Methods of Intervention

Psychodynamic Approach

‘The Past in the Present’presented by Ali Harrison

Social Work Theory and Interventions Psycho (of the mind) dynamic (movement)

Theory for understanding what is going on in a case

(ie Ego development -Freud, or strength of Attachment- Bowlby)

Methods of Intervention which come from that understanding

(i.e working with ego defences or life story work, play therapy, inner child work, exploring subpersonalities etc)

Aim of Psychodynamic work

for the service user to become a fully functioning person who has more control over what they do, and is not driven by unresolved, unconscious past events.

Focuses on the inner world of the client and that which is hidden from consciousness

‘Our behaviour, including what we say do and think, is caused by experiences memories and needs many of which, we are not consciously aware’

Freud

Psychodynamic Approach is used ..retrospectively to understand current problems in parenting and behaviour,proactively to prevent future damage, to make sense of the clients internal world, to give insight and to build self confidence and ego strength

Deals with the emotional inside of the client

Understands current behaviour in terms of past experiences

Problems in key relationships in childhood can effect development and lead to current problems in relationships or behaviour

Psychodynamic Writers

Sigmund and Anna Freud/Melanie Klein, Margaret Mahler, Donald Winnicott, John Bowlby, Michael RutterJuliet Mitchell Alice Miller Virgina Axaline Micheal JacobsEric BurnEric Erikson

Intervention

Using the relationship workers meet emotional and developmental needs of the client through support, nurturing, re-parenting, containment and insight

Making sense allows people to gain control of the meaning of their experiences, changing the meaning, brings about changes in behaviour.

This creates a more robust, mature and independent personality which will be more socially competent and able to handle relationships more effectively

The emphases is on the clients capacity for adaptation and problem solving within the personality. This development takes place within the central framework of the relationship between the client and the worker

FreudPersonality Theoryunderstanding ego developmentand Ego defencesworking in the relationship with transference and countertransference

Personality Theory

Super ego

Ego

Id

Idinstinctual drives of the child for survival, wants, urges,needsimpulses for sex and aggressionlargely unconscious

Super egoInternalised voice of authority (parent, teachers, school, church etc)

‘shoulds’, ‘ought to’, rules, guilt, moral principles, teaching

Can be underdeveloped or too rigid

EgoThe ‘thinking’ reality centre which mediates between the unconscious tension between the id and superego, causing anxiety and dis-equilibrium in the psyche

Tension in Ego

from internal and external pressures from others and societyResulting anxiety is dealt with by employing defence mechanisms(Anna Freud)

Building Ego strength or dismantling Ego Defences

The work involves helping a client find a way through to their true feelings that the defences mask

Ego Defence MechanismsSplitting, Idealisation and Projection (primitive defences) Reaction Formation (defences originating in toddlerhood))Denial and Repression Sublimation, Rationalisation and Displacement Regression and Fixation

Ego Defence Mechanisms

Splitting and Denial (a primitive defence formed in early infancy described by Klein.) Anxiety in infant caused by baby's merged identity with mother, who is sometimes present and soothing other times absent and frustrating.

Good breast/bad breast and eventual object consistency

Ego Defence Mechanisms

Repressionthreatening or painful thoughts and feelings are pushed out of conscious awareness

(i.e. early sexual abuse)

Ego Defence Mechanisms

Displacementanxiety is discharged by shifting energy to a safer or closer target

(i.e. intimidation of a meek father at work, can cause acting out at home in domestic violence and /or child abuse)

Ego Defence Mechanisms

Sublimation

redirecting aggressive or sexual energy into creative or athletic activity

Ego Defence Mechanisms

Regression and Fixation Reverting to a form of behaviour the client has ‘outgrown’, to an earlier stage of development when the demands were not so great.(i.e. thumb sucking and smoking are ‘oral phase’ activities)

Or failing to move on in developmental stages (ie anorexia)

Ego Defence Mechanisms

Reaction Formation

exaggerated feelings are expressed, opposite to what is truly being felt

(ie someone being extremely off hand when what they feel is affection they cannot risk expressing)

Exercises on Ego Defences

Discuss with your partner times when you employ any of the ego defences described, what effect do they have in your life?

Exercises in Ego Defences

Think about a client you are working with, what are the primary defences being used by this client, how is that impacting on their ability to function?Is it useful to challenge this ego defence or is ego strengthening work required?

