Psychotherapy – Flashcards
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4. Notes on Counter-transference (Kernberg) a. Compare and contrast the classical and totalistic positions on counter transference discussed by Kernberg. b. How is projective identification related to empathy?
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Countertransference[1] is defined as redirection of a psychotherapist's feelings toward a client—or, more generally, as a therapist's emotional entanglement with a client. 1. Classical concept of counter-transference: as the unconscious reaction of the psychoanalysis to the patient's transference. This approach stays close to the use of the term as first proposed by ·Freud· (8) ·and to his recommendations that the· analyst .overcome his counter transference. This· approach also tends to view neurotic conflicts of the analyst as the main origin of the counter-transference~ 2. The second approach, totalistic: Here counter transference is viewed as the total emotional reaction of the psychoanalyst to the patient in the treatment situation. This school of thought believes that the analysts conscious and unconscious reactions to the patient in the treatment situation are reactions to the patients reality as well as to his transference, and also to the analysts own reality needs as well as to his neurotic needs. This second approach also implies that these emotional reactions of the analyst are intimately fused, and that although counteroffensive should certainly be resolved , it is useful in gaining more understanding of the patient. In short, this approach uses broader definitions of counter-transference and advocates a more active technical use of it. Some radical proponents of this approach. (broadens) totallistic ... women beat me, so all women beat me classical... a kid picked on me, i forgot 10 years later , a patient picked on a kid and I subconciously become bias towards the patient.
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4.B b. How is projective identification related to empathy?
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It is important to be aware that the aim of projective identification in therapy is as an affective communication to evoke empathy and understanding as well as to secure a container outside of oneself, which will hold and manage the unwanted feelings. The projector, with a certain attitude and behaviour, exerts unconscious pressure on the therapist to accept and identify with the projections and has a fantasy of inhabiting not only the mind but also the body and emotions of the receiver.
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3. Common Factors of Psychotherapy a. Describe what is meant by the "therapeutic alliance" and identify at least 4 components in establishing a "therapeutic alliance". b. List and describe the 6 common factors of psychotherapy that are considered most comprehensive by the authors of this article
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refers to the relationship between a healthcare professional and a client (or patient). It is the means by which a therapist and a client hope to engage with each other, and effect beneficial change in the client. 1. expression of'feelings and thoughts (Rosenzweig 1936). 2 self ·examination and self-understanding (Rosenzweig 1936). 3.Providing a 'rationale that includes a plausible system of explanation of the Patient's problems or distress (Frank and Frank 1991). 4 .. Strengthening the patient's expectations of help, the arousal of hope (Frank and Frank 1991). 5. Encouragement of mastery efforts and testing different approaches and solutions(Lambert 1986) 6. Patient Therapist or helping relationship (Frank and Frank1991) _________________________________ In a recent review of the literature, Gaston (1990) identified four important dimensions that have been repeatedly used to define alliance: 1) the patient's effective bond to the therapist and commitment to therapy (e.g., Luborsky 1976); 2) the patient's capacity to work purposefully in therapy (e.g., Frieswyk et al. 1986), 3) the therapist's emphatic understanding and involvement (e.g., Rogers 1957), and 4) the agreement of patient and therapist on the tasks and goals of therapy (Bordin 1979).
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5. Countertransference: A cognitive perspective a. Discuss the fundamental principles of cognitive therapy , which are inconsistent with psychodynamic therapy. Include why they are inconsistent. b. What is the therapy belief system (TBS) as described by the authors and how is it used to conceptualize transference and countertransference?
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There are 3 basic underlying principles 1.(Cognition affects behavior) 2. Cognitive activity may be monitored and modified 3. By changing ones belief, one can exert desired changes in behavior and experiance more satisfying emotional reactions. active tacit conceptual framework
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6. Notes on Origins of Psychoanalysis Lectures 1 and 2: S. Freud a. Discuss the origins of hysterical symptoms, the role of emotion in those symptoms, the cathartic treatment, and the role of resistance and repression in those symptoms
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...Psychoanalysis is a set of psychological and psychotherapeutic theories and associated techniques, created by Austrian physician Sigmund Freud and stemming partly from the clinical work of Josef Breuer and others.[1] Over time, psychoanalysis has been revised and developed in different directions. Some of Freud's colleagues and students, such as Alfred Adler and Carl Jung, went on to develop their own ideas independently. Freud insisted on retaining the term psychoanalysis for his school of thought, and Adler and Jung accepted this.[2] The Neo-Freudians included Erich Fromm, Karen Horney, and Harry Stack Sullivan. The basic tenets of psychoanalysis include: 1 a person's development is determined by often forgotten events in early childhood rather than by inherited traits alone. 2 human attitude, mannerism, experience, and thought is largely influenced by irrational drives that are rooted in the unconscious 3 it is necessary to bypass psychological resistance in the form of defense mechanisms when bringing drives into awareness 4 conflicts between the conscious and the unconscious, or with repressed material can materialize in the form of mental or emotional disturbances, for example: neurosis, neurotic traits, anxiety, depression etc. 5 liberating the elements of the unconscious is achieved through bringing this material into the conscious mind (via e.g. skilled guidance, i.e. therapeutic intervention).[3]
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7. Discuss the origins of psychopathology, treatment goals and what helps the client reach mental health according to Adler.
