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Do you know the difference between Psychoanalytic Therapy and Psychodynamic Therapy? The latter places focus on the patient’s relationship with their external world. A psychodynamic approach to therapy will utilise a focus on acknowledging, understanding, and dealing with repressed emotions to help the patient reform their relationships. Use the material below to help prepare yourself for sessions with patients.
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Id, Ego and Super-ego
It is important to understand the Id, Ego, and Super-ego when taking the psychodynamic approach.
Are you able to think of a situation where your Ego was able to be the compromise between your Id and Super-ego? Read about it in an extract from Counselling Skills and Studies, a CPCAB co-pub.
Strong and Stable Structure
Formal structure provides a sense of security and reliability for the client.
Break down your sessions in two three groups: Initial sessions, Intermediate sessions, and Final sessions.
I Have a Dream
Helping clients make sense of their own dreams and the association or interpretations they make is important.
How would you help Kim make sense of her dream and the association and interpretation she makes?
Attachment Patterns
Fonagy (2001) took forward Bowlby’s ideas, applying them to therapy supported by empirical research. Ainsworth’s ‘strange situation’ test observed what happened when a care-giver left a child then later returned (Ainsworth et al., 1978), the subsequent interactions revealing different forms of attachment. Four attachment patterns have been identified:
- Secure attachment occurs when a child experiences confidence in the security of the relationship and presence of a care-giver. This enables the capacity to think about and manage feelings in self and the other (which Bateman and Fonagy, 2004, call mentalisation), as well as coping with disappointment or loss. Resilience has its origins in a secure attachment
- Avoidant attachment (insecure-avoidant) happens when a child learns they cannot rely on the care-giver. It appears they don’t miss the care-giver when they are absent but do not initiate contact on their return. Despite this apparent lack of distress, they have learnt it is not worth attempting to gain comfort or care. This leads a child to expect rejection and believe it is wholly undeserving. Being dismissive and an avoidance of feelings have origins in avoidant attachment
- Ambivalent attachment (insecure-ambivalent) occurs when a child experiences the care-giver as unpredictable or does not pick up emotional cues. They experience ambivalence, wanting the care-giver but unable to engage with them, becoming angry and distressed, or passive and helpless. This exacerbates the unpredictability of the care-giver who cannot work out the unpredictability of the baby. This pattern leads the child, then the adult, to experience themselves as loveable but undeserving, needing to cling to others in relationships, but distrustful of them
- Disorganised attachment (insecure-disorientated) happens when a child experiences a previously ‘safe’ care-giver become rejecting, unpredictable, frightening or frightened. They become caught in a dilemma. When a care-giver returns to the room, the child’s behaviour appears bizarre as they become confused, dazed or immobilised as if frozen. The child believes they cause the care-giver’s fear and so take on the care-giving role to protect themselves and others. Feelings of anxiety or fear remain unresolved and can reappear in chaotic, even destructive forms at times of stress caused by change, separation or loss.
Extract taken from An Introduction to Counselling and Psychotherapy by Andrew Reeves (2nd Edition)