Human Growth and Development Theory (understanding Regression and Fixation)

Freud-Psychosexual developmentErikson -Lifespan Development PsychologyKlein, Mahler and Winnicott-Object RelationsBowlby- Attachment Theory

Linear and nested personality developmentFreud and Eriksonlinear development

birth--------------------------------death

developmental stages

Freud’s Psychosexual Stages

maturity dependant on successful completion of the one before,

regression to earlier stages in times of stress

OralAnal

Phallic (Oedipal)LatencyGenital

Eric Erikson Life span development stages

Whole life cycle as a series of tasks in which opposing tensions must be brought

into some sort of equilibrium.Erikson places individual development in

family, social and cultural context

Eriksons Lifespan Development Stages

Basic Trust versus Mistrust 0-12 months

Trust that ones basic needs will be met

Autonomy versus Shame and Guilt 1-6 years

Establishing autonomy and self control without a loss of self esteem

Initiative versus Guilt 6-10years

having the initiative to strive for goals which will fulfil personal potential and give a sense of purpose

Industry versus Inferiority 10-14 years

Competence - acquisition of skills needed for full and productive involvement in society

Identity versus Role Confusion 14-20 years

Identity- developing an integrated self consept and a coherent set of values and beliefs

Intimacy versus Isolation20-35 years

Intimacy the establishment of close committed relationships with others

Generativity versus Stagnation 35-65 years

Generativity - the creation of a lasting contribution that will extend beyond ones own lifetime

Integrity versus Despair 65+Integrity- acceptance and satisfaction with ones life, and an understanding of its place as part of a wider humanity

References

Joyce Lishman ‘A handbook of theory for Practice Teachers in Social Work’ Chapter 2

and

Micheal Jacobs’The Presenting Past’

Nested or layered developmental stages

inner infant

inner child

inner adolescent

inner young adultetc

Reference Firman and Gila ‘Psychosynthesis Psychology of Spirit’

We carry the wounds of earlier stages which can unconsciously impact on relationships in the present

i.e issues of dependency and trust………

Object Relations how the infant constructs his internal world

The ‘Maternal care system’ acts as the External Unifying Centre for the baby, being responsive, empathic, soothing, holding and stroking thereby ‘transforming his environment’

as the social worker acts for the chaotic and disorganised client

By providing empathic listening, responding appropriately to need, holding the client psychologically in times of distress, building self esteem and a sense of personal effectiveness and worth….

The relationship is the main tool of intervention in Psycho-dynamic casework

Early Childhood Development Revision

The Jurassic Park World of the new born baby…..

No boundaries no concept of time fragmented

experiences instinctual drives to

survive

Melanie Klein

Breasts good and bad

Margaret Mahler

0-2 Autism 2-6 months Symbiosis 6-10 Hatching 10-16 months

Practising 16-24 months

Reappoachment 24-36 Object

Consistancy

Donald and Claire Winnicott

Transitional Love Object

The Holding environment

Direct work with Children

Bowlby and Ainsworth attachment Theory secure / insecure attachments and resilienceKlein Paranoid Schizoid and Depressive positionsMahler Separation and Individuation from the maternal care systemImportance of external unifying centre to process anxiety and need for transitional objects in process of separation

‘Strange Situation Test’ Mary Ainsworth

building on the observational work of John BowlbyMaternal Deprivation and the Growth of Love

Secure attachment

Cry when mum leaves, happy and greet her on return,

use her as secure base from which to explore, returning occasionally for reassurance

Co-operative and generally free from anger

Aviodant (anxious or insecure attachment)

rarely cry when mum leaves, and avoid her when she comes backdislike being held, dislike being put down moretend to be angry and do not reach out in time of need

Ambivalent or Resistant attachment

become anxious even before mum leaves and are very upset when she goes outwhen she returns they show ambivalence by seeking contact, but resisting and squirming or kickingThey do little exploration and are hard to comfort

Disorganised or Disorientated Attachment

Main and Solomon 1986)Babies show contradictory behavioursGreet mum on return then turn away or approach her without lookingseem confused and afriadmost likely to happen when mumis insensitve, intrusive or abusive

Intergenerational Transmission of Attachment Patterns The way a mother remembers her attachment to her parents seems to predict the way her children attach to her. Parents who can clearly, coherently and consistently describe their own early experiences (favourable or unfavourable) tend to have babies that become securely attached to them (Main and Cassidy 1985)If there are no memories, the mother may consider herself unlovable, and insensitive to the babies signals

A mother who was securely attached, or understands why she wasn’t can accurately recognise their babies attachment behaviour, respond encouragingly and help the baby make strong attachments to her (Brotherton 1990)

Interventions for working with developmental stagesand transitions

Understanding how past impacts on present

Life - lines and Genograms

how might you creatively work with these tools in the case study?

