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Psychology
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Essay
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English (U.S.)
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Final
Essay Instructions:
Students are required to conduct a simulated psychotherapy session based on a clinical vignette provided in class. The session should be conducted in the spirit of the model outlined by Hannah Levenson (2010) and in accord with the approaches of Sharpless (2019). Students will be paired up with a colleague from class and must record the sessions in audio format. Students will then (a) self -assess their own clinical work in the simulation exercises using the Vanderbilt Therapeutic Strategies Scale (Butler, 1995), (b) reflect upon challenges and dilemmas experienced in session, (c) examine their own countertransference to the “client” in the simulation, (d) identify potential transference re-enactments from the simulated sessions, and (e) conceptualize the clinical case according to Levenson’s model (2010) and the model of the Psychodyamic Formulation Collective (2022) model too. Systematic written analysis of the issues will be required. Explicitly, students will use both Levenson’s (2010) cyclical maladaptive pattern (CMP) approach while applying the work and techniques of Brian Sharpless (2019) approach to key competencies in dynamic psychotherapy. The Collective model (2022) approach shall be utilized to write up a formal case conceptualization and treatment plan for the case. Finally, students must integrate 5 scholarly journal readings of their choice from the semester and 3 additional scholarly publications (e.g., journal articles or book chapters), which they obtain on their own, and apply all of them meaningfully to the case. This entire assignment must be 13-15 pages in length and written in APA format.
*** there are no readings attached. These are open access suggested readings that the instructor listed without attached copies.
*Vignette will be attached separately (Case 1 "Todd")
*List of suggested scholarly journal readings/articles below from class that you can use from below:
The Psychodynamic Formulation Collective. (2022). Psychodynamic Formulation: An expanded Approach, 2nd edition. John Wiley & Sons.
Levenson, H. (2010). Brief dynamic therapy. Washington, DC: American Psychological Association.
Luepnitz, D. (2003). Schopenhauer's porcupines: Intimacy and its dilemmas: Five stories of psychotherapy. New York, NY: Basic Books.
Mitchell, S. A., & Black, M. (2016). Freud and beyond: A history of modern psychoanalytic thought. New York, NY: Basic Books.
Sharpless, B. A. (2019). Psychodynamic therapy techniques: A guide to expressive and supportive interventions. Oxford University Press.
Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy, 51(3), 372-380.
Gardner, J.R. (1991). The application of self-psychology to brief psychotherapy. Psychoanalytic Psychology, 5, 477-500.
Giacomantonio, G. (2013). On the role of theory and models of change in psychotherapy research. Psychotherapy in Australia, 19, 18-24.
Haskayne, D., Larkin, M., & Hirschfeld, R. (2014). What are the Experiences of Therapeutic Rupture and Repair for Clients and Therapists within Long-Term Psychodynamic Therapy?. British Journal of Psychotherapy, 30, 68-86.
Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, research, practice, training, 38(4), 357-361.
Levy, K. N., & Scala, J. (2012). Transference, transference interpretations, and transference- focused psychotherapies. Psychotherapy, 49, 391-403.
Levenson, H. (2003). Time-limited dynamic psychotherapy: An integrationist perspective. Journal of Psychotherapy Integration, 13(3-4), 300-333.
Liang, B., Tummala-Narra, P., & West, J. (2011). Revisiting community work from a psychodynamic perspective. Professional Psychology: Research and Practice, 42, 398-404.
Luyten, P., & Blatt, S. J. (2013). Interpersonal relatedness and self-definition in normal and disrupted personality development: Retrospect and prospect. American Psychologist, 68, 172-183.
McWilliams, N. (2020). The future of psychoanalysis: Preserving Jeremy Safran’s integrative vision. Psychoanalytic Psychology, 37, 98-107.
McWilliams, N. (2017). Integrative research for integrative practice: A plea for respectful collaboration across clinician and researcher roles. Journal of Psychotherapy Integration, 27, 283-295.
McWilliams, N. (2003). The educative aspects of psychoanalysis. Psychoanalytic psychology, 20, 245-260.
McWilliams, N. (2013). The impact of my own psychotherapy on my work as a therapist. Psychoanalytic Psychology, 30(4), 621-626.
Norcross, J. C., & Wampold, B. E. (2018). A new therapy for each patient: Evidence-based relationships and responsiveness. Journal of clinical psychology, 74, 1889-1906.
Pine, F. (1988). The four psychologies of psychoanalysis and their place in clinical work. Journal of the American Psychoanalytic Association, 36, 571-596.
