The Case Approach Psychodynamic and Family of Origin

The Case Approach: Psychodynamic and Family of Origin (FOO) Meeting 3 © Cheung, M. , & Leung, P. (2008). Multicultural practice and evaluation: A case approach to evidence-based practice. Denver, CO: Love. Instructors who adopt this book may use this Power. Point to teach your course without prior permission. Please address questions and comments to mcheung@uh. edu. (c) Love Publishing: Monit Cheung & Patrick Leung 1

Mary’s DSM Diagnoses— An Example n n n Axis I: Clinical disorder II: Personality disorder III: General medical conditions IV: Psychological & environmental problems Axis V: Global assessment of functioning © Love Publishing: Monit Cheung & Patrick Leung 2

Mary’s Axis I: Clinical Disorders 300. 01 Panic Disorder 300. 04 Dysthymic Disorder 313. 82 Identity Problem 307. 1 Eating Disorder: Anorexia Nervosa–Binge Eating Type © Love Publishing: Monit Cheung & Patrick Leung 3

Mary’s Axis II: Personality Disorders 309. 28 Adjustment Disorder with Mixed Anxiety and Depressed Mood © Love Publishing: Monit Cheung & Patrick Leung 4

Mary’s Axis III: General Medical Conditions None Unexplained Headaches © Love Publishing: Monit Cheung & Patrick Leung 5

Mary’s Axis IV: Psychosocial & Environmental Problem V 61. 1 Partner Relational Problems Want to Complete Graduate School © Love Publishing: Monit Cheung & Patrick Leung 6

Mary’s Axis V: Global Assessment of Functioning GAF=60 Moderate Symptoms © Love Publishing: Monit Cheung & Patrick Leung 7

DSM-IV-TR? Joe’s DSM Diagnoses? Do we also need one for each family member? One for the entire family? © Love Publishing: Monit Cheung & Patrick Leung 8

Psychodynamic and FOO Theories & Applications © Love Publishing: Monit Cheung & Patrick Leung 9

Psychodynamic Practice n Goal n To free clients of unconscious restrictions so that they will be able to interact with family members and become healthy persons on the basis of current realities rather than unconscious images of the past. © Love Publishing: Monit Cheung & Patrick Leung 10

Psychodynamic Stems n Freudian Drive Psychology n n Self Psychology n n Sexual and aggressive drives Anxiety is an unpleasure associated with punishment because of a particular wish DM use Human beings crave appreciation Object Relations Theory / Attachment Theory n Need for attachment and relationships © Love Publishing: Monit Cheung & Patrick Leung 11

Joe and Mary Assign two role plays in pairs n First two persons: Issue 1: Unstable Relationship (pp. 93– 94) n Next two persons: Issue 2: Children as the Focus (pp. 95– 96) In groups of 4 discuss what it is like to use only psychodynamic as your approach © Love Publishing: Monit Cheung & Patrick Leung 12

Tic-Tac-Techniques © Love Publishing: Monit Cheung & Patrick Leung 13

Psychodynamic Techniques: Write down 9 techniques (i. e. , the corresponding number) on the bingo sheet. No repeats!! You need to get all 9 to win a prize. 1. 2. 3. 4. 5. 6. 7. 8. 9. Analysis of Anxiety Root Confrontation Dream Analysis Enactment Exploration Free Association Interpretation Intrapsychic conflict analysis Projection 10. 11. 12. 13. 14. 15. 16. Reexperiencing Resolving past issues Seeking the Unconscious Transference Using Past Feelings Universalization Investigating the Family of Origin © Love Publishing: Monit Cheung & Patrick Leung 14

Practice n n n Form a group of two students Take turns and practice each technique (from 1– 9) Process what social workers would do with these techniques (c) Love Publishing: Monit Cheung & Patrick Leung 15

Psychodynamic Techniques n n n DM analysis Genogram Object relations evaluation n Cultural values and norms Central egos Unconscious forces © Love Publishing: Monit Cheung & Patrick Leung 16

DM Analysis: pp. 114– 115 In pairs, read each example and find the DM n n n n n A. Compensation B. Denial C. Displacement D. Introjection E. Projection F. Rationalization G. Reaction Formation H. Regression I. Repression J. Sublimation © Love Publishing: Monit Cheung & Patrick Leung 17

DM Analysis: Applications Direct Approach: You said you ___; that sounds like a psychological defense. What are you worried about? Indirect Approach: People usually hide their feelings behind what they talk about; what kind of feeling do people have when they hide it? Game: Let’s try this game to see if you have use any DM in the past in your relationship. (Pay attention to contrast healthy vs. unhealthy DM’s) (c) Love Publishing: Monit Cheung & Patrick Leung 18

Families of Origin Theories FOO Principles n n Primary motivation is to establish a successful relationship. Early relationships with parents create frustrating experiences that the child couldn't change. © Love Publishing: Monit Cheung & Patrick Leung 19

Families of Origin Theories FOO Principles n Introjects may surface later in life through: n n n Forming close relationships through marrying and having children Allowing the frustrations experienced in the family of origin (FOO) in childhood to be recreated Resulting intrapsychic problems because of unresolved conflicts in the FOO Selecting partners who will precipitate the reexperiencing of unresolved FOO conflicts Projecting unresolved issues from FOO onto children, which causes symptoms in children. © Love Publishing: Monit Cheung & Patrick Leung 20

Families of Origin Theories FOO Principles n Problems are best resolved by taking them back to the FOO source by: n n Exploring the past to resolve issues with the FOO Relating to their own spouse and children as they actually are, rather than as symbols of unresolved conflict in the FOO. © Love Publishing: Monit Cheung & Patrick Leung 21

James Framo’s Techniques n n n n Meet with both partners in couple sessions Focus on events occurring in each FOO Initiate “group” family sessions Prepare couples who are reluctant Draw the couple's attention through preparation for “FOO sessions” Develop an agenda of issues to be discussed with the FOO Spouses are not included in the initial FOO session Spouses may be included in a later FOO session © Love Publishing: Monit Cheung & Patrick Leung 22

Limitations n n Not designed for couples with minor marital difficulties May not have access to their FOO Highlight the need for individual therapy, which may not be the original intent of the family Assumptions are based on past experiences in the FOO © Love Publishing: Monit Cheung & Patrick Leung 23

Joe and Mary Again… In the same group, n Three members role-play; one member observes, reading the technique line n Issue #3: Unresolved Conflict (pp. 96– 99) n Issue #4: Family of Origin Issues (pp. 99– 101) Discuss: What techniques you would use with your clients? © Love Publishing: Monit Cheung & Patrick Leung 24

FOO Techniques n n Using past feelings and experience to gain insight Seeking the unconscious Universalization Investigating the Family of Origin © Love Publishing: Monit Cheung & Patrick Leung 25

Practice n n n Form groups of two students Take turns and practice each technique (from 10– 16 in your Tic-tac game) by reading the line to your partner Process what social workers would do with these techniques © Love Publishing: Monit Cheung & Patrick Leung 26

How does a genogram help your client? n Find the most significant relationship issue n n n Beware of repeated incidents n n n Conflict patterns FOO Transmission Health/Illness Issues Job Causes of Death Role & Responsibilities Identify life cycle perspectives © Love Publishing: Monit Cheung & Patrick Leung 27

Daily Affirmation Today I continue to seek and find people who are positive, healthy and nurturing. Fishel, R. (1988). Time for joy. Deerfield Beach, FL: Health Communications. © Love Publishing: Monit Cheung & Patrick Leung 28