Psychoanalytic Therapy

Freud’s psychoanalytic system is a model of personality development and an approach to

psychotherapy. calling attention to psychodynamic factors that motivate behavior, focusing on
the role of the unconscious, and developing the first therapeutic procedures for understanding
and modifying the structure of one’s basic character.

We are in an era of theoretical pluralism in psychoanalytic theory today and can no longer speak
of the psychoanalytic theory of treatment. So we have now psychoanalytic oriented
psychotherapy. contemporary psychoanalytic approaches:

- Psychoanalysis
- object-relations theory,
- self psychology,
- relational model of psychoanalysis.
- Brief psychodynamic theories

These contemporary theories are variations on psychoanalytic theory (modification but it still
retains emphasis on the unconscious processes).

Psychodynamic therapy: Psychodynamic therapy is talk therapy that focuses on unconscious

processes observed in the person's current state. Rather than focusing on the person's overall
behavior, psychodynamic perspective focuses on the effects of past events on the mental and
emotional processes of the present. It allows the individual to reconcile their past experiences
with the reasons they are experiencing today and to confront their past.

Key concepts:

View of Human Nature

early life experiences shape one’s social interactions and relationships in adulthood. Humans are
conceptualized largely in terms of biological instincts and psychological drives, and maladaptive
behaviors are symptoms of a subconscious response to things that the mind interprets as unsafe,
thereby threatening the stability of the human personality structure.

According to Freud, our behavior is determined by irrational forces, unconscious motivations,

and biological and instinctual drives (instincts) as these evolve through key psychosexual stages
in the first six years of life (deterministic approach).

Instincts are central. Although he originally used the term libido to refer to sexual energy, he
later broadened it to include the energy of all the life instincts. These instincts serve the purpose
of the survival of the individual, they are oriented toward growth and development. Libido, then,
should be understood as a source of motivation that encompasses sexual energy but goes beyond
it. Freud also postulates death instincts, which account for the aggressive drive (at times people
manifest through their behavior a wish to die or hurt themselves)
Structure of Personality

According to the Freudian psychoanalytic view, the personality consists of three systems: the id,
the ego, and the superego. The personality functions as a whole with these parts:

- The id (the demanding child motivated by pleasure principle) is roughly all the
untamed drives or impulses that might be likened to the biological component. It is
majorly unconscious.
- The ego (traffic cop ruled by reality principle) attempts to organize and mediate
between the id and the reality of dangers posed by the id’s impulses. it mediates between
the instincts and the surrounding environment. The superego represents the traditional
values and ideals of society as they are handed down from parents to children. It
functions to inhibit the id impulses, to persuade the ego to substitute moralistic goals for
realistic ones, and to strive for perfection. Actions of the ego may or may not be
conscious. Defense mechanisms are unconscious.
- One way to protect ourselves from the dangers of our own drives is to establish a
superego (the judge ruled by morality principle), which is the internalized social
component, largely rooted in what the person imagines to be the expectations of parental
figures. (These imaginations protect us from our own impulses). The superego represents
the traditional values and ideals of society as they are handed down from parents to
children. It functions to inhibit the id impulses, to persuade the ego to substitute
moralistic goals for realistic ones, and to strive for perfection.

Humans are viewed as energy systems. The dynamics of personality consist of the ways in
which psychic energy is distributed to the id, ego, and superego. Because the amount of energy is
limited, one system gains control over the available energy at the expense of the other two
systems. Behavior is determined by this psychic energy. The id is the primary source of psychic
energy.

Consciousness and the Unconscious

Freud’s greatest contribution to the understanding of behavior and the problems of personality
are the unconscious and the levels of consciousness.

The unconscious cannot be studied directly but is inferred from behavior. Clinical evidence for
postulating the unconscious includes the following:

 dreams, which are symbolic representations of unconscious needs, wishes, and conflicts;
 slips of the tongue and forgetting
 posthypnotic suggestions;
 material derived from free-association techniques;
 material derived from projective techniques;
 the symbolic content of psychotic symptoms.

