PSYCHOANALYTIC

THERAPY
DR. CHAFICA MANSOUR GHARBIEH

EDUCATION & ABA/VB CONSULTANT

WHAT IS PSYCHOANALYSIS? A DEFINITION AND
HISTORY OF PSYCHOANALYTIC THEORY

• Psychoanalysis is a type of therapy that aims to release pent-up or repressed emotions

and memories in or to lead the client to catharsis, or healing (McLeod, 2014). In other
words, the goal of psychoanalysis is to bring what exists at the unconscious or
subconscious level up to consciousness.
• This goal is accomplished through talking to another person about the big questions in
life, the things that matter, and diving into the complexities that lie beneath the
simple-seeming surface.
THE FOUNDER OF PSYCHOANALYSIS:
SIGMUND FREUD AND HIS CONCEPTS
• SIGMUND FREUD (1856–1939): was the firstborn in a Viennese family of three boys
and five girls. His father, like many others of his time and place, was very authoritarian.
Freud’s family background is a factor to consider in understanding the development of
his theory.
• Even though Freud’s family had limited finances and was forced to live in a crowded
apartment, his parents made every effort to foster his obvious intellectual capacities.
Freud had many interests, but his career choices were restricted because of his Jewish
heritage. He finally settled on medicine. Only 4 years after earning his medical degree
from the University of Vienna at the age of 26, he attained a prestigious position there
as a lecturer..
FREUD

• Freud devoted most of his life to formulating and extending his theory of psychoanalysis.
Interestingly, the most creative phase of his life corresponded to a period when he was
experiencing severe emotional problems of his own. During his early 40s, Freud had
numerous psychosomatic disorders, as well as exaggerated fears of dying and other
phobias, and was involved in the difficult task of self-analysis. By exploring the meaning of
his own dreams, he gained insights into the dynamics of personality development.
• He first examined his childhood memories and came to realize the intense hostility he
had felt for his father. He also recalled his childhood sexual feelings for his mother, who
was attractive, loving, and protective. He then clinically formulated his theory as he
observed his patients work through their own problems in analysis.
FREUD

• Freud had very little tolerance for colleagues who diverged from his psychoanalytic
doctrines. He attempted to keep control over the movement by expelling those who
dared to disagree. Carl Jung and Alfred Adler, for example, worked closely with Freud,
but each founded his own therapeutic school after repeated disagreements with Freud
on theoretical and clinical issues. Freud was highly creative and productive, frequently
putting in 18-hour days. His collected works fill 24 volumes. he contracted cancer of the
jaw. During his last two decades, he underwent 33 operations and was in almost
constant pain. He died in London in 1939.
FREUD

• As the originator of psychoanalysis, Freud distinguished himself as an intellectual giant.

He pioneered new techniques for understanding human behavior, and his efforts
resulted in the most comprehensive theory of personality and psychotherapy ever
developed.
FREUD

• A prolific writer, Freud published numerous books and essays throughout his career,
including The Interpretation of Dreams, Jokes and Their Relation to the Unconscious,
Beyond the Pleasure Principle, The Ego and the Id, and Civilization and its Discontents.
As he continued to develop and refine his thought, he garnered renown both in Europe
and in the United States, as well as a wide array of students, including Carl Jung, Alfred
Adler, and many other prominent scientists and thinkers of the early twentieth century.
FREUD

• Freud was a practicing psychoanalyst for much of his career, often treating high-profile
patients, and writing about their symptoms using pseudonyms. Freud's treatment
included therapies such as free association, during which patients were encouraged to
speak freely in a stream of conscious style with direction from Freud, as well as the
interpretation of dreams, in which Freud listened to accounts of remembered dreams
and subsequently analyzed their unconscious significance.
FREUD AND PSYCHOANALYSIS

