Clinical Certificate Program Syllabus
Winter/Spring 2009
Program Description
Understanding and sensitively handling the vicissitudes of the therapeutic relationship are hallmarks of effective treatment. No one theory guarantees that therapeutic change will occur. However, clinicians are best served by using theory to inform their practice. This program explores the therapeutic process from several complementary psychodynamic frameworks, including: Attachment; Intersubjectivity; and Object Relations. These and other theories are used to formulate
strategies for assessment and intervention. Discussion includes how to meaningfully integrate neurobiological knowledge and cognitive behavorial strategies within a psychodynamic approach. The program aims to deepen and expand participants' understanding of key relational concepts such as: holding environmant; transference; countertransference; projective identification; self-disclosure; and enactment.
The program is designed for all levels of clinicians and is relevant to practitioners working in a variety of agency settings as well as those in private practice. It will focus primarily, but not exclusively, on clinical interventions with individual adult clients. The program’s faculty and supervisors are senior members of the Pennsylvania Society for Clinical Social Work (PSCSW), a professional organization which promotes and advances the specialization of clinical practice within the social work profession
Program Objectives:
Participants in this certificate program will: 1) explore the therapeutic process from several complementary psychodynamic frameworks including Object Relations, Intersubjectivity, and Attachment Theories; 2) use these and other theories to formulate strategies for assessment and intervention; and 3) discuss how to meaningfully integrate cognitive behavioral strategies within a psychodynamic approach.
Program Outline: January 8 – March 5
January 8, 15 and 22
Sessions 1-3: Attachment Theory
Instructor: Leda Sportolari, MSW, LCSW
“The therapist’s role is analogous to that of a mother who provides her child with a secure base from which to explore the world.”--Bowlby
Attachment Theory provides an overarching framework from which to understand our clients’ distress and their attempts to cope with that distress, as well the reparative potential of the therapy relationship. We will consider the centrality of attachment in early pre-verbal development, our ongoing attachment needs in adulthood, and the attachment styles which typically develop when a child or adult does not feel securely attached, exploring how these dimensions manifest and can be worked with in the therapy relationship. We will specifically discuss the developmental effects of neglect, abuse and loss in early childhood from an attachment perspective. Placing the theory in historical context, we will look at the evolution of thinking about attachment including: Bowlby and Ainsworth’s early seminal work on child development; Main’s consideration of adult attachment needs and styles; Johnson’s model for conceptualizing the dynamics of couples in distress; Main and Fonagy’s ideas about attachment’s role in developing the capacity for metacognition or “mentalizing”; and Cozolino’s explanation of the neurobiological underpinnings and implications of attachment. We will discuss Attachment Theory’s historically uneasy relationship with psychoanalytic thought and how it fits in with other psychodynamic theories.
January 29
Session 4: The Therapeutic Frame
Instructor: Karen Fraley, MSW, LCSW, BCD
Establishing and maintaining the therapeutic frame provides the essential groundwork for creating a psychological space in which both client and therapist can reflect, “play” and consider aspects of the self and other. This section will focus on setting boundaries and negotiating the nuts and bolts of the therapeutic relationship such as the initial phone call, starting and ending sessions, missed sessions and cancellations. In addition we will consider the therapist’s role in maintaining the therapeutic relationship through listening, responding and containing.
February 5 and 12
Session 5-6: Projective Identification
Instructor: Karen Fraley, MSW, LCSW, BCD
In the first of these two sessions, we will consider what projective identification is and how it works. The discussion will focus on the history of projective identification, the functions of it, as well as defense mechanisms related to it. Emphasis will be given to explicating the motivational forces of the internal world and the development of ego structure. The second session on this topic will focus on clinical experiences of projective identification and therapeutic technique. The class will explore the concepts of splitting and projective identification and their meaning according to the level of character structure. We will discuss the therapist's task in containing, listening and intervening. Readings will be taken from Ogden and Feldman.
February 19
Session 7: Subjectivity: Winicott’s Contributions
Instructor: Karen Fraley, MSW, LCSW, BCD
We will consider the question of subjectivity: How does a subject capable of experiencing emotions get developed? We will focus on Winnicott's elaborations and understandings of the establishment of an internal world as it applies to ego development and to the client-therapist relationship and his contributions to understanding projective identification within the baby/mother dyad. Using Winicott’s writing, we will discuss his ideas about transitional space and the work of the therapist in understanding the client.
