Psychoanalysis and

Psychodynamic Therapies
 Psychodynamics

- According to Vinney (2019), the Psychodynamic approach was developed

by Sigmund Freud (1856-1939) through his critical work with patients.
Psychodynamic- refers to all the theories derived from Freud’s work.

- He is the founder of the psychoanalytical approach to therapy.

Psychoanalytical- refers to Freudian theory

- Freudian theory suggests that as children develop, they progress through

a series of psychosexual stages. At each stage, the libido's pleasure-
seeking energy is focused on a different part of the body.
 Freud’s Psychoanalytical Model

Freud’s clinical experience

Case- “Anna O”- serious symptoms of hysteria- without physical cause

Anna O- hypnotized

Asked her to tell him about circumstances that led to her symptoms

Under hypnosis-able to tell upsetting events that clearly explained her symptoms
After she described the upsetting events the symptoms disappeared

From example of Anna O

Freud’s conclusion- there must be a division within the mind

Being unaware of such memories

Connected to having pathological symptoms

When feelings are verbally expressed the symptoms

disappeared
Freud’s idea- mind is divided into two
Acceptable- conscious part
Unacceptable- unconscious part

Conflicts between these two parts can cause mental symptoms

Pathology results when a person has failed to find a good solution

Freud- dissatisfied with his theory- revisions made

Topographic theory- included the preconscious

Preconscious- contains thoughts that are not the focus of conscious part, but are not also on the
unacceptable part (therefore not repressed)

To fix the problem: new theory- structure theory of the mind

Three psychic features: id, ego, and superego

Id- childhood desires and general pleasure seeking- similar with unconscious
Superego- moral judgements
Ego- reconcile the demands of the id and superego;
- part of the mind that is oriented to reality
Psychopathology results when conflicts involving the id, ego, and
superego, and reality are not successfully negotiated by adaptive
defense mechanisms and coping strategies
Freud’s Psychosexual Stages

- The infant derives pleasure from oral stimulation

through gratifying activities such as tasting, sucking,
swallowing.
- If fixation occurs at this stage, the individual would
have issues with dependency, aggression, and
hostility.
- Oral fixation can result in problems with drinking,
eating, smoking, or nail-biting.
- Erikson: Trust vs. Mistrust
- The primary focus of the libido was on controlling bladder
and bowel movements.
- The major conflict at this stage is toilet training—the child
has to learn to control their bodily needs.
- Success at this stage is dependent upon the way in which
parents approach toilet training.
Praise and rewards- positive outcomes (competent
and productive)
Punish, ridicule, shame the child- negative outcomes
(messy)
Parents too lenient- messy, wasteful, destructive,
disorganized, stubborn personality
- Erikson: Autonomy vs. Shame and Doubt
- The primary focus of the libido is on the genitals.
- Child begins to discover the differences between males and
females.
- Oedipus complex- a son wanting to possess the mother and
the desire to replace the father.
Castration anxiety- fear of being punished by the
father for these feelings.
- Electra complex- similar set of feelings experienced by
young girls toward the father.
Penis envy- young girls feel deprived and envious that
they do not have a penis.
- Eventually, the child begins to identify with the same-sex
parent as a means of indirectly possessing the other parent.
- Erikson: Initiative vs. Guilt
- The superego continues to develop while the id’s energies
are suppressed.
- The development of the ego and superego contribute to
this period of calm.
- Child develop social skills, values, and relationships with
peers and adults outside of the family.
- A time in which the sexual energy is suppressed/dormant.
The energy is still present, but it is converted into other
areas such as social interactions.
- Fixation at this stage can result in immaturity and inability
to form fulfilling relationships as an adult.
- Erikson: Industry vs. inferiority
- The onset of puberty causes the libido to become active
once again
- The individual develops a strong sexual interest in the
opposite sex.
- Where in earlier stages the focus was solely on individual
needs, interest in the welfare of others grow during this
stage.
- Sexual instinct is directed to heterosexual pleasure, rather
than self-pleasure.
- The ego and superego were fully formed and functioning at
this point.
- Erikson: Identity vs. role confusion
- Erikson, like Freud, was largely concerned with how personality and behavior are influenced after birth
- not before birth - and especially during childhood.

