Monday, October 13, 2014

Introduction to Psychodynamic Theory: Paper Assignment

This is the paper requirement for second year Doctoral Candidates at William James College who take my section of “Introduction to Psychodynamic Theory”.  The point of the assignment is for students to integrate theory and practice. I am especially interested in having students think about and describe how their self-presentation is a key factor in their work.

Introduction to Psychodynamic Theory: Paper Assignments

You will be required to write two papers.  The first paper, 5 to 7 pages, is due the 9th week of class. Your first assignment is to demonstrate mastery of a key psychodynamic concept of your choice. Your task involves explicating the concept by showing its usage in theory and clinical practice. You will need to position the concept historically through reference to the literature.  Use at least three primary sources.  Consider whether the concept has undergone changes in meaning and whether the concept is used consistently by different theorists and practitioners. Provide at least two paradigmatic examples of how the concept is empirically or clinically employed.  

The second paper is due the next to last  week of class, 10 to 12 pages, not longer. Grades will be based on both the quality of the writing and the appropriate use of description, concepts, references, and theory. Note the hyperlinks that will take you to relevant content. 

The second paper is described below. 

Your task is to describe a clinical case. Attempt the following: I know you will not have all the information I am asking.  Don’t make anything up. Don’t be clearer than the available information allows. Be very clear about the status of the information you have. Backup your formulations with relevant clinical data from your relationship with your client and your understanding of your client's history. Respect what is ambiguous and uncertain. If it is ambiguous and uncertain, qualify what you say accordingly. If you speculate, say that that you are speculating. Your developing expertise requires a clear and honest acknowledgment of uncertainty and ambiguity. We never have the whole story but we always have enough to describe and act.  Clinical action, like everything else, has a degree of uncertainty. Your job requires you to improvise with the available information. This is what psychologists do. This is part of our essential expertise. We are experts at uncertainty. Psychotherapeutic engagement involves a trained and tolerant "mindful uncertainty".

Remember, if a description is adequate, little or no explanation may be necessary.  The devil is in the details.  Be detailed. Write in first person since this is your understanding. Provide appropriate reference to the course literature and lecture content. An absence of reference will weigh against you since I want evidence that you are actively considering the course content.  

I want you to provide a clinical formulation that begins with a clear and nuanced description in ordinary language of a person you are or have worked with. How well do you know this client? Tell me at the start how often and how long you have worked together. Describe your client so that I can see him or her as you do. This description should be followed by a developmental history that highlights the facts that seem relevant to understanding your client's clinically relevant opportunities and dilemmas. Following the developmental history, I want a description of the nature of your encounters with this person. 
           
I am not especially interested in the DSM diagnosis but you can comment on this if it is relevant to your interactions and understanding of your client.

The initial description should note the key status markers of age, birth order, gender, race, ethnicity, education, economic status, and physical presentation including grooming, manner of dress, attractiveness, and any other significant status or presentation marker. This description should also include what you see as the person’s significant values and life goals and their relevant knowledge base and skills.  Assets and liabilities should be apparent from the description including the nature of your client's intelligence and their ability to use language in making sense of themselves and their worlds. 

The developmental history should focus on life in their family, school, and other key relationships.  To the extent relevant and available, information regarding infancy, childhood, adolescence, early adulthood, and later periods should be offered. Note significant stresses, traumas, losses and opportunities taken or missed. This history should include details relevant to your formulation especially as it pertains to styles of relatedness and defense, patterns of trust and intimacy, hopes, anxieties and fears, life dreams, disappointments and accomplishments.

Why is this person in treatment or being assessed? 

Interaction for both the therapist and the client brings out different versions of our possibilities. What was evoked in your interaction? What personal attributes were engaged as you interacted? Did the relationship bring out strengths, vulnerabilities? 

With this in mind, I want a description of the nature of your relationship to this client.  Begin with a description of how this person sees you. Try to address the following:

Can they identify with you? What is the significance of your real world status and presentation to your client? How is your age, race, ethnicity, speech, gender, attractiveness, and social class relevant to how you are heard, understood and appreciated?   What do you have in common that facilitates or impedes therapeutic engagement? What do you not have in common? What informs, restricts or enhances your eligibility to effectively interact? How does the way your client see you shape the manner they work with you (and you, them)? Are there elements of competition or attraction in play? 

Themes of working alliance, transference, counter-transference, and role responsiveness should be illustrated with examples. Difficulties in empathy and appreciation should be noted.  If there have been previous therapies, indicate how this earlier work effects what your client expects from you.

Describe what you believe is a salient Through-line that characterizes your client's problematic behaviors. What is their perspective on this? Do they see it as you do?  Keep in mind that the significance of their behavior from their perspective may differ from its significance to you. If you believe they have significant  motivations that differ from what they are able or willing to acknowledge, describe this and note whether you think they are reluctant or unable to acknowledge these motivations. See Bad Faith, Self-Deception, and Unconscious Motivation: Restrictions in Effective Choice and On the Interpretation of Unconscious Action and Self-Deception for a guide in understanding and describing this unconscious or defensively avoided content.

(The through-line description should indicate features of what your client wanted (W), recognized (K), and knew how (KH) to do in problematic circumstances, what they actually achieved (A) and the significance (S) of this action for your client.)

Describe your client from the vantage of  DriveEgoObject-Relations, and Self Experience with reference to how these inter-related themes are manifested in your client’s relationship with you and others. This formulation is secondary to clear description and must refer back to an observational or developmental/historical base.  

This requires a summary of key "driven" motivations, urges and appetites, both conscious, reluctantly conscious, and unconscious (drive), and how these drives or urges are defended, satisfied and represented, including the possible presence of primary process thinking. The client's key defenses, adaptations and assets should be described (ego) as well as other key values and motives that are not "driven" such as major prudential, moral/ethical and aesthetic values (ego). Impulse control skills and affect toleration are part of this. Conscious and unconscious relational and body generated fantasies that provide toleration and strength or that provoke guilt, shame, anxiety, desire, and/or inhibition should be elaborated (object-relations). The client's sense of self, including self-esteem, cohesiveness, and authenticity should be described.

Finally, given your formulation, I want you to discuss possible treatment goals, strategies, and limitations.  Be realistic especially regarding the actual limitations of time and resource. What is ideal versus what is available should be considered. Keep in mind that your client may have goals that are different from what you wish and if so elaborate.  This is especially significant to the extent your client is a volunteer or partner in the treatment.  Remember, coercion elicits resistance and/or resigned compliance. Mandated clients are different from those that can fire you.

You might do well to follow this structure:

1. Describe your client’s appearance and presenting problems and note how often and for how long you have seen him or her.

2. Provide the information you have regarding your client’s developmental history.
3. Write about the nature of your relationship with your client and what you evoke in each other. 
4. Clarify a salient problematic intentional action pattern, a "through-line" and its significance to both you and your client. 
5. Summarize your client from the perspectives of drive, ego, object-relations, and self-experience. 
6. Indicate what the therapy is attempting to accomplish, your goals, the client’s goals and outcome. 



Edit carefully, it is a good idea to have someone read what you have written before I do.