Coun 174: Chapter 4: Psychoanalytic Therapy

psychodynamic factors

Very deterministic in nature

Meaning that if I tell you what happened in the first 5 years of your life will determine your whole psych.

Early life experiences determine a person

Libido

sexual energy

later broadened to include the energy of all the life instincts

Life instincts

serve the purpose of the survival of the individual and the human race

- There is an instinct for people to seek life, even though the life situation is very bad.

- Many people will apply to be euthanized, but many do not go through with it? Why? We just want to live. Like animal instincts.

death instincts

aggressive drive

• For people who actually choose to kill themselves

• When people go to a high place, there is an urge to jump. We don't know what instinct is the driving force behind people do it.

People manifest through their behavior an unconscious wish to die or to hurt themselves or other

THE ID

The Demanding Child

- Ruled by the pleasure principle

pleasure

all the untamed drives or impulses that might be likened to the biological component. (impulses)

THE EGO

The Traffic Cop

- Ruled by the reality principle

reality

attempts to organize and mediate between the id and the reality of dangers posed by the id’s impulses (actions of the ego may or may not be conscious)

THE SUPEREGO

The Judge

- Ruled by the moral principle

morals

the internalized social component, largely rooted in what the person imagines to be the expectations of parental figures.

realistic goals, psychological rewards or punishments

Clinical evidence for postulating the unconscious

1. dreams (which are symbolic representations of unconscious needs, wishes, and conflicts)

2. Slips of the tongue and forgetting (e.g., a familiar name)

3. Posthypnotic suggestions (when someone follows a suggestion given under hypnosis later on, even without consciously remembering it, showing unconscious influence)

4. Material derived from free-association techniques (when clients freely say whatever comes to mind, unconscious material can slip through)

5. Material derived from projective techniques (tests like the Rorschach inkblot, where ambiguous stimuli are thought to reveal unconscious themes)

6. Symbolic content of psychotic symptoms

The aim of psychoanalytic therapy

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 behavior, and the repressed materials that interfere with healthy functioning

  • The client’s need to cling to old patterns (repetition) must be confronted by working through transference distortion

Repetition

The client’s need to cling to old patterns

Consciousness vs unconsciousness

- Consciousness is a thin slice of the total mind

(Like the iceberg that lies below the surface of the water, the larger part of the mind exists below the surface of awareness)

- Unconscious stores all experiences, memories, and repressed material

(Root of all forms of neurotic symptoms and behaviors)

Anxiety

Feeling of dread resulting from repressed feelings, memories, and desires

- Develops out of conflict among the id, ego, and superego to control psychic energy

three types of anxiety

Reality Anxiety, Neurotic Anxiety, Moral Anxiety

Reality Anxiety

fear of danger from the external world

• The level of such anxiety is proportionate to the degree of real threat.

(9/11, or school shooting) The danger is more real than imagined

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.

- comes from your psych

Moral Anxiety

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.

- comes from your conscious (always tells you that you are doing the wrong thing, that you are doing bad)

Ego-Defense Mechanisms

• Help the individual cope with anxiety and prevent the ego from being overwhelmed

• They either deny or distort reality, and they operate on an unconscious level

• Are normal behaviors that have adaptive value if they do not become a style of life to avoid facing reality

• defense mechanisms have a purpose until it becomes dysfunctional

two characteristics in common between Ego-Defense Mechanisms

- They either deny or distort reality.

- They operate on an unconsciousness level.

Repression

Threatening or painful thoughts and feelings are excluded from awareness.

- Uses for behavior: One of the most important Freudian processes, it is the basis of many other ego defenses and neurotic disorders. (You do not remember it) Freud explained repression as an involuntary removal of something from consciousness. It is assumed that most painful events of the first five or six years of life are buried, yet these events do influence later behavior.

Denial

"Closing one's eyes" to the existence of a threatening aspect of reality.

Uses for behavior: Denial of reality is perhaps the simplest of all self-defense mechanisms. It is a way of distorting what the individual thinks, feels, or perceives in a traumatic situation. This mechanism is similar to repression, but it generally operates at preconscious and conscious levels.

