How to Practice Brief Psychodynamic Psychotherapy, Howard Book (1998)

Goal (descriptively): symptom relief and limited but meaningful character change.

Core-Conflictual Relationship Theme (CCRT) is a sentence that consists of three components: (1) the patient’s wish in the context of a relationship (W), (2) an actual or anticipated response from the other (RO), and (3) a subsequent response from the self (RS). The RS has two components: a behavioral response and an affective response (or what the patient did and how the patient felt).

Example: Mr. Black gets upset when he’s driving and someone in a Porsche cuts him off. However, Mr. Black doesn’t say anything out of fear that the driver might be a drug dealer and will pll out a gun. W: to speak up forcefully when mistreated. RO: a violent retaliation against him. RS: to remain silent and passive (action) while feeling deflated and ashamed (affect).

Goal (dynamically): to help the patient actualize his/her wish.

Example: The goal for Mr. Black is for him to speak up in situations in which he feels unfairly treated.

We help the client to actual his/her wish by helping him to understand the other’s response (RO) as either a transference distortion or a repetition compulsion.

Example of Transference Distortion: Mr. Black’s father was cruel, causing him to displace his fear of his father to his view of other people. Example of Repetition Compulsion: Ms. Rose wishes to be treated respectfully (W), but others actually treat her disrespectfully (RO), meaning that her RO actually occurs. The goal of therapy is to help her understand how she provokes others to treat her disrespectfully as a way of attempting to master early childhood experiences.

Treatment, usually 16 sessions. Phase #1 (sessions 1-4): goal is to help patient become aware of how frequently and forcefully the CCRT governs their relationships; goal is to turn what is ego-syntonic into what is ego-dystonic. Phase #2 (sessions 4-12): the patient attempts to work through the childhood roots that fuel his/her RO. Phase #3 (sessions 13-16): therapist and patient focus on termination issues, particularly enactments as they reflect the patient’s fantasy of why treatment is ending.

Comments

Post a Comment

Popular posts from this blog

Misc. Index

Brief Psychodynamic Psychotherapy Book, Howard — How to Practice Brief Psychodynamic Psychotherapy (1998) Gabbard Neuroscience and Psychoanalysis Rethinking Therapeutic Action Long-Term Psychodynamic Psychotherapy (2010) McWillians, Nancy Psychoanalytic Psychotherapy (2004) Modell,  Arnold Reflections on Metaphor and Affects Shedler, Jonathan The Efficacy of Psychodynamic Psychotherapy (2010) The Tyranny of Time: How Long Does Effective Therapy Really Take? (2020) That Was Then, This Is Now (2022) Wachtel, Paul Therapeutic Communication (2011)
Read more

Unconscious Thoughts and Feelings in Psychotherapy

The mammalian brain continuously and automatically makes associations. Neuroscientist Joseph LeDoux gives the example of a rabbit that encounters a fox at a specific watering hole and barely escapes. The watering hole and the fox are now associated in the rabbit’s brain and connected together by fear. If the rabbit visits the watering hole again, it will automatically think about the fox and feel afraid. Related associations join to form schemas — that is, internal working models of ourselves and others. Imagine a young girl we’ll call Jasmine who repeatedly gets criticized by her parents for expressing an opinion. This experience evokes feelings of shame. Like the rabbit that comes to associate the watering hole with (physical) danger, Jasmine comes to associate expressing her opinion with (social) danger. She, in other words, comes to develop a schema that holds that it is unsafe to express her opinion with others. Like the associations that form them, schemas are originally adaptiv...
Read more

Schizoid Factors in the Personality, Fairbairn (1940)

Fairbairn wants to focus on schizoid mental processes, which exist on a spectrum, schizophrenia existing at one extreme. He wants to focus on schizoid processes for a number of reasons, one of them being that these processes are experienced by most patients, even those considered non-schizoid — e.g., patients described as hysterical, obsessional, and phobic individuals. The “fundamental schizoid phenomenon is the presence of splits in the ego,” a feature shared by all people. (Although theoretically, someone “whose development had been optimum” might not have such splits.) At the most extreme level, a split in one’s ego results in depersonalization or derealization; at a less extreme level, a split can result in one feeling artificial or emotionally disconnected from friends. Psychoanalysis have long believed that schizoid processes are caused by a fixation in the early oral stage. The infant at this stage focuses on taking (over giving), which comes in the forms of incorporation and ...
Read more