Ch 4: Psychoanalytic Therapy

• Deterministic
• According to Freud, our behaviour is determined by irrational forces, unconscious motivations, and biological and instinctual drives as these evolve through key psychosexual stages in the first 6 years of life.
• Libido: originally referred to sexual energy; later broadened to include the energy of all the life instincts. A source of motivation
• Life instincts: instincts oriented toward growth, development, and creativity that serve the purpose of the survival of the individual and the human race.
• Freud sees the goal of much of life as gaining pleasure and avoiding pain.
• Death instincts: account for the aggressive drive. Refers to a tendency of individuals to harbour an unconscious wish to die or hurt themselves or others.

• According to Freudian psychoanalytic view- personality consists of 3 systems; the id, the ego and the superego.
• Id: roughly all the untamed drives or impulses that might be likened to the biological component. Function is to discharge tension and return to homeostasis. 
• Ego: Attempts to organise and mediate between id and the reality of dangers posed by the id's impulses. 
• Superego: the internalised social component, largely rooted in what the person imagines to be the expectation of parental figures. Protects ourselves from our own impulses.

• Orthodox freudian perspective: humans are viewed as energy systems. Dynamics of personality consist of the ways in which psychic energy is distributed to the ed, ego and superego.
• Because the amount of energy is limited, one system gains control over the available energy at the expense of the other two systems.

• The original system of personality.
• At birth, a person is all id.
• Lacks organisation and is blind, demanding and insistent. 
• Id cannot tolerate tension and it functions to discharge tension immediately.
• Ruled by the pleasure principle: aimed at reducing tension, avoiding pain and gaining pleasure.
• Id never matures, does not think but only acts.
• Id is largely unconscious, or out of awareness.

• Has contact with the external world of reality.
• The 'executive' that governs, controls and regulates personality.
• Mediates between the instincts and the surrounding environment.
• Ego controls consciousness and exercises censorship.
• Ruled by the reality principle: ego does realistic and logical thinking and formulates plans of actions for satisfying needs.
• Has the seat of intelligence and rationality, checks and controls the blind impulses of the id.

• The judicial branch of personality.
• Includes a person's moral code.
• Main concern being whether an action is good or bad, right or wrong.
• Represents the ideal rather than the real and strives not for pleasure but for perfection.
• Represents the traditional values and ideals of society as they are handed down from parents to children.
• Functions to inhibit the id impulses.
• Superego is related to psychological rewards and punishments.
• Rewards are feeling of pride and self-love; punishments are feelings of guilt and inferiority.

• Unconsciousness cannot be studied directly but is inferred from behaviour.
• Clinical evidence for postulating unconscious includes the following:
• 1. dreams, which are symbolic representations of unconscious needs, wishes and conflicts
• 2. slips of the tongue and forgetting (eg. a familiar name
• 3. Posthypnotic suggestions
• 4. material derived from free-association and techniques
• 5. material derived from projective techniques
• 6. the symbolic content of psychotic symptoms

• For Freud, consciousness is a thin slice of the total mind. The larger part of the mind exists below the surface of awareness.
• Unconscious: stores all experiences, memories and repressed material.
• Most psychological functioning exists in the out-of-awareness realm.

• Aim of psychoanalytic therapy is to make the unconscious motives conscious, for only then can an individual exercise choice.
• From this perspective, a 'cure' is based on uncovering the meaning of symptoms, the causes of behaviour, and the repressed materials that interfere with healthy functioning.
• Note: intellectual insight alone does not resolve the symptom.
• Client's need to cling to old patterns (repetition) must be confronted by working trough transference distortions.

• Anxiety: a feeling of dread that results from repressed feelings, memories, desires and experience that emerge to the surface of awareness. 
• Considered as a state of tension that motivates us to do something.
• Develops out of a conflict among the id, ego and superego over control of the available psychic energy.
• Function of anxiety is to warn of impending danger.

3 kinds of anxiety: reality, neurotic and moral.

