Psychoanalytic Therapy

1
Psychoanalytic Therapy

• EDCE 655
• Theories Techniques II

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Sigmund Freud Chronology

• Born May 6, 1856 in Freiberg (Czech Republic)
• 1860 Move to Vienna
• 1873 Enters Vienna University
• 1881 Qualifies as a doctor of Medicine
• 1882 1883 works at Theodor Meynerts
  Psychiatric Clinic
• 1886 Married Martha Bernays
• 1887 Becomes interested in hyptnotherapy
• 1893 Works with Josef Breuer on Studies in
  Hysteria

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Sigmund Freud Chronology

• 1895 Freud analyzes one of his own dreams (this
  is a first)
• 1900 First Copies of The Interpretation of
  Dreams
• 1901 Begins analysis with 18 yr old Dora
• 1906 Carl Jung begins correspondence with Freud
• 1908 1st Congress of Freudian Psychology in
  Salzburg
• 1910 Founded International Psychoanalytical
  Association

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Sigmund Freud Chronology

• 1911 Adler resigns from the Vienna
  Psychoanalytic Society
• 1913 Break with Carl Jung
• 1914 WWI Begins
• 1918 Loses entire fortune in Austrian Bonds
• 1923 First signs of oral Cancer detected
• 1924 Conflict with Otto Rank over meaning of
  birth trauma.
• 1930 heart attack forces Freud to give up
  smoking

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Sigmund Freud Chronology

• 1933 Hitler becomes the Reichs Chancellor
  Freud corresponds with Einstein on the question
  Why War?
• 1935 Elected Honorary Member of British Royal
  Society of Medicine
• 1938 Austria is annexed to German Reich on
  March 13 persecution breaks out / Freud
  searched Anna held by Gestapo for questioning.
• 1939 September 23 Freud Dies in London

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Freud (Age 50) in 1906

• Always holding his cigar
• He sent this photograph to Jung with Jung asked
  for a photograph (in admiration)

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The Secret Committee (1912-1927)

• After conflict with Jung in 1912 Freud formed
  the Secret Committee
• Members Freud, Otto Rank, Karl Abraham, Max
  Etingon, Ernest Jones, Sandor Ferenczi, Hanns
  Sachs.
• Purpose monitor activities of the psychoanalytic
  movement (Watch Jungs activities)
• Jung Freud Break Jung rejected the belief that
  sexuality was the source of all neuroses
• Jung was one said to be the crown prince heir
  to the psychoanalytic movement

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The Secret Committee (1912-1927)
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Anna Dad in 1927 Talking About Death

• Picture taken after last (16th) operation for
  cancer of the jaw
• Picture taken after discussion with Schur
  (Freuds personal physician) re when Freud
  thinks he is dying Schur would administer
  Morphine
• In Sept 1939 Freud asked Schur to relieve his
  pain.

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Psychoanalytic Theory

• Human Nature (Freud)
• Life instincts
• Survival
• Gain pleasure
• Avoid pain
• Death instincts
• Aggressive drive
• Unconscious desire to hurt self or others

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Psychoanalytic Theory

• Components of Personality (Freud)
• ID
• Instinctive
• Pleasure principle
• EGO
• executive
• Regulative function
• SUPEREGO
• Judicial branch of personality
• Moral code

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Psychoanalytic Theory

• Anxiety
• Reality
• Fear of external danger
• Neurotic
• Fear of uncontrollable instincts
• Moral
• Fear of ones own conscience

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Ego-Defense Mechanisms

• Repression
• painful, threatening thoughts excluded from
  awareness
• Denial
• Closing ones eyes to existence of threatening
  reality
• Reaction Formation
• Expressing the opposite impulse
• Projection
• Attributing ones desires to others
• Displacement
• Directing energy (i.e., anger) to a safer target
• Rationalization
• Explaining away failures or losses

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Ego-Defense Mechanisms

• Sublimation
• Diverting sexual or aggressive energy into other
  channels
• Regression
• Reverting to a form of previously outgrown
  behavior
• Introjection
• Accepting values and standards of others
• Identification
• Identifying oneself with successful people or
  organizations
• Compensation
• Developing positive traits to make up for
  perceived limitations

