Introduction toPsychotherapy
Introduction to psychotherapy
Müge Alkan, PhD
0 532 385 9299
6 October - Introduction
13 October – Key concepts of psychotherapy
20 October – Assessment and Therapeutic interventions
27 October –Introduction to Psychodynamic psychotherapy
3 November – Psychodynamic psychotherapy
10 November - Psychodynamic psychotherapy
17 November - Cognitive behavioral psychotherapy
24 November - Cognitive behavioral psychotherapy
1 December – Midterm and Group therapy
8 December - Group therapy
15 December -Interpersonal psychotherapy
22 December – Transactional analysis
29 December - Family therapy
5 January - General overview
Midterm % 30
Presentation and paper % 30
Final exam % 40
Who are the patients?
Patients suffer from problems that interferewith their attaining life goals
Maximize potentials
Lead happy lives
Problems stem from unconscious conflicts
Presented as symptoms or personality traitsand patterns
Either bothersome to patients or justinterference with life of patients
Can patients be placed indiagnostic groups?
Yes, in many ways..
Differences in ego functioning
Normal-neurotic
Narcissistic
Borderline
Psychotic
Assessment of egofunctioning
Reality testing
Sense of reality
Adaptation to reality
Impulse control and frustrationtolerance
Object relations
Thought processes
Defensive functioning
Normal-neurotic group
Good ego functioning
Intact reality testing
Good interpersonal relations
Good adaptation to reality
Good impulse control
Stable identity
Affective stability
Mature defenses
Normal-neurotic group
Object relations; integrated, coherent andstable sense of self and objects.
Others are viewed as individuals of theirhaving needs and desires of their own.
There may be some slippage in all areas,though rarely in reality testing.
All “normal“ people use numerous neuroticdefenses, may have episodic difficulties.
Borderline group
Relative (may easily break) intactreality testing/thought processes/interpersonal relations/adaptation toreality
Poor impulse control
Primitive ego defenses
Identity diffusion
Affective instability
Narcissistic group
Integrated but pathological identitybased on grandiose self.
Labile self-esteem, sensitive torejects, disappointments, failures.
Psychotic group
Poor ego functioning
Weak reality testing
Problems in almost all ego functions
Who are the therapists?
Psychiatrists, psychologists, clinicalsocial workers, nurses, counselors.
Some –unconsciously- enter the fieldto solve their own problems.
What are some problemsinherent in psychotherapy?
Psychotherapy is fascinating, intellectuallystimulating when done well.
Can be exhausting, demanding,
Challenge of facing own problems andthose of patients.
Projecting one’s problems onto patients
Taking own anger at them
Treating them as one wished to be treated
Using them for one’s own gratification
Boundary violations and sexual acting.
Can be isolating..
How important is one’s personaltherapy or psychoanalysis?
Crucial..
To understand one’s own problemsand minimize their influence in thetherapy process.
Which personal characteristics andexperiences help to make a goodtherapist?
Some stability
Concern
Dedication
Integrity
Conscientiousness
Competence
High intelligence
Psychological mindedness
Empathy
Which personal characteristics andexperiences help to make a goodtherapist?
Certain amount of suffering, depression andneurotic conflict.
A reflective, thoughtful person on thepessimistic, realistic side
Too much optimism is associated withdenial.
Ability to listen
To be able to bear criticism and hostilitywithout the need to retaliate
Intuition and creativity
Some life experience
How long does it take to becomean effective psychotherapist?
Years.....
10 years is mentioned..
Psychotherapy is a continual andneverending learning.
Understanding oneself through personalanalysis
Life experience
Learn theory and technique through reading
Supervision
Psychotherapy
<-------------------------------------------------------------->
Explorative therapies Supportive psychotherapy
Insight oriented
Psychoanalysis
Analytically oriented psychotherapy
Dynamically oriented psychotherapy
Supportive psychotherapy
Cognitive psychotherapy
Psychoanalysis
4-5 times a week on the couch
Free association
Resistance
Gradual process of unconsciousbecoming conscious
Context of transference
Neutral position
Psychoanalysis
Intense transference, in a regressedstate
Feelings, thoughts (and defenses)originally directed toward importantpeople in childhood
Actual and fantasized past asexperienced by patient
Current relationships, pastrelationships
Issues in psychotherapy
Stable therapeutic environment
Therapy is carried out in a stable, consistentand caring way in a safe, nonthreateningand nonintrusive environment.
Expectations of treatment should be clearlyspelled out, discussed and always followed.
Good-enough mothering (Winnicott, 1958)
Holding environment (Winnicott, 1958)
Therapeutic alliance
Issues in psychotherapy
Neutral therapist
Equal distance from id, ego andsuperego
Important in analytic therapies
Transference “blank screen” fordisplacement of feelings
Clarity of judgement and criticism
Issues in psychotherapy
Flexible therapist
Need to oscillate methods with more troubled patients
Be ready for unpredictable and new challanges
Issues in psychotherapy
Countertransference
Therapist’s conscious and unconscious reactions tothe patient’s transference
Borderline patients: guilt, rescue fantasies, rage,hatred, helplessness, worthlessness, anxiety, terror.What is your response to such feelings ? !!!!!
Narcissistic patients: idealization, devaluation (actingas if the therapist does not exist)
Psychotic patients: passive, dependent and unable tochange: helplessness may lead to taking over patient’slife.
Issues in psychotherapy
Empathy
1. Understanding
Building trust
“Empathy is not a cure itself”
2. Explaining; gain insight
Issues in psychotherapy
Action
Active in listening
More passive at first, but active later
What is the mechanism ofchange in psychotherapy?
Change via insight: (insight orientedinterventions) “healthier patients”
Change via the relationship:(identification and internalization)“more troubled patients”
What are the basic strategiesfor psychotherapy?
Reexperiencing and working throughthe conflicts.
Strategy: maximize development andresolution of transference
Comment on resistance to theformation of transference
Help patient understand himselfthrough transference with current andchildhood relationships
What are the basic strategiesfor psychotherapy?
Second strategy:
Focusing on present day interactions andrelationships
Downplay transference
Third strategy:
Supportive therapy
Supporting and enhancing ego functions
Blocking regression