Samenvatting Psychodynamische therapie: integratie slides, colleges, handboek & artikels

PSYCHODYNAMISCHE THERAPIE
COLLEGE 1: PSYCHODYNAMISCHE THERAPIE - PSYCHOANALYSE .................................................15
Vrije associatie ..........................................................................................................................................15
Psychodynamische therapie versus psychoanalyse ...................................................................................15
Overeenkomsten .............................................................................................................................15
• Focus op het onbewuste: ............................................................................................15
• Bevrijding van verdrongen gevoelens: ..........................................................................15
• Rol van de therapeut: ..................................................................................................15
Verschillen.......................................................................................................................................15
• Intensiteit en duur: ......................................................................................................15
• Werkwijze: ..................................................................................................................15
• Focusthema's: ............................................................................................................15
• Evidence-based ..........................................................................................................15
Waarom psychodynamische psychotherapie? ...........................................................................................16
1. Waarom psychotherapie? ............................................................................................................16
Artikel: “Is more psychotherapy a dead horse?”: STEPPED CARE .......................................................16
Werkzaamheid psychotherapie: Algemene factoren in de psychotherapie (artikel Berk, 2008) ...........20
Figuur: Percent of improvement in psychotherapy patients as a function of therapeutic factors ....20
o Common factors (algemene of gemeenschappelijke factoren) .........................................20
o Placebo-effect ................................................................................................................21
o Techniek..........................................................................................................................21
o Extratherapeutische factoren...........................................................................................21
Dodobird Verdict .........................................................................................................................21
Opgelet: ......................................................................................................................................21
Psychotherapy effectiveness (Bruce Wampold & Pim Cuijpers) ....................................................22
Tabel 4.1. Professional characteristics and treatment outcome ...................................................23
Waarom psychodynamische therapie? .............................................................................................23
o Keuzemogelijkheid ..........................................................................................................23
o Diagnostiek .....................................................................................................................23
o (Tegen)overdracht ............................................................................................................23
o Eigen leertherapieproces & supervisie .............................................................................23
o Belang van onbewuste factoren .......................................................................................23
2. Wat is psychodynamische therapie? ............................................................................................24
Figuur: What therapy? ......................................................................................................................24
Basisingrediënten over alle vormen van psychodynamische therapie heen: ......................................24
o Het kader: .......................................................................................................................24
o De relatie: .......................................................................................................................24
o Analyse van conflicten/weerstanden/afweermechanismen ..............................................24
o Het onbewuste/‘vreemde’ ...............................................................................................25
3. Hoe werkt psychodynamische therapie?......................................................................................25
The status of psychodynamic psychotherapy as an empirically supported treatment for common
mental disorders..............................................................................................................................25
4. Een voorbeeld van psychodynamische therapie ...........................................................................26
Psychodynamische behandeling van somatische symptoomstoornis in de praktijk ...........................26
Freud versus Abbass ........................................................................................................................27
Aanpak ‘Somatische symptoomstoornissen’ in de kliniek .................................................................28
5. Conclusie: waarom psychodynamische therapie in het curriculum? ............................................28
Waarom psychodynamische therapie? .............................................................................................28
o Keuzemogelijkheid ..........................................................................................................28
o Diagnostiek .....................................................................................................................28
o (Tegen)overdracht ............................................................................................................28
o Eigen leertherapieproces & supervisie .............................................................................28


1

, o Belang van onbewuste factoren .......................................................................................28
De student als scientist-practitioner: ...............................................................................................29

