General Instructions: The purpose of this exam is to assess your knowledge and ability to conceptualize theory and practice from a psychoanalytic perspective. The exam is open-ended and thus you may use the course material (texts, readings, lectures etc.) to assist you in developing your best response to each question. Completed exams should be uploaded in Microsoft Word (i.e. .docx) format to CANVAS by THURSDAY, MARCH 24 BY 3:00PM. Be sure to use your time wisely as there will be 10pts automatically deducted from exams submitted after the deadline.
Question 1: Effectiveness of Psychodynamic Therapy (10 points)
Summarize the research providing the evidence base for psychodynamic therapy. What do studies show about the efficacy of long-term and short-term psychodynamic therapy? What kinds of psychological disorders is psychodynamic therapy effective in treating? Do these clinical benefits last?
Question 2: Classical Freudian Psychodynamic Theory (10 points)
Describe some of the basic concepts presented in Sigmund Freud’s classical theoretical models (drive, topographic—preconscious, conscious, and unconscious, structural—id, ego, superego etc.). How did he conceptualize the role of unconscious impulses and wishes in the development of symptoms? Discuss how classic methodologies like free association, interpretation and defense analysis can be used to create therapeutic change.
Question 3: Conceptualizing Interpersonal Psychoanalysis & Self Psychology (20 points)
Compare and contrast Sullivan’s Interpersonal Psychoanalysis and Kohut’s Self Psychology. How does each theory conceptualize healthy development of the self? What is their perspective on the role of parents in healthy personality development? Describe the clinical methodology used in each approach especially with regard to the relationship between the therapist and client?
Question 4: Considering Relational Psychoanalysis & Intersubjective Theory (20 points)
Describe the focus of Relational Psychoanalysis including the ways in which Relational Psychoanalysis conceptualizes the therapeutic relationship, and how social and/or cultural factors influence the process of psychotherapy. Remember that this model was influenced by Interpersonal Psychoanalysis, Self-Psychology, and Object Relations Theories. How do intersubjective concepts like empathic introspection reinforce multiple ways of understanding psychological phenomena?
Question 5: Case Conceptualization (40 points)
Read the following case material. Then, describe how you would conceptualize the case using psychoanalytic theory. Consider various psychoanalytic perspectives (drive, object relations, self psychology, interpersonal psychoanalysis, relational psychoanalysis etrc.) in your formulation. Describe the client’s presenting concerns and central themes as well as sociocultural issues that provide insight regarding her subjective experience of her symptom presentation. Be sure to note the major goals of psychotherapy, transference and counter-transference issues, and the nature of the therapeutic relationship. Describe how earlier life experiences may be impacting current emotional and relational functioning.
Justina, is a 32yo Puerto Rican cisgender woman presenting with depression who sought therapy to help her with symptoms of depression and anxiety. She recently took a leave of absence from her long-time position as a nurse due to the frequency of her panic attacks. She feels depressed, wakes up early in the morning (4-5am), and has little energy for work and family obligations. She reluctantly shared that one way she copes with her emotional difficulties is through eating and feels great shame that she has gained over 12 pounds in the past year. Moreover, she feels significant guilt about not fulfilling her family obligations. Most recently, her younger brother who had been living with her decided to move back to Puerto Rico. From her perspective, his decision to move back home represented her failure to resolve a dispute between him and her husband.
Justina was born and raised in Puerto Rico. She is the eldest child and has a younger sister and two younger brothers all who live in Puerto Rico. She describes her relationship with her mother as very close and idealizes her stating that she is “the perfect mother and wife”. She shares that her mother is nurturing, generous and “always there for the family” but sometimes to the detriment of her own personal needs. For example, she worries that her mother keeps putting off seeing a doctor despite some recent complaints about chronic pain because she wants to be available in case she is needed to provide childcare for her grandchildren. She describes her relationship with her father as similarly close. She notes that her father is a hard-worker and is impressed by his ability to provide for their family despite chronic instability to the Puerto Rican economy. As a young adult Justina boarded at her college institution in Puerto Rico while she earned a nursing degree. Her family expressed a lot of pride in her educational achievement and ability to live on her own. At the age of 20 she married a widower with a 12 yo son who was 10 years her senior. Following the wedding she moved to the mainland of the United States with her new family. She has tried to visit her family-of-origin once a year. While Justina is a U.S. citizen, she strongly identifies as Puerto Rican and adheres to the cultural values (respeto, familism, Marianismo, spiritualism via the Catholic faith) central to her ethnic culture. She is fluent in Spanish and English and speaks both languages at home with her husband and children.
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She describes her family life in the Northeast of the U.S. as generally positive. However, the family has endured several medical crises that have left her feeling vulnerable to anxiety at certain times of the year (July through November) when one or another of her family has been ill or seriously injured. In recent years, it has been increasingly difficult for her to live so far away from her parents as she worries about their health and ability to financially take care of themselves.
Justina is beginning therapy with some ambivalence. She is at a loss for how to reduce her depression and anxiety and feels like she needs help. However, she says that she is nervous about therapy and scheduled this initial appointment with you only at the recommendation of her family physician who has seen her family through many medical crises in the past. She trusts, respects and to some extent idealizes her PCP. In this initial appointment she is extending that trust to you, stating, “If Dr. Jones says you can help then I can at least give you a try. He’s the best and I’m sure he would only recommend me to someone who is just as good”. When you ask about her presenting concerns, she says that she has become increasingly worried and even depressed. She believes that this is an important time for her to make changes to her life to improve her mood.