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Development of Personality

• Oral Stage (0-1)
• Oral-incorporative behavior, involving
  pleasurable stimulation of the mouth
• Anal Stage (1-3)
• Anal zone becomes of major significance in
  formation of personality
• Phallic Stage (3-6)
• Conflict centers on unconscious incestuous
  desires that child develops for parent of
  opposite sex Oedipus Electra complex
• Latency Stage (6-12)
• Child turns outward and forms relationships with
  others
• Genital Stage (12)
• Trend away from narcissism and toward altruistic
  behavior and concern for others

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Other Contributors of the Psychoanalytic Theory

• Alfred Adler
• Colleague of Freud
• Thought Freud underestimated the role of social
  political pressures
• The Encounter Movement / Primal Scream
• 2 forms of therapy that centrally emphasize
  emotional catharsis
• Albert Ellis (Rational Emotive)
• Moderating the influence of the superego on the
  total psychological balance
• Carl Rogers (Person Centered)
• Having its roots in uncritical, empathetic
  relationship between client patient

• Carl Jung
• Colleague of Freud broke with him over
  differences in drives
• Emphasis on human development particularly
  midlife symbolic representations (Freud
  emphasized dev. Processes)
• Prominent Neo-psychoanalytic analysts
• Harry Stack Sullivan (1953) interpersonal
  relationships
• Karen Horney (1940) social, cultural factors
• Erik Erikson (1968) life cycle personality
  changes

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Counselors Role Function

• Blank Screen approach
• Counselor is anonymous
• Very little self disclosure
• Transference
• Relationship is attempted
• Clients makes projections onto the counselor
• Assist clients in achieving
• Self-awareness
• Honesty
• More effective personal relationships
• Gaining control over impulsive and irrational
  behaviors

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Therapeutic Process

• Clients Experience
• Intensive Long term
• Fundamental Rule
• Free association

• Relationship between counselor client
• Transference relationship is explored
• Working through unconscious material defenses
  from early childhood
• Countertransference
• Counselors reactions to clients may interfere
  with process

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Psychoanalytic Techniques Procedures

• Free Association
• Client reports any thought which comes to mind
• Opens door to unconscious wishes, fantasies,
  conflicts
• Interpretation
• Counselor teaches client the meanings of given
  behaviors
• Interpretation of resistance and transference
• Dream Analysis
• Latent content hidden, symbolic meaning
• Manifest content dream as appears to dreamer

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Psychoanalytic Basic Concepts

• Conflict is at the heart of psychoanalysis
• Psychoanalysis reflects the primal struggle of an
  individual as both a biological animal a social
  being
• The pleasure principle assumes that human psych.
  is governed by a tendency to seek pleasure and
  avoid pain
• This principle operates throughout life but is
  dominant in the first few years of existence and
  plays a crucial role in shaping each individuals
  psychic structure

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Significant Workings of Freud

• Studies of Hysteria (1895) summary of Freud
  Joseph Breurers work with Anna O. other
  clients. Symptoms of hysteria were the result of
  undischarged emotion connected with a very
  painful childhood memory.
• Interpretation of Dreams (1900) second phase
  of Freuds understanding of the psyche. Dreams
  symptoms were both the end product of a
  compromise between 2 sets of conflicting forces.
• Papers on Metapsychology (1915) mental
  process in all of its aspects, dynamic,
  topographical, and economic.
• Dual Instinct Theory (1920) put forth the
  notion of 2 instincts libido aggression
• Structural Theory (1923) grouped mental
  functions according to the role they played in
  conflict. The 3 major divisions are the id, ego,
  and superego.

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Psychoanalytic Key Terms

• Abreaction emotional release resulting from
  recalling and reliving painful repressed
  experiences
• Anal Stage the 2nd stage of psychosexual
  development at which time pleasure is derived
  from retaining and expelling feces
• Catharsis the release into awareness of
  repressed material from the unconscious
  venting!
• Countertransference counselors unconscious
  emotional responses to a client that are likely
  to interfere with objectivity unresolved
  conflicts of the counselor that are projected
  onto the client
• Ego part of the personality that is the
  mediator between external reality and inner
  demands
• Ego-defense Mechanisms intropsychic processes
  that operate unconsciously to protect the person
  from threatening therefore anxiety producing
  thoughts, feelings, impulses