The unconscious stores all experiences, memories, and repressed material. Needs and
motivations that are inaccessible—that is, out of awareness—are also outside the sphere of
conscious control. Most psychological functioning exists in the out-of-awareness realm. The aim
of psychoanalytic therapy is to make the unconscious motives conscious, for only then can an
individual exercise choice. The unconscious:

• Sex (Oedipus complex)

• Destruction (death instinct)
• Dependence
• Unformulated experiences

Unconscious processes are at the root of all forms of neurotic symptoms (neuroticism) and
behaviors. 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. It is to be
noted, however, that intellectual insight alone does not resolve the symptom. The client’s need to
cling to old patterns (repetition) must be confronted by working through transference distortions.

Anxiety

Also essential to the psychoanalytic approach is its concept of anxiety. anxiety is a feeling of
dread that results from repressed feelings, memories, desires that emerge to the surface of
awareness. It can be considered as a state of tension that motivates us to do something. It
develops out of a conflict among the id, ego, and superego over control of the available psychic
energy. The function of anxiety is to warn of impending danger.

There are three kinds of anxiety:

1- reality anxiety is the fear of danger from the external world, and the level of such
anxiety is proportionate to the degree of real threat.

Neurotic and moral anxieties are evoked by threats to the “balance of power” within the
person. They signal to the ego that unless appropriate measures are taken the danger may
increase until the ego is overthrown.

2- Neurotic anxiety results from the ego feeling overwhelmed by the id, which threatens to
express its irrationality in thoughts and behavior. A fear of instincts going out of hand.
There is a fear of external punishment for such expression.  
3- Moral anxiety is based on a feeling that one's internalized values are about to be
compromised. There is a fear of self-punishment (e.g., guilt) for acting contrary to one's
values. Moral anxiety is a function of the development of the superego. Whatever the
anxiety, the ego seeks to reduce it. Operating at the unconscious level, it employs defense
mechanisms to distort or deny reality.

Ego-Defense Mechanisms
ego-defense mechanisms help the individual cope with anxiety and prevent the ego from being
overwhelmed. Rather than being pathological, ego defenses are normal behaviors that can have
adaptive value provided they do not become a style of life that enables the individual to avoid
facing reality. The defenses employed depend on the individual’s level of development and
degree of anxiety. Defense mechanisms have two characteristics in common: (1) they either
deny or distort reality, and (2) they operate on an unconscious level.

Defense Uses for Behavior

Threatening or painful
thoughts and feelings It is assumed that most of the painful events of the
are involuntarily first five or six years of life are buried, yet these
Repression
excluded from events do influence later behavior. E.G (Being abused
awareness (from as a child but not remembering the abuse)
conscious mind)
Denial of reality is perhaps the simplest of all self-
defense mechanisms. It is a way of distorting what the
Denying the existence individual thinks, feels, or perceives in a traumatic
Denial of a threatening aspect situation. This mechanism is similar to repression, yet
of reality. it generally operates at preconscious and conscious
levels (being the victim of domestic abuse and
denying that It happens).
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
Replacing an unwanted they were to recognize these dimensionsof
Reaction
impulse with its themselves. Individuals may conceal hate with a
formation
opposite. facade of love, be extremely nice when they harbor
negative reactions, or mask cruelty with excessive
kindness. (being sad about a break up but acting
happy about it)
This is a mechanism of self-deception. Lustful,
aggressive, or other impulses are seen as being
Attributing one’s own
possessed by “those people out there, but not by me.”
unacceptable feelings,
Projection (a wife desires to cheat on her spouse, and then fears
desires and qualities to
that her spouse is being unfaithful) (you hate
others
someone, but your superego finds it immoral so you
believe that they hate you)
Directing energy or
Displacement is a way of coping with anxiety that
feelings on another
involves discharging impulses by shifting from a
Displacement object or person when
threatening object to a “safer target.” (you are angry
the original object or
with your boss, but you take it out on your children)
person is inaccessible.
Rationalization Justifying an Rationalization helps justify specific behaviors,
unacceptable feeling or and it aids in softening the blow connected with
thought with logic “or a disappointments. When people do not get positions
bruised ego) they have applied for, 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.