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...two conditions are present... 1. an exaggerated inferiority 2. insufficient developed feeling in community The ultimate goal is helping an individual develop from a partially functioning person into a more fuly functioning one. empathy relationship information clarification encouragement stage recognition stage knowing stage missing experiance stage doing different stage reinforcement stage community goal directing support and launching stage.
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8. Compare and contrast the Adlerian approach to cognitive, psychodynamic and emotion-focused approaches?
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The Person Centred Approach (Originator: Carl Rogers 1902 - 1987) focuses on the belief that we are all born with an innate ability for psychological growth if external circumstances allow us to do so. Clients become out of touch with this self-actualising tendency by means of introjecting the evaluations of others and thereby treating them as if they were their own. As well as being non-directive the counselling relationship is based on the core conditions of empathy, congruence and unconditional positive regard. By clients being prized and valued, they can learn to accept who they are and reconnect with their true selves. The Psychodynamic Approach (Originator: Sigmund Freud 1856 - 1939) focuses on an individual's unconscious thoughts that stem from childhood experiences and now affect their current behaviour and thoughts. The urges that drive us emanate from our unconscious and we are driven by them to repeat patterns of behaviour. Therapy includes free association, the analysis of resistance and transference, dream analysis and interpretation and is usually long term. The aim is to make the unconscious conscious in order for the client to gain insight. Cognitive Behavioural Therapy (Contributors: Ellis 1913 - ; Beck 1921 - ) focuses on how an individual's thoughts and perceptions affect the way they feel (emotions) and behave. We are reactive beings who respond to a variety of external stimuli and our behaviour is a result of learning and conditioning. Because our behaviour is viewed as having being learned, it can therefore be unlearned. By helping clients to recognise negative thought patterns they can learn new positive ways of thinking which ultimately will affect their feelings and their behaviour. An Adlerian therapist assists individuals in comprehending the thoughts, drives, and emotions that influence their lifestyles. People in therapy are also encouraged to acquire a more positive and productive way of life by developing new insights, skills, and behaviors. These goals are achieved through the four stages of Adlerian therapy: Alderian Adler was a pioneer in the area of holistic theory on personality, psychotherapy, and psychopathology, and Adlerian psychology places its emphasis on a person's ability to adapt to feelings of inadequacy and inferiority relative to others. He believed that a person will be more responsive and cooperative when he or she is encouraged and harbors feeling of adequacy and respect. Conversely, when a person is thwarted and discouraged, he or she will display counterproductive behaviors that present competition, defeat, and withdrawal. When methods of expression are found for the positive influences of encouragement, one's feelings of fulfillment and optimism increase. Adler believed strongly that "a misbehaving child is a discouraged child," and that children's behavior patterns improve most significantly when they are filled with feelings of acceptance, significance, and respect. A teen speaks to her therapistAdler believed that feelings of inferiority and inadequacy may be a result of birth order, especially if the person experienced personal devaluation at an early age, or they may be due to the presence of a physical limitation or lack of social empathy for other people. This method of therapy pays particular attention to behavior patterns and belief systems that were developed in childhood. Clinicians who use this form of therapy strongly believe that these strategies are the precursors for later self-awareness and behaviors and are directly responsible for how a person perceives themselves and others in their life. By examining these early habitual patterns, we can better develop the tools needed to create our own sense of self-worth and meaning, and ultimately create change that results in healing. Engagement: A trusting therapeutic relationship is built between the therapist and the person in therapy and they agree to work together to effectively address the problem. Assessment: The therapist invites the individual to speak about his or her personal history, family history, early recollections, beliefs, feelings, and motives. This helps to reveal the person's overall lifestyle pattern, including factors that might initially be thought of as insignificant or irrelevant by the person in therapy. Insight: The person in therapy is helped to develop new ways of thinking about his or her situation. Reorientation: The therapist encourages the individual to engage in satisfying and effective actions that reinforce this new insight, or which facilitate further insight
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10. List and describe the 3 essential conditions for therapy according to Rogers.
