Psychodynamic and Psychoanalytic Therapy - 2nd Edition

Educational Objectives

Upon completing this educational activity, participants will be able to:
1. Utilize knowledge of recent developments in genetics and neuroscience to more effectively diagnose and manage psychiatric disorders.
2. Discuss optimal diagnosis, treatment, and clinical understanding of bipolar disorder.
3. Identify and overcome barriers to the effective management of personality disorders.
4. Identify and manage key factors that may affect a patient's risk for violent behavior.
5. Recognize common causes of treatment failures in patients suffering with anxiety and depression.
6. Implement therapy techniques for managing patients with somatic disorders.

Summary

Psychodynamic and Psychoanalytic Therapy

Jonathan Shedler, PhD, Associate Professor of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado

Introduction: psychodynamic and psychoanalytic therapy diverse collection of different theories and treatment approaches; review overarching principles; provide concepts and tools to be more effective practitioner; principles of unconscious mental life, psychological conflict or intrapsychic conflict, influence of past on present, transference, defense, psychological determinism

Unconscious mental life: do not fully know our own hearts and minds; thinking and feeling go on outside of conscious awareness; important memory, perceptual, judgmental, affective, motivational processes not consciously accessible; things we do not want to know (eg, threatened, dissonant, vulnerable); goal of treatment to expand freedom and choice; most psychological difficulties adaptive solutions to challenges

Intrapsychic conflict: mind in conflict; humans can be of 2 or more minds; recognition of complex contradictory feelings and motives; inner contradiction and techniques to help alleviate suffering; intrapsychic conflict refers to contradiction or dissonance within own mind; resolve contradiction by disavowing aspects of feelings; working at cross-purposes with ourselves; reduce internal conflict; internal friction creates depression and anxiety; areas of conflict intimacy, anger common; William Styron, Darkness Visible: A Memoir of Madness, 1990; anger feelings disavowed; displaced anger and resentment onto self; anger turned inward pathway to depression; passive-aggressive behavior; binge eating, bulimia; psychological symptoms have multiple causes, serve multiple purposes; over-determination, multiple function; every therapy tradition addresses conflict; universal recognition that inner dissonance part of human condition; Daniel Kahneman System 1 and System 2 processes; System 1 intuitive, automatic, unresponsive to changing circumstances; System 2 slower, serial, effortful, consciously monitored, deliberate controlled; systems work in tandem, produce contradictory results; contradictions may be rooted in structure of brain; cognitive science and neuroscience research provide assumption foundation

Influence of past on present: past alive in present; past experiences contextualize present day experience, shape perceptions, interpretations, reactions; positive or negative trajectory of prior life experience; all psychotherapy addresses impact of past on present; goal to loosen bonds of past experience to create new life possibilities

Transference: activation of preexisting expectations in context of therapy relationship; patient perception of physician not incidental to treatment (heart of therapy); help patient recognize, examine, understand, and rework old patterns; allow transferences to unfold, become palpable, salient; therapists who recognize and use transference therapeutically most effective; Treatment of Depression Collaborative Research Program; therapy relationship exerts regressive pull; therapists become magnet for unresolved desires, fears; frequent appointments intensify transference feelings; scheduling should depend on patient

Psychological defense: anything a person does that distracts attention from anything unsettling or dissonant; defense normal part of life; Herbert Schlesinger, defense in systems theory regulate to preserve homeostasis; therapists work to disrupt homeostatic processes that maintain symptoms and problems; repression of thoughts term no longer useful; disavow common, normal; character or personality habitual pattern of coping and defending against distressing thoughts and feelings; any thought or feeling can be used to defend against any other thought or feeling; projection, reaction formation, denial, intellectualization, counter phobic behavior, displacement, projective identification, externalization; defending our enduring personality or character; defense and personality intertwined; psychodynamics help recognize disavowing aspects of experience; effect of expanding freedom in choice; desire to deny responsibility can become significant resistance to change; dynamic unconscious

Psychological causation: psychological symptoms seem senseless, unpredictable, no apparent cause; as symptom awareness expands meaning and function become clear; psychodynamic therapy helps recognize connection of thoughts, feelings, actions, events; associations; symptoms or behavior can have multiple causes (over-determination), can serve multiple purposes (multiple function); psychodynamic therapy relies on empathically attuned inquiry into aspects of inner experience; no 2 treatments alike; nothing in life of the mind random; all mental activity follows logic of associative network; random mental events traced through linked associations; free association helps make associative links, suspends usual editing and censoring; encourage free flow of thought; psychoanalytic therapy at border between known and unknown; nonrandomness of mental processes called psychic determinism; influenced or determined by preceding mental events; psychic continuity vs psychic determinism; thoughts chained in meaningful sequences; psychotherapists believe in human capacity to grow, change; if behavior were determined would be no reason to practice any form of therapy

Readings

Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PSBR160152

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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