In the essay, “Basic concepts of psychodynamic psychotherapy” I have delved deep into the concept psychodynamic psychotherapists. Who are they? What is their role and how they help emotionally disturbed patients. Freud was the first to formulate the concept psychodynamic psychotherapy and then with the passage of time, many types of therapies have been conceived.
It is based on the simple concept that we all are emotionally related to each other and these emotions may from time to time create disturbances in our daily lives, which we are unable to find out.
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Therapists help us to find these problems and give the solutions. But there are certain problems too in the treatment process in the various concepts of Psychodynamic psychotherapy. These problems can arise due to transference, counter-transference, defense and resistance. All in all, this essay will be beneficial for all the people concerned and students of psychotherapy. Introduction: Psychodynamic psychotherapy involves patients to understand their emotional turmoil and effectively deals with them.
It is a therapy provided to the young adults to help them deal with the emotional problems arising out of the depression and anxiety caused due to the relationship problems either with family, peers, friends, or professors. It is a method of verbal communication enabling patients to get relief from emotional pains. People go for psychodynamic psychotherapy for number of reasons like prolonged sadness, anxiety, sexual frustration, physical symptoms without any basis, continuous feelings of isolation and loneliness, and an ardent desire to achieve more success in work and love.
People ask for therapist, as they cannot solve the resolution in the time of their difficulties in their own way. The roots of the concepts psychodynamic psychotherapy had arisen out of the theories and techniques of psychoanalysis. As said by Nancy McWilliams, “Psychoanalytic therapists, including psychoanalysis, are approaches to helping people that derive ultimately from the ideas of Sigmund Freud and his collaborators and his followers”. (McWilliams, 2004, p. 1)
The overall theme of the psychodynamic approach of helping people is based on the simpler premises that the more we are honest with ourselves, the more we have chances of living a better, satisfied and useful life. Psychoanalytical and clinical writing espouses from within our unconscious level those aspects that we have not realized or are not evident and if we are aware of these disavowed aspects, we will get relief from emotional pain and also from the time and energy spent to keep ourselves at unconscious level.
Michael Guy Thompson and the inheritors of Rieff argued that psychoanalysis as a field has adorned an ethic of honesty as a means to achieve therapeutic goals. Thomas Szasz in 2003 defined psychoanalysis as a “moral dialogue, not a medical treatment. ” (McWilliams, 2004, p. 2) Since decades therapists have personified themselves as most honest in their personal analysis with the patients and also fostering the achievements as a result of the same. (McWilliams, 2004) There are differences in the goals of therapy depending on the methods of treatment that could be either expressive or supportive.
Expressive therapy enables the patients to relieve themselves from symptoms through the development of awareness of feelings and thoughts. The therapy is based on the concept that difficulties, which are experienced by the adults have their emergence in childhood; children neither possess the ability of making suitable choices for themselves nor they have an independence to follow the same and the methods that are developed in the childhood are no longer effective during adulthood.
With counselling, adults get to know the ineffective ways they had been adopting and today’s ways of adoption to come out of the various problems and hurdles. Another is supportive therapy, more relevant to give patient immediate relief. Therapist adopts this approach with the previous level of functioning of a person and helps him to strengthen the ways already been adopted by him. While many patients can get benefited from one treatment but in several cases, other therapies may also be involved like family therapy, couple therapy, or group therapy, which could be separately given and also in combination.
Concepts of Psychodynamic psychotherapy Psychodynamic psychotherapy provides a unique model for the mental functioning involving five key concepts, and these are: “Unconscious processes in the mental level; Transference; Counter-transference; Defense and resistance; and the past repeating itself in the present. ” (Yager, Mellman & Rubin, 2005, p. 340) 1. Unconscious processes in the mental level “Unconscious is an adjectival description of areas of mental experience not available to normal awareness”. (McGrath & Margison, 2000) It is the part of the mental process about which we are not aware of.
There could be different levels of unconscious mental activity including our inability to realize what is going on in our mind and secondly partial awareness. Most of the Freud’s writings were based on this unconscious level of mind, which is “a reservoir that contained dynamically repressed contents that were kept out of awareness because they created conflict. ” (Gabbard, 2004, p. 3) Freud’s earlier attempts were his efforts to bring out to surface the unconscious part of our mind for easily identifying the problem and understanding it in a better way.
Freud formulated what is known as the topographical model and the structural model. The topographical model describes the parts of the mind that functions at various levels of consciousness and creates awareness of the same. It reveals and studies the quality that is playing its part in the mental processes rather than function it is playing. On the other hand is the structural model, which delves into the three important parts of the personality i. e.
id, ego and superego and they perform motivational, interactive and executive functions. In the structural model, ego is shown as different from aggressive and sexual drives. Freud explains that, “The conscious part of the ego involves that part of the mind, which performs the function of decision making, integration of perceptual data, and the mental calculation whereas the unconscious part of the ego involves defense mechanisms that are designed to counteract the power instinctual derives harbored in the id”. (Gabbard, 2004, p.