The EGO is bruised.

Reaction Formation

Actively expressing the opposite impulse when confronted with a threatening impulse.

Uses for behavior: By developing conscious attitudes and behaviors that are diametrically opposed to disturbing desires, people do not have to face the anxiety that would result if they were to recognize these dimensions of themselves. Individuals may conceal hate with a facade of love, be extremely nice when they harbor negative reactions, or mask cruelty with excessive kindness.

Projection

Attributing to others one's own unacceptable desires and impulses.

Uses for behavior: This is a mechanism of self-deception. Lustful, aggressive, or other impulses are seen as being possessed by "those people out there, but not by me."

- When I want to be aggressive, lustful, want to have an affair. I keep telling myself that these other people are lustful, they are bad.

Displacement

Directing energy toward another object or person when the original object or person is inaccessible.

Uses for behavior: Displacement is a way of coping with anxiety that involves discharging impulses by shifting from a threatening object to a "safer target." For example, the meek man who feels intimidated by his boss comes home and unloads inappropriate hostility onto his children.

- Different from projection: you divert your negative energy from your original target to someone else, someone who is safer

- A lot of child abuse happens between siblings

Rationalization

Manufacturing "good" reasons to explain away a bruised ego.

Uses for behavior: Rationalization helps justify specific behaviors, and it aids in softening the blow connected with disappointments. When people do not get positions they have applied for in their work, they think of logical reasons they did not succeed, and they sometimes attempt to convince themselves that they really did not want the position anyway.

Ex., I didn't even want it anyway. It's so far away. They don't pay right. It is unfair.

If we can train the ego to see that not getting a job is part of reality. You can not afford to feel so bad about yourself.

- People do not accept their negative emotion, so they will do something to rationalize it. They do not express their true feelings.

Sublimation

Diverting sexual or aggressive energy into other channels.

Uses for behavior: Energy is usually diverted into socially acceptable and sometimes even admirable channels. For example, aggressive impulses can be channeled into athletic activities, so that the person finds a way of expressing aggressive feelings and, as an added bonus, is often praised.

(Not verbal.

Some pent-up energy within)

Volunteering can be this, but not all people who volunteer partake in this

- Something that is honorable or noble and elevates

Regression

Going back to an earlier phase of development when there were fewer demands.

Uses for behavior: In the face of severe stress or extreme challenge, individuals may attempt to cope with their anxiety by clinging to immature and inappropriate behaviors. For example, children who are frightened in school may indulge in infantile behavior such as weeping, excessive dependence, thumb-sucking, hiding, or clinging to the teacher.

(Sometimes it is not clinically dysfunctional)

Ex. Can be some gender differences: male sickness

- When you are sick, there is a stress, so you go back into baby behavior

Introjection

Taking in and "swallowing" the values and standards of others.

Uses for behavior: Positive forms of introjection include incorporation of parental values or the attributes and values of the therapist (assuming that these are not merely uncritically accepted). One negative example is that in concentration camps some of the prisoners dealt with overwhelming anxiety by accepting the values of the enemy through identification with the aggressor.

Identification

Identifying with successful causes, organizations, or people in the hope that you will be perceived as worthwhile.

Uses for behavior: Identification can enhance self-worth and protect one from a sense of being a failure. This is part of the developmental process by which children learn gender-role behaviors, but it can also be a defensive reaction when used by people who feel basically inferior.

(Identification, you identify with groups to feel an elevated sense of self)

Ex. Going to church, environmental protections - how can you tell people are actually supporting those causes? Genuineness. And if you use it as a defense mechanism, you still feel small. "If I am not part of a growth, I am nothing.

Compensation

Masking perceived weaknesses or developing certain positive traits to make up for limitations.

Uses for behavior: This mechanism can have direct adjustive value, and it can also be an attempt by the person to say "Don't see the ways in which I am inferior, but see me in my accomplishments."

Freud's Psychosexual Stages: Oral stage (love and trust)

- First year

Sucking at mother's breasts satisfies need for food and pleasure. 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; love, and fear of or inability to form intimate relationships.

