Transcript Methods of Intervention

Methods of Intervention
Psychodynamic Approach
‘The Past in the Present’
presented by Ali Harrison
Social Work Theory and
Interventions
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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 Rutter
Juliet Mitchell
Alice Miller
Virgina Axaline
Micheal Jacobs
Eric Burn
Eric 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
Freud
Personality Theory
understanding ego
development
and Ego defences
working in the relationship
with transference and
countertransference
Personality Theory
Super ego
Ego
Id
Id
instinctual drives of the child for
survival, wants, urges,needs
impulses for sex and aggression
largely unconscious
Super ego
Internalised voice of authority
(parent, teachers, school, church etc)
‘shoulds’, ‘ought to’, rules, guilt,
moral principles, teaching
Can be underdeveloped or too rigid
Ego
The ‘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 society
Resulting 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 Mechanisms
Splitting, 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
Repression
threatening or painful thoughts and
feelings are pushed out of conscious
awareness
(i.e. early sexual abuse)
Ego Defence Mechanisms
Displacement
anxiety 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 development
Erikson -Lifespan Development
Psychology
Klein, Mahler and WinnicottObject Relations
Bowlby- Attachment Theory
Linear and nested
personality development
Freud and Erikson
linear 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
Oral
Anal
Phallic (Oedipal)
Latency
Genital
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 adult
etc
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
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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
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The Jurassic Park
World of the new
born baby…..
No boundaries
no concept of time
fragmented
experiences
instinctual drives to
survive
Melanie Klein
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Breasts good and
bad
Margaret Mahler
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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
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Transitional Love
Object
The Holding
environment
Direct work with
Children
Bowlby and Ainsworth attachment
Theory secure / insecure attachments
and resilience
Klein Paranoid Schizoid and Depressive
positions
Mahler Separation and Individuation
from the maternal care system
Importance 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 Bowlby
Maternal Deprivation and the
Growth of Love
Secure attachment
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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 back
dislike being held,
dislike being put down more
tend 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 out
when she returns they show
ambivalence by seeking contact, but
resisting and squirming or kicking
They do little exploration and are
hard to comfort
Disorganised or
Disorientated Attachment
Main and Solomon 1986)
Babies show contradictory
behaviours
Greet mum on return then turn
away or approach her without
looking
seem confused and afriad
most 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
stages
and 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 Work
Life Story Work
Author: 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 Countertransference 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 countertransferal feelings
Exercise in working with
transference
Think of a client or someone you know
that brings up strong feelings in you.
What transference or countertransference reactions might be at
play?
What insight might this give you about
the persons relationship with
dependency, aggression, grief etc..
Understanding and working with internal
conflict/parts
transactional analysis,
subpersonality work,
inner child work,
play therapy
Workig with Ego
states
Trasactioal
Aalysis Eric Bere
Workig with Parts
Subpersoalities
Joh Rowe
Workig with the
Ier child
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 Burns
Transactional 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 selfscrutiny. 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)
usig a
Psychodyamic
Approach for
social workers
by focusig o the ier world
of the cliet it fits cliet
back ito status uo doest
chage structural problems
Sometimes behaviour eeds
chagig uickly,
Psychodyamic theory may give
useful isights but it does ot
guaratee chagig behaviour
Social workers may ot have
time, expertise or adeuate
supervisio to use the
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)
Please complete your
exercises for next week and
report back