4) Sexuality and aggression are drives requiring deep level defensive efforts from the ego to prevent them from becoming intrusive to the person’s functioning. According to Freud, unconsciousness continues to create an influence on our behavior even though we are unaware about it. For e. g. during one of the clinical trials, I studied the patient’s problem on his communication process. I assumed that the patient’s verbal and nonverbal communication to us was unconsciously organized, and consciously as well as unconsciously had certain meaning.
This meant from his speech and non-verbal behavior, I had to find out the central conflict patient was undergoing through unwillingly organized thoughts, feelings and behaviors in his relation to the persons he was concerned. When I listened to the patient, certain portion of this conflicting tendency in his mental power was quite visible. This could be in the form of phrases, images, nonverbal behaviors etc. These signs help in interpreting the root cause of the problem. After the thorough investigation of the verbal phrase, I interpreted that his focal conflict was related to his phallic competitive wishes.
But it was not clear whether his phallic conflicts were regressive arising from his struggle or he went to an extent of powerful regression towards the sadistic tendency. In other words, it was not clear that his difficulty with phallic competitive feelings toward males had arisen from his feeling of jealousy or looking at them as rivals or his anxiety had arisen due to the sad feelings and his impulses. But one thing that I found was he often felt very anxious and often had a great feeling of anxiety over the affects and that could be created on his impulses by the people he thinks to be rivals.
Psychotherapeutic acts like a friend, and as said by must act like a therapeutic distance or therapeutic neutrality; never treating with any personal desires yet always maintaining the relationship with the patient focusing on the treatment process. 2. Transference Second concept is transference, involving the relationship client feels towards his psychotherapist. It is very natural for the client to experience the feeling of transference, also known as the transference reactions. These feelings are no less than in-depth feelings of love or hate.
Jacques Lacan, a psychoanalyst explains that this love means having a belief or faith in the other, in other words, the other person has knowledge you don’t have. (Wright, 1998) This intense belief on the part of the client can cause problem that should be solved during the process psychotherapeutic treatment. For e. g. these feelings could be mixed feelings of love and hate that can arise out of the relationship problems with parents and they look at therapist with these mixed feelings. In such a situation, there is a need to realize that psychotherapist is only trying to reduce these feelings.
A patient also begins to feel that the psychotherapist has a personal ability to come out of the sense of inner worthlessness and there can be fondness and even sexual attraction with the psychotherapist. This happens as the therapeutic cure comes from the emotional feeling and removes emotional emptiness. It is said if transference is not handled carefully it can lead to disaster consequence. For e. g. many patients have their lives ruined because psychotherapists play with the patients erotic feelings in a personal way and fail to make the client understand that it is the medical treatment.
In many cases transference can also make you frighten putting a stop to the treatment prematurely. For e. g. it was October 18th 2000, I had one patient in my clinic that most of the time got into the fits of anxiety and depression. I lovingly asked him several questions and during the process, I found he had an odd problem with his parents. He acknowledged the fact that his parents loved him but at the same time was always had a feeling of insecurity, anger and confusion towards his parents thinking they didn’t love him as much as they loved their other children.
The first thing about him that came to my mind was he had a craving for love and it was love he needed the most. He was fourteen years old boy with smart and innocent boyish look in his face, with black and blonde hair. So my initial step of treatment started by getting emotionally close to the patient, and I initiated to give the parental care he craved for, understand his differences with his parents and try not to repeat the same mistakes what he felt his parents were doing.
Slowly, his signs of depression began to reduce and he felt more relaxed and tension free. My more and more closeness with him created a situation of transference, as I soon realized he was not able to spend even few minutes of his time without calling me or having a talk with me. He was now looking at me as his saviour and parents. I soon realized this would create a more problem if I leave him, as he could feel sadder and get into more depression. I then called his parents, discussed problem with them and explained them the importance and real meaning of love.
Love means not just fulfilling the responsibilities but also coming close to your child, keeping your hands on his head and saying, “I am with you. ” These are magical words best than the medicine that can reduce the emotional pains and can trigger the self-confidence and faith in others and oneself. I gave his parents some tips to follow and soon they realized it. This was the beginning of new life for my patient as he felt more relaxed, happy and relieved from all the pains and I slowly and slowly made him realize I was only his doctor and had to go.
3. Counter-transference Counter transference is a reverse of the transference. This is described for the reactions and the emotional and unconscious reactions that can be felt by psychotherapist for his client. If these feelings are taken personally then psychotherapist can get into angry bout, abusive, spiteful, indifferent, or even seductive and if the counter-transference gets very deep and intense, then psychotherapist has to stop the treatment himself and get his patient referred to someone else for client’s protection.