• Reality anxiety: fear of danger from the external world, and the level of such anxiety is proportionate to the degree of real threat.
• Neurotic and moral anxieties are evoked by threats to the 'balance of power' within the person. They signal the ego that unless appropriate measures are taken, the danger may increase until the ego is overthrown.
• Neurotic anxiety: the fear that the instincts will get out of hand and cause the person to do something for which she or he will be punished.
• Moral anxiety: the fear of one's own conscience. 
• People with a well-developed conscience tend to feel guilty when they do something contrary to their moral code.
• When the ego cannot control anxiety by rational and direct methods, it relies on the indirect ones- ego-defence behaviour.

• Help the individual cope with anxiety and prevent the ego from being overwhelmed.
• Ego defences are normal behaviours that can have adaptive value provided they do not become a style of life that enables the individual to avoid facing reality.
• Defences employed depend on the individual's level of development and degree of anxiety.
• DM have 2 characteristics in common: 1) they either deny or distort reality 2) they operate on an unconscious level

• Repression: threatening or painful thoughts and feelings are excluded from awareness. 
• Denial: denying the existence of threat in reality. Similar to repression yet it generally operate at preconscious and conscious levels.
• Reaction formation: actively expressing the opposite impulse when confronted with a threatening impulse. By developing conscious attitudes and behaviours that are opposed to disturbing desires, people do not have to face the anxiety that would result if they were to recognise these dimensions of themselves.
• Projection: attributing one's own unacceptable desires and impulses. A mechanism of self deception.
• Displacement: directing energy toward another object or person when the original object or person is inaccessible. Discharging impulses by shifting from threatening object to a 'safer target'.
• Rationalisation: manufacturing 'good' reasons to explain aware a bruised ago. Aid in softening the blow connected with disappointments.
• Sublimation: diverting sexual or aggressive energy into other channels, usually socially acceptable or admirable channels. 
• Regression: Going back to an earlier phase of development when there were fewer demands.
• Introjection: taking in and 'swallowing' the values and standards of others. Positive- parents or therapists. Negative; concentration camps
• Identification: identifying with successful causes, organisations or people in the hope that you will be perceived as worthwhile. Can enhance self-worth and protect form a sense of being a failure. 
• Compensation: masking perceived weaknesses or developing certain positive traits to make up for limitations.

• 0-1 oral stage: Infant needs to get basic nurturing, or later feelings of greediness and acquisitiveness may develop. Oral fixations result from deprivation of oral gratification in infancy.
• Later personality problems can include mistrust of others, rejecting others, and fear of or inability to form intimate relationships.
• Ages 2-3 anal stage: Main developmental tasks include learning independence, accepting personal power and learning to express negative feelings such as rage and aggression.
• Parental discipline patterns and attitudes have significant consequences for child's later personality development.
• Ages 3-6 Phallic stage: basic conflict centres on unconscious incestuous desires that child develops for parent of opposite sex and that, because of their threatening nature, are repressed.
• Oedipus complex: male phallic stage. Involves mother as love object for boy.
• Electra complex: female phallic stage. Involves girl's striving for father's love and approval. How parents respond, verbally and non verbally, to child's emerging sexuality has an impact on sexual attitudes and feelings that child develops.
• Age 6-12 Latency stage: time of socialisation as child turns outward and forms relationships with others.
• Age 12-18 Genital stage:can deal with sexual energy by investing it in various socially acceptable activities
• Ages 18-35: genetical stage continues. freedom to love and to work. Freedom from parental influence and capacity to care for others.

