CLINICAL INTERVENTIONS

Madelyn P. Nino
 Clinical Intervention

occurs when clinicians acting in a professional capacity, attempt to

change a client’s behavior, thoughts, emotions, or social circumstances
in a desirable direction.

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Psychological Intervention

is a method of inducing changes

in a person’s behavior, thoughts, or feelings.

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Psychotherapy

involves intervention in the context of a professional

relationship which is sought by the client or the
client’s guardians.

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Psychotherapy
FOCUS:

1. SOLVING a specific problem or IMPROVING the individual’s

capacity to deal with existing behaviors, feelings, or thoughts that
impair functioning at work, school, or in relationships.
2. Preventing problems rather than remedying an existing
condition
3. Increasing the person’s ability to take pleasure in life or to achieve
some latent potential.
 Psychotherapy
a form of treatment for problems
of an emotional nature in which a trained person deliberately
establishes a professional relationship with a patient with the
object
of removing, modifying or retarding existing symptoms, of
mediating disturbed patterns of behavior, and of promoting
positive personality growth and development.
Intervention and psychotherapy
are used interchangeably
 Tripartite Model of Psychotherapy
(Stupp)

1. Client

Affected by the therapy

The focus
They look for outcomes
They have views on the therapy

Pomerants, A.M. (2011). Clinical Psychology, Science, Practice, and Culture, 2nd ed. Age Publications, Inc
 Tripartite Model of Psychotherapy
2. Therapist

• Has more experience in mental health issues

• witness only a fraction of clients’ lives

Pomerants, A.M. (2011). Clinical Psychology, Science, Practice, and Culture, 2nd ed. Age Publications, Inc
 Tripartite Model of Psychotherapy
3. Society

any outsider to the therapy process who has an interest in how

therapy progresses

Pomerants, A.M. (2011). Clinical Psychology, Science, Practice, and Culture, 2nd ed. Age Publications, Inc
 Tripartite Model of Psychotherapy
3. Society

• general public, the legal system, clients’ family and

friends,
clients’ employers

Pomerants, 2011

Pomerants, A.M. (2011). Clinical Psychology, Science, Practice, and Culture, 2nd ed. Age Publications, Inc
 Which Psychotherapy Best

Which one produces outcome

Change
Benefit

“dodo bird verdict”

Alice in Wonderland
Psychotherapies are equally effective

Pomerants, A.M. (2011). Clinical Psychology, Science, Practice, and Culture, 2nd ed. Age Publications, Inc
 Basic Features of Psychotherapy
Are common factors to effectiveness of psychotherapies

1. Therapeutic Relationship/Alliance
therapeutic alliance/working alliance

- the most crucial single aspect of

psychotherapy
- best predictor of therapy outcome

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy
1. Therapeutic Relationship/Alliance

- important to the client

- a good therapeutic alliance facilitates
client improvement
- the therapist gives unconditional acceptance to the client

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

2. The Expert’s Role

to be a competent (accepting, warm, respectful, and interested) therapist

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

3. Sense of Mastery

Those who feel confident and good

about themselves are more likely
to function more effectively.

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

3. Non-specific factors
a. Hope
- believing and motivated clients are more likely
to show progress than the pessimistic ones
- also includes optimistic therapists

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

3. Non-specific factors
b. Attention
Hawthorne effect
- awareness of being observed results to improved
performance

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

3. Non-specific factors
b. Attention
attention of the client and the therapist to the issues
acknowledgment of the problems

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

4. The Patient/Client

The degree of his/her distress

Intelligence
(complex thematic association tasks)

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

4. The Patient/Client
Age
Younger adults are more flexible
Better able to make connections

Motivation
Necessary for positive change
Psychotherapy is voluntary process

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy

4. The Patient/Client
Openness
Gender
Race, ethnicity, and social class
Therapist’s reaction to patients

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy
5. The Therapist
Age, sex, ethnicity
(sensitivity)

Personality
(cultural similarity, therapist’s dominance produced better
outcomes; low dominance produced better outcomes
in dissimilar cultures)

