Psychodynamic Psychotherapy

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Psychodynamic Psychotherapy
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How therapy used to work

• 7 times a week.
• Laying on a couch.
• The therapist says very little.
• Very, very expensive.
• Only for a select few.
• One had to meet very stringent requirements to be
  a therapist.

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The way Psychodynamic therapy is now

• 1-2 times per week.
• 50 minutes.
• Clients often sit across from therapist.
• Therapy is more of a conversation than a
  one-sided monologue.
• Still very expensive. However, lots of
  opportunities for low-cost psychotherapy are
  available.
• One still has to meet very stringent requirements
  to be a therapist, but these are now related to
  training and character and are more culturally
  sensitive.

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Misconceptions about therapy

• It is only for people who have problems.
• It is only for people who dont have friends.
• It is only for people who are weak.
• It is only for people who are crazy.
• Being in Psychotherapy isnt beneficial to your
  own career as a therapist.

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Free Association and Catharsis

• Free association is the process of saying
  anything that comes to mind regardless of the
  content.
• This type of talking is thought to lead to the
  unconscious. If you talk long enough, youll
  start hitting on things that are important and
  begin recognizing patterns.
• Catharsis is one of the main components of free
  association. Talking about everything will let
  you get things off your chest and reduce some
  anxiety.

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II recognize that my ploys for attention have
grown increasingly more desperate and are not
well-received by others!
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My pop songs are amazingly catchy, but I realize
that I sometimes wear things that make statements
not even I understand in order to be edgy and
controversial!
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The work of Psychodynamic Therapy

• Pull these feelings back out of the unconscious.
• And then sit with them.
• This is very difficult. Both for the client and
  the therapist.
• The therapists work is to understand the client
  and be a container for them while being
  non-judgmental.
• The therapists work is to formulate hypotheses
  and have thoughts about what is going on while
  intervening ONLY when it seems clinically
  important. The therapist must tolerate ambiguity
  and recognize that a client may be working on the
  same issue and saying the same thing for years.

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What is the not-work of Psychotherapy

• Giving advice.
• Helping people.
• Not allowing clients to feel their feelings.
• Being optimistic.
• Being a friend.
• Overextending yourself.

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How do we pull it out?

• Talk about the feelings.
• Recognize what is going on for the client and
  empathize with them genuinely. Be able to weather
  the clients storm. Allow them to have negative
  feelings toward you if that is what they are
  feeling without being defensive.
• Recognize and respect the clients defenses as
  things that have worked for them and discuss.
• Always be curious, never accusatory.

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Resistance!

• Resistance is a clients way of trying to avoid
  pain and difficult issues by fighting the process
  of therapy as well as the therapist.

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Is Resistance Inevitable?

• Yes! Prepare for it!
• Why? Because change is hard.
• No matter how much someone is willing to do it
  (or pay for it), it is still incredibly difficult
  to change and to recognize things we do not like
  about ourselves. Especially with someone we may
  not trust yet.
• Resistance often happens after someone has shared
  something very important or personal.

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How does resistance manifest?

• Missed appointments with or without phone calls.
• Being habitually late.
• Client goes blank.
• Client changes the subject.
• Not paying the therapist or never having money.
• Telling the therapist theyre bad at what they do
  and are wrong about everything.
• Client begins intellectualizing, rationalizing,
  or using other defense mechanisms.
• Insisting that they wont come back because of
  price, time, location, decorations, etc.
• The thing is all of these reasons may SEEM real,
  but are about the issues discussed in therapy
  above anything else.

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What can you do with resistance?

• Recognize it.
• Discuss it.
• Go with it.

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Transference

• Transference happens in ALL therapeutic
  situations (and even non-therapeutic ones).
• Its when the client transfers expectations of
  the important people in their history onto other
  people.
• This is important because it tells the therapist
  how the client interacts with others. The client
  will do to the therapist what the client does to
  other people in their life.

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Heres what it looks like

• My mother is an important figure in my life.
• My mother criticizes me constantly because I am
  doing nothing with my life.
• I expect other people to criticize me the way my
  mother does when I discuss my life.
• Therefore, I expect my therapist to do the same
  thing to me. I unconsciously cast the therapist
  as my mother and respond to them in the way that
  I do to my mother, regardless of whether they are
  criticizing me or not.
• This is perhaps why when the therapist says
  well, what are your goals? the client says
  WHAT DO YOU MEAN, WHAT ARE MY GOALS? NOW YOURE
  LAYING INTO ME?

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Heres what it looks like

• This doesnt have to be about the core issue of
  not doing anything with their life many things
  that the therapist says will make the client feel
  like they are talking to their mother because
  that is the role they cast the therapist in.
• This role can change.
• It is important to address what is going on and
  point out patterns. You know, I just said this
  and you got really angry in the way you would get
  angry at your mother. What do you think about
  that?

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Countertransference

• Your reactions to what the client is talking
  about, the role they are placing you in, or your
  reaction to the client in general.
• Countertransference is inevitable because we are
  all people with issues.
• You need to acknowledge your countertransference
  to yourself and think about it. Sometimes you
  have to talk about it with the client.

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You will make mistakes!

• Every therapist makes inaccurate interventions.
  No one scores a perfect 100. We are dealing with
  people, not machines!
• Good therapists CAN and DO make a lot of
  mistakes. The important thing is that they think
  about them and apply them to the case
  formulation.
• Most mistakes can be repaired from. Many will go
  unnoticed depending on the relationship with the
  client.

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Working Through

• Working and talking through painful feelings,
  issues, why transference occurs, and what
  feelings are associated with all of these things
  OVER AND OVER AGAIN until there is no more energy
  invested in keeping them hidden.
• This is why people sometimes leave therapy
  feeling horrible.
• You do not do this at one time. It often takes
  years.

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What? Why should I delve into my horrible past?

• No one comes out of childhood unscathed.
• It is a time when you have little to no control
  and your relationships with primary caregivers
  are formed. Its also when a lot of hurt
  happens.
• I believe that we spend the rest of our lives
  recovering from our childhoods regardless of
  whether they were good or bad.

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Working Through

• In childhood feelings and emotions seem
  dangerous and like they can destroy us and our
  parents. Psychodynamic theory believes that we
  then spend a lot of energy pushing them down.
• Then they come back up.
• Then we push them back down again. This is
  exhausting and takes up a lot of unconscious
  space.

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The Job of the therapist

• The job of the therapist is to be the good
  parent. The therapist helps the adult (or child
  they are working with) express these feelings and
  see them as manageable and okay to have.
• The therapist does this by sitting with the
  client through even the hardest times. This shows
  the client that their painful feelings are
  incapable of destroying themselves or the
  therapist.
• They can then recognize that their painful
  feelings cant destroy other people in their
  lives.

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That sounds really painful and time-consuming.
What is the point?

• The client begins to see their feelings as
  normal, important, and not something to run from.
• Recognizing and accepting these feelings then
  allows you to move on with your life and put the
  energy that youve been putting into making sure
  these feelings dont come up into something more
  enjoyable and productive.
• This doesnt mean your problems are solved. It
  just means that you are growing emotionally and
  are able to be more accepting of yourself and
  more authentic in the world around you.

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This Panda is also emotionally exhausted!