Psychoanalysis: Development, Transference, Assessment & First-Wave Psychodynamic Therapy

Historical Development of Psychoanalytic Thinking

• Freud – Drive/Instinct Psychology (1st Wave)

  • Psyche governed by unconscious sexual & aggressive drives.

  • Psychosexual stages: oral → anal → phallic → genital.

  • Oedipus complex indispensable for healthy development.

  • Environment mattered (often mis-understood as ignored by Freud).

• Anna Freud & Classic “Ego Psychology” (2nd Wave)

  • Continued father’s work but centred on the ego and its defensive operations.

  • Expanded the list of defence mechanisms beyond repression.

  • Focus on how ego adapts to reality (Hartmann, Rapaport, Kernberg, etc.).

• British “Object-Relations” & Early Self-Psychology (3rd Wave)

  • Melanie Klein: infant relates to objects that are largely projections of its internal world (introjected & projected mother).

  • Ronald Fairbairn: real external objects/people can be pathogenic when they fail to satisfy needs.

  • Bion: importance of containment, reverie, alpha-function.

  • Shift from drives → relationships with real objects.

• Key Conceptual Shifts

  • From intrapsychic drives → internal objects → actual interpersonal relations.

  • In part of the ego resides a structured concept of the Self.

Transference

• Freud (1905)

  • Unconscious displacement of old feelings/fantasies onto analyst (“new editions of old conflicts”).

  • Manifestation of the repetition compulsion.

  • Initially viewed as resistance; later the very vehicle of cure.

  • Split into:

  • Positive (warm, hopeful, trusting feelings).

  • Negative (hostile, angry, hateful feelings).

• Klein (1952)

  • Roots of transference in earliest object-relations (love/hate oscillations).

  • Full analysis of negative transference necessary to reach deepest layers.

Countertransference

• Definition: Therapist’s total internal/external reactions to a client, shaped by the therapist’s own vulnerabilities & conflicts.

• Historical views

  • Freud: obstacle—projection of analyst’s past figures onto patient.

  • Winnicott: broader, “objective” countertransference—normal, understandable reactions to patient’s actual personality.

  • Mother–infant analogy: infant must experience and learn to hate; therapist likewise may feel hate and must manage it.

• Clinical Management

  • Personal therapy, supervision, ongoing self-reflection.

  • When processed, becomes a diagnostic & empathic tool.

• Typology

  • Proactive (Freud’s original sense) – stems from therapist’s own life.

  • Concordant: patient evokes feelings linked to therapist’s personal past.

  • Complementary: patient triggers therapist’s archaic object representations (therapist feels burdened, dislike, etc.).

  • Reactive – response to patient’s communications/behaviour in the room.

  • Can also be complementary (feeling as the original object felt) or concordant (feeling as the patient felt with that object).

Clinical Interview & Multimodal Assessment

• Foundation stone of the therapeutic relationship; may span up to ≈4 sessions.

• Core elements:

  • Referral question & specification of presenting problem.

  • History and timeline of the problem.

  • Analysis of maintaining & eliciting variables.

  • Motivation & insight assessment.

• Mental Status Examination (MSE) via open-ended questions, empathic observation, attention to process.

• Triangulation for robustness:

  • Clinical interview.

  • Objective tests (e.g., MMPI); beware of deliberate distortion.

  • Projective tests (e.g., Rorschach inkblots).

• Formulation

  • Integrative hypothesis uniting triggers, history, resilience, context.

  • Tailored to theoretical orientation (e.g., jointly constructed in CBT, deeper transferential layer in psychodynamic work).

First-Wave Psychoanalytic Psychotherapy (Contemporary View)

Theoretical Assumptions & Image of the Person

• Mind largely unconscious.

• Psychic determinism: every act/thought multiply determined by unconscious meaning.

• Core motivators: sexuality & aggression, later amended by object-relations needs.

• Structural model:

  • Id: instinctual reservoir, pleasure principle.

  • Ego: mediator, reality testing, defences (mostly unconscious).

  • Superego: internalised parental standards, moral conscience.

Psychopathology

• Drive Theory: conflict between instinctual drives (id) & external reality (ego).

• Neurosis: product of repression; all humans neurotic to degree, but defended.

• Aggression conceptualised eventually as defensive—death instinct idea largely abandoned by modern Freudians.

Healthy Development

• Successful navigation of psychosexual stages.

• Resolution of Oedipus complex ⇒ capacity for mature love & sexuality.

Acquisition of Disturbance

• Early interplay of constitution + adverse environment/trauma.

• Loss (object death, rejection) → anxiety → defensive patterns.

• Transition toward two-person psychology: drives & object relations equally influential.

Perpetuation Mechanisms

• Intrapersonal: Resistances (repression, secondary gain, transference, repetition-compulsion, superego resistance).

• Interpersonal: Internalised sadomasochistic templates → seeking abusive relationships that reaffirm pathology.

Change & Determinism Challenge

• Crisis occurs when defences fail; therapy sought.

• Linear deterministic model cannot fully explain spontaneous recovery; contemporary analysts incorporate relational & resilience factors.

Indications, Contra-Indications & Patient Suitability

• Best candidates: neurotic disorders (anxiety, depression), mild–moderate personality issues—especially interpersonal.

• Pre-requisites:

  • Adequate ego strength to face emergent anxiety.

  • Insight, curiosity, acceptance of need for help.

  • Capacity for reflection & psychological thinking.

• Caution: active suicidality, substance abuse, severe psychosis—risk of symptom exacerbation.

Therapist Factors

• Effective therapist qualities:

  • Genuine curiosity about human motives.

  • Empathy; ability to take the patient’s perspective.

  • Tolerance of uncertainty & intense affect without acting out.

  • Flexibility, openness, stamina for slow change.

• Classical Style

  • Abstinence: avoid gratifying demands; prevent substitute satisfaction.

  • Anonymity & neutrality: limit self-disclosure, refrain from advice, teacher, judge roles.

  • Maintain space for transference to unfold.

Psychodynamic Assessment & Formulation Specifics

• Dual stance: empathic elicitation vs. objective data collection.

• Evaluate rapport potential, affect tolerance during interview.

• Formulation triad:

  1. Presenting problems.

  2. Childhood conflicts/deficits.

  3. Transferential data from interview.

• Collaborative discussion of practicalities: setting, frequency, fees, breaks, time-limit.

• Informed implicit consent; contrast with explicit CBT contracts.

Therapeutic Space, Strategies & Techniques

• Holding Environment: protected psychic space for unconscious material (dreams, fantasies, wishes) to surface.

• Setting

  • Classical: patient on couch, analyst out of view.

  • Once-weekly models: face-to-face.

• Free Association: patient articulates thoughts uncensored—the “fundamental rule.”

• Intervention Spectrum

  • Starts supportive → moves to interpretive as ego strengthens.

  • Work “from surface to depth”: analyse resistances/defences before core fantasies.

• Dream Analysis

  • Dreams = “royal road” to the unconscious.

  • Distinction: manifest vs. latent content; therapist solicits personal associations to symbols.

• Interpretation Types

  • Genetic/Reconstructive: links present to developmental origins.

  • Transference (Here-and-Now): highlights re-enactment of past conflicts within patient-therapist relationship.

• Working-Through

  • Time lag between intellectual insight & emotional conviction—repetition across sessions integrates change.