This section describes eleven psychodynamic psychotherapy microskills that focus on interpersonal relationship patterns and the role of the unconscious. These skills emphasize the importance of gaining insight into unconscious patterns in order to enhance human functioning. Many of these skills go all the way back to Freud's notion that the goal of psychoanalysis was to make the unconscious conscious. Other skills are drawn more directly from contemporary forms of psychodynamic psychotherapy including time-limited dynamic psychotherapy (Strupp & Binder, 1984) and the core conflictual relationship theme method (Luborsky & Crits-Christoph, 1997; Book, 1998).
Please rate your abilities for each of these psychodynamic microskills in order to identify current strengths and areas that need more practice and refinement. Please use the following scale to evaluate your skills:
A: I ALREADY use this skill with comfort and success.
B: I'm okay at this skill; I would like to be BETTER.
C: I CAN'T implement this skill very well.
D: I DON'T want to include this skill in my repertoire.
PS1. ______ Clarifying the impact of interpersonal relationship patterns on thoughts, feelings, and actions.
Psychological distress is often related to interpersonal patterns that are repeated across the life span. By attending carefully to past and present relationships, a psychotherapist can help a client see the impact of these patterns on their thoughts, feelings, and actions. The relationships that we experience early in life with our family members or other significant individuals often shape our experiences later. Psychotherapy can provide an opportunity to see how parts of these early relationships may be influencing current experience.
PS2. ______ Clarifying the impact of unconscious impulses, motives, and defense mechanisms on thoughts, feelings, and actions.
Psychotherapy has a long history of enhancing awareness of subtle or unconscious processes. To enact this skill, it is important to help clients see how their thoughts, feelings, and actions may be influenced by impulses and desires that may lie outside of conscious awareness. A psychotherapist can be very helpful in attending to and accepting behavior that may be ignored by a client because it is unacceptable in some way. When these defenses are recognized and acknowledged, they can begin to be understood and modified.
PS3. ______ Interpreting subtle processes that may be outside a client's awareness and highlighting the dynamic interplay between different parts of the psyche.
Attending to verbal or behavioral cues that a client may not notice is a helpful way to begin to recognize and address the unconscious. Providing interpretations that help organize one's observation can encourage insight into subtle patterns. These interpretations also may be used to point out how different aspects of a client's psyche may interact and compete for influence.
PS4. ______ Recognizing dysfunctional patterns that were effective earlier in life but may not be adaptive now.
Current distress is often the result of enacting behavior that may have been effective in the past but is no longer needed. For example, in one's family of origin it may have been adaptive to withdraw from a disapproving parent, but the same behavior may create unhealthy distance in an adult intimate relationship. Encouraging insight about how the past influences the present is an important psychodynamic skill.
PS5. ______ Facilitating the reduction of internal conflicts by gratifying needs in new, socially appropriate ways.
If psychotherapy leads to the acknowledgement of needs that previously were unrecognized, conflicts sometimes arise around the fulfillment of these desires. Part of the healing process may be to find new, more effective ways to gratify these impulses. For example, if a client is learning not to depend on unhealthy adoration from needy relationships, it may be helpful to explore healthy ways to celebrate one's unique and special qualities. Psychotherapy can provide an opportunity to find appropriate ways to fulfill emotional needs.
PS6. ______ Revealing the impact of early childhood experiences and family dynamics on current interpersonal expectations, social patterns, and identity.
Psychodynamic psychotherapy provides an emphasis on understanding how one's early family experiences provide a crucial context that impacts how individuals view themselves and shape their lives. This skill allows a psychotherapist to explore the past in order to understand the present. Examining interpersonal interactions to identify a client's wish, the response of another individual, and the client's subsequent reaction often reveals patterns that can be traced back to childhood. Illuminating these patterns can prepare a client for active choices and personal change.
PS7. ______ Illuminating the importance of early and ongoing attachment experiences and negotiating appropriate ways for clients to fulfill these needs.