COLLEGE 2: BASISASSUMPTIES V/H PSYCHOANALYTISCH REFERENTIEKADER ..............................30

HOOFDSTUK 1 HANDBOEK – INLEIDING ................................................................................................... 30
Basisassumpties (p.16-17 handboek) ........................................................................................................30
o Psychoanalyse = grens psychologie & biologie .................................................................30
o Onbewuste processen.....................................................................................................30
o Onbewust t.g.v.: ..............................................................................................................30
o Pathologie = 2 vormen: ....................................................................................................30
o Continuüm normaliteit – pathologie .................................................................................31
o Verdringing = vorm van afweer of beveiligingsmechanisme ...............................................31
o Objectrelaties .................................................................................................................31
o 2 polen op 1 as: autonomie – verbondenheid/intimiteit: ...................................................31
o Afgeweerde processen of voorstellingen kunnen in symbolische vorm opnieuw tot uiting
komen:...................................................................................................................................32
o Elk gedrag heeft betekenis, of zin. ....................................................................................32
Hoe werkt PDT: basisprincipes...................................................................................................................32
Misvattingen (7): ..............................................................................................................................32
4 Basisprincipes: .............................................................................................................................32
6 onderscheidende technische kenmerken PDT ( i.t.t. common factors): ......................................33
Theoretical and empirical foundations of contemporary psychodynamic approaches (Luyten et al.,
2015) ..........................................................................................................................................33
Artikel: That was then, this is now: psychoanalytic psychotherapy for the rest of us (Shedler, 2002) ...34
I. Onbewust mentaal leven ..........................................................................................................34
II. Intrapsychisch conflict - defensiemechanismen ......................................................................34
III. Herhaling van het verleden .....................................................................................................39
IV. Overdracht & tegenoverdracht ................................................................................................40
Psychological causation ..............................................................................................................42
What’s good for the goose ...........................................................................................................44

COLLEGE 3: HET ONBEWUSTE (S. FREUD) .....................................................................................46

HOOFDSTUK 3 HANDBOEK– FREUD: HET DRIFT- EN CONFLICTMODEL ............................................................... 46
Deel 1 – Nabespreking film ‘My name was Sabina Spielrein’ .......................................................................46
Deel 2 – De deeltheorieën: driftmodel ........................................................................................................46
1. Inleiding ......................................................................................................................................46
o 2 stromingen ...................................................................................................................46
o Ontwikkeling van het model van het onbewuste: ‘anatomie van de subjectiviteit’ ..............46
o Intrasubjectiviteit → intersubjectiviteit.............................................................................47
o De psychische realiteit van de ander is per definitie onkenbaar ........................................47
2. De deeltheorieën ........................................................................................................................47
Theoretical and empirical foundations of contemporary psychodynamic approaches (Luyten et al.,
2015): overzicht deeltheorieën (tabel) ..............................................................................................47
3. Ontwikkeling van het drift- en conflictmodel bij Freud ..................................................................48
Drift .................................................................................................................................................48
o Oftewel ...........................................................................................................................48
o Basisaanname: ...............................................................................................................48
o De drift ligt voor Freud op de grens v/d .............................................................................48
o Streeft naar .....................................................................................................................49
o 2 driftmatige tendenties binnen het organisme:................................................................49
o Er zijn ook partiële driften ................................................................................................49
Drift- en conflictmodel .....................................................................................................................49
o Centraal ..........................................................................................................................49
o Ontwikkeling: ..................................................................................................................49

