Psychoanalytic Therapy – Comprehensive Notes

Conscious and Unconscious

• 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.
• Later developed a concept of the Pre-conscious, an area where content isn’t actively conscious, but can be brought to conscious awareness easily.

Structure of Personality

• ID — The Demanding Child; ruled by the pleasure principle.
• EGO — The Traffic Cop; ruled by the reality principle.
• SUPEREGO — The Judge; ruled by the moral principle.

Freud’s Evidence for the Unconscious

• Dreams.
• Slips of the tongue.
• Posthypnotic suggestions.
• Material derived from free-association techniques.
• Material derived from projective techniques.
• Symbolic content of psychotic symptoms.

View of Human Nature

• Life instincts – Libido or Eros — serve the purpose of the survival of the individual and the human race.
• Death instincts – Thanatos — People manifest through their behavior on unconscious wish to die or to hurt themselves or others.

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.
• Motivates action.
• The following are the $3$ types of anxiety:
  • Reality Anxiety — fear of danger from the external world, proportional to degree of threat.
  • Neurotic Anxiety — fear that instincts may cause them to do something for which they may be punished.
  • Moral Anxiety — fear of one’s conscience, guilt.

Ego-Defense Mechanisms

• Help the individual cope with anxiety and prevent the ego from being overwhelmed.
• Are normal behaviors that have adaptive value if they do not become a way to avoid facing reality.
• They either deny or distort reality.
• They operate on an unconscious level.

Ego-Defense Mechanisms (List)

• Repression – burying painful thoughts and feelings away from conscious.
• Denial – pretending a threat doesn’t exist.
• Reaction Formation – hiding an impulse by behaving in the opposite manner (hiding hate by appearing loving).
• Projection – believing one’s faults are actually the faults of others.
• Displacement – focusing on something else.
• Rationalization – justifying behaviors through logic.
• Sublimation – diverting energy from unwanted impulses into other things.
• Regression – a break from reality, exhibiting childlike behaviors.
• Introjection – taking in the values of others (adopting your parents' values, or becoming more like bullies).
• Identification – joining a group to feel less inferior.
• Compensation – emphasizing strengths to hide weaknesses.

Development of Personality: Freud’s Psychosexual Stages

• Oral stage — First year.
• Anal stage — Ages $1 ext{-}3$.
• Phallic stage — Ages $3 ext{-}6$.
• Latency stage — Ages $6 ext{-}12$.
• Genital stage — Ages $12+$.

Development of Personality: Erikson’s Psychosocial Stages

• Infancy — Trust vs Mistrust — can we trust others to help us; ages $0 ext{-}1$ year.
• Early Childhood — Autonomy vs Shame and Doubt — can we explore our world; ages $1 ext{-}3$ years.
• Preschool Age — Initiative vs Guilt — can we make decisions on our own; ages $3 ext{-}6$ years.
• School Age — Industry vs Inferiority — can we learn skills for success; ages $6 ext{-}12$ years.
• Adolescence — Identity vs Role Confusion — can we test limits and establish our own identity; ages $12 ext{-}60$ years.
• Young adulthood — Intimacy vs Isolation — can we form intimate relationships; ages $18 ext{-}35$ years.
• Middle age — Generativity vs Stagnation — can we build a work reputation and take care of our family; ages $35 ext{-}60$ years.
• Later life — Integrity vs Despair — can we look back on our life without regrets; ages $60+$ years.

The Therapeutic Process

• The goal is to make the unconscious conscious and strengthen the ego so that behavior is based on reality.
• Increase adaptive functioning, which involves the reduction of symptoms and the resolution of conflicts.
• Not limited to solving problems and learning new behaviors.
• Achieving insight but not just an intellectual understanding.

Therapist’s Function and Role

• Blank-screen approach, also known as anonymous nonjudgmental stance, fosters transference.
• 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.

Relationship Between Therapist and Client

• Transference is the client’s unconscious shifting of feelings to the analyst.
• Working-through process consists of repetitive and elaborate explorations of unconscious material, originated in early childhood.
• Countertransference occurs when therapists lose their objectivity because their own conflicts are triggered.

Therapeutic Techniques and Procedures

• Maintaining the Analytic Framework - Therapist uses a range of procedural and stylistic factors (e.g., analyst’s relative anonymity, consistency of meetings).
• Free Association - Clients are encouraged to say whatever comes to mind.
• Interpretation - Analyst’s pointing out, explaining, and even teaching the client the meanings of behavior.

Therapeutic Techniques and Procedures (Dreams, Resistance, and Transference)

• Dream Analysis - Therapist uses the “royal road to the unconscious” to bring unconscious material to light.
• Analysis and Interpretation of Resistance - Works against the progress of therapy and prevents the client from producing previously unconscious material.
• Analysis and Interpretation of Transference - Therapist points out, explains, and teaches the meanings of whatever is revealed.

Jung’s Analytical Psychology

• An elaborate explanation of human nature that combines ideas from history, mythology, anthropology, and religion.
• Places central importance on psychological changes associated with midlife.
• Achieving individuation—the harmonious integration of the conscious and unconscious aspects of personality—is an innate and primary goal.

Jung’s Analytical Psychology (continued)

• 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 archetypes (the persona, the anima and animus, and the shadow).

Contemporary Trends

• Object Relations – Melanie Klein
  • Emphasizes attachment and separation.
• Self Psychology – Heinz Kohut
  • Emphasizes how we use interpersonal relationships (self objects) to develop our own sense of self – brought empathy and nonjudgmental acceptance into psychoanalysis.
• Relational Psychoanalysis – Stephen Mitchell
  • Emphasizes the interactive process between client and therapist.
• Brief Psychodynamic Therapy
  • Applies the principles of psychodynamic theory and therapy to treating selective disorders within 10 to 25 sessions.

Contributions of the Classical Psychoanalytic Approach

• Applying psychoanalytic point of view to therapy practice is useful in understanding resistances that take the form of canceling appointments, fleeing from therapy prematurely, and refusing to look at oneself.
• Understanding that unfinished business can be worked through to provide a new ending to events that have restricted clients emotionally.
• Understanding the value and role of transference.
• Understanding the overuse of ego defenses.

Contributions of Contemporary Psychoanalytic Approach

• Helps therapists understand the extensive empirical literature on attachment, emotion, defenses, personality, and other areas that support the theoretical models and clinical experiences of psychoanalytic therapists.
• The value of concepts such as unconscious motivation, the influence of early development, transference, countertransference, and resistance.

Limitations and Criticisms of Psychoanalytic Approach

• This approach may not be appropriate for all cultures or socioeconomic groups.
• Deterministic focus does not emphasize current maladaptive behaviors.
• Minimizes role of the environment.
• Requires subjective interpretation.
• Relies heavily on client fantasy.
• Lengthy treatment may not be practical or affordable for many clients.