanded new edition of a widely-used guide to the theory and practice of psychodynamic psychotherapy, Cabaniss' Psychodynamic Psychotherapy: A Clinical Manual, 2nd Edition provides material for readers to apply immediately in their treatment of patients.

Deborah Cabaniss is Professor of Clinical Psychiatry, Director of Psychotherapy Training, and Associate Director of Residency Training in the Columbia University Department of Psychiatry. Dr. Cabaniss, who is also Director of the Virginia Apgar Academy of Medical Educators at the Columbia University College of Physicians and Surgeons, is a recipient of Columbia University's Presidential Award for Outstanding Teaching. She has published extensively on topics related to psychiatric and psychoanalytic education, and is a Training and Supervising Analyst at the Columbia University Center for Psychoanalytic Training and Research.

Carolyn J. Douglas is Associate Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons, and Adjunct Associate Professor of Clinical Psychiatry at Weill Medical College of Cornell University. Dr. Douglas is the author of several publications on teaching supportive psychotherapy to psychiatric residents, the psychotherapy selection process, and psychodynamic psychotherapy.

Anna R. Schwartz is Assistant Clinical Professor of Psychiatry at the Columbia University College of Physicians and Surgeons, and Director of the Psychodynamic Psychotherapy Program at the Columbia University Center for Psychoanalytic Training and Research. Dr. Schwartz is also a former recipient of the Irma Bland Teaching Award from the American Psychiatric Association.

Sabrina Cherry is Associate Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons and currently practices psychiatry and psychoanalysis in New York City. Dr. Cherry is also a Training and Supervising Analyst and active teacher of psychoanalytic candidates at Columbia Center for Psychoanalytic Training and Research.

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An updated and expanded new edition of a widely-used guide to the theory and practice of psychodynamic psychotherapy, Cabaniss' Psychodynamic Psychotherapy: A Clinical Manual, 2nd Edition provides material for readers to apply immediately in their treatment of patients. This expanded and updated edition of a widely-used, practical guide to psychodynamic psychotherapy provides material that readers can apply immediately in their treatment of patients. It is built around a unique and proven approach that clearly teaches psychodynamic psychotherapy using three key steps - listening, reflecting, and intervening. These are applied to all aspects of treatment, and supported by core psychotherapeutic concepts such as evaluation, empathic listening, and setting the frame. The Second Edition has been fully revised to reflect the latest developments in the field. While retaining the structure, clarity, and relevance that have made this one of the most popular texts in its field, the authors have added new research, a wealth of new exercises, and an educators' guide to help teachers and program directors make best use of the book in training programs. The result is an invaluable resource for those seeking to teach, understand, and practice psychodynamic psychotherapy.

Inhalt

Preface xi

Acknowledgments xiii

Use of This Manual xv

About the Companion Website xvii

Introduction xix

Part One What Is Psychodynamic Psychotherapy? 1

1 The Treatment for a Mind in Motion 3

2 How Does Psychodynamic Psychotherapy Work? 8

Part Two Assessment 15

3 Creating a Safe Place and Conducting an Assessment 17

4 Assessing Domains of Function 27

5 The Initial Formulation 47

6 Indications for Psychodynamic Psychotherapy 57

Part Three Beginning the Treatment 69

7 Informed Consent and Collaborative Goal Setting 71

8 Setting the Frame and Establishing Boundaries 80

9 Developing a Therapeutic Alliance 94

10 Technical Neutrality 103

11 Conducting a Psychotherapy Session 111

12 Our Patients' Feelings about Us and Our Feelings about Our Patients 120

13 Empathic Listening 129

14 Looking for Meaning 138

15 Medication and Therapy 142

Part Four Listen/Reflect/Intervene 151

16 Learning to Listen 153

17 Learning to Reflect 159

18 Learning to Intervene 169

Part Five Conducting a Psychodynamic Psychotherapy: Technique 201

19 Affect 205

20 Free Association and Resistance 219

21 Transference 234

22 Countertransference 254

23 Unconscious Conflict and Defense 266

24 Dreams 283

Review Activity for Part Five: The "Microprocess Moment" - Understanding a Moment in Therapy 296

Part Six Meeting Therapeutic Goals 299

25 Improving Self-Perceptions and Self-Esteem Regulation 301

26 Improving Relationships with Others 311

27 Improving Adapting to Stress 319

28 Improving Cognitive Function 327

Part Seven Working Through and Ending 341

29 Working Through 343

30 Ending 352

Review Activity for Parts Six and Seven: "The Macroprocess Summary" - Understanding How Things Change in Treatment 365

31 Continuing to Learn 370

Appendix 1 How to Use Psychodynamic Psychotherapy: A Clinical Manual - A Guide for Educators 375

Appendix 2 Template for Assessment of the Microprocess Moment and Video Review 384

Appendix 3 The Post-Evaluation Psychodynamic Psychotherapy Educational Resource - The "PEPPER" 385

Recommended Reading 388

Index 401

Textauszug

1
The Treatment for a Mind in Motion

Key Concepts

Psychodynamics means mind in motion.

