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PT19 Enable the client in analytic/dynamic therapy to become aware of unexpressed or unconscious feelings
Overview
This standard is about enabling the client to find ways of acknowledging and expressing emotions against which they currently protect themselves: feelings that they fear or feelings of which they are only dimly aware. It includes sharing interpretations with the client in which the therapist uses information from a variety of sources. The therapist is open to the response from the client and is prepared to adapt and change their interpretation accordingly.
This standard describes therapeutic practice that has been shown to benefit individual adult clients engaged in therapy for healthcare reasons. (See reference in the additional information section on page 3.) To apply this standard, practitioners also need to take account of the multiple problems and complex co-morbidities that individual clients may bring to therapy.
Users of this standard will need to ensure that they are receiving supervision and that their practice reflects up to date information and policies. This standard should be understood in the context of the Digest of National Occupational Standards for Psychological Therapies.
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Knowledge and Understanding
You will need to know and understand:
Unconscious affect
- affects that are commonly expressed through unconscious processes
- common ways in which affects find indirect expression
- the ways in which the client’s imaginative life can be a vehicle for understanding their unconscious experience of themselves and others
Unconscious communication
- meaning in latent communication
- conditions under which unconscious communication is likely to emerge
- how to recognise unconscious communications
- how people use their bodies to communicate
Working with symbolic material and dreams
- theories relating to symbolic communication, including dreams
- how to explore and consider symbolic communication
- how to examine, explore and interpret symbolic communication and dreams
Work in the transference
- the forms of transference
- how to develop and work in the transference
- when and how to formulate dominant transference themes from the client’s assessment
- how to make a transference interpretation
- the emotional impact of transference interpretations
- the rationale and features of the analytic setting and stance
Work in the countertransference
- the forms of countertransference
- how to reflect on and consider countertransference
- how to make appropriate use of countertransference
- when and when not to interpret from countertransference
Working with defences
- psychoanalytic conceptions of the nature, processes and purposes of unconscious defences and how to identify them
- how to gauge the effects and implications of the client’s psychological functioning on their personality presentation
- the role of anxiety and defences in rendering some interpretations ineffective or destructive
- how to adopt and maintain an analytic stance
Interpretation
- the aims and work of interpretation
- the collaborative process of interpretation
Risk
- the potential for, and mechanisms of, exacerbation of problems for the client in therapy
- potential negative effects of the exploration of transference and counter-transference phenomena
- how to balance the risks around the exploration of transference and counter-transference phenomena
- how to use supervision in reducing the risks from the exploration of transference and counter-transference phenomena
Diversity in therapy
- how the characteristics of the client that help to construct identity may be subject to discrimination in therapy
- how to work with the psychodynamics of difference within the therapeutic relationship
- the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices
- the effect on personality and development of the experience of difference and external discrimination
Analytic/dynamic model of the mind
- the nature of mental life
- the different structures of the mind and their contribution to personality development
- the nature of the unconscious inner world of object-relations
- various analytic/dynamic models and techniques
Developmental theory
- developmental factors that shape the client’s experience of themselves and others
- theories of personality organisation
- developmental psychopathology
Interpersonal
- different interpersonal styles of relating and communicating
- skills of clarification
- skills of confrontation
- the significance of the therapist’s own experience of psychotherapy and self-knowledge
Performance Criteria
You must be able to do the following:
- help the client express the subjective meaning of their use of particular words, dreams, fantasies, non-verbal behaviours or somatic responses
- help the client explore internal and interpersonal obstacles to the awareness and expression of particular feelings
- draw attention to the client’s states of mind that seem unacceptable or uncomfortable to them
- enable the client to explore and become more aware of painful conflicts involving unacceptable or uncomfortable feelings that are otherwise managed by being kept out of their conscious awareness
- enable the client to become aware of and give meaning to incongruent, puzzling or unclear elements in their communication
- draw the client’s attention to anxieties that may lie behind their questions, statements and comments when you become aware of these
- explore with the client unverbalised affect when it is manifested in the session
- communicate to the client clear interpretations that capture multiple levels of meaning about their affective experiences beyond what they report consciously
- share interpretations with the client in a manner that:
- match what they can bear to think about at any given point
- are not too close to the end of a session
- move gradually from pre-conscious content to more unconscious content
- are pertinent to the focus of the session
- make it clear to them how you arrived at the interpretation
- maintain the focus of exploration on the transference relationship when necessary
- draw attention to how the client may be unconsciously protecting themselves and help them explore the meaning of their defensive structures
- facilitate the client’s reflection on the meaning of their anxiety generated by the exploration of defences
- contain the client’s experience of anxiety at a level they can work with if they feel too exposed
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help the client understand why they need to protect themselves from the experience of particular feelings or states of mind.
Additional Information
This National Occupational Standard was developed by Skills for Health.
This standard is derived from research reported in Lemma A, Roth A D and Pilling S (2009) The competences required to deliver effective Psychoanalytic/ Psychodynamic Therapy. Centre for Outcomes Research & Effectiveness (CORE) University College London.
This standard has indicative links with the following dimension within the NHS Knowledge and Skills Framework (October 2004).
Dimension: Core 1 Communication