Schore, A. N. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51, 388-397.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American
Psychologist, 65, 98-109.
Shedler, J. (2018). Where is the evidence for “evidence-based” therapy?. Psychiatric Clinics,
41, 319-329.
Tummala-Nara, P. (2013). Psychoanalytic applications in a diverse society.
Psychoanalytic Psychology, 30, 471-487.
Wampold, B. E. (2012). Humanism as a common factor in psychotherapy. Psychotherapy, 49,
445-449.
Wampold, B. E. (2017). What should we practice. In T., Rousmaniere, RK, Goodyear, SD, Miller,
BE Wampold,(Eds.), The cycle of excellence, pp. 49-65. New York, NY: Wiley & Sons.
Westen, D. (1998). The scientific legacy of Sigmund Freud: Toward a psychodynamically informed psychological science. Psychological Bulletin, 124, 333-371.
Zerubavel, N. & Wright, M. O. (2012). The dilemma of the wounded healer. Psychotherapy, 49, 482-491.
Essay Sample Content Preview:
Case 1 Todd: Simulated Psychotherapy Session Paper
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Psychodynamic theories are tailored to offer coherent rationales for interpersonal and intrapsychic workings. Given the inherent significance of such an approach in modern therapy development, the techniques that emanate from these theories are leveraged in any form of psychotherapy, whether it is established as "psychodynamic" or not. For instance, individuals who have worked with clients struggling with substance abuse disorders are conversant with "denial" regardless of whether they are informed that this procedure constitutes one of the psychodynamic defense techniques. This paper will discuss a clinical simulation of Todd's case through the lens of the Vanderbilt therapeutic strategies scale, dilemmas and challenges encountered during the session, transference and countertransference, and its conceptualization according to psychodynamic models.
Background to the Case
Todd is a 28-year-old male who presented to the physician after his neighbor advised him. This was after Todd demonstrated radical behavioral changes that saw him become increasingly irritable, have sleeping difficulties, be excessively fatigued, general anxiety about going to places or interactions with colleagues, and physical manifestations of sweating and heart beating fast when he thinks about activities of daily living, poor hygiene, and isolation. Two of Todd's siblings have a history of struggling with depression and anxiety for extended timescales. As a child, he struggled with the sudden demise of his father, who happened to be the sole breadwinner. Todd constantly struggled to accept the death of his father, which drove him to drop out of school. Todd's mother, who had been a housewife for most of his life, had to seek a job to support the family following the demise of her husband. Todd quit his computer programming course at the local community college after he was tasked with a group project.
Todd was employed at a small upstart computer college and had to move with his employer 400 miles away from his hometown. Todd had no friends apart from the neighbors he met in his new residential area. Staying away from home did more harm to him because he was mostly withdrawn from his house after working overnight at the company. Recently, Todd struggled with diarrhea and fear of an unknown issue. The thought of leaving the house to buy groceries makes his heart racing and his body sweat. His coworkers have noted that he is more irritable and looks sleepy during working hours due to insufficient sleep. In summary, Todd's presenting symptoms include insomnia, irritability, ease of getting fatigued, isolation, poor hygiene, physical sweating, heart racing when thinking about daily activities, and general worry about interacting with others and going to places.
Summary of the Simulated Psychotherapy Session
In a group of two, a simulated psychotherapy session was conducted based on Todd's case through the lens of the Cyclic Maladaptive Pattern (CMP) by Levenson (2010) and approaches proposed by Sharpless (2019). Todd was referred to the clinic by a friend, and the first step is to create a good rapport and reassure him that everything will return to normal. At first, Todd was unsure if the therapy session was necessary, and he stated that he was just okay with his recurrent anxiety. The psychological history of Todd and his family was assessed comprehensively to decide on the severity of this condition. Client-centered therapy techniques were employed to reassure Todd, make him feel comfortable, and involve him proactively in the session. Todd confessed to avoiding going out for basic household necessities, tensing when interacting with people, missing the impact of his father in his life, and constantly expecting the worst to happen, among other anxiety issues. Todd's CMP was created based on his past experiences and current struggles with guilt and anxiety. The session was recorded in audio format for future reference.
Self-Assessment
The Vanderbilt Therapeutic Strategies (VTSs) is an interviewing style with 21 components. Butler (1995) proposed the VTSs to aid clinicians in managing psychiatric illnesses. Each of the 21 questions has 5 choices, and they include strongly disagree, disagree, neutral, agree, and strongly agree.