2

, o Focus ..............................................................................................................................49
o Structurele model ...........................................................................................................49
o Ambivalenties → schuldgevoelens: .................................................................................50
o In therapie: ......................................................................................................................50
Deel 3 – Een zoekende Freud .....................................................................................................................50
Evolutie in de ontwikkeling van zijn denken over het psychisch functioneren in 3 modellen ................50
1. Affecttraumamodel: van herinneren naar afweer en verdringen ....................................................51
Studien über Hysterie ......................................................................................................................51
Het hysterische symptoom ..........................................................................................................51
Psychisch trauma als oorzaak van de neurose .............................................................................51
Omstandigheden eigen aan de pathogene situatie .......................................................................52
Seksualiteit .................................................................................................................................52
Nachträglichkeit..........................................................................................................................52
Affecttraumamodel of verleidingstheorie: ....................................................................................53
Afweer & verdringing: ..................................................................................................................53
Onderscheid angstneurose/psychoneurose: ...............................................................................54
Hysterie: .....................................................................................................................................54
Overdeterminering ......................................................................................................................54
Weerstand ..................................................................................................................................54
Entwurf einer Psychologie ................................................................................................................55
2. Het topografisch model: intrapsychische wensen ........................................................................55
Trauma → seksualiteit .................................................................................................................55
Die Traumdeutung ...........................................................................................................................56
o Eerste traumatheorie wordt verworpen o.b.v. 2 argumenten..............................................56
o Fantasieën ......................................................................................................................56
o Innerlijke wensen/strevingen = motivationele kracht achter: .............................................56
o Compromisvorming als oplossing van een conflict tussen: .............................................57
o Droom .............................................................................................................................57
o Centraal ..........................................................................................................................57
o Het onbewuste ................................................................................................................57
o Het voorbewuste .............................................................................................................57
o Het bewuste ....................................................................................................................58
o Psychoanalyse als betekenisverlenende activiteit ............................................................58
Drei Abhandlungen zur Sexualtheorie ...............................................................................................58
o 3 hoofdstukken: ..............................................................................................................58
o 2 grote driften: .................................................................................................................58
o Biseksualiteit: .................................................................................................................58
o Psychoseksuele ontwikkeling ..........................................................................................59
• Partiële driften: ...........................................................................................................59
• Erotogene zones: ........................................................................................................59
• Soma/zelf ...................................................................................................................59
• Biologische strevingen kanaliseren ..............................................................................59
• Deze strevingen ...........................................................................................................59
• ‘Seksuele’ wensen.......................................................................................................59
• Fasen psychoseksuele ontwikkeling ............................................................................59
o Normale ontwikkeling v/d partiële driften in de vroegkinderlijke seksualiteit versus
vroegseksuele uitingen bij volwassenen ..............................................................................59
• Orale karakter: (perverte) fixatie orale fase .................................................................59
• Anale karakter: ............................................................................................................60
• Fallische karakterfase: ................................................................................................60
o Tegenwoordig: .................................................................................................................60
o Verdringing ......................................................................................................................60
o Herhalingsdwang en doodsdrift .......................................................................................60
o Aanzet tot das Ich und das Es (tweede topografie) ............................................................61

3

, • Herhalingsdwang ........................................................................................................61
• Taak van de therapeut : ................................................................................................61
3. Tweede topgrafie: het structurele model ......................................................................................61
o ID: ...................................................................................................................................61
o SUPEREGO: ....................................................................................................................61
o EGO: ...............................................................................................................................62
o Aandacht verschoven van ID naar EGO ............................................................................62
o Conclusie in dit model .....................................................................................................62

COLLEGE 4: A. FREUD EN M. MAHLER - OBJECTRELATIETHEORIEËN VANUIT DE EGOSPYCHOLOGIE 63

HOOFDSTUK 4 – A. FREUD EN M. MAHLER: OBJECTRELATIETHEORIEËN VANUIT DE EGOPSYCHOLOGIE ...................... 63
4.1. Inleiding ....................................................................................................................... 63
Vorige les: 1ste & 2de topiek .........................................................................................................................63
Objectrelationele benadering ....................................................................................................................63
o In structureel model of 2de topiek: ....................................................................................63
o Objectrelatietheorieën: ...................................................................................................63
Deeltheorieën ...........................................................................................................................................64
Meerstromenland in de psychoanalyse (figuur) ..........................................................................................65
Van buiten naar binnen ..............................................................................................................................66
In de behandeling ......................................................................................................................................66
o Corrigerende emotionele ervaring ....................................................................................66
o Houding van de therapeut ................................................................................................66
o Doel: ...............................................................................................................................66
o Angst:..............................................................................................................................66
o Pre-oedipale problematiek ..............................................................................................66
o Ambitendenties ...............................................................................................................66
o Mentale representaties ....................................................................................................66
Objectrelatietheorieën vanuit de egopsychologie .......................................................................................67
Objectrelatietheorieën in meer strikte zin...................................................................................................67
Objectrelatietheorieën vanuit de independents .........................................................................................67
4.2. A. Freud ........................................................................................................................ 68
o Interpretatie/verwerking van scheiding in de mind: ...........................................................68
o Internaliseren ..................................................................................................................68
o Conflict- en structurele model: ........................................................................................68
o Nadruk op bevrediging van driften ....................................................................................68
o Reële ouders ...................................................................................................................68
o Concept van ontwikkelingslijnen:.....................................................................................68
o Ontwikkeling objectrelaties .............................................................................................68
o 1 ontwikkelingslijn uitgelicht ............................................................................................68
8 stappen ontwikkeling naar balans autonomie/verbondenheid: .......................................................68
o Biologische eenheid tussen moeder en kind (1ste levensjaar):..........................................69
o Behoeftebevredigende anaclytische relatie (2de deel 1ste levensjaar): ..............................69
o Objectconstantie (2de & 3de levensjaar): ..........................................................................69
o Verdragen van ambivalenties (3de levensjaar): .................................................................69
o Objectgerichtheid (4-5 jaar): ............................................................................................70
o Latentieperiode (6-7 jaar):................................................................................................70
o Preadolescentie/puberteit (12-13 jaar): ............................................................................70
o Adolescentie (vanaf 18 jaar): ............................................................................................70
Visie van A. Freud op de ontwikkeling v/d angst: ................................................................................71
Onderscheid tussen conflictpathologie & ontwikkelingspathologie ...................................................71
4.3. M. Mahler ..................................................................................................................... 71
o Biologische geboorte ≠ psychologische geboorte .............................................................71
o Invloeden van de drift- en egopsychologie ........................................................................71
o Differentiatie (ik – ander) via separatie en individuatie ......................................................71

