Psychoanalytic Therapy PDF

Saint Louis College City of San Fernando, La Union Beacon of Wisdom in the North Psych El 2: Introduction to Counseling CHAPTER III...

Saint Louis College City of San Fernando, La Union Beacon of Wisdom in the North Psych El 2: Introduction to Counseling CHAPTER III PSYCHOANALYTIC THERAPY A. KEY CONCEPTS B. THE THERAPEUTIC PROCESS 1. Therapeutic Goals a. The 2 goals of psychoanalytic therapy: ∙ Make the unconscious conscious – increasing awareness, fostering insights into client’s behavior, and understanding the meaning of symptoms ∙ Strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt b. Successful analysis is believed to result in significant modification of the individual’s personality and character structure c. Childhood experiences are: ∙ Reconstructed ∙ Discussed ∙ Interpreted ∙ Analyzed ∙ Probing deeper of the past to develop self-understanding necessary for a change in character 2. Therapist’s Role a. Analyst assume an anonymous stance called the “blank-screen” approach b. Engage in very little self-disclosure and maintain a sense of neutrality to foster a transference relationship in which their clients will make projections onto them c. Transference relationship – transfer of feelings originally experienced in an early relationship to other important people in a person’s present environment 3. Therapist’s Function a. Help clients acquire the freedom to love, work, and play b. Assist clients in achieving self-awareness, honesty, and more effective personal relationships c. Deal with anxiety in a realistic way d. Gain control over impulsive or irrational behavior e. Teach clients the meaning of the process through interpretation so that they are able to achieve insight to their problems 4. Therapeutic Process a. Particular attention is given to the client’s resistances and to make appropriate interpretation b. Interpretations accelerate the process of uncovering unconscious material c. Change in clients depends on their readiness to change and the accuracy of the analyst’s  interpretations. Change occurs through the process of reworking old patterns so that clients might become freer to act in new ways 5. Client’s Experience in Therapy Saint Louis College City of San Fernando, La Union Beacon of Wisdom in the North Psych El 2: Introduction to Counseling a. Classical Psychoanalysis ∙ Intensive and long-term therapy process ∙ After some face-to-face sessions with the analyst, clients lie on a couch to engage in a free association (say whatever comes to mind without self-censorship) ∙ Clients report their feelings, experiences, associations, memories, and fantasies to the analyst b. Contemporary Psychodynamic Therapy ∙ Emerged as a way of shortening and simplifying the lengthy process of classical psychoanalysis ∙ Psychodynamic therapists remain to alert transference manifestations, explore the meaning of clients’ dreams, explore both the past and the present, and are concerned with unconscious material ∙ Clients make a commitment with the therapist to stick with the procedures of an intensive therapeutic process. They agree to talk because verbal productions are the heart of psychoanalysis ∙ They are typically asked not to make any radical changes in their lifestyle during the period of the analysis ∙ Clients are ready to terminate their sessions when they and their analyst mutually agree that they have resolved those symptoms and conflicts that were amenable to resolution, have clarified and accepted their difficulties, have mastery of core themes, and can integrate their awareness of client’s “why” questions regarding his or her life 6. Therapeutic Relationship a. In classical analysis: Analyst stands outside the relationship, comments on it, and offers insight-producing interpretations (detached and objective stance) b. Contemporary psychoanalytic theory and practice highlights the importance of the therapeutic relationship as a therapeutic factor in bringing about change c. Transference – client’s unconscious shifting to the analyst of the feelings and fantasies that are reactions to significant others in the client’s past. It reflects the deep patterning of old experiences in relationships as they emerge in current life d. Relational model of psychoanalysis – regards transference as being an interactive process between the client and the therapist e. Working through process consists of an exploration of unconscious material and defenses, most of which originated in early childhood f. Countertransference – 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  C. THERAPEUTIC TECHNIQUES AND PROCEDURES 1. Maintaining the analytic framework ∙ refers to a whole range of procedural and stylistic factors such as the analyst’s relative anonymity, the regularity and consistency of meetings, and starting and ending session on time Saint Louis College City of San Fernando, La Union Beacon of Wisdom in the North Psych El 2: Introduction to Counseling 2. Free association ∙ clients are encouraged to say whatever comes to mind; ∙ clients flow with any feelings or thoughts by reporting them immediately without censorship; ∙ one of the basic tools used to open the doors to unconscious wishes, fantasies, conflicts, and motivations 3. Interpretation ∙ Consists of the analyst’s pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free associations, resistances, and the therapeutic relationship itself ∙ It includes identifying, clarifying and translating the clients’ material ∙ Less is more; do not overwhelm patient, small dosages are best ∙ Guidelines: ∙ Close to conscious awareness ∙ Go only as deep as the client is able to go ∙ Point out resistance or defense before interpreting the emotion or conflict that lies beneath 4. Dream analysis ∙ Dreams are considered the “road to the unconscious” and its contents have two levels namely: ∙ Latent content: consists of hidden, symbolic, and unconscious motives, wishes and fears; can be used to discover unconscious wishes ∙ Manifest content: the dream as it appears to the dreamer; what actually happens in a dream ∙ Dream work – the process by which the latent content of a dream is transformed into the less threatening manifest content ∙ Important procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problem 5. Analysis of resistance ∙ Resistance ∙ Anything that works against the progress of therapy and prevents the client from producing previously unconscious material ∙ Client’s reluctance to bring to the surface of awareness unconscious material that has been repressed ∙ Because resistance blocks out threatening material from entering awareness, analytic  therapist points it out, and clients must confront it if they hope to deal with conflicts realistically ∙ Analysis of resistance helps the client become aware of the reasons for the resistance (e.g., avoiding pain or anxiety) 6. Analysis of transference ∙ Transference ∙ Patient reacts as if the therapist represents an important figure from childhood ∙ Positive or negative feelings Saint Louis College City of San Fernando, La Union Beacon of Wisdom in the North Psych El 2: Introduction to Counseling ∙ Provides clues about nature of patient’s problems ∙ Form of resistance ∙ This allows the client to experience feelings that would otherwise inaccessible ∙ Analysis of transference allows client to achieve insight into the influence of the past ∙ Countertransference: the reaction of the toward the client that may interfere with objectivity D. CONTRIBUTIONS TO MULTICULTURAL COUNSELING Its focus on family dynamics is appropriate for working with many cultural groups. The therapist’s formality appeals to clients who expect professional distance. Notion of ego defense is helpful in understanding inner dynamics and dealing with environmental stresses. E. LIMITATONS IN MULTICULTURAL COUNSELING Its focus on insight, intrapsychic dynamics, and long-term treatment is often not valued by clients who prefer to learn coping skills for dealing with pressing daily concerns. Internal focus is often in conflict with cultural values that stress an interpersonal and environmental focus. F. CONTRIBUTIONS AND LIMITATIONS OF THE PSYCHOANALYTIC APPROACH ∙ Contribution: More than any other system, this approach has generated controversy as well as exploration and has stimulated further thinking and development of therapy. It has provided a detailed and comprehensive description of personality structure and functioning. It has brought into prominence factors such as the unconscious as a determinant of behavior and the role of trauma and shed light on the dynamics of transference and countertransference, resistance, anxiety, and the mechanisms of ego defense. ∙ Limitation: Requires lengthy training for therapists and much time and expense for clients. The model stresses biological and instinctual factors to neglect of social, cultural, and interpersonal ones. Its methods are less applicable for solving specific daily life problems of clients and may not be appropriate for some ethnic and cultural groups. Many clients lack the degree of ego strength needed for regressive and reconstructive therapy. It may be inappropriate for certain counseling settings.