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Psychoanalytic Key Terms

• Ego Psychology psychosocial approach of Erik
  Erikson emphasis on development of the ego or
  self at various stages in life
• Electra Complex unconscious sexual desire of
  the female child for her father, along with
  feelings of hostility toward her mother
• Fixation condition of being arrested or stuck
  at one level of psychosexual development
• Free Association a primary technique consisting
  of spontaneous and uncensored verbalization by
  the client, which gives clues to the nature of
  the clients unconscious conflicts
• Genital Stage final stage of psychosexual dev.
  Usually attained at adolescence, in which
  heterosexual interests and activities are
  predominant
• Id part of personality, present at birth, that
  is blind, demanding, insistent functioning to
  discharge tensions and return to homeostasis

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Psychoanalytic Key Terms

• Identity Crisis developmental challenge,
  occurring during adolescence, whereby the person
  seeks to establish a stable view of self to
  define a place in life
• Latency Stage period of psychosexual
  development following the phallic stage that is
  relatively calm before the storm of adolescence
• Libido instinctual drives of the Id and the
  source of psychic energy
• Narcissism extreme self-love, as opposed to
  love of others A narcissistic personality is
  characterized by a grandiose and exaggerated
  sense of self-importance and an exploitive
  attitude toward others, which hides poor
  self-concept
• Object-Relations Theory newer versions of
  psychoanalytic thinking, which focus on
  predictable developmental sequences in which
  early experiences of self shift in relation to an
  expanding awareness of others
• Oedipus Complex unconscious sexual desire of
  the male child for his mother, along with
  feelings of hostility and fear toward his father

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Psychoanalytic Key Terms

• Oral Stage initial stage of psychosexual dev.
  During which the mouth is the primary source of
  gratification a time when the infant is
  learning to trust or mistrust the world
• Phallic Stage - 3rd stage of psychosexual
  development, during which the child gains maximum
  gratification throught direct experience with the
  genitals
• Psychodynamics interplay of opposing forces and
  intropsychic conflicts providing a basis for
  understanding human motivation
• Psychosexual Stages the Freudian chronological
  phases of developmetn, beginning in infancy
  each is characterized by a primary way of gaining
  sensual and sexual gratification
• Psychosocial Stages Eriksons critical turning
  points, from infancy through old age each
  presents psychological and social tasks that must
  be mastered if maturation is to proceed in a
  health fashion

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Psychoanalytic Key Terms

• Reaction Formation defense mechanism against a
  threatening impluse, involving actively
  expressing the opposite impulse
• Repression ego-defense mechanism whereby
  threatening or painful thoughts or feelings are
  excluded from awareness
• Resistance clients reluctance to bring to
  awareness threatening unconscious material that
  has been repressed
• Superego aspect of personality that represents
  ones moral training striving for perfection
  not pleasure
• Transference clients unconscious shifting to
  the counselor feelings fantasies, both positive
  and negative, that are displacements from
  reactions to significant others from the clients
  past

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Psychoanalytic Key Terms

• Transference neurosis the point in classical
  psychoanalysis when the patients fantasies about
  the counselor are at their peak, at which time
  the therapeutic relationship becomes the focus of
  therapy
• Unconscious the aspect of psychological
  functioning or of personality that houses
  experiences, wishes, impulses, and memories in an
  out-or-awareness state as a protection against
  anxiety
• Working-through a process of resolving basic
  conflicts that are manifested in the clients
  relationship with the counselor, achieved by the
  repetition of interpretations and by exploring
  forms of resistence

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Tim A child molester

• Assume that you are working in a state mental
  hospital for the rehabilitation of mentally
  disordered sex offenders. The psychiatrist who is
  the head of your ward, also your supervisor,
  maintains that a psychoanalytic perspective is
  most useful for understanding the dynamics of the
  child molesters on the ward. Although she
  realizes full well that most members of the Tx
  staff are limited both in time available skill
  in using psychoanalytic techniques, she also
  believes that the staff can draw on
  psychoanalytic concepts to guide the therapy with
  their patients. She contends that you can think
  in psychoanalytic terms, even though you do not
  practice in strict psychoanalytic ways. With this
  in mind, she presents a case study at a staff
  meeting, giving some summary details of the
  psychological development of a client named Tim.

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Background on Tim A child molester

• Tims mother was overprotective overpossessive
  controlled him with guilt. Even now she reminds
  him of all she have sacrificed of how he was
  a difficult child from birth on. She almost
  died delivering him, she tells him that she has
  been suffering because of him for many years. Tim
  was the only boy in a family of 5 children.
  Psychosexually, he eventually decided to become a
  neuter in an effort to become what he thought his
  mother wanted of him. He became quite overweight,
  developed a very passive unassertive style
  (especially with women), has avoided developing
  lasting relationship with women for 50 years.
• Tim saw his father as being extremely weak
  uncaring. He reports that he cannot remember any
  events in which he his father did anything
  together. His father showed no interest in him,
  his typical way of dealing with Tim was to ignore
  him. Tims father was controlled by Tims mother
  his grandmother (who lived with the family).
  Tim recalls tension between his mother his
  grandmother (the mother of Tims father) each
  fighting to run the house in the way she saw fit.
  They had very different ideas about how the
  family should be, so conflict was a continual
  pattern in the home. Things Tim did to please his
  mother often upset his grandmother, the reverse
  happened when he tried to please the older woman.
• As a child Tim envied his sisters because he
  thought they were treated more fairly than he
  was. Eventually, the discriminatory Tx he felt he
  was receiving changed his envy to resentment. He
  grew to fear females who were older than he, for
  he continually felt that they could would
  dominate him. His relationship with others have
  been inadequate, he has never been able to form
  maintain satisfactory relationships with adults
  of either sex.
• Tim discovered that he felt relatively
  comfortable around small children, especially
  boys. They seemed to take a liking to him, they
  did not make demands on him, he did not feel
  inadequate around them. For a while during his
  early adult life he worked as a teachers aide in
  an elementary school. He began his pattern of
  molesting your boys in this job. He would invite
  some of these children to climb onto his lap,
  he would then stroke their hair cuddle them.
  Eventually, he progressed with several boys to
  the point of touching their genitals he also
  encouraged them to touch him. His pattern
  continued, eventually he was arrested.
• During the rest of his adult life he has been in
  out of state hospitals for sex offenders a
  number of times. When he finishes his time as
  stipulated by the court, he is released, goes
  into the community, then reoffends. He feels
  that he never hurts his victims that he is
  typically very nice kind to them. He even
  rationalizes that they often enjoys the attention
  physical affection he demonstrates. Yet at
  times he also feels that what he does is wrong,
  he feels guilty over his deeds. Tim does not
  think that his actions are normal, yet he worries
  about how he will deal with the impulses he might
  feel toward certain children. He has made
  resolutions to control himself, yet he has often
  acted on his impulses. Tim says he would like to
  learn to control his desires be able to relate
  well with adults.

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Questions for Reflection (Tim A child molester)

• By attempting to think psychoanalytically, show
  how you might proceed in your contacts with Tim
  by addressing yourself to these questions
• What value do you see in knowing Tims
  developmental history, family background,
  experiences as a child adolescent in school,
  work history, other key adult experiences? Do
  you think that knowing this information will help
  you be a more effective counselor? How might you
  proceed differently with him if you had no prior
  knowledge about his past instead simply relied
  on what you could learn about him through your
  contacts with him on the ward observing his
  behavior? What advantages disadvantages do you
  see in having prior knowledge about a client?
• From the summary notes about Tim alone, how might
  you react to a person like him? What reaction
  does it evoke in you when you think about a
  middle-aged man who has a pattern of sexual
  molestation of children? In what ways can you
  predict that your own reactions to a person such
  as Tim could affect your ability to work with him
  therapeutically? How might you be able to deal
  with your own feelings so that they would not be
  a barrier between you him?
• Tim says that he feels guilt sorrow over what
  he recognizes are his offenses also that he
  would like to learn how to control his impulses.
  How might you be able to tell the degree to which
  this is so? Might he be saying what he feels he
  is expected to say so that he will obtain a
  release from the hospital? How do you think that
  either your belief or lack of belief in what he
  is saying will affect your work with him?
• Do you think that Tim can change (stop his
  child-molesting behavior) without gaining insight
  into the cause of his problems? How much
  importance might you put on factors such as his
  understanding of his early childhood? His
  resolutions of psychic conflicts with his mother
  grandmother? A resolution of his feelings
  toward his father? If you see value in focusing
  on the above issues, how might you do this within
  the limited time that you would have to work with
  him?
• Do you see Tim as a victim of his early
  experiences? Or do you see that, even though he
  has had adverse experiences in growing up, he
  could do something to change his behavior now?
  Again, how do your answers to the above questions
  determine how you will work with him in
  counseling?
• As you proceed with Tim, what would be your major
  goals for him? Merely stopping his antisocial
  behavior? Changing his basic personality
  structure? Merely seeing that he has a choice in
  doing something about the problem that keeps him
  in the hospital?