- In the 'nature v nurture' (genes v experience) debate, Erikson was firmly focused on nurture and
experience.

Nature= Genes and hereditary factors

physical appearance
Nurture= environmental variables
childhood experiences
how we were raised
social relationships
surrounding culture
 What is a Psychodynamic Therapy?

- Is designed to help patients explore the full range of their emotions,

including feelings they may not be aware of (Vinney 2019).

- By making the unconscious elements of their life a part of their present

experience, psychodynamic therapy helps people understand how their
behavior and mood are affected by unresolved issues and unconscious
feelings.

- With the help of the therapist, the patient finds ways to talk about
feelings that include contradictory feelings, feelings that are troubling or
threatening, and feelings that the patient may not have recognized or
acknowledged in the past.
 How Does Psychodynamic Therapy Work?

- Unwanted thoughts and behaviors can stem from unconscious triggers

that were developed in response to early life experiences (Devlin 2020).
-
- Psychodynamic therapy is designed to uncover the psychological
processes that formed during early life experiences. Once the processes
are uncovered, the client begins to understand their motivations and
behaviors, and this alleviates the symptoms.
-
- Behaviors and patterns will begin to lessen once the past event is
completely investigated, evaluated, and understood.
 Key features of the Psychodynamic approach are:

 Our behavior and feelings as adults are rooted in our childhood experiences.
 Relationships (particularly parenting) are of primary importance in determining how we
feel and behave.
 Our behavior and feelings are powerfully affected by the meaning of events to the
unconscious mind.
 Information can be obtained from dreams, irrational behavior, and what patients in
therapy say.
 The personality is made up of three distinct structures: id, ego, and superego.
 Defense mechanisms are used to protect the ego
 Some assumptions that drive the psychodynamic
approach are:

 The unconscious is one of the most powerful effects on

behavior and emotion.
 No behavior is without cause and is therefore determined.
 Childhood experiences greatly affect emotions and
behavior as adults.
 The id, ego, and super-ego make up the personality.
 Various conflicts throughout childhood development shape
overall personality.
The psychodynamic perspective asserts that in childhood
certain incidents may occur that produce behaviors in
adulthood. As children, defense mechanisms are utilized,
then as adults, behaviors manifest as a result.
 Benefits of Psychodynamic Therapy

 The ability to recognize symptoms before they get out of control.

 Confidence
 Self-awareness
 Coping skills
 A deeper knowledge of self
 Acceptance
The benefits of psychodynamic therapy are rooted in the understanding
that recognizing behaviors for what they are can help patients build
healthy coping mechanisms.
Psychodynamic therapy provides answers to why we do what
we do. Once there is an answer to why, it is easier to address
the behavior for what it is. The benefits are long-lasting
because there is an answer to the behavior and coping skills
to alleviate the symptoms.
 Psychodynamic Therapies

Art Therapy
 Involves the use of creative techniques such as drawing, painting, collage,
coloring, or sculpting to help people express themselves artistically and
examine the psychological and emotional undertones in their art.
 No artistic talent is necessary for art therapy to succeed, because the
therapeutic process is not about the artistic value of the work, but rather about
finding associations between the creative choices made and a client's inner
life.
 Is a creative therapy that is used to relax the individual and help them express
themselves and learn about themselves through art.
 Aim
 To utilize the creative process to help patients explore self-
expression and, in doing so, find new ways to gain personal
insight and develop new coping skills.
Indication
 Art therapy helps explore patient’s emotions, improve self-
esteem, relieve stress, improve symptoms
of anxiety and depression, and cope with a physical illness or
disability.
 How to Conduct

