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Samenvatting Psychoanalytische behandelingen
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Handboek Psychoanalytische behandelingenHoofdstuk 1: Psychoanalytisch kader ...................................................................................................................... 4
1. Bewust-onbewust ............................................................................................................................................ 4
2 Intersubjectiviteit en innerlijk werkmodel .......................................................................................................... 4
3 Twee vormen van pathologie ........................................................................................................................... 5
4 Psychodynamische attitude ............................................................................................................................. 5
Hoofdstuk 2: Veranderen......................................................................................................................................... 5
2.1 Inleiding ......................................................................................................................................................... 5
2.2 Verandering en weerstand ............................................................................................................................ 6
2.3 Holding .......................................................................................................................................................... 6
2.4 Autonomie en verborgenheid ........................................................................................................................ 7
2.5 Idealisering .................................................................................................................................................... 7
2.6 Bevestiging.................................................................................................................................................... 7
2.7 Verandering, angst en identiteit..................................................................................................................... 7
2.8 Therapie als managen van angst en regressie ............................................................................................. 8
2.9 Overdacht en tegendracht........................................................................................................................... 10
Hoofdstuk 3: Structurele verandering .................................................................................................................... 10
3.1 Inleiding ....................................................................................................................................................... 10
3.2 Innerlijke werkmodellen............................................................................................................................... 10
3.3 Structurele verandering: van interpretatie naar relatie ................................................................................ 11
3.4 Structurele verandering en steun ................................................................................................................ 11
3.5 Structurele verandering en mentaliseren .................................................................................................... 12
3.6 Structurele verandering en geheugen ......................................................................................................... 12
Hoofdstuk 4: Angst ................................................................................................................................................ 13
4.1 Inleiding ....................................................................................................................................................... 13
4.2 Aktualneurose en psychoneurose (FREUD) ............................................................................................... 13
4.3 Freuds angsttheorieën ................................................................................................................................ 14
4.4 Paranoïde-schizoïde positie en de depressieve positie .............................................................................. 14
4.5 Attachment .................................................................................................................................................. 15
4.6 Gehechtheid bij kinderen ............................................................................................................................ 15
4.7 Gehechtheid bij volwassenen ..................................................................................................................... 16
4.8 Conclusie .................................................................................................................................................... 17
Hoofdstuk 5: Weerstand ........................................................................................................................................ 17
Inleiding ............................................................................................................................................................. 17
Innerlijke werkmodellen en mentaliseren .......................................................................................................... 18
, Reflectief functioneren ...................................................................................................................................... 19
Vormen van afweer ........................................................................................................................................... 19
Hoofdstuk 6: regressie en ontwikkelingsstagnatie ................................................................................................. 20
6.1 Inleiding ....................................................................................................................................................... 21
6.2 Innerlijke structurering ................................................................................................................................. 21
6.3 Binnen versus buitenwereld ........................................................................................................................ 22
6.4 Fixatiepunten............................................................................................................................................... 22
Hoofdstuk 7: De psychotherapeutische relatie ...................................................................................................... 24
7.1 Inleiding ....................................................................................................................................................... 24
7.2 De primaire relatie ....................................................................................................................................... 24
7.3. De reële en de werkrelatie ......................................................................................................................... 26
7.4. De overdrachtsrelatie ................................................................................................................................. 26
7.5. Het ontwikkelaspect van de therapeutische relatie .................................................................................... 26
Casus Sarah ..................................................................................................................................................... 27
Hoofdstuk 8 Overdracht en Tegenoverdracht........................................................................................................ 29
8.1. Inleiding ...................................................................................................................................................... 29
8.2. Overdracht als intersubjectief ..................................................................................................................... 30
Definitie overdracht ....................................................................................................................................... 30
Een overdrachtsrelatie .................................................................................................................................. 30
De vorm van overdracht................................................................................................................................ 30
Nauwe relatie tussen overdracht en innerlijkwerkmodel ............................................................................... 30
Noodzakelijk om te komen tot overdracht ..................................................................................................... 30
Overdracht en de behandeling...................................................................................................................... 30
8.3. Overdracht en psychopathologie................................................................................................................ 31
Introductie: „overdrachtsneurose‟ .................................................................................................................. 31
Overdracht kan zich kwalitatief heel verschillend manifesteren. ................................................................... 31
Continuüm van overdracht ............................................................................................................................ 31
