Psychodynamic 1

Analysing the video

Manvi Bhargav – 22223064

3MPCLA Department of Psychology,

Christ (Deemed to be) University (NCR)

MPS331N Psychotherapy – II

Dr. Nupur

24 September,2023
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Case Conceptualization

In this session, a middle-aged man presented anxiety issues from the past six weeks. The client

is battling several related problems, such as conformity, trouble saying no, procrastination,

creative repression, and a desire for personal development. These difficulties result from past

events, such as his compliance strategy from elementary school and his wish to be quiet to avoid

trouble. The acknowledgement of 25 years of work triggered feelings of undervaluation and

fueled his desire to reconnect with neglected aspects of himself. The client is internally

conflicted, desiring personal growth while fearing failure, particularly in creative pursuits. The

client is encouraged to think about these problems until the next session ends. The therapist uses

a psychodynamic method to focus on the client's internal problems, relationships, and prior

experiences.

The following Psychodynamic concepts are applicable in this session ;

1. Childhood experience: The client recalled feeling scared and apprehensive on his first day of

secondary school in a huge city because it was such a big adjustment. He used to keep his head

down to avoid being held accountable for his actions to deal with this. (the way I got through

secondary school if you know if you keep your head down, then people won't target you.)

2. Defense mechanisms:

 Rationalisation: The client rationalised when he said he would pursue his artistic

endeavours after retirement. By using this defense mechanism, he is justifying his

procrastination behaviour. (I still sort of know sort of promised myself I'm going to sit
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down and draw, but I think that sort of laughingly I've say to myself, ah that's the kind of

thing I'll do when I retire)

 Avoidance: The client uses this defense mechanism by saying yes to people to avoid

conflicts or disappointing others. Also, when the client went for the first time to school,

he felt anxious, so he put his head down to avoid any conversation. (the way I got

through secondary school if you know if you keep your head down, then people won't

target you.)

 Compensation: The client's avoidance of creative endeavours and emphasis on obeying

instructions from others may be used as a kind of remuneration. He compensates for

inadequacy or concerns about failing his creative endeavours by excelling at compliance

and serving others' desires.

 Intellectualisation may be seen in the client's analytical attitude towards his difficulties,

such as when he addresses procrastination as a topic rather than examining its emotional

causes. This strategy involves ignoring unpleasant feelings by concentrating on the truth

and reasoning.

The conflict between ego and superego: as we know, ego works on the reality principle; one can

quickly analyse it. His inability to say no is causing problems for him, but his superego, which is

based on moral principles, is not allowing him to say no as he doesn't want to disappoint others.

Avoidant attachment: though his patterns with his family were not explored well, the client's

tendency to put his head down in school or avoid any conflicting situation, in general, makes it

evident that he might have an avoidant attachment style.

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Techniques used by Therapist

The therapist uses the Free Association technique to help the client explore his unconscious

thoughts and emotions. The therapist aims to uncover underlying conflicts and patterns

contributing to his current struggles by allowing the client to speak freely without censorship or

judgment. This approach allows the client to gain insight into his unconscious mind and

understand how past experiences may influence his current challenges. By delving into these

deeper layers, the therapist can help the client better understand himself and work towards

resolving these internal conflicts.

Symbolic Language: The therapist uses this technique when she explores the metaphor of cloaks

of invisibility used by the client. This helps the therapist explore the client's hidden feelings and

emotions. The therapist can help the patient connect their prior experiences to their current

challenges by looking at the symbolism hidden under the client's metaphor.

Directive behaviour – the therapist asked open-ended questions in the session and encouraged

the client to reflect on his personal experiences, feelings, and emotions. By actively engaging the

client in self-reflection, the therapist fostered a sense of empowerment and autonomy within the

therapeutic relationship.

Interpretation: the therapist uses the method of interpretation by linking the past experiences

with the present situations and behaviour and helps the client understand the root cause of the

problem and where it stems from.

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Ethical considerations

 Confidentiality: The therapist upheld the confidentiality principle by assuring the client

that she would keep everything private and that confidentiality would be broken only if

she believed there was a risk of harm to him or others.

 Consent: When the therapist told the client that she would make a note of a few things

while having a discussion, she asked for his consent and also mentioned that he could

read those notes whenever he wanted.

 Autonomy: The therapist told the client that he could come up with anything in a further

session if he wanted to. She also mentioned that he can tell her whenever he feels

comfortable with her or the session.

 Debriefing: At the beginning of the session, the therapist only provides the client with an

overview of her areas of expertise and the direction the session will take.

Critical Evaluation

Pros

1. Exploration of unconscious feelings: Psychodynamic therapy enables an in-depth

investigation of unconscious feelings, memories, and experiences that may be influencing

one's actions and emotions at present. This may help one comprehend themselves and the

underlying causes of their distress. Additionally, long-term betterment and personal

development can happen by addressing these underlying problems.

2. In-depth understanding of the past: psychoanalysis emphasises the importance of

understanding one's past experiences and how they shape one's current thoughts,
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behaviours, and emotions. By exploring the past in a safe and supportive therapeutic

environment, individuals can gain insight into unresolved conflicts or traumas

contributing to their present difficulties. This deeper understanding can lead to healing

and growth, allowing individuals to make positive changes.

3. Emphasis on Therapeutic relationship - The relationship is central to psychodynamic

therapy. The video session demonstrates a warm and empathetic therapeutic alliance,

which can be highly therapeutic and supportive.

Cons

Lack of Empirical Support: Psychodynamic treatment is criticised for having weak empirical

backing, particularly compared to other therapeutic modalities. Psychodynamic ideas like the id,

ego, and superego are criticised for lacking empirical support and being viewed as theoretical

constructs rather than model-based theories.

Limited Attention to Symptoms: Psychodynamic therapy frequently focuses on deeply

ingrained unconscious tensions and may not explicitly address specific symptoms or offer

helpful coping mechanisms. This method might not be appropriate for immediate symptom

alleviation or quick fixes.

Subjectivity: Interpretations and insights in psychodynamic therapy heavily rely on the

therapist's subjective judgements and interpretations. This subjectivity introduces bias, and

interpretations are not always empirically verifiable.