1. The therapist encourages the patient to experience/express affect in the session. (Agree)
2. The therapist encourages the patient's expression/exploration of feelings in relation to significant others. (Agree)
3. The therapist encourages the patient's expression/exploration of thoughts and beliefs in relation to a significant other. (Agree)
4. The therapist actively attempts to engage the patient in collaboration. (Agree)
5. The therapist responds to the patient in an accepting/understanding manner. (Agree)
6. The therapist attempts to maintain a focused line of inquiry. (Agree)
7. The therapist inquires into the personal, unique meanings of the patient's words. (Strongly agree)
8. The therapist responds to the patient's statements by seeking concrete detail. (Strongly agree)
9. The therapist attends to seemingly important statements or events. (Agree)
10. The therapist shows evidence of listening receptively. (Agree)
11. The therapist appears to maintain an optimal participant-observer stance. (Disagree)
12. Therapist uses open-ended questions. (Agree)
13. Therapist specifically addresses transactions in patient-therapist relationship. (Neutral)
14. The therapist encourages the patient to explore feelings/thoughts about the therapist/therapeutic relationship. (Agree)
15. The therapist encourages the patient to discuss how a therapist might feel or think about the patient. (Agree)
16. The therapist uses their reactions to some aspects of the patient's behavior to clarify communications/guide exploration of possible distortions in the patient's perceptions. (Agree)
17. The therapist explores patterns that might constitute cyclical maladaptive patterns in the patient's relationships. (Strongly agree)
18. The therapist asks about the patient's introject. (Agree)
19. The therapist links recurrent behaviors or interpersonal conflict to patient-therapist transactions. (Agree)
20. Therapist addresses obstacles (e.g., silences, coming late, avoidance of meaningful topics). (Neutral)
21. The therapist discusses the time limits of time-limited dynamic psychotherapy or termination. (Neutral)
Sharpless (2019) justifies that psychotherapy sessions should be detailed and specific because it is a strange business and hard to do well. All the requirements outlined in the VTSS were observed during the simulation exercise. The therapy sessions were conducted in pairs and recorded in audio format for future reference. The comprehensive analysis done using VTSS will inform further steps taken to address underlying factors that Todd faces.
Challenges and Dilemmas during the Session
The diagnostic conclusion from Todd's case is a generalized anxiety disorder. However, there are additional concerns that exacerbate the severity of generalized anxiety disorder for Todd. They include a lack of social support, decreased ability and interest in self-care, and isolation. The factors above presented a background of challenges to overcome and dilemmas that require critical thinking during the therapeutic session. During the therapy session, establishing a therapeutic rapport was challenging. This was due to Todd's guardedness and reluctance to share his experiences. As time went by, active listening, demonstration of empathy, and constant validation of Todd's battles with anxiety created a safe and supportive environment for Todd to share his thoughts and feelings (Kaluzeviciute, 2020). The second challenge was addressing Todd's avoidance behavior. Todd did not turn up for the second session even though the first session was a success. This was a testament to Todd's avoiding meeting with people because he confessed to fearing leaving his house that day. The client apologized, and the session took a more proactive approach, where Todd was required to confirm sessions the day before and a few hours before the scheduled time.
Todd's psychiatric history has many incidents of trauma and grief. The loss of his father was still an unresolved grief in his life. The fact that his two sisters are also battling anxiety problems was worrying Todd, and he had assumed that this was a genetic problem that would not be solved via therapy. The therapists employed techniques like mindfulness-based interventions and narrative therapy to create a safe space for Todd. This approach helped Todd to explore his feelings of loss and accept that he now needs to develop coping strategies that will help in managing his grief. Moreover, navigating Todd's negative self-appraisals was a big challenge. Having grown up in a close-knit family that had lost its sole breadwinner, Todd abruptly had his life-changing and lost faith in positivity. He had low self-esteem due to negative beliefs about himself. Todd had to reframe his thoughts and adopt a more positive self-image using self-compassion exercises and cognition improvements (Goldberg, 2022). The therapy session also had time constraints and treatment goals to be achieved. Todd was working at night, and he rested during the day. This means that the therapy sessions had to be scheduled for afternoon hours to allow Todd to sleep. The therapist must prioritize treatment goals and interventions that align with Todd's immediate needs while laying the groundwork for long-term progress.
The therapy sessions had dilemmas that had to be addressed promptly. The first dilemma is balancing empathy an...
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