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy
5. The Therapist

Empathy, warmth, genuineness

Necessary conditions of therapeutic change (C. Rogers)

Trainable and learnable skills

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy
5. The Therapist

Emotional Well-being

(resolve personal emotional issues/difficulties first

before leading the therapy)

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 Basic Features of Psychotherapy
5. The Therapist

Experience and Professional Identification

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
3-stage sequential model (factors)

Action factors

taking risks, facing fears, practicing

and mastering new behaviors,
Learning factors working through problems
Change of self-expectations
Changes in thought patterns
Support factors corrective emotional experiences
Aha! phenomena
Therapeutic alliance
Therapist’s AWRT
EVIDENCE-BASED TREATMENT
originally, empirically supported treatment
empirically validated treatment

refers to those interventions or techniques that have produced

significant change in clients and patients in controlled experiments

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
EVIDENCE-BASED PRACTICE

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 GOALS OF CLINICAL INTERVENTIONS
Reducing emotional discomfort
provide safe and supportive atmosphere
Fostering insight
knowing about the errors of the past helps to avoid repeating them
Encouraging catharsis
through their release they will be eased
Education
provide new valuable information; new ways to understand client problems
Developing faith, hope and expectations for changes
Increase!
Kramer, G.P., Berstein, D. A., & Phases, V. (2009). Introduction to clinical psychology (7th ed.). Upper Saddle River, NJ: Pearson Prentice Hall
 COURSE OF PSYCHOTHERAPY
1. Initial contact

Discuss:
what the clinic all about the kind of help
that can be given

(Confused, anxious, suspicious, doesn’t what to expect, embarassed)

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
1. Initial contact

Discuss:
The professional staff
Fees
Confidentiality

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
1. Initial contact

Discuss:
What to expect:
Inpatient?
Medical complications?
Medical and psychotherapy?
Referral?

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
2. Assessment

Make appointment/s for assessment

Intake interview
Case history interview
Psychological tests
Interview family members and friends
Behavioral assessment

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
2. Assessment

Preliminary integration of results

Conceptualization

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY

1. Intial Contact
2. Assessment
3. Goals of Treatment

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
3. Goals of Treatment
Period of negotiation
over the goals of treatment
Contract signing:
• goals of therapy
• length of therapy
• frequency of meetings
• cost
• general format of therapy
• client’s responsibilities.
Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY

1. Intial Contact
2. Assessment
3. Goals of Treatment
4. Implementing Treatment

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
4. Implementing Treatment

Informed consent:

o Treatments
o How they relate to client problems
o Length of time involved
o Possible difficulties
o Expectations on the clients:
free association, homeworks, self-monitoring, etc.
Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
4. Implementing Treatment

Information patients have the right to know

p. 332

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY

1. Intial Contact
2. Assessment
3. Goals of Treatment
4. Implementing Treatment
5. Termination, Evaluation, and Follow-up

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
5. Termination, Evaluation, and Follow-up

Termination is sometimes gradual:

number of meetings are reduced
Discuss termination details:
clients attitudes and feelings are expressed and
clarified

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 COURSE OF PSYCHOTHERAPY
5. Termination, Evaluation, and Follow-up

Termination contract
Waiver
Schedule “booster sessions” 6 mos./1 yr after termination
Evaluate progress (with clients)
Compile data
Make notes on progress

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 STAGES OF CLIENT CHANGE
1. PRECONTEMPLATION

Client has no plans of changing his behavior in the near future

They are in the therapy because of outside pressure

50-60% or patients are in this stage

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 STAGES OF CLIENT CHANGE
2. CONTEMPLATION

The client is aware that he has problems but is not yet

committed to trying to make changes.

