1. Psychodynamic & Interpersonal Therapies
Melissa Stern
PSY 4930
October 24, 2006

2. History
Developed from adult techniques--psychoanalytic theory of Sigmund Freud
Late 1800s-early 1900s in Austria
Theory of development, personality, and psychopathology
This theory influences almost all psychological theories today!

3. Freud’s Psychoanalytic Theory
Id: predetermined set of psychological needs, drives, instincts
Seek pleasure, avoid pain
Superego: internalization of the moral principles/rules of society
“conscience”
Ego: awareness of one’s self and ability to interact with the world
Balances id and superego

4. Psychoanalytic Theory
The three aspects of personality inevitably come into conflict with each other
Conflict = anxiety
However, much of this conflict is unconscious due to defense mechanisms

5. Defense Mechanisms Denial Repression Intellectualization
Rationalization
Displacement
Sublimation
And many others…

6. Psychoanalytic Theory
Stage Theory of Development
Oral stage—sucking and feeding
Anal stage—control bodily functions
Phallic stage—Oedipus Complex
Latency phase
Genital phase
Individuals can become “fixated” at various stages if the issues at each stage are not mastered

7. Psychoanalytic Theory
Freud worked with only a few type of psychological conditions:
Conversion disorders
Hysterias
Most psychopathology involved underlying sexual or aggressive instincts
Rely on single case studies
Psychological or physical symptoms = internal conflicts

8. Psychoanalytic Theories
A variety of more recent theories were developed from Freud’s original ideas:
Erickson’s stage theory of psychological development
Object relations theory
Attachment theory
Interpersonal approaches

9. Psychoanalysis
Primary goal = help individuals achieve insight into the origins of their distress
Seeks to bring about more global personality changes
Methods used:
Hypnosis
Free association—to eliminate conscious control over thoughts
Dream analysis—ego controls are relaxed during sleep

10. Psychoanalysis
Resistance—patient is motivated to continue using defense mechanisms
Transference—patient “projects” their unconscious thoughts/feelings onto the therapist
Catharsis—experiencing of emotions previously repressed
Interpretations
Working through—repeated interpretations of patients behavior and feelings

11. Psychodynamic Psychoanalytic
Not so ambitious goals
Focused
Not so intensive
Less intensive therapist training
Flexible
Ambitious
Global
Intensive
Intensive therapist training
Focus on understanding origins
More rigid

12. Psychodynamic Approaches with Children
Assume that the child has deviated from normal development
Play is used as the child’s way of communicating
More focused on the development of a relationship with the child
Anna Freud, Melanie Klein

13. Change in Psychodynamic Therapies
Catharses & Labeling Feelings
Corrective Emotional Experiences
Insight and Working Through
Learning Coping Techniques
Development of Internal Structure
Other variables

14. Insight Oriented Therapies
Form of therapy most associated w/psychodynamic approach
Best for children with internalizing difficulties (most often recommended)
Anxiety
Trauma specifically
Depression

15. Insight Oriented Therapies
Use play and interpretation to work through internal conflicts
Conflict resolution is the goal
Child must:
Trust adults
Have some psychological mindedness
Use play effectively

16. Structure-Building Approaches
Best for children with problems in relationships (esp. with primary caregivers)
Goal is to help child separate and individuate from the parent
Object relations theory
Empathy is the focus rather than interpretation

17. Object Representations
The child must invest in the mental representation of the loved external object
Mental representation of primary caregiver

18. Object Representations:
Provide a feeling of safety
Establish internal regulatory functions
Promote ego autonomy
Serve as a model for character formation
Promote superego development
Provide an ego ideal
Enforce resolution of Oedipal wishes

19. Supportive Approaches
Best for externalizing problems
These children have not developed ability to delay gratification and have trouble empathizing with others
Viewed as a developmental problem!
Children recommended for this treatment are characterized as:
Egocentric
Demonstrate an absence of shame and guilt
Impaired ability to empathize with others

20. Supportive Approaches
Treatment focuses on problem solving and building coping skills
For example, role-play how to handle teasing at school
Focus is on the present not the past
Generally, supportive psychodynamic treatment is not the treatment of choice (CBT approaches much better)

21. Play as Therapy Play helps:
Foster communication and a relationship between child and therapist
Serve as a vehicle for change
During play, the therapist would use other techniques such as labeling, empathizing, and interpreting

22. Stages of Play Initial period of nonengagement
Early phase of affective engagement
Emergence of central fantasies
Period of working through

