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心理动力疗法

Psychodynamic Therapy

作者信息

Opland Caitlin, Torrico Tyler J.

机构信息

University of Denver

Consilient Interventional Healthcare

Abstract

Psychodynamic models propose that unconscious thoughts, desires, and memories inaccessible to conscious awareness still primarily influence human behavior; therefore, the psychodynamic model informs the psychodynamic therapeutic approach. Over the years, psychodynamic therapy has dramatically evolved to emphasize the role of past unresolved conflicts and how they manifest themselves in shaping people's behavior and personality. Some key concepts include the following: : A significant influence on how conscious behavior is affected by hidden thoughts, feelings, and memories; these are in a vast reservoir of often repressed or forgotten material that continues to influence behaviors and emotions, even if people are unaware of its influence.  : Dreams are considered a window into the unconscious. Analyzing dreams can reveal hidden desires, fears, and conflicts. They are the mind's way of resolving repressed desires or conflicts that are too difficult to handle in our conscious state. The content of our dreams is divided into 2 parts: manifest and latent. While dream analysis cannot be formally recommended as a reliable and effective tool, it is unlikely to cause any harm. Dream analysis should, therefore, be left up to the client and therapist whether to include it in the treatment regimen. Dream analysis involves discussing the client's dreams in detail. The therapist guides the client through this discussion, asking questions and prodding the client to remember and describe the dream in as much detail as possible. While Freud would nearly always find a repressed sexual urge or sex-related significance in the latent content, today's dream interpreters have broadened their scope of meaning. There are nearly countless ways that therapists, coaches, and counselors of the more "mystical arts" engage in dream analysis, none of which have been identified as more practical or useful than the others. This psychology emphasizes the role of the ego in adaptation, reality testing, and defense mechanisms, highlighting an individual's capacity for resilience and problem-solving. : While it includes many of the same principles as psychoanalysis, this model often incorporates more modern theories; it is less focused on the id's instincts and more on the ego's role in managing relationships and coping with stress.  These terms refer to the unconscious redirection of feelings and attitudes from significant others onto the clinician, while countertransference involves the clinician's unconscious emotional reactions to the patient. These dynamics are explored in therapy to gain insight into relational patterns and unresolved conflicts. : This concept involves unconsciously repeating past patterns of behavior or recreating situations to resolve unresolved conflicts or traumas. Psychodynamic therapists may address this by helping patients understand how their past influences their present, focusing on improving current functioning and relationships. This phenomenon suggests that individuals unconsciously repeat behavior patterns or recreate situations reminiscent of past experiences, particularly those involving unresolved conflicts or traumas. Such repetition serves as a way for the individual to try to master or resolve the original conflict, even though it often leads to similar adverse outcomes. Freud believed that the unconscious mind drove repetition compulsion, considering it a fundamental aspect of human behavior. This theory explains how early relationships with primary caregivers influence later personality development. These early interactions are internalized as 'internal objects,' shaping our future interactions and emotional responses. The theory emphasizes social relationships as critical motivators in human behavior. Therapists use object relations theory to help clients work through unresolved conflicts and improve interpersonal relationships. Initially focused on individual drives, it now includes the dynamics between self and others, utilizing the therapist-client relationship to resolve internal conflicts. Integrating object relations theory with modern neuroscience, the authors posit that early caregiver interactions form cognitive-affective units encoded in the brain via the hippocampus and amygdala, consolidated by the medial prefrontal cortex. These units influence lifelong mental development, and their poor integration can lead to emotional and social issues, including personality disorders. Understanding these neural mechanisms can enhance psychodynamic psychotherapy and improve mental health treatments. : These mechanisms are unconscious psychological strategies that individuals use to cope with anxiety and protect themselves from uncomfortable thoughts or feelings. Examples include repression, denial, projection, and sublimation. Understanding and identifying defense mechanisms is an essential aspect of psychodynamic therapy. Anna Freud helped develop the idea that there could be adaptive or maladaptive defense mechanisms, and creating awareness