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

2. Background Roots in psychoanalysis
Freud, Jung
Principle developers: Gail Fidler and Anne Mosey
Neo-Freudian/ humanistic/existential theory base
Height of use ’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

3. 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

4. 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

5. 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
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OT 460A

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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
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OT 460A

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

15. 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
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OT 460A

16. The role of the OT: Mutual Responsibility
Behavior Awareness through Activity
Participant Observer
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OT 460A

17. Role of Activities in Humanistic FOR:
Appropriate expression of feeling
Activity Process
Regaining a sense of control
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OT 460A

18. 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
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OT 460A

19. 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
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OT 460A

20. Treatment in the Psychodynamic FOR:
Goals:
Therapist Responsibility:
Specific Tx Objectives
Impact of Group Process in Treatment
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OT 460A

21. 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

22. 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