• deals with the inability to trust oneself and others, resulting in the fear of loving and forming close relationships and low self-esteem.

Freud's Psychosexual Stages: Anal stage (dealing with negative feelings)

Ages 1-3

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 the child's later personality development.

• deals with the inability to recognize and express anger, leading to the denial of one’s own power as a person and the lack of a sense of autonomy.

Freud's Psychosexual Stages: Phallic stage (developing a postive acceptance of sexuality)

Ages 3-6

Unconcious incestuous desires that child develops for parent of opposite sex and that, because of their threatening nature, are repressed.

Male phallic stage, known as Oedipus complex, involves mother as love object for boy. Female phallic stage, known as Electra complex, involves girl's striving for father's love and approval.

(How parents respond has an impact on developed sexual attitudes and feelings)

• deals with the inability to fully accept one’s sexuality and sexual feelings, and also to difficulty in accepting oneself as a man or a woman

Freud's Psychosexual Stages: Latency stage

Ages 6-12

Sexual interests are replaced by interests in school, playmates, sports, and a range of new activities. This is a time of socialization as child turns outward and forms relationships with others.

Freud's Psychosexual Stages: Genital stage (adolescence)

Ages 12-18

This stage begins with puberty and lasts until senility sets in. Adolescents can deal with sexual energy by investing it in various socially acceptable activities such as forming friendships, engaging in art or in sports, and preparing for a career.

Freud's Psychosexual Stages: Genital stage continues (young adulthood)

Ages 18-35

the freedom "to love and to work."

Core characteristic of mature adult is the freedom "to love and to work." This move toward adulthood involves freedom from parental influence and the capacity to care for others.

Freud's Psychosexual Stages: Genital stage continues (middle age)

Ages 35-60

Genital stage continues

Freud's Psychosexual Stages: Genital stage continues (later life)

Ages 60+

Genital stage continues

Erikson's Psychosocial Stages: Infancy: : Trust versus mistrust

First Year of life

If significant others provide for basic physical and emotional needs, infant develops a sense of trust. If basic needs are not met, an attitude of mistrust toward the world, especially toward interpersonal relationships, is the result.

Erikson's Psychosocial Stages: Early Childhood: Autonomy versus shame and doubt

Ages 1-3

A time for developing autonomy. Basic struggle is between a sense of self-reliance and a sense of self-doubt. 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 the world successfully is hampered.

Erikson's Psychosocial Stages: Preschool Age: Initiative versus guilt

Ages 3-6

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 an active stance and allow others to choose for them.

Erikson's Psychosocial Stages: School Age: Industry versus inferiority

Ages 6-12

Child needs to expand understanding of the world, continue to develop appropriate gender-role identity, and learn the basic skills required for school success. 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.

Erikson's Psychosocial Stages: Adolescence: Identity versus role confusion

Ages 12-18

A time of transition between childhood and adulthood. A time for testing limits, for breaking dependent ties, and for establishing a new identity. Major conflicts center on clarification of self-identity, life goals, and life's meaning. Failure to achieve a sense of identity results in role confusion.

Erikson's Psychosocial Stages: Young Adulthood: Intimacy versus isolation

Ages 18-35

Developmental task at this time is to form intimate relationships. Failure to achieve intimacy can lead to alienation and isolation.

Erikson's Psychosocial Stages: Middle Age: Generativity versus stagnation

Ages 35-60

There is a need to go beyond self and family and be involved in helping the next generation. Failure to achieve a sense of productivity often leads to psychological stagnation.

Erikson's Psychosocial Stages: Later Life: Integrity versus despair

Ages 60+

If one looks back on life with few regrets and feels personally worthwhile, ego integrity results. Failure to achieve ego integrity can lead to feelings of despair, hopelessness, guilt, resentment, and self-rejection.

Blank-screen approach

Also known as anonymous nonjudgmental stance, fosters transference.

- In classical psychoanalysis, analysts typically assume an anonymous nonjudgmental stance. They avoid self-disclosure and maintain a sense of neutrality to foster a transference relationship, in which their clients will make projections onto them.