…….. In a case you are currently working with?

Preparation for transitions, loss and attachment issues

Life-story-work, crisis intervention, loss and bereavement stages

Life Story WorkAuthor: Tony Ryan and Rodger Walker

A practical guide to helping children understand their past. Life Story Work is an attempt to give back the past to children separated from their birth families. It can help children begin to accept their past and move forwards positively into the future, giving them a structured and understandable way of talking about themselves. It also enables adults working with children to listen to them and respect their views and wishes.

The Child's Own Story: Life Story Work with Traumatised Children

Richard Rose, Terry Philpot

Interventions for accessing issues from the past that are affecting the present… Psychodynamic Counselling

The ‘Triangle of Insight’ (Jacob 1991)

The psychodynamic counselling approach uses the processes of the relationship between the worker and the service user. Within the relationship there is the experience of patterns, emotions and reactions of past relationships – this re-enactment of the past in the present can offer insight and understanding, and new ways of dealing with problems involving past, present and worker/service user relationships

the service-user experiences a caring relationship (i.e. the ‘good parent’) and this helps to work through painful experiences, whilst being held and contained

Transference and Counter-transference in the client worker relationship

How does the client make me Feel and React?What's being Projected?

TRANSFERENCE

can be positive or negative. The feelings a service user may have about a significant other person in their past are transferred into the present and onto the social worker

COUNTERTRANSFERENCE

feelings that are stirred up in the social worker in response to the service user’s behaviour or story .It is important that the worker involved is clear about what feelings are personal to them and what is not their own, if not social workers can end up responding to their counter-transferal feelings

Exercise in working with transferenceThink of a client or someone you know that brings up strong feelings in you. What transference or counter-transference reactions might be at play?What insight might this give you about the persons relationship with dependency, aggression, grief etc..

Creative ways of working Psychodynamically

Understanding and working with internal conflict/parts

transactional analysis,

subpersonality work, inner child work, play therapy

We all have, with in us, an Inner Child, and yet for those of us who have been abused in childhood, that inner child is very often a hurt and frightened inner child. Inner Child work, and inner child therapy, are a means by which we can start to learn to love ourselves, feel safer within and reduce the nightmares in order to recover from childhood sexual abuse abuse, and other forms of childhood abuse. Inner Child therapy and inner-child work, is growing in popularity as the therapy is both less invasive of exactly what happened and helps survivors to understand their own behaviours. Inner Child work can also help us understand any disassociative tendencies that we may have as well, no matter where we are on the disassociative scale. Becoming a friend to your inner child can also help with self harm tendencies,

comfort eating etc

Play Therapy

Working with Parts

Inner Child ‘Healing the inner child’ Penny Parkes

Ego States Eric BurnsTransactional Analysis

Play Therapy ‘Dibs’ Virginia Axaline Using Puppets, symbols, letters, toys etc

Working with Subpersonalities John Rowen

Empty Chair Perles

using transference and counter-transference played out in the social work relationship

Working with Ego Defences

Assessment of Ego Strengths

a service user’s ego needs to be assessed in terms of its strength to tolerate self-scrutiny. What are the stresses on the functioning of the service user’s ego? Crisis Intervention- When the clients personality is overwhelmed , use ego sustaining and supporting skills building self esteem

If the clients ego defences are too strong ego use direct work to modifying and challenge defences (Coulshed and Orme 1998, Hollis 1964)

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Recent developments from Psychodynamic theory

Psycho-social approach (see

article), working with inner and outer world of client (Hollis and Woods) casework is about people, their environment and the relationship between them CAT cognitive analytic therapy combining psychodynamic with cognitive approaches to provide brief interventions (Ryle and Kerr)

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