Energy is usually diverted into socially acceptable and

Diverting sexual or
channels. For example, aggressive impulses can be
aggressive energy into
Sublimation channeled into athletic activities, so that the person
other channels.
finds a way of expressing aggressive feelings and, as
“unacceptable impulses”
an added bonus, is often praised.
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
Reverting to earlier
Regression example, children who are frightened in school may
behaviors
indulge in infantile behavior such as weeping,
excessive dependence, thumb-sucking, hiding, or
clinging to the teacher.
Taking in and Positive forms of introjection include incorporation
Introjection “swallowing” the values of parental values. negative example could be an
and standards of others. abused child becoming an abusive parent
Identifying with Identification can enhance self-worth and protect one
successful causes, from a sense of being a failure. This is part of the
organizations, or people developmental process by which children learn
Identification
in the hope that you will gender-role behaviors, but it can also be a defensive
be perceived as reaction when used by people who feel basically
worthwhile. inferior.
Masking perceived
This mechanism can have direct adjustive value, and it
weaknesses or
Compensatio can also be an attempt by the person to say “Don’t see
developing certain
n the ways in which I am inferior, but see me in my
positive traits to make up
accomplishments.”
for limitations.

Development of personality (psychosexual and psychosocial erikson and freud on book)

Ego psychology

Erikson is often credited with bringing an emphasis on social factors to contemporary

psychoanalysis. classical psychoanalysis is grounded on id psychology, and it holds that
instincts and intrapsychic conflicts are the basic factors shaping personality development (both
normal and abnormal). contemporary psychoanalysis tends to be based on ego psychology,
which does not deny the role of intrapsychic conflicts but emphasizes the striving of the ego for
mastery and competence throughout the human life span. Ego psychology therapists assist clients
in gaining awareness of their defenses and help them develop better ways of coping with these
defenses. Ego psychology deals with both the early and the later developmental stages, for the
assumption is that current problems cannot simply be reduced to repetitions of unconscious
conflicts from early childhood. The stages of adolescence, mid-adulthood, and later adulthood all
involve particular crises that must be addressed. As one’s past has meaning in terms of the
future, there is continuity in development, reflected by stages of growth; each stage is related to
the other stages.

Note: By taking a combined psychosexual and psychosocial perspective, counselors have a

helpful conceptual framework for understanding developmental issues as they appear in therapy.
The key needs and developmental tasks, along with the challenges inherent at each stage of life,
provide a model for understanding some of the core conflicts clients explore in their therapy
sessions.

Conflicts include:

– Conscious vs unconscious
– Memories or representations vs censorship barrier
– Drives vs prohibitions
– Drives vs defense mechanisms
– Life instinct vs death instinct

The Therapeutic Process

Therapeutic Goals

The ultimate goal of psychoanalytic treatment is to increase adaptive functioning, which involves
the reduction of symptoms and the resolution of conflicts.

Successful analysis is believed to result in significant modification of the individual’s personality

and character structure. Therapeutic methods are used to bring out unconscious mate- rial. Then
childhood experiences are reconstructed, discussed, interpreted, and ana- lyzed. It is clear that
the process is not limited to solving problems and learning new behaviors. Rather, there is a
deeper probing into the past to develop the level of self-understanding that is assumed to be
necessary for a change in character. Psychoanalytic therapy is oriented toward achieving insight,
but not just an intel- lectual understanding; it is essential that the feelings and memories
associated with this self-understanding be experienced.

Two goals of Freudian psychoanalytic therapy are to make the unconscious conscious and to
strengthen the ego so that behavior is based more on reality and less on instinctual cravings or
irrational guilt.

Therapist’s Function and Role

In classical psychoanalysis, analysts typically assume an anonymous non- judgmental stance,

which is sometimes called the “blank-screen” approach. They avoid self-disclosure and
maintain a sense of neutrality to foster a transference relationship, in which their clients will
make projections onto them. This transference relationship is a cornerstone of psychoanalysis
and “refers to the transfer of feelings originally experienced in an early relationship to other
important people in a person’s present environment” . these projections are the essence of the
therapeutic work. Functions of analysis include:

- Assisting the client in self-exploration and self awareness, acceptance,

- Help them acquire freedom in work, love, play
- Have effective relationships
- Deal with anxiety in a realistic way
- And gaining control over impulses and instinctual drives

Establishing a therapeutic alliance is a primary treatment goal, and a special attention is given
towards the client’s resistance. The analyst listens in a respectful, open-minded way and decides
when to make appropriate interpretations; tact and timing are essential for effective
interpretations. A major function of interpretation is to accelerate the process of uncovering
unconscious material. The psychoanalytic therapist pays attention to both what is spoken and
what is unspoken, listens for gaps and inconsistencies in the client’s story, infers the meaning of
reported dreams and free associations, and remains sensitive to clues concerning the client’s
feelings toward the therapist. And the analyst must teach clients the meaning of these processes
(through interpretation) so that they are able to achieve insight into their problems, increase their
awareness of ways to change, and thus gain more control over their lives. A primary aim of
psychodynamic approaches is to foster the capacity of clients to solve their own problems.

