Key concepts:
- The unconscious: Individual dynamic psychotherapy is based on the premise that a person's behaviour is influenced by unconscious factors (thoughts, feelings, fantasies). Evidence for the existence of unconscious activity include
- Dreams
- Artistic and scientific creativity
- Hysterical symptoms
- Abreaction
- Parapraxes slips of the tongue.
- Psychological defences: Just as the immune system protects our physical integrity, so psychological vulnerability is shielded by psychological defences. As with the immune system, overactive defences can lead to trouble. They include:Psychotic defences:
- Delusional projection
- Denial
- Distortion.
Immature defences:- Projection
- Schizoid fantasy
- Dissociation
- Acting out
- Hypochondriasis
- Passive aggression.
Neurotic defences:- Repression
- Displacement
- Reaction formation
- Intellectualization.
Mature defences.- Altruism
- Humour
- Suppression
- Anticipation
- Sublimation.202
- Transference and counter-transference: The past patterns (transfers) our present reactions to people. If we have trusted our parents, we will be likely to trust our doctors, teachers, and friends. The intense psychotherapeutic relationship brings these assumptions to the fore where they can be examined, understood, and learned from. The doctor in turn has unconscious reactions to her patients based on the past, ie counter-transference. For example, if her mother was an alcoholic she may be oversolicitous, or rejecting, with alcoholic patients. The doctor's reactions are also a key to the patient's feelings: if a patient makes us feel rejected (as alcoholics often do), perhaps that person himself was rejected as a child and has turned to the bottle in compensation.
Assessment of suitability
Psychological understandibility
The patient's difficulties must be understandable in psychological terms
Psychological mindedness
The capacity to think about problems in psychological terms
Motivation
The patient must have sufficient motivation for insight and change.
Intelligence and verbal fluency
The ability to communicate thoughts and feelings through talking.
Introspectiveness
The ability to reflect and think about their feelings.
Dreams
The capacity to remember dreams.
Ego strength
The ability to tolerate frustrating or distressful feelings without engaging in impulsive behaviour.
Capacity to form relationships
There should be a history of at least one sustained relationship in the past or current life.
Specific indications
- Dissociative/Conversion disorders
- Depressive disorders
- Psychosomatic disorders
- Personality disorders
- Relationship problems
- Grief reactions.
Technique
The therapist provides a secure frame a regular time and place and her own consistency and acceptingness. The patient narrates vignettes about himself and his life usually about three per session. The therapist listens carefully, both to the stories and to her reactions to them. She then makes linking hypotheses, or interpretations that offer meaning to the patient. Previously inexplicable behaviour begins to make sense. At the same time the patient forms a close relationship with the therapist based on empathy, genuineness, and non-possessive warmth (shown experimentally to be key therapeutic factors) and, where necessary challenge. These may be novel experiences for the patient that can be internalized. The patient can work through his difficulties in the comparative safety of the therapeutic relationship, especially his reactions to ending, which will bring up previously unprocessed losses.
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