Psychodynamic &

Interpersonal Therapies
Melissa Stern
PSY 4930
October 24, 2006
History
Developed from adult techniques--
psychoanalytic theory of Sigmund
Freud
Late 1800s-early 1900s in Austria
Theory of development, personality,
and psychopathology
This theory influences almost all
psychological theories today!
 Freuds
Psychoanalytic Theory
Id: predetermined set of psychological
needs, drives, instincts
Seek pleasure, avoid pain
Superego: internalization of the moral
principles/rules of society
conscience
Ego: awareness of ones self and ability to
interact with the world
Balances id and superego
Psychoanalytic Theory
The three aspects of personality
inevitably come into conflict with
each other
Conflict = anxiety
However, much of this conflict is
unconscious due to defense
mechanisms
Defense Mechanisms
Denial
Repression
Intellectualization
Rationalization
Displacement
Sublimation
And many others
Psychoanalytic Theory
Stage Theory of Development
Oral stagesucking and feeding
Anal stagecontrol bodily functions
Phallic stageOedipus Complex
Latency phase
Genital phase
Individuals can become fixated at
various stages if the issues at each stage
are not mastered
Psychoanalytic Theory
Freud worked with only a few type of
psychological conditions:
Conversion disorders
Hysterias
Most psychopathology involved
underlying sexual or aggressive instincts
Rely on single case studies
Psychological or physical symptoms =
internal conflicts
Psychoanalytic Theories
A variety of more recent theories
were developed from Freuds original
ideas:
Ericksons stage theory of psychological
development
Object relations theory

Attachment theory

Interpersonal approaches
Psychoanalysis
Primary goal = help individuals achieve
insight into the origins of their distress
Seeks to bring about more global
personality changes
Methods used:
Hypnosis
Free associationto eliminate conscious
control over thoughts
Dream analysisego controls are relaxed
during sleep
Psychoanalysis
Resistancepatient is motivated to
continue using defense mechanisms
Transferencepatient projects their
unconscious thoughts/feelings onto the
therapist
Catharsisexperiencing of emotions
previously repressed
Interpretations
Working throughrepeated
interpretations of patients behavior and
feelings
 Psychodynamic Psychoanalytic
Not so ambitious goals Ambitious
Focused Global
Not so intensive Intensive
Less intensive therapist Intensive therapist
training training
Flexible Focus on
understanding origins
More rigid
Psychodynamic Approaches
with Children
Assume that the child has deviated
from normal development
Play is used as the childs way of
communicating
More focused on the development of
a relationship with the child
Anna Freud, Melanie Klein
 Change in
Psychodynamic Therapies
Catharses & Labeling Feelings
Corrective Emotional Experiences
Insight and Working Through
Learning Coping Techniques
Development of Internal Structure
Other variables
Insight Oriented Therapies
Form of therapy most associated
w/psychodynamic approach
Best for children with internalizing
difficulties (most often
recommended)
Anxiety
Trauma specifically
Depression
Insight Oriented Therapies
Use play and interpretation to work
through internal conflicts
Conflict resolution is the goal
Child must:
Trust adults
Have some psychological mindedness

Use play effectively

 Structure-Building
Approaches
Best for children with problems in
relationships (esp. with primary
caregivers)
Goal is to help child separate and
individuate from the parent
Object relations theory
Empathy is the focus rather than
interpretation
Object Representations
The child must invest in the mental
representation of the loved external
object
Mental representation of primary
caregiver
Object Representations:

Provide a feeling of safety

Establish internal regulatory functions

Promote ego autonomy

Serve as a model for character

formation
Promote superego development

Provide an ego ideal

Enforce resolution of Oedipal wishes

Supportive Approaches
Best for externalizing problems
These children have not developed ability
to delay gratification and have trouble
empathizing with others
Viewed as a developmental problem!
Children recommended for this treatment
are characterized as:
Egocentric
Demonstrate an absence of shame and guilt
Impaired ability to empathize with others
Supportive Approaches
Treatment focuses on problem solving
and building coping skills
For example, role-play how to handle teasing
at school
Focus is on the present not the past

Generally, supportive psychodynamic

treatment is not the treatment of choice
(CBT approaches much better)
Play as Therapy
Play helps:
Foster communication and a
relationship between child and therapist
Serve as a vehicle for change

During play, the therapist would use

other techniques such as labeling,
empathizing, and interpreting
Stages of Play
Initial period of nonengagement
Early phase of affective engagement
Emergence of central fantasies
Period of working through
Initial Period of
Nonengagement
Setting the stage
Setting expectations
Structure

limits

Meaningful play developed

Sometimes more structure
Sometimes less structure
Early phase of Affective
Engagement
Child becomes attached to both
process and therapist
regression in the service of the
ego
Play becomes more open as child
masters anxiety/conflicts
Emergence of Central
Fantasies
Repetitive Play to deal with past
traumatic situations
New solutions played out
Period of Working Through
This period is necessary for a series
of interpretations
Symptoms are discussed in different
contexts
Why is play so important?
Play helps children develop in a
number of ways
Cognitive developmentexpands
vocabulary, helps child develop
cognitive flexibility, link objects with
actions
Emotional developmenthelps child
resolve conflicts, allows child to freely
express and deal with emotions
Does it work?

Generally, these approaches have

not been well-tested
Focus on more general goals
Too long term

Not well specified

Other approaches have been found

to be effective for internalizing and
externalizing problems
The future of
psychodynamic approaches
Moving towards shorter treatment
approaches
Integrating psychodynamic
approaches with other orientations
More focused approaches
Focusing on specific populations and
new treatment settings
Shorter Treatment
Approaches/Focused
Approaches
6-12 sessions
Necessary (HMO restrictions)
Some evidence to suggest time-limited
psychotherapy is just as effective as long-
term psychotherapy
focal therapy
Brief forms more appropriate who have
transient regressions, mild problems with
age-appropriate behaviors, acute phobias
Specific Populations in New
Settings
In schools
In Hospitals
With Abuse Populations
Interpersonal Theory
Focus on the importance of interpersonal
relationships in determining behavior and
psychopathology
Harry Sullivan, Adolf Meyer (1950s)
Sullivan (1940): personality is: the
relatively enduring pattern of recurrent
interpersonal situations which
characterize a human life (p. xi)
Now have manualized treatments
Interpersonal Theory
Although childhood experiences are
important, IPT regards current
relationships as more important
Family systems theories are also
based on IPT
Family relationships are interdependent
Family systems tend to maintain a
certain structure or homeostasis
Interpersonal Theory
IPT does not necessarily assert that
psychopathology arises from impaired
relationships
But, problems are manifested in these
relationships
Research has supported this idea
Individuals with depression have less supportive
relationships
Individuals with other problems (e.g., alcohol abuse)
more frequently have marital difficulties
Risk of relapse in depression and schizophrenia
increases when patients live with critical, negative
family members
Interpersonal Therapy
Originally developed by Klerman &
Weissman for treatment of depression
Therapist must actively gather
information about a patients
interpersonal interactions and
relationships
Overall, therapist takes a more active,
supportive approach
Usually brief in length
Educate patient about nature of
depression
IPT is good for:
Acute treatment for symptom
removal
Prevention of relapse/recurrence
Correction of secondary
consequences of depression
Also used for Bulimia Nervosa
Often used in combination with
medication
Interpersonal Therapy
Major goal of treatment= change
interpersonal functioning by encouraging:
More effective communication
Emotional expression
Increased understanding of behavior in
interpersonal settings
IPT assumes that by improving
relationships, symptoms and the patients
life in general will improve
IPT Therapists
Must be able to maintain optimism
Must be able to adhere to treatment
protocol
Must be comfortable with the
medical model
Must have a good social support
network
Must be satisfied with discrete gains
IPT for depression
A negative cycle occurs:
The individual has an effect on others
Others have an effect on the individual

Three phases of treatment

Phase 1: assessment and evaluation
Diagnostic evaluation for depression
Symptom Review
Education about depression
Assessment of interpersonal relationships
Interpersonal Inventory
The Sick Role
IPT for depression
Phase 2:
Which interpersonal problem characterizes the
patient?
Grief
Interpersonal role dispute
Role transitions
Interpersonal deficits
Therapist uses specific techniques designed to
help the patient work through these problems
IPT for depression
Phase 3:
Consolidation
Helps patients recognize and counter
symptoms of depression
Prevents relapse
Special considerations in termination
IPT and Adolescent
Depression
Brief treatment useful with
adolescents
Modifications of IPT for adolescents
include:
Flexibility in timing/spacing of sessions
Telephone contact

Therapist may have active role outside

of therapy
Specific focus on single parent families
Does it work?
Unlike other psychodynamic
approaches, IPT has empirical
support
When compared with CBT and
medication and supportive therapy,
IPT was just as effective
Has also been empirically supported
in adolescents
Case Example
The Adolescent who was frozen with
grief