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Psychoanalytic Family Therapy (PowerPoint)

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					Chapter 9 review by Maria Granados
   1909-Sigmund Freud –Family seen as a place where people learned fears
    (Little Hans)
   1930- more interested in contemporary families
   1940’s Henry Dicks Family Psychiatric Unit established with Social
    workers to reconcile couples ready to divorce-
   1950’s Ego Psychology
   1953-NIMH=research on families of schizophrenics coined the terms
    pseudo mutuality, trading of dissociation, delineation, and project
    identification
   1960 –Henry Dicks focused on Object relations theory in his famous
    book “Marital Tensions”
   1960’s and 1970’s produced a shift by ignoring and denigrating
    psychoanalytic thinking
   1960’s Ruckoff and Wynee spearheaded a course in family dynamics and
    began the first Family Therapy program
   1980’s a renewed interest in the individual occurred-Washington school
    of psychiatry became established the center of psychoanalytic family
    therapy lead by David Sharff
   1994-David and Jill Sharff formed their own instituteof Family therapy
   Shift from individualism of Freudian theory to
    relationship oriented object relations theory
    and self psychology
   Dissatisfaction with cybernetic model
   Truths were found in systematic interactions,
    but self awareness was key to unlocking the
    inner conflict and confusion of an individual
   Psychoanalytic therapist probe beneath family
    dialogue by exploring individual family
    member’s fears and longings
   Freud
    ◦ Saw Family as a place where fears developed
    ◦ Later Psychiatrist began to study Mother’s and
      infants concurrently to see what maintained fears

    Adelaide Johnson
     Coined the term super ego lacunae –gaps in
     personal morality passed on by parents
   An important feature of psychoanalytic view is
    that family are a group of interlocking, intra
    psychic system
   Psychoanalytic treatment involves uncovering and
    interpreting unconscious impulses and defenses
    against them. Family interactions should be
    analyzed and to know where to look and discover
    basic wants and fears that keep individuals from
    interacting in a mature way
   Nature of interactions are partly dictated by
    psychic organization of unsuspected depth and
    complexity
   Freudian Driven Psychology
       Sexual and aggressive drives lead
       to acting on impulses
   This results in conflict that drive behaviors
    and lead to punishment

   Expression of Anxiety or Depression is
    punishing due to unconscious past
    experiences and associations

   Balances of conflict can be associated by
    strengthening the defenses against impulses
    or relaxing defense to permit gratification
   Every Human longs to be appreciated
   Parents who demonstrate appreciation have
    children who internalize acceptance and form
    strong self confident personalities. They are
    able to stand alone and love
   Flat, unresponsive or withdrawn parents have
    children who crave appreciation. They are
    unhappy, cheated out of loving affirmation,
    and will live life craving attention he was
    denied
   Psychoanalysis + Family Therapy=The study
    of individuals and their deepest motives
    combined with the study of social
    relationships
   Childhood experiences are key to later
    problems in relationships
   People relate to others on the basis of
    expectations formed by early experience
   Internal Objects-mental images of self and
    others are built up from experience and
    expectations
   Fairbairn redefined Freud’s concept of
    splitting into a 3 part ego division resulting
    ina central,rejecting and exciting ego



    ◦ External object is experienced by
    ◦ 1) An ideal object which leads to satisfaction
    ◦ 2) A rejecting object which leads to anger
    ◦ 3) An exciting object which leads to longing
    If splitting isn’t resolved, object relations retain
      either an “all good” or “all bad” quality
   Attachment is considered a basic need in all creatures
    (Spitz and Bowlby).
    Analectic depression results from a denial of such an
    attachment resulting in a turning away from the
    world and withdrawal into apathy
   Denial of such a need results in enmeshed and
    disengaged relationships
   Separation-individuation –a gradual process of
    separation from the mother which, successfully
    done, will produce a well differentiated self (Marget
    Mahler)
    ◦ Failure of separation process results in overly intense
      emotional attachments which may be seen during life’s
      transitions (school, adolescence)
   A mother who does not meet a child’s need for tenderness
    may dissociate to escape anxiety when exposed to pain or
    frustration that would be intolerable
   This creates responses to future interpersonal situation.
    These self dynamism are:
    ◦ Good me, bad me and not me
   An individual’s capacity for dealing with conflict and failure is
    related to the depth of maturity of the internal world of object
    relations
   Trust in self is based on the goodness of others and
    confirmation of love form internalized good objects
   An average expectable environment featuring
    good enough mothering is adequate in order
    to thrive
   Early attachment between mother and child
    are critical aspect of healthy development
   An infant needs emerging and identification
    with the mother as a foundation for growth
   Infants become less dependent on mothers
    and may adopt a transitional object
   Phases of development
    ◦ Initial Autistic phase and Symbiotic phase
    ◦ Separation individuation period- allows the child to
      know the mother is constantly there as in “peek a
      boo” phase
    ◦ Earliest introjections occur in process of separation
      from mother-successfully done ensures child is an
      independent being
    ◦ Process is subverted if infant clings and separation
      is anxiety driven/provoking
    ◦ A child with a history of good object relations can
      tolerate closeness and separation
   Self Psychology-secure attachments
    developed through
   1) mirroring( I see how you feel)
   2) idealization -parents are terrific and I am
    part of them)
   Grandiosity gives way to self esteem;
    idealization of parents becomes the basis for
    personal values
   Not subdued grandiose self can result in
    Narcisstic personality disorder(NPD)
   Lasch describes NPD as lonely craves
    attention and is easily angered who craves to
    be a hero since this does not occur rage takes
    place (result of the narcisstic wound)
   Freud said this a disruption of self preserving
    instinct
   Daniel Stern claimed child development is not
    a gradual process of separation and
    individuation
   Infants differentiate from birth through
    increasing complex modes of relatedness
   From Attunement to empathy these are life
    long needs
   Individual personalities make up families
   These interlocking fantasy have been referred to
    as: mutual projective identification, neurotic
    complementary, marital collusion, mutual
    adaption, conscious and unconscious contracts.
   Boszormentyi-Nagy Contributions of
    psychodynamic family therapist is the concept of
    contextual therapy which emphasizes the ethical
    dimension of family development.
   Poorly differentiated children face a crisis in
    adolescence when developmental pressures
    for independence conflict with infantile
    attachments
    ◦ When they marry they may seek constant approval
      or automatically reject any influence or both
    ◦ Over evaluation of a loved object leads us to
      make poor judgments based on idealization
    ◦ Your own identity glows in the radiance of a
      companion
◦ False Self-Children suppress feeling s that
  lead to rejection which may lead to
  schizoid behavior
◦ Prior to marriage powerful dependency
  needs, narcissim and unruly impulsive
  come to light
◦ Projective identification is a mutual way in
  which interactions between two people
  can activate latent elements in each
  other’s personality
   In Marriage:
    Our own needs and feelings are hidden to win
    approval
   Marriage is a balance of rights and responsibilities
   Projective identification is a mutual way in which
    interactions between two people can activate latent
    elements in each other’s personality
   Marriage is a transaction between hidden
    internalized objects
   Maritial studies looked at marital bonds due to
    unconscious fantasy-
   Martial Contracts have unconscious factors
    and 3 levels of awareness (Sager)
    ◦ 1) Verbalized, not always heard
    ◦ 2) Conscious not verbalized due to feaar of anger or
      disapproval
    ◦ 3) Unconscious