4

, o Ontwikkeling kind → zwaartepunt: ...................................................................................71
o Ontwikkeling van objectrelaties .......................................................................................71
o Ontwikkelingsfasen: ........................................................................................................72
• Normaal autisme: .......................................................................................................72
• Symbiotische fase (2de maand): ...................................................................................72
• Separatie- en individuatieproces .................................................................................72
• Separatie- en individuatieproces (vanaf 3 maand) ........................................................72
Schematische weergave v/h separatie-individuatieproces ................................................................73
o Differentiatie (3-8 maand) ................................................................................................73
o Practising (8-16 maand) ...................................................................................................73
o Toenaderingsfase (16-24 maand) .....................................................................................74
o Toenemende objectconstantie (3 jaar) .............................................................................74
A. Freud versus M. Mahler ................................................................................................................75

COLLEGE 5: M. KLEIN EN DE OBJECTRELATIETHEORIE & ‘THE INDEPENDENTS’ M. BALINT EN D.W.
WINNICOT ...................................................................................................................................76

HOOFDSTUK 5 – M. KLEIN EN DE OBJECTRELATIETHEORIE ............................................................................. 76
Deeltheorieën ...........................................................................................................................................76
Vorige les: A. Freud & Mahler .....................................................................................................................77
5.1. M. Klein ........................................................................................................................ 78
o Zowel drifttheorie als objectrelationele theorie ................................................................78
o Objectrelaties .................................................................................................................78
o Het ego: ..........................................................................................................................78
o M. Mahler separatie-individuatie ......................................................................................78
o Essentieel: ......................................................................................................................78
o Centraal: .........................................................................................................................78
Phantasy: ........................................................................................................................................78
o Wat? ...............................................................................................................................78
o Onbewuste expressie van driften in het onbewuste mentale leven....................................78
o Het vormen van primitieve onbewuste fantasieën is een egofunctie: ...............................78
o Phantasy .........................................................................................................................78
o Phantasy simpel: .............................................................................................................79
o Van in ’t begin = actief primitief fantasieleven ...................................................................79
o Spel ................................................................................................................................79
o Het slechte......................................................................................................................79
o Het goede .......................................................................................................................79
o Hypochondrische angsten ...............................................................................................79
o Scheiding ........................................................................................................................79
o Phantasy: innemen en uitstoten, introjectie en projectie ..................................................79
Hanna Segall (1973) .........................................................................................................................80
o In de fase van behoeftebevrediging (‘lustprincipe heeft de overhand’): .............................80
o Voorbeeld van incorporeren van de melkgevende borst: ..................................................80
o Voorbeeld hongerige, razende baby die krijst en schopt en de borst letterlijk aanvalt .........80
Envy & gratitude ...............................................................................................................................80
o Essentieel .......................................................................................................................80
o Rol die primitieve ervaringen spelen.................................................................................80
o Bij kinderen .....................................................................................................................80
o Nijd .................................................................................................................................81
•
Destructieve impuls ....................................................................................................81
•
≠ jaloersheid: ..............................................................................................................81
•
≠ gretigheid: ................................................................................................................81
o Gratitude of dankbaarheid: ..............................................................................................81
Een zekere mate van agressie is nodig voor zelfbehoud .....................................................................81