• Refer to the Freudian chronological phases of development, beginning in infancy.
• Freud postulated 3 early stages of development that often bring people to counselling when not appropriately resolved.
• Oral stage: mouth is primary source of gratification. Deals with the inability to trust oneself and others, resulting in the fear of loving and forming close relationships and low self-esteem.
• Anal stage: deals the inability to recognise and express anger, leading to the denial with the inability to recognise and express anger, leading to the denial of one's own power as a person and the lack of a sense of autonomy.
• Phallic stage: deals with the inability to fully accept one's sexuality and sexual feelings, and also difficulty in accepting oneself as a man or woman. 
• When a child's needs are not adequately met during these stages of development, an individual may become fixated

• Basic psychological and social tasks crises to be resolved), which individuals need to master at intervals from infancy through old age.
• Crisis: a turning point in life when we have the potential to move forward or regress. At these turning points, we can either resolve our conflicts or fail to master the developmental task.
• To a large extent, our life is the result of the choices we make at each of these stages. 
• Erikson often credited with brining an emphasis on social factors to contemporary psychoanalysis.
• Erikson believed Freud did not go far enough in explaining the ego's place in development and did not give enough attention to social influences throughout the life span.

• Infancy: trust vs mistrust. If significant others provide for basic physical and emotional needs, infant develops a sense of trust. If not, attitude of mistrust toward the world, especially toward interpersonal relationships.
• Early childhood: autonomy vs shame and doubt. A time for developing autonomy. Child needs to explore and experiment, to make mistakes and to test limits. If parents promote dependency, child's autonomy is inhibited and capacity to deal with world successfully is hampered.
• Preschool age: initiative vs guilt. Basic task is to achieve a sense of competence and initiative. If children are given freedom to select personally meaningful activities, they tend to develop a positive view of self and follow through with their projects. If they are not allowed to make their own decisions, they tend to develop guilt over taking initiative. They then refrain from taking active stance and allow others to choose for them.
• School age: industry vs inferiority. Basic task is to achieve a sense of industry, which refers to setting and attaining personal goals. Failure to do so results in a sense of inadequacy.
• Adolescence: identity vs role confusion. Major conflicts centre on clarification of self-identity, life goals and life's meaning. Failure to achieve a sense of identity results in role confusions.
• Young adulthood: intimacy vs isolation. Task is to form intimate relationships. Failure to do so can lead to alienation and isolation.
• Middle age: generativity vs stagnation.Time of adjusting to the discrepancy between one's dream and one's actual accomplishments. Failure to achieve a sense of productivity often leads to psychological stagnation.
• Later life: integrity vs despair. If one looks back on life with few regrets and feels personally worthwhile, ego integrity results. Failure to achieve this can lead to feelings of despair, hopelessness, guilt, resentment and self rejection.

• Ultimate goal of psychoanalytic treatment is to increase adaptive functioning, which involves the reduction of symptoms and the resolution of conflicts.
• 2 goals of Freudian psychoanalytic therapy: make the unconscious conscious and to strengthen the go so that behaviour is based more on reality and less on instinctual cravings or irrational guilt.
• Therapeutic methods are used to bring out unconscious material.
• Then childhood experiences are reconstructed, discussed, interpreted, and analysed.
• Looking into past to develop level of self-understanding that is assumed to be necessary for a change in character.

• In classical psychoanalysis, analysts typically assume an anonymous nonjudgemental stance, sometimes called the 'blank-screen' approach.
• They avoid self disclosure and maintain a sense of neutrality to foster a transference relationship, in which their clients will make projections onto them.
• This is a cornerstone of psychoanalysis.
• The assumption is that whatever the client feels toward them will largely be the product of feelings associated with other significant figures from the past.

• Central functions of analysis is to assist clients in achieving self-awareness, honestly and more effective personal relationships; in dealing with anxiety in a realistic way; and in gaining control over impulsive and irrational behaviour.
• Major function of interpretation is to accelerate the process of uncovering unconscious material.
• Insight into their problems increases their awareness of ways to change and thus gain more control over their lives.
• A primary aim of psychodynamic approaches is to foster the capacity of clients to solve their own problems.

• Clients interested in classical psychoanalysis must be willing to commit themselves to an intensive, long-term therapy process.
• Free association: lie on couch and try to say whatever comes to mind without self-censorship.
• Lying on couch encourages deep, uncensored reflections and reduces ability of clients to 'read' their analyst's face for reactions.
• Client free to express any idea or feeling. Analyst remains nonjudgemental.
• Analyst is not free to engage in spontaneous self-expression.
• Working through: a process of resolving basic conflicts that are manifested in the client's relationship with the therapist; achieved by the repetition of interpretations and by exploring forms of resistance.