• One of Freud's most important contributions to the field of psychology was the
development of the theory and practice of psychoanalysis. Some of the major tenets of
psychoanalysis include the significance of the unconscious, early sexual development,
repression, dreams, death and life drives, and transference.
• In terms of practical treatment, psychoanalytic sessions often feature a process of free
association, where patients discuss thoughts, feelings, memories, and dreams, and the
psychoanalyst attempts to uncover elements of their unconscious thoughts and desires.
One of the key components of psychoanalysis is the idea that many psychological
disorders stem from childhood trauma and repressed sexuality. The task of the
psychoanalyst is often to uncover these buried experiences and feelings, to reduce the
tension between the conscious and unconscious minds.
MODELS OF THE MIND
MODELS OF THE MIND

• His model divides the mind into three layers, or regions:

• Conscious: This is where our current thoughts, feelings, and focus live;
• Preconscious (sometimes called the subconscious): This is the home of everything we
can recall or retrieve from our memory;
• Unconscious: At the deepest level of our minds resides a repository of the processes
that drive our behavior, including primitive and instinctual desires (McLeod, 2013).
THE UNCONSCIOUS

• One of the significant concepts in the study of psychoanalysis is unconscious. According

to Freud, certain ideas, thoughts, and memories are repressed and made unavailable to
the conscious mind. When this happens, they don't simply disappear, but instead, reside
in the unconscious, and continue to affect the mind as a whole.
• In particular, the unconscious is often home to repressed memories of childhood
trauma, as well as to repressed sexual urges. These memories and desires often come
into conflict with a patient's conscious desires and ideas, the result of which is often a
psychological disorder according to Freud.
THE ID, EGO, AND SUPEREGO

• According to Freud, the human mind could be divided up into three distinct parts: the id,
the ego, and the superego. The id is the unconscious seat of many human impulses,
desires, and drives. The id is present from birth and involves the satisfaction of basic
needs, including hunger, thirst, and libido.
• The super-ego is the component of the mind that makes moral decisions regardless of
practical circumstances. The super-ego often reflects cultural rules, including those
taught by parents, and involves ideas such as right and wrong, guilt, shame, and judgment.
THE ID, EGO, AND SUPEREGO

• The basic dilemma of all human existence is that each element of the psychic apparatus
makes demands upon us that are incompatible with the other two. Inner conflict is
inevitable.
• For example, the superego can make a person feel guilty if rules are not followed. When
there is a conflict between the goals of the id and superego, the ego must act as a
referee and mediate this conflict. The ego can deploy various defense
mechanisms (Freud, 1894, 1896) to prevent it from becoming overwhelmed by anxiety.
THE PSYCHE APPARATUS
THE ID, EGO, AND SUPEREGO
THE ID, EGO, AND SUPEREGO

• The ego attempts to balance the conflicting desires of the id and super-ego. In doing so,
the ego often engages in various defense mechanisms, including repression,
rationalization, and projection to regulate the conflicting ideas and impulses of the id and
super-ego.
FREUD AND DREAMS

• According to Freud, dreams are a form of thought that disguise and ameliorate the more
disturbing aspects of the unconscious. For this reason, dreams are often veiled in
symbolism and imagery that is difficult to interpret on a literal level. While Freud
characterizes dreams as a sort of wish fulfillment, the manifest content of the narrative of
the dream often seems unrelated, while the latent content of unconscious desires is
difficult to uncover. During psychoanalytic sessions, dreams can often be discussed to
analyze them for possible unconscious thoughts, feelings, and desires.
DREAM ANALYSIS

• Freud (1900) considered dreams to be the royal road to the unconscious as it is in

dreams that the ego's defenses are lowered so that some of the repressed material
comes through to awareness, albeit in distorted form. Dreams perform important
functions for the unconscious mind and serve as valuable clues to how the unconscious
mind operates.
• On 24 July 1895, Freud had his own dream that was to form the basis of his theory. He
had been worried about a patient, Irma, who was not doing as well in treatment as he
had hoped. Freud, in fact, blamed himself for this, and was feeling guilty.
DREAM ANALYSIS