30-40% of clients are in this stage

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 STAGES OF CLIENT CHANGE
3. PREPARATION

The client intends to make a change

in the near future

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 STAGES OF CLIENT CHANGE
4. ACTION

The client is changing

maladaptive behaviors, behaviors, and/or environment

10-20% of patients are in this stage

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 STAGES OF CLIENT CHANGE
5. MAINTENANCE

Working more on changes

and preventing lapses

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
 STAGES OF CLIENT CHANGE
6. TERMINATION

The client has made necessary changes

No more fear of relapse

Trull, T.J. & Prinstein, M.J. (2013) Clinical psychology, 8th ed. Belmont, CA: Cengage Learning
THEORETICAL ORIENTATIONS TO THERAPY

Pomerants, 2011
 2 Categories of Treatment
of Psychological Disorders

A. Biologically based - relies on drugs and medical procedures to

improve psychological functioning.

B. Psychotherapy
A. BIOLOGICAL APPROACH: Biomedical Therapy
focuses treatment directly on brain chemistry
and other neurological factors using
drugs, electric shock and surgery
to alleviate psychological disturbances.

- Balance physiology
 A. BIOLOGICAL APPROACH: Biomedical Therapy

relies on drugs and medical procedures to improve

psychological functioning.
 1. Drug Therapy

control of psychological
disorders through the use of drugs
by altering the neurotransmitters
and neurons in the brain.
- For severely abnormal behavior

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy
Ways:
a. Inhibit neurotransmitters or receptor neurons reducing activity at
a particular synapse

b. the activity of certain

neurotransmitters or neurons,
allowing particular neurons to fire more frequently

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Antipsychotic Drugs

drugs that temporarily

reduce psychotic symptoms
such as agitation, hallucinations,
and delusions.

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Antipsychotic Drugs

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antipsychotic Drugs
EFFECTS:
Affect both dopamine and serotonin levels
in certain brain parts related to planning
and goal-directed activity.
- they block dopamine receptors at the brain synapses

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antipsychotic Drugs
SIDE EFFECTS
dryness of the mouth and throat
dizziness
sometimes tremors and loss of muscle control
They may continue after drug treatments are stopped

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

- Medications that improve a severely depressed

patient’s mood and feeling of wellbeing

- Also sometimes used to treat

anxiety disorders and bulimia nervosa

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Antidepressant Drugs

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

HOW they work

change the concentration of neurotransmitters in

the brain

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

HOW they work

Tricyclic drugs
the availability of norepinephrine
in the synapse

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

HOW they work

MAO Inhibitors
prevent the enzyme monoamine oxidase (MAO)
from breaking down neurotransmitters

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

Lexapro

selective serotonin reuptake inhibitors (SSRIs)

They target the neurotransmitter serotonin and permit it to
linger at the synapse.

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

nefazodone(Serzone)

produce a combination of effects

blocks serotonin at some receptor sites but not
others

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Antidepressant Drugs

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Antidepressant Drugs

Glutamate NT

plays an important role in mood regulation

and the ability to experience pleasure

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

Ketamine blockers

blocks the neural receptor NMDA, which affects the

neurotransmitter glutamate

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antidepressant Drugs

- produce lasting, long-term recovery from depression

SIDE EFFECTS
drowsiness and faintness

BIOLOGICAL
SSRI antidepressants can APPROACH: Biomedical
increase the risk Therapy
of suicide in children and adolescents
 1. Drug Therapy: Antidepressant Drugs

Most Popular
Prozac
Best seller, effective, few side effects
(nausea and diarrhea, sexual dysfunction)
St. Joseph’s wort

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Mood Stabilizers

Drugs used to treat mood disorders

They prevent manic episodes

of bipolar disorder.

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Mood Stabilizers

BIOLOGICAL APPROACH: Biomedical Therapy

1. Drug Therapy: Mood Stabilizers

Lithium (mineral salts)

Divalproex sodium ( Depakote )
carbamazepine ( Tegretol )

They effectively reduce manic episode

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antianxiety Drugs

Drugs that reduce the level of anxiety

a person experiences essentially by reducing excitability
and increasing feelings of well-being.