5

, o Agressie = normaal ..........................................................................................................81
o Andere bron van agressie: ................................................................................................81
o Pijnlijke affecten worden naar buiten geprojecteerd: ......................................................82
Patiënt autonomer dan bij de Freudianen .........................................................................................82
Paranoïde-schizoïde en depressieve positie .....................................................................................82
Paranoïd-schizoïde positie ...............................................................................................................82
o Wat? ...............................................................................................................................82
o Anderen: .........................................................................................................................82
o Partiële deelobjecten: .....................................................................................................82
o Splijting ...........................................................................................................................82
o Vroege phantasy: .............................................................................................................82
o Goede objecten ...............................................................................................................83
o Verlies v/h ‘goede’ object: ................................................................................................83
o P: ....................................................................................................................................83
o S: ....................................................................................................................................83
o In de normale ontwikkeling ..............................................................................................83
o Splitsing ..........................................................................................................................83
Depressieve positie..........................................................................................................................84
o Wat/wanneer? .................................................................................................................84
o Centraal: .........................................................................................................................84
o Integratie .........................................................................................................................84
o Angst...............................................................................................................................84
o Het kind zal gaandeweg ervaren dat: ................................................................................84
o Ego..................................................................................................................................84
o Angsttolerantie ................................................................................................................84
o De ander kan gezien worden als een totaliteit ...................................................................84
o Introjectie versus projectie ..............................................................................................84
o Nieuwe opgave: ...............................................................................................................85
o Angst...............................................................................................................................85
o Almacht versus onmacht .................................................................................................85
o Oedipaal conflict .............................................................................................................85
Projectieve identificatie....................................................................................................................85
5.2. W. R. Bion ..................................................................................................................... 86
Kleiniaan: ........................................................................................................................................86
Learning from experience .................................................................................................................86
o ‘Container en contained’: ................................................................................................86
o Primaire relatie met de moeder ........................................................................................86
o Verdragen + verteren: .......................................................................................................86
o Rêverie ............................................................................................................................86
o Afwezigheid adequate container: .....................................................................................87
o Learning from experience: ...............................................................................................87
α-elementen en β-elementen ...........................................................................................................87
o β-elementen ...................................................................................................................87
o α-functie .........................................................................................................................87
o α-elementen: ..................................................................................................................87
HOOFDSTUK 6 – BALINT EN WINNICOT..................................................................................................... 88
6.1. Winnicot ....................................................................................................................... 88
o Historiek: ........................................................................................................................88
o Beroemde uitspraak: .......................................................................................................88
o Geen model van driftbevrediging of frustratie ...................................................................88
o Wel de primaire relatie of de verbondenheid tussen moeder en kind .................................88
o 2 centrale begrippen: .......................................................................................................88
Holding ............................................................................................................................................88
o Wat? ...............................................................................................................................88

6

, o Primaire moederlijke preoccupatie ..................................................................................88
o Noodzakelijk voor: ...........................................................................................................89
o Wat betekent dit? ............................................................................................................89
o In therapie .......................................................................................................................89
True en false self ..............................................................................................................................89
o True self: .........................................................................................................................89
o False self:........................................................................................................................90
o Voorbeelden....................................................................................................................90
6.2. Balint ........................................................................................................................... 90
o Centraal: .........................................................................................................................90
o Behoefte of wens om geliefd te worden ............................................................................90
o Relatie autonomie/verbondenheid: ..................................................................................90
o BASIC FAULT ...................................................................................................................91
o Heling .............................................................................................................................91

