Pub Date : 2019-03-01DOI: 10.1093/MED-PSYCH/9780190676278.003.0005
B. Sharpless
Psychodynamic therapy can be flexibly applied to a wide range of psychopathology. However, different patient problems imply different techniques. If inappropriate interventions are used, therapy progress could stall or negative patient events could occur. A useful tool for selecting the best mix of psychodynamic techniques is the supportive–expressive continuum. When patients are properly situated on this continuum, it is far easier to choose interventions. After the different intentions of the more purely supportive or expressive therapies are described, the clinical indicators for each approach are listed. Finally, patient transitions along the continuum (i.e., they require a different mix of supportive and expressive techniques) are discussed with suggestions on how to make these changes while minimizing therapy disruptions.
{"title":"The Supportive–Expressive Continuum","authors":"B. Sharpless","doi":"10.1093/MED-PSYCH/9780190676278.003.0005","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780190676278.003.0005","url":null,"abstract":"Psychodynamic therapy can be flexibly applied to a wide range of psychopathology. However, different patient problems imply different techniques. If inappropriate interventions are used, therapy progress could stall or negative patient events could occur. A useful tool for selecting the best mix of psychodynamic techniques is the supportive–expressive continuum. When patients are properly situated on this continuum, it is far easier to choose interventions. After the different intentions of the more purely supportive or expressive therapies are described, the clinical indicators for each approach are listed. Finally, patient transitions along the continuum (i.e., they require a different mix of supportive and expressive techniques) are discussed with suggestions on how to make these changes while minimizing therapy disruptions.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"33 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114106251","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 : 2019-02-01DOI: 10.1093/med-psych/9780190676278.003.0009
B. Sharpless
This second chapter on foundational techniques begins with a discussion of how psychodynamic therapists typically behave. These behaviors often differ markedly from normal social conventions but help maintain professional boundaries and a therapeutic focus on the patient. An example of this is therapist ambiguity, or limiting the patient’s general knowledge about the therapist’s personal history and beliefs (e.g., limiting reciprocal self-disclosure). Another example is psychodynamic abstinence, or not gratifying the patient’s unhealthy wishes or desires. Technical neutrality is also considered in the context of the patient’s level of personality organization but, in general, consists of taking a nonjudgmental stance. Finally, therapists model healthy and adaptive behaviors for their patients (e.g., thoughtfulness, honesty). The second section of this chapter focuses on how to begin a course of psychodynamic psychotherapy. Therapy contracts, the therapeutic alliance, and ways to socialize patients into treatment are all discussed.
{"title":"Foundational Techniques Part II","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0009","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0009","url":null,"abstract":"This second chapter on foundational techniques begins with a discussion of how psychodynamic therapists typically behave. These behaviors often differ markedly from normal social conventions but help maintain professional boundaries and a therapeutic focus on the patient. An example of this is therapist ambiguity, or limiting the patient’s general knowledge about the therapist’s personal history and beliefs (e.g., limiting reciprocal self-disclosure). Another example is psychodynamic abstinence, or not gratifying the patient’s unhealthy wishes or desires. Technical neutrality is also considered in the context of the patient’s level of personality organization but, in general, consists of taking a nonjudgmental stance. Finally, therapists model healthy and adaptive behaviors for their patients (e.g., thoughtfulness, honesty). The second section of this chapter focuses on how to begin a course of psychodynamic psychotherapy. Therapy contracts, the therapeutic alliance, and ways to socialize patients into treatment are all discussed.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129853320","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 : 2019-02-01DOI: 10.1093/med-psych/9780190676278.003.0013
B. Sharpless
Interpretations are efforts by the therapist to connect conscious (or preconscious) feelings, thoughts, and behaviors (e.g., symptoms) to the unconscious materials that gave rise to them. Interpretations may consist of therapist observations or the presentation of a hypothesis that goes beyond what the patient already knows. Interpretations are often considered to be the epitome of the expressive therapy approach and, when done well, have been empirically linked to a positive outcome. Unfortunately, many beginning therapists are reluctant to use interpretations due to their complexity. Therefore, this chapter describes a clear, six-step procedure for generating psychodynamic interpretations and presenting them to patients. It also includes a list of questions for therapists to answer as they organize patient material. The chapter concludes with a lengthy clinical vignette following the six-step process and a discussion of the potential risks and rewards of interpretation.
{"title":"The Process of Interpretation","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0013","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0013","url":null,"abstract":"Interpretations are efforts by the therapist to connect conscious (or preconscious) feelings, thoughts, and behaviors (e.g., symptoms) to the unconscious materials that gave rise to them. Interpretations may consist of therapist observations or the presentation of a hypothesis that goes beyond what the patient already knows. Interpretations are often considered to be the epitome of the expressive therapy approach and, when done well, have been empirically linked to a positive outcome. Unfortunately, many beginning therapists are reluctant to use interpretations due to their complexity. Therefore, this chapter describes a clear, six-step procedure for generating psychodynamic interpretations and presenting them to patients. It also includes a list of questions for therapists to answer as they organize patient material. The chapter concludes with a lengthy clinical vignette following the six-step process and a discussion of the potential risks and rewards of interpretation.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133239318","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 : 2019-02-01DOI: 10.1093/MED-PSYCH/9780190676278.003.0016
B. Sharpless
:Ruptures (i.e., deteriorations or strains in the therapeutic alliance) are an inevitable part of any psychotherapy. They are not only common but are also clinically meaningful. If not adequately attended to, ruptures are associated with poor therapy outcome and premature termination. Fortunately, a strong research base is available that provides clinically useful guidance for identifying and resolving alliance ruptures. After a brief review of the theoretical and empirical literatures, a list of “markers” used to identify the two subtypes of ruptures (i.e., withdrawal and confrontation) is provided. Proper assessment of the subtype is critical, as they each require slightly different rupture resolution techniques across a four-stage process. Finally, a list of specific rupture resolution techniques is provided.
{"title":"Repairing Ruptures in the Therapeutic Alliance","authors":"B. Sharpless","doi":"10.1093/MED-PSYCH/9780190676278.003.0016","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780190676278.003.0016","url":null,"abstract":":Ruptures (i.e., deteriorations or strains in the therapeutic alliance) are an inevitable part of any psychotherapy. They are not only common but are also clinically meaningful. If not adequately attended to, ruptures are associated with poor therapy outcome and premature termination. Fortunately, a strong research base is available that provides clinically useful guidance for identifying and resolving alliance ruptures. After a brief review of the theoretical and empirical literatures, a list of “markers” used to identify the two subtypes of ruptures (i.e., withdrawal and confrontation) is provided. Proper assessment of the subtype is critical, as they each require slightly different rupture resolution techniques across a four-stage process. Finally, a list of specific rupture resolution techniques is provided.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"210 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131632948","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 : 2019-02-01DOI: 10.1093/med-psych/9780190676278.003.0015
B. Sharpless
This chapter concludes the section on supportive therapy and describes four additional sets of techniques with clinical examples. Interventions that are intended to reduce and prevent unhelpful anxiety or other emotions are discussed first. These include techniques such as supportive bypassing, encouraging the use of adaptive defenses, and reframing. Next, supportive approaches meant to enhance patient self-awareness are discussed (e.g., the use of “upward explanations”). A third set of interventions focuses on what have been called, for lack of a better term, “parenting strategies.” Examples include containing affect, setting limits, and providing limited advice. Techniques to create and sustain a positive therapeutic alliance are discussed last. Displaying interest and empathy, sharing agendas, jointly agreeing upon treatment contracts, and many other approaches and interventions serve to foster a therapeutic alliance. The alliance is a critical component of all therapies and may be particularly challenging to achieve with lower-functioning patients. The chapter concludes with a discussion of the process of “working through” in supportive therapies.
{"title":"Supportive Therapy Techniques Part II","authors":"B. Sharpless","doi":"10.1093/med-psych/9780190676278.003.0015","DOIUrl":"https://doi.org/10.1093/med-psych/9780190676278.003.0015","url":null,"abstract":"This chapter concludes the section on supportive therapy and describes four additional sets of techniques with clinical examples. Interventions that are intended to reduce and prevent unhelpful anxiety or other emotions are discussed first. These include techniques such as supportive bypassing, encouraging the use of adaptive defenses, and reframing. Next, supportive approaches meant to enhance patient self-awareness are discussed (e.g., the use of “upward explanations”). A third set of interventions focuses on what have been called, for lack of a better term, “parenting strategies.” Examples include containing affect, setting limits, and providing limited advice. Techniques to create and sustain a positive therapeutic alliance are discussed last. Displaying interest and empathy, sharing agendas, jointly agreeing upon treatment contracts, and many other approaches and interventions serve to foster a therapeutic alliance. The alliance is a critical component of all therapies and may be particularly challenging to achieve with lower-functioning patients. The chapter concludes with a discussion of the process of “working through” in supportive therapies.","PeriodicalId":345555,"journal":{"name":"Psychodynamic Therapy Techniques","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116539365","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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