Psychoanalytic Therapy

1
Psychoanalytic Therapy

• Chapter Four

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The Importance of Freud

• Psychoanalytic theory is more than a theory of
  psychotherapy it is a theory of personality
  development, a philosophy of human nature, a
  worldview!
• Freud was the first person to formalize a method
  of talk therapy. All other theories of
  psychotherapy can be viewed as building upon or
  reacting against Freuds theories.

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A Little History. . .

• Freud earned a medical degree and, by 1885, was
  working with a psychiatrist named Charcot, who
  was using hypnotherapy to treat hysteria.
• Freud developed many of the important concepts of
  psychoanalysis between 1895 and 1900. He found
  that free association could be as effective as
  hypnosis in unlocking the secrets of the
  unconscious.

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A Little History. . . (continued)

• Freud attracted many followers, and the
  Psychoanalytic Society was founded in 1910.
• Freud was forced to leave Vienna as the Nazis
  gained power in Austria, and he died in London in
  1939. World War I and the rise of Nazism
  profoundly influenced Freuds view of humanity.

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The Freudian Worldview

• Freud believed that human nature is largely
  deterministic, meaning that our behavior is
  determined by our biological and instinctual
  drives, as well as by our powerful unconscious
  motivations.
• Insight and awareness can increase the level of
  choice and control that one has over these drives
  and motivations.

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The Role of Instincts

• Freud believed that instincts are central to
  understanding the behavior of humans.
• Libido or Eros originally referred to sexual
  energy, but was later revised to mean the life
  instinct and the drive toward pleasure and away
  from pain.
• Thanatos refers to the death instinct, which is
  the aggressive drive.

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The Structure of Personality

• Idruled by the pleasure principle driven to
  satisfy basic needs, the id remains immature,
  illogical, largely unconscious. It is the
  earliest part of our personality, present at
  birth.
• Egoruled by the reality principle serves as a
  mediator between the id and the external world.
  Also works to mediate between the id and the
  superego.
• Superegoruled by the perfection principle
  represents the ideal, a moral code.

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The Unconscious

• Freud postulated that the unconscious forms the
  largest part of the mind the conscious portion
  is much smaller.
• The unconscious cannot be seen or proven, but
  must be inferred from certain mental processes.

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Evidence for the Unconscious

• Dreamssymbolic of needs, wishes, anxieties,
  conflicts.
• Slips of the tongueFreudian slips, what you
  really wanted to say.
• Posthypnotic suggestions.

• Material from free associationwhy would I think
  of that?
• Material from projective testsmaking meaning.
• Symbolic content of psychotic processesoften
  wish fulfillment.

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Anxiety

• Anxiety (state of tension) motivates us.
• Reality anxiety is fear caused by external world,
  and is in proportion with the actual threat.
• Neurotic anxiety is the tension between an
  unconscious wish and the prohibition against that
  wish fear of being overcome by instincts.
• Moral anxiety is the fear of ones own super-ego
  guilt reaction.

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Anxiety (continued)

• The ego works to control anxiety, and will resort
  to defense mechanisms if necessary.
• Defense mechanisms serve to deny or distort
  reality, and operate out of the conscious
  awareness.
• Defense mechanisms are normal and adaptive as
  long as they are not a constant way of life.

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Ego-Defense Mechanisms

• Repressionexcluded from awareness
• Denialnot acknowledged
• Reaction formationopposite of what is true
• Projectionattribute your feelings to others
• Displacementshift to safer target

• Rationalizationjustify behaviors
• Sublimationdivert sexual energy to other
  channels
• Regressionrevert to earlier stage of development
• Introjectiontake on values of others
• Undoingtaking it back

13
Personality Development

• Freud believed that the first six years of life
  laid the foundation upon which personality is
  built.
• There are key developmental tasks at the
  various stages of development.
• In discussing psychosexual development in
  children, remember that we arent talking about
  adult sexuality. Its more about the drive
  toward pleasure!

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Stages of Psychosexual Development

• Oral stage (first year)feeding satisfies need
  for food and pleasure basic nurturing.
• Anal stage (ages 1-3)toilet-training leads to
  independence, fosters sense of control learn to
  accept angry feelings.
• Phallic stage (ages 3-6)desire to join with
  opposite-sex parent and remove competition of
  same-sex parent castration anxiety (boys) and
  penis envy (girls) are part of this stage.

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Stages of Psychosexual Development (continued)

• Latency stage (ages 6-12)time of socialization
  and forming relationships with others outside
  family, developing interests, etc.
• Genital stage (ages 12-adult)sexual energy
  re-emerges, interest in sexual relationships
  begins and must be appropriately expressed.

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Goals of Psychoanalytic Therapy

• To make the unconscious conscious.
• To strengthen the ego so that it is better able
  to keep a lid on the id, and also able to keep
  the superego from totally taking over.

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Therapists Role

• Classical analytic stance is blank-screen.
• Therapist takes a neutral stance, says very
  little, cautiously makes interpretations as
  relationship develops.
• This allows for projection.

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Process of Therapy

• Therapy is often long (can be 3-5 years), and
  often takes place more than once a week.
• Client is first assessed to see if they are
  appropriate for psychoanalytic therapy must have
  some level of ego strength, not floridly
  psychotic, etc.

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Process of Therapy (continued)

• Maintaining the frame
• Free association
• Dream analysisclients must agree to remember and
  report their dreams

• Interpretationlistening for patterns, themes
• Analysis and interpretation of resistance
• Analysis and interpretation of transference

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Transference

• Much of the work of analysis is looking at
  transference. Transference is the process of
  transferring unresolved feelings or issues onto
  the therapist and the therapeutic relationship
  the client reacts not to the therapist, but to
  their own unresolved feelings.
• Transference is an important part of the therapy,
  not a mistake or problem.

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Countertransference

• Therapists can also be guilty of transference,
  but then it is called countertransferencea
  reaction to the client based on therapists own
  issues.
• Countertransference can damage the therapists
  objectivity, so therapist must have an awareness
  of when it occurs so that it can be dealt with,
  minimized.

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Criticisms and Limitations

• Not appropriate for every client or every type of
  problem.
• Feminist perspective argues that psychoanalytic
  therapy places too much emphasis on penis envy,
  mothers responsibility for patients problems.
• Closed systemFreud could always prove himself
  right.
• Long term and lots of commitment, cost.

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Psychodynamic Therapists

• Believe in the unconscious, that people do things
  for reasons that are not always available to
  them.
• Attend closely to clients language, the words
  they chooseimportant.
• There would be a reason why. . .
• Respond to latent meaning in clients messages.
• Attend carefully to own reactions, feelings.