One crucial aspect of early experience is whether an individual was able to experience secure relationships with significant caregivers. If a client has not had healthy attachment experiences as a child, it will be more difficult to create secure relationships in adulthood. If attachment is a concern in psychotherapy, the relationship between the client and the psychotherapist can be used to understand and repair past injuries. This process is sometimes described as “reparenting” and, ideally results in a greater ability to connect and separate in healthy ways. A psychotherapist can also guide a client as new choices are made that may lead to more secure relationship experiences.
PS8. ______ Examining transference as a way of seeing how the client views the world.
The relationship between the client and the psychotherapist provides a small window that illuminates how a client views the world and reacts to others. Investigating the assumptions that a client may have about the psychotherapist can lead to insight into how clients experience significant others in their personal life. In addition, the interactions created by these assumptions may play out in session, and can lead to insight about pervasive interpersonal patterns in the client's life. Understanding transference can provide valuable information about the client that may facilitate positive change.
PS9. ______ Attending to your own reactions to clients to gain insight on how others may experience them.
Another way of learning from the client-psychotherapist relationship is to attend to countertransference. By paying attention to their own reactions to the client, psychotherapists can begin to understand how other people may experience the client. This insight can be invaluable for a client trying to understand his or her own interpersonal experiences.
PS10. ______ Maintaining therapeutic neutrality and encouraging non-directive expression to allow clients to reveal unconscious material.
Taking charge and directing psychotherapy sessions may interfere with clients' ability to explore their own issues and make important self-discoveries. The psychodynamic tradition emphasizes the importance of maintaining therapeutic neutrality. If a psychotherapist play s a less active role in psychotherapy, he or she is more likely to view and have access to a client's unconscious impulses and desires.
PS11. ______ Listening to clients without pushing for change in order to enhance intrinsic motivation and increase the chance for personal insight.
A psychotherapist's desire and expectation for change may interfere with a client's intrinsic motivation and sometimes results in resistance. Psychotherapists who take a less active role and monitor their own anxiety may be able to enhance the client's motivation to gain insight and work for personal change. Personal transformation may be facilitated best by a client's acceptance of personal responsibility for change without direct pressure from the psychotherapist.
Identifying Strengths and Areas for Growth
Now that you have had a chance to read descriptions of these eleven psychodynamic skills, please complete the Identifying Strengths and Areas for Growth worksheet focusing on psychodynamic skills.
Written Practice
Next, please write a specific example for each of the psychodynamic skills described in this section. Here is an example of what a written example might look like for Psychodynamic Skills 6: Revealing the impact of early childhood experiences and family dynamics on current interpersonal expectations, social patterns, and identity:
CL: “It seems like all my boyfriend can do is criticize me. All I want is for him to compliment me or do something nice and all he does is put me down. So, I just try harder hoping he'll notice all the nice things I do.”
PS: “That pattern sounds kind of familiar. It's not all that different from the way that you've described your relationship with your father. I'm wondering if you see any of the parallels that I'm noticing.”
Role Play Practice
After writing examples of each of these psychodynamic skills, the next step is to practice them in a role-play. You may want to choose some of the skills that you identified as areas for growth and practice them with a classmate or colleague.
Treatment Planning
You may want to think about a specific client who would benefit from a psychodynamic approach and identify the skills that you would like to use. A Treatment Planning Worksheet is provided for this purpose.
Reflecting on a Single Session
You may want to identify a session in which you used a psychodynamic approach and identify the specific skills from the catalog that you used. A worksheet for Reflecting on a Single Session is provided for this purpose.
Copyright © 2001 Jeff E. Brooks-Harris &
Michael F. Gavetti.
Skill-Based Psychotherapy Integration: A Practicum Handbook of
Intermediate Miscroskills.
http://www2.hawaii.edu/~jharris/sbpi.html
Permission is granted to copy these materials for educational
purposes provided this copyright notice remains intact.