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1 Congruence - the willingness to transparently relate to clients without hiding behind a professional or personal facade. 2 Unconditional positive regard - the therapist offers an acceptance and prizing for their client for who he or she is without conveying disapproving feelings, actions or characteristics and demonstrating a willingness to attentively listen without interruption, judgement or giving advice. 3 Empathy - the therapist communicates their desire to understand and appreciate their clients perspective.
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11. What are the 6 steps Rogers identifies for successful therapy?
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1. repor is astablished 2. free expression 3. acceptance of self 4. responsible choices 5. the gaining of insight 6. growing into independance
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12. You ask Carl Rogers to interview a client and determine a diagnosis. How do you think he will respond to that request?
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I think he would first ask me why I want a diagnosis.. Then I think he would ask me if I was 1.genuinely engaged in the therapeutic relationship 2.Had unconditional positive regard for the client 3. Felt empathy for the client 4. Clearly communicated these attitudes Once I said "no". I think he would ask me to return to the client and try this for myself and then return to him for further input. I think he would also emphasise how important it would be for client centered care and to not give up on my client and stick to the main 4 ideas above.
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13. Discuss the origin and definition of neurosis from a Gestalt perspective. How does it differ from the Freudian perspective?
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Neurotic disturbances arise from the individual's inability to find and maintain balance between himself and the world and the social boundary extends too far •Neurosis is a defensive maneuver to protect from excessive outside influence Neurosis occurs when outside influences impinge too much on the individual ex. ocd, perfectionism
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14. Describe the 4 mechanisms of creating neurosis from a Gestalt perspective. (introjection, projection, confluence, and retroflection)
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1. Introjection -Taking in outside standards without assimilation -outside boundry extends too far within the individual 2. projection -makes the enviornment responsible for something inside you 3. confluence -no boundary between self and environment * peak experience -neurosis occurs when chronic -cannot connect with others or self 4. Retroflection -Person in conflict with himself - I have to make myself do that -similar to Freuds concept of intrapsychic conflict.
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1. What is MI? a. Explain how MI conceptualizes and manages "denial" and "resistance" in a client. Our best current definition is this: Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with nondirective counselling, it is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal.
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Resistance and "denial" are seen not as client traits, but as feedback regarding therapist behaviour. Client resistance is often a signal that the counsellor is assuming greater readiness to change than is the case, and it is a cue that the therapist needs to modify motivational strategies. Resistance and denial often go hand.
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1. Ethics of MI a. Identify and explain the 4 mechanisms of change involved in MI (motivational interviewing). b. An ethical concern regarding MI is that it is coercive. Discuss the argument that MI is not coercive
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1. 2 3 4
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1. Ethics of MI a. Identify and explain the four mechanisms of change involved in MI. b. An ethical concern regarding MI is that it is coercive. Discuss the argument that MI is not coercive. · The accusation that MI is coercive is commonly comes from more psychodynamically trained professionals whose style to therapy is to explore client's offerings, without an overt attempt to altered what is offered. · Another concern with in this debate is, how do we decide what is manipulative? To say that a MI is manipulative, depends on (1) the accuracy of the description assertion and (2) agreement with the evaluative judgment. · It precisely when we have powerful treatments that our ethical responsibility as therapists becomes most apparent. Yet the very enterprise of psychotherapy is intended to bring about beneficial change. Aka " we hope that our treatments are manipulative; that is that they effectively alter behavior. 2. What is MI? a. Explain how MI conceptualizes and manages "denial" and "Resistance" in a client. · Practitioners have long recognized motivation as a key issue in addressing addictive behaviors , "denial is an obstacle to change". It is often characterized that denial is when the patient doesn't agree with the counselor, it is important to understand the clients perceptive as to what is "normal" when addressing a problem such as heavy drinking. . · Resistive bevahior is often seen as ambivalence, such as the client when confronted with one side of their issue often start to voice a rebuttle (the other side of the argument). · In either event of Denial or resistance the core problem is perceptual- the person see no need to change, and the other do perceive a problem and a need to change but are hesitant to make the change. · Sources include conscious lying, normal self-protective cognitive biases, genuine lack of awareness, or ambivalent counterreations. 