Transference

refers to the client's tendency to view the therapist in terms that are shaped by his or her experiences with important caregivers and other significant figures who played important roles during the developmental process

- the client's unconscious shifting to the analyst of feelings.

Psychodynamics

foster the capacity of clients to solve their own problems. (puzzle pieces)

Working-through

process consists of repetitive and elaborate explorations of unconscious material, originated in early childhood.

- repeating quesitons

Clients learn to accept their defensive structures and recognize how they may have served a purpose in the past. Requires that the client develop a relationship with the therapist in the present that is a corrective and integrative experience.

Countertransference

occurs when therapists lose their objectivity because their own conflicts are triggered

Maintaining the Analytic Framework

Therapist uses a range of procedural and stylistic factors

(e.g., analyst's relative anonymity, maintaining neutrality and objectivity, the regularity and consistency of meetings, starting and ending the sessions on time, clarity on fees, and basic boundary issues such as the avoidance of advice giving or imposition of the therapist’s values)

Free Association

clients are encouraged to say whatever comes to mind, regardless of how painful, silly, trivial, illogical, or irrelevant it may seem

• lie on the couch and try to say whatever comes to mind without self-censorship (known as the “fundamental rule.”)

  In classical analysis, therapeutic neutrality and anonymity are valued by the analyst

Interpretation

Analyst's pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free association, resistances, defenses, and the therapeutic relationship itself.

• Identifying, clarifying, and translating the client’s material.

• Present possible meanings associated with a client’s thoughts, feelings, or events as a hypothesis.

Dream Analysis

Therapist uses the "royal road to the unconscious" to bring unconscious material to light

a. Freud sees dreams as the “royal road to the unconscious,”

b. Latent content: hidden, symbolic, and unconscious motives, wishes, and fears

c. Manifest content: the dream as it appears to the dreamer

d. dream work: the process by which the latent content of a dream is transformed into the less threatening manifest content

Analysis and Interpretation of Resistance

Works against the progress of therapy and prevents the client from producing previously unconscious material (there is a push-back, what is the push-back about)

Analysis and Interpretation of Transference

Therapist points out, explains, and teaches the meanings of whatever is revealed

Jung's Perspective on the Development of Personality

Jung developed a spiritual approach that places great emphasis on being impelled to find meaning in life in contrast to being driven by the psychological and biological forces described by Freud.

- Jung maintained that we are not merely shaped by past events (Freudian determinism), but that we are influenced by our future as well as our past.

- Achieving individuation—the harmonious integration of the conscious and unconscious aspects of personality—is an innate and primary goal.

- Places central importance on psychological changes associated with midlife

- To become integrated, it is essential to accept our dark side, or shadow

- Dreams are aimed at integration and resolution; they contain messages from the collective unconscious, our source of creativity

- Images of universal experiences contained in the collective unconscious are called archetypes (the persona, the anima and animus, and the shadow)

Archetypes (Jung)

Images of universal experiences contained in the collective unconscious

- (the persona, the anima and animus, and the shadow

- the anima is the unconscious feminine side of a man, and the animus is the unconscious masculine side of a woman

individuation

the harmonious integration of the conscious and unconscious aspects of personality—is an innate and primary goal

Collective unconscious

"the deepest and least accessible level of the psyche," which contains the accumulation of inherited experiences of human and prehuman species

Object Relations Theory

Emphasizes attachment and separation (sometimes we project our relationship to that object. How we attach and separate ourselves from that object)

• A branch of psychoanalysis that focuses on how early relationships—especially with caregivers—shape the way we connect with others. It looks at how the experiences we’ve had with important people in our lives become “internal pictures” or mental models inside us, and these affect how we handle attachment, separation, and relationships later on.

• interpersonal relationships as these are represented intrapsychically, and they influence our interactions with the people around us.

• mental “pictures” or inner models we carry of our relationships with others. These inner images shape how we interact with people in real life.

