PSYCHODYNAMIC PSYCHOTHERAPY OBJECTIVES. Jennifer Scroggie, APRN, BC 1. Jennifer Scroggie APRN, BC Psychoanalyst APNA Conference 2016

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1 PSYCHODYNAMIC PSYCHOTHERAPY Jennifer Scroggie APRN, BC Psychoanalyst APNA Conference 2016 OBJECTIVES Identify three core assumptions of Psychodynamic Psychotherapy Describe key elements of optimal ego functioning Identify the basic requirements for a Psychodynamic Formulation The presenter has no conflict of interest to disclose Jennifer Scroggie, APRN, BC 1

2 Psychodynamic Assumptions Psyche Unconscious mental functioning Dynamics Mind in motion Psychodynamic elements in the unconscious impact thoughts, feelings and behavior. Centrality of Conflict Unconscious wishes and fears drive mental life. Psychodynamic Psychotherapy Understand derivatives of the patients unconscious life which effect conscious thoughts, feeling and behavior Support and enhance weakened ego functioning Reactivate developmental process Psychodynamic Assumptions Unconscious Implicit Memory Developmental perspective Focus on the past as it is re enacted with others, and in there here and now with patient and therapist. Attention to affect unexpressed unconscious emotions and beliefs. Transference and Countertransference Anxiety/ Conflict & Resistance/ defense & Wish/ fear Jennifer Scroggie, APRN, BC 2

3 UNCONSCIOUS Centrality of conflict Habitual patterns are motivated by unconscious process. Anxiety and defenses lead to character style and subjectivity which can become rigidly defined Psychic Determinism/ Repetition Compulsion Transference and Counter transference Dreams, body language, parapraxes (slips) Freud s Structural Model Conscious EGO Conscious Unconscious EGO ID Superego Unconscious Access to the Unconscious Dreams are often most profound when they seem the most crazy Freud s Interpretation of Dreams 1899 Wish fulfillment to resolve unconscious conflict Jennifer Scroggie, APRN, BC 3

4 Optimal Ego Functioning Insight Agency (self efficacy) Reality testing Identity consolidation/ self esteem Affect management Tolerate ambivalence Defer gratification Higher order secondary defense mechanisms Developmental Theory Reactivate developmental growth Anxiety at each developmental stage is assuaged with successful management of the central conflict Trauma causes developmental arrests/ lags Psychotic Borderline Neurotic functioning Psychodynamic Techniques Working Alliance Therapeutic Frame Continuum of approaches based on developmental considerations Supportive Expressive Psychoanalytic Jennifer Scroggie, APRN, BC 4

5 Psychodynamic Techniques Free Association Dreams Body language Jokes Transference Countertransference Jennifer Scroggie, APRN, BC 5

6 Clarify/ listen Interventions Confront/ Reflect Interpret/ Intervene Defensiveness and Conflict Psychic conflict causes pain Psychic pain evokes defenses Primitive defenses increase pathology Mature defenses decrease pathology Psychotherapy enhances mature defenses Adapted from VP Gay Psychiatry Handbook pp Psychodynamic Formulation Why now? How has THIS patient managed illness/ stressors/ trauma in the past What does the patient need from me to heal? What do I need to do/ be to help this patient? How will the patient and I know when they are healing? What can we anticipate will happen in the future? Jennifer Scroggie, APRN, BC 6

7 Psychodynamic Formulation DSM Nosology (descriptive commonalities) is included in a dynamic formulation (uniqueness) Four levels of psychodynamic formulation Recognizing psychological dimension Constructing illness narrative Modeling a formulation Naming the elements Psychodynamic/ Bio psychosocial 5 P s: Presenting Problem Predisposing Precipitating Perpetuating (Maintaining internal/ external) Protective Prognosis Core Conflict Psychodynamic Formulation OPD Dimensions Self Perception Self Regulation Maturity of Defenses Object Perception Communication Capacity for Attachment Jennifer Scroggie, APRN, BC 7

8 Psychodynamic case formulation Self Perception Self Regulation Manage affect Defenses Primary Defenses Secondary PSYCHODYNAMIC CASE FORMULATION Object Perception Communication Capacity for attachment Primary Conflicts Dependence v. Autonomy Submission v. control Desire for care v. autarchy Valuing self v. valuing object Guilt conflicts Oedipal /sexual conflicts Identity conflicts Jennifer Scroggie, APRN, BC 8

9 Being entirely honest with oneself is a good exercise. Sigmund Freud Jennifer Scroggie, APRN, BC 9