Lisa is a 35-year-old lady, diagnosed with depression. She has been referred by her psychiatrist for psychodynamic psychotherapy. According to her therapist, Lisa has the ability to conceive of her own mental state as explanations of her behaviour.
This phenomenon is called:
B. The capacity for mentalizing grows out of attachment theory and refers to a person’s ability to conceive of his or her own and others’ mental states as explanations of behaviour. Hence, it is related to psychological mindedness. The psychodynamic clinician assesses the ability of a patient to see that his or her behaviour grows out of a set of beliefs, feelings, and perspectives that are not necessarily the same as others’. Like empathy, mentalizing requires a capacity to sense what is going on in another’s mind and respond accordingly. This capacity to be sensitive to what others are feeling and to know that one’s internal states contribute to one’s behaviour augurs well for a more exploratory or interpretative approach in dynamic psychotherapy.
Which of the following suggests sufficient psychological mindedness in Lisa?
D. According to Nina Coltart, during psychotherapy, a therapist is exercising his/her skills and psychological mindedness to explore the patient’s psyche. If the patient is also psychologically minded, the prospects of treatment success are thought to be greatly increased. Whether a patient is psychologically minded depends on a number of characters. They include:
During her first session, Lisa asks her therapist about certain terms she came across on the internet. “What is transference?”
C. Transference is the displacement of feelings and thoughts associated with a figure in the patient’s past onto the therapist. Transference is often unconscious, at least initially, and the patient is often puzzled by their behaviour towards the therapist because it does not make sense, based on who the therapist really is. Hence the enactment of missing a session or of coming late to a session may reveal unconscious transference. The prevailing view about transference is that the therapist’s actual behaviour always influences the patient’s experience of the therapist. Hence the transference to the therapist is partly based on real characteristics and partly on figures from the patient’s past: a combination of old and new relationships. Many therapists believe that interpretation of this transference is an essential process of psychodynamic psychotherapy. Gabbard says that one should postpone the interpretation of transference until it becomes a resistance and until it is close to the patient’s awareness. In other words, if things are going reasonably well, it makes no sense to interpret transference. If the patient develops, for example, erotized or highly negative feelings, which impede the process of the therapy, interpretation may be essential. Many therapists regard treatment that focuses on transference as more exploratory than therapy geared to extra-transference relationships. In supportive therapy, interpretation of the transference may be minimized, although the therapist may silently interpret the transference as a way of increasing his or her understanding of the patient.
Which of the following correctly describes counter-transference?
D. Freud used the term counter-transference to describe the analyst’s transference towards the patient. In other words, the patient might remind the therapist of someone from the therapist’s past, so that the therapist starts to treat the patient as though he or she were that figure. Over time, this view of counter-transference was broadened to include the total emotional reaction of the therapist to the patient. Today it is recognized that countertransference is jointly created—it partly involves the therapist’s past relationships, but it also involves feelings induced in the therapist by the patient’s behaviour. Counter-transference is variously defined as:
These responses are manifestations of the requisite engagement by the therapist or analyst in the emotional process of treatment. Moreover, these reactions are a rich source of understanding of the patient’s experience as it touches the therapist affectively.
During the psychotherapy sessions, the therapist notes that Lisa uses a number of defense mechanisms that are classified as ‘mature defenses’ according to Vaillant.
Which of the following is a mature defense?
A. George Vaillant classified defenses hierarchically according to the relative degree of maturity associated with them. Narcissistic defenses (denial, distortion, and projection) are the most primitive and appear in children and persons who are psychotically disturbed. Immature defenses (acting out, passive-aggression, blocking, introjection, and regression) are seen in adolescents and some non-psychotic patients. Neurotic defenses (dissociation, displacement, intellectualization, isolation, reaction formation, and repression) are encountered in obsessive– compulsive and hysterical patients as well as in adults under stress. Mature defenses according to Vaillant are altruism, anticipation, asceticism, humour, sublimation, and suppression. These mechanisms often are used in healthy coping mechanisms.
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