A psychodynamic frame of reference postulates that dynamic (moving) elements in the unconscious affect conscious thoughts, feelings, and behavior.

A psychotherapy that is based on the psychodynamic frame of reference is a psychodynamic psychotherapy.

The basic goal of psychodynamic psychotherapy is to help people with problems and patterns that lead to unhappiness and dissatisfaction in life by uncovering unconscious thoughts and feelings and/or directly supporting function in the context of the relationship with the therapist.

Both uncovering and supporting techniques are used in almost every psychodynamic psychotherapy.

What is Psychodynamic Psychotherapy?

Literally, psychotherapy means treatment for the mind. Psychotherapy has its origins in psychoanalysis – the “talking cure” that was first developed by Sigmund Freud [1]. Consequently, the word psychotherapy has come to refer to a treatment that involves talking. But it's not just any talking – in order to be psychotherapy, the talking has to be:

• a treatment
• conducted by a trained professional
• within a set framework
• in order to improve the mental and emotional health of a patient

And what about psychodynamic? You've probably heard this word many times – but what does it mean? Psycho comes from the Greek word psyche, which meant soul but has come to mean mind, and dynamic comes from the Greek word dynamis, which meant power but has come to mean physical force in motion. Simply stated, the word psychodynamics refers to the forces of the mind that are in motion. Freud coined this word when he realized that, as opposed to earlier conceptualizations of a static psyche, the mind was an ever-changing system, rolling with perpetually moving energized elements. These unconscious elements could explode into consciousness and vice versa, while powerful wishes and prohibitions could barrel into one another, releasing the psychic equivalent of colliding subatomic particles [2].

Freud realized not only that elements of the mind were in motion, but also that most of this frenzied mental activity was going on outside of awareness. He described this mental activity as unconscious and hypothesized that it could affect conscious thoughts, feelings, and behavior. Thus, we arrive at the two definitions that provide the foundation for this manual:

1. A psychodynamic frame of reference is one that postulates that unconscious mental activity affects our conscious thoughts, feelings, and behavior.
2. A psychodynamic psychotherapy is any therapy based on a psychodynamic frame of reference.

The Unconscious

We often refer to our unconscious mental activity as the unconscious. Feelings, memories, conflicts, ways of relating to others, self-perceptions – all of these can be unconscious and can cause problems with thoughts and behavior. Unconscious thoughts and feelings develop in a person from childhood, and are a unique mix of early experiences and temperamental/genetic factors. We keep certain thoughts, feelings, and fantasies out of awareness because they threaten to overwhelm us if they become conscious. They might be too frightening or stimulating; they might fill us with shame or disgust. Because of this, we make them unconscious but they do not disappear – they remain full of energy and constantly push to reach awareness. Their energy affects us from their unconscious hiding places, and they exert their influence on the way we think, feel, and behave. A good analogy comes from Greek mythology:

Zeus, the young god, was tired of being ruled by the patriarchal Titans, so he buried them in a big pit called Tartarus. Deep beneath the earth, they no longer posed a threat to Zeus's dominance. Or did they? Though out of sight, they had not disappeared, and their rumblings were thought to cause earthquakes and tidal waves.

So too, unconscious thoughts and feelings are hidden from view but continue to rumble in their own way, causing unhappiness and suffering in the form of maladaptive thoughts and behaviors.

Psychodynamic Psychotherapy and the Unconscious

In many ways, the psychodynamic psychotherapist is like the plumber you call to fix your leaky ceiling. You see the dripping, but you can't see the source; you can catch the drops in a pail, but that doesn't stop the flow. The plumber knows that the rupture lies behind the plaster, somewhere in pipes that as yet can't be seen. Here, though, the plumber has an advantage over the psychodynamic psychotherapist – he can use a sledgehammer to break through the plaster, reveal the underlying pipes, find and fix the offending leak, and patch the ceiling. But the psychodynamic psychotherapist is working with a human psyche, not a plaster ceiling, and thus requires more subtle tools to seek and mend what's beneath the surface.

