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Long-Term Psychodynamic Psychotherapy

Glen O. Gabbard

Summary Notes

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Key Elements/Definition of Long-Term Psychodynamic Psychotherapy

A therapy that involves careful attention to the therapist-patient interaction, with thoughtfully time interpretation of the transference and resistance embedded in a sophisticated appreciation of the therapist’s contribution to the two-person field (Gunderson and Gabbard 1999, p. 685).
Yet another hallmark of the practic of psychodynamic psychotherapy is its focus on what is unique, idiosyncratic, and different abou the individual. Psychodymaic therapists recognize that the patient has lived a life like no other, and the techniques and strategies are tailored to the individual charcterisitcs of the patient.

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[thcol]Distinctive features of technique in psychodynamic psychotherapy[/thcol]
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[tcol]Focus on affect and expression of emotion[/tcol]
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[tcol]Exploration of attempts to avoid aspects of experience[/tcol]
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[tcol]Identification of recurring themes and patterns[/tcol]
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[tcol]Discussion of past experience[/tcol]
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[tcol]Focus on interpersonal relations[/tcol]
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[tcol]Focus on therapeutic relationship[/tcol]
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[tcol]Exploration of wishes, dreams, and fantasies[/tcol]
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[thcol]Basic principles of psychodyamic psychotherapy[/thcol]
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[tcol]Much of the mental life is unconscious[/tcol]
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[tcol]Childhood experiences in concert with genetic factors shape the adult[/tcol]
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[tcol]The patient’s transference to the therapist is a primary source of understanding[/tcol]
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[tcol]The therapist’s countertransference provides valuable understanding about what the patient induces in others[/tcol]
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[tcol]The patient’s resistance to the therapy process is a major focus of therapy[/tcol]
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[tcol]Symptoms and behaviors serve multiple functions and are determined by complex and often unconscious forces[/tcol]
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[tcol]A psychodynamic therapist assists the patient in achieving a sense of authenticity and uniqueness[/tcol]
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Freud originally focused on the topographic model of the mind, which involved a stratified hierarchy of conscious, preconscious, and unconscious domains.
Freud soon learned, though, that the derepression of memories through cathartic abreactions did not result in durable changes.
Freud’s model gradually became more complicated, culminating, in 1923, in the introduction of the tripartite structural theory comprising ego, id, and superego (Freud 1923/1961). In the structural model, the ego is viewed as distinct from the aggressive and sexual drives. The conscious aspects of the ego principally involve defense mechanisms designed to counteract the powerful instinctual drives harbored in the id. Sexuality and aggression are regarded as the basic drives, and they require massive defensive efforts from the ego to prevent them from becoming disruptive to the person’s functioning.
Signal anxiety is produced by conflict between these agencies (Freud 1926/1959). This type of anxiety alerts the ego that a defense mechanism is required to curb expressions of aggression or sexuality that seem forbidden.
In other words, conflict produces signal anxiety, which the results in a defense, which then leads to a compromise between the id and the ego or the id and the superego. A symptom, then, can be understood ass a compromise formation that defends against a wish while also gratifying the wish in disguised form.

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– Chapter SubSection One –

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