February 26 and March 5
Sessions 8-9: Understanding Empathy: The Discipline of Psychotherapy
Instructor: Jacqueline Falkenheim, PhD, MSS, LCSW
Empathy is a familiar term in psychotherapy theory and practice. In order to appreciate the importance of this concept for clinical work, we will tease out the various attitudes, ways of communicating and perceiving (cognitive as well as affective), and categories for conceptualizing a client that are all aspects of empathic attunement. Drawing on the thinking of Greenson, Kohut, Mitchell, and Stolorow and Atwood, we will look at the evolution of ideas about empathy as a clinical function. We will then go on to examine the key role empathic attunement plays in assessment and treatment, or what Greenson (1960) refers to as developing a working model of who the client is and connecting to his or her subjective experience.
Program Outline: March 19 – May 21
March 12: No Class
March 19 and 26
Session 10-11: Personality Assessment: Psychodynamic Perspectives
Instructor: Jacqueline Falkenheim, PhD, MSS, LCSW
Following our discussion of empathic attunement, we will explore the significance of a psychodynamic form of personality assessment, as a way of connecting successfully to a client’s internal world. We will attend specifically to the work of Nancy McWilliams and her recommendations for thorough personality assessment and conceptualization. Taking as an example McWilliams’ humane and lucid explanation of how a person organized around a narcissistic personality structure tends to respond interpersonally and in therapy, we will consider why successful treatment often relies on our ability to have an elaborated conceptual model to guide interventions, understand countertransference, ground the ongoing therapy experience, and most importantly, help the client feel known and thus enhance her/his capacity for self-reflection.
April 2, 16 and 23 (no class April 9)
Sessions 12-14: Transference and Countertransference
Instructor: Miriam Field, MSS, LCSW
Facilitating self understanding is one of the main goals in psychodynamic treatment. Psychodynamic therapists recognize that much of mental life is outside of our conscious awareness and that childhood experiences work to shape the adult. By maintaining an awareness of our experiences in the room with our clients, we can learn a great deal about their early experiences and the quality of their relationships with others. In our first session, we will discuss how understanding the transferences in the therapeutic relationship can enhance our work with clients, looking carefully at what we mean when we talk about transference and how can we use transference as a technique to further growth. The second session will focus on the countertransference. Awareness of our own emotional reactions to the client provides further insight and understanding in our work. We will take up the technical question of how countertransference differs from the therapist’s transference to the client. In the third session we will look at enactments which occur as a result of the intense interaction between the therapist and the client, considering their inevitability as well as their usefulness if they are understood and handled thoughtfully. The third session of this series will also be concerned with therapeutic boundaries. We will consider the difference between boundary crossings and boundary violations.
April 30
Session 15: Termination
Instructor: Nita Laver, MSW, LCSW
The termination phase of treatment is an opportunity to consolidate and integrate the growth that has occurred in the therapy. For both the therapist and the client there are important issues around separation and loss, transference and countertransference, maintaining the frame and experiencing and exploring a wide range of emotions that impact on the process of the ending.
May 7, 14 and 21
Sessions 16-18: Enhancing Relational Psychodynamic Therapy with CBT
Instructor: Peggy Vogt, MSW, LCSW
The demands of contemporary clinical practice require flexibility in the use of self and choice of interventions. These two sections will present an approach for using cognitive-behavioral techniques within a relational psychodynamic framework.
May 7: Overview of the Cognitive and Behavioral Therapies
Historical overview of the cognitive-behavioral therapies, including behavior therapy and Beck’s model of cognitive therapy. Relevant ideas about the therapeutic alliance in CBT will be compared and contrasted with a psychodynamic approach. This class will discuss specific techniques and interventions, such as symptom logs, relaxation training, skills training, and behavioral experiments. Attention will be paid to how such interventions may impact on transference and countertransference. Case material from the instructor’s own practice will be used to illustrate concepts.
May 14: Mindfulness in Therapy
The “third wave” of contemporary approaches to cognitive-behavioral therapy that integrate mindfulness meditation practices will be discussed. Concepts and strategies drawn from Kabat-Zinn, Linehan, and other authors will be included.
May 21: Trauma as a Paradigm for Integrating CBT into Relational Therapy
A case example of treating a trauma survivor will be presented and used to illustrate ideas and strategies from the two preceding classes.
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