PSYCHOANALYTIC THERAPY

GROUP I

Psychoanalysis Assumptions
Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.

Manifest symptoms are caused by latent (hidden) disturbances.

Typical causes include unresolved issues during development or repressed trauma. Treatment focuses on bringing the repressed conflict to consciousness, where the client can deal with it.

Sigmund Freud
Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining insight. The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e. make the unconscious conscious.

PSYCHOANALYTIC THERAPY

INTRODUCTION

 Freuds psychoanalytic system is a model of personality development and an approach to psychotherapy. The following approaches retain the emphasis on the unconscious, the role of transference and countertransference, and the importance of early life experiences: - Erik Eriksons theory of psychosocial development - Carl Jungs approach - Contemporary self-psychology, object relations theory, and the relational model of psychoanalysis

PSYCHOANALYTIC THERAPY

KEY CONCEPTS

View of Human Nature

Our behavior is determined by irrational forces, unconscious motivations, and biological and instinctual drives as these evolve through key psychosexual stages in the first years of life. Libido = sexual energy => energy of all life instincts oriented toward growth, development, and creativity. Freud sees the goal of much of life as gaining pleasure and avoiding pain. Death instincts = aggressive drive an unconscious wish to die or to hurt themselves or others.

Structure of Personality
Personality consists of: Id, Ego, Superego Humans are viewed as energy systems. The dynamics of personality consist of the ways in which psychic energy is distributed to the id, ego, and superego. One system gains control over the other systems because the amount of energy is limited.

Slogan for psychoanalysis: making the unconscious conscious to where there was id, let there be ego

Consciousness and the Unconscious

Clinical evidence for postulating the unconscious includes the following:
I.

II. III. IV. V. VI.

Dreams symbolic representations of unconscious needs, wishes, and conflicts Slips of the tongue and forgetting Posthynoptic suggestions Material derived from association techniques Material derived from projective techniques Symbolic content of psychotic symptoms

Consciousness and the Unconscious

The aim of psychoanalytic therapy is to make the unconscious motives conscious, for only then can an individual exercise choice.

Unconscious processes are at the root of all forms of neurotic symptoms and behavior. From this perspective, cure is based on uncovering the meaning of symptoms, the cause of behavior, and the repressed materials that interfere with healthy functioning.

Anxiety
Anxiety is a feeling of dread that results from repressed feelings, memories, desires, and experience that emerge to the surface of awareness.
Reality Anxiety: danger from external world proportionate to the degree of real threat Neurotic Anxiety: the instincts will get out of hand and cause one to do something for which one will be punished Moral Anxiety: ones own conscience

Ego-Defense Mechanisms
Ego-defense mechanisms help the individual cope with anxiety and prevent the ego from being overwhelmed.

Defense mechanisms have two characteristics in common:

1) they either deny or distort reality, and 2) they operate on an unconscious level - (Table 4.1, page 61)

Development of Personality
Freuds Psychosexual stages:
1) 2) 3) Oral stage Anal stage Phallic stage

According to psychoanalytic view, these three areas of personal and social development love and trust, dealing with negative feelings, and developing a positive acceptance of sexuality are all grounded in the first 6 years of life. When a childs needs are not adequately met during these stages of development, an individual may become fixated at that stage and behave in psychologically immature ways later on in life.

Development of Personality
Eriksons psychosocial stages:
1) 2) 3) 4) 5) 6) 7) 8) Trust vs Mistrust Autonomy vs Shame and Doubt Initiative vs Guilt Industry vs Inferiority Identity vs Role Confusion Intimacy vs Isolation Generativity vs Stagnation Integrity vs Despair
(Table 4.2, page 64)

Development of Personality
According to Erikson, crisis is equivalent to a turning point in life when we have the potential to move forward or to regress. Classical psychoanalysis is grounded on id psychology, and it holds that instincts and intrapsychic conflicts are the basic factors shaping personality development. Contemporary psychoanalysis tends to based on ego psychology, which does not deny the role of intrapsychic conflicts but emphasizes the striving of the ego for mastery and competence throughout the human life span.

PSYCHOANALYTIC THERAPY

THE THERAPEUTIC PROCESS

Therapeutic Goals
The ultimate goal of psychoanalytic treatment is to increase adaptive functioning, which involves the reduction of symptoms and the resolution of conflicts (Wolitzky, 20IIa). Two goals of Freudian
To make unconscious conscious To strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt

Therapeutic Goals
Psychoanalytic therapy is oriented toward achieving insight, but not just an intellectual understanding; it is essential that the feelings and memories associated with this self understanding be experienced.