around them would help in the therapeutic process. Conversely, resistance is the patient's unconscious defense mechanisms that prevent progress in therapy. While closely related, "Psychoanalysis" and "Psychodynamic" theories have differing ideals. The psychoanalytic perspective refers to theories and therapeutic methods based on the original works of Sigmund Freud, an Austrian neurologist. Freud, often called the father of psychoanalysis, developed this model in the 1890s; the term "psychoanalysis" was introduced by Freud in 1896. Freud proposed that the subconscious mind plays a significant role in human behavior, including psychological and emotional challenges an individual may face. His interest in the unconscious mind was sparked by the case of "Anna O," who claimed recovery when her repressed memories were uncovered. The basic assumptions of this approach include: : : Psychological problems are rooted in the unconscious; treatments focus on bringing the repressed conflict to consciousness. The unconscious ideas are patients' emotionally charged beliefs about their experiences formed from early life experiences, which the patients treat as facts rather than hypotheses due to the anxiety, guilt, or shame they provoke. : Childhood experiences primarily influence personality; therefore, early relationships with caregivers (objects) shape individuals' internal representations of themselves and others, influencing their interpersonal dynamics and relational patterns. In 1905, Freud introduced the concept of an object of an instinctual drive, along with object-directedness, object choice, and object finding. He made contradictory statements about the nature of drives in infancy and the timing of object choice. His clinical work revealed the complexity of children's mental lives, enhancing his understanding of drive objects and leading to a sequence of sexual life organizations based on drive sources and object-directedness. While object choice and directedness depend on the drive object concept, they require additional explanatory constructs. In 1915, Freud defined "object" in his drive theory but did not introduce a new object concept, though progress was evident. : Individuals employ these against threatening information from the unconscious, which is developed subconsciously to protect against mental health disorders such as anxiety, perhaps learned from culture. : The 3 main components of the mind that govern personality are the id (instinctive behaviors for pleasure, seeking immediate gratification), the superego (a moral center representing internalized societal and parental standards), and the ego (the reality principle that balances and mediates the id and superego). : Dream theories can map the subconscious mind and, compared with empirical research findings, examine functions like wish fulfillment and distinguish between latent and manifest content. : A child's feelings of desire for the opposite-sex parent and jealousy toward the same-sex parent. : Personality development occurs through a series of psychosexual stages (oral, anal, phallic, latent, and genital), each characterized by a focus on different erogenous zones and associated developmental challenges. A study of participants between 3 and 17 years chose between pairs of shapes representing masculinity or femininity, and results indicated that shape preferences aligned with the phallic, latency, and genital stages. Men and women 13 and older preferred masculine shapes, reflecting cultural male orientation; younger children in the phallic stage indicate a lack of cultural bias. Psychoanalytic theory is the cornerstone of psychodynamic theories and models' evolution. Freud's original concepts have transformed through a collaborative and dynamic process that has now expanded into the culmination of the contemporary iteration of the psychodynamic model recognized today. These models are enriched and diversified through the contributions and critiques of Freud's followers: : Jung created analytical psychology through concepts like the collective unconscious and around 9 universal, symbolic, and primary archetypes. : Adler created a school of thought known as individual psychology that emphasizes the importance of social factors and community in personality development and the concept of the inferiority complex. : Sigmund Freud's daughter; she contributed significantly to child psychoanalysis and ego psychology. : Erikson was influenced by Freud's theories; these helped him with his work on psychosocial development, where he proposed the 8 stages of human development. : Reich developed theories on character analysis and the role of sexual energy, leading to the creation of orgone therapy. Kohut worked in the area of self-psychology. : Klein developed play therapy and introduced concepts such as the paranoid-schizoid and depressive positions in early childhood. : Lacan reinterpreted Freud's work and emphasized the importance of language and the unconscious in the structure of the psyche—which has significantly impacted contemporary psychoanalytic thought and critical theory. : Bowlby introduced the attachment theory. : Ainsworth developed the individual differences in attachment theory.