Four months into the work, Justina reacted in one session, when she felt that you didn’t understand her point of view. She began to feel irritated with you, and questioned whether therapy could truly help her. In this session she was sharing more about the decision to move to the Northeast part of the U.S. shortly after she got married. She said that the initial decision was made by her husband in part due to the cultural prescription that the husband be the primary decision-maker in the household. She remembered that he had inquired whether she supported the decision but she was very clear that this query seemed pro forma and that to disagree would be a violation of cultural gender role expectations and considered disrespectful. However, she married at a time in her life when she was independent, making her own decisions and supporting herself. She wonders if part of her current unhappiness is related to not fulfilling her own expectations for who she is as a woman, wife, mother and professional. You ask if she wishes she had taken a different approach to her husband’s initial question about her support of the move. When asked this question, Justina felt annoyed and wondered if you were criticizing her for moving away from her family. You try to understand how Justina experienced your query and aspects of your and her subjectivity that may have contributed to this misattunement. Justina explains that she doesn’t want to disappoint her husband or children by saying she is unhappy but feels confused about how to meet her own needs. She says that your question feels both like a challenge as well as an invitation to put herself first. She feels conflicted.
SOURCES TO USE AND CITE ON THE MIDTERM BELOW:
Overview of Psychoanalytic Personality Theory & Therapy; Drive Theory Safran, Chapters 1&2
Freud, S. (1989). “The Case of Anna O”. P. Gay (ed.). In The Freud Reader: Sigmund Freud 1856-1939 1st Edition, pp61-78. New York: W.W. Norton
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109.
Psychoanalytic Personality Theory – Psychoanalytic Technique Safran, Chapter 3
Freud, S. (1989). “On Beginning Treatment”. P. Gay (ed.). In The Freud Reader: Sigmund Freud 1856-1939 1st Edition, pp363-378. New York: W.W. Norton
Freud S. (1993). Observations on Transference-Love : Further Recommendations on the Technique of Psycho-Analysis III. The Journal of psychotherapy practice and research, 2(2), 171–180.
Interpersonal Psychoanalysis and Object Relations Theory
Greenberg, J.R., & Mitchell, S.A. (1983). Object relations in psychoanalytic theory, pp.
79-115. Cambridge, MA: Harvard University Press.
McWilliams, N. (2012). Beyond Traits: Personality as Intersubjective Themes. Journal of
Personality Assessment, 94(6), 563-570.
Winnicott, D.W. (1986). Transitional objects and transitional phenomena: A study of the first not-me possession. In P. Buckley (Ed.), Essential papers on object relations, pp. 254- 271. New York: New York University Press.
Object Relations Theory and Self Psychology
Kohut, H. (1977). The restoration of the self. New York: International Universities Press.
Chapters 4-6.
Mahler, M. (1986). On human symbiosis and the vicissitudes of individuation. In P.
Buckley (Ed.), Essential papers on object relations, pp. 200-221. New York: New York University Press.
Intersubjective Theory and Relational psychoanalysis Safran, Chapters 4-5
Mitchell, S.A. (1998). The analyst’s knowledge and authority. The Psychoanalytic Quarterly, 67(1), 1-31.
Stolorow, R.D. (2002). Impasse, affectivity, and intersubjective systems. Psychoanalytic Review, Vol 89(3), Jun 2002, pp. 329-337.
Yi, K.Y. ( 2006) Transference and Race: an intersubjective conceptualization. InR.Moodley & S. Palmer (eds.). Race, Culture and Psychotherapy: critical perspectives in multiculturap practice, pp.74-88. New York: Routledge.
Psychoanalysis and Social Context: Race, Immigration, Social Class Ainslie, R.C. (2011). Immigration and the psychodynamics of class. Psychoanalytic
Psychology, 28(4), 560-568.
Leary, K. (2007). Racial insult and repair. Psychoanalytic Dialogues, 17(4), 539-549.
Tummala-Narra, P. (2015). Cultural competence as a core emphasis of psychoanalytic psychotherapy. Psychoanalytic Psychology, 32(2), 275-292.
Yi, K. (2014). Toward formulation of ethnic identity beyond the binary of White oppressor and racial other. Psychoanalytic Psychology, 31(3), 426-434.
Psychoanalysis and Social Context: Gender, Sexual Orientation Greene, B. (2013). The use and abuse of religious beliefs in dividing and conquering be
tween socially marginalized groups: The same-sex marriage debate. Psychology of Sexual Orientation and Gender Diversity, 1(S), 35-44.
Harris, A. (2002). Gender as contradiction. In M. Dimen & V. Goldner (Eds.), Gender in psychoanalytic space: Between clinic and culture, pp. 91-115. New York: Other Press.
McNamara, S. (2013). Gay Male Desires and Sexuality in the Twenty-First Century: How I Listen. Journal of the American Psychoanalytic Association, 61(2), 341-362.
Chodorow, N. J. (2005). Gender On the Modern-Postmodern and Classical-Relational Divide: Untangling History and Epistemology. Journal of the American Psychoanalytic Association, 53(4), 1097–1118.