Therapists Function and Role

In classical psychoanalysis, analysts typically assume on anonymous stance, which is sometimes called the blank screen approach. They engage in very little disclosure and maintain a sense of neutrality to foster a transference relationship, in which their clients will make projections onto them.

Therapists Function and Role

One of the central functions of analysis is to help clients acquire the freedom to love, work, and play. Other functions include assisting clients in achieving self awareness, honesty, and more effective personal relationships; in dealing with anxiety in a realistic way; and in gaining control over impulsive and irrational behavior.

Therapists Function and Role

A major function of interpretation is to accelerate the process of uncovering unconscious material. The analyst listens for gap and inconsistencies in the clients story, infers the meaning reported dreams and free associations, and remains sensitive to clues concerning the clients feelings toward the analyst.

Therapists Function and Role

The process of psychoanalytic therapy is somewhat like putting the pieces of a puzzle together. Change occurs through the process of reworking old patterns so that clients might become freer to act in new ways (Luborsky et al., 2011)

Clients Experience in Therapy

Free association, they try to say whatever that comes to mind without self censorship. Free association is known as the fundamental rule The client in psychoanalysis experiences a unique relationship with the analyst. It is a responsibility of the analyst to keep the analytic situation safe or the client, so the analyst is not free to engage in spontaneous self expression.

Clients Experience in Therapy

Psychodynamic therapy emerged as a way of shortening and simplifying the lengthy process of classical psychoanalysis. (Luborsky et al., 2011) Traditional analytic therapists make more frequent interpretations of transferences and engage in fewer supportive interventions than is the case with psychodynamic therapists (Wolitzky, 2011a)

Clients Experience in Therapy

Wolitzky(2011a) lists other optimal criteria for termination, including the reduction of transference, accomplishing the main goals of therapy, an acceptance of the futility of certain strivings and childhood fantasies, an increased capacity for love and work, achieving more stable coping patterns, and a self analytic capacity.

Relationship Between Therapists and Client

The classical analyst stands outside the relationship, comments on it, and offers insight producing interpretations. In contemporary relational psychoanalysis, the therapist does not strive for a nonparticipating, detached, and objective stance, but is attuned to the nature of the therapeutic relationship, which is viewed as a key factor in bringing about chance (Ainslie, 2007; Curtis & Hirsch, 2011; Wolitzky, 2011b).

Relationship Between Therapists and Client

Contemporary analysts focus as much on here andnow transference as on earlier reenactment. Transference is the clients unconscious shifting to the analyst feelings and fantasies that are reactions to significant others in the clients past. It reflects the deep patterning of old experiences in relationships as they merge in current life (Luborsky et al., 2011, p47)

Relationship Between Therapists and Client

The working through process consists o repetitive and elaborate explorations of unconscious material and defenses, most of which originated in earlychildhood. By experiencing a therapists who is engaged, caring, and reliable, clients can be changed in profound ways, which can lead to new experiences of human relationships (Ainslie, 2007).

Relationship Between Therapists and Client

It is a mistake to assume that all feelings of clients have toward their therapists are manifestations of transference. Not every positive response (such as liking the therapist) should be labeled positive transference. Clients anger toward the therapist may be a function of the therapists behavior; it is a mistake to label all negative reactions as s signs of negative transference

Relationship Between Therapists and Client

From a traditional psychoanalytic perspective, countertransference is viewed as a phenomenon that occurs when there is inappropriate affect, when therapist respond in irrational ways, or when they lose their objectivity in a relationship because their own conflicts are triggered. Not all countertransference reactions are detrimental to therapeutic progress.

Relationship Between Therapists and Client

Although countertransference can greatly benefit the therapeutic work, this is true only if therapists study their internal reactions and use them to understand their clients (Ainslie, 2007; Gelso & Hayes, 2002; Wolitzky, 2011a, 2011b) Psychoanalytic therapists vary in the manner in which they use their observations of countertransference.

Relationship Between Therapists and Client

Hayes, Gelso, and Hummel (2011) present the following guidelines foe working effectively with countertransference:
Effective therapists prevent acting out and are aware of and manage their countertransference in a way that benefits the therapeutic work. The ability of therapists to gain self understanding and to establish appropriate boundaries with clients are fundamental to managing and effectively using their countertransference reactions.