• Freud dreamed that he met Irma at a party and examined her.  He then saw a chemical
formula for a drug that another doctor had given Irma flash before his eyes and realized
that her condition was caused by a dirty syringe used by the other doctor. Freud's guilt
was thus relieved.
• Freud interpreted this dream as wish-fulfillment. He had wished that Irma's poor
condition was not his fault and the dream had fulfilled this wish by informing him that
another doctor was at fault. Based on this dream, Freud (1900) went on to propose that
a major function of dreams was the fulfillment of wishes.
DREAM ANALYSIS

• Freud distinguished between the manifest content of a dream (what the dreamer
remembers) and the latent content, the symbolic meaning of the dream (i.e., the
underlying wish). The manifest content is often based on the events of the day. The
process whereby the underlying wish is translated into the manifest content is called
dream-work. The purpose of dream-work is to transform the forbidden wish into a
non-threatening form, thus reducing anxiety and allowing us to continue sleeping.
Dream-work involves the process of condensation, displacement, and secondary
elaboration.
DREAM ANALYSIS

• The process of condensation is the joining of two or more ideas/images into one. For
example, a dream about a man may be a dream about both one's father and one's lover.
A dream about a house might be the condensation of worries about security as well as
worries about one's appearance to the rest of the world.
• Displacement takes place when we transform the person or object we are really
concerned about to someone else. For example, one of Freud’s patients was extremely
resentful of his sister-in-law and used to refer to her as a dog, dreamed of strangling a
small white dog.
DREAM ANALYSIS

• Freud interpreted this as representing his wish to kill his sister-in-law.  If the patient
would have really dreamed of killing his sister-in-law, he would have felt guilty. The
unconscious mind transformed her into a dog to protect him.
• Secondary elaboration occurs when the unconscious mind strings together wish-fulfilling
images in a logical order of events, further obscuring the latent content.  According to
Freud, this is why the manifest content of dreams can be in the form of believable events.
FREUD'S LEGACY

• Freud widely popularized the practice of psychotherapy throughout the western world,
including talk therapy in general, as well as psychoanalysis in particular. Freud's students,
including Carl Jung, Alfred Adler, Jacques Lacan, and many others continued to develop
theories of psychoanalysis after his death, often diverging from Freud's legacy to create
their own respective theories and disciplines.
• While Freud was enormously influential in the fields of psychology and psychiatry, many
of his ideas are contested by contemporary psychologists, who argue that scientific
evidence does not always bear them out. In particular, Freud's ideas about women,
homosexuality, repression, and sexual development are often called into question by
psychologists and scientists who believe these ideas are not scientifically accurate.
FREUD'S LEGACY

• Freud also had a lasting influence in fields outside of psychology and science, including
philosophy, literary criticism, and religious studies. In particular, Freud had a significant
impact on continental philosophy, with philosophers including Jean-Paul Sartre, Maurice
Merleau-Ponty, Louis Althusser, and Jacques Derrida all having written on or been
influenced by Freud. Freud has also had a lasting effect on literary criticism, with Freudian
interpretations offering a significant lens through which to analyze and interpret literary
texts. While Freud's influence has waned somewhat in the field of psychology, his
intellectual contributions to literary theory and comparative literature continue to have a
significant place in the field.
FREUD TODAY

• One of Freud's most lasting contributions to the field of psychology is the popularization of talk
therapy. Due to Freud and his students and followers, therapy became a popular and
effective way to treat a variety of psychological disorders. Although some of Freud's more
extreme ideas have fallen out of fashion, the central focus of his practice is still widely
implemented, including dialogue between patient and therapist, along with a concerted effort to
understand and improve one's mental states. While this "talking cure" isn't a perfect fit for all
patients, it can have a significant impact on those looking to improve their mental health and
learn more about themselves.
• Whether you need help understanding yourself better, need professional advice, or are simply
looking for someone to talk to, therapy could be a great choice for mental health support. Get
in touch today to learn more about BetterHelp's online therapy services!
THE UNCONSCIOUS MIND
THE UNCONSCIOUS MIND

