A Clinical Guide to Psychodynamic Psychotherapy

What is psychodynamic psychotherapy?The core competences of psychodynamic psychotherapyAim and outline of the bookNotes on terminology and use of clinical materialTheory and research An overview of psychoanalytic theory Freud’s structural and developmental theoriesThe topographical model of the mindThe structural model of the mindStages of psychosexual developmentAnxiety and psychopathologyAnna Freud’s concept of developmental linesThe beginnings of Object Relations theory: Melanie Klein and Wilfred BionUnconscious phantasy and internalised objectsThe Paranoid-Schizoid PositionWilfred Bion: on containment and thinkingObject Relations Theory: the British independentsFairbairn and object-seeking motivationWinnicott: the holding environment and the ‘good enough mother’Winnicott: the development of the true self or false selfNorth American developments: a greater focus on the SelfObject-relational models: Kohut and KernbergInterpersonal-relational models: Sullivan and MitchellRelated theoretical developmentsAttachment theoryMentalisation theoryNeuropsychoanalysisThinking about theory and practiceEfficacy and outcome research The rise of evidence-based practiceThe efficacy of psychodynamic psychotherapyThe ‘active ingredients’ of therapyResearch on patient experience of therapyDistinctive features of psychodynamic psychotherapyNeuroscientific evidence for the benefits of psychotherapyWorking with outcome measuresCompetences The setting and the analytic frame Assessment and formulation What is a psychodynamic assessment?The purpose of a psychodynamic assessmentWhat works for whom?The referral routeThe different roles of assessor and therapist in organisational settingsConducting an assessmentWhen to consider the role for psychotropic medicationDeveloping a psychodynamic formulationStructuring a psychodynamic formulationAn illustrative psychodynamic formulationAssessing suitability for psychodynamic psychotherapyKey areas around suitability for psychodynamic psychotherapyRealistic aims for psychotherapyAnxiety and defences “Why are you being so defensive?” Understanding anxiety and defencesAre defences necessary?Types of defencesDestructive defensive behaviourDefences and attachment stylesThe false selfWorking with defences in therapyResistance in psychotherapyMentalising What is mentalisation?A brief history of mentalisationHow do we develop the capacity to mentalise?Recognising impaired mentalisingRestoring good mentalisingManaging ruptures in the therapeutic relationshipMonitoring our own mentalising capacities as therapistsUnconscious communications Listening for unconscious communicationTypes of unconscious communicationFree association, manifest and latent contentPatterns of verbal and non-verbal communicationDreams as unconscious communicationUnconscious communication through the transference and countertransferenceMaking an interpretationTransference and countertransference TransferenceWhat is transference?Different types of transferenceTransference neurosisSelf object transferencesThe cautionary taleWorking in the transferenceMaking transference interpretationsCountertransferenceRole responsiveness and countertransferenceHow to recognise and monitor your countertransferenceParticular types of transference-countertransference dynamicsProjective identification and countertransferenceActing out and acting inEndings Termination vs endingDevelopmental perspectives on endingsWhen to end?Endings, recapitulated losses and resistanceEndings from the therapist’s perspectiveAdaptations and practicalities Brief applications of psychodynamic work What do we mean by brief?Selection criteria for brief psychodynamic therapyTrajectory of brief psychodynamic therapyWhy offer brief psycho dynamic therapy?Challenging situations and clinical dilemmas Challenges to the analytic frameChallenges in the therapeutic relationshipRuptures in the therapeutic allianceErotic transference and countertransferencePatients who ask questions and request advicePatients who challenge therapeutic boundariesThe ‘good patient’ and/or the idealised therapistRisks in the clinical setting Suicide and safeguarding risksRegression in psychotherapyWorking with difference Sexuality and gender diversityRacialised and classed identitiesDisability and ableismWorking with differencesTechnology and social media The therapist’s online presencePrivacy, confidentiality and data protectionPatient’s use of technology in the setting and the transferenceOnline communication: emails and textsOnline bankingDistance psychotherapyAppendix 1: Specimen terms and conditionsAppendix 2: Specimen referral/pre-assessment questionnaireAppendix 3: Specimen end of therapy reportAppendix 4: Specimen social media contractAppendix 5: Specimen privacy notice for website
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