COLLEGE 6: KOHUT & KERNBERG .................................................................................................92
Deeltheorieën ...........................................................................................................................................93
HOOFDSTUK 7 – KOHUT: DE ZELFPSYCHOLOGIE ......................................................................................... 95
7.1. Kohut en het zelf ........................................................................................................... 95
2 kernbegrippen ........................................................................................................................................95
o Narcisme: .......................................................................................................................95
o Zelf: ................................................................................................................................95
Narcistische persoonlijkheidsstoornis .......................................................................................................95
o Voor Kohut: .....................................................................................................................95
o Narcisme bij Kohut verschilt van narcisme bij Kernberg: ...................................................96
7.2. De zelfpsychologie ........................................................................................................ 96
Twee soorten zelfobjecten: ........................................................................................................................96
1. Archaïsche zelfobjecten ..............................................................................................................96
2. Rijpere zelfobjecten ....................................................................................................................96
• Spiegelende objecten: grandioze zelf ...........................................................................96
• Geïdealiseerd zelfobject: geïdealiseerde ouderobjecten ..............................................96
• Alterego: twinship .......................................................................................................96
Normaal- pathologisch narcisme ...............................................................................................................97
o Normaal narcisme: ..........................................................................................................97
o Pathologisch narcisme: ...................................................................................................97
• Beschadigd zelf: ..........................................................................................................97
• In therapie:..................................................................................................................97
• Verwachtingen ............................................................................................................97
• Objectrelaties .............................................................................................................97
• Continuüm .................................................................................................................97
• 2 ontwikkelingslijnen ...................................................................................................97
• Therapie......................................................................................................................97
Sidenote: ..................................................................................................................................................98
Stoornissen van het zelf .............................................................................................................................99
Primaire stoornissen: .......................................................................................................................99
o Psychose:........................................................................................................................99
o Borderline: ......................................................................................................................99
o Narcistische stoornissen volgens Kohut: ..........................................................................99
7.3. Pathologische vormen van het zelf ................................................................................. 99
o Ondergestimuleerde zelf: ................................................................................................99
o Gefragmenteerde zelf .................................................................................................... 100
o Overgestimuleerde zelf: ................................................................................................. 100
o Overbelaste zelf: ........................................................................................................... 100


7

, Narcistische persoonlijkheidsstoornissen ............................................................................................... 101
o Persoonlijkheden hongerend naar spiegeling: ................................................................ 101
o Persoonlijkheden hunkerend naar geïdealiseerde objecten: ........................................... 101
o Alterego- persoonlijkheden ............................................................................................ 101
o Persoonlijkheden hunkerend naar samensmelting: ........................................................ 101
o Contactvermijdende persoonlijkheden: ......................................................................... 101
HOOFDSTUK 8 – KERNBERG: INTEGRATIE VAN HET DRIFT- EN HET OBJECTRELATIONELE CONFLICTMODEL .................. 102
8.1. Kernberg ..................................................................................................................... 102
8.2. Innerlijke structuur ...................................................................................................... 102
INTROJECTIE .................................................................................................................................. 103
IDENTIFICATIE ............................................................................................................................... 103
IDENTITEIT ..................................................................................................................................... 104
8.3. Ontwikkelingsfasen bij Kernberg ................................................................................... 104
6. Gezonde (‘normale’) persoonlijkheid .................................................................................... 106
8.4. Structurele pathologie ................................................................................................. 106
o Neurotische pathologie ................................................................................................. 106
o Structurele pathologie ................................................................................................... 106
o ‘Borderline states’ – borderline ‘structuur’: ..................................................................... 106
o Borderline structuur naast psychotische en neurotische structuur ................................. 106
o Indeling langs 3 dimensionele concepten: ..................................................................... 106
Verschillende persoonlijkheidsorganisaties ............................................................................................. 107
Identiteit: ....................................................................................................................................... 107
o Wat? ............................................................................................................................. 107
o Identiteitsdiffusie .......................................................................................................... 107
o NPO: ............................................................................................................................. 107
o BPO: ............................................................................................................................. 107
o PPO: ............................................................................................................................. 108
Afweer: .......................................................................................................................................... 108
o Convergerende afweer .................................................................................................. 108
o Divergerende afweer:..................................................................................................... 108
o NPO: ............................................................................................................................. 108
o BPO: ............................................................................................................................. 108
o PPO: ............................................................................................................................. 108
Realiteitstoetsing: .......................................................................................................................... 109
o Wat? ............................................................................................................................. 109
o Bij NPO & BPO ............................................................................................................... 109
o NPO: ............................................................................................................................. 109
o BPO: ............................................................................................................................. 109
3 Niveaus van mentaal functioneren .............................................................................................. 110
o Hoog: ............................................................................................................................ 110
o Gemiddeld: ................................................................................................................... 110
o Laag: ............................................................................................................................. 110
Therapie ........................................................................................................................................ 111
o NPO: ............................................................................................................................. 111
o BPO: ............................................................................................................................. 111
o PPO: ............................................................................................................................. 111
Tot slot: NPO/BPO .......................................................................................................................... 112
o Fantasieën .................................................................................................................... 112
o BPO: afstand/nabijheid.................................................................................................. 112
o Relatie .......................................................................................................................... 112
o Verleden/heden............................................................................................................. 112