• Freud (1900, 1905) developed a topographical model of the mind, whereby he described
the features of the mind’s structure and function. Freud used the analogy of an iceberg to
describe the three levels of the mind.
• On the surface is consciousness, which consists of those thoughts that are the focus of
our attention now, and this is seen as the tip of the iceberg. The preconscious consists
of all which can be retrieved from memory. 
• The third and most significant region is the unconscious. Here lie the processes that are
the real cause of most behavior. Like an iceberg, the most important part of the mind is
the part you cannot see.
THE UNCONSCIOUS MIND

• The unconscious mind acts as a repository, a ‘cauldron’ of primitive wishes and impulse
kept at bay and mediated by the preconscious area.
• For example, Freud (1915) found that some events and desires were often too
frightening or painful for his patients to acknowledge, and believed such information was
locked away in the unconscious mind. This can happen through the process
of repression. 
• Sigmund Freud emphasized the importance of the unconscious mind, and a primary
assumption of Freudian theory is that the unconscious mind governs behavior to a
greater degree than people suspect. Indeed, the goal of psychoanalysis is to make the
unconscious conscious.
DEFENSE MECHANISM
CRITICAL EVALUATION

• Is Freudian psychology supported by evidence? Freud's theory is good at explaining but

not at predicting behavior (which is one of the goals of science). For this reason, Freud's
theory is unfalsifiable - it can neither be proved true or refuted. For example, the
unconscious mind is difficult to test and measure objectively. Overall, Freud's theory is
highly unscientific.
CRITICAL EVALUATION

• Most of the evidence for Freud's theories are taken from an unrepresentative sample.
He mostly studied himself, his patients and only one child (e.g., Little Hans). The main
problem here is that the case studies are based on studying one person in detail, and
with reference to Freud, the individuals in question are most often middle-aged women
from Vienna (i.e., his patients). This makes generalizations to the wider population (e.g.,
the whole world) difficult. However, Freud thought this unimportant, believing in only a
qualitative difference between people.
DEFENSE MECHANISMS

• Freud believed these three parts of the mind are in constant conflict because each part has a
different primary goal. Sometimes, when the conflict is too much for a person to handle, his or
her ego may engage in one or many defense mechanisms to protect the individual.
• These defense mechanisms include:
• Repression: The ego pushes disturbing or threatening thoughts out of one’s consciousness;
• Denial: The ego blocks upsetting or overwhelming experiences from awareness, causing the
individual to refuse to acknowledge or believe what is happening;
• Projection: The ego attempts to solve discomfort by attributing the individual’s unacceptable
thoughts, feelings, and motives to another person;
DEFENSE MECHANISMS

• Displacement: The individual satisfies an impulse by acting on a substitute object or

person in a socially unacceptable way (e.g., releasing frustration directed toward your
boss on your spouse instead);
• Regression: As a defense mechanism, the individual moves backward in development in
order to cope with stress (e.g., an overwhelmed adult acting like a child);
• Sublimation: Similar to displacement, this defense mechanism involves satisfying an
impulse by acting on a substitute but in a socially acceptable way (e.g., channeling energy
into work or a constructive hobby) (McLeod, 2013).
THE 5 PSYCHOSEXUAL STAGES OF
DEVELOPMENT
• Finally, one of the most enduring concepts associated with Freud is his psychosexual stages.
Freud proposed that children develop in five distinct stages, each focused on a different source
of pleasure:
• First Stage: Oral—the child seeks pleasure from the mouth (e.g., sucking);
• Second Stage: Anal—the child seeks pleasure from the anus (e.g., withholding and expelling
feces);
• Third Stage: Phallic—the child seeks pleasure from the penis or clitoris (e.g., masturbation);
• Fourth Stage: Latent—the child has little or no sexual motivation;
• Fifth Stage: Genital—the child seeks pleasure from the penis or vagina (e.g., sexual intercourse;
McLeod, 2013).
THE 5 PSYCHOSEXUAL STAGES OF
DEVELOPMENT
• Freud hypothesized that an individual must successfully complete each
stage to become a psychologically healthy adult with a fully formed ego
and superego. Otherwise, individuals may become stuck or “fixated” in a
particular stage, causing emotional and behavioral problems in adulthood
(McLeod, 2013).
THE APPROACH: PSYCHOANALYTIC
PERSPECTIVE