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antianxiety Drugs

They are prescribed to:

✓reduce general tension in people who are experiencing temporary

difficulties

✓treat more serious anxiety disorders

BIOLOGICAL APPROACH: Biomedical Therapy

 1. Drug Therapy: Antianxiety Drugs

SIDE EFFECTS

o they can cause fatigue

o long-term use can lead to dependence
o Can be lethal when taken in with alcohol
(some antianxiety drugs)
o suppress anxiety

BIOLOGICAL APPROACH: Biomedical Therapy

 2. Electroconvulsive Therapy (ECT)

A procedure used in the treatment of

severe depression in which an electric
current of 70–150 volts is briefly
administered to a patient’s head.

BIOLOGICAL APPROACH: Biomedical Therapy

 2. Electroconvulsive Therapy (ECT)

EFFECTS
loss of consciousness
seizures

BIOLOGICAL APPROACH: Biomedical Therapy

2. Electroconvulsive Therapy (ECT)

10 ECT treatments/month
Or maintenance treatments

BIOLOGICAL APPROACH: Biomedical Therapy

 2. Electroconvulsive Therapy (ECT)

SIDE EFFECTS

disorientation, confusion, and sometimes

memory loss that may remain for months
• No long-term improvement
DRAWBACKS

May produce permanent brain damage

(according to critics)

BIOLOGICAL APPROACH: Biomedical Therapy

2. Electroconvulsive Therapy (ECT)

But it is the only quick

effective treatment of depression
(quicker than antidepressants)

BIOLOGICAL APPROACH: Biomedical Therapy

Transcranial Magnetic Stimulation (TMS)

A depression treatment in
which a precise magnetic pulse is
directed to a specific area of the brain

BIOLOGICAL APPROACH: Biomedical Therapy

Transcranial Magnetic Stimulation (TMS)

It activates particular neurons

and in effect relieves the symptoms
of major depressive disorders.

BIOLOGICAL APPROACH: Biomedical Therapy

Transcranial Magnetic Stimulation (TMS)

EFFICACIOUS, NO EFFECTIVENESS YET

BIOLOGICAL APPROACH: Biomedical Therapy

Transcranial Magnetic Stimulation (TMS)

EFFICACY VS. EFFECTIVENESS

The extent to which psychotherapy works

in experimental laboratories

BIOLOGICAL APPROACH: Biomedical Therapy

 3. Psychosurgery

Brain surgery in which the object

is to reduce symptoms of mental disorder

A treatment of “last resort” in the 1930s

BIOLOGICAL APPROACH: Biomedical Therapy

 3. Psychosurgery

Prefrontal lobotomy

REMOVAL of parts of the frontal lobes

which surgeons thought would control emotionality

BIOLOGICAL APPROACH: Biomedical Therapy

 3. Psychosurgery

EFFECTS OR SIDE EFFECTS

remission of symptoms
personality changes
bland, colorless, unemotional
aggressiveness
inability to control impulses
death

BIOLOGICAL APPROACH: Biomedical Therapy

 3. Psychosurgery

Cingulotomy
destroy tissue in the
anterior cignulate area
of the brain to treat
obsessive-compulsive disorder

BIOLOGICAL APPROACH: Biomedical Therapy

 3. Psychosurgery

gamma knife surgery

destroy brain areas related to

obsessive-compulsive disorder
by using beams of radiation

BIOLOGICAL APPROACH: Biomedical Therapy

 B. PSYCHOTHERAPY

Literally, it means treatment of the mind

Originated from Psychonalysis

(talking cure)

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPY

Treatment in which a trained person uses psychological techniques

to help a person overcome psychological
difficulties and disorders, resolve problems in living,
or bring about personal growth.

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

“Treatment for a mind in motion”

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Psychodynamic means

mind in motion

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Frame of Reference

the mind is an ever-changing system, blending with

perpetually moving energized (unconscious) elements.

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Frame of Reference

changing or moving elements in the unconscious affect

conscious thoughts, feelings, and behavior.

(unconscious mental activity)

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Frame of Reference
Unconscious
Threatening, frightening, stimulating, overwhelming feelings,
thoughts, conflicts, relationship issues, self-perceptions are kept in the
unconscious because they bring shame or disgust.

