Psychoanalytic Therapy PDF

+-----------------------------------------------------------------------+ | I. **Goals** | +-----------------------------------------------------------------------+ - [Make the unconscious conscious] - Increase awareness & insight -...

+-----------------------------------------------------------------------+ | I. **Goals** | +-----------------------------------------------------------------------+ - [Make the unconscious conscious] - Increase awareness & insight - Insight - not just intellectual understanding; memories & feelings associated with self-understanding must be experienced - [Strengthen ego] so behavior is based more on reality - Can lead to significant changes in personality +-----------------------------------------------------------------------+ | II. **Human Nature** | +-----------------------------------------------------------------------+ - Deterministic - Driven by life (survival, pleasure, sex) & death instincts (aggression) +-----------------------------------------------------------------------+ | III. **Concepts** | +-----------------------------------------------------------------------+ - Classical psychoanalysis & psychodynamic therapy can be subsumed under psychoanalytic therapy. +-----------------------------------+-----------------------------------+ | **Classical Psychoanalysis | **Psychodynamic** | | (Freudian)** | | | | **Therapy (referred to by Corey | | | as psychoanalytic therapy)** | +-----------------------------------+-----------------------------------+ | Intensive, long-term | Still intensive but shorter & | | | simpler | | More sessions per week | | | | Fewer sessions per week | +-----------------------------------+-----------------------------------+ | Frequent use of interpretations | Less use of interpretations | +-----------------------------------+-----------------------------------+ | Fewer supportive interventions | More supportive interventions | | | (reassurance, empathy, support, | | (More therapeutic regression - | suggestions) | | less rigid level of adjustment, | | | loosened defense mechanisms; | (Less therapeutic regression) | | allowing for both therapeutic | | | growth & vulnerability) | | +-----------------------------------+-----------------------------------+ | Less emphasis on the here & now | More emphasis on the here & now | | relationship | relationship | +-----------------------------------+-----------------------------------+ | Therapist self-disclosure | More latitude for therapist | | strictly avoided | self-disclosure without polluting | | | transference | +-----------------------------------+-----------------------------------+ | Very important that the client | Less relevant: not making radical | | does not make radical changes in | changes in lifestyle during | | lifestyle during period of | period of analysis | | analysis | | | | | | Why? Because defenses are | | | loosened during psychoanalytic | | | therapy | | +-----------------------------------+-----------------------------------+ ---------------------------------- **IV. Psychopathology & Health** ---------------------------------- - Unconscious conflicts - Unresolved childhood conflicts --------------------------------- **V. Therapeutic Relationship** --------------------------------- - Blank-screen approach - Therapists assume an anonymous, nonjudgmental stance - Avoid self-disclosure - Function: facilitate **transference** - the transference of feelings (both negative & positive) associated with significant others from the past to the therapist - Not all clients' feelings towards their therapist are due to transference. They can also be grounded in reality / therapist's present behavior. - **Countertransference** - from therapist to client; not just a reaction to client's transference but also broadly includes all aspects of the client's behavior - Important for therapist to undergo own psychoanalytic therapy -\> key outcome is humility (foundation for authentic relationship with client) - Not all countertransference is bad - can be a good source of data for understanding client's world and also for self-understanding of therapists - Some express their countertransference to clients; some don't (traditional psychoanalysts) ----------------------------------------- ------------------------------------------------------------------------------------ **Classical Psychoanalysis** **Contemporary Relational Psychonalysis** Analyst stands outside the relationship Therapeutic relationship is central - bring the past into the present relationship ----------------------------------------- ------------------------------------------------------------------------------------ -------------------------- **VI. Theory of Change** -------------------------- - For change to occur, transference relationship must be worked through - **Working-through process** - repetitive and elaborate explorations of unconscious material & defenses ---------------------- **VII. Major Steps** ---------------------- - Client's talk -\> catharsis (expression of emotions) -\> insight (self-understanding) -\> working through --------------------- **VII. Techniques** --------------------- - **Maintaining the analytic framework** - having a consistent pattern of procedures - Consistent meeting schedules & environment - Analyst anonymity - Boundaries - When unavoidable departures from the analytic framework happen, they become the focus of interpretations - **Free association** - say whatever comes to mind without censorship; fundamental or basic rule - Therapist's task: identify repressed material in the unconscious + interpret the material - Cue of repressed, anxiety-arousing material: blocks/resistance during free