Psychodynamic and Humanistic Frames of Reference Psychodynamic Frame of Reference 10/4/2012 Psychodynamic and Humanistic Frames of Reference OT 460A OT 460A

Background Roots in psychoanalysis Freud, Jung Principle developers: Gail Fidler and Anne Mosey Neo-Freudian/ humanistic/existential theory base Height of use- 1950-1970’s when hospitalizations were lengthy Goal: for patients to gain insight into their behavior through analysis of metaphor, mental states and general “inner life”. 10/4/12 OT 460A

Definition Perceptions, thoughts and feelings both conscious and unconscious influence one’s selection of, participation in, and satisfaction with occupation Humans create a relationship with the nonhuman and human environment satisfying needs, interests, and purpose Therapeutic activity facilities healthy emotional experiences, enhances self awareness. PD For can be used in a restorative model where some aspect of the person is expected to change. Can also be used to identify compensatory strategies, such as caregiver education, environmental/task adaptations. 10/4/12 OT 460A

Psychodynamic Frame of Reference Is the theoretical approach that views persons, media and activities as objects invested with psychic energy. Projective and functional tasks are used to promote self-awareness and identification of intrapsychic content Interaction with these objects is necessary to satisfy personal needs. Once basic needs are satisfied, energy is available for personal expression and balance 10/4/12 OT 460A

Psychodynamic FOR (cont’d) Activities are selected for their utility in enhancing interpersonal communication and facilitating healthy emotional experiences Activities are designed to lead to an understanding of patient needs, conflicts, feelings and behaviors Azima and Fidler as well as Mosey (1970) used it to describe an eclectic approach that included Jung, Freud, Humanistic and Existential influences from psychology and medicine 10/4/12 OT 460A

Applications of the psychodynamic approach Means for understanding feelings, thoughts, behaviors Alters the therapists styles of relating within occupation Provides a framework for understanding how occupation becomes meaningful to all persons underscoring the “person’s experience of illness” and their perceptions of occupational choices Speaks to the significance of therapeutic relationship 10/4/12 OT 460A

Applications of the psychodynamic approach Proper use requires specialized training Helps therapists work with people who have a psychodynamic explanation for their behavior. (e.g. anxiety, PTSD, abuse, dissociative disorder, eating disorders, borderline personality disorder) Useful means for OT’s to evaluate confusing behavior or to understand the “why” behind a behavior 10/4/12 OT 460A

Defense Mechanisms Understanding the function of defense mechanisms is useful in therapeutic relationships Individuals may protect selves from anxiety by using “defense mechanisms” Some defense mechanisms are healthy and some are not Defense mechanisms are grouped into a hierarchy according to phases of maturity associated with them 10/4/12 OT 460A

Defense Mechanisms Narcissistic mechanisms: Denial: failure to acknowledge the existence of some aspect of reality (e.g., substance abuse) that is apparent to others Projection: Attributing attributes or unacknowledged feelings, impulses or thoughts to others Splitting: Rigid separating of positive and negative thoughts and feelings 10/4/12 OT 460A

Defense Mechanisms Immature mechanisms: Passive-aggression: aggression towards others which is indirectly or unassertively expressed Regression: returning to earlier stage of development to avoid the tension and conflict of the present one Somatization: Conversion of psychological symptoms into physical illness 10/4/12 OT 460A

Defense Mechanisms Neurotic mechanisms Rationalization: creating self-justifying explanations to hide real reason’s for own or another’s behavior Repression: blocking painful memories and anxiety provoking thoughts from memory Displacement: redirecting emotions or reactions from one object to a similar but less threatening one Reaction Formation: switching of unacceptable impulses into its opposite 10/4/12 OT 460A

Defense Mechanisms Mature mechanisms: Humor: using comedy to express feelings and thoughts without provoking discomfort in self and others Sublimation: redirecting energy from socially unacceptable impulses to socially acceptable activities, e.g., sports Suppression: Consciously or semi-consciously avoiding thinking about disturbing problems, thoughts, or feelings 10/4/12 OT 460A

Defense Mechanisms Psychotic Immature defenses: Personality Disorders Delusional projection, distortion, psychotic denial Immature defenses: Personality Disorders Projection, fantasy, hypochondriasis, passive aggression, acting out Neurotic defenses: Anxiety Disorders Displacement, isolation of affect (intellectualization), repression, reaction formation Mature defenses Altruism, sublimation, suppression, anticipation, humor 10/4/12 OT 460A

Early Model of OT (Psychodynamic): Projective activities Therapeutic milieu/ community Task oriented group: purposeful activities Activity dynamics and awareness 10/4/12 OT 460A

Current Concepts in OT: Mix psychodynamic and humanistic Person and behavior Dynamic Energy System Psychodynamic beings and Choices Process of Self Actualization Implications for Research 10/4/12 OT 460A

The role of the OT: Mutual Responsibility Behavior Awareness through Activity Participant Observer 10/4/12 OT 460A

Role of Activities in Humanistic FOR: Appropriate expression of feeling Activity Process Regaining a sense of control 10/4/12 OT 460A

Role of activities (Cont’d) Improving Ego function- Through gaining proficiency and skills. Offering a Choice Seeing Oneself in a new way Processing the activity 10/4/12 OT 460A

Theoretical Assumptions of the Humanistic FOR: pt. is valuable pt is capable of logical thinking and increased understanding pt’s perception of his/her reality is more valid than a diagnosis pts most pressing needs must be dealth with first pt’s sense of wholeness though 10/4/12 OT 460A

Treatment in the Psychodynamic FOR: Goals: Therapist Responsibility: Specific Tx Objectives Impact of Group Process in Treatment 10/4/12 OT 460A

Contributions of the psychodynamic FOR: Provides a vocabulary for understanding the subjective nature of clients with regard to their history, past experiences, meaning, etc... Positive emphasis Emphasizes the importance of the therapeutic relationship- supports client-centered care Increased understanding of behavior 10/4/12 OT 460A

Limitations of Psychodynamic and Humanistic approaches May take longer Research needed to evaluate outcomes Risk drawing false conclusions if not checked with client Client needs capacity for insight 10/4/12 OT 460A