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Psychodynamic Therapies
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Semester - 4

Module I - Introduction to Psychotherapies

_____Goal and Scope of Psychotherapy_____

What is Psychotherapy?
Psychotherapy can be defined in a broad fashion as comprising three distinct components: a healing
agent, a sufferer, and a healing or therapeutic relationship (Frank and Frank 1991). Strupp (1986)
specified that psychotherapy is the systematic use of a human relationship for therapeutic purposes of
alleviating emotional distress by effecting enduring changes in a client’s thinking, feelings, and
behaviour. The mutual engagement of the client and the psychotherapist, both cognitively and
emotionally, is the foundation for effective psychotherapeutic work. Traditionally, the term
psychotherapy has been used to refer to the treatment of mental disorders by means of psychological
techniques, in a client-therapist relationship. It is a process in which a trained professional enters a
relationship with a client for the purpose of helping the client with symptoms of mental illness,
behavioral problems or for helping him towards personal growth. Wolberg (1988) conceptualizes
psychotherapy as an endeavor to alter the behaviour and change the attitude of a maladjusted person
towards a more constructive outcome. He defines psychotherapy as, “, a form of treatment for
problems of an emotional nature in which a trained person deliberately establishes a professional
relationship with a client with the object of…removing, modifying or retarding existing symptoms,
mediating disturbed patterns of behaviour, and promoting positive personality growth and
development”

Aims of Psychotherapy
Psychotherapy is more than a talk between two people regarding some problem. It is a collaborative
undertaking, started and maintained on a professional level towards specific therapeutic objectives.
These are:
• Removing existing symptoms: To eliminate the symptoms that are causing distress and
impediments is one of the prime goals in psychotherapy.
• Modifying existing symptoms: Certain circumstances may militate against the object of removing
symptoms (e.g. inadequate motivation, diminutive ego strength or financial constraints); the objective
can be modification rather than cure of the symptoms.
• Retarding existing symptoms: There are some malignant forms of problems e.g. dementia where
psychotherapy serves merely to delay an inevitable deteriorative process. This helps in preserving the
client's contact with reality.
• Mediating disturbed patterns of behaviour: Many occupational, educational, marital,
interpersonal, and social problems are emotionally inspired. Psychotherapy can play vital role from
mere symptom relief to correction of disturbed interpersonal patterns and relationships.
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• Promoting positive personality growth and development: Deals with the immaturity of the
normal person and character logical difficulties associated with inhibited growth. Here psychotherapy
aims at a resolution of blocks in psycho-social development to a more complete creative
self-fulfillment, more productive attitudes, and more gratifying relationships with people. It also aims
at…

– Strengthening the client’s motivation to do the right things.

– Reducing emotional pressure by facilitating the expression of feeling.
– Releasing the potentials for growth.
– Changing maladaptive habits.
– Modifying the cognitive structure of the person.
– Helping to gain self-knowledge.
– Facilitating interpersonal relations and communications.

GOAL AND SCOPE OF PSYCHOTHERAPY

Ultimate goals: The ultimate goal is what the psychologist wants to achieve at last.

● Removing the symptoms.

● Freeing the person to be self-actualizing.
● Restoring earlier levels of functioning.
● Helping the patient find personal meaning and values.

Mediate goals: They are not less important than the ultimate goal. The mediate goals define the
needs which are necessary to move the patient towards the ultimate goal.

● Releasing pend-up feelings.

● Conditioning or reconditioning of particular responses.
● Examining ones values and concepts.
● Muscular relaxation.
● Becoming aware of unconscious impulses.

SCOPE

● Reinforcing client’s resolve for betterment.

● Lessening emotional pressure.
● Unfolding the potential for positive growth.
● Modifying habits.
● Changing thinking patterns.
● Increasing self-awareness.
● Improved interpersonal relations and communication.
● Facilitating decision-making.
● Becoming aware of ones preferences in life.
● Development of adaptive behaviour.

______Types of Psychotherapies______

➢ Psychodynamic Therapy
Psychodynamic theory begins with contribution of Sigmund Freud with the focus on increasing ego
strength and /or reducing the pressure of denied impulses, so that the client will be free to run his own
life. Psychodynamic therapy is based upon the assumption that problems occur because of
unresolved — usually unconscious — conflicts, often originating from childhood. This therapy
promotes understanding and enhances coping amongst the clients. Free association is often used by
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the psychoanalysts in order to bring out the hidden unconscious wishes and conflicts in an individual.
In free association, the client is asked to say whatever that comes to his/ her mind. This therapy also
focuses on dream analysis, because according to this therapy, during sleep there is profound
relaxation of normal ego controls than is possible in free association and hence unconscious
processes are freer to operate in sleeping than in waking thought. Consequently dream provides a
potentially rich source of information about unconscious needs. The analysis of transference is also
the core of psychoanalytic therapy. In which the client held strong personal feelings toward the analyst
which simply could not be understood in terms of actual events of therapy or the analyst’s character or
behaviour. This transference can be positive (like admiration, love and respect) as well as negative
(hate, contempt or anger). Freud believed that such reactions were not only barriers to therapy but
they might indeed be vehicle of therapeutic change. The essential fact about transference is that it
brings hidden and repressed feelings and conflict into the present where they can be examined,
understood and resolved.

➢ Behaviour Therapy
Behaviour therapy mainly deals with modifying or changing undesirable behaviour. In this
psychotherapy the maladaptive behaviour are identified and then with the help of various techniques
such behaviour are replaced or modified. Learning theories have played an important role in
behaviour therapy. And the contributions of Ivan Pavlov in terms of classical conditioning and of B. F.
Skinner in terms of operant conditioning are noteworthy.
Classical conditioning: Classical conditioning was proposed by Ivan Pavlov. His experiment in which
the dog was conditioned to salivate after ringing of the bell forms basis of this learning theory. It can
be described as a learning process that is a result of associations between an environmental and a
natural stimulus. Learning thus occurs due to pairing between conditioned stimulus and unconditioned
stimulus.
Operant conditioning: This learning theory was proposed by B. F. Skinner. This is also known as
instrumental conditioning. Here the learning takes place as a result of reinforcement, reward and
punishment that determine whether a particular behaviour will be repeated or not.

➢ Humanistic Psychotherapy
Humanistic therapy is an approach where the main emphasis is on client’s subjective, conscious
experiences. The therapist’s focus is more on the present. The client plays far active role as
compared to the therapist who mainly plays the role of creating a conducive environment. The major
form of humanistic therapy is client developed by Carl Rogers. The therapy by Carl Rogers is known
as Client Centered Therapy or more recently as Person Centered therapy. This therapy mainly
focuses on empathy, unconditional positive regard by the therapist towards the client and
communication of empathy and unconditional positive regard by the therapist to the client.
Existential Psychotherapy
Existential approaches to psychotherapy have tended to emerge at times, and in regions the world,
where there was a groundswell of interest in existential philosophy. Frankel and Rollo May were the
major contribute Existentialism is a philosophy concerned with the meaning of human existence. They
believe that people are free to choose among alternatives available to them have a large role in
shaping their own problems of moral conflicts falls under Logo therapy. In meaning of life for himself.
This meaning I uniqueness, his destiny, his heritage all come together to give a new meaning to his
life.

➢ Gestalt Therapy
Perls’s Gestalt therapy was born in Germany. Gestalt psychologists Wertheimer, Koffka, Kohler, Lewin
and Goldstein contributed to development of this therapy. Gestalt theory emphasises organization and
relatedness, which is in contrast with reductionism of Wundt -Tichner and mechanical behaviorism of
applied this theory to human life, integrating the various aspects dynamic, affective, cognitive and
social in one whole and then understanding it as a total unity.
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➢ Interpersonal Therapy
Interpersonal therapy was given by Gerald L. Klerman and Myrna Weissman based on the ideas of
Harry Stack Sullivan. As the name suggests this therapy mainly focuses on the present and past
social roles and interactions of the client. One or two problems currently experienced by the client are
taken in to consideration during the therapy. Issue related to conflicts with friends and family member
or even colleagues. It can also help individuals deal with grief and loss. Other issues like retirement
and divorce can also be dealt with this therapy.

_______Psychotherapy vs Counselling________

Counselling is a type of therapeutic method that aids a person in overcoming unwanted emotions
and behavioural habits. The fundamental goal of counselling is to enable the client reveal his
concerns to a professional with extensive knowledge of the human mind, so that the client can receive
help in adapting to normal and efficient everyday routines.
There are different aptitudes involved in counselling:
● Proper listening and attention skills.
● Empathy and understanding
● A non-judgmental attitude
● Patience and kindness
● Ability to cope with emotional situations
● Ability to relate to and adapt communication style to suit a wide range of people
● A Good Communicator
● Analysis

Psychotherapy is a developmental process that will assist the client in gaining a logical and clear
understanding of their core attitudes, beliefs and recurrent emotions, patterns of thinking, behaviour,
and personality, which may have resulted in specific challenges, poor quality of life, and interpersonal
relationships.

DIFFERENCE
Psychotherapy and counselling are two diverse concepts but get frequently mistaken for one another.
They both use psychological methods to alleviate mental health issues and are both forms of
cognitive therapy. Psychotherapy (also known as cognitive treatment or psychological therapy) is the
application of psychodynamic therapy strategies in assisting people with fickle behavioral patterns,
increasing positivity and fulfillment, as well as overcoming difficulties. Psychotherapy is used to
continue improving a person’s state of mind short – term and long – term wellbeing, as well as to
remedy and maybe ameliorate problematic behaviour, ideologies, impulses, thought processes, and
sentiments, and to also strengthen social connections capabilities. Independent adults, families and
children are all capable of benefitting from these various forms of psychotherapy.
Counselling and psychotherapy both use psychological techniques to help patients deal with stressors
and mental illnesses.
These are a few distinct differences between both specialties:
● Counselling is usually done in an outpatient context, whereas psychotherapy is done in both
an inpatient and outpatient setting.
● Counselling addresses social, career, and educational issues, whereas psychotherapy
concentrates on adaptation and psychological issues.
● Counselling focuses on basic life challenges that most people encounter at some point in their
lives, such as stress at work, relationship problems, family issues or emotionally difficult
changes like the death of a loved one, where psychotherapy specializes in working to improve
problems with a person’s fundamental thoughts, beliefs, or feelings.
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Counselling Psychotherapy

Counselling is a short term process Psychotherapy is a long-term process

Support the patient to perform day to day Uncover the foundation of the problem and
activities in a normal and efficient manner address it in the most efficient manner

Address issues in a less in-depth manner Address issues in a very deep manner

Deal with patients who are fit enough to think Involve individuals who are dependent on the
rationally and find solutions to their problems by psychotherapist to gain control over their
themselves personality, mind, emotions and behaviour.

Counselling is more like guidance to make well Psychotherapy involves an intensive search and
informed decisions while psychotherapy investigation of the issue at hand while
involves deep rooted and fundamental counselling places more emphasis on providing
behavioral patterns and psychological issues. an immediate solution to current grievances.

Counselling has always been connected with Psychotherapy is frequently used to treat a
educational and social-work settings, whereas diagnosable mental health illness such as
psychotherapy has traditionally been associated depression, schizophrenia amidst others while
with psychopathology, psychiatrists, clinical counselling is typically wellness-oriented,
psychologists, and medical settings. offering deeper insight and teaching how to
effectively handle problems and challenges.

Counselling focuses on less serious difficulties

and is a temporary procedure while
psychotherapy involves quite an amount of time
to get to the root of chronic, visceral issues and
address them properly.

Module II - Theoretical Background

_____Freudian techniques: Free Association, Resistance, Transference.

Catharsis, Hypnosis, Indications and Contraindications, Limitation_____

FREE ASSOCIATION
Free association is the expression (as by speaking or writing) of the content of consciousness without
censorship as an aid in gaining access to unconscious processes. The technique is used in
psychoanalysis (and also in psychodynamic theory) which was originally devised by Sigmund Freud
out of the hypnotic method of his mentor and colleague, Josef Breuer.
Freud described it as such: "The importance of free association is that the patients spoke for
themselves, rather than repeating the ideas of the analyst; they work through their own material,rather
than parroting another's suggestions"

Origins
Historically, reflections on the activity of thought, and the free association which characterizes it,
emerged during the 18th century through the “exteriorized” conceptions of Franz-Anton Mesmer. His
notion of “animal magnetism” as a “universal flux” that must be harmoniously reordered through
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various processes (magnetism, passes of hands, etc.) offered a view of mental energy as an external
force (Méheust, 1999). This first attempt to represent a “psychic flux” gradually became more
“internalized” with the development of psychoanalysis.

During the 19th century, Pierre Janet evoked “points of fixation” in psychic activity to describe such
obstruction, and Freud (1895) pursued this idea in his Project for a Scientific Psychology, yet added
the hypothesis that specific “primary defenses” led to these points of fixation. Freud’s originality also
consisted in his conception of these defense mechanisms being the consequence of traumas and
previous life experiences

Freud then supposed that mental functioning and psychopathology could be studied, thanks to free
association, according to the particularities of the associative flow and that patients could work
through these fixations via free association.

The Interpretation of Dreams (Freud, 1900). Freud showed that the latent content of the dream could
be deciphered through the thoughts the patient spontaneously associated with the dream. Freud later
used the same technique in Psychopathology of Everyday Life (Freud, 1901) to understand slips of
the tongue, forgotten words, etc.

In his essay On Beginning the Treatment, Freud (1913) proposed a clear metaphor to describe the
mechanisms of free association to his patients: “Act as though, for instance, you were a traveller
sitting next to the window of a railway carriage and describing to someone inside the carriage the
changing views which you see outside”

During the psychoanalytic treatment, Freud would help the patient to deploy free associations in order
to restore or catalyze “blocked” psychological processes and conflicts. Thus, it was largely through the
free association method that Freud came to analyze the different layers of the psyche and to
distinguish between primary and secondary processes corresponding to different “treatments” of
psychic energy.

Freud supposed that the analyst should be in a specific state of mind called “free floating attention”
while the patient is free associating. In this way, analysts might use their own unconscious to decipher
the unconscious of the patient. This “shared” free association, or co-associativity (Roussillon, 2011)
implies that the patient associates freely in the presence of the clinician and addresses oneself
through the other.

Analysis Of Free Association

After listening to his patient's seemingly random thoughts, Freud would analyze and examine the
information to find any hidden meaning. Early psychoanalysis or the Freudian therapy aimed to find
the source of a person's problem and reveal it to them. Freud thought that once you understood what
was causing you to think or behave in maladaptive ways, the problem, for most people, would
naturally resolve.

How Free Association Works

Free association often starts with instructions and prompts from the therapist, in some cases the
therapist asks guiding questions or gives cues to prompt more thinking. Often getting started and
speaking the first word is the most challenging part. The therapist may then use their expertise to go
beyond the words spoken to discover the unconscious meaning and help the patient to make sense of
their world.
1. Lie Down And Relax
To start a free association session in the beginning, you might lie down and get comfortable. In
Freud's day, you would lie down on a couch. Now you might sit in a comfortable chair instead.
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The therapist instructs you to speak your thoughts freely, without embarrassment. They may tell you
not to censor yourself but to say any words that come to mind.

2. Talk About Anything

Saying every thought that comes to mind may feel awkward when you first try it, you may talk about
your past, your mother or father, bring up repressed memories, or explore other areas of your life. You
may feel your string of thoughts is nonsensical. Freud often told clients that their stream of
consciousness would make perfect sense once they discovered the underlying problem.

3. Listen To Interpretations
Freud typically said little while his patients were free associating. His goal was to listen closely,
interpret the free thoughts, and offer his analysis. Today, therapists may include you in this process,
asking if anything surprised you and seeking your opinion on what something means. This process
may provide you and your therapist another avenue into your psyche via your conscious mind. It could
also prevent a therapist from adding too many personal anecdotes into their interpretation of your
free association.

Functions
Benefits Of Free Association
● Discover Essential Lessons In free association, almost everything that you think or say may be
important and you may not discard thoughts even if you think they're irrelevant. Because your
therapist hears every thought during the session, they might learn about areas of your psyche that
neither of you previously noted. While you might not see the significance of a thought or feeling, a
therapist often has a broader perspective and understanding of unconscious motives.

● Uncover Hidden Thoughts At times, we may file painful thoughts away so deeply in our unconscious
that we don't realize they're there. A free association session may reveal them. When this happens,
the knowledge of what you've been hiding from yourself can bring you a sense of relief and closure.
Once you know about a thought, you may deal with it consciously and decide what to do

● Express Repressed FeelingsPeople may repress feelings that feel too painful or confusing to deal
with. However, studies show that repressing emotions can be harmful. Free association can allow you
to open up about these feelings.

● Get To The Root Of The Problem Understanding the root of a problem can be challenging. Free
association sessions may help you identify the source of problems, so you can work with your
psychologist to create a plan for overcoming them.

INDICATION
Free association is a technique commonly used in psychoanalysis and psychodynamic therapy. It
involves the spontaneous and uncensored verbal expression of thoughts, feelings, and associations
that come to mind without consciously censoring or filtering them. The primary goal of free association
is to access the unconscious mind and gain insight into unconscious conflicts, motivations, and
patterns of thinking. Here are some indications for the use of free association:

1. Psychoanalysis and Psychodynamic Therapy: Free association is a fundamental technique in

psychoanalysis and psychodynamic therapy. It is used to explore the deeper layers of the psyche,
uncover unconscious material, and gain insight into the origins and dynamics of psychological
difficulties.
2. Unresolved Childhood Issues: Free association can be helpful in uncovering and processing
unresolved issues from childhood, such as early traumas, attachment disruptions, or unresolved
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conflicts with parents or caregivers. It allows individuals to tap into unconscious memories and
emotions associated with these experiences.

3. Understanding Repressed or Suppressed Thoughts and Feelings: Free association can bring
repressed or suppressed thoughts, emotions, desires, or fantasies into conscious awareness. By
allowing thoughts to flow without censorship, individuals can access deeper layers of their psyche and
gain insight into unconscious motivations and conflicts.

4. Exploring Complex or Ambivalent Feelings: Free association can help individuals explore
complex or ambivalent feelings that they may struggle to articulate or understand consciously. By
allowing associations to arise freely, contradictory emotions and thoughts can surface, providing a
more comprehensive understanding of inner conflicts and dilemmas.

5. Accessing Symbolic or Dream Content: Free association can assist in understanding symbols,
metaphors, and dream content. It allows individuals to make connections between seemingly
unrelated thoughts, images, and experiences, leading to a deeper understanding of unconscious
symbolism and meaning.

6. Enhancing Self-Reflection and Insight: Free association fosters self-reflection and insight by
providing an opportunity to explore thoughts and emotions in a spontaneous and unfiltered manner. It
can help individuals gain awareness of their automatic thought patterns, emotional reactions, and
underlying motivations.

CONTRAINDICATION
While free association can be a valuable technique in psychoanalysis and psychodynamic therapy,
there are certain situations or conditions where it may not be recommended or may require careful
consideration. Here are some contraindications and factors to consider:

1. Severe Psychotic Disorders: Individuals with severe psychotic disorders, such as schizophrenia
or severe dissociative disorders, may have difficulty distinguishing between reality and fantasy. Free
association may exacerbate confusion or lead to a loss of touch with reality. In such cases, more
structured or reality-based interventions may be more appropriate.

2. Lack of Cognitive Functioning: Individuals with severe cognitive impairments or intellectual

disabilities may struggle to engage in free association effectively. The capacity for abstract thinking,
insight, and verbal expression necessary for free association may be limited. Alternative therapeutic
approaches that align with their cognitive abilities should be considered.

3. Active Substance Abuse or Addiction: Individuals who are actively abusing substances or
struggling with addiction may have impaired judgment, reduced capacity for introspection, and
compromised ability to engage in the self-reflective process required for free association.Substance
abuse or addiction issues should be addressed and stabilized before attempting free association.

4. Lack of Trust or Safety: Free association relies on creating a safe and trusting therapeutic
relationship. If an individual lacks trust in the therapist or feels unsafe disclosing their thoughts and
feelings, free association may not be productive or beneficial. Building rapport and establishing a
sense of safety and trust should be prioritized before attempting free association.

5. Emotional Instability or Impulsivity: Individuals with significant emotional instability, impulsivity,

or difficulties regulating their emotions may find it challenging to engage in the unfiltered and
spontaneous process of free association. In such cases, it may be necessary to first develop
emotional stabilization skills before introducing free association as a therapeutic technique.
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CRITICISM OF FREE ASSOCIATION

The main criticism of free association has been that people may overproduce associations. This can
be caused by pressure from a therapist. Someone in therapy may struggle to say as many random
words and thoughts as possible. Difficulty can occur even if the person is not actually thinking about
these topics. Associations may also be random and unrelated to a person’s psyche.
For example, someone may start by recalling a memory of their mother. They may remember song
lyrics associated with the memory and then begin naming musical artists. This could create the
appearance of associations and memories that do not actually exist.

In this, Freud made his patients lie down and start talking about whatever came to their minds. This
was known as "free association," as no boundaries were maintained, and they could talk about
anything and everything. It was done because, at some point, the psychologist would be able to make
a pattern of the client's thoughts and then work accordingly.

RESISTANCE
Resistance is both a trait that some people possess in higher degrees and an emotional state that can
be observed during therapy. Resistance in psychology refers to any opposition to the therapeutic
process. Resistance is a way of pushing back against suggestions, even those that could help you
solve mental or emotional health concerns. Sometimes a person tells themselves that they aren't
ready. Maybe they say advice is unfair, or they explain that the therapist doesn't understand the whole
story. Whatever the form, resistance is considered a defence of ego on a subconscious level

History
Having developed the theory of resistance through his direct experiences with patients undergoing
therapy, Sigmund Freud noticed that patients would avoid subjects and topics that struck too closely
to uncomfortable memories or unacceptable emotions and desires. Freud then integrated these
findings with his previous theories concerning the functions of the id, ego and super-ego. As a result,
he eventually advanced his concept of resistance by developing it into a multitude of individual forms
that included repression, transference, ego-resistance, "working-through", and self-sabotage.

In an early exposition of his new technique, Freud wrote that "There is, however, another point of view
which you may take up in order to understand the psychoanalytic method. The discovery of the
unconscious and the introduction of it into consciousness is performed in the face of continuous
resistance on the part of the patient. The process of bringing this unconscious material to light is
associated with pain, and because of this pain the patient again and again rejects it". He went on to
add that "It is for you then to interpose in this conflict in the patient's mental life. If you succeed in
persuading him to accept, by virtue of a better understanding, something that up to now, in
consequence of this automatic regulation by pain, he has rejected (repressed), you will then have
accomplished something towards his education.

Common Signs of Resistance in Therapy

● Not Talking
Every therapist fears the silent session. Although complete silence is a rare occurrence, it is not
unusual to find a client that gives short answers and has difficulty opening up.
● Small Talk
Some clients will talk extensively, but it is about their weekly activities and other inconsequential
information. When guided to talk about thoughts and feelings, they tend to avoid and distract.
● No Homework/Don’t Use Suggestions
In many forms of psychotherapy it is popular to give homework. A telltale sign of resistance is a client
who does not complete their homework or follow up on your suggestions.
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● Canceling Sessions
Almost all clients cancel a session from time to time, but when a pattern develops it is a worrisome
sign. Someone who is motivated to change will make attending sessions a priority.

● You Are Trying Harder Than Your Client

When you feel like a client is not much making much progress it is natural to feel frustrated and a bit
guilty. You want to make sure you are providing them with the best therapy possible so you spend
extra time on their case, planning new strategies and interventions. Unfortunately, the client does not
seem to be making much effort other than showing up for treatment. Therapy is a two-way street. If
you are working harder than your client, it is probably not going anywhere.

INDICATIONS
Resistance is a common phenomenon in therapy where individuals consciously or unconsciously
resist the exploration or expression of certain thoughts, emotions, or experiences. It can manifest in
various ways and may indicate underlying issues or challenges that need to be addressed. Here are
some indications of resistance in therapy:
1. Avoidance of Topics: When individuals consistently avoid discussing certain topics or repeatedly
change the subject, it can be an indication of resistance. They may steer the conversation away from
areas that evoke discomfort or anxiety, preventing deeper exploration.

2. Intellectualization: Some individuals may engage in intellectualization as a defense mechanism to

distance themselves from emotional content. They may overanalyze or focus on abstract concepts,
theories, or unrelated details to avoid engaging with their emotions or personal experiences directly.

3. Excessive Defensiveness: If individuals become excessively defensive or guarded when certain

topics are raised, it may indicate resistance. They may react with anger, deflection, denial, or
dismissiveness to protect themselves from addressing sensitive or painful issues.

4. Rationalization or Excuses: When individuals consistently rationalize or make excuses for Their
thoughts, behaviors, or experiences, it can be a form of resistance. They may attribute their actions to
external factors or logical explanations to avoid exploring underlying emotions or taking responsibility.

5. Silence or Withdrawal: Individuals may withdraw, become silent, or shut down emotionally during
therapy sessions when resistance is present. They may create a barrier between themselves and the
therapist, making it difficult to establish a therapeutic connection or engage in deeper exploration.

6. Repetitive Patterns: When individuals repeatedly engage in certain behaviors or face similar
challenges despite efforts to address them in therapy, it can indicate resistance. They may
unconsciously recreate familiar patterns or dynamics as a way of avoiding unresolved issues or facing
uncomfortable emotions.

7. Noncompliance with Homework or Therapeutic Tasks: Resistance can be observed when

individuals consistently fail to complete assigned tasks, homework, or therapeutic exercises. They
may resist engaging in activities that require self-reflection or active participation, hindering progress
in therapy.

CONTRAINDICATION
Resistance is a common phenomenon in therapy, and it can be an important area to explore and
address. However, there are certain situations or conditions where addressing resistance directly may
not be appropriate or effective. Here are some contraindications and factors to consider:
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1. Lack of Therapeutic Alliance: If a strong therapeutic alliance has not been established, addressing
resistance directly may cause further resistance or ruptures in the therapeutic relationship. Building
trust, rapport, and a collaborative working alliance should be prioritized before exploring resistance.

2. Severe Psychopathology: In cases of severe mental illness or acute crisis, addressing resistance
directly may not be the immediate focus. Stabilization, symptom management, and safety concerns
may need to be addressed before delving into resistance-related issues.

3. Overwhelming Emotional Distress: If addressing resistance triggers overwhelming emotional

distress or exacerbates symptoms, it may be necessary to first develop emotional regulation skills and
increase coping mechanisms. Gradually working towards exploring resistance can be more beneficial
in these cases.

4. Limited Insight or Reflective Capacity: Some individuals may have limited insight,self-awareness, or
reflective capacity due to developmental factors, cognitive impairments, or other limitations. In these
cases, it may be necessary to use alternative therapeutic approaches that focus on building
foundational skills before addressing resistance.

5. Lack of Motivation or Readiness: If an individual is not motivated or ready to explore resistance,

attempting to address it directly may be unproductive or met with resistance. It's important to assess
the client's readiness for exploring resistance and respect their pace and preferences.

6. External Factors or Stressors: Sometimes resistance in therapy may be influenced by external

factors, such as ongoing stressors or life circumstances. In these cases, addressing the underlying
external factors may be more helpful than focusing solely on resistance within the therapy process.

LIMITATIONS
While psychoanalysis and its techniques have contributed significantly to the field of psychology, they
also have several limitations:
Time-consuming and costly: Traditional psychoanalysis typically requires long-term therapy
sessions multiple times per week, making it inaccessible to many individuals due to time and financial
constraints.

Subjectivity and interpretation: Psychoanalysis relies heavily on the therapist's interpretation of the
patient's thoughts, feelings, and behaviors, which can introduce bias and subjectivity into the
therapeutic process.

Limited empirical support: Some aspects of psychoanalytic theory, such as the Oedipus complex or
the role of unconscious conflicts, are difficult to empirically validate, leading to skepticism among
some researchers and clinicians.

Focus on past experiences: Psychoanalysis places a significant emphasis on exploring past

experiences and childhood events to understand current psychological functioning, which may not
always be relevant or helpful for addressing present-day issues.

Not suitable for all individuals: Psychoanalysis may not be appropriate for individuals with severe
mental illness, cognitive impairments, or those who are unwilling or unable to engage in introspective
or insight-oriented therapy.

Lack of cultural sensitivity: Some aspects of psychoanalytic theory and technique may not be
culturally sensitive or applicable across diverse populations, leading to potential limitations in its
effectiveness for individuals from different cultural backgrounds.
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TRANSFERENCE
Transference is a complex phenomenon and can sometimes be an obstacle to therapy. Based on
their feelings, the client may feel tempted to cut off the relationship with their therapistaltogether, for
instance. Or they might become sullen and withdrawn during therapy sessions,

Paternal transference: A relationship that feels fatherly in nature, either an idealized one, a realistic
one or a challenging one. Unconscious feelings might result in expectations like power, authority,
kindness, intelligence or protection projected onto another paternal type figure. There could also be
projected feelings of assumed betrayal, mistrust or judgement.

Maternal transference: A relationship that feels motherly in nature, either an idealized one, a realistic
one or a challenging one. Unconscious feelings might result in expectations like love, influence,
nurturing, or protection projected onto another maternal type figure. There could also be projected
feelings of assumed nagging, unrealistic expectations, mistrust or judgement.

Sibling transference: When a sibling took on a more parental, nurturing role than the parent there
could be a similar sort of transference as that of a parental role. This type of dynamic tends to
particularly impact peer relationships.

Non-familial transference: When idealized expectations override reality, there can be a different sort of
transference. These types of relationships (such as a teacher, rabbi, priest, principal or coach) can
potentially cause significant impact, almost as much as a parent. When a person starts to show their
humanity outside their particular role it can cause emotional unrest for the person who holds that
black and white stereotype.

Sexualized transference: Usually refers to a person in therapy who develops a sexual or erotic
attraction to their therapist.

TRANSFERENCE IN THERAPY
A person’s social relationships and mental health may be affected by transference, as transference
can lead to harmful patterns of thinking and behavior. The primary concern is generally the fact that, in
the case of transference, an individual is not seeking to establish a relationship with a real person, but
with someone onto whom they have projected feelings and emotions.

When transference occurs in a therapeutic setting, a therapist may be able to better understand an
individual by gaining knowledge of the projected feelings and, through this new understanding, help
the person in therapy achieve results and recovery. Transference may often occur between a therapist
and a person in therapy. For example, the therapist may be viewed as an all-knowing guru, an ideal
lover, the master of a person’s fate, a fierce opponent, and so on.

A therapist might also educate a person in treatment on the identification of various situations in which
transference may be taking place. Techniques such as journaling can allow a person in therapy to
identify possible patterns in both thought and behavior, through the review and comparison of past
entries.One type of therapy known as transference-focused therapy (TFP) harnesses the transference
that occurs in therapy to help individuals gain insight into their own behavior and thought patterns. It is
most commonly used to treat borderline personality (BPD).

How Can the Therapist Deal with Client Transference?

● Regarding how a therapist should deal with client transference, Freud has made several
suggestions (Freud, 1914).
 13

● Foremostly, it is imperative that no actions from the therapist contribute to the patient’s
expressed emotionality. Hence, regardless if feelings are positive or negative, they must not
stem from the therapeutic relationship.
● It is thus important for the therapist to clarify that the client’s emotional experience does not
apply to the therapist.
● Secondly, once that baseline has been established, the therapist can begin to explain the idea
of transference and its basis in previous relationships.
● By doing so, the patient can then begin to enter a state of “free association,” during which
they start to recognize their transference and notice any repetitive behaviors/patterns.
● Finally, they can work with the therapist to move unconscious memories to the conscious
level and derive new learning

INDICATIONS
Transference is a phenomenon that occurs in therapy when individuals unconsciously transfer
feelings, attitudes, or dynamics from past relationships onto the therapist or the therapeutic
relationship. It can provide valuable insights into the client's internal world and relational patterns.
Here are some indications of transference in therapy
1. Intense Emotional Reactions: If an individual exhibits intense emotional reactions towards the
therapist that seem disproportionate to the current situation or the therapist's behavior, it may indicate
transference. This can manifest as intense love, anger, fear, or dependency towards the therapist.

2. Idealization or Devaluation: Individuals may idealize the therapist, attributing qualities, or abilities
beyond what is realistic. Alternatively, they may devalue or criticize the therapist, perceiving them as
disappointing, ineffective, or unhelpful. These extreme evaluations can be indicative of transference
dynamics.

3. Projection: Individuals may project aspects of themselves onto the therapist, attributing their own
thoughts, feelings, or characteristics to the therapist. They may perceive the therapist as having
qualities or intentions that are more accurate descriptions of themselves.

4. Repetition of Relationship Patterns: Transference can manifest as the repetition of relationship

patterns from past experiences. Individuals may recreate dynamics, roles, or conflicts they have
experienced in previous significant relationships within the therapeutic relationship.

CONTRANDICATION
Transference is a common and natural phenomenon in therapy, and addressing it can be an important
part of the therapeutic process. However, there may be situations or conditions where addressing
transference directly may not be appropriate or effective. Here are some contraindications and factors
to consider:
1. Lack of Therapeutic Alliance: If a strong therapeutic alliance has not been established, addressing
transference directly may cause confusion, resistance, or rupture in the therapeutic relationship.
Building trust, rapport, and a collaborative working alliance should be prioritized before exploring
transference dynamics.

2. Severe Psychopathology: In cases of severe mental illness, acute crisis, or when an individual's
symptoms are overwhelming, addressing transference directly may not be the immediate focus.
Stabilization, symptom management, and safety concerns may need to be addressed first.

3. Lack of Insight or Reflective Capacity: Some individuals may have limited insight, self-awareness,
or reflective capacity due to developmental factors, cognitive impairments, or other limitations. In
these cases, addressing transference directly may be challenging or unproductive. Focusing on
building foundational skills and increasing self-awareness may be more beneficial.
 14

4. Active Suicidal or Self-Harming Behavior: If an individual is actively engaging in suicidal or

self-harming behavior, addressing transference directly may need to be temporarily set aside to
prioritize safety and stabilization. Crisis intervention and safety planning should be the primary focus.

LIMITATIONS:
Misinterpretation: Therapists may misinterpret transference dynamics, leading to misunderstandings
or incorrect assumptions about the patient's feelings or motivations.

Resistance and avoidance: Patients may resist or avoid discussing transference-related feelings or
experiences, hindering the therapeutic process and limiting opportunities for growth.

Overemphasis on past relationships: Focusing too heavily on transference dynamics may overshadow
present-day issues and challenges, potentially neglecting the patient's immediate needs and
concerns.

Cultural considerations: Transference dynamics may not always translate across different cultural
contexts, leading to potential misunderstandings or misinterpretations in therapy.

Limited applicability: Transference may not be relevant or applicable to all individuals or therapeutic
approaches, particularly those that emphasize cognitive-behavioral techniques or short-term
interventions.

CATHARSIS
Catharsis is a concept in psychoanalytic theory wherein the emotions associated with traumatic
events come to the surface. The word has its origin in a Greek term for cleansing or purging, and
catharsis is associated with the elimination of negative emotions, affect, or behaviors associated with
unacknowledged trauma. Catharsis is often an integral component of therapy that addresses
repressed memories, and the phenomenon often occurs while under hypnosis. In previous
generations, psychoanalytic mental health practitioners used catharsis to treat symptoms associated
with what Freud called hysteria.

History of Catharsis
The term was first used in a psychological context by Josef Breuer, a colleague and mentor of
Sigmund Freud, who used hypnosis to cause people to reenact traumatic events. According to
Breuer, when clients were able to freely express the emotions associated with repressed traumatic
events, they had a catharsis.

In psychoanalytic theory, the word catharsis has been used to refer specifically to the discharge of
previously repressed effects or emotions connected to traumatic events that occur when these events
are brought back into someone’s consciousness and re-experienced.

Later, therapists and psychologists saw catharsis as an outburst of emotion leading to a sense of
profound enlightenment. In modern psychology, however, the term has taken on a lighter meaning,
defined as any form of expressing and releasing feelings and emotions. It is this articulation of
emotion that psychologists posit to lead to healing and positive mental health. For example, an artist
throwing paint at a canvas or a boxer punching a punching bag in an act of range may not be
considered to be acts of catharsis (Powell, 1995).

The concept of catharsis later would become foundational to Freud’s psychoanalytic theory. Freud
believed that healing can only occur when meaningful, unconscious thoughts and feelings are brought
into consciousness (Guinnagh, 1987).
 15

INDICATION
Catharsis refers to the release or expression of strong emotions or emotional tension, often
associated with a sense of relief or purification. In therapy, catharsis can be a valuable and
transformative experience. Here are some indications of catharsis in therapy:
1. Emotional Intensity: Indications of catharsis can include experiencing intense emotions during
therapy sessions, such as sadness, anger, fear, or joy. These emotions may be deeply felt and
expressed with a sense of release and relief.
2. Expression of Previously Suppressed Emotions: Catharsis often involves the expression of
emotions that individuals have consciously or unconsciously suppressed or repressed. It may occur
when individuals feel safe and supported enough to express emotions that they have held back due to
social conditioning, fear, or past experiences.
3. Verbal or Non-Verbal Expression: Catharsis can involve both verbal and non-verbal expression. It
may manifest as individuals speaking openly about their feelings, thoughts, or experiences, or it could
be expressed through non-verbal means like crying, shouting, or physical gestures.
4. Release of Tension or Emotional Blockages: Catharsis often involves the release of pent-up tension
or emotional blockages. It can be experienced as a cathartic "letting go" of emotional burdens, allwing
individuals to experience a sense of lightness or relief.
5. Increased Emotional Awareness: Catharsis can lead to an increased awareness and understanding
of one's emotions. Through the process of expressing and exploring emotions, individuals may gain
insights into the underlying causes or triggers of their emotional experiences.

CONTRAINDICATION
While catharsis can be a powerful and beneficial experience in therapy, there are certain situations or
conditions where it may not be appropriate or effective. Here are some contraindications and factors
to consider:
1. Lack of Therapeutic Alliance: If a strong therapeutic alliance has not been established, engaging in
catharsis may be premature or potentially harmful. Building trust, rapport, and a collaborative working
relationship should be prioritized before delving into emotionally intense experiences.
2. Severe Psychopathology: In cases of severe mental illness, acute crisis, or when an individual's
symptoms are overwhelming, engaging in catharsis directly may not be the immediate focus.
Stabilization, symptom management, and safety concerns may need to be addressed before
exploring cathartic experiences.
3. Limited Emotional Stability or Regulation: If an individual struggles with significant emotional
instability or has difficulty regulating their emotions, engaging in catharsis without appropriate
emotional coping skills or support may be overwhelming or exacerbate emotional distress. Developing
emotional regulation skills may need to precede or accompany cathartic work.
4. Trauma and PTSD: Individuals with a history of trauma, especially those diagnosed with
post-traumatic stress disorder (PTSD), require careful consideration when engaging in catharsis.
Uncontrolled or unguided cathartic experiences may potentially retraumatize the individual or lead to
overwhelming emotional distress. Trauma-informed approaches and safety measures should be
implemented.
5. External Factors or Stressors: Cathartic experiences can be influenced by external factors or
ongoing stressors in an individual's life. If these external factors are significantly impacting the
individual's ability to engage in therapy or handle cathartic experiences, they may need to be
addressed before exploring catharsis more deeply.

LIMITATIONS
Venting your feelings is very similar to the modern meaning of catharsis. Unfortunately, venting has
not been associated with positive outcomes. Whether it is vocalizing your feelings or expressing
yourself through aggression, venting has not shown to help.
A comparable concept to catharsis is rumination. Rumination is when you continuously think about
and/or express your thoughts and emotions.
 16

Rumination is frequently talked about as a way to cope with anxious thoughts, kindred to emotional
processing. Similar to venting, however, rumination does not work in alleviating anxiety.

Some people note that the concept of catharsis may give people tacit permission to act
inappropriately. When a person acts aggressively to express their anger, for example, it can be
passed off as catharsis. It is important to note that catharsis is never an excuse for inappropriate
behavior.

Proponents of catharsis argue that expressing anger does not have to result in behavior that is
offensive or harmful to others. They talk about punching a pillow instead of threatening a person or
destroying property. Regrettably, learning to express yourself through aggression (even if it is aimed
at an inanimate object) just leads to more aggressive behavior. We have found that anger and
aggression do not dissipate just because you express it through catharsis

HYPNOSIS
Hypnosis, also called hypnotherapy, is a state of deep relaxation and focused concentration. It’s a
type of mind-body medicine.
Hypnosis is a trance-like mental state in which people experience increased attention, concentration,
and suggestibility. While hypnosis is often described as a sleep-like state, it is better expressed as a
state of focused attention, heightened suggestibility, and vivid fantasies. People in a hypnotic state
often seem sleepy and zoned out, but in reality, they are in a state of hyper-awareness.

Hypnosis, a therapeutic technique rooted in inducing a trance-like state of focused attention and
heightened suggestibility, has been employed for centuries to address various psychological and
medical concerns. Within the realm of psychoanalysis, hypnosis initially held a prominent role as
Freud explored its potential to access repressed memories and unconscious material. However,
Freud later shifted his focus towards techniques such as free association and dream analysis, finding
them more effective in uncovering unconscious conflicts. Despite its historical significance, hypnosis
has faced controversies and skepticism, particularly regarding concerns about false memories and the
potential for suggestibility to influence recall. As a result, its use within psychoanalysis has diminished
over time.

Nevertheless, hypnosis continues to find application in contemporary therapeutic contexts, albeit to a

lesser extent within psychoanalysis. It is often utilized in cognitive-behavioral therapy (CBT),
hypnotherapy, and certain forms of psychotherapy to address issues such as anxiety, pain
management, and habit modification. Despite its varied applications, individual variability in
responsiveness to hypnosis exists, with factors such as suggestibility, imagination, and cognitive
functioning influencing its effectiveness as a therapeutic tool. Overall, while hypnosis remains a
subject of debate and ongoing research within the field of psychology, it persists as a complementary
tool for promoting relaxation, enhancing suggestibility, and facilitating therapeutic change in select
contexts.

Types of Hypnosis
Traditional Hypnosis: Also known as "authoritarian" or "direct suggestion" hypnosis, this type
involves inducing a trance state through the guidance of a hypnotist who delivers direct suggestions to
the subject. These suggestions aim to modify behaviors, thoughts, or perceptions.

Ericksonian Hypnosis: Named after Milton H. Erickson, this approach emphasizes indirect
suggestions, storytelling, metaphors, and language patterns tailored to the individual's unique
experiences and beliefs. It focuses on leveraging the unconscious mind to facilitate therapeutic
change.
 17

Neuro-Linguistic Programming (NLP): NLP incorporates hypnosis techniques alongside language

and behavioral patterns to address communication, personal development, and psychotherapy. It
aims to reprogram the mind by changing patterns of thought and behavior.

Self-Hypnosis: Self-hypnosis involves inducing a hypnotic state independently, often through

relaxation techniques, guided imagery, or audio recordings. Individuals can use self-hypnosis for
self-improvement, stress reduction, or managing specific issues such as anxiety or pain.

Hypnotherapy: Hypnotherapy combines hypnosis with therapeutic techniques to address

psychological or behavioral issues. It may involve exploring and resolving underlying emotional
conflicts, enhancing self-awareness, or promoting positive behavioral change.

Regression Hypnosis: Regression hypnosis involves guiding individuals to revisit past experiences
or memories, including those from childhood or earlier stages of life. It aims to uncover and resolve
unresolved conflicts or traumas that may be influencing present-day behavior or emotions.

Clinical Hypnosis: Clinical hypnosis refers to the use of hypnosis techniques within a clinical or
therapeutic setting to address specific psychological or medical concerns. It may be integrated into
various therapeutic approaches, including cognitive-behavioral therapy, psychoanalysis, or
counseling.

INDICATION
Hypnosis is a therapeutic technique that involves inducing a state of deep relaxation and focused
attention to promote positive changes in thoughts, feelings, or behaviors. While the specific
indications for hypnosis may vary depending on the therapeutic goals and the individual's needs, here
are some common indications of hypnosis in therapy:
1. Behavior Modification: Hypnosis can be effective in addressing and modifying unwanted behaviors
such as smoking, overeating, nail-biting, or other habits. It can help individuals gain control over their
behavior patterns and develop healthier alternatives.
2. Anxiety and Stress Reduction: Hypnosis can be beneficial in reducing anxiety and stress-related
symptoms. It can help individuals achieve deep relaxation, develop coping strategies, and promote a
sense of calm and well-being.
3. Phobias and Fears: Hypnosis can be used to treat phobias and fears by accessing and
reprogramming the subconscious mind. It can help individuals confront and overcome their fears,
promoting a sense of empowerment and freedom.
4. Pain Management: Hypnosis has been found to be effective in managing acute and chronic pain. It
can help individuals reduce pain perception, enhance relaxation, and promote the release of
endorphins, the body's natural pain-relieving substances.
5. Self-Exploration and Personal Growth: Hypnosis can be utilized as a tool for self-exploration and
personal growth. It can help individuals access their subconscious mind, gain insight into their
thoughts and beliefs, and promote self-awareness and self-empowerment.

CONTRAINDICATION
While hypnosis is generally considered safe and well-tolerated, there are certain situations or
conditions where hypnosis may not be recommended or may require special precautions. Here are
some contraindications and factors to consider:
1. Psychotic Disorders: Individuals with psychotic disorders, such as schizophrenia or severe
dissociative disorders, may have difficulty distinguishing between reality and fantasy. Hypnosis may
exacerbate or distort their symptoms, potentially leading to increased confusion or distress. Therefore,
it is generally contraindicated in these cases.
 18

2. Severe Mental Illness: In cases of severe mental illness or acute psychiatric conditions, hypnosis
should be approached with caution. The focus should be on stabilization, symptom management, and
addressing the primary psychiatric condition before considering hypnosis as an adjunctive therapy.
3. Substance Abuse or Addiction: Hypnosis may not be appropriate for individuals with active
substance abuse or addiction issues. It is important to address and stabilize the addiction-related
concerns through appropriate substance abuse treatment before incorporating hypnosis into the
therapeutic approach.
4. Cognitive Impairment or Intellectual Disability: Individuals with significant cognitive impairment or
intellectual disabilities may have difficulty understanding or engaging in hypnosis effectively. The
ability to follow instructions, maintain focus, and engage in imagery-based may be limited.
5. Unwillingness or Lack of Consent: Hypnosis requires the individual's cooperation and willingness to
engage in the process. If someone is unwilling, resistant, or does not give informed consent for
hypnosis, it should not be pursued. Forced or non-consensual hypnosis is ethically and legally
unacceptable.

LIMITATIONS
Effectiveness varies: Not everyone responds equally to hypnosis. Some individuals may be highly
suggestible and experience significant benefits, while others may be less responsive or unaffected by
hypnosis altogether.

Not a magic cure: Hypnosis is not a cure-all and may not be effective for all conditions or issues.
While it can be helpful for certain concerns such as smoking cessation, anxiety, or pain management,
it may not be suitable or effective for more complex psychological disorders or medical conditions.

Dependence on practitioner skill: The effectiveness of hypnosis can depend on the skill and
experience of the practitioner. A poorly trained or inexperienced hypnotist may not be able to induce a
trance state effectively or deliver appropriate suggestions, limiting the therapeutic benefits of
hypnosis.

Potential for false memories: There is a risk of inadvertently implanting false memories or beliefs
during hypnosis, particularly if the subject is highly suggestible or if the hypnotist uses leading or
suggestive language. This can lead to confusion, distress, or ethical concerns.

Limited long-term effects: While hypnosis can produce immediate changes in behavior or
perception, its long-term effects may be limited without ongoing reinforcement or follow-up therapy.
Without continued practice or therapeutic support, the benefits of hypnosis may diminish over time.

Not suitable for everyone: Hypnosis may not be appropriate for individuals with certain
psychological conditions, such as psychosis, schizophrenia, or severe personality disorders. It may
also be contraindicated for individuals with certain medical conditions or cognitive impairments.

Module III - Psychodynamic Psychotherapy-I

______Introduction of the concept______

Psychodynamic therapy is a form of talk therapy. It is based on the idea that talking to a professional
about problems people are facing can help them find relief and reach solutions. Through working with
a psychodynamic therapist, people are able to better understand the thoughts, feelings, and conflicts
 19

that contribute to their behaviors. This approach to therapy also works to help people better
understand some of the unconscious motivations that sometimes influence how people think, feel,
and act. This approach to psychotherapy can be helpful for dealing with mental or emotional distress.
It can help promote self-reflection, insight, and emotional growth.Psychodynamic therapy is an
approach that involves facilitation a deeper understanding of one's emotions and other mental
processes. It works to help people gain greater insight into how they feel and think.

By improving this understanding, people can then make better choices about their lives. They can
also work on improving their relationships with other people and work toward achieving the goals that
will bring them greater happiness and satisfaction.

Uses of psychodynamic psychotherapy

While it is similar to psychoanalysis in many respects, it is often less frequent and shorter in duration.
Like other forms of therapy, it can be used to treat a variety of mental health problems.
● Anxiety
● Depression
● Eating disorders
● Interpersonal problems
● Personality disorders
● Psychological distress
● Post-traumatic stress disorder
● Social anxiety disorder
● Substance use disorders

Factors that may impact what type of treatment is used include costeffectiveness,availability, patient
preferences, and the severity of the symptoms the person is experiencing. While cognitive-behavioral
therapy (CBT) is a popular and effective approach, evidence suggests that psychodynamic therapy
can be just as effective for many conditions.

Psychodynamic therapy is rooted in psychoanalytic theory but is often a less intensive and lengthy
process than traditional psychoanalysis. While psychoanalysis tends to focus a great deal on the
patient and therapist relationship, psychodynamic therapy also places a great deal of emphasis on a
patient’s relationships with other people in the outside world.

How It Works
Psychodynamic therapy helps people recognize repressed emotions and unconscious influences that
may be affecting their current behavior. Sometimes people act in certain ways or respond to others for
reasons that they don’t really understand. Psychodynamic therapy helps people learn to
acknowledge, bear, and put into perspective their emotional lives. It also helps people learn how to
express their emotions in more adaptive and healthier ways.

_______Expressive Psychotherapy: Goals Techniques Indication and

Contraindication and Limitation______

Expressive Psychotherapy
Art, music, and dance are forms of creative expression that can help you process and cope with
emotional issues, including depression. Expressive therapy goes beyond traditional talk therapy. It
focuses on creative outlets as a means of expression. This therapy can be especially helpful for
people who find it difficult to talk about their thoughts and emotions. According to the California
 20

Institute of Integral Studies, psychologists use expressive arts therapy in many settings to help people
explore difficult issues in their lives. These issues may be:
● Emotional
● Social
● Spiritual
● Cultural
“It’s often used with kids,” explains Jaine L. Darwin. Darwin is a psychologist and psychoanalyst in
Cambridge, Massachusetts. “They can’t fully talk about what’s going on, not on a nuanced level.
Expressive therapy often serves people who don’t know how to use ‘feeling’ words.”

The therapy is based on the belief that all people have the ability to express themselves creatively.
The therapy can promote:
● Self-awareness
● Emotional well-being
● Healing
● Self-esteem

How it works
Expressive therapy can include various forms of artistic expression. This can include:
● Art
● Music
● Dance
● Drama
● Writing and storytelling

In expressive therapy, the therapist encourages you to use these arts to communicate about emotions
and life events. These are often subjects that you may find difficult to put into words. For example, a
child might draw a scene that represents a traumatic event. They may dance to express emotion by
moving their body. The art becomes the mode of expression for personal exploration and
communication.
The therapist’s focus isn’t to critique the expressive artwork. The therapist works with you to interpret
the meaning of your art and the feelings that surround it. Psychologists often combine expressive
therapy with other forms of psychotherapy. For example, you may create an image that represents
your problem or feelings. Then you and your therapist will discuss the art and emotions surrounding it.
For some, the process of creating the art is therapeutic in itself

Goals of Expressive Therapy

The goal of Expressive therapy is to promote healing and reveal any hidden truths or conflicts in a
patient. The individual has no obligations in analyzing their own work because the goal is to help them
by discussing the art in a nonjudgmentalmanner and supportive setting. It is a unique way to
represent a verbal description through art, dance and music. The focus of treatment is getting to know
the feelings that are associated with the patient's aesthetics being that auditory and visual stimuli are
often used as a mental and emotional outlet. The art symbolizes the pain that the client is
experiencing, such as trauma or fear. The goal isn't to diagnose the final product but allow the patient
to express themselves in a manner that they are comfortable with.

Techniques
Many definitions of expressive arts therapy mention its use of distinct features such as music,
movement, play, psychodrama, sculpture, painting, and drawing. If necessary, though, therapists may
choose to combine several techniques in order to provide the most effective treatment for the
individual in therapy.
Popular therapeutic approaches may involve the use of various drawing and art techniques, including:
 21

● Finger Painting
Finger painting involves using the fingers and hands to apply paint directly onto a surface, such as
paper or canvas, without the use of brushes or other tools. This tactile approach allows clients to
engage in spontaneous, uninhibited expression and explore emotions, sensations, and memories
through color, texture, and movement. Finger painting can be particularly beneficial for individuals who
may struggle with verbal expression or who find traditional art techniques intimidating.

● Mask Making
Mask making involves creating masks or facial representations using various materials, such as clay,
paper mache, or found objects. The process of making a mask allows clients to explore different
aspects of their identity, emotions, and persona. By decorating or altering the mask's appearance,
clients can symbolically express hidden or repressed parts of themselves, as well as explore themes
of concealment, authenticity, and transformation.

● The Blob and Wet Paper Technique

In this technique, clients are provided with blobs of paint or ink on a sheet of wet paper. As the paint
spreads and merges with the wet surface, clients are encouraged to observe and interpret the
evolving shapes, colors, and patterns. This process can evoke spontaneous imagery, associations,
and emotions, providing insight into unconscious thoughts, feelings, and conflicts. The fluid nature of
the medium allows for a free-flowing and non-linear exploration of the client's inner world.

● The Kinetic Family Drawing Technique

Developed by Florence Goodenough, the Kinetic Family Drawing (KFD) technique involves asking
clients to draw their family members engaged in a specific activity, such as having a meal together or
going on a trip. Clients are encouraged to depict the interactions, roles, and dynamics within their
family system through their drawings. The technique can reveal underlying family patterns, conflicts,
and unresolved issues, providing a visual representation of the client's family relationships and history.
It can also serve as a starting point for exploring family dynamics and promoting insight and
communication within the family system.

These expressive psychotherapy techniques offer alternative avenues for self-expression, exploration,
and healing, complementing verbal communication and traditional talk therapy approaches. They
provide clients with opportunities to access and process unconscious material, explore complex
emotions and relationships, and gain insight into themselves and their experiences in a creative and
non-threatening manner.

INDICATIONS
Difficulty with Verbal Expression: Expressive psychotherapy can be beneficial for individuals who
struggle to articulate their thoughts, emotions, or experiences verbally. Non-verbal techniques such as
art, music, or movement provide alternative means of expression and communication.

Emotional Regulation: Expressive techniques can help individuals learn to regulate and express
their emotions in a safe and constructive manner. Engaging in creative activities may facilitate
emotional release, catharsis, and self-awareness.

Trauma and PTSD: Expressive psychotherapy can be effective in addressing trauma-related

symptoms, such as intrusive memories, flashbacks, and emotional dysregulation. Art, movement, and
other creative modalities can provide a safe outlet for processing traumatic experiences and
promoting healing.
 22

Exploration of Identity and Self-Expression: Expressive techniques allow individuals to explore

and express different aspects of their identity, self-concept, and personal narratives. This can be
particularly beneficial for individuals experiencing identity issues, existential concerns, or a desire for
self-discovery.

CONTRAINDICATIONS
Severe Psychopathology: Expressive techniques may not be appropriate for individuals with severe
mental illness, psychotic disorders, or acute psychiatric symptoms. In such cases, verbal processing
and structured interventions may be more suitable for ensuring safety and stability.

Cognitive Impairment: Individuals with significant cognitive impairments or intellectual disabilities

may have difficulty understanding and engaging in expressive techniques. Modifications and
adaptations may be necessary to accommodate their cognitive abilities and communication styles.

Resistance to Creativity or Artistic Expression: Some individuals may have a resistance to

engaging in creative or artistic activities due to past negative experiences, self-judgment, or cultural
beliefs. In such cases, alternative approaches or interventions may be more effective in promoting
therapeutic engagement and progress.

Lack of Interest or Motivation: Expressive psychotherapy requires active participation and

engagement from the client. If an individual lacks interest, motivation, or readiness to engage in
creative activities, the effectiveness of expressive techniques may be limited.

LIMITATIONS
Non-verbal communication challenges: Some clients may struggle with interpreting or expressing
themselves through non-verbal mediums such as art or movement. This can limit the effectiveness of
expressive techniques for those who have difficulty understanding or utilizing non-verbal
communication.

Interpretation subjectivity: Interpreting expressive materials, such as artwork or body movements, can
be subjective and open to interpretation. Therapists must be mindful of their biases and interpretations
to ensure they accurately understand and support the client's experiences.

Access barriers: Access to certain expressive mediums may be limited due to factors such as cost,
availability of materials, or physical disabilities. This can hinder some individuals from fully engaging in
expressive psychotherapy and accessing its potential benefits.

Resistance and discomfort: Clients may experience resistance or discomfort with certain expressive
techniques, particularly if they are unfamiliar or challenging. This resistance can impede therapeutic
progress and require careful exploration and support from the therapist.

Ethical considerations: Ethical considerations arise when working with vulnerable populations, such
as children or trauma survivors, in expressive psychotherapy. Therapists must ensure that clients are
fully informed, empowered, and protected from potential harm or exploitation during the therapeutic
process.

Lack of standardized assessment: Unlike some traditional therapy modalities, there is a lack of
standardized assessment tools for evaluating the effectiveness of expressive psychotherapy. This can
make it challenging to measure treatment outcomes and compare the efficacy of different expressive
techniques.
 23

Module IV - Psychodynamic Psychotherapy-II

______Supportive Psychotherapy: Goals Techniques Indication and

Contraindication and Limitation______

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic

schools as well as interpersonal conceptual models and techniques to reduce or relieve the intensity
of manifested or presenting symptoms, distress, or disability. It also reduces the extent of behavioral
disruptions caused by the patient's psychic conflicts or disturbances.
● Supportive psychotherapy aims at the creation of a therapeutic relationship as a temporary bridge
for the deficient patient. It has roots in virtually every therapy that recognizes the ameliorative effects
of emotional support and a stable, caring atmosphere in the management of patients.
● It can be applied as primary or ancillary treatment.
● The global perspective of supportive psychotherapy (often part of a combined treatment approach)
places major etiological emphasis on external rather than intrapsychic events, particularly on stressful
environmental and interpersonal influences on a severely damaged self.
● Unlike in psychoanalysis, in which the analyst works to maintain a neutral demeanor as a "blank
canvas" for transference, in supportive therapy, the therapist engages in a fully emotional,
encouraging, and supportive relationship with the patient as a method of furthering healthy defense
mechanisms, especially in the context of interpersonal relationships.
● Supportive psychotherapy can be used as a treatment for a variety of physical, mental, and
emotional ailments, and consists of a variety of strategies and techniques in which therapists or other
licensed professionals can treat their patients.
● Supportive psychotherapy is often practiced for patients who are considered lower functioning, too
fragile, or too unmotivated to participate in more demanding emotionally expressive therapy, which
might have more chance of leading to personality change.
● As a dyadic treatment that is characterized by the use of direct measures to ameliorate symptoms
and to maintain, restore, or improve self-esteem, adaptive skills, and psychological (ego) function, the
treatment itself works to observe relationships (real or transferential) and both current and past
patterns of emotional or behavioral response.
● As supportive psychotherapy is introduced in environments less formal than a primary care office,
supportive psychotherapy can appear as an expression of interest, attention to concrete services,
encouragement, and optimism. The relationship between the patient and the professional during
supportive treatment exists solely to meet the needs of the patient, and it should not develop as a
platonic relationship outside of professionalism.

GOALS
The general aim of supportive treatment is the amelioration or relief of symptoms through behavioral
or environmental restructuring within the existing psychic framework. This often means helping the
patient to adapt better to problems and to live more comfortably with his or her psychopathology. To
restore the disorganized, fragile, or decompensated patient to a state of relative equilibrium, the major
goal is to suppress or control symptoms and to stabilize the patient in a protective and reassuring
benign atmosphere that militates against overwhelming external and internal pressures. The ultimate
goal is to maximize the integrative or adaptive capacities so that the patient increases the ability to
cope while decreasing vulnerability by reinforcing assets and strengthening defenses.

TECHNIQUES
Supportive therapy uses several methods, either singly or in combination, including warm, friendly,
strong leadership; partial gratification of dependency needs; support in the ultimate development of
legitimate independence, help in developing pleasurable activities (e.g., hobbies); adequate rest and
diversion; removal of excessive strain, when possible; hospitalization, when indicated; medication to
 24

alleviate symptoms; and guidance and advice in dealing with current issues. This therapy uses
techniques to help patients feel secure, accepted, protected, encouraged, safe, and not anxious.

Some common ones are:

● Listening
As argued by author John Battaglia as “the most powerful skill of supportive psychotherapy”,the
element of listening regarding supportive psychotherapy helps patients feel “heard” by their therapists
or health professionals. Effective listening “includes careful attentiveness to the body language,
emotional tone, and overall bearing of patients in the sessions.”

● Plussing
Plussing is defined as “promoting a positive atmosphere in the therapy by finding the good in the
patient and accentuating the positive in the patient’s situation.” Battaglia compares this supportive
psychotherapy strategy to “putting on rose-colored glasses and seeing what the patient presents as
half full,” and assisting patients with finding a positive outlook even if it appears difficult to find.

● Explaining Behavior or Advice

Using the explaining behavior strategy within supportive psychotherapy allows therapists and health
professionals to lead patients to areas of comfort or security as they navigate complex and
overwhelming emotions or compulsions. With this technique, the behavioral explanations brought
forth by the professional should aim to make sense to the patient and help them feel supported.
Advice is another supportive psychotherapy strategy that branches from the explaining behavior
technique. Advice is effective usually when the patient can connect it to their goals.

● Confrontation and Reframing

Confrontation is essentially allowing the patient to reflect and comprehend how their patterns of
behavior are contributing to their suffering. Therapists and professionals help guide patients to
understand how repeated behaviors or emotions contribute to their mental health and symptoms.
Reframing is related to the technique of confrontation as reframing involves looking at something in a
different light or different angle and can provide patients with a new perspective as they undergo
supportive psychotherapy.

● Encouragement or Praise
Encouragement or Praise is often used in doses that are based on preexisting elements of the patient,
such as their history, strengths, and weaknesses. Encouragement should be used sparingly to avoid
the patient experiencing emotions of falling short of what their therapist expected of them. Using
encouragement in this environment combines opportunities for education and movement to bring
patients upward in their treatment or outside of their comfort zone. Additionally, this technique can be
used to reinforce accomplishments or positive changes in behavior and can be positioned as the
reinforcement of the patient's steps toward achieving their stated goals.

● Hope
Very similar to encouragement, hope is to be used sparingly and appropriately by therapists and
health professionals to “provide enough hope for the patient to see change as a realistic opportunity.”

● Metaphor
The use of metaphors is a stimulating element of supportive psychotherapy that “[utilizes] different
parts of the patient’s brain than those stimulated by many of the other more languagebased
techniques.” A metaphor is said to “stick” in a patient's head in a “very durable way.”

● Coping Skills
 25

Therapists and health professionals assisting patients with developing cognitive and behavioral
coping skills are another technique used for supportive psychotherapy. These techniques range in
complexity and can consist of mantras or coping plans for the patient.

● Self-soothing
Giving patients the tools necessary to develop self-soothing habits in opposition to unhealthy
acting-out behavior, such as extreme mood swings, substance abuse, or acting out.

● Creative Opportunities
Creative opportunities allow therapists and health professionals to introduce their patients to creative
outlets to express their emotions. Some of these techniques within this strategy include storytelling,
journaling, and writing letters they won’t send.
Some techniques identified, but generally avoided and used with caution are humor and comparing
pain.

INDICATIONS
Supportive psychotherapy is generally indicated for those patients for whom classic psychoanalysis or
insight-oriented psychoanalytic psychotherapy is typically contraindicated to those who have poor ego
strength and whose potential for decompensation is high.
Amenable patients fall into the following major areas:
(1) individuals in acute crisis or a temporary state of disorganization and inability to cope (including
those who might otherwise be well functioning) whose intolerable life circumstances have produced
extreme anxiety or sudden turmoil (e.g., individuals going through grief reactions, illness, divorce, job
loss, or who were victims of crime, abuse, natural disaster, or accident);
(2) patients with chronic severe pathology with fragile or deficient ego functioning (e.g., those with
latent psychosis, impulse disorder, or severe character disturbance);
(3) patients whose cognitive deficits and physical symptoms make them particularly vulnerable and,
thus, unsuitable for an insight-oriented approach (e.g., certain psychosomatic or medically ill per-
sons);
(4) psychologically unmotivated individuals, although not necessarily characterologically resistant to a
depth approach (e.g., patients who come to treatment in response to family or agency pressure and
are interested only in immediate relief or those who need assistance in very specific problem areas of
social adjustment as a possible prelude to more exploratory work).

CONTRAINDICATION
Because support forms a tacit part of every therapeutic modality, it is rarely contraindicated as such.
The typical attitude regards better-functioning patients as unsuitable not because they will be harmed
by a supportive approach, but because they will not be sufficiently benefited from it.
In aiming to maximize the patient's potential for further growth and change, supportive therapy tends
to be regarded as relatively restricted and superficial and, thus, is not recommended as the treatment
of choice if the patient is available for, and capable of, a more in-depth approach.

LIMITATIONS
To the extent that much supportive therapy is spent on practical, everyday realities and on dealing
with the external environment of the patient, it may be viewed as more mundane and superficial than
in-depth approaches. Because those patients are seen intermittently and less frequently, the
interpersonal commitment may not be as compelling on the part of either the patient or the therapist.
Greater severity of illness (and possible psychoses) also makes such treatment potentially more
erratic, demanding, and frustrating. The need for the therapist to deal with other family members,
caretakers, or agencies (auxiliary treatment, hospitalization) can become an additional complication
because the therapist has to negotiate with the outside world of the patient and with other professional
 26

peers. Finally, the supportive therapist must be able to accept personal limitations and the patient's
limited psychological resources and tolerate the often unrewarded efforts until small gains are made.

Module V - Brief Psychodynamic Psychotherapy

_____Introduction_____

Brief psychodynamic psychotherapy is a time-limited treatment (10 to 12 sessions) that is based on

psychoanalysis and psychodynamic theory.
In 1946, Franz Alexander and Thomas French identiϧed the basic characteristics of brief
psychodynamic psychotherapy. They described a therapeutic experience designed to put patients at
ease, to manipulate the transference, and to use trial interpretations flexibly.

Alexander and French conceived psychotherapy as a corrective emotional experience capable of

repairing traumatic events of the past and convincing patients that new ways of thinking, feeling, and
behaving are possible. It is used to help persons with depression, anxiety, and posttraumatic stress
disorder, among others.

Practitioners of brief psychodynamic therapy believe that some changes can happen through a more
rapid process or that an initial short intervention will start an ongoing process of change that does not
need the constant involvement of the therapist. A central concept in brief therapy is that there should
be one major focus for the therapy rather than the more traditional psychoanalytic practice of allowing
the client to associate freely and discuss unconnected issues (Malan, 1976). In brief therapy, the
central focus is developed during the initial evaluation process, occurring during the first session or
two. This focus must be agreed on by the client and therapist. The central focus singles out the most
important issues and thus creates a structure and identifies a goal for the treatment. In brief therapy,
the therapist is expected to be fairly active in keeping the session focused on the main issue. Having
a clear focus makes it possible to do interpretive work in a relatively short time because the therapist
only addresses the circumscribed problem area. When using brief psychodynamic approaches to
therapy for the treatment of substance abuse disorders, the central focus will always be the substance
abuse in association with the core conflict. Further, the substance abuse and the core conflict will
always be conceptualized within an interpersonal framework.