Uncovering and Supporting

Like the plumber, the psychodynamic psychotherapist's first goal is to understand what lies beneath the surface – that is, to understand what's going on in the patient's unconscious. Many of the techniques of psychodynamic psychotherapy are designed to do just that. Once we think that patients are motivated by thoughts and feelings that are out of their awareness, we then have to decide how to use what we have learned in order best to help them. Sometimes we decide that making patients aware of what's going on in their unconscious will help. We call this uncovering – Freud called it “making conscious what has so far been unconscious” [3]. We have many techniques for helping patients to uncover – or become aware of – unconscious material. What we're uncovering are inner thoughts and feelings that they keep hidden from themselves but that nevertheless affect their self-perceptions, relationships with others, ways of adapting, and behavior.

Sometimes, however, we decide that making patients aware of unconscious material will not be helpful. We generally make this decision when we judge that the unconscious material could be potentially overwhelming. Then we use what we have learned about the unconscious to support functioning without uncovering thoughts and feelings. (See Chapter 18 for discussion of uncovering and supporting techniques.)

Here are two examples – one in which we would choose to uncover and one in which we would choose to support:

Ms A is a 32-year-old woman who has a trusting relationship with her husband, many close friends, and a satisfying personal career. In the past, she has used journaling, cooking, and athletics to work through short periods of anxiety. She presents to you complaining of insomnia that she believes has been triggered by a fight she is having with her younger sister, B. Ms A says that she's “mystified” by B's hostile behavior, which began about a month ago in the context of B's impending graduation from medical school. Further exploration reveals that although B wanted to become a dermatologist, she was not offered a position in this field and will have to do an interim year of internal medicine and then reapply. Ms A says that she has been very sympathetic about this setback and does not know why B is so hostile toward her. When you ask about their earlier relationship, you discover that Ms A has cruised effortlessly from one Ivy League institution to another, while B has struggled academically. You hypothesize that B's hostility toward Ms A may be fueled by envy, and that Ms A has been unconsciously keeping herself from becoming aware of this out of guilt. You think that Ms A will benefit from learning about her unconscious guilt and decide to help her uncover it. Once she grapples with her guilty feelings, she is able to recognize her sister's hostility and envy. This awareness helps her to understand their recent interpersonal difficulties and resolves the insomnia.

Ms C is a 32-year-old woman who is isolated, moves frequently from job to job, and often reacts to stress by binge eating and purging. She presents to you complaining of insomnia that she believes has been triggered by a fight with her younger sister, D. She says that she is shouldering the entire burden of caring for their chronically ill mother while D “just sits in her suburban home with the other soccer moms and sends checks.” Ms C, who is struggling to make ends meet, tells you that she thinks that her sister, who is married to a very wealthy man, is “shallow and materialistic” and that she “wouldn't switch lives with her if you paid me.” She says that she is “enraged” at D for not doing more to help their mother and that ruminations about this are causing her to stay awake at night. You hypothesize that Ms C's rage is fueled by envy of D, but you decide that learning about the way in which this might be contributing to the insomnia will not help her at this time. Instead, you decide to support Ms C's functioning by empathizing with the amount of work she is doing to care for her ailing mother, and by suggesting that she use her mother's Medicare benefits to get some help with eldercare. Once she feels validated, Ms C relaxes, her insomnia resolves,...

Produkt-Details

• Erscheint lt. Verlag: 26.7.2016
• Co-Autor: Sabrina Cherry, Carolyn J. Douglas, Anna R. Schwartz
• Sprache: englisch
• Themenwelt: Geisteswissenschaften ► Psychologie ► Psychoanalyse / Tiefenpsychologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
• Schlagworte: Depth Psychology • Individual Psychotherapy • intervening • listening • Medical Science • Medizin • Psychiatrie • Psychiatry • Psychoanalysis • psychoanalytic therapy • Psychodynamic Psychotherapy • Psychologie • Psychology • Psychotherapie u. Beratung • psychotherapy • Psychotherapy & Counseling • Reflecting • Social Policy & Welfare • Social Work • Sozialarbeit • Sozialpolitik u. Wohlfahrt
• ISBN-10: 1-119-14199-0 / 1119141990
• ISBN-13: 978-1-119-14199-0 / 9781119141990