摘要

心理动力学模型认为,意识无法触及的潜意识思想、欲望和记忆仍然是人类行为的主要影响因素;因此,心理动力学模型为心理动力学治疗方法提供了理论依据。多年来,心理动力学疗法发生了巨大的演变,转而强调过去未解决冲突的作用,以及这些冲突如何在塑造人们的行为和性格中表现出来。一些关键概念如下:隐藏的思想、情感和记忆对有意识行为有着重大影响;这些存在于大量常常被压抑或遗忘的材料中,即便人们并未意识到其影响,它们仍在持续影响行为和情感。梦被视为通向潜意识的一扇窗口。对梦进行分析可以揭示隐藏的欲望、恐惧和冲突。梦是大脑解决在意识状态下难以处理的被压抑欲望或冲突的方式。梦的内容分为两个部分:显梦和隐梦。虽然梦的分析不能被正式推荐为一种可靠且有效的工具,但它不太可能造成任何伤害。因此,是否将梦的分析纳入治疗方案应留给客户和治疗师自行决定。梦的分析包括详细讨论客户的梦。治疗师会引导客户进行此讨论,提出问题并促使客户尽可能详细地回忆和描述梦境。虽然弗洛伊德几乎总能在隐梦内容中找到被压抑的性冲动或与性相关的意义,但如今的梦的解析者们拓宽了其意义范围。“神秘艺术”领域的治疗师、教练和顾问们进行梦的分析的方式几乎数不胜数,且没有一种方式被认为比其他方式更实用或更有用。这种心理学强调自我在适应、现实检验和防御机制中的作用,突出了个体的恢复力和解决问题的能力。虽然它包含许多与精神分析相同的原则,但该模型通常融入了更现代的理论;它较少关注本我的本能,而更多关注自我在管理人际关系和应对压力中的作用。这些术语指的是将情感和态度从重要他人无意识地转移到临床医生身上,而反移情则涉及临床医生对患者的无意识情绪反应。在治疗中会探讨这些动态关系,以深入了解关系模式和未解决的冲突。这个概念涉及无意识地重复过去的行为模式或重新创造情境,以解决未解决的冲突或创伤。心理动力学治疗师可能会通过帮助患者理解过去如何影响现在来解决这个问题,重点是改善当前的功能和人际关系。这种现象表明,个体无意识地重复行为模式或重新创造让人联想到过去经历的情境,尤其是那些涉及未解决的冲突或创伤的情境。这种重复是个体试图掌握或解决原始冲突的一种方式,尽管它常常导致类似的不良后果。弗洛伊德认为无意识思维驱动着强迫性重复,将其视为人类行为一个基本方面。该理论解释了与主要照顾者的早期关系如何影响后期的人格发展。这些早期互动被内化为“内在客体”,塑造着我们未来的互动和情绪反应。该理论强调社会关系是人类行为的关键驱动因素。治疗师运用客体关系理论帮助客户解决未解决的冲突并改善人际关系。最初聚焦于个体驱力,现在它涵盖了自我与他人之间的动态关系,利用治疗师与客户的关系来解决内部冲突。将客体关系理论与现代神经科学相结合,作者们认为早期照顾者的互动通过海马体和杏仁核在大脑中形成认知 - 情感单元,并由内侧前额叶皮质巩固。这些单元影响终身心理发展,它们整合不佳会导致包括人格障碍在内的情绪和社会问题。理解这些神经机制可以增强心理动力学心理治疗并改善心理健康治疗。这些机制是个体用来应对焦虑并保护自己免受不舒服的想法或感受影响的无意识心理策略。例子包括压抑、否认、投射和升华。理解和识别防御机制是心理动力学治疗的一个重要方面。安娜·弗洛伊德推动了这样一种观点的发展,即可能存在适应性或适应不良的防御机制,围绕它们建立意识将有助于治疗过程。相反,阻抗是患者阻碍治疗进展的无意识防御机制。虽然“精神分析”和“心理动力学”理论密切相关,但它们有着不同的理念。