• Psychodynamic psychotherapy: emerged as a way of shortening and simplifying the lengthy process of classical. 
• Do not use all the techniques associated with classical.
• However do remain alert to transference manifestations, explore the meaning of clients' dreams, explore both the past and present, offer interpretations for defences and resistance, and concerned with unconscious material.
• Traditional make more frequent interpretations of transferences and engage in fewer supportive interventions.

• Psychoanalytic clients are ready to terminate their sessions when they and their analyst mutually agree that they have resolved those symptoms and core conflicts that were amenable to resolution, have clarified and accepted their remaining emotional problems, have understood the historical roots of their difficulties, have mastery of core themes, have insight into how their environment affects them and how they affect the environment, have achieved reduced defensiveness and can integrate their awareness of past problems with their present relationships.
• Some suggest that termination tends to bring up intense feelings of attachment, separation and loss. Thus a termination date is set well in advance to talk about these feelings and about what the client learned in psychotherapy.

• Classic: stands outside relationship, comments on it and offers insight-producing interpretation.
• Contemporary: view their emotional communication with clients as a useful way to gain information and create connection. 
• Current findings lend strong support for the effectiveness of the psychoanalytic relationship when treating clients who have suffered interpersonal trauma and neglect.

• Transference: feelings become conscious and are transferred to the therapist, clients can understand and resolve past 'unfinished business'.
• Childhood feelings and conflicts begin to surface from unconscious and clients regress emotionally, reexperience them and attach them to the therapist.

• Working-through: process consists of repetitive and elaborate explorations of unconscious material and defences, most of which originated in early childhoof.
• Clients learn to accept their defensive structure and recognise how they may have served a purpose in the past.
• This results in a resolution of old patterns and enables clients to make new choices.

• Assumed for clients to become psychologically independent, must achieve some level of freedom form behaviour motivated by infantile strivings, such as need for total love.
• Traces of childhood needs and traumas will never be completely erased.
• Not all feelings clients have toward their therapists are manifestation of transference.

Countertransference: a phenomenon that occurs when there is inappropriate affect, when therapists respond in irrational ways, or when they lose their objectivity in a relationship because their own conflicts are triggered.

Analytic approach requires therapists to undergo their own analytic psychotherapy.

• Not all countertransference reactions are detrimental to therapeutic process.
• Eg. therapist who notes a countertransference mood of irritability may learn something about a client's pattern of being demanding, which can be explored in therapy.

• 6 basic techniques of psychoanalytic therapy
• 1. maintaining the analtic framework
• 2. free association
• 3. interpretation
• 4. dream analysis
• 5. analysis of resistance
• 6. analysis of transference

• Refers to a whole range of procedural and stylistic factors, such as the analyst's relative anonymity, maintaining neutrality and objecyivity, the regularity and consistency of meetings, starting and ending sessions on time, clarity on fees and basic boundary issues such as the avoidance of advice giving or imposition of the therapist's values.
• The consistent framework is itself a therapeutic factor.
• Analysts attempt to minimise departures fro this consistent pattern.

• Clients are encouraged to say whatever comes to mind without censorship.
• Most clients will occasionally depart from this basic rule, and these resistances will be interpreted by the therapist when it is timely to do so.
• Used to open doors to unconscious.
• Therapist's task is to identify the repressed material that is locked in the unconscious.
• Sequence of association guides the therapist in understanding the connections clients make among events.
• Blockings or disruptions in associations serve as cues to anxiety-arousing material.
• Nothing is taken at face value.
• Eg. slip of the tongue can suggest that an expressed emotion is accompanied by a conflicting affect

• Consists of the analyst pointing out, explaining, and even teaching the client the meanings of behaviour that is manifested in dreams, free association, resistances, defences and the therapeutic relationship itself.
• Function is to enable the ego to assimilate new material and to speed up the process of uncovering further unconscious material.