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Frame of Reference
Unconscious
But they remain strong and constantly push to reach awareness and
influence the way we think, feel, or behave.

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Frame of Reference

Childhood experiences determines present and future behavior.

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

GOALS
1. understand elements of the patient’s unconscious that are affecting
his/her conscious thoughts, feelings, and behavior

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

GOALS

2. decide whether uncovering or supporting will help most at that moment

Making the unconscious, conscious

PSYCHOTHERAPIES:
 B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

GOALS

3. uncover unconscious material or support mental functioning in the way

that will best help the patient

Uncovering and/or supporting

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Psychoanalysis Therapy

Freudian psychotherapy in which the goal is

to release hidden unconscious thoughts and feelings
in order to reduce their power
in controlling behavior.

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Psychoanalysis Therapy -“talking cure” (Freud)

Ego Psychology – play therapy, ego defenses, current
interactions, play therapy (Erikson)
Object Relations – Melanie Mcklein
Developing relationships between the child and
significant others or other love objects
Analysis of the Self - Heinz Kohut
Object – the image of the idealized parent
Subject – the graindiose self (Aren’t I wonderful)
Self-object – representations of another

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Structural and Topographical Models

Defense Mechanisms

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

1. Free association
patients to say aloud whatever comes to mind,
regardless of its apparent irrelevance or senselessness
Put thoughts, feelings, and memories into words

Uncensored thoughts

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

1. Free association
Gradually break down the defenses that block
awareness of unconscious processes

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

1. Free association
Clients are told not to censor or screen out thoughts
Let mind wander from thought to thought
Analyst monitors the dynamic conflict between
the compulsion and resistance
to utter

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

1. Free association

“what comes to mind”

“Any thoughts about that?”

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

1. Free association

Signs of resistance are often suggestive

of meaningful material

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

2. Dream Analysis
Represents the royal road to the unconscious
During sleep, ego’s defenses are lowered,
unacceptable impulses find their ways through
dreams

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

2. Dream Analysis
Manifest content
– the material of the dream
Latent content
– the unconscious material the dream symbolizes
or represents

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

3. Freudian Slips (parapraxes)

verbal or behavioral

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

4. Resistance

(change the topic, coming in late,

falls asleep, skips appointment)

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

5. Identifying defense mechanisms

identifying clients’ unconscious defense

mechanisms and bringing them into the clients’
awareness can improve the quality of clients’ lives.

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

12. Defense mechanisms

- when used infrequently, they are adaptive ways
of dealing with stress

- when used frequently, they are pathological

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

6. Transference
the client’s transfer of feelings, expectations, and
assumptions from early relationships to the therapist

feelings of love or anger that have been originally

directed to his parents or other authority figures

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

6. Transference

• Redo an earlier interaction

ex. The therapist as a symbol of the client’s father

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

6. Transference

offer interpretation of the transference

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

7. Countertransference

is the sum of the of conscious and

unconscious feelings that a therapist
has about his or her patients.

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

7. Countertransference

Originate either in the patient or within the therapist

Acknowledging and understanding our feelings about patients

decreases the chances that we will act on them

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

8. Clinical implications of the psychosexual

stages

Fixation

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

9. Relaxed atmosphere

(couch therapy)

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

10. Catharsis

Sudden outpouring of emotions

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

TECHNIQUES

11. Insight
Aha! Moments
Being aware of the source of emotion
of the original traumatic event

PSYCHOTHERAPIES: Psychoanalytic Therapy

B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy
TECHNIQUES

13. Silence
in psychodynamic psychotherapy, silence is an
intervention
- remaining silent helps clients to continue
associating on their own in order to move toward
unconscious material.
- also help to slow a patient down
- sometimes be soothing after a patient has talked
about something very difficult

PSYCHOTHERAPIES:
B. PSYCHOTHERAPIES: Psychodynamic Psychotherapy

Interpersonal Psychotherapy

PSYCHOTHERAPIES: