Pub Date : 2019-03-01DOI: 10.1093/MED-PSYCH/9780190676278.003.0008
B. Sharpless
There are a number of “basic” psychodynamic techniques that serve as a foundation for more specific interventions (e.g., interpretations). Therapist silence is one of these, and its usage varies greatly according to a patient’s relative location on the supportive–expressive continuum. After discussing the purpose and potential meanings of therapist silence, suggestions are made for effectively using this technique in session. Next, ways of fostering patient free association are noted. This can differ markedly according to duration of treatment (e.g., a short-term, manualized therapy vs. a more open-ended psychotherapy). The chapter ends with a discussion of how therapists can listen in a psychodynamic manner. First, Freud’s early concept of evenly-hovering attention is evaluated in the context of contemporary psychodynamic theory. Next, the 4 channels of communication available to psychodynamic therapists are discussed. These include what is said, what is not said, nonverbal behavior, and information gained from countertransference.
{"title":"Foundational Techniques Part I","authors":"B. Sharpless","doi":"10.1093/MED-PSYCH/9780190676278.003.0008","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780190676278.003.0008","url":null,"abstract":"There are a number of “basic” psychodynamic techniques that serve as a foundation for more specific interventions (e.g., interpretations). Therapist silence is one of these, and its usage varies greatly according to a patient’s relative location on the supportive–expressive continuum. After discussing the purpose and potential meanings of therapist silence, suggestions are made for effectively using this technique in session. Next, ways of fostering patient free association are noted. This can differ markedly according to duration of treatment (e.g., a short-term, manualized therapy vs. a more open-ended psychotherapy). The chapter ends with a discussion of how therapists can listen in a psychodynamic manner. First, Freud’s early concept of evenly-hovering attention is evaluated in the context of contemporary psychodynamic theory. Next, the 4 channels of communication available to psychodynamic therapists are discussed. These include what is said, what is not said, nonverbal behavior, and information gained from countertransference.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114462232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/MED-PSYCH/9780190676278.003.0004
B. Sharpless
The psychodynamic stance (as known as the psychodynamic sensibility) is a collection of essential values and theoretical assumptions that support a therapist’s moment-to-moment practice. This chapter describes 13 components of the psychodynamic stance and situates them in historical and theoretical contexts. Several of these components are fairly unique and serve to distinguish psychodynamic therapy from other approaches. It is argued that the process of articulating one’s stance facilitates the selection and use of specific psychodynamic techniques. Further, when unexpected clinical events occur, a therapist’s stance can serve as a useful guide for difficult decisions. Throughout the chapter, the common mistakes of beginning therapists (e.g., intervening too quickly, placing their values on the patient) are explored and suggestions are provided.
{"title":"The Psychodynamic “Stance”","authors":"B. Sharpless","doi":"10.1093/MED-PSYCH/9780190676278.003.0004","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780190676278.003.0004","url":null,"abstract":"The psychodynamic stance (as known as the psychodynamic sensibility) is a collection of essential values and theoretical assumptions that support a therapist’s moment-to-moment practice. This chapter describes 13 components of the psychodynamic stance and situates them in historical and theoretical contexts. Several of these components are fairly unique and serve to distinguish psychodynamic therapy from other approaches. It is argued that the process of articulating one’s stance facilitates the selection and use of specific psychodynamic techniques. Further, when unexpected clinical events occur, a therapist’s stance can serve as a useful guide for difficult decisions. Throughout the chapter, the common mistakes of beginning therapists (e.g., intervening too quickly, placing their values on the patient) are explored and suggestions are provided.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116181583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0007
B. Sharpless
Whenever individual psychodynamic techniques are applied, it is important to quickly assess their proximal clinical impacts. Therefore, this chapter focuses on helping clinicians identify the many, and sometimes subtle, signs that an intervention was either corroborated or disconfirmed. Common examples of both sets of patient signs are included. Some characteristic indicators of corroboration include the generation of new and emotionally rich clinical material. Signs of disconfirmation may include the patient verbally rejecting the intervention, stalled free association, or an alliance rupture. However, clinical context is important to consider, as indicators may vary greatly across patients and according to their relative location on the supportive–expressive continuum. Finally, the concept of a corrective emotional experience is discussed as another possible clinical impact. Clinical criteria for an in-session corrective emotional experience are proposed.
{"title":"How to Assess the Impacts of Interventions","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0007","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0007","url":null,"abstract":"Whenever individual psychodynamic techniques are applied, it is important to quickly assess their proximal clinical impacts. Therefore, this chapter focuses on helping clinicians identify the many, and sometimes subtle, signs that an intervention was either corroborated or disconfirmed. Common examples of both sets of patient signs are included. Some characteristic indicators of corroboration include the generation of new and emotionally rich clinical material. Signs of disconfirmation may include the patient verbally rejecting the intervention, stalled free association, or an alliance rupture. However, clinical context is important to consider, as indicators may vary greatly across patients and according to their relative location on the supportive–expressive continuum. Finally, the concept of a corrective emotional experience is discussed as another possible clinical impact. Clinical criteria for an in-session corrective emotional experience are proposed.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125006400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0003
B. Sharpless
After briefly discussing the process of “translating” a patient’s desire for change into usable psychodynamic targets for change, eight specific therapy goals are described. These include several that have been discussed since the earliest days of psychoanalysis (e.g., the generation of insight, an increased ability to love and work, personality change) as well as the more transtheoretical goals of autonomy from the therapist and symptom reduction. Goals derived from existential versions of dynamic therapy are also considered (e.g., acceptance of that which cannot be changed; an increased sense of meaning and purpose). Specific suggestions for assessing clinical progress (e.g., questionnaires and interviews) and relevant citations are listed in a table and at the end of each section.
{"title":"Goals of Psychodynamic Therapy","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0003","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0003","url":null,"abstract":"After briefly discussing the process of “translating” a patient’s desire for change into usable psychodynamic targets for change, eight specific therapy goals are described. These include several that have been discussed since the earliest days of psychoanalysis (e.g., the generation of insight, an increased ability to love and work, personality change) as well as the more transtheoretical goals of autonomy from the therapist and symptom reduction. Goals derived from existential versions of dynamic therapy are also considered (e.g., acceptance of that which cannot be changed; an increased sense of meaning and purpose). Specific suggestions for assessing clinical progress (e.g., questionnaires and interviews) and relevant citations are listed in a table and at the end of each section.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"362 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123127989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0012
B. Sharpless
Confrontations direct attention to important but overlooked, denied, or incongruous patient communications. These interventions are used to (a) encourage the patient to resolve inconsistencies, (b) note denial or acting out behaviors, (c) help the patient face an uncomfortable reality, or (d) indicate that clinical material has psychodynamic importance. This chapter outlines three specific forms of confrontation (i.e., spotlight, connective, and prohibitive), provides suggestions for when to confront patients, and includes detailed clinical examples. Although they are potentially powerful interventions, confrontations are not without clinical risk. Improperly worded or poorly timed confrontations can lead to alliance ruptures or unnecessary patient distress. They can also be overused or underused by psychodynamic therapists. Suggestions for wording and the appropriate using confrontations are provided.
{"title":"The Process of Confrontation","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0012","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0012","url":null,"abstract":"Confrontations direct attention to important but overlooked, denied, or incongruous patient communications. These interventions are used to (a) encourage the patient to resolve inconsistencies, (b) note denial or acting out behaviors, (c) help the patient face an uncomfortable reality, or (d) indicate that clinical material has psychodynamic importance. This chapter outlines three specific forms of confrontation (i.e., spotlight, connective, and prohibitive), provides suggestions for when to confront patients, and includes detailed clinical examples. Although they are potentially powerful interventions, confrontations are not without clinical risk. Improperly worded or poorly timed confrontations can lead to alliance ruptures or unnecessary patient distress. They can also be overused or underused by psychodynamic therapists. Suggestions for wording and the appropriate using confrontations are provided.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126780049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0011
B. Sharpless
Clarifications are statements intended to expand upon and/or clarify readily available patient or therapist information. The process of clarification usually involves either the patient or therapist describing, elaborating upon, reordering, or restating material to the other party. All of these efforts are intended to facilitate mutual understanding between the patient and the therapist. After briefly describing the history of clarification in psychodynamic theory, three specific subtypes of clarifications are described with examples. These include (a) the therapist inviting the patient to clarify, (b) the therapist tentatively clarifying the patient’s communication, and (c) the therapist clarifying their own communication. Suggestions for presenting clarifications to patients are also provided.
{"title":"The Process of Clarification","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0011","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0011","url":null,"abstract":"Clarifications are statements intended to expand upon and/or clarify readily available patient or therapist information. The process of clarification usually involves either the patient or therapist describing, elaborating upon, reordering, or restating material to the other party. All of these efforts are intended to facilitate mutual understanding between the patient and the therapist. After briefly describing the history of clarification in psychodynamic theory, three specific subtypes of clarifications are described with examples. These include (a) the therapist inviting the patient to clarify, (b) the therapist tentatively clarifying the patient’s communication, and (c) the therapist clarifying their own communication. Suggestions for presenting clarifications to patients are also provided.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121834265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0010
B. Sharpless
Therapist questions are meant to generate patient information that is unknown to the therapist but needed for treatment. They are used to (a) facilitate free association/foster patient exploration and (b) to gain specific information about the patient, their problems, and the unique ways that they think, feel, behave, and respond to the therapy process. Suggestions are provided for the proper wording of questions as well as determining an appropriate frequency for their use. This is because an overuse of questions, or even the inclusion of irrelevant questions, can derail the therapy process and lead to alliance ruptures. However, questions can be used to meet a number of important clinical aims and are a necessary part of any treatment. The chapter ends with a consideration of how therapists can effectively handle patient questions.
