Samenvatting Psychodynamische Therapie (15/20 eerste zit!)
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Course
Psychodynamische therapie (010086)
Institution
Vrije Universiteit Brussel (VUB)
Deze samenvatting is een volledige samenvatting van het vak psychodynamische therapie gedoceerd door professor Ho-Shu Eileen Tang. Het wordt gegeven in eerst jaar master aan de VUB. De samenvatting omvat de slides aangevuld met uitgebreide lesnota's met voorbeelden van het academiejaar .
, 1 Construct ............................................................................................................................................................................................... 39
1.1 Een streepje geschiedenis ............................................................................................................................................. 39
1.2 Definitie ................................................................................................................................................................................. 40
1.3 Vier dimensies aan mentaliseren ............................................................................................................................... 40
1.3.1 Dimensie 1................................................................................................................................................................... 41
1.3.2 Dimensie 2................................................................................................................................................................... 43
1.3.3 Dimensie 3................................................................................................................................................................... 43
1.3.4 Dimensie 4................................................................................................................................................................... 44
1.4 Belangrijke noten .............................................................................................................................................................. 44
2 Ontwikkeling ....................................................................................................................................................................................... 47
2.1 Ontwikkelingslijn .............................................................................................................................................................. 47
2.1.1 Baby van 0 – 1 jaar................................................................................................................................................... 47
2.1.2 één jaar tot 3 jaar ..................................................................................................................................................... 49
2.1.3 Drie jaar tot 4 jaar .................................................................................................................................................... 50
2.1.4 Vier jaar tot vijf jaar ................................................................................................................................................ 50
2.1.5 Vijf tot zes jaar ........................................................................................................................................................... 50
2.1.6 Zes tot zeven jaar (latentiefase)......................................................................................................................... 50
2.1.7 Zeven tot twaalf jaar ............................................................................................................................................... 51
2.1.8 Twaalf tot 22 jaar ..................................................................................................................................................... 52
2.3 Factoren die de ontwikkeling van mentaliseren beïnvloeden ...................................................................... 53
2.3.1 Belang van de primaire gehechtheidsrelaties ............................................................................................. 54
2.3.2 Individuele verschillen kinderen ...................................................................................................................... 63
2.3.3 Risico op non-mentaliserende vicieuze cirkels ........................................................................................... 64
2.3.4 Belangrijke noot: risico om deze “non-mentaliserende” modi (altijd en overal) als pathologie
te beschouwen ...................................................................................................................................................................... 64
H4: Prototype 1: Mentalization-Based Treatment for Children ................................................................... 65
1 Doelstellingen en opbouw.............................................................................................................................................................. 65
2 Assessment / Initiële fase ............................................................................................................................................................... 65
2.1 Doelstelling .......................................................................................................................................................................... 65
2.2 Eerste sessie ........................................................................................................................................................................ 66
2.3 Sessies met kind................................................................................................................................................................. 67
2.4 Sessies met ouders............................................................................................................................................................ 68
2.5 Contacteren van andere belangrijke volwassenen ............................................................................................. 70
2.6 Delen en bespreken van case formulation en therapiedoelstellingen ....................................................... 70
2.7 Beslissen over verdere therapie ................................................................................................................................. 71
3 Individuele kindertherapie............................................................................................................................................................ 71
3.1 (Deel)doelstellingen......................................................................................................................................................... 71
3.2 Vier componenten van spel in PDT met kinderen .............................................................................................. 72
3.2.1 Actie en lichamelijkheid ........................................................................................................................................ 72
3.2.2 Relationaliteit ............................................................................................................................................................ 72
3.2.3 Spel als drager van betekenis via beeld en metafoor ............................................................................... 73
3.2.4 Spel als drager van een narratief veranderingsproces ............................................................................ 73
3.3 Therapeutische attitude t.a.v. spel ............................................................................................................................. 74
3.3.1 Twee dimensies in therapeutpositie ............................................................................................................... 74
3.4 Verschillende niveaus van therapeutische interventies .................................................................................. 75
3.4.1 Wat de therapeut niet doet .................................................................................................................................. 76
3.4.2 Dit alles vergt dus een fundamentele ‘speelsheid’ bij de therapeut................................................... 76
4.5 Opdracht speltherapie - beeldfragment .................................................................................................................. 77
2
,H5: Dynamic Interpersonal Therapy (DIT) ......................................................................................................... 79
1 Achtergrond ......................................................................................................................................................................................... 79
1.1 Rationale ............................................................................................................................................................................... 79
1.2 Basisassumpties................................................................................................................................................................. 79
2 Kern ......................................................................................................................................................................................................... 80
2.1 Therapiedoelstellingen ................................................................................................................................................... 80
2.2 Therapeutische basisattitude ...................................................................................................................................... 80
2.3 Kenmerken ........................................................................................................................................................................... 81
2.4 De vijf strategische stappen .......................................................................................................................................... 82
2.5 Kernstrategieën ................................................................................................................................................................. 82
2.6 Indicatiestelling.................................................................................................................................................................. 83
3 Initiële fase ........................................................................................................................................................................................... 84
3.1 Doelstellingen ..................................................................................................................................................................... 84
3.1.1 Cliënt engageren: opbouwen van therapeutische relatie ....................................................................... 84
3.1.2 Komen tot een dynamische case formulation.............................................................................................. 84
3.1.3 Identificeren van en onderhandelen over therapeutische doelstellingen ...................................... 87
4 Middenfase ........................................................................................................................................................................................... 92
4.1 Opvolgen van de IPAF: interpersoonlijke narratieven als illustraties van de activatie van de IPAF
........................................................................................................................................................................................................... 92
4.2 Aanhouden van de focus op de IPAF......................................................................................................................... 92
4.3 Technieken ........................................................................................................................................................................... 93
4.3.1 Inzichtgevende/explorerende technieken .................................................................................................... 93
4.3.2 Steungevende technieken..................................................................................................................................... 95
4.3.3 Mentaliseren-bevorderende technieken........................................................................................................ 95
4.3.4 Directieve technieken............................................................................................................................................. 96
4.4 Werken met verdedigingsmechanismen ................................................................................................................ 97
5 Afrondingsfase .................................................................................................................................................................................... 98
5.1 Rationale ............................................................................................................................................................................... 98
5.2 Voorbereiden op afronden ............................................................................................................................................ 98
5.3 Sessies 13 – 16 .................................................................................................................................................................... 99
5.3.1 Doelstellingen ............................................................................................................................................................ 99
5.3.2 Voortijdige en verlengde afrondingen ............................................................................................................ 99
5.4 ‘Weerstand’ in de afrondingsfase .............................................................................................................................100
5.4.1 Strategieën ................................................................................................................................................................100
5.5 De afscheidsbrief .............................................................................................................................................................100
5.5.1 Rationale ....................................................................................................................................................................100
5.5.2 In de praktijk ............................................................................................................................................................100
5.6 Casusvoorbeeld IPAF Rebecca...................................................................................................................................101
Psychodynamische theorieën zijn fundamenteel ontwikkelingspsychologisch en
ontwikkelingspsychopathologisch
● Uitgesproken klemtoon op de formatieve rol van vroege levenservaringen op latere
psychische structuren en gedrag
○ ! cave: formatief ≠ deterministische of lineair-causale, ꞊ belangrijke doch complexe
invloed, in interactie met de rol van genetica, epigenetica, en latere ervaringen en
omgevingsinvloeden (probabilistisch)
○ Formatief
■ = dat het een een heel belangrijke invloed heeft. Ze zijn vormend en
maakt dat je andere levensvormen krijgt dan een ander persoon. We
gaan er niet per se vanuit dat het een bepaalde richting in gaat.
● Klemtoon op de geleidelijke ontwikkeling van mentale capaciteiten, waardoor
verschillende ontwikkelingsfasen verschillende manieren van de wereld begrijpen en
kennen met zich meebrengen
○ Tussen de leeftijd van 9 maanden en 5 jaar wordt je gevormd
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