精神分析视角指的是基于奥地利神经学家西格蒙德·弗洛伊德原著的理论和治疗方法。弗洛伊德常被称为精神分析之父,他在19世纪90年代发展了这个模型;“精神分析”一词由弗洛伊德在1896年引入。弗洛伊德提出潜意识在人类行为中起着重要作用,包括个体可能面临的心理和情感挑战。他对无意识思维的兴趣源于“安娜·O”的案例,当她被压抑的记忆被揭示时,她声称病情有所好转。这种方法的基本假设包括:心理问题根源于潜意识;治疗的重点是将被压抑的冲突带入意识层面。无意识观念是患者基于早期生活经历形成的、对自身经历带有情感色彩的信念,由于它们引发的焦虑、内疚或羞耻感,患者将其视为事实而非假设。童年经历主要影响人格;因此,与照顾者(客体)的早期关系塑造了个体对自己和他人的内在表征,影响他们的人际动态和关系模式。1905年,弗洛伊德引入了本能驱力客体的概念,以及客体指向性、客体选择和客体寻找。他关于婴儿期驱力的本质和客体选择的时机发表了相互矛盾的陈述。他的临床工作揭示了儿童心理生活的复杂性,加深了他对驱力客体的理解,并导致了基于驱力来源和客体指向性的一系列性心理发展阶段。虽然客体选择和指向性依赖于驱力客体概念,但它们还需要额外的解释性结构。1915年,弗洛伊德在他的驱力理论中定义了“客体”,但没有引入新的客体概念,不过进展是明显的。个体运用这些机制来对抗来自潜意识的威胁信息,这些信息是潜意识发展出来以预防诸如焦虑之类的心理健康障碍的,可能是从文化中习得的。人格的三个主要组成部分是本我(追求快乐的本能行为,寻求即时满足)、超我(代表内化的社会和父母标准的道德中心)和自我(平衡和调节本我与超我的现实原则)。梦的理论可以描绘潜意识思维,并与实证研究结果相比较,考察诸如愿望满足等功能,并区分隐梦和显梦内容。孩子对异性父母的渴望和对同性父母的嫉妒之情。人格发展通过一系列性心理阶段(口唇期、肛门期、性器期、潜伏期和生殖期)发生,每个阶段的特点是关注不同的性敏感区以及相关的发展挑战。一项针对3至17岁参与者的研究让他们在代表男性气质或女性气质的形状对中进行选择,结果表明形状偏好与性器期、潜伏期和生殖期一致。13岁及以上的男性和女性更喜欢男性化形状,反映出文化上的男性取向;处于性器期的年幼孩子则没有文化偏见。精神分析理论是心理动力学理论和模型演变的基石。弗洛伊德的原始概念通过一个协作且动态的过程发生了转变,如今已发展成为当代心理动力学模型的集大成者。这些模型通过弗洛伊德追随者们的贡献和批评得以丰富和多样化:荣格通过集体无意识等概念以及大约9个普遍、象征性和主要的原型创造了分析心理学。阿德勒创建了一个名为个体心理学的思想流派,强调社会因素和社区在人格发展中的重要性以及自卑情结的概念。西格蒙德·弗洛伊德的女儿;她对儿童精神分析和自我心理学做出了重大贡献。埃里克森受到弗洛伊德理论的影响;这些理论帮助他开展关于心理社会发展的工作,他在其中提出了人类发展的8个阶段。赖希发展了性格分析理论以及性能量作用的理论,从而创立了生机疗法。科胡特在自我心理学领域开展工作。克莱因发展了游戏疗法,并引入了诸如幼儿期的偏执 - 分裂和抑郁状态等概念。拉康重新诠释了弗洛伊德的作品,并强调语言和无意识在心理结构中的重要性——这对当代精神分析思想和批判理论产生了重大影响。鲍尔比引入了依恋理论。安斯沃思发展了依恋理论中的个体差异。

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