{"title":"The Process of Questioning","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0010","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0010","url":null,"abstract":"Therapist questions are meant to generate patient information that is unknown to the therapist but needed for treatment. They are used to (a) facilitate free association/foster patient exploration and (b) to gain specific information about the patient, their problems, and the unique ways that they think, feel, behave, and respond to the therapy process. Suggestions are provided for the proper wording of questions as well as determining an appropriate frequency for their use. This is because an overuse of questions, or even the inclusion of irrelevant questions, can derail the therapy process and lead to alliance ruptures. However, questions can be used to meet a number of important clinical aims and are a necessary part of any treatment. The chapter ends with a consideration of how therapists can effectively handle patient questions.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122598407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0006
B. Sharpless
This chapter describes eleven characteristics of “good” interventions that have been extracted from a number of psychodynamic texts and manuals. It is argued that interventions be logically-derived from a good case formulation, based upon accurate clinical data, and potentially falsifiable. Interventions should also be formulated using standard psychodynamic principles (e.g., precision, concision, parsimony) and reflect the patient’s location on the supportive-expressive continuum. Good interventions are also worded in a respectful manner and, at least in most cases, “experience-near” for the patient. Interventions can also be used to instantiate the psychodynamic therapy process for patients (i.e., learn by doing) and socialize them into therapy. Examples and practical advice are provided.
{"title":"Characteristics of “Good” Psychodynamic Interventions","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0006","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0006","url":null,"abstract":"This chapter describes eleven characteristics of “good” interventions that have been extracted from a number of psychodynamic texts and manuals. It is argued that interventions be logically-derived from a good case formulation, based upon accurate clinical data, and potentially falsifiable. Interventions should also be formulated using standard psychodynamic principles (e.g., precision, concision, parsimony) and reflect the patient’s location on the supportive-expressive continuum. Good interventions are also worded in a respectful manner and, at least in most cases, “experience-near” for the patient. Interventions can also be used to instantiate the psychodynamic therapy process for patients (i.e., learn by doing) and socialize them into therapy. Examples and practical advice are provided.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129989716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med-psych/9780190676278.003.0002
B. Sharpless
This research-focused chapter attempts to justify the continued relevance of psychodynamic therapy for clinical practice. Evidence collected over the past several decades indicates that it is a flexible treatment, at least as effective as other approaches, and leads to significant reductions in patient healthcare costs. In addition, psychodynamic therapy may be associated with unique clinical benefits beyond symptom reduction. Further, a number of important psychodynamic constructs (e.g., the therapeutic alliance, attachment theory) have been adopted by other orientations, and this trend continues to the present (e.g., corrective emotional experiences, mentalization). Finally, the current and future challenges for psychodynamic therapy are briefly reviewed.
{"title":"Do We Really Need Psychodynamic Therapy?1","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0002","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0002","url":null,"abstract":"This research-focused chapter attempts to justify the continued relevance of psychodynamic therapy for clinical practice. Evidence collected over the past several decades indicates that it is a flexible treatment, at least as effective as other approaches, and leads to significant reductions in patient healthcare costs. In addition, psychodynamic therapy may be associated with unique clinical benefits beyond symptom reduction. Further, a number of important psychodynamic constructs (e.g., the therapeutic alliance, attachment theory) have been adopted by other orientations, and this trend continues to the present (e.g., corrective emotional experiences, mentalization). Finally, the current and future challenges for psychodynamic therapy are briefly reviewed.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133643734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/MED-PSYCH/9780190676278.003.0014
B. Sharpless
A number of patients seen in contemporary clinical practice are not appropriate for traditional insight-oriented therapy (i.e., expressive approaches). These may include sicker patients or those who are not interested in exploratory work. Supportive therapy refers to a flexible treatment approach that is intended to be responsive to the particular needs of these patients. Supportive therapy also benefits from the integration of techniques from other orientations (e.g., cognitive-behavioral therapy). After discussing supportive therapy more generally and differentiating it from the expressive approaches, this chapter focuses on two sets of supportive techniques. The first focuses on ways to support and enhance realistic patient self-esteem. The second set consists of techniques used to increase patient knowledge and build adaptive skills (e.g., psychoeducation, reality testing).
{"title":"Supportive Therapy Techniques Part I","authors":"B. Sharpless","doi":"10.1093/MED-PSYCH/9780190676278.003.0014","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780190676278.003.0014","url":null,"abstract":"A number of patients seen in contemporary clinical practice are not appropriate for traditional insight-oriented therapy (i.e., expressive approaches). These may include sicker patients or those who are not interested in exploratory work. Supportive therapy refers to a flexible treatment approach that is intended to be responsive to the particular needs of these patients. Supportive therapy also benefits from the integration of techniques from other orientations (e.g., cognitive-behavioral therapy). After discussing supportive therapy more generally and differentiating it from the expressive approaches, this chapter focuses on two sets of supportive techniques. The first focuses on ways to support and enhance realistic patient self-esteem. The second set consists of techniques used to increase patient knowledge and build adaptive skills (e.g., psychoeducation, reality testing).","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125167915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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