What did all of you learn from this exercise? Are you using psychodynamic approaches without even realizing it? What aspects of psychodynamic work do you like or support? What aspects are you not supportive of? Offer any thoughts and opinions about this topic. For those of you in more macro settings, can you see any usefulness for psychodynamic understanding in organizations.
Please remember that we have an uneven number in class - so you may need to share with a group of three. Let me know if it would be more helpful to assign partners. Try to pick someone that you have not worked with before.
ReplyDeleteWk 5 DB Adv Prac 3
ReplyDeleteThere is observed evidence that back the effectiveness of psychodynamic therapy. Patients who go through psychodynamic therapy sustain therapeutic gains and seem to endure that improvement over time. The session frequency is usually once or twice per week, and the management can be either time restricted or non-restricted. “The essence of psychodynamic therapy is exploring the aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship” (Shedler, February–March 2010, p. 98).
Psychodynamic therapists work to recognize and discover recurring themes and patterns in patients’ views, moods, self-concept, interactions, and life practices. (Shedler, February–March 2010, p. 99). I do this on a daily basis as I discuss things with my clients about their moods, interactions with their family and friends, as well as discussing any troublesome thoughts they may be having. Psychodynamic therapists look into early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present (Shedler, February–March 2010, p. 99). As I get to know my clients more I am able to link things that have happened in the past, that sometimes get them almost “stuck” with moving forward in treatment and I try to help them to recognize this and support them with moving forward, rather than continuing the cycle or not moving at all.
Reference
Shedler, J. (February–March 2010). The Efficacy of Psychodynamic Psychotherapy. American Psychologist, (65),2, 98-109.
Christine McGovern
I will post again when I get my process recording back. I apologize I exchanged with them on Thursday and have not had time to finish reviewing it and complete all the videos and reading.
I appreciate that the psychodynamic approach was included in one of our modules. As I have mentioned before I am so incredibly fortunate to be doing my internship beside another MSW intern from Smith College . We have had countless conversations pertaining to our futures in the field and techniques that we would like to utilize. Joe is extremely interested in the psychodynamic approach and it appears, based on our conversations, that his school primarily follows this model. We have had a lot of conversations in regards to this approach, as I continue to remain a little "shaky" on my psychodynamic feet. Before this week's module I believe I was hung up on some of the superficial aspects of this approach-Freud, laying on a couch, being in therapy for years. I missed the defense mechanisms component, which can be extremely important when working with an individual, couples or family structure. I also appreciate the video on transference and the examples given, I was able to gain a better understanding of transference and how it can easily come into play in sessions.
ReplyDeleteLooking at my work with individuals and the modules/techniques we have covered, I see examples of where each approach can be helpful. For better or worse (as I am now discovering), my brain is hardwired to a specific type of therapeutic approach-DBT/CBT. I have actually worked with a few patients and their families and I wished I had more knowledge and skill in the psychodynamic approach, as I felt it would be helpful picking apart significant events and processing their conscious and unconscious impact. After an especially difficult family meeting, where DBT failed me over and over again, I actually talked to Joe about how I wished to be more open to using different approaches. I have actually been using my supervision, of late, to discuss this exact issue and I remain grateful for the structure and content of this class. I truly am learning a lot.
Okay, now to answer the actual blog question:
I do not think that I am using the psychodynamic approach in my current work. I do however believe that I am discovering patients with specific backgrounds or needs that would benefit from this approach. For example, I worked with a young lady who had so much conscious/unconscious pain and confusion regarding her mother's infidelity for the majority of her life. Whether this young lady was aware of this or not, it impacted her ability to trust others and her ability to form intimate relationships herself. I believe this would have been an appropriate situation where sitting down, digging deep and sorting out the pieces would be helpful. Unfortunately, at the Retreat, teens are with us for 7-10 days. My supervisor is constantly reminding us not to help kids "unpack" emotionally while they are here. There simply isn't enough time and by doing this it makes them even more vulnerable when leaving if appropriate services are not followed through (unfortunately a very real reality). Therefore, I do not seeing myself using this approach while at my current internship, except for possibly identifying defense mechanisms. However, I will continue to keep an open mind and try to be less rigid in terms of me always seeing things from a behavioral/DBT/CBT lens. My supervisor has been great in challenging me and my thinking by assigning me clients who do not benefit from this model. While I open feel like I am grasping at air trying to find a therapeutic way to interact and build a rapport, I am being reminded that we cannot pick and choose our patients and what they bring to the table.
