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A Clinical Guide to Psychodynamic Psychotherapy
What is psychodynamic psychotherapy?
The core competences of psychodynamic psychotherapy
Aim and outline of the book
Notes on terminology and use of clinical material
: Theory and research
An overview of psychoanalytic theory
Freud’s structural and developmental theories
The topographical model of the mind
The structural model of the mind
Stages of psychosexual development
Anxiety and psychopathology
Anna Freud’s concept of developmental lines
The beginnings of Object Relations theory: Melanie Klein and Wilfred Bion
Unconscious phantasy and internalised objects
The Paranoid-Schizoid Position
Wilfred Bion: on containment and thinking
Object Relations Theory: the British independents
Fairbairn and object-seeking motivation
Winnicott: the holding environment and the ‘good enough mother’
Winnicott: the development of the true self or false self
North American developments: a greater focus on the Self
Object-relational models: Kohut and Kernberg
Interpersonal-relational models: Sullivan and Mitchell
Related theoretical developments
Attachment theory
Mentalisation theory
Neuropsychoanalysis
Thinking about theory and practice
Efficacy and outcome research
The rise of evidence-based practice
The efficacy of psychodynamic psychotherapy
The ‘active ingredients’ of therapy
Research on patient experience of therapy
Distinctive features of psychodynamic psychotherapy
Neuroscientific evidence for the benefits of psychotherapy
Working with outcome measures
: Competences
The setting and the analytic frame
Assessment and formulation
What is a psychodynamic assessment?
The purpose of a psychodynamic assessment
What works for whom?
The referral route
The different roles of assessor and therapist in organisational settings
Conducting an assessment
When to consider the role for psychotropic medication
Developing a psychodynamic formulation
Structuring a psychodynamic formulation
An illustrative psychodynamic formulation
Assessing suitability for psychodynamic psychotherapy
Key areas around suitability for psychodynamic psychotherapy
Realistic aims for psychotherapy
Anxiety and defences “Why are you being so defensive?”
Understanding anxiety and defences
Are defences necessary?
Types of defences
Destructive defensive behaviour
Defences and attachment styles
The false self
Working with defences in therapy
Resistance in psychotherapy
Mentalising
What is mentalisation?
A brief history of mentalisation
How do we develop the capacity to mentalise?
Recognising impaired mentalising
Restoring good mentalising
Managing ruptures in the therapeutic relationship
Monitoring our own mentalising capacities as therapists
Unconscious communications
Listening for unconscious communication
Types of unconscious communication
Free association, manifest and latent content
Patterns of verbal and non-verbal communication
Dreams as unconscious communication
Unconscious communication through the transference and countertransference
Making an interpretation
Transference and countertransference
Transference
What is transference?
Different types of transference
Transference neurosis
Self object transferences
The cautionary tale
Working in the transference
Making transference interpretations
Countertransference
Role responsiveness and countertransference
How to recognise and monitor your countertransference
Particular types of transference-countertransference dynamics
Projective identification and countertransference
Acting out and acting in
Endings
Termination vs ending
Developmental perspectives on endings
When to end?
Endings, recapitulated losses and resistance
Endings from the therapist’s perspective
: Adaptations and practicalities
Brief applications of psychodynamic work
What do we mean by brief?
Selection criteria for brief psychodynamic therapy
Trajectory of brief psychodynamic therapy
Why offer brief psycho dynamic therapy?
Challenging situations and clinical dilemmas
Challenges to the analytic frame
Challenges in the therapeutic relationship
Ruptures in the therapeutic alliance
Erotic transference and countertransference
Patients who ask questions and request advice
Patients who challenge therapeutic boundaries
The ‘good patient’ and/or the idealised therapist
Risks in the clinical setting
Suicide and safeguarding risks
Regression in psychotherapy
Working with difference
Sexuality and gender diversity
Racialised and classed identities
Disability and ableism
Working with differences
Technology and social media
The therapist’s online presence
Privacy, confidentiality and data protection
Patient’s use of technology in the setting and the transference
Online communication: emails and texts
Online banking
Distance psychotherapy
Appendix 1: Specimen terms and conditions
Appendix 2: Specimen referral/pre-assessment questionnaire
Appendix 3: Specimen end of therapy report
Appendix 4: Specimen social media contract
Appendix 5: Specimen privacy notice for website
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