    ◦ Partners become angry if the other does not live up
      to the terms
   Children represent a more devoted love object
    than the spouse, someone to succeed when
    parents failed, or a peace offering to
    grandparents
   Delineations(Zinner and Shapiro) occur when
    parental actions communicate parental fantasy to
    their children
   Pathological delineations are based on parents
    defensive needs than on realistic perceptions of
    children-children are labeled as bad, brilliant,etc
    regardless of the truth
   Children identified as patients project identification
    to cement attachments, assuage unconscious guilt,
    or preserve their parents shaky marriage
   Family myths serve the same function in families by
    simplifying and distorting reality
   Families experience fixation and regression. When
    under stress they become stuck in dysfunctional
    patterns and regress to earlier levels of
    development
   Invisible loyalties are unconscious commitments
    children take on to help families to the detriment
    of their own well being which result in pathological
    reactions
   Relationship problems occur because children
    distort their perceptions by attributing the
    qualities of one person to someone else. This
    is referred to as:
        Transference (Freud)
        Scapegoating
        Trading of Disassociations
        Merging
        Irrational role assignments
        Delineations
        Symbiosis
        Family projection Process
   To free families members of unconscious constraints so
    that they are able to interact with one another as healthy
    individuals
   Provide long term therapy, however, many times crisis
    resolution with symptom reduction is key as seen in family
    therapy.
   Separation-Insinuation or differention emphasize
    authonmy
   To help families convene and learn to let go of one
    another in a way that allows individuals to be independent
    as well as related
   To help family members overcome irrational unproductive
    guilt and to claim their entitlements-each person works
    towards self fullfillmetn by asserting his rights and living
    up to his obligations
 Listening
 Empathy
 Interpretations-clarifies hidden aspect of
  experience
 Analytic Neutrality-understanding without
  worrying on solving problems. Anxious
involvement is suspended with outcomes
Couple therapy organizes exploration along 4
   channels
1. Internal experience
2. History of experience
3. How partner triggers the experience
4. How context of session and therapist input
   might contribute to what’s going on
1.     Sessions begin by inviting family members
     to discuss concerns, thought and feelings.
2.   Have family’s decide what to discuss
3.   Interpretations are made about how family
     members continue to re enact the past and
     distorted images from childhood
  Projective identification may occur when feelings are
   communicated and provoked by subtle symbols. To
   work through this a therapist must:
1. Interrupt squabbling which may be masking true
   feelings
2. Explore how each individual is feeling
3. Projecting partner is told to listen, not communicate
   or comment
4. Once finished, the projector is to feedback what she
   understood the partner to be saying in an empathetic
   manner.
   What is hidden in family dialogues is not
    consciously withheld but repressed into
    unconsciousness
   Insight and understanding is urged in order
    to consider what families are going to do
    about problems they discuss
   Families are urged to develop a balance of
    fairness
   Psychoanalysis have been criticized for
    absolving people for responsibility of their
    actions
   Resistance to empirical standards for
    Psychoanalytical therapy-difficult to measure
   Symptom reductions is not the goal but the
    presence or absence of unconscious conflict
   What distinguishes Attachment theory from
    Psychoanalytic theory?
   How can true synthesis between
    Psychoanalytical Family therapy and Systems
    theory actually occur?
   If there’s little empirical evidence as to the
    benefits of Psychoanalytical Family Therapy,
    then how is success measured and
    documented?