8.4. Overdracht reparatie .................................................................................................................................. 31
8.5. Overdracht en de evidentie uit de neurowetenschappen ........................................................................... 33
8.6. Tegenoverdracht ........................................................................................................................................ 34
Casus Anna....................................................................................................................................................... 35
Hoofdstuk 10: basale psychoanalytische attitude .................................................................................................. 35
10.1 Inleiding ..................................................................................................................................................... 35
10.2 Innerlijk proces .......................................................................................................................................... 35
10.3 Falend mentaliseren of regressie .............................................................................................................. 36
10.4 Psychoanalytische behandelingen ............................................................................................................ 36
, 10.5 Diversificatie van interventiemethodieken: ontwikkeling versus conflict .................................................... 37
10.6 diversificatie van interventiemethodieken: deeltheorieën .......................................................................... 38
10.7 Diversificatie van interventiemethodieken: kortdurende varianten ............................................................ 38
10.8 conclusie ................................................................................................................................................... 38
Hoofdstuk 11: Effectiviteit van psychoanalytische behandelingen......................................................................... 39
11.1 Inleiding ..................................................................................................................................................... 39
11.2 De werkzaamheid van kortdurende psychoanalytische psychotherapie (KPP)......................................... 39
11.3 De werkzaamheid van langdurige psychoanalytische behandelingen (LPB) ........................................... 41
11.4 Algemene conclusie .................................................................................................................................. 46
Hoofdstuk 15: Kortdurende psychoanalystische behandelingen ........................................................................... 46
15.1 Inleiding ..................................................................................................................................................... 46
15.2 Malan ........................................................................................................................................................ 46
15.3 In de tijd gelimiteerd .................................................................................................................................. 47
15.4 De focus .................................................................................................................................................... 47
15.5 Het duiden en containen ........................................................................................................................... 47
15.6 Het bewerken van overdracht en weerstand ............................................................................................. 47
15.7 Davanloo ................................................................................................................................................... 48
15.8 Sifneos ...................................................................................................................................................... 48
15.9 Mann ......................................................................................................................................................... 49
15.10 Strupp en Binder ..................................................................................................................................... 49
15.11 Klerman en Weissman ............................................................................................................................ 49
15.12 Horowitz .................................................................................................................................................. 50
Hoofdstuk 17: as II cluster C affectfobiebehandeling ............................................................................................ 51
17.1 Inleiding ..................................................................................................................................................... 51
17.2 Affectfobie en de driehoeken van Malan ................................................................................................... 53
17.3 Indicatiestelling: de aard van de behandeling meer steunend of openleggend......................................... 55
17.4 Behandeling: bewerken afweer en verborgen gevoel en S/O representaties ........................................... 56
17.5 Herstructureren van de affecten ................................................................................................................ 58
17.6 Herstructurering van zelf en objectrepresentaties ..................................................................................... 60
17.7 conclusie ................................................................................................................................................... 62
Hoofdstuk 22: Dromen in psychoanalytische behandelingen ................................................................................ 63
22.1 Inleiding ..................................................................................................................................................... 63
22.2 Traumdeutung (Droombetekenis) ............................................................................................................. 63
22.3 Droomonderzoek....................................................................................................................................... 66
22.4 Droom in de droom ................................................................................................................................... 68
Conclusie .......................................................................................................................................................... 69
, Hoofdstuk 23: As I Behandeling Depressie KPSP................................................................................................. 70
23.1 Inleiding ..................................................................................................................................................... 70
1. Positionering van de KPSP binnen het psychoanalytisch referentiekader .................................................... 70
23.2 Samenvattende tot nu ............................................................................................................................... 72
2. Het relationele perspectief van KPSP ...................................................................................................... 72
3. Indicatiestelling met betrekking tot KPSPµ .............................................................................................. 74
4. Werkwijze binnen KPSP ........................................................................................................................... 75
5. De gehanteerde therapeutische techniek binnen KPSP........................................................................... 76
Hoofdstuk 1: Psychoanalytisch kader
1. Bewust-onbewust
Onbewust < Primair onbewuste / niet-bewuste = nooit ih bewustzijn geweest + zal daar ook nooit id vorm van
herinneringen kunnen worden opgenomen => kan wel tot uitdrukking komen in gedrag (procedureel onbewuste)
Dynamisch onbewuste = iets dat verdrongen moet worden want niet acceptabel
Voorbewuste = niet spontaan herinneren, maar wel bewust vanaf aandacht richten
Expliciete geheugen < semantisch en episodisch gedeelte => mogelijkheid tot verdringing pas vanaf 3-4 jaar
(LTG)
Expl geheugen = gebruikt talige symbolen + verbale mediatie om ervaringen vast te leggen => materiaal moet
worden gestimuleerd om herinnerd te worden
Impliciete geheugen = kenmerkende vaardigheden en routines => gevoelstoestanden die niet verbaal zijn
verwerkt
2 Intersubjectiviteit en innerlijk werkmodel
Psychotherapeutisch koppel staat centraal => doel = revisie van de procedures => innerlijk werkmodel wordt
geprovoceerd + gereviseerd
Is de manier om angst te reguleren => gaat om de manier waarop patient de ander beleeft en met hem
interacteert (verleden alleen van belang om heden te begrijpen)
Impliciete structuren < interactie tss individu en omgeving
Innerlijk werkmodel = patronen van interacties => sturen later gedrag (representaties over zelf en anderen)
Zaken die rol spelen = manier waarop persoon door zijn primaire objecten werd gezien en is behandeld + zijn
reactie hierop + manier waarop primaire objecten met die reactie omgingen
Psychoanalytische behandeling = werkmodellen manifest maken en ze corrigeren
verinnerlijken/introjecteren = proces: dat wat buiten is wordt binnen gerepresenteerd
Mentale representatie stoornis < categorien van representaties afwezig zijn
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