Relationship Between Therapists and Client

Personal therapy and clinical supervision for therapists can be most helpful in better understanding how their internal reactions influence the therapy process and how to use these countertransference reactions to benefit the work of therapy.

PSYCHOANALYTIC THERAPY

APPLICATION: THERAPEUTIC TECHNIQUES AND PROCEDURES

 Psychoanalytic therapy, or psychodynamic therapy (as opposed to traditional psychoanalysis) includes these features: The therapy is geared more to limited objectives than to restructuring ones personality. The therapist is less likely to use the couch. There are fewer sessions each week. There is more frequent use of supportive interventions such as reassurance, expressions of empathy and support, and suggestions.

 There is more emphasis on the here-and-now relationship between therapist and client. There is more latitude for therapist self-disclosure without polluting the transference. Less emphasis is given to the therapists neutrality. There is focus on mutual transference and countertransference enactments. The focus is more on pressing practical concerns than on working with fantasy material.

 Procedure:
Clients talk Catharsis

Insight

Working through unconscious material

The six basic techniques of psychoanalytic therapy are: 1) Maintaining the Analytic Framework 2) Free Association 3) Interpretation 4) Dream Analysis 5) Analysis of Resistance 6) Analysis of Transference

Maintaining the Analytic Framework

refers to a whole range of procedural and stylistic factors, such as the analysts relative anonymity, maintaining neutrality and objectivity, the regularity and consistency of meetings, starting an ending the sessions on time, clarity on fees, and basic boundary issues such as the avoidance of advice giving or imposition of the therapist's values (Curtis & Hirsch, 2011). Where departures are unavailable, these will often be the focus of interpretations.

Free Association
a central technique in psychoanalytic therapy, and it plays a key role in the process of maintaining the analytic framework one of the basic tools used to open the doors to unconscious wishes, fantasies, conflicts, and motivations

Clients are encouraged to say whatever comes to mind.

The therapist interprets the material to clients, guiding them toward increased insight into the underlying dynamics. Areas that clients do not talk about are as significant as the areas they do discuss.

Interpretation
consists of the analysts pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free association, resistances, and the therapeutic relationship itself. The functions of interpretations are to:
1) enable the ego to assimilate new material 2) speed up the process of uncovering further unconscious material

Interpretation
Interpretations are provided in a collaborative manner to help clients make sense of their lives and to expand their consciousness. A general rule is that the interpretation should be presented when the phenomenon to be interpreted is close to conscious awareness. Another general rule is that interpretation should start from the surface and go only as deep as the client is able to go.

Dream Analysis
an important procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problems. Freud sees dreams as the royal road to the unconscious Dreams have two levels of content:
1) Latent content hidden, symbolic, and unconscious motives, wishes and fears 2) Manifest content- the dream as it appears to the dreamer

Analysis and Resistance

Resistance

Interpretation

of

anything that works against the progress of therapy and prevents the client from producing previously unconscious material. Specifically, the clients reluctance to bring to the surface of awareness unconscious material that has been repressed. - refers to any idea, attitude, feeling, or action (conscious or unconscious) that fosters the status quo and gets in the way of change. - Freud defined resistance as an unconscious dynamic that people use to defend against the intolerable anxiety and pain that would arise if they were to become aware of their repressed impulses and feelings.

Analysis and Resistance

Interpretation

of

Clients tend to cling to their familiar patterns, regardless o how painful they may be. Therapists need to create a safe climate that allows clients to explore their defenses and resistances. The therapists interpretations is aimed at helping clients become aware of the reasons for the resistance so that they can deal with them.

Analysis and Resistance

Interpretation

of

As a general rule, therapists point out and interpret the most obvious resistances to lessen th possibility of clients rejecting the interpretation and to increase the chance that they will begin to look at their resistive behavior.

Resistances need to be recognized as devices that defend against anxiety but that interfere with the ability to accept change that could lead to experiencing amore gratifying life.

Analysis and Transference

Transference

Interpretation

of

when clients earlier relationships contribute to their distorting the present with the therapist.

Interpreting Interference a route to elucidating the clients intrapsychic life (Wolitzky,

2011b).

Analytically oriented therapists consider the process of exploring and interpreting transference feelings as the core of the therapeutic process because it is aimed at achieving increased awareness and personality change.

