Psychodynamic Theory and Practice

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• Psychodynamic Theory and Practice
• Course COP020M01OA
• Postgraduate Diploma in the Practice of
  Counselling Psychology/MSc
• School of Psychology and Therapeutic Studies,
  Whitelands College.

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Evaluation

• The pros and the cons
• Research issues
• Ethical issues
• Authority

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Evaluation from which point of view?

• As a consumer? What are the variables?
• Client says after therapy that she still has the
  problem with which she went into therapy. She is
  able to articulate her problem and demonstrates
  her anger in the transference towards the
  therapist whereas earlier she was big on passive
  resistance. What are the issues in evaluation?

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Evaluation as an academic

• Cassie Cooper has described Klein as
  pre-scientific (in Dryden 1990 39-68
  Individual Therapy a handbook Milton Keynes OU)
• Outcome studies? What sort of outcome is being
  measured? In general they do not favour any one
  model
• At which point of psychodynamic development do I
  evaluate? Classical early Freudianism, object
  relations, attachment theory, self psychology?

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Evaluation as a clinician?

• Who sets the goals? Was that process adequately
  reflected in the formulation?
• Did the formulation need to be modified
• Did the client make progress in terms of the
  formulation?
• How much more aware of their issues is the client
• How much has internal organisation of the psyche
  been modified?

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Analytic Psychotherapy and Psychodynamic
Counselling still controversial

• Is in many senses counter-intuitive
• Arouses passionate feelings as the many schisms
  in analytic schools demonstrate
• Easy to knock in the media etc. Complex so not
  easy to explain in sound bites
• Complainants therefore get an easy ear
• No voice that is authoritative outside of the
  cognoscenti

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Research

• Not outcome orientated in the same way as say,
  CBT.
• Comparable with Person-Centred in this respect
• However the tradition of extensive recording
  (verbatim) gives a potential rich source of data
  (See Klein Richard on your booklist)

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A general outline of research

• Luborsky et al (1975 and 1993) Everyone has won
  and all have won prizes a meta study used 19
  variables. Burton and Davey (1996 129) make a
  plea for fuzzy logic in this area.
• See useful chapter in Handbook of Counselling
  Psychology (1996) The psychodynamic paradigm
  will give you a useful start point for your essay
  question

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See also

• Roth A (1996)What works for whom? a critical
  review of psychotherapy research New York London
  (616.8914)
• Shapiro D (1995) Finding out how psychotherapies
  help people change Psychotherapy Research Vol. 5
  (1) pp1-21) (short loan offprint
• Kaye John (1990) Towards meaningful research in
  psychotherapy Dulwich Centre Newsletter Vol. 2
  pp27-38) Short Loan offprint
• Rowland Nancy (2000)Evidence-based counselling
  and psychological therapies research and
  applications London Routledge 362.2 /ROW

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About the research you have read

• You have been given a great deal to read during
  this semester so far
• What has stood out as being illuminating and
  helpful to you as a counsellor in training, using
  a psychodynamic approach?
• Spend 10 minutes in groups of 3.

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Famous critiques

• Masson (1989) London Collins Against therapy-
  an ex psychotherapist.
• Objections to the theory but most of all to the
  history. Seems compelling but does a biography
  necessarily discredit a theory? Jung/ Nazism etc.
  Cult of digging the dirt is important in
  revealing the many- sidedness of constructed
  truth.
• Psychologists confuse deeds with behaviour
• E. Erikson1964 Insight and responsibility
  London Norton

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Anna Sands (2000) Falling for Therapy London
Macmillan

• Falling for Therapy Thoughtful non-attacking
  account of her encounter with different therapies
• She seems to feel that her intellect was
  discounted in her psychodynamic work
• Designed to question rather than criticize
• Objects to imposed interpretations

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More on the Sands
She claims psychotherapy should help us to live
with complexity She would like more
acknowledgement of the role and power of language
in therapy She felt that life was relegated to a
second place cf. the transference Difficulty of
getting out of therapy that doesnt work. Whose
responsibility?
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Anna Sands

• Problem of psychotherapeutic models providing a
  meta explanation for everything (like theology!)
  so easy to discount counter-arguments
• Can make the client uncertain of their own reality

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Anna Sands

• Complaints bring out the shadow side in
  therapists
• Need to acknowledge how serious a process therapy
  is. An operation on the heart
• Can be traumatised by the unnaturalness of the
  context. Damage by the perceived absence of love.

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Consuming Therapy Ann France (1988), London
Free Association Books

• Profoundly intelligent book
• Author committed suicide after the book had been
  written
• Profound and devastating effect of psychoanalysis

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A good source

• You will find chapters on Sands and on France in
  your recommended book for Counselling in
  Context
• Richard House (2003) Therapy beyond modernity
  London Karnac

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More general critiques

• All models are a construction e.g. there is no
  such thing as the id, ego, super-ego. ( see
  complex band very recent research handout by
  Diamond and Milton 2003
• Psychodynamic Counselling, because of its
  relationship with psychoanalytic psychotherapys
  long history may reify its claims.
• Psychodynamic counselling is not as democratic as
  say co-counselling or other forms of humanistic
  models

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More critiques

• The interpretation is necessarily authoritarian
• The setting including special boundaries are all
  on the therapists terms
• Because the therapist seems to define what is
  happening it is hard for the client to
  distinguish between his/her own resistance and a
  therapy that is bad for them

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This therefore raises ethical questions

• Need for the client to be thoroughly informed
  about the therapist stance
• Increased emphasis on the fidelity (honouring
  trust) of the therapist because the client may be
  working outside of his/her awareness
• Needs to be still a clear awareness of the
  clients autonomy. e.g. transactions that fall
  in, and outside of the client role. These again
  depend on clear understandings in the initial
  contract

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Beneficence

• Need for good and searching supervision in order
  to stay outside of a persecutory stance in
  interpretations etc.
• The cost of the invitation to transference needs
  to be counted beforehand. Sometimes it is hard to
  resist counter-attacking

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Non- Malificence and Justice

• Need to watch over the client and pace the
  interventions so that defences are understood
  rather than stripped away
• In long psychotherapy (as in all other models), a
  need to hold on to the client-ness of the
  individual. Especially necessary in cases of
  complaint which can be very protracted and
  difficult for the counsellor

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On the other hand

• Psychodynamic counselling can be seen as deeply
  relational the therapist is required to look at
  self and to process through counter-transference
  much asked of the therapist
• Tight boundaries can produce a safety in which
  conflicts can be looked at and resolved

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And more

• The world of symbols, fantasy and dreams may be a
  release from the rationalisation that dogs some
  methods of therapy
• The claim to have a language and a way of
  understanding the unconscious can be deeply
  liberating to people who have exhausted their
  thinking, problem-solving and behavioural
  adjustments

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And almost finally

• It provides a way of understanding the
  contradictions that seem to be at the heart of
  our experience
• It helps us to deal with our multiple senses of
  self, in the end not in terms of a theory, but in
  terms of relationship
• It makes a particular claim to the process of
  working through

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And really finallya quote from Burton and Davey
130

• Psychodynamic counselling in its dogmatic claims
  is as authoritarian and wrong- headed as any
  100-year-old piece of positivism is likely to
  be in its radical and subversive deconstruction
  of the unitary subject it profoundly challenges
  many of the sacred cows of the late twentieth
  century.