Psychoanalytic Therapy PDF

Summary

This document provides notes on psychoanalytic therapy, outlining its goals, theories of human nature, and key concepts. It examines differences between classical psychoanalysis and psychodynamic therapy. The document also covers aspects of the therapeutic relationship, psychopathology, and relevant theory. The notes appear to be for study purposes.

Full Transcript

+-----------------------------------------------------------------------+ | 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

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