Analysis and Transference

Interpretation

of

Interpretation of the transference relationship enables clients to work through old conflicts that are keeping them fixated and retarding their emotional growth. In essence, the effects of early relationships are counteracted by working through a similar emotional conflict in the current therapeutic relationship.
(example on the case of Stan, in the later section)

Application to Group Counseling

A basic tenet of psychodynamic therapy groups is the notion that group participants, through their interactions within the group, re-create their social situation, implying that the group becomes a microcosm of their everyday lives (Rustan, Stone, & Shay, 2007).

Groups can provide a dynamic understanding of how people function in out-of-group situations.

Application to Group Counseling

Projections onto the leader and onto the members are valuable clues to unresolved conflicts within the person that can be identified, explored, and worked through in the group.

Countertransference can be a useful tool for the group therapist to understand the dynamics that might be operating in a group.
It is important to differentiate between appropriate emotional reactions and countertransference.

PSYCHOANALYTIC THERAPY

JUNGS PERSPECTIVE ON THE DEVELOPMENT OF PERSONALITY

 Jungs ANALYTICAL PSYCHOLOGY is an elaborate explanation of human nature combines ideas from history, mythology, anthropology, and religion. Jung made monumental contributions to our deep understanding of the human personality and personal development, particularly during middle age. The task facing us during the midlife period is to be rational thought and to instead give expression to these unconscious forces and integrate them into our conscious life. Jung made a choice to focus on the unconscious realm in his personal life, which also influenced the development of his theory. Jung became convinced that he could no longer collaborate with Freud because he believed Freud placed his own authority over truth.

 Jung maintained that we are not merely shaped by past event, but we are influenced by our future as well as or past. For Jung, our present personality is shaped both by who and what we have been and also by what we aspire to be in the future. His theory is based on the assumption that humans tend to move toward the fulfilment or realization of all of their capabilities. Achieving the individuation ------ the harmonious integration of the conscious and unconscious aspects of personality ---------- is innate and primary goal. For Jung, we have both constructive and destructive forces and to became integrated, it is essential to accept our dark side, or our shadow, with its primitive impulses such as selfishness and greed. Jung referred to the collective unconscious as the deepest level of the psyche containing the accumulation of inherited experiences of human and prehuman species.

 Jung saw a connection between each persons personality and the past, not only childhood events but also the history of the species. The images of universal of universal experiences contained in the collective unconscious are called archetypes. Among the most important archetypes are the persona, the anima and the animus and the shadow. In a dream all of these parts can be considered manifestations of who and what we are. Jung viewed dreams more as an attempt to express than as an attempt to repress and disguise. Dreams are creative effort of the dreamer in struggling with contradiction, complexity, and confusion.

PSYCHOANALYTIC THERAPY

CONTEMPORARY TRENDS: OBJECTRELATIONS THEORY, SELF PSYCHOLOGY, AND RELATIONAL PSYCHOANALYSIS

 Ego Psychology- is a part of classical psychoanalysis with the emphasis placed on the vocabulary of id, ego, and super ego, and on Anna Freuds identification of defense mechanism. Object Relations Theory encompasses the work of number of rather different psychoanalytic theorist. They emphasize is how our relationships with other people are affected by the way we have internalized our experiences of others and set up representations of others within our selves.
Object relations are interpersonal relationships as these are represented intrapsychically, and as they influence our interactions with the people around us. The term object was used by Freud to refer to that which satisfies a need, or to the significant person or thing that is the object, or target, of ones feelings or drives.

 Self- psychology, which grew out of the work of Heinz Kohut emphasizes how we use interpersonal relationships (selfobject) to develop our own sense of self.

Relational Model, is based on the assumption that is an attractive process between client and therapist. Whether called intersubjective, interpersonal, or relational, a number of contemporary approaches to analysis are based on the exploration of the complex conscious and unconscious dynamic at play with respect to both therapist and client.

Treating Borderline and Narcissistic Disorder

Some of the most powerful tools for understanding borderline and narcissistic personality disorder have emerged from psychoanalytic models. Among the most significant theorist in this area are Kernberge (1975, 1976, 1997), Kohut (1971, 1977, 1984), and Masterson (1976). A great deal of recent psychoanalytic writing deals with the nature and treatment of borderline and narcissistic personality disorder and sheds new light on the understanding of these disorder. Kohut (1984) maintains that people are their healthiest and best when they can feel both independence and attachment, taking joy in themselves and also being able to idealize others.