Christine
Some feedback in regards to the process recording related assignments: It may be helpful for you, Lee, to assign partners each week. It also may be helpful to not have the blog topic associated with the review of the process recording, as I have struggled to coordinate with a partner and complete the assignment before the required Wednesday night deadline.
DeleteChristine
Christine the example of the woman you are working with unconscious/conscious feelings about her mothers infidelity and how that translates in her own ability to trust and have intimate relationships is a great example of your awareness and ability to practice psychodynamic therapy. I am also blocked by scheduling when it comes to working with patients only weekly and I don't at the time have the option to see people more than once a week- although I image three times a week being a great experience for all.
DeleteHi Annie,
DeleteYes I can see some benefit in working with someone multiple times a week for therapeutic sessions, however, I wonder how exhausting this may become for the clinician. It sounds emotionally draining to dig deep into the conscious/unconscious/past experiences several times a week, it also sounds even more exhausting trying to facilitate this and hold the space in a helpful, therapeutic way.
Christine
Christine, thanks for he feedback. I appreciate it and have thought about both ideas as well. I release you all from a deadline. I will have to refresh my memory about a Wednesday deadline, but would you prefer to use the work with partners as another learning exercise, whenever you can fit it into the week, as close to the module as you can.
DeleteChristine, I think its great that you have such insight into the way you practice and that you are so good at CBT/DBT that its engrained in you. I also think that because you can identify the need to practice other techniques, you will be mindful when working with clients in order to use the other techniques.
DeleteHi Christine,
ReplyDeleteI could have written your thoughts regarding Psychodynamic- wait, I did, in my Journal!
I do like this approach now that we have learned more about it. I find myself comfortable using self, especially with permission. However I would need lots more exposure and training.
Gail
Hi Gail,
DeleteYes I agree. I think the psychodynamic approach could get the clinician and client into trouble without the proper training. Once the emotional walls break down, it is important to know how to handle all of this in a helpful and therapeutic way. I think as an intern and new appointed MSW I will stay clear of this approach, but keep my sights set on these skills for the future.
Christine
This week Alice and I exchanged PRs. Although Alice gave me a heads up that she did not think there was much Psychodynamic in hers, I found the opposite to be true. I found use of self, building trust, affirmation and deep empathy in Alice's PR.
ReplyDeleteI tried to point to places where an opportunity may have existed to look for reoccurring patterns, origins of life practices, or origins of self-concepts.
This was a good exercise, though the logistics were challenging. I think for Alice and me to learn we are more psychodynamic than not, and to (for me) put aside ideas about what I thought it was has been helpful.
If I were to go into counseling I would like this line, I am comfortable with the principles and I think there is a time for someone who has training, knowledge and life experiences to be a guide out of the muck and mire.
I could not agree more that to have a successful session the clinician really needs training- from what I understand to be technically a psychoanalyst its a four year training for LMSWs. could be interesting!
DeleteHi Gail -
DeleteI agree that in order for a clinician to feel comfortable with any of these practices, it is essential to be properly trained and feel completely confident in the approach prior to "trying it out" with a client. Through these exercises I have noticed that I have used minimal techniques (in large part due to the internship setting), and would be interested to see if I can add any techniques even in the brief time I spend with the patients in the ER. I think it is fantastic that we are learning about all these techniques but I feel as though I lack in actually practicing them, with the exception of motivational interviewing which seems fairly diverse. Great insight.