Self Psychology

Emphasizes how we use interpersonal relationships (self objects) to develop our own sense of self (who we are as an object and we deal with who we are to that object, how do we relate)

• focuses on how our relationships with others help us build our sense of who we are. The people we rely on for support, called “self-objects,” play a key role in shaping our self-esteem and identity. (emphasis on empathy)

Relational Psychoanalysis (Relational psychodynamic model)

Emphasizes the interactive process between client and therapist

What happens between them—the trust, connection, and interaction—is central, because the relationship itself helps create change.

Brief Psychodynamic Therapy

Applies the principles of psychodynamic theory and therapy to treating selective disorders within 10 to 25 sessions (it is still a lot)

adaptive functioning

involves the reduction of symptoms and the resolution of conflicts

transference relationship

refers to the client’s tendency to view the therapist in terms that are shaped by his or her experiences with important caregivers and other significant figures who played important roles during the developmental process

Psychodynamics

foster the capacity of clients to solve their own problems. (puzzle pieces)

latent content

hidden, symbolic, and unconscious motives, wishes, and fears

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

analysis of resistance

a. Resistance: anything that works against the progress 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.

b. A defense against anxiety

analysis of transference

a. Transference manifests itself in the therapeutic process when earlier relationships contribute to clients distorting the present with the therapist.

b. Through this interpretation, clients can recognize how they are repeating the same dynamic patterns in their relationships with the therapist, with significant figures from the past, and in present relationships with significant others.

c. clients are able to become aware of and to gradually change some of their long-standing patterns of behavior.

d. aimed at achieving increased awareness and personality change

Play therapy

toys acted as a therapeutic vessel, enabling the students to more fully express themselves

Defense mechanisms

ways in which we manage anxiety. What looks like deliberate misbehavior may in fact be the child’s use of a defense mechanism.

normal infantile autism (Mahler)

• the first three or four weeks of life.

• the infant is presumed to be responding more to states of physiological tension than to psychological processes.

• (babies mainly react to physical needs—like hunger or discomfort—rather than to psychological or emotional experiences.)

no whole self, and there are no whole objects

Symbiosis (Mahler)

• recognizable by the 3rd month and extends roughly through the 8th month.

• At this age, the infant has a pronounced dependency on the mother.

• She (or the primary caregiver) is clearly a partner and not just an interchangeable part.

• The infant seems to expect a very high degree of emotional attunement with its mother.

separation–individuation process (Mahler)

• Begins in the 4th or 5th month.

• During this time the child moves away from symbiotic forms of relating.

• The child experiences separation from significant others yet still turns to them for a sense of confirmation and comfort.

• The child may demonstrate ambivalence, being torn between enjoying separate states of independence and dependence.

Clinical evidence for postulating the unconscious

• first

dreams

Clinical evidence for postulating the unconscious

• dreams

symbolic representations of unconscious needs, wishes, and conflicts

Clinical evidence for postulating the unconscious

• second

Slips of tongue and forgetting

Clinical evidence for postulating the unconscious

• Slips of tongue and forgetting

An example of this is forgetting or mentioning a familiar name

Clinical evidence for postulating the unconscious

• third

Posthypnotic suggestions

Clinical evidence for postulating the unconscious

• Posthypnotic suggestions

When someone follows a suggestion given under hypnosis later on, even without consciously remembering it

• Showing unconscious influence

Clinical evidence for postulating the unconscious

• fourth

Material derived from free-association techniques

Clinical evidence for postulating the unconscious

• Material derived from free-association techniques

When clients freely say whatever comes to mind, unconscious material can slip through

Clinical evidence for postulating the unconscious

• fifth

Material derived from projective techniques 

Clinical evidence for postulating the unconscious

• Material derived from projective techniques

tests like the Rorschach ink block

• where ambiguous stimuli are thought to reveal unconscious themes

Clinical evidence for postulating the unconscious

• sixth

Symbolic content of psychotic symptoms

Clinical evidence for postulating the unconscious

• Symbolic content of psychotic symptoms

represents abstract ideas, wishes, and conflicts as concrete and literal experiences

• For example, delusions of persecution can symbolize a person's internal conflict and feelings of being overwhelmed, while hallucinations may represent repressed fears or desires