Some Directions of Contemporary Psychodynamic Therapy

Some of the directions in psychodynamic theory and practice that Strupp identifies: Increased attention is being given to disturbances during childhood and adolescence. The emphasis on the treatment has shifted from the classical interest in curing neurotic disorder to the problems of dealing therapeutically with chronic personality disorder, borderline conditions, and narcissistic personality disorder. Increased attention is being paid to establishing a good therapeutic alliance early in therapy. There is a renewed interest in the development of briefer forms of psychodynamic therapy largely due to societal pressures for accountability and cost effectiveness.

The trend toward brief, time-limited Psychodynamic Therapy

Many psychoanalytically oriented therapist are adapting their work a time limited framework while retaining their original focus on depth and the inner life, which are characteristic of the psychoanalytic model. Although there are different approaches to brief psychodynamic therapy, Prochaska and Norcross (2010) believe they all share these common characteristic: ` Work within the framework of time limited therapy. ` Target a specific interpersonal problem during the initial session. ` Assume a less neutral therapeutic stance than is true of traditional analytic approaches. ` Establish a strong working alliance. `Use interpretation relatively early in the therapy relationship.

 In keeping with the context of brief, time-limited therapy, Messer and Warren (2001) describe Brief Psychodynamic Therapy as a promising approach . This adaptation applies the principles of psychodynamic theory and therapy to treating selective disorders within a pre-established time limit of, generally 10-25 sessions. PBT uses key psychodynamic concepts such as the enduring impact of psychosexual, psychosocial, and object-relational stages of development; the existence of unconscious process and the resistance; the usefulness of interpretation; the importance of the working alliance; and re-enact of the clients past emotional issues in relation to the therapist.

PSYCHOANALYTIC THERAPY

PSYCHOANALYTIC THERAPY FROM A MULTICULTURAL PERSPECTIVE

Strengths From a Diversity Perspective

Psychoanalytically oriented therapy can be made appropriate for culturally diverse populations if technique are modified to fit the settings in which a therapist practices. Therapists can help their clients review environmental situations at the various critical turning points in their lives to determine how certain events have affected them either positively or negatively.

Strengths From a Diversity Perspective

Psychotherapists need to recognize and confront their own potential sources of bias and how countertransference could be conveyed unintentionally through their interventions.

Shortcomings From a Diversity Perspective

Traditional psychoanalytic approaches are costly, and psychoanalytic therapy is generally perceived as being based on upper and middle class values. Another shortcomings pertain to ambiguity inherent in most psychoanalytic approaches. Intrapsychic analysis may be indirect conflict with some clients social framework and environmental perspective.

Shortcomings From a Diversity Perspective

Atkinson, Thompson, and Grant (1993) underscore the need for the therapists to consider possible external sources of clients problem, especially if clients have experienced an oppressive environment. The psychoanalytic approach can be criticized for failing to adequately address the social, cultural, and political factors that result in an individuals problems.

Shortcomings From a Diversity Perspective

There are likely to be some difficulties in applying a psychoanalytic approach with low income clients. Smith (2005) contends that psychotherapists willingness and ability to work with low income clients is compromised by unexamined classist attitudes and that these attitudes constitute a significant obstacle for practitioners success in working with the poor.

Psychoanalytic Therapy Applied to the Case of Stan

Summary and Evaluation

 Psychoanalytic theory include the dynamics of

the unconscious and its influence on behavior, the role of anxiety, an understanding of transference and countertransference, and the development of personality at various stages in the life cycle. It focuses primarily on childhood experiences, which are discussed, reconstructed, interpreted, and analyzed. Jung viewed humans positively and focused on individuation. The therapist assists the client in tapping his or her inner wisdom.

The contemporary trends in psychoanalytic theory are reflected in these general areas:
Ego psychology Object-relation approaches

Self psychology
Relational approaches

Applying the psychoanalytic point of view to therapy practice is particularly useful in:
Understanding resistances that take the from of

canceling appointments, fleeing from therapy prematurely, and refusing to look oneself Understanding that unfinished business can be worked through, so that clients can provide a new ending to some of the events that have restricted them emotionally Understanding the value and role of transference Understanding how the overuse of ego defenses, both in the counseling relationship and in daily life, can keep clients from functioning effectively.

Limitation and Criticism of the Psychoanalytic Approach

Thankyouuuuuu!

References: Counselling and Psychotherapy Theory & Practice 2nd Edition by Gerald Corey http://www.simplypsychology.org/psyc hoanalysis.html