8

,COLLEGE 7: PSYCHODYNAMISCHE THERAPIE BIJ KINDEREN, JONGEREN EN GEZINNEN - COMPLEX
TRAUMA .................................................................................................................................... 113
1. Complex trauma, een definitie................................................................................................... 113
DSM-V definitie trauma: ................................................................................................................. 113
Wanneer is een (reeks) gebeurtenis(sen) traumatisch? ................................................................... 113
Impact op zorgomgeving: ............................................................................................................... 114
Gedragspatronen ........................................................................................................................... 115
2. De impact van complex trauma op de ontwikkeling van het kind ................................................ 115
4 ontwikkelingsdomeinen waar de impact van complex trauma aanzienlijk is: ................................. 116
3. De impact van complex trauma op primaire zorgfiguren en het netwerk...................................... 117
4. Diverse en complexe mentale gezondheidsnoden van getraumatiseerde kinderen en hun gezin . 118
5. Basisveronderstellingen v/e psychodynamisch behandelmodel voor complex trauma ................ 119
Ontwikkelingsperspectief............................................................................................................... 119
Mentaliserende relaties facilteren het herstel van complex trauma ................................................. 119
Interventies op proces- en inhoudsniveau ...................................................................................... 121
Spel en speelsheid als basis van herstel ......................................................................................... 124

COLLEGE 8: GEHECHTHEIDSMODEL - INTERACTIONEEL DENKEN, OP WEG NAAR INTEGRATIE -
LAATSTE DEELTHEORIE: ‘HET INTERACTIONEEL MODEL’ .............................................................. 127
Deeltheorieën ......................................................................................................................................... 127
HOOFDSTUK 9 – BOWLBY & D. STERN: ATTACHMENT EN INTERSUBJECTIVITEIT .................................................. 128
9.1. Bowlby ....................................................................................................................... 128
Wat is hechting? ............................................................................................................................ 128
Hechtingssysteem ......................................................................................................................... 128
o Wat? ............................................................................................................................. 128
o Veiligheid & hechting ..................................................................................................... 128
Onbewuste innerlijke werkmodellen .............................................................................................. 128
o Wat zijn onbewuste innerlijke werkmodellen? ................................................................ 128
o Welke rol spelen deze werkmodellen in het verdere leven? ............................................. 128
Behandeling .................................................................................................................................. 129
o Een psychoanalytische behandeling is erop gericht deze onbewuste werkmodellen: ...... 129
o Centraal: ....................................................................................................................... 129
o Op welk niveau interveniëren we? .................................................................................. 129
o Therapeut:..................................................................................................................... 129
Onderzoek ..................................................................................................................................... 129
Veilige versus onveilige hechting .................................................................................................... 130
Classificatie................................................................................................................................... 130
Gehechtheidsstijlen Adult Attachment Interview (Main, Kaplan & Cassidy, 1985) ............................ 130
o Veilig/autonoom: ........................................................................................................... 130
o Gepreoccupeerd: .......................................................................................................... 130
o Vermijdend:................................................................................................................... 130
o Gedesorganiseerd (switchen tussen angstig en vermijdend): .......................................... 130
9.2. Stern .......................................................................................................................... 131
Ontwikkeling van het zelf ................................................................................................................ 131
o Emergent self ................................................................................................................ 131
o Core self ....................................................................................................................... 131
o Subjective self ............................................................................................................... 131
o Verbal self ..................................................................................................................... 131
Belangrijke concepten voor therapie .............................................................................................. 131
o The present moment ..................................................................................................... 131
o Intersubjective moment:................................................................................................ 132
o Emotionele afstemming................................................................................................. 133
o Moments of intersubjective meeting: ............................................................................. 133