Take into consideration that:

– clients change depends considerably more on their readiness to change than on the
accuracy of the therapist’s interpretations.
– If the therapist pushes the client too rapidly or offers ill-timed interpretations, therapy
will not be effective.
– Change occurs through the process of reworking old patterns so that clients might
become freer to act in new ways

Client’s Experience in Therapy

- commit themselves to an intensive, long-term therapy process.

- After some face-to-face sessions with the analyst, clients lie on a couch and engage in
free association clients try to flow with any feelings or thoughts that comes to mind by
reporting them immediately without censorship. This technique often leads to some
recollection of past experiences and, at times, a catharsis or release of intense feelings
that have been blocked..

– During the free-association process, the therapist’s task is to identify the repressed
material that is locked in the unconscious. The sequence of associations guides the
therapist in understanding the connections clients make among events. The therapist
interprets the material to clients, guiding them toward increased insight into the
underlying dynamic. achieving insight, but not just an intellectual understanding; it is
 essential that the feelings and memories associated with this self-understanding be
experienced

Comparing psychoanalysis and psychodynamic/psychoanalytic therapy:

Classical psychoanalysis:

– Lengthy therapy: high level of commitment

– Lying on the couch:
– encourages deep, uncensored reflections and reduces the stimuli that might
interfere with getting in touch with internal conflicts and productions.
– It also reduces the ability of clients to “read” their analyst’s face for reactions,
which fosters the projections characteristic of a transference.
– asked not to make any radical changes in their lifestyle during the period of analysis

Termination: Psychoanalytic clients are ready to terminate their sessions when they and their
analyst mutually agree that they have resolved those symptoms and core conflicts that were
amenable to resolution, have clarified and accepted their remaining emotional problems, have
understood the historical roots of their difficulties, have mastery of core themes, have insight into
how their environment affects them and how they affect the environment,

The techniques of psychoanalytic therapy are aimed at increasing awareness, fostering insights
into the client’s behavior, and understanding the meanings of symptoms. The therapy proceeds
from the client’s talk to catharsis (or expression of emotion), to insight, to working through
unconscious material. This work is done to attain the goals of intellectual and emotional
understanding and reeducation, which, it is hoped, will lead to personality change.

The six basic techniques of psychoanalytic therapy are

(1) maintaining the analytic framework ) 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 imposi- tion of the therapist’s values

(2) free association, The sequence of associations guides the therapist in understanding the
connections clients make among events. Blockings or disruptions in associations serve as cues to
anxiety-arousing material.

(3) interpretation, consists of the analyst’s pointing out, explaining, and even teach- ing the client
the meanings of behavior that is manifested in dreams, free associa- tion, resistances, defenses,
and the therapeutic relationship itself. The thera- pist interprets the material to clients, guiding
them toward increased insight into the underlying dynamics. The functions of interpretations are
to enable the ego to assimilate new material and to speed up the process of uncovering further
unconscious material. The therapist uses the client’s reactions as a gauge in determining a
client’s readiness to make an interpretation. It is important that interpretations be appro- priately
timed because the client will reject therapist interpretations that are poorly timed. interpretation
should start from the surface and go only as deep as the client is able to go
(4) dream analysis, Latent content consists of hidden, symbolic, and unconscious motives,
wishes, and fears. Because they are so painful and threatening, the unconscious impulses that
make up latent content are transformed into the more acceptable manifest content, which is the
dream as it appears to the dreamer. The process by which the latent content of a dream is
transformed into the less threatening manifest content is called dream work

(5) analysis of resistance, The client’s reluctance to bring to the surface of awareness
unconscious material that has been repressed. Resistance refers to any idea, attitude, feeling, or
action (conscious or unconscious) that gets in the way of change Because they are afraid of the
pain and discomfort of becoming aware of their repressed impulses. An assumption of analytic
treatment is that clients wish both to change and to remain embedded in their old world. Clients
tend to cling to their familiar patterns, regardless of how painful they may be. Therapists’
interpretations help clients become aware of the reasons for the resistance so they can deal with
them. As a general rule, therapists point out and interpret the most obvious resistances to lessen
the possibility of clients’ rejecting the interpretation and to increase the chance that they will
begin to look at their resistive behavior.