Rebecca
This week I exchanged process recordings with Christine Mcgovern, and I was able to find so many moments where she was recognizing a mood or feeling in her client and clearly responded with empathy and understanding which encouraged her client to go on. I know CBT was last week but I also saw a lot of reflecting and positive reinforcement in her use of language and response to what her client was fearful of. I thought Christine's client presented maybe some delusions and I imagine when a client is mentally ill, it being really challenging to practice psychodynamic therapy. Christine, I wonder in the case of the bugs in her house, what the cleanliness of her house represented to her? She was complaining a lot about her house not being tidy enough- she spoke about her place being "contaminated" and that shes not moving until they are "uncontaminated" I thought that was very interesting.
ReplyDeleteI think its important to be aware of what psychodynamic therapy is but its also a very in dept way of working with clients. I know that i am not meeting with people more than once a week as of and I wonder if any of you are working with people two to three times a week. I will be starting a new parent group which will meet twice a week and is based on some psychodynamic theory. I will make sure to share when this happens-
Annie,
DeleteThe client does have a delusion disorder, with the DSM-5, I am not sure if that changed her diagnosis, but that was what it was under the DSM-IV. The hard part is she sees things on her skin that most times looks like scabs to me. I listen to her and do not challenge her, as it upsets her and she is not harming anyone or hurting herself if she has a tiny scab and picks it off to say it is a bug, as the skin is going to fall of anyways. If she was digging into her skin and it became a medical issue, then I would go with her to the doctors and be there for support.
I met with two today in order to do intake assessments, I am going to try to do PR from that. I was told I should be getting a caseload of 2 to 4 clients soon, starting to co-facilitate Anger Management, then branching off to teach it myself on another floor. I will also be teaching another group when a LCMHC starts coming to the center to do groups, as they are revamping the group schedule.
Christine McGovern
Hi Annie -
DeleteI think its great that you were able to recognize other theories that it appears Christine is using in her work with clients. It is difficult to exchange process recordings and point out a theory that may or may not have been used when we have had minimal time to practice the technique or review for key components.
Rebecca
I reviewed Annie’s process recording on a separation group for parents with children who are just under 2 and teachers. Psychodynamic therapy it emphases on core emotions and relationships, this kind of therapy offers the ability of change that is more than superficial. In the beginning you wrote about the nannies and the mothers not conversing. This is problematic, especially since the nanny may or may not be spending more time with the child than the parent. If there are emotional or behavioral issues at home that the nanny is witnessing and not communicating, these problems will continue to escalate.
ReplyDeleteI found it disturbing that the parents were unable to separate from their children and did not trust the teachers. I was not sure if this was something they were bringing to the table as part of their own baggage or they felt superior to the teacher and they could do a better job teaching their young children, so they were going to stay and oversee for a while to make sure. What is your opinion? You had mentioned the teachers having a lack of confidence and that is understandable, as the parents are not leaving and letting them do their job, which is making them feel they cannot do it adequately. In this case Psychodynamic Psychotherapy would be a useful tool that would help teachers and parents can begin to understand and become comfortable with underlying feelings that can be confusing.
You talked about being the only one in the group who is not a mother, does that affect you in the work that you do with the parents? I ask because I had a woman who I worked with today, she is in recovery from Alcohol and asked me if I was also in Recovery. She said “that is great you are going to school for your MSW and then your M-LADC, but sometimes you need to walk the walk to talk the talk”. I told her even though I have not had problems with alcohol myself, I know a lot of people who have and I have worked for many years in this field with people working on their recovery. I love questions like that, it keeps me sharp and in this field I need to be prepared for things like this.
Christine McGovern
With no big surprise, I have learned that fitting a variety of these techniques into my work in my placement is difficult. The time frame spent with clients is often rushed and focuses predominately on obtaining a psychosocial assessment (which is very brief and collects minimal information) as well as providing the patient with community resources they may find helpful. Essentially, I feel like we are putting a bandaid over any problems when a client presents in the ER. Yesterday, however, I was able to shadow the social worker in the maternity, labor/delivery and NICU unit. Many of these techniques could be better utilized and I could certainly see some appropriateness even with the psychodynamic approach (ie: one mom felt very scared and uncomfortable to hold her new born - how could her ego have played into this? was she afraid to fail as a mother? how was the relationship with her own mother). I think this is certainly an interesting technique and theory and would be open to adding more of it to my direct practice with clients in a more appropriate setting.
ReplyDeleteRebecca, I agree that its difficult at times to reflect on our use of techniques given the nature of our placements and the length of time at our placement. When I interned at MA Hospital last semester I too found my time rushed and only focused on getting certain information. AT MAH the focus was on physical therapy and getting patients ready to discharge after surgery or an injury. PT and OT worked with patients up to five hours a day which meant I only had brief windows of time to see patients before they were off to the gym. Am I wrong in thinking you are hoping to work in the hospital setting after you graduate? If so I would be interested to see if you still feel the same way? I really thought I wanted to work in the hospital setting, but after my placement I know it is not the direction I want to head in. What are your thoughts?
DeleteSorry for my late submission my computer kept saying BlogSpot.com not responding when I tried to get in... This week I gave my PR to my supervisor to review as I did not have a partner and she was reviewing it when we had class and discussed options. It was really challenging to psychodynamic technique when completing a computerized clinical assessment that only allows for box checking and brief answers so my supervisor was only able to find brief examples. She did point out that the questions being asked are out of my control and our EMR system is very specific in its questioning. She did point out that the questions were all created with psychodynamic technique and many other clinical techniques in mind when created. Had I been meeting with a client to do most anything other than the initial intake I would have had better success at seeing an using psychodynamic technique in practice. We will be looking at a PR when I start meeting one on one with clients because she agrees that being able to use and identify psychodynamic techniques is an important skill for all clinicians at HCRS. I feel personally that its hard right now being such a new intern with limited responsibilities to be able to do a lot of reflecting until we are fully integrated into the team. I do look forward over the coming weeks to doing more reflecting and connecting with the learning....
ReplyDeleteHi Jennifer,
DeleteIt must be hard to find process recordings that reflect these therapeutic techniques when it sounds like your internship is focusing you more on intakes. I agree that it is hard to do a lot of reflecting when one is not fully integrated into the team. That said, it seems you were able to show your supervisor some "brief examples" of this stuff, which means you are getting experience. Maybe more than you think?
I haven't done a very good job "managing the clock" this week, or last for that matter. Here it is the eleventh hour of week five and I am without a partner to swap process recordings with. If anyone remains on the sideline (Amanda) and is able and willing, let's get something done together.
ReplyDeleteHi William. You are not alone! For some reason, I am also having a great deal of trouble "managing the clock" this semester. I had to rearrange my work schedule in order to facilitate a third internship day, which makes my week a lot more busy...and I know that's a major factor. Still, I feel like I'm struggling to get the discussion board stuff done on time. Part of it too is that swapping PRs takes a few days...which prevents me from getting the discussion posts done early in the week. And the later the week goes on the less time I have (or so it seems.) Still, I know I am not managing my time as well as I could be. Something for us both to work on, I suppose.
DeleteAs time is nearing expiration, I am falling back on a plan B. I am sharing my process recording with my wife, who is also a social worker --- she works in a detox unit at a regional hospital.
ReplyDeleteShe agrees that my client may benefit from psychodynamic therapy as there is evidence of the maladaptive coping strategy and defense mechanism "displacement."
I found the experience of sharing process recordings to be rewarding. I shared with Gail, and the PR she picked was full of good therapy techniques. I found it difficult to find concrete examples of psychotherapy in my own PRs...I don't think I've done a lot of it yet. Yet I can definitely see myself incorporating parts of psychodynamic theory into my own practice. I think that it is interesting that the concepts of transference and countertransference...which are something to be careful about in most other techniques...is seen as something to be cultivated positively in psychodynamics. It's a different way of looking at the client-therapist relationship, which I think could be very helpful in certain settings. Overall, I found it to be very educational.
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