 Materials: bond papers, crayons

 Gather patients in position; give instructions on what to do (clients are encouraged to
visualize, and then create, the thoughts and emotions that they cannot talk about; draw
what you like); let the patient interpret the drawing.
 The nurse may, at times, simply observe the patient’s process as s/he works, without
interference or judgment. When the patient has finished a piece of artwork—and
sometimes while they are still working on it—the nurse will ask patient questions along
the lines of how s/he feels about the artistic process, what was easy or difficult about
creating his/her artwork, and what thoughts or memories s/he may have had while s/he
was working.
 Generally, the nurse will ask about their experience and feelings before providing any
observations.
 Music Therapy
 Incorporates techniques such as listening to, reflecting on,
and creating music to improve a patient’s health and well-
being.
 Patients don’t need to have any musical training or talent;
the practice doesn’t focus on the technical skill but employs
music as a tool for reflection and communication.
 Aim
 Immersing people in music can allow them to more easily express
themselves, identify and process difficult experiences, develop social
and communication skills, or simply find emotional release.
 Musical experiences—particularly singing songs from the past—can
open a window to expression and emotional awareness, temporarily
allowing those patients to express themselves, gain awareness of their
emotions, and make connections with their loved ones.
 Provide avenues for communication that can be helpful to those who find
it difficult to express themselves in words.
 Indication
 The practice can help people suffering
from anxiety, depression, and trauma to illuminate
or express underlying sources of pain.
 Music therapy can be especially powerful for
individuals with Alzheimer’s disease, dementia,
and brain damage due to stroke or traumatic brain
injury.
 How to Conduct
 A nurse might ask what song/s remind them of or
what they’re feeling.
 The nurse and the patient listen to a song together
or sing the song together.
 They discuss the emotions and memories the song
elicits.
 Or let the patient choose a lyric of the song that
elicits past memories and feelings.
 Or the patient might write a song, which can
illuminate a character or conflict in their lives.
 Play therapy
 Is used to help patients explore their lives and freely express repressed thoughts and
emotions through a play. Mentally ill individuals have difficulty with social interactions,
play therapy has been shown to be essential in developing social skills.
Aim
 To help patients learn to express themselves in healthier ways, become more
respectful and empathetic, and discover new and more positive ways to solve
problems.
 The nurse uses play and other creative activities to communicate with the patient and
observe how the patient uses these activities to express thoughts and feelings that are
not expressed in words.
 Indication
 Therapeutic play helps patients with social or emotional deficits learn to
communicate better, change their behavior, develop problem-solving
skills, and relate to others in positive ways.
 It is appropriate for patients undergoing or witnessing stressful events,
such as a serious illness or hospitalization, domestic violence,
abuse, trauma, a family crisis, or an upsetting change in their
environment.
 It can also help patients with academic and social problems, learning
disabilities, behavioral disorders, anxiety, depression, grief, or anger, as
well as those children with attention deficit disorders or who are on
the autism spectrum.
 How to Conduct
 The patient is encouraged to play with very specific types of toys that
encourage self-expression and facilitate the learning of positive
behaviors.
 Arts and crafts, music, dancing, storytelling, and other tools may also
be incorporated into play therapy.
 The nurse occasionally makes interpretive comments designed to
trigger conscious responses from the patient.
 The nurse immersed in the play, providing structure and direction as
well as openly and directly discussing issues and making interpretations
to invite the patient to consciously process material that might have
previously been less consciously available to the patient.
 Dance/Movement Therapy
 A type of therapy that uses movement to help individuals achieve
emotional, cognitive, physical, and social integration.
 The nurse assesses body language, non-verbal behaviors, and emotional
expressions.
Aim
 Beneficial for both physical and mental health, dance therapy can be used
for stress reduction, disease prevention, and mood management.
 Promotes self-awareness, self-esteem, and a safe space for the
expression of feelings.
 Indication
 It is commonly used to treat physical, psychological, cognitive, and social issues
such as Anxiety, Depression, Disordered eating, Poor self-esteem, Posttraumatic
stress.
How to Conduct
 A dance therapy session is different. The nurse isn’t trying to make the patient
talented performers. S/he is trying to help patients heal from a specific mental illness
by using movement and connection. As a result, the movements in a dance therapy
course tend to be spontaneous and unrehearsed, and they tend to originate with the
patient.
 At the end of the session, the nurse can provide notes about what took place, and
how well the person is progressing in the achievement of goals. The patient might be
exposed to awakened feelings or new sensations that merit deeper exploration.
The four stages of the dance therapy are:
Preparation: the warm-up stage, safety is established
Incubation: relaxed, let go of conscious control, movements
become symbolic
Illumination: meanings become apparent
Evaluation: discuss significance of the process, prepare to end
the therapy
 Re-motivation Therapy
 A technique of simple group therapy, objective in nature, used with a
group of patients to reach the ‘unwounded’ areas of each patient’s
personality and to get them thinking about reality concerning
themselves.
 A simple group therapy which aims to bridge the fantasy world of
psychotics to the real world.
 It differs from other therapies because it focuses on the patients’
abilities rather than disabilities”
 Aim
 Stimulate the patient to be fellow explorer of the real world.
 Develop the ability to communicate and share ideas and experiences
with others.
 Develop feelings of acceptance and recognition.
Indication
 It benefits those who have dementia, need more sensory stimulation,
also patients who are physically and cognitively able to participate.
 It is also a tool that can reach nonresponsive individuals. This tool aids
others with their resocialization skills.
 How to Conduct

