Counseling and Psychotherapy. Группа авторов
capacity to reflect on their own state of mind and so enhance their ability to manage interpersonal difficulties. The counselor assumes that changes will happen rapidly and that a short intervention will begin a long change process that continues beyond counseling. The number of sessions varies from one approach to another, but brief psychodynamic counseling relies on the estimated time that is needed to achieve the counseling goals as determined at the beginning of counseling and generally does not extend beyond 16 sessions (Lemma et al., 2011).
The brief psychodynamic approach is conceptualized in three phases. In the initial phase, the client is engaged in the counseling process, and by providing structure, direction, and confrontation, the counselor engages the client in assessing current difficulties and defenses. In the middle phase, the counselor focuses on one problem or pattern, and, using a variety of interpretation methods, such as dynamic interpretation, resistance interpretation, transference interpretation, or dream interpretation, the client develops an awareness of the presentation of symptoms related to the identified problem. In the ending phase, the counselor and client cooperatively review the material, evaluate progress, and transition toward the end of treatment by focusing on the conscious and unconscious meaning of separation from the counselor following termination (Lemma et al., 2011).
Psychodynamic counseling generally involves developing a therapeutic alliance and addressing defense mechanisms and intrapsychic conflicts in an attempt to show the multiple conscious and unconscious factors that influence a client’s symptoms and behaviors. A current example of psychoanalytic evolution is the introduction of psychodynamic interpersonal therapy and interpersonal psychotherapy. Each approach has a basis in classical psychoanalysis but can be applied in a brief context and has a specific set of techniques that uniquely define it.
Expressive Psychotherapy
Expressive psychotherapy uses similar techniques to those used in psychoanalysis, although there is more focus on the client’s problems and external life. The counselor’s neutrality may need to be suspended when the client enters a crisis, but the counselor reassumes neutrality as soon as the crisis has been appropriately addressed. Clients are usually seen face to face instead of in the traditional couch/ chair context and are seen far less frequently than in classical analysis (weekly or bimonthly rather than biweekly). Although the results of expressive therapy are expected to be less extensive than the results of psychoanalysis, both forms of treatment are assumed to be capable of producing structural personality change (Bush & Meehan, 2011).
Object Relations and Attachment
Object relations theory suggests that internal representations of oneself and other people acquired in childhood are later replicated in adult relationships. To establish a healthy relationship with others, the client must examine how self-esteem, self-concept, and unhealthy attachments are impeding healthy social support. Psychologist John Bowlby developed this concept further with his attachment theory, which suggests that relationships with primary caregivers during early development influence emotional and behavioral responses across the life span through a behavioral system that influences expectations of both self and others in close relationships (Bowlby, 1969).
Self-Psychology
Self-psychology was founded by Heinz Kohut in the 1970s on the premise that the self is the essence of a person’s being and consists of sensations, feelings, and self-image. Although this approach is aligned in many ways with psychoanalysis, a significant conceptual difference is the self as the dynamic foundation for personality that shapes the client’s establishment of boundaries and the differentiations of the self, rather than a system of drives and motivations (Riker, 2013).
Self-psychology suggests that the quality of the relationship between a child and a caregiver has a significant role in the development of a healthy and cohesive personality structure. When a child does not have an appropriate self-object differentiation because of early life trauma, the child is unable to separate the self from the object (in this case, the traumatic experience). The trauma then remains unprocessed and stays in the unconscious as a core negative experience, which derails normal development into adulthood. This would be expressed in the adult client as preoccupations with negative thinking, depression, suicidal thinking, attention deficits, hyperactivity, self-mutilation, and eating disorders (Rowe, 2013).
Psychodynamic Interpersonal Therapy
Psychodynamic interpersonal therapy is a time-limited treatment that integrates psychodynamic, humanistic, and interpersonal concepts. The emphasis of the sessions is on the counselor and client collaborating to develop a feeling of partnership through a mutual understanding of language and communication, resulting in a conversational style of insight-driven dialogue. The counselor’s role is to remain unbiased and help the client consolidate their own identity and to exhibit total acceptance of the client by engaging in an ongoing, self-reflective awareness of any bias that can lead to therapeutic ineptitude and impairment. The duration of the treatment is approximately 12 weeks and is delivered in three phases. The counselor first identifies the diagnosis and the interpersonal contexts in which it presents. The counselor then links the diagnosis to an interpersonal focus and brings the client into the second phase of treatment, during which the counselor uses specific strategies to help the client identify and resolve clear interpersonal problem areas. The final phase consists of the counselor and client discussing role transition and rebuilding interpersonal deficits with a focus on termination and maintenance beyond counseling (Markowitz & Weissman, 2004). Attention to cultural dynamics is emphasized; psychodynamic techniques may reveal the influences of trauma that were caused or shaped by diversity inequities.
Transactional Analysis
Transactional analysis suggests that emotional conflicts do not arise from the superego mediating the id and ego but instead emerge from unhealthy mutual interactions among the three. A therapist gains significant understanding of a problem by observing verbal and nonverbal communications between two or more people, which helps the therapist and client identify the source of the crossed, or unhealthy, response style. The three styles of responding are the parent, the child, and the adult. The first ego state, the parent, holds the memory of rules and norms absorbed by exposure to external events in childhood. The second ego state, the child, holds the emotional memory of the client, including emotional responses to interactions with caregivers. The final ego state, the adult, assimilates the thoughts, feelings, and behavioral responses learned from childhood differentiation of rules and norms versus internal motivations. The therapist can use this triadic ego model to help clients understand their communication styles; for example, they might have learned a dominant ego state as a reactive response to child-rearing practices in the first 5 years of life, and their identified problems emerged because of inefficient reinforcement of healthy human interaction patterns (Berne, 1961).
Clients With Serious Mental Health Issues
Past experiences provide valuable insight into the client’s current functioning and object relations themes and may be included in a dialogue with the client to meaningfully frame current difficulties in the context of contributed experiences. This concept provides the foundation for the counselor working with clients with challenging diagnoses and serious mental health issues. Using a psychodynamic model, the counselor focuses on a core segment of the client’s interpersonal functioning, which is closely connected with the presenting symptoms causing functional impairment. The unconscious, recognizable as urges and impulsivity or a flattened affect, remains the primary focus of treatment, and the aim in the treatment of serious mental illness is to trace the overt symptoms of the diagnosis back to their unconscious origins and analyze them through the use of rational thought and processing. This is an active and directive process for the counselor in the beginning, and the goal is to develop a sense of stability in the client by creating