Psychoanalytic Therapy

Psychoanalytic View of Life

• Freud wrote “Psychoanalysis transforms neurotic misery into ordinary unhappiness”

• Life involves various forms of suffering 

• Existential suffering is unavoidable 

• Neurotic suffering is avoidable and can be lessened through therapy 

• Psychotherapy restores vitality and happiness 

• There are different ways of being in the world

• The goal is to allow people to live more fully and direct their lives more fully while recognizing the obstacles in life and it LOOKS DIFFERENTLY FOR EVERYBODY - some people think this is a pessimistic way of thinking

• The therapist is not guiding the client in a certain way

Two models of psychoanalysis: 

• Freudian

• Contemporary

Psychoanalytic Values 

• Complexity, depth, nuance, patience, acceptance 

• Humans are complex creatures shaped by multiple and conflicting conscious and unconscious forces

• Psychoanalysts value tolerance of ambiguity in life and therapy 

• Tend to oppose mainstream US values such as 

• Clarity, activity, speed, concreteness, practicality, realism, efficiency, independence, and responsibility

• Psychoanalytic values can lead to long treatments with no clear endpoint

• Not a structured approach to psychoanalytic therapy therapists are supposed to be open to the clients they are helping  

• "tolerance of ambiguity" refers to an individual's ability to remain calm, patient, and composed when faced with uncertain, complex, or contradictory situations without needing immediate resolution or clear answers. It reflects a capacity to manage psychological discomfort and anxiety in the presence of ambiguous or unclear stimuli, ideas, or emotions.

Honesty

• A goal of therapy is shedding illusions including self-deception

• But knowing ourselves is difficult because of the unconscious because it hides things from us to protect us

• Being a psychoanalytic therapist involves ongoing self-discovery and personal growth

• This includes becoming skilled at seeking the role of your own unconscious 

Rejection of treatment manuals

• What is a treatment manual? Is something that was originally developed to do psychotherapy research 

• A manual has step by steps on what to do 

• Psychoanalysts reject the utility of manuals 

• Therapy involves spontaneity and authenticity 

• Each dyad is unique, each moment is unique 

• Reflection-in-action - experts solve problems holistically and in the moment, not in a prescribed stepwise fashion

• It is not a treatment you can develop a manual because there isnt a way to tell someone what to do in this type of therapy 

• Your job as a psychoanalytic therapist is to be OPEN to what is going on with thoughts and feelings and be open to the unconscious of both the client and therapist 

• There are principles but there is no step-by-step process to this therapy 

Focus On Conflict 

• Unconscious conflict 

• There are many forms of psychoanalysis today 

• Fruidian (classical) focus is on the conflict between id, ego, and superego 

• Rationality is the goal 

Ex. What we want is to take things out of the unconscious and know them and people are aware of their forces drawing them from the unconscious 

• Contemporary psychoanalysis (also) focuses on conflict involving meaning and relationships 

• Authenticity is the goal - vitality, living fully as oneself

Ex. The question is how can I be my full self 

Unconscious According to Freud (Freudian psychoanalysis)

• Consciousness - secondary process 

• Rational, reflective thinking, logical, sequential 

• Part of the ego is conscious and part is unconscious

• Unconscious - primary process 

• Dreams and fantasy 

• Id - pleasure 

• Repression - a defense mechanism that keeps conflict and id impulses out of awareness 

• A therapist helps bring the unconscious into consciousness 

• Where id (means “it” in German) was, there ego (means “I” in German) shall be 

• “One-person psychology” - focuses on the patient’s unconscious

Superego - knowing what is right and what is wrong

Ego - conscious decision maker, helps satisfy the Id in a realistic way 

Contemporary View of the Unconscious 

• Multiple self-states may be in conflict with each other 

• self-states may be dissociated or split off from each other

• Dissociation is a different defense mechanism than repression 

• Or self-states may be un-symbolized - it is an experience that is not being thought 

• No central controlling function -ego

• A therapist is a “partner in thought” - because of the unconscious and because things are dissociated or repressed sometimes people can’t bring things together and need another mind to help bring things together

• “Two person psychology” - unconscious of both people affect the therapy process 

Therapy Process - Definitions 

• Transference - pateients experience of the therapist/therapy relationship as though it is an important relationship from the past

• Countertransference - same thing but what the therapist brings to the relationship and how they are feeling; this term is also used more broadly 

• Enactment - when a therapist and patient are interacting according to unconscious dynamics - the therapist and client are acting without thinking and not acknowledging it 

• One-person vs. two-person psychology 

• Role of “the frame” (not in the chapter)

Interpretation

• Statement that identifies unconscious motivation, thought, or conflict 

• 3 types - transference, non transference, genetic 

• Most psychoanalysts do not care too much about the difference in type 

Transference Interpretation

• Explanation of unconscious dynamics in a current moment with the therapist 

• Grounded in the here and now 

• Experientially fresh and immediate 

• Less likely to be intellectualized or theoretical 

• Collaborative exploration or meta communication

Non-tranference or extra-transference interpretation 

• About a relationsip/sistuation outside the therapy

• Can help the patient see something new about the situation

• Should facilitate exploration 

• Can be experienced as therapist defensiveness if therapist similarities are not addressed 

Genetic Interpretation 

• Explanation of a current dynamic in terms of past/childhood dynamics

• Can help patients understand the origins of their ways of being 

• Current problems are understable given past situations 

• Goal is to help patients develop new ways of being 

Dreams 

• Royal road to the unconscious 

• Freud considered a dream to be a disguised wish 

• Can be useful to consider the dreamer to be each of the characters in a dream 

• Manifest content - the dream you report - the content of the dream 

Latent content - the hidden meaning of the dream