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, HOOFDSTUK 10 – VAN DIFFERENTIATIE NAAR INTEGRATIE: FONAGY ............................................................... 135
10.1. Op weg naar integratie: toewending tot de research....................................................... 135
o Wat? ............................................................................................................................. 135
o Intersubjectiviteit .......................................................................................................... 135
o 2 ≠ tendensen in de psychoanalyse (continuüm) ............................................................ 135
o Balans........................................................................................................................... 135
Fonagy, Target et al. (start 2002) ..................................................................................................... 135
o Mentaliseringsconcept centraal:.................................................................................... 135
o Combi ........................................................................................................................... 135
o Pathologie → Onderscheid tussen: ................................................................................ 135
Epistemic trust .............................................................................................................................. 136
o Wat is epistemic trust? .................................................................................................. 136
o Definitie: ....................................................................................................................... 136
o Broaden & build circles: ................................................................................................. 136
Reflectief functioneren: concept gedacht vanuit intersubjectiviteit ................................................. 136
o Wat? ............................................................................................................................. 136
o Bouwt verder op het concept intersubjectiviteit van Bowlby/Stern (en anderen): ............. 136
• Basisaanname: ......................................................................................................... 136
• Mensen worden daarbij geleid door 2 systemen: ........................................................ 136
• Psychopathologie...................................................................................................... 136
• ‘Falen’ van primaire verzorgingsfiguren kan gerepareerd worden:................................ 137
Mentaliseren.................................................................................................................................. 137
o Vanaf wanneer?............................................................................................................. 137
o Dit wordt mogelijk gemaakt door een veilige hechtingsreactie met voldoende:................ 137
o Het kind gaat mentaliseren d.w.z. .................................................................................. 137
Reflectief functioneren .................................................................................................................. 137
o Wat? ............................................................................................................................. 137
o 3de positie ...................................................................................................................... 137
o RF-scale ........................................................................................................................ 138
o Continuïteit zelfbeleving ................................................................................................ 138
o ‘Psychological mindedness’ .......................................................................................... 138
Niet-mentaliserende modi: ............................................................................................................ 138
o Equivalentiemodus: ...................................................................................................... 138
o Teleologische modus ..................................................................................................... 139
o Pretend of ‘alsof’-modus: .............................................................................................. 139
o Koppeling niet mentaliserende modi aan: ...................................................................... 139
Representatie- en processtoornissen ............................................................................................. 139
o Representatiestoornissen: conflictpathologie ................................................................ 139
o Processtoornissen: deficitpathologie ............................................................................. 139
o Mentalization-based treatment (MBT) ............................................................................ 139
Onbewuste? .................................................................................................................................. 140
o Interne werkmodellen ontstaan al heel vroeg in de ontwikkeling (onbewust) ................... 140
o Pas later ontstaan er interne werkmodellen die wel bewust zijn: ..................................... 140
HOOFDSTUK 11 – BLATT: AUTONOMIE EN VERBONDENHEID ........................................................................ 141
2 soorten depressie: ...................................................................................................................... 141
o Anaclytische depressie.................................................................................................. 141
o Introjectieve depressie .................................................................................................. 141
o Dezelfde diagnose = depressie MAAR 2 ≠ drijfveren: ....................................................... 141
o Het ≠ tussen beide wortelt in de vroege relatie met hechtingsfiguren: ............................. 141
o Zo ontstaan er 2 ontwikkelingswegen: ............................................................................ 141
Therapie: ....................................................................................................................................... 142
o Therapeut...................................................................................................................... 142
o Focus therapie: ............................................................................................................. 142
Conclusie: ..................................................................................................................................... 142

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