Counter-transference should be distinguished from the feelings he generated during the process of treatment, because these feeling are used for treatment. At this point we can say that feelings generated by psychotherapists could be good as well as bad as both the extremity of the emotional feelings can have adverse effect on both the psychotherapist as well as on the part of patient. With the patient I mentioned above, I also began to feel emotional closeness but I controlled my emotions and with some careful analysis of the situation and adopting the balanced approach I dealt with him.
4. Defense and resistance Yet another therapeutic concept needs to be undertaken is defense and resistance. Freud defines resistance as “whatever interrupts the progress of analytic work, like getting late, missing a session, or avoiding a particular issue”. (Fink, 1997, 230) Simply defense and resistance occurs owing to the fear and fear we have to face and relinquish from the anger of the victim. In other words, the treatment task is very complex and frightening and there is often the fear of facing the anger of a patient and overcoming an inclination to lie to yourself.
Nonetheless Lacan said resistance should be distinguished from defense, and gave the statement that “there is no other resistance to analysis than that of the analyst himself. ” (Fink, 1997, p. 225) For e. g. if the psychotherapist makes interpretation or makes intervention, which seemed to be not proper clinically, the client can be defensive and that can cause interruption in the work of therapists. In other words client will only get into the process of treatment when he himself feels comfortable about. The psychotherapist must feel the awareness of the fact that to what extent of the treatment process client is willing to go.
Attempts to forcefully get client deep into the treatment process without getting him emotionally prepared can result in the client getting away from the treatment itself. In my case during the initial visit of the client, he showed reluctance in the treatment process. He often came late from the time schedule and felt hesitant in disclosing. I assured him the best of my treatment and with great patience and slight conversations slowly yet steadily made him come closer to the treatment process. Then I was comfortable with me and he too was finding comfort in the treatment.
5. The past repeating itself in the present In the psychodynamic language, it implies the past experiences of the patient continue to haunt him in the present. This happens with most of the suicidal patients - the past horrible experiences of the patients may continue to haunt him in his unconscious level. This may cause resistance on the part of the patient and treatment may suffer. In the clinical words, the transference to the clinician may have a major impact on the treatment, and counter – transference may also occur in subsequent time duration.
(Gabbard & Allison, 2006) During the treatment period, practitioners have to face this situation and have to look into the patient’s past to bring out the root cause of his present situation and formulate this phase also. This process of integration of the past with the present is very painful thing for patients and in severe cases they can get emotionally disturbed, more depressive, anxious and can be aggressive, but nonetheless it is a temporary phase. I still remember she was nineteen years old and had gone into deep depression.
When I asked about her past life, she entered into deeper state of depression and got completely silent and saddened and scared. I tried to relive her and promised not to ask about her past. She then slowly recovered herself, came back to normal and then after few days told me about her past. The treatment psychodynamic psychotherapy is all about the treatment of caring and love. In number of upheavals in our life, we need someone who can listen to us and care for us and here psychotherapist role starts. They listen to us and strive to give us good hearing and relieve us from emotional pains.
But, finally it is you only who is a healer and psychotherapist is only a guide who can take you on a self-guiding path. . Reference List Busch, F. N. & Milrod,B. L. 2008. Panic-Focused Psychodynamic Psychotherapy. Psychiatric Times. 25 (2). Corradi, R. B. (2006). Psychodynamic Psychotherapy: A Core Conceptual Model and Its Application. Journal of American Academy of Psychoanalysis, 34:93-116. Fink, B. 1997. A Clinical Introduction to Lacanian Psychoanalysis: Theory and Technique Harvard University Press. Gabard, G. O. & Allison, S. (2006). Psychodynamic Treatment.
In Robert I. Simon, Robert E. Hales (Eds. ) The American Psychiatric Publishing Textbook of Suicide Assessment and Management: assessing the unpredictable. Arlington, VA: American Psychiatric Publishing, Inc. , 221-234. Gabbard, G. O. (2004) Long-Term Psychodynamic Psychotherapy: A Basic Text. Arlington, VA: American Psychiatric Publishing, Inc. McGrath, G. & Margison, F. (2000) An Introduction to Psychodynamic Psychotherapy: BASIC PSYCHODYNAMIC CONCEPTS I. Retrieved on September 25, 2008 from W. W. W: http://www. geocities. com/nwidp/course/basic1. htm
McWilliams, N. (2004) Psychoanalytic Psychotherapy: A Practitioner's Guide. New York: Guilford Press. Shervin, H. , Bond, J. A. & Brakel, L. A. W. 1996. Conscious and Unconscious Processes: Psychodynamic, Cognitive, and Neurophysiological Convergences. New York: Guilford Press Wright, Elizabeth. 1998. Psychoanalytic Criticism: A Reappraisal. London & New York: Routledge. Yager,J. Mellman,L. & Rubin, E. 2005. The RRC Mandate for Residency Programs to Demonstrate Psychodynamic Psychotherapy Competency Among Residents: A Debate. Academic Psychiatry, 29:4, p. 339-349.
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