• Relational psychoanalytic therapists present possible meanings associated with a client's thoughts, feelings or events as a hypothesis rather than a truth about a client's inner world.
• Interpretations are provided in a collaborative manner.

Important that interpretations be appropriately timed because the client will reject therapist interpretations that are poorly timed.

• General rule: interpretation should be presented when the phenomenon to be interpreted is close to conscious awareness. Ie. therapist interpret material that the client have not seen yet but is capable of tolerating and incorporating.
• Interpretation should start from the surface and go only as deep as the client is able to go.

• Procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problems.
• During sleep, defences are lowered and repressed feelings surface.

• Dreams have two levels of content:
• laten content: consists of hidden, symbolic and unconscious motives, wishes and fears. because they are so painful and threatening, the unconscious sexual and aggressive impulses that make up latent content are transformed into
• Manifest content: the dream as it appears to the dreamer. 
• Dream work: the process by which the latent content of a dream is transformed into the less threatening manifest content.

Therapist task to uncover disguised meanings by studying symbols in the manifest content of the dream.

• Dreams may serve as a pathway to repressed material, but dreams also provide an understanding of client's current functioning.
• The dream is viewed as a significant message to clients to examine something that could be problematic if left unexamined.

• Resistance: anything that works against the process of therapy and prevents the client from producing previously unconscious material.
• The client's reluctance to bring to the surface of awareness unconscious material that has been repressed.
• Any idea, attitude, feeling or action that fosters the status quo and gets in the way of change.
• Freud viewed resistance as defence against anxiety that would arise if they were to become aware of repressed impulses and feelings.
• They are representative of usual defensive approaches in daily life, need to be recognised as devices that defend against anxiety but that interfere with the ability to accept chance that could lead to experiencing a more gratifying ilfe.

• Transference situation is considered valuable because its manifestations provide clients with the opportunity to reexperience a variety of feelings that would otherwise be inaccessible.
• Through the interpretation of transference, clients can recognise how they are repeating the same dynamic patterns in their relationships with the therapist, significant figures from the past, and in present relationships with significant others.
• Through appropriate interpretations and working through of these current expressions of early feelings, clients are able to become aware of and to gradually change some of their long-standing patterns of behaviour.

• Group work may re-create early life situations that continue to affect the client.
• members will most likely find symbolic mothers, fathers, siblings and lovers in their group.
• Group participants frequently compete for the attention of the leaser- reminiscent of earlier times when they had to vie for parent's attention.
• This rivalry can be explored as a way of gaining increased awareness of how participants dealt with competition as children and how their past success or lack of it affects their present interactions with others.

• 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.
• Must remain vigilant that they do not misuse their power by turning group into a forum for pushing clients to adjust by conforming to the dominant cultural values at the expense of losing their own worldview and cultural identity.

• Places central importance on the psychological changes that are associated with midlife.
• Maintained that at midlife, we need to let go of many of the values and behaviours that guided the first half of our life and confront our unconscious.
• Can best do this by paying attention to dreams and engaging in creative activities such as writing or painting.

• 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 realisation of all their capabilities.
• Individuation: the harmonious integration of the conscious and unconscious aspects of personality. An innate and primary goal.
• Shadow: Jung archetype representing thoughts, feelings and actions that we tend to disown by projecting them outward.
• To become integrated, essential to recognise that the 'shadow' is part of our nature.
• Collective unconscious: the deepest and east accessible level of the psyche. Contains the accumulation of inherited experiences of human and prehuman species.
• Archetypes: the images of universal experiences contained in the collective unconscious. Eg:
• Persona: a mask or public face, that we were to protect ourselves.
• Animus (anima): represents both the biological and psychological aspects of masculinity and femininity, which are thought to coexist in both sexes.