The number of sessions varies from one approach to another, but brief psychodynamic therapy is
typically considered to be no more than 25 sessions (Bauer and Kobos, 1987). Crits-Christoph and
Barber included models allowing up to 40 sessions in their review of short-term dynamic
psychotherapies because of the divergence in the scope of treatment and the types of goals
addressed (Crits-Christoph and Barber, 1991). For example, some brief psychodynamic models focus
mainly on symptom reduction (Horowitz, 1991), while others target the resolution of the Oedipal
conflict (Davanloo, as interpreted by Laikin et al., 1991). The length of therapy is usually related to the
ambitiousness of the therapy goals. Most therapists are flexible in terms of the number of sessions
they recommend for clinical practice. Often the number of sessions depends on a client's
characteristics, goals, and the issues deemed central by the therapist.

_____Difference with Psychoanalysis and Psychoanalytic Psychotherapy_____

 27

Differences between psychoanalysis and psychoanalytical psychotherapy

a. Therapeutic situation. Patients in analysis lie on a couch with the analyst seated behind out of the
patient’s field of vision. In psychoanalytic psychotherapy, patients and analysts are seated
face-to-face.
b. Frequency. Psychoanalysis has a frequency of three to five sessions per week. Psychoanalytic
psychotherapy has a frequency of one to three sessions per week. Frequency is a function of the
depth and intensity of the therapeutic work needed.
c. psychotherapy deals with what we call the ego, the I or the active agency with which you make
decisions on a daily basis. In contrast, psychoanalysis deals with the unconscious – those
experiences that are beyond language, outside of our awareness; the part of us that was vastly
suppressed by culture, social norms, rules and regulations.
d. the goals of psychoanalysis and psychotherapy are also different. Psychotherapy attempts to
restore a persons relationship to the social norms and regulations, while psychoanalysis works to
restore a person’s relationship to their sexuality. Psychotherapy works to strengthen the ego, while
psychoanalysis works to strengthen the subject’s relationship to their own unconscious.
e. Psychotherapists use their relationship with you, the client, to influence your decisionmaking,to
teach coping strategies, change behaviors or thoughts, and to modify the ways you relate to others.
Psychoanalysts use their relationship with you to help you reorganize the way you relate to yourself
and your body with all its human qualities.
f. Duration. Psychoanalysis is long term, usually 3-5+ years. Psychoanalytical psychotherapy could be
short or long term.
g. Modus operandi. In psychoanalysis, a systematic analysis is done of all positive and negative
transference and resistance. In psychotherapy analysis of dynamics and defenses and focus is given
on current interpersonal events,
h. Patient prerequisites: in psychoanalysis- high motivation, psychological mindedness, good
frustration tolerance. In psychoanalytical psychotherapy-moderate to high motivation, psychological
mindedness, ability to form therapeutic alliance, some frustration tolerance.

_____Types_____

Brief Focal Psychotherapy (Tavistock–Malan)

Brief focal psychotherapy was originally developed in the 1950s by the Balint team at the Tavistock
Clinic in London. Malan, a member of the team, reported the results of the therapy. Malan’s selection
criteria for treatment included eliminating absolute contraindications, rejecting patients for whom
certain dangers seemed inevitable, clearly assessing patients’ psychopathology, and determining
patients’ capacities to consider problems in emotional terms, face disturbing material, respond to
interpretations, and endure the stress of the treatment. Malan found that high motivation invariably
correlated with a successful outcome. Contraindications to treatment were serious suicide attempts,
substance dependence, chronic alcohol abuse, incapacitating chronic obsessional symptoms,
incapacitating chronic phobic symptoms, and gross destructive or self-destructive acting out.

Requirements and Techniques. In Malan’s routine, therapists should identify the transference early
and interpret it and the negative transference. They should then link the transferences to patients’
relationships with their parents. Both patients and therapists should be willing to become deeply
involved and to bear the ensuing tension. Therapists should formulate a circumscribed focus and set
a termination date in advance, and patients should work through grief and anger about termination.
An experienced therapist should allow about 20 sessions as an average length for the therapy; a
trainee should allow about 30 sessions. Malan himself did not exceed 40 interviews with his patients.

Time-Limited Psychotherapy (Boston University–Mann)

 28

A psychotherapeutic model of exactly 12 interviews focusing on a speciϧed central issue was

developed at Boston University by James Mann and his colleagues in the early 1970s. In contrast with
Malan’s emphasis on clear-cut selection and rejection criteria, Mann has not been as explicit about
the appropriate candidates for time-limited psychotherapy. Mann considered the major emphases of
his theory to be determining a patient’s central conflict reasonably correctly and exploring young
persons’ maturational crises with many psychological and somatic complaints. Mann’s exceptions,
similar to his rejection criteria, include persons with major depressive disorder that interferes with the
treatment agreement, those with acute psychotic states, and desperate patients who need, but cannot
tolerate, object relations.

Requirements and Techniques. Mann’s technical requirements included strict limitation to 12

sessions, positive transference predominating early, specification and strict adherence to a central
issue involving transference, positive identification, making separation a maturational event for
patients, absolute prospect of termination to avoid development of dependence, clarification of
present and past experiences and resistances, active therapists who support and encourage patients,
and education of patients through direct information, reeducation, and manipulation. The conflicts
likely to be encountered included independence versus dependence, activity versus passivity,
unresolved or delayed grief, and adequate versus inadequate self-esteem.

Short-Term Dynamic Psychotherapy (McGill University–Davanloo)

As conducted by Davanloo at McGill University, short-term dynamic psychotherapy encompasses
nearly all varieties of brief psychotherapy and crisis intervention. Patients treated in Davanloo’s series
are classiϧed as those whose psychological conflicts are predominantly oedipal, those whose
conϩicts are not oedipal, and those whose conϩicts have more than one focus. Davanloo also
devised a speciϧc psychotherapeutic technique for patients with severe, long-standing neurotic
problems, speciϧcally those with incapacitating obsessive-compulsive disorders and phobias.
Davanloo’s selection criteria emphasize evaluating those ego functions of primary importance to
psychotherapeutic work: the establishment of a psychotherapeutic focus; the psychodynamic
formulation of the patient’s psychological problems; the ability to interact emotionally with evaluators;
a history of give-and-take relationships with a signiϧcant person in the patient’s life; the patient’s ability
to experience and tolerate anxiety, guilt, and depression; the patient’s motivations for change,
psychological mindedness, and an ability to respond to interpretation and to link evaluators with
persons in the present and past. Both Malan and Davanloo emphasized a patient’s responses to
interpretation as an important selection and prognostic criterion.

Requirements and Techniques. The highlights of Davanloo’s psychotherapeutic approach are

flexibility (therapists should adapt the technique to the patient’s needs), control, the patient’s
regressive tendencies, active intervention to avoid having the patient develop overdependence on a
therapist, and the patient’s intellectual insight and emotional experiences in the transference. These
emotional experiences become corrective as a result of the interpretation.

Short-Term Anxiety-Provoking Psychotherapy (Harvard University–Sifneos)

Sifneos developed short-term anxiety-provoking psychotherapy at the Massachusetts General
Hospital in Boston during the 1950s. He used the following criteria for selection: a circumscribed chief
complaint (implying a patient’s ability to select one of a variety of problems to be given top priority and
the patient’s desire to resolve the problem in treatment), one meaningful or give-and-take relationship
during early childhood, the ability to interact flexibly with an evaluator and to express feelings
appropriately, aboveaverage psychological sophistication (implying not only above-average
intelligence but also an ability to respond to interpretations), a speciϧc psychodynamic formulation
(usually a set of psychological conflicts underlying a patient’s diϫculties and centering on an oedipal
focus), a contract between therapist and patient to work on the speciϧed focus and the formulation of
minimal expectations of outcome, and good to excellent motivation for change, not just for symptom
 29

relief.

_____Techniques______

Brief Psychodynamic Psychotherapy (BPP) is a time-limited form of psychodynamic therapy that

focuses on identifying and addressing core conflicts and patterns within a shorter timeframe. Here are
some techniques commonly used in BPP:

Exploration of the Past:

BPP involves exploring the client's early life experiences, relationships, and attachment patterns to
identify recurring themes, conflicts, and unresolved issues. By understanding how past experiences
influence present behavior and emotions, clients can gain insight into their underlying motivations and
patterns.

Focus on Current Symptoms:

Unlike traditional long-term psychodynamic therapy, BPP prioritizes addressing current symptoms and
concerns within a limited number of sessions. Therapists work collaboratively with clients to identify
specific goals and develop strategies for managing and resolving presenting issues.

Interpretation and Insight:

Therapists use interpretation to help clients gain insight into unconscious thoughts, feelings, and
conflicts. By highlighting connections between past experiences and current behavior, therapists help
clients understand the underlying meaning behind their symptoms and develop alternative ways of
coping.

Exploration of Defense Mechanisms:

BPP involves identifying and exploring the defense mechanisms that clients use to protect themselves
from uncomfortable emotions or conflicts. By becoming aware of these defenses and their underlying
purposes, clients can begin to develop healthier coping strategies and emotional regulation skills.

Clarification and Confrontation:

Therapists use clarification and confrontation techniques to challenge clients' maladaptive beliefs,
assumptions, or behaviors. By gently confronting inconsistencies or discrepancies in their thinking,
therapists help clients gain clarity and develop more adaptive ways of functioning.

Therapeutic Relationship:
The therapeutic relationship is central to BPP, providing a safe and supportive environment for
exploration and change. Therapists offer empathy, acceptance, and validation while also providing
structure, guidance, and feedback to help clients achieve their therapeutic goals.