3. Common factors of Psychotherapy. a. Describe what is meant by the "therapeutic alliance" and identify at least 4 components in establishing a therapeutic alliance. · Patients-therapist relationships (bond) may be the most important key in any psychotherapy. · Gaston (1990) identified four important dimensions that have been repeatedly used to define allinance (1) the patient's affective bond to the therapist and commitment to therapy. (2) the patients capacity to work purposefully in therapy. (3) the therapists empathetic understanding and involvement. (4) the agreement of patient and therapist on the task and goals of therapy. · Alliance is a highly predictor of cognitive therapy. · Contributing factors to the Alliance: o Patient personality: good interpersonal functioning related predicted good alliance. Patients with submissive interpersonal styles have better outcomes in short-term psychotherapy. o Therapist personalities: therapists with certain self-hostile introjects engage in greater frequencies of countertherapeutic interpersonal process, such as negative or complex communications. o Ruptures in the alliance and their resolution as a change event: confrontation of defensive behavior led to an improved therapeutic alliance and outcome, where as unimproved patients, the defensives were not addressed. Exploration of issues that come up in therapy may constitute a "corrective emotional response" which modifies the patient's generalized representation of self-others interactions. b. List six common factors of psychotherapy that are considered most comprehensive by the authors of this article. · (1) Expression of feelings and thoughts: allows for a cathartic or abreactive experience. "correctional emotional experience" · (2)self-examination and self-understanding: raising the individuals self-awareness, often results in enhanced self-esteem and an increased sense of mastery. · (3) providing a rationale that includes a plausible system of explanation of the patients problem or distress: · (4) Encouragement of mastery efforts and testing different approaches and solutions · (5) strengthening the patients expectations of help, the arousal of hope. · (6) patient-therapist or helping relationship 4. Notes on countertransference (kernburg) a. compare and contrast the classical and totalistic positions on countertransference discussed by kernberg. There are two types of countertransference, classical and totalistic. The classical view of countertransference is defined as the "unconscious reaction of the psychoanalyst to the patient's transference." Originally proposed by Freud, this view focuses in on the issues of the analysis or therapist. The Totalistic view of countertransference is "viewed as the total emotional reaction of the psychoanalyst to the patient in the treatment situation". In the totalistic view it is believed that the therapist is reacting to the patient consciously and unconsciously to the patients transference. · Some criticisms of the totalistic view is that the definition or term is used so broadly that the actual term countertransference looses its specific meaning and can become confusing. There are a few criticisms of the classical approach such as, the definition is too "restricted" and tends to blur the importance of countertransference. Another is that some focus on the analyst's emotional reactions can give clue to important aspects of the psychotherapy. Lastly, the more complex issues that patient has will "evoke intense countertransference reactions in the therapist..." b. How is projective identification related to empathy ? · Projective identification may be a form of the mechanism of projection, anxiety can provoke the projection to an object this is a chaotic interference within the ego. · Projective identification differs from projection in that the impulse projected on to an external object does not appear as some thing alien (it is relateable ) and distant from the ego because the onnection of the ego with that projection impulse still continues , snd thus the ego "emphathizes" with the object. 5. countertransference: a cognitive perspective. a. Discuss the fundamental principles of cognitive therapy, which are inconsistent with psychodynamic therapy. Include why they are inconsistent? · The drive theory in psychodynamic therapy is inconsistent with a number of the fundamental principles of cognitive therapy. 1, that individuals actively participate in the construction their reality. 2, the cognitive therapy is a meditational theory .3, that cognition is knowledgeable and accessible.4, that cognitive change is central to the human change process and finally. 5, that cognitive therapy adopts a present time frame. · Application of transference-countertransference constructs to cognitive therapy violates the principles summarized above in a number of ways. First, it diminishes the active role played by the patient in the constructing reality by emphasizing and pathologizing more passive, unconscious, and potentially inaccessible components. Second, the application of psychodynamic constructs in cognitive therapy provides oppurtonity to view emotion as the primary mediator and clouds the conceptual picture. Third, the psychodynamic constructs of transference -countertransference reactions imply that certain aspects of cognition are potentially inaccessible. Fourth, integration of psychodynamic theory elevates emotional processing to a more central role in the human change process than cognitive change. Finally, a focus on transference- countertransference reactions shifts the focus from here and now to the past in terms of understanding emotional dysphoria and psychopathology. b. what is the therapy Belief system (TBS) as described by the authors and how is it used to conceptualize transference and countertransference. · The TBS allows the therapist to address the therapeutic relationship at two levels (active and tacit), organizing content accessible at a conscious level characterized by automatic thoughts and related beliefs and assumptions, as well as conceptualized less accessible material consistent with core, tacit cognitive structures and underlying schemata. 6. Notes on origins of psychoanalysis lectures 1and 2, S. Freud. A. Discuss the origins of hysteria symptoms, the role of emotion in those symptoms, the cathartic treatment, and the role of resistance and repression in those symptoms.
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