• In the psychoanalytic approach, the focus is on the unconscious mind

rather than the conscious mind. It is built on the foundational idea that
your behavior is determined by experiences from your past that are
lodged in your unconscious mind.
• While the focus on sex has lessened over the decades since
psychoanalysis was founded, psychology and talk therapy still place a big
emphasis on one’s early childhood experiences.
METHODS AND TECHNIQUES

• A psychoanalyst can use many different techniques, but there are four basic components
that comprise modern psychoanalysis:
• Interpretation;
• Transference analysis;
• Technical neutrality;
• Countertransference analysis.
1. INTERPRETATION

• Interpretation is the verbal communication between analysts and clients in which analysts
discuss their hypotheses of their clients’ unconscious conflicts.
• Generally, analysts will help clients see the defensive mechanisms they are using and the
context of the defensive mechanisms, or the impulsive relationship against which the
mechanism was developed, and finally the client’s motivation for this mechanism
(Kernberg, 2016).
1. INTERPRETATION

• There are three classifications of interpretation:

• Clarification, in which the analyst attempts to clarify what is going on in the patient’s
consciousness;
• Confrontation, which is bringing nonverbal aspects of the client’s behavior into his or her
awareness;
• Interpretation proper, which refers to the analyst’s proposed hypothesis of the
unconscious meaning that relates all the aspects of the client’s communication with one
another (Kernberg, 2016).
2. TRANSFERENCE ANALYSIS

• Transference is the term for the unconscious repetition in the “here and now” of
conflicts from the client’s past. Transference analysis refers to “the systematic analysis of
the transference implications of the patient’s total verbal and nonverbal manifestations in
the hours as well as the patient’s direct and implicit communicative efforts to influence
the analyst in a certain direction” (Kernberg, 2016).
• This analysis of the patient’s transference is an essential component of psychoanalysis and
is the main driver of change in treatment.
2. TRANSFERENCE ANALYSIS

• In transference analysis, the analyst takes note of all communication, both verbal and
nonverbal, the client engages in and puts together a theory on what led to the defensive
mechanisms he or she displays. That theory forms the basis for any attempts to change
the behavior or character of the client.
3. TECHNICAL NEUTRALITY

• Another vital piece of psychoanalysis is what is known as technical neutrality, or the

commitment of the analyst to remain neutral and avoid taking sides in the client’s
internal conflicts; the analyst strives to remain at an equal distance from the client’s id,
ego, and superego, and from the client’s external reality.
• Additionally, technical neutrality demands that the analyst refrains from imposing his or
her value systems upon the client (Kernberg, 2016).
• Technical neutrality is sometimes considered indifference or disinterest in the client, but
that is not the goal; rather, analysts aim to serve as a mirror for their clients, reflecting
clients’ own characteristics, assumptions, and behaviors back at them to aid in their
understanding of themselves.
4. COUNTERTRANSFERENCE ANALYSIS

• This final key component of psychoanalysis is the analysis of countertransference, the

analyst’s reactions to clients and the material they present in sessions.
• Countertransference analysis can be generally understood as the analyst’s attempts to
analyze their own reactions to the client, whatever form they take.
• To engage in psychoanalytic treatment, the analyst must see the client objectively and
understand the transference happening in the client and in their own experience.
TRANSFERENCE AND OTHER FORMS OF
RESISTANCE IN PSYCHOANALYSIS

• Speaking of transference, it is one of the many forms of resistance considered in

psychoanalysis. In psychoanalytic theory, resistance has a specific meaning: the blocking
of memories from consciousness by the client (Fournier, 2018).
• Resistance is the client’s general unwillingness to change their behavior and engage
in growth through therapy. This resistance can develop by myriad reasons, some
conscious and some unconscious, and can even be present in those who want to change.
• It frequently occurs in treatment in the form of transference onto the therapist, in which
the client applies their feelings and expectations toward another person onto the
therapist.
TRANSFERENCE AND OTHER FORMS OF
RESISTANCE IN PSYCHOANALYSIS
• There are many different types of transference, but the most common include:
• Paternal transