hi this is dr. Diane Gayheart and this is my online lecture on psychodynamic and psychoanalytic counseling and psychotherapy and this lecture accompanies my text and case documentation and counseling and psychotherapy and theory of treatment planning in counseling and psychotherapy both of which are available through cengage publishers you so as you probably know psychoanalysis and psychodynamic theory in general with the original theories developed by Freud and are generally considered the first form of psychotherapy period I guess in the Western world I guess you could say but um so these theories have an incredibly long history have been developed for over a century and so they're actually by now many different schools that are considered broadly psychodynamic with psychoanalysis referring typically to you the work of Freud or those who and we'll talk about this in terms of the process of therapy or who kind of do a longer term approach that was similar to Freud using you typically some of these older approaches so so basically that I think one of the first things to know is that there are many different schools within psychodynamic therapy so just because someone calls himself psychodynamic or a psychoanalyst you're still not quite sure what school of psychodynamic theory that they're using and there's no way in this 40-minute lecture that I'm going to cover all of these in great depth you can go for weeks on a single one so hopefully what you will get by listening to this lecture is just the broad picture overview of psychodynamic and the various schools within it and also just a general sense of how it typically looks so so let's start with some of these different schools of psychodynamic or psychoanalytic theory so psychoanalysis like I said is typically refers to the work of Freud and emphasizes drive theory and instincts and cotton and we'll talk about these conflicts between the various parts of the self the next set of theories to evolve become known as ego psychology and they focus on the ego as the name implies as well as defense mechanisms frequently used by the ego so that's ego psychology and and so that's the work of Anna Freud and Erikson and horney are generally considered within this school the next school is object relations and this is a well-developed school and I would say that most of the people I know who practice psychodynamic therapy today actually are using object relations their their theory specifically within that and so this focuses on the relationship between self and objects are the others or object relations so the inner psychic representations of our caregivers so this is a very popular theory in the practice of psychodynamic therapy today and there are various many schools associated with this but Klein and Mahler and Winnicott these are some of the names that are familiar with object relations so next we have an actual self psychology typically on you would think of next and that is the work of Kohut and his work specifically focuses on the relationship with the self as well and self objects or internal representations these self objects and so that's the focus of that particular school interpersonal theory was developed by Harry stack Sullivan and his isn't unique and unusual in that it's focusing on observable interactions what rather than inter psychic and it also looks at self systems and his work is often cited as some of the foundational theories for contemporary family therapy approaches then we also have a relational intersubjectivity theories these are more recent theories um associated with folks like Mitchell Greenberg and Staller oh and it focuses on the interpersonal world and the relational matrix and so these are a little more have a little more of a postmodern influence they certainly take broader contextual issues into consideration so these are the most modern or contemporary form of psychodynamic therapy in addition there are brief psychodynamic theories and these are the ones that typically have the most research behind them and these are basically brief psychodynamic therapy takes a lot of the concepts and the concepts of psychodynamic and focuses it on a specific set of symptoms like depression or anxiety rather than psychodynamic theories and psychoanalysis in general are much more focused on the whole you know personality of a person rather than trying to just reduce depression or anxiety and so it's really about restructuring the you know the parts of the self and developing a healthy personality structure in general more than reducing symptoms but these brief psychodynamic theories are symptom focused using the traditional ideas of psychodynamic therapy so that is a very broad overview of area schools and you talk to different people the different authors they will have a different list of these and but hopefully and this is kind of represents I think a pretty typical list of the various schools so in that she'll the least you need to know so psychoanalytic and psychodynamic approaches as I just mentioned they focus on analyzing or conceptualizing the personality structures and its functioning and that's what it's really the general focus is like except for the exception I just mentioned which is the brief approaches and so the basic idea is to foster client insight to help the client understand how their personality is working and then once they have this through this insight that they're then able to make different choices and decisions and what they call working through these insights to change their actions in the outside world and it is typically considered a slow process very intense slow process that typically a person would engage in if the psychoanalysis are going to be going to three times a week and typically for several years but it's really about restructuring the personality more so than we're you know treating depression or anxiety or something along those lines the two significant tribution to the field and so next i want to talk about what are some of the key concepts from the this theory or these sets this set of theories that is used by many counselors and therapists regardless of their particular approach the concept of transference and countertransference originally developed by freud discussed by varieties so it's a very old idea in this approach is frequently discussed by counselors and therapists regardless of their theoretical orientation and so this is very foundational I think that the whole field of psychotherapy that said there are different ways to use transference and countertransference so let's start with the whole first concept of transference and the idea of transference is that the client is projecting onto the therapist you know characteristics related to their primary unresolved issues from primary caregivers or their significant people in their life and so one way to think about this is that our example of this is when a therapist is sitting relatively quiet nodding their head listening to the client a client could project judgment or feeling that that sitting there quietly nodding your head somehow implies the clients feeling judged where the therapist isn't actually judging at least in this example um the client but instead is just listening trying you know thinking through doing their case conceptualization you know their heads busy doing other things but the client assumes because that's when his or her parent did this at home there was judgment that came afterwards that's a source that's a form of transference so and so there are many many different ways of transference and forms of it but it's basically when the client is kind of projecting on to the therapist certain attributes based maybe on sometimes it pays not much of anything and or sometimes just a neutral stimulus the client kind of assumes and projects quote/unquote it's a defense we'll talk about a couple minutes in more detail but projects them to the therapist this judgment or or this you know some kind of an attribute that really belongs to their primary caregiver or other significant person in their life so that's transference and transference is generally considered negative and something that needs to be worked through and cleared cleared up in more traditional therapies the therapists worked really hard to be a blank neutral slate so that the client liked to be this you know white blank you know projection screen or screen then the client could literally like project on - so you'll hear the blank slate on some of those earlier ones you may have seen TV movies where the the analyst is sitting you know in a place the client can't see him or her and the client lying on a couch you know and so that's where the clients the therapist is trying to be this blank neutral slate so that the clean-out the Clank and then have you know purely project onto them in later forms of psychodynamic therapy which are more empathetic and more most there is more emotional engagement less of a blank slate there is still this concept of transfers but of course it's going to work a little differently since the therapist is engaged so it's sometimes a little trickier to figure out you know where that is coming from because it could just be counter transference so counter transference is when the therapist projects back onto clients typically it's thought to the where the therapist is losing their therapeutic neutrality so a therapist can is projecting onto the client attributes of primary caregivers or significant others and that's typically how countertransference is typically used with a negative the negative also kind of a problem that the therapist needs to work on to be a psychoanalyst formal psychoanalyst takes years and use of your own psychoanalysis so that you can be more neutral and so you don't do a lot of projecting on to your clients and so it's very much part of the formal training of someone who's trains in these approaches to get their own psychoanalysis very in-depth lengthy cyclin al us to avoid countertransference sometimes I have heard countertransference use just to refer to the therapist emotional response to the client and not also necessarily in the negative way but it helps the therapist maybe gain insight into what the other people in the client's life are experiencing but most the time you'll hear transference and countertransference used meaning that either the kleiner that there and this is projecting unresolved issues that need to be addressed and the hope of all of this is that there can be this corrective emotional experience what that means is that the therapist is going to respond differently then the client experienced in childhood and this allows them to resolve you know the inner conflicts of the example I started with whether the client is projecting judgment on you know that the therapists you know lack of chitchat e behavior and kind of being quiet manner they're assuming there's negative judgment when the therapist when the clients you know says something about that the third the client and the therapist are able to clarify that the therapist is just thinking and listening you know attentively without judging the client that hopefully can be a corrective emotional experience where the client can say oh just because a person's you know not readily agreeing or jumping on the bandwagon doesn't mean bandwagon with me doesn't mean they're necessarily being judged they might just be listening they might be you know try to understand you there might be neutral and so that allows the client to have a corrective emotional experience so that they don't project so much in their personal lives going forward so now we're going to talk about the big picture the overview of the therapeutic and counseling process so in its most basic form the process of psychodynamic therapy is about listening interpreting and working through and this is a process that typically repeats itself as the therapist and client address the various issues that the client has and so the first part about listening is when the therapist is listening often using empathy and later approaches on listening objectively to the client's story and doing the case conceptualization in their head and trying to understand how the clients personality is structured so that the therapist can help the client restructure that person the personalities so there's this listening being empathetic where they're also assessing the personality dynamics and unconscious processes then in this next phase they offer interpretation to promote insight for the client and so in the next phase they are offering the client new insights into the personality and in this process it's important that the client needs to accept those in order for the therapy to be helpful and unable to do get into that last part which is working through their insight which is getting through you know repressed defenses or repressed strivings which are related to the drives and to help make this unform early unconscious process conscious and through this working through the clients able to change how they respond to others in their life what they're feeling anxious or depressed about changes so they're able to work through things work through these unconscious struggles that have they were either unaware of that we're affecting them in order to promote change so that's the basic process and this would and this can go on for years as I mentioned so typically psychoanalysis will refer to a much more lengthy of forma treatment that's really focusing on the overall personality structure where psychodynamic therapy would typically refer to a more brief psychodynamic approach where you're using psychodynamic theory to address you know anxiety depression you know some kind of more smaller scale that rather than the whole personality structure you're working more on a specific problem so you'd be addressing the personality structures related to feeling depressed or feeling anxious or having panic attacks whatever that might be so the psychoanalysis those typically reserved for that long multi-year intense process of restructuring the personality and again the sides sums up what I was saying on the last one about psychoanalysis that it is it's different than psychodynamic therapy in that it is referring to the long term process of meeting you know several times a week for several years oh so what's great is it you're going to really get this concept because I've talked about it now three slides in a row but here we go so psychodynamic psychotherapy though is about is like I said targeting the specific problems now it still can be go on for a year or two and so even psychodynamic therapy and even brief psychodynamic therapy is often much briefer is much longer often in many cases then you will talk about other cycle of their other psycho therapies that are considered brief that are actually much briefer like solution focus therapy or many of the systemic therapies are brief in terms of 10 to 12 sessions but psychodynamic therapy even though it's briefer than psychoanalysis we're still talking 1 to 2 years and even brief psychodynamic is often longer than an approach such as solution-focused or even CBT can be briefed too so now let's talk about the therapeutic relationship and psychodynamic therapy so the therapeutic relation is actually can look quite different across the various different schools of psychodynamic theory so it's important to get a sense and to be aware of this that there's one thing that does really shift across the schools it's the quality of the therapeutic relationship so the first distinction to make is one person versus two person relationships so and one person relationships are associated with Freud's original work and some of the ego psychologists where the idea really is is that the therapist is a blank neutral slate and the client is projecting on to them and so for that projection process to work that it's really with a color one person relationship the one person is the client and that the therapist is not in a it's not a two-way relationship where there are two kind of selves interacting and kind of working through that process so in general the oldest schools the ones that really focus on that blank slate are considered one person relationships most of the rest are considered more two-person relationships and so we talked about how that transference and countertransference worked earlier in the Jews section so the next major concept that comes in is this idea of the holding environment and this was introduced by object relation theorists and the idea here is that the the therapist creates a holding environment that relates to the concept of good enough mothering and the good enough a mother is able to create a safe nurturing environment and which a child can go from an undifferentiated you know unintegrated ego state to one to a fully-integrated ego state you know to a health having a healthy structured sense of self and so this holding environment is a very safe nurturing environment in which the therapist kind of helps protect the client from overwhelm whelming anything that might be too overwhelming and and helps the client learn to develop a healthy sense of self and along with that is empathy and this extra Kohut who talked on was one of the first strong advocates of empathy empathy in psychodynamic typically looks a bit different than we'll talk about empathy with Carl Rogers and the humanistic approaches it's a little less well let's say it's a little less warm typically and and in the use of empathy is is to help the client gain insight into into what's going on and so that and so the empathy is used in a different way I would say in psychodynamic therapy it's part of this helping the client gain insight into their own world but this empathy is used where the therapist is able to you know get a sense of the client's inner world and reflect this back in a way that will promote a you know insight as well in this as well as a sense of being heard and understood there's also mirroring which is a concept that comes out of self psychology and so that is where Kohut really believed that the the self still needs to have mirroring um by other important people in the world as adults just like little kids need to have their emotions mirrored back to them and their sense of self-worth mirrored back to them that this is also very important for adults to have their sense of self-worth and recognize recognition of the self being mirrored back and so that's a process of mirroring which is related as you can tell to empathy then when we get to the more contemporary relational cycle analysis and intersubjectivity they do something a bit different from other psychodynamics schools because they actually have the more postmodern assumption that the therapist is affecting the client in the relationship and the therapist is affecting what is being seen and so they don't believe the therapist can really be neutral and they think it's very important for the therapists to actually track and be aware of how his or her behavior is affecting the client and so um so it's a different assumption where the therapist is now focusing on analyzing this interaction knowing that they're not a neutral unbiased party but they're part of creating what's being observed in the client and this relationship is something that the therapist is actually shaping and is not personally neutral so again I would say one thing that is true across schools is that a psychoanalyst or psychodynamic therapist really needs to go through their own personal a now this is kind of key to all of these approaches kind of working and so that's very much an assumption in terms of working this way that the therapist will take it the responsibility and as part of the training is basically required to get their own psychoanalysis in order to effectively work this way so next we're going to talk about case conceptualization and psychodynamic theory and this is a huge topic because in many ways psychodynamic theory is much more about how the therapist thinks about what's going on to use what's going on then about doing something in particular in the room and so more so I would say than any other fit all any other theories out there that psychodynamic theory requires extensive case conceptualization and it is I would say some of the more difficult case conceptualization to do in the field and so that said um we also have now you know several different schools which each conceptualize the clients situation the clients ego in various different ways and so well I'm going to take you through some of them kind of emphasizing some of the more contemporary ones um but again this is one where people could be very strictly object relations and they would be using some of the other concepts or there are also a lot of psychodynamic theorists who do kind of borrow from several of these in terms of turn in terms of conceptualizing the clients that they work with so let's start with levels of consciousness I would say most schools refer to these in one way or another so the first level of consciousness is consciousness and this is what a person is actually aware of in their psyche then there's pre was considered preconscious material and that is when you hold on to these are memories and experiences the person can fairly easily retrieve with a little bit of effort so consciousness is what's there pre consciousness is typically accessible sometimes with some effort but it's there then there is the unconscious and the unconscious is where memories and thoughts that the conscious mind cannot tolerate is stored here and this is also the source of na drive so there's this whole unconscious part of the self where we kind of put the parts of ourselves that are not tolerated or acceptable and to the conscious mind and so a lot of the focus in psychodynamic theory is to help people become aware of those unconscious you know elements and to work through those so that they no longer are an unconscious but a conscious process and by bringing and that's kind of the working through process helps bring them from the unconscious to the conscious so that the person is free now to make conscious choice about how to respond to you know stressors in their environment and such so another basic concept in psychodynamic therapies the structures of the self and so this was developed by Freud initially and so it's certainly used in the older forms and is sometimes to refer to in later forms often some variation and what a person may mean by ego specifically but the classic elements of the structures of the self include the it'd which is the unorganized part of the personality and it's very much is the kind of those where all the instinctual drives come from then there is the ego which is which is part of the conscious mind it's the part of the personality that most of us would recognize as the self and but it involves intellect in and includes the self defense mechanisms and really is a part that mediates between the it'd and the super-ego which is the third part and the super-ego is the social ideal ideals is you know that we have that generally are going to prohibiting the ID's basic drives and fantasies and so generally the super-ego kind of basically keeps your it in check in terms of you know if you felt like running naked through the streets you know like sometimes little kids love to run because they feel like it you know that would be the it'd and the super-ego is the part that develops saying that is not you know socially appropriate so don't do that and so in its the ego that helps manage between those two struggles so you will also hear about drive theory and this does refer to Freud's early and early work so the earliest work in the field and drive Theory refers to these instinctual drives that are that are pretty much housed in that in part of us that are inherent part of being human and they're experienced and shared by us all so they're there and there are two types of zom drives that Freud I used one is the libido or sexual energy and then he also talked about the death Drive which is more of an aggressive energy and you know along the way some other folks have talked about drives but typically they're talking about you know some sort of inherent almost instinctual part of being you know human for you know sex or aggression and and so this is what drive theories analyze when they work with clients and how this is the expen expressed and in the client and the particular struggles in their life so Freud's psychosexual stages of development have been a source of debate since I think they were introduced and I'm not going to spend a lot of time on these because typically these are not necessarily used in contemporary practice as much and there's debate to they often say that in the United States people take these much more literally when they're meant to be more metaphorically as today sometimes are seen in Europe so there's even debate in terms of some of this but the psychosexual stages Freud use these to conceptualize what was going on with his clients and and there is psychosexual development and where they might be stuck in the type of problems they might be having so this is like I said use less so today but it is a kind of classic element of psychodynamic theory so another concept that is frequently used in psychodynamic work is that seeing the symptom as a form of us intrapsychic conflict and so you know the symptoms such as depression is a is a reflection or a natural kind of occurrence because of the inter psychic conflict between perhaps the the ego having to repress the it'd or the super-ego you know being very you know harshly suppressing the it'd sorts of things um so that's how they can look at you know where the depression or anxiety gets created and then they also look at some of the primary gains um for example if you're severely depressed maybe when the primary gains are you get out of having to do certain social activities or work activities if you're that depressed and then they also look at secondary gains it may not be clear clearly obvious but you know for example you might get more sympathy from you know a significant others or a certain form of attention might come as a secondary gain of having a particular symptom and so a psychoanalysis analysts look at what's the what's the complaint or the symptom and you know what are the primary secondary gains and what type of intrapsychic conflict could explain this particular symptom and so that's part of the process of analysis when they're listening to clients is trying to understand why this symptom and what is its function for the personality so defense mechanisms are used widely and by most practitioners of psychodynamic therapy and they can refer to a lot of different defense mechanisms we're just going to talk about a handful here but they are often used and are very efficiently I would say typically to get a sense of how the personnel the clients personality is structured and it helps also understand some the symptoms so the I think this is a more getting into I think the most more useful territory here on a day to day basis so but these defense mechanisms are very automatic they're typically unconscious and but their response is to perceive psychological threats and so you have things like denial um where and this again was one of four II was a one of his original ones but basically refusing to accept any external reality that doesn't you know that does not fit with what your conscious mind it will accept and so you just kind of deny it you see a lot of this in families with substance abuse for example it's very classic the denial that there's a drinking problem or a substance use problem but you know all of us can use it on a daily basis for lots of different things to deny that there is a problem you know that your child actually has a point over you know that your boss has a point or whatever that might be interjection um this is a little less it's it this isn't the idea here is that the person and they do refer to this often with infants they the normal process and infants where they take in whole without analyzing or reflecting upon taking in whole on some kind of behavior belief or an attitude from somebody else um and so you're kind of taking these things in whole as a way of coping and so this is when the you know you're it you in order to get along with people you will just take and hold their opinions or their ideas and that can help reduce anxiety and help reduce conflict and or help you get approval from somebody else so I think often of children and teenagers going to do often an interjection of you know what's the coolest thing out there and this will help me and be popular with my peers splitting um which is a particular interest in object relations and self psychology refers to the inability to separate out the good and bad elements of positive and negative qualities in a person so this goes back to an infant in an infant's mind you know the good mother who you know feeds them and you know cuddles with them is different than the you know the bad mother who straps them into an uncomfortable car seat or doesn't come they're crying or whatever that might be so that's what they call splitting when you can't except you can't integrate the good in the bad until I understand this is the whole person and that the person has both good and bad you know elements to then and so you win this this is normal natural and young infants but in adults ideally if there's good enough mother the the infant and child is able to reconcile oh yes this good mother who takes care of me it's also the one who you know has to remind me that it's bed time and and those things I don't like and being able to put that into one understanding how that's one person I'm rather than you know I love you I hate you I love you I hate you which if it you don't as an adult when they talk about splitting it's very much I love you I love you when you do what I want I hate you when you don't so that would be like a bad self is being projected onto another person it could be a very sexualized part of the self is projected onto another person rather than just a you know a less than Pleasant habit um the last two here are repression and suppression and the main difference here is repression is a very uncommon unconscious process where you repress some unacceptable part of the self where suppression is there's some consciousness to it you consciously kind of suppress the the knowledge of your angry side or that you're drinking too much or whatever that might be you're consciously pushing it out of your consciousness so projection we talked about earlier and that's when you inappropriately or wrongly kind of attribute attribute your own negative unacceptable disowned feelings onto somebody else which could be a partner type of thing and obviously this is something one is usually not aware of and where projective identification is similar to projection but it's um actually involves projecting onto another person not just discrete impulses or smaller things but kind of like a part of the self is an unacceptable part of the self is projected onto another person and and then from that that person that person which just represents now a part of the self is being rejected so it's a little it's a it's a bigger process a larger process or a larger thing so another way that psychodynamic people therapists might can conceptualize what's going on with their clients is using Erikson's psychosocial stages of development and this is actually kind of in dialogue and in response to Freud psychosexual stages of development and Erickson's stage as a he's an ego psychologist so it's a little more developed and you're probably familiar with this from any undergraduate psychology or development class and there are eight different stages um that all of us move through and each one kind of is encompassed by a particular struggle like trust versus mistrust in the first one autonomy versus shame and doubt in the toddler stage you know initiative versus guilt and what the therapist would do is look to see where the you know given whatever the person's problems are where they might be stuck so you know so for example if there is this there they're very much guilt ridden much of the time you would look back at the preschool and kindergarten ages where that is a predominate or a sense of never being good enough looking at that in the industry versus a inferiority in the school age so this is just used to help again conceptualize the struggles that clients are having so as I mentioned earlier object relations theory is a very popular theory in use in contemporary psychodynamic work and the term object actually refers to a person and most often actually mother or early caregiver and as we talk about objects and it's kind of a little bit of an awkward term but it just means you know the object of your kind of psyches attention and this object can actually sometimes is referring to internal objects your internal you know picture of this person and as well as external one's actual true people and in object relations they talk a lot about the good enough mothering that allows for the development of the true self and so the good enough mother is not perfect and she's not actually supposed to be because some of that frustration is important in terms of developing in a way to get used to the real world where there are quite a few frustrations and life is less usually less than perfect so the good enough mothering is a mother who is able to Mir back to their child I'm going to provide that nurturance you know on a regular reliable basis but now with absolute you know perfection and precision you know sometimes the baby may have to wait 10 30 seconds because the mother you know is engaged in something else so it doesn't mean having some frustration is theorized by some theorists and that it is also part of a healthy normal development but when there is good enough mothering and the mother is able to be empathetic nurturing and miR back to the child that this develops the child's true self and a healthy kind of the healthy development of self and so this is something that the object relations theorist will look look at and so like many other psychodynamic theorists they're looking a lot at you know ages zero to three or ages zero to five Moller actually has the stages of separation and individuation you know these very very early years and so that's the focus of the object relations theory so looking at where that were there may have been problems there in terms of understanding an adult's current situation or an older child's current situation so self objects are a concept that comes out of Co Hut's work originally who focus on working with narcissistic patients who Freud believed could not be treated and what co hook the concept Kohut introduces here are self objects where basically self objects are things persons or objects that are experienced as part of the self or in some way are used in terms of the selfs identity so children could be a self object where you experience your children as part of who you are and they're not separate and distinct your you know your job or your title your social economic class can all be part of these self objects that are used to define who you are and so the development of these self objects are kind of based on two color elements one is the ideal D lized image of these of your parents parents are perfect and young childhood at least non teenage years but certainly in young childhood and at the other end is kind of this grandiose part of the self which is part of the child who believes that they deserve to get whatever they want and if you talk to a toddler that certainly is where we all seem to start and so ideally these two polarized elements are through the parent-child relationship and an empathetic understanding and when a parent child relationship includes empathy where the parents are teaching empathy the child is able to coalesce this and come into a cohesive self that can make sense of these kind of polarities whereas if they do not this is where the narcissistic personality and similar problems develop so the relational matrix is used in more contemporary approaches that have more of an postmodern influence and so in the relational matrix we're looking at the self the object and the interpersonal patterns or relationships and the idea here is that the self and objects really can't be even interpreted outside of this relational matrix and so that everything is contextualized by the culture gender and the actual dynamics of the relationship rather than in more traditional forms where you're looking at the individual and kind of considering them more out of context so this is definitely comes out of a much more postmodern perspective so and finally we have these unconscious organizing principles in culture which again are part of these later more contemporary approaches and intersubjectivity theory that basically positive people will experience the world through their particular set of organizing frameworks which are unconscious principles or templates primarily fueled by culture and gender norms as well as early relational experiences so it's all these templates and these unconscious organizing principles is kind of our filter we use for making sense of the world and so the therapists job in terms of case conceptualization is to begin to identify what are those assumptions what are what are those frameworks and are there parts that are not accurate or working for the client and related to whatever symptoms that the person is experiencing well next we're going to move on to talk about goal setting in a psychodynamic therapy the goals in psychoanalysis and psycho dynamically informed therapy are generally broad long-term and relating to overall patterns of coping and so much more focusing on the personality structure than just reducing you know depressive or anxiety symptoms and so and depending on what you know theoretical lens you've used which specific theoretical lens you've used and focused on for your case conceptualization that would inform your goals so but here are some of the common ones so reducing irrational impulses this clearly relates to the drive theory I mean improving stress management and reducing the use of defenses so again this is relating to the ego psychology and you know assessment of defenses then you know generally you would have some form of ego improving ego strength the self esteem self cohesion and this is kind of that larger personality and configuration you can always talk about you know having insights into particular dynamics and following that up with agency which would mean behavioral change due to insight in general you could also frame it in terms of emotional maturity or emotional intelligence reducing perfectionism perfectionism is generally seen as some form of Defence and so reducing that an overall personality change and also the capacity to develop mature dependency and mature forms of intimacy in relationships so these are some of the kind of long-term goals that you would have working from a psychodynamic perspective so next we're going to talk about interventions in psychodynamic therapy now if you were hoping for some real concrete you know how to intervene four step processes psychodynamic is typically not known for that a lot of the interventions are based on the therapist having done his or her own psycho you know analytic work being very clear and therefore being able to interpret what's going on for the client providing insight and allowing the client to work through this so I mean not only our dreams and fantasies interpreted but also symptoms and transference and metaphors you know Freudian slips of the tongue you know jokes and aside all that stuff can be used for interpretation so you know the actual conversation as well as unintended parts of the conversation everything can be used for interpretation to promote insight and to use that insight then to work through it to see those denied or unconscious parts of the self and to thereby change behavior so that's the bread and butter really of intervention and psychodynamic therapy and again it comes from the therapist having done a lot of their own work in turn another intervention is empathy and this is described by Kohut is a two step process of having understanding so you know telling the client in some way you have empathy I can understand how you how am I being late must have been upsetting for you and then explanation and that's the second part would have some form of interpretation to help the client understand the source of the emotion so you know talking about how we might all you know we all care about how those are wanting to see us especially those who are important to us and so helping them flesh that out and why this client is having this particular you know experience around in the example here's a therapist running late you know it could be the therapist having a particular expression or using a particular you know expression to those sorts of things and so that's kind of related to its using interpretation and empathy together to again promote insight so that you can work through it and have a corrective emotional experience through that process you also have some you know classic things such as free association this is a very traditional one that Freud uses where the client um is asked the therapist may you know give a word which you know be maybe neutral you know like beach or it may be more pointed such as your mother and say what you know things first come to mind and they use that free association to help access the unconscious dream interpretations are also used to help access the consciousness and then also more contemporary work they talk about intersubjective responding and that is when the therapist is using themselves and the relationship itself to help them gain insight to make change so in this case you could be talking about how the therapy is experiencing the client then looking at how that might also be true with other people in the clients lives so it's using that relationship in a very kind of in vivo way to help the clients again develop insight and understanding into their own dynamics and pretty much anything you know the client says or does becomes used to help promote more insight and understanding either by you know set using for assessment and or commenting on it directly to help the client work through in terms of research in the evidence-base the best evidence for psychodynamic work really comes from brief psychodynamic approaches again these are the ones that target you know depression or anxiety or more time-limited there happens in large stay of skills studies can comparing interpersonal psychotherapy one of the newer psychodynamic approaches with humanistic and CBT and generally no significant differences are found between those three for treating depression there is also some research on but they call the core conflictual relationship theme which is looking at transference and so there's is some evidence that transference is a real phenomena from the evidence base and again most of the research is done on a time limited dynamic psychotherapy rather than us like a long term psychoanalysis and kind of look at restructuring the whole personality and finally I want to say a word about using psychodynamic approaches with diverse populations there is a lot of caution that is encouraged when working with diverse populations in terms of working with race ethnicity diversity and even social economic class generally this approach is tends to be favored by white educated clients more so than diverse clients who often who may find going back and exploring you know ages 0 to 3 very they may not know why they may need more of an explanation as to why they're doing that it's also councillors need to be very cautious in trying to interpret cross-culturally because symbols and meanings are not the same across culture and expectations and expectations for even parent-child relations and what that should look like is it can be different across cultures and so it is something that one needs to perceived very cautiously when working across culturally in terms of working with sexual diversity this is quite a hot topic because especially Freud's early on theories of the psychosexual development pretty much pathologize --is any not anything that's not a hetero hetero sexual interests so there has been a lot of work in developing gay affirmative versus gay neutral approaches to psychodynamic therapy for working with LGBTQ clients there's some work around the psychodynamics of bisexuality and how to conceptualize that and actually the whole concept of internalized homophobia also has its roots in basic psychodynamic concepts so there are quite a few clinicians actually using psychodynamic concepts with gay lesbian transgendered clients but these theories are definitely kind of mono fied in order to work successfully with these populations and so you'll need to look into the kind of special modifications for working with these various groups so yeah in summary you want to just proceed cautiously when working with diverse populations it certainly has been done there's work done on working with diverse clients using these concepts and again I would encourage you to do some more research in terms of working with a specific population you have in mind well I hope this lecture has been at least somewhat helpful and introducing you to psychodynamic theories the very very complex multifaceted multi theory world in many ways of working with psychodynamic therapy arguably the oldest therapy approach we have and hopefully you found this useful and getting you started and I wish you luck in your journey of learning more