L5 - Psychodynamic approaches

• [Jung's psychological types]

  2 attitude  types based on habitual direction of an individual’s interests:

  • Intraversion
  • Extraversion
• [Jung's psychological types]

  4 function types based on an individual’s predisposed/preferred mode of mental processing:

  • Thinking
  • Feeling
  • Sensation
  • Intuition

  Everyone has all functions, but 2 are well-developed while other 2 remain mostly unconscious in the shadow
• [Attitude types]

  Extraversion

  • I am seen as "outgoing" or as a "people person."
  • I have a wide range of friends and know lots of people.
  • I feel comfortable in groups and like working in them.
  • External objects
  • Open, sociable, quarrelsome
• [Attitude types]

  Introversion

  • I am seen as "reflective" or "reserved.“
  • I prefer to know just a few people well.
  • I feel comfortable being alone and like things I can do on my own.
  • Inner world
  • Reflective, hesitant, reserved
• [Function Types] Rational

  Thinking

  • I make decisions with my head and want to be fair.
  • I believe telling the truth is more important than being tactful.
  • I can be seen as too task-oriented, uncaring, or indifferent.
  • Reflective thinking
• [Function Types] Rational

  Feeling

  • I make decisions with my heart and want to be compassionate.
  • I believe being tactful is more important than telling the "cold" truth.
  • I am sometimes experienced by others as too idealistic, mushy, or indirect.

  Values arising from feeling
• Rational function types lead to reasoning + judging functions
• Irrational function types are associated with intensity of perception rather than rational judgement
• [Function types] Irrational

  Sensing

  • I solve problems by working through facts until I understand the problem.
  • I am pragmatic and look to the "bottom line."
  • I start with facts and then form a big picture.
  • Function of the senses
• [Function types] Irrational

  Intuiting

  • I solve problems by leaping between different ideas and possibilities.
  • I am interested in doing things that are new and different.
  • I like to see the big picture, then to find out the facts.
  • Hunches + insights
• 8 possible combinations of psychological types
• Expression or ‘form’ of mental distress varies based on a person’s Psychological Type.
• [Mental distress] - Jungian therapy

  NOT consistent with medical model - ‘…problem is always the whole person, never the symptom alone.’

  ‘We discover nothing new and unknown in the mentally ill, rather we encounter…our own natures.’
• Hysteria and schizophrenia – extreme persistent expressions of two basic attitudes

  Hysteria

  • Extreme extraversion
  • Libido withdrawn from inner world
  • Over-concern with influence in social relationships (living in persona)

  Schizophrenia

  • Extreme introversion
  • Libido withdrawn from reality
  • World of fantasy and archetypes (living in unconscious)
• [Jungian therapy] view on neuroses

  Mental health/distress – balance or imbalance between needs of the individual and demands of collective.

  Neuroses: homeostatic imbalance between conscious and unconscious.

  Symptoms are a form of adaptation ‘created’ as part of individuation.
• [View on neuroses]

  Freud - Early childhood, backward looking, reductive

  Jung - Any stage in life cycle, forward looking, adaptive
• [Goals of therapy]

  Attain specific goals, deal with complexes, strengthen consciousness.

  Understand own inner being and meaning of lives.
• [Goals of therapy]

  • All stages of life (two-thirds in second half of life).
  • One-third – no clinical neuroses.
  • Self-actualization, new balance
• Therapeutic process

  Individual

  Eye-to-eye

  2/3 sessions/wk

  Break after 10 wks

  Not a ‘cure’ - better able to deal with life’s challenges; better integration of conscious and unconscious
• 1.   Confession – share secrets.

  2.   Elucidation – therapist ‘interprets’.

  3.   Education – new and adaptive habits.

  4.   Transformation – individuation, acceptance of self.
• Analysis of transference – understand projections that take place from client to therapist.
• Active imagination – get in touch with unconscious material

  • May use dreams as a starting point.
  • Allow unconscious to produce series of images.
  • ‘the art of letting things happen’.
  • Integrate unconscious and conscious.
• [Dream analysis]

  Amplification

  • Elaboration and clarification of dream images to establish context.
  • Directed association
• [Dream analysis]

  Interpretation

  • Keep record of dreams and interpretations (dream series).
• [Dream analysis]

  Assimilation

  Client and therapist make conscious sense of dreams.

  Client’s assent of therapist’s interpretation.
• Does psychotherapy work?

  Eysenck (1952) – ‘The effects of Psychotherapy: An evaluation’

  
• Randomised controlled trials

  internal validity

  
• Average person receiving treatment is better off than 75% of untreated individuals (Smith & Glass, 1977).

  
• Traditional Psychoanalytic Pychotherapy AND more contemporary and specific approaches, e.g. STPP; CAT; MBT; PIT.

  Share features that differentiate from other types of therapy, e.g.

  • focus on expression of emotion.
  • avoidance of distressing thoughts/feelings.
  • discussion of past experience.
  • focus on therapeutic relationship).
• • Evidence for Psychodynamic Therapies – limited.•

  BUT – research less supported by Psychodynamic therapists?   – privacy in therapy; can it measure important benefits?

  • Some research – little difference across therapies (e.g. Wampold, 2001).
  • Where there are differences, Cognitive or Behavioural approaches usually favoured (Lambert & Ogles, 2004).
• Evidence-Based Treatments (EBTs)–Assumes we can classify mental health problems categorically.–Ensures that therapy offered has been shown to ‘work’.
•  Dare et al (2001) – Anorexia Nervosa

  • Compared focal STPP with other therapies.

  
• Dave et al (2001)

  • Approx 33% no longer met DSM criteria compared with 5% Routine.
  • Psychodynamic therapy effective when specific (Fonagy et al.,2005).

  
• Leichsenring (2001) – Depression

  • Meta-analysis of 6 RCTs comparing STPP with Cognitive Behavioural Therapy (CBT).
  • Overall, following STPP:
  • Reduction in depressive symptoms.
  • Reduction in general psychiatric symptoms.
  • Improvement  in social functioning.
  • No difference between CBT and STPP.
• Leichsenring et al (2015) and Fonagy (2014)

  • PDT largely effective for: depression, some anxiety disorders, anorexia nervosa, somatic disorders.
  • Lacks evidence for: OCD, PTSD, psychosis, bulimia nervosa, bipolar disorder.
• No evidence that psychodynamic approaches more effective in treating specific mental health problems
• [challenges]

  • Freud worked with a very narrow section of society – not representative.
  • Evidence that rates of mental distress/disorder differ based on factors such as ethnicity and cultural background.
  • Other factors such as age (children or older adults), and level of income may also affect how accessible and how effective psychotherapy can be.