 A Re-motivation therapy session is designed to create fun. The session consists of

five structured steps.
STEP I Climate of Acceptance: the nurse greets each member of the
group. He/she says something positive to each person.
STEP II The Bridge to the Real World: In this step, the nurse utilizes bounce
questions to lead the group to the topic for the day.
STEP III Sharing the world We Live in: this is where a discussion on the topic is
held in the everyday world.
STEP IV An Appreciation of the Work of the World: In this step, a discussion is
held on the work aspect of the topic
STEP V Climate of Appreciation: The nurse individually thanks to the patients for
attending the session.
 Occupational Therapy
 Any activity either mental or physical prescribed or guided to aid an
individual’s recovery from disease or injury (e.g. the use of rug weaving,
painting or sketching to satisfy creative and egotistical needs)
 It can help the patient consider not only their needs, strengths, abilities,
and interests, but also their physical, social, and cultural environment.
 Enhances patient’s capabilities and psychomotor capacity
 Aim
 To improve the individual’s quality and enjoyment of life by identifying
and meeting appropriate behaviors and skills.
Indication
 Individuals with physical injuries, cognitive impairments, psychosocial
dysfunction, mental illness, and developmental or learning disabilities.
 Occupational therapy (OT) assessment focuses on functions related to
daily living that patients need to perform (eating, hygiene, dressing),
want to do, and are expected to do.
 How to Conduct

 Therapists interview patients about their capacity (what they can do)
to perform activities they need, want, or are expected to do and their
daily habits (what they do).
 The conclusion to be drawn is not how independently or well can
patients do the activity but how adequate is their executive
functioning.
 Bibliography:

Ann M York, PT, PhD, Handbook of Remotivation Therapy, Physical Therapy, Volume
86, Issue 3, 1 March 2006, Page 463, https://doi.org/10.1093/ptj/86.3.463
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https://www.verywellmind.com/freudian-theory-2795845. Access date July 23, 2020.

Chiang, M., Reid-Varley, W., & Fan, X. (2019). Creative art therapy for mental illness. Retrieved from
https://www.sciencedirect.com/science/article/abs/pii/S0165178119305347. Access date July 24, 2020.
Hohmann L, Bradt J, Stegemann T, Koelsch S (2017) Effects of music therapy and music-based
interventions in the treatment of substance use disorders: A systematic review. PLoS ONE 12(11):
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McLeod, S. A. (2019, July 18). Psychosexual stages. Simply Psychology.
https://www.simplypsychology.org/psychosexual.html
Psychodynamic Psychotherapy Brings Lasting Benefits through Self-Knowledge.
American Psychological Association. Retrieved from
https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy. Access
date July 22, 2020.
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Thank you
 Groupings:

N31 Group 1- Art Therapy (M’ Mante’s group)

Group 2- Music Therapy (M’ Oja’s group)
Group 3- Play Therapy (S’ Pasiliao’s group)
Group 4- Dance Therapy (M’ Asendente’s group)
N32 Group 1- Re-motivation Therapy (M’ Basan’s group)
Group 2- Occupational Therapy (M’ Carin’s group)
Group 3- Music Therapy (M’ Elicano’s group)
Group 4- Re-motivation Therapy (S’ Candog’s group)
Group 5- Occupational Therapy (M’ Costiniano’s group)