association - Interpretation - uncover hidden meanings - **Interpretation** - Point out & explain the meaning of client's behavior - Ensure that interpretations are appropriately timed - use client's reaction as a gauge - Only interpret materials close to client's conscious awareness - interpret what the client cannot see but can tolerate or incorporate - Start from the surface and go only as deep as the client can go - Goal: accelerate the process of uncovering unconscious material + enable ego to incorporate new material - Contemporary relational analysis - interpretations are presented as hypothesis rather than truths - **Dream analysis** - therapist's task is to uncover latent content by studying the manifest content; uses free association - **Dream** - royal road to the unconscious; contains unconscious material - **Latent content** - underlying meaning - **Manifest content** - the dream as it appears to the dreamer; more acceptable form - **Dream work** - process of transforming latent content to manifest content - Goal: To uncover unconscious material and use insight to understand present struggles - Contemporary relational analysis: - Dreams do not only contain repressed material - Dreams are a message to clients to examine something in their lives that may become problematic - **Interpretation of Resistance** - point out resistance & help clients be aware of reason for resistance - Resistance - client's reluctance to bring unconscious material into awareness - Can be conscious or unconscious - But according to Freud, resistance is an unconscious defense against intolerable anxiety that could arise from bringing unconscious material into the surface - **Interpretations of Transference** - central technique in both classical psychoanalysis & psychodynamic therapy - Goal: To help clients become aware and gradually change long-standing behavioral patterns ------------------------------------------------- **VIII. Development of Psychoanalytic Therapy** ------------------------------------------------- -------------------------------- **Anna Freud: Ego Psychology** -------------------------------- - Shifted the focus from biological drives to ego development - Certain ego functions are autonomous from biological drives - Intelligence - Motor function - Ego defense mechanisms - help clients gain awareness of defense mechanisms and how to better cope with them - Anna Freud - studied children directly - Erikson - psychosocial stages of development - Psychosexual & psychosocial growth can take place together - Addressed both early & later developmental stages - Each stage has its own crisis to be resolved - Crisis - turning point where we can either move forward or regress - Developmental tasks help in understanding client's core conflicts ------------------------------ **Object Relations Therapy** ------------------------------ - Shifted focus from Oedipal parent-child dynamics to pre-oedipal (earlier) parent-child dynamics - Shifted focus from biological drives to desire for interpersonal connection - Fairbairn: "Libido is object-seeking, not pleasure seeking." - **Goal**: Replace bad object with good object. - Therapist acts as good object -\> empathy ---------------------------------- **Heinz Kohut: Self-Psychology** ---------------------------------- - Focus is on developing healthy narcissism - Cohesive self develops from parental provision of empathic mirroring and availability of parent for idealization - **Goal**: Empathic understanding and repeated working through of optimal failures - Client engages in mirroring & idealizing transference with therapist - Mirroring & idealizing transference - seeks to reengage mirroring & ideal object to repair self-structure - Since the therapist is imperfect, therapist will fail in providing for the client's need for perfect empathy and will not be a perfect figure for idealization. - Client will retreat from intimacy. - Therapist will acknowledge failures and interpret client's retreat from intimacy. - Failures will become "optimal" failures and client will acquire new self-structure and strengthen existing ones -------------------------------------------- **Contemporary Relational Psychoanalysis** -------------------------------------------- - Also termed two-person psychology and intersubjectivity - Assumption: Psychoanalytic therapist is always subjective - Therapist is a participant-observer and therapeutic relationship is egalitarian - Interpretations by therapist are treated as hypotheses rather than truths - Therapist participates in mutual enactments - client's enactment of transference is important but so is therapist's enactment of countertransference --------------------------------------- **Attachment-Informed Psychotherapy** --------------------------------------- - **Goal:** Correct dysfunctions in internal working model (early child-caretaker relationship w/c serve as model for future interpersonal relationships) - W/ emphasis on real (rather than imagined) early relationships ---------------------------------------------------- **Short-term/Time Limited Psychoanalytic Therapy** ---------------------------------------------------- - **Role-playing/ Seeding/Manipulating the transference** - therapist adopts the same attitude as the significant other to further the transference (if client had overly-critical parents, therapist would also be critical); might traumatize client - **Corrective emotional experience (Alexander & French)** - therapist adopts compensatory role (if client had overly-critical parents, therapist would be very supportive) - **Focal psychotherapy (French, Balint, Ornstein, Balint) -** focus on one significant conflict rather than doing complete analysis