(6) analysis of transference, Through interpreting transference, 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.

Interpretations should be:

– Timeliness
– Exactness
– Brevity
– Commonness of language

Talking cure

– Truth comes via insights of what was repressed

– The insight can be the consequence of the analyst interpretation
– Importance of words
– The only thing that heals is the truth
– ”neurotic suffer from forgetting
– Remembering vs repeating

Psychoanalytic or psychodynamic therapy differs from traditional psychoanalysis in these

ways:

– The therapy has more to limited objectives than restructuring one's personality.
– The therapist is less likely to use the couch more face to face
– There are fewer sessions each week.
 – There is more frequent use of supportive interventions such as reassurance, expressions
of empathy and support, and suggestions.
– There is more emphasis on the here-and-now relationship between therapist and client.
– There is more latitude for therapist self-disclosure without "polluting the transference.'
– Less emphasis is given to the therapist's neutrality.
– There is a focus on mutual transference and countertransference enactments.
– The focus is more on pressing practical concerns than on working with fantasy material.

However studies have showed that Frequency of session- no difference, Couch or not – no
difference. Ongoing going studies on distance analysis

Relationship Between Therapist and Client

There are some differences between how the therapeutic relationship is conceptualized by
classical analysis and contemporary relational analysis. The classical analyst stands outside the
relationship, comments on it, and offers insight-produc- ing interpretations. In contemporary
relational psychoanalysis, the therapist does not strive for an objective stance. Contemporary
psychodynamic therapists focus as much on here-and-now transference as on earlier
reenactment.

Transference and countertransference are central to understanding psychodynamic therapy. A

significant aspect of the therapeutic relationship is manifested through transference reactions.
transference is the client’s unconscious shifting of feelings, attitudes, and fantasies (both
positive and negative) to the analyst that are reactions to significant others in the client’s past.
Transference involves the uncon scious repetition of the past in the present. “

Countertransference

Even if the conflicts of therapists have surfaced to awareness, and even if therapists have dealt
with these personal issues in their own intensive therapy, they may still project distortions onto
clients. From a traditional psychoanalytic perspective, countertransference is viewed as a
phenomenon that occurs when there is inappropriate affect, when therapists respond in irrational
ways, or when they lose their objectivity in a relationship because their own conflicts are
triggered. (unconscious). However, In today’s psychoanalytic practice, countertransference is
manifested in the form of subtle nonverbal, tonal, and attitudinal actions that inevitably affect
clients, either consciously or unconsciously

Corrective emotional experience : Therapists responds differently than the client experienced
in childhood to resolve inner conflict

Ps: It is a mistake to assume that all feelings clients have toward their therapists are
manifestations of transference

The therapist’s role in managing transference/counter

– Provide safe space for self-exploration

Contemporary Trends: Object-Relations Theory, Self Psychology, and Relational
Psychoanalysis

Today psychoanalytic theory is comprised of a variety of schools, including the classical

perspective, ego psychology, object relations and interpersonal psychoanalysis, self psychology,
and relational psychoanalysis. All presuppose a supportive, warm, but neutral and fairly
unobtrusive therapist who strives to create a safe, supportive, and therapeutic relationship”

1- ego psychology is part of classical psychoanalysis with the emphasis placed on the
vocabulary of id, ego, and superego, and on Anna Freud’s identification of
defensemechanisms
2- Object-relations theory especially concerned with investigating attachment and
separation. Their emphasize is how our relationships with other people are affected by the
way we have internalized our experiences of others and set up representations of others
within ourselves. The term object refers to what satisfies our needs
3- self psychology, emphasizes how we use interpersonal relationships (self objects) to
develop our own sense of self. emphasize nonjudgmental acceptance, empathy, and
authenticity. empathy in the forefront of psychoanalytic healing and choose
interventionsbased on them being genuinely empathically attuned to clients
4- The relational model is based on the assumption that therapy is an interactive process
between client and therapist. the exploration of the complex conscious and unconscious
dynamics at play with respect to both therapist and client. The task of relational analysis
is to explore each client’s life in a creative way, customized to the therapist and client

Limitations of psychoanalysis:

– 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

Advantages:

Curiosity about the mind

– Therapy that last more than 18 months have a good outcome

– Change continue after therapy
– “Don’t just do something, stand there”