23. Initial Period of Nonengagement
Setting the stage
Setting expectations
Structure
limits
Meaningful play developed
Sometimes more structure
Sometimes less structure

24. Early phase of Affective Engagement
Child becomes attached to both process and therapist
“regression in the service of the ego”
Play becomes more open as child masters anxiety/conflicts

25. Emergence of Central Fantasies
Repetitive Play to deal with past traumatic situations
New solutions played out

26. Period of Working Through
This period is necessary for a series of interpretations
Symptoms are discussed in different contexts

27. Why is play so important?
Play helps children develop in a number of ways
Cognitive development—expands vocabulary, helps child develop cognitive flexibility, link objects with actions
Emotional development—helps child resolve conflicts, allows child to freely express and deal with emotions

28. Does it work? Generally, these approaches have not been well-tested
Focus on more general goals
Too long term
Not well specified
Other approaches have been found to be effective for internalizing and externalizing problems

29. The future of psychodynamic approaches
Moving towards shorter treatment approaches
Integrating psychodynamic approaches with other orientations
More focused approaches
Focusing on specific populations and new treatment settings

30. Shorter Treatment Approaches/Focused Approaches
6-12 sessions
Necessary (HMO restrictions)
Some evidence to suggest time-limited psychotherapy is just as effective as long-term psychotherapy
“focal therapy”
Brief forms more appropriate who have transient regressions, mild problems with age-appropriate behaviors, acute phobias

31. Specific Populations in New Settings
In schools
In Hospitals
With Abuse Populations

32. Interpersonal Theory
Focus on the importance of interpersonal relationships in determining behavior and psychopathology
Harry Sullivan, Adolf Meyer (1950s)
Sullivan (1940): personality is: “the relatively enduring pattern of recurrent interpersonal situations which characterize a human life” (p. xi)
Now have manualized treatments

33. Interpersonal Theory
Although childhood experiences are important, IPT regards current relationships as more important
Family systems theories are also based on IPT
Family relationships are interdependent
Family systems tend to maintain a certain structure or homeostasis

34. Interpersonal Theory
IPT does not necessarily assert that psychopathology arises from impaired relationships
But, problems are manifested in these relationships
Research has supported this idea
Individuals with depression have less supportive relationships
Individuals with other problems (e.g., alcohol abuse) more frequently have marital difficulties
Risk of relapse in depression and schizophrenia increases when patients live with critical, negative family members

35. Interpersonal Therapy
Originally developed by Klerman & Weissman for treatment of depression
Therapist must actively gather information about a patient’s interpersonal interactions and relationships
Overall, therapist takes a more active, supportive approach
Usually brief in length
Educate patient about nature of depression

36. IPT is good for: Acute treatment for symptom removal
Prevention of relapse/recurrence
Correction of secondary consequences of depression
Also used for Bulimia Nervosa
Often used in combination with medication

37. Interpersonal Therapy
Major goal of treatment= change interpersonal functioning by encouraging:
More effective communication
Emotional expression
Increased understanding of behavior in interpersonal settings
IPT assumes that by improving relationships, symptoms and the patient’s life in general will improve

38. IPT Therapists Must be able to maintain optimism
Must be able to adhere to treatment protocol
Must be comfortable with the medical model
Must have a good social support network
Must be satisfied with discrete gains

39. IPT for depression A negative cycle occurs: Three phases of treatment
The individual has an effect on others
Others have an effect on the individual
Three phases of treatment
Phase 1: assessment and evaluation
Diagnostic evaluation for depression
Symptom Review
Education about depression
Assessment of interpersonal relationships
Interpersonal Inventory
The Sick Role

40. IPT for depression Phase 2:
Which interpersonal problem characterizes the patient?
Grief
Interpersonal role dispute
Role transitions
Interpersonal deficits
Therapist uses specific techniques designed to help the patient work through these problems

41. IPT for depression Phase 3: Consolidation
Helps patients recognize and counter symptoms of depression
Prevents relapse
Special considerations in termination

42. IPT and Adolescent Depression
Brief treatment useful with adolescents
Modifications of IPT for adolescents include:
Flexibility in timing/spacing of sessions
Telephone contact
Therapist may have active role outside of therapy
Specific focus on single parent families

43. Does it work?
Unlike other psychodynamic approaches, IPT has empirical support
When compared with CBT and medication and supportive therapy, IPT was just as effective
Has also been empirically supported in adolescents

44. Case Example
The Adolescent who was frozen with grief