• Jung wrote that dreams have two purposes:
• 1. they are prospective. They help people prepare themselves for the experiences and events they anticipate in the near future.
• 2. Serve as a compensatory function. Working to bring about a balance between opposites within the person. They compensate for the overdevelopment of one facet of the individual's personality.
• Aim of the dream is resolution and integration.
• According to Jung, each part of the dream can be understood as some projected quality of the dreamer.

• Object-relations theory: encompasses work of very different psychoanalytic theorists. Especially concerned with investigating attachment and separation.
• Their emphasis is how our relationships with other people are affected by the way we have internalised our experiences of others and set up representations of others within ourselves.
• Object relations: interpersonal relationships as these are represented intrapsychically, and as they influence our interactions with the people around us.
• Helps us see the ways in which clients interacted with significant others in the past and how they are superimposing these early experiences on present relationships.
• Term object used by Freud to refer to that which satisfies a need

• Self-psychology: emphasises how we use interpersonal relationships (self objects) to develop our sense of self.
• Put empathy at the forefront of psychoanalytic healing and choose interventions based on them being genuinely empathically attuned to clients.

• Relational model: based on the assumption that therapy is an interactive process between client and therapist.
• Emphasis on more egalitarian therapeutic style and not knowing and approaching clients with genuine curiosity.

• Had a central influence on contemporary object relations theory.
• Belief that the individual begins in a state of psychological fusion with the mother and progresses gradually to separation.
• The unfinished crises and residues of the earlier state of fusion, as well as the process of separating and individuating, have a profound influence on later relationships.
• Object relations of later life build on the child's search for a reconnection with the mother.
• Psychological development can be thought of as the evolution of the way in which individuals separate and differentiate themselves from others.

• Normal infantile autism: first 3-4 weeks. Infant is presumed to be responding more to states of physiological tension that to psychological process.
• Symbiosis: 3-8 month. Infant has pronounced dependent on the mother.
• Separation-individuation: begins 4-5 months. Child moves away from symbiotic forms of relating. Child experiences separation from significant others yet still turns to them for a sense of confirmation and comfort.

Children who do not experience the opportunity to differentiate, and those who lack opportunity to idealise others while also taking pride in themselves, may later suffer from narcissistic character disorder.

Borderline personality disorder: have moved into the separation process but parents are unable to tolerate this beginning individuation and withdraw emotional support.

• Increased attention is being given to disturbances during childhood and adolescence
• The emphasis on treatment has shifted to dealing therapeutically with chronic personality disorders.
• Increased attention is being paid to establishing a good therapeutic alliance early in therapy.
• There is renewed interest in the development of briefer forms of psychodynamic therapy largely due to societal pressures for accountability and cost-effectiveness.

• Target a specific interpersonal problem and goals during the initial session
• Assume a less neutral therapeutic stance than is true of traditional analytic approaches
• Establish a strong working alliance early in the therapy
• Use interpretation relatively early in the therapy relationship

Instead of thinking of time-limited dynamic psychotherapyas a definitive intervention, it is best to view this approach as offering multiple, brief therapy experiences over an individual’s life span

Psychotherapists need to recognise and confront their own potential sources of bias and how countertransference can be conveyed unintentionally though their interventions.

Stresses the value of intensive psychotherapy as part of training of therapists.

• Traditional psychoanalytic approaches are costly and psychoanalytic therapy is generally perceived as being based on upper and middle class values.
• All clients do not share these values.
• Shortcoming is the ambiguity inherent in most psychoanalytic approaches. Can be problematic for clients from cultures who expect direction from a professional.
• Can be criticised for failing to adequately address the social, cultural and political factors that result in an individual's problem.
• If there is not a balance between the external and internal perspectives, clients may feel responsible for their condition.

• Practical applications of many psychoanalytic applications are limited due to time, expense and availability of trained psychoanalytic therapists.
• May severely disturbed clients lack the level of ego strength needed for this treatment.
• Anonymous role: assumed by therapists. Appropriate self-disclosure tends to enhance therapy outcomes.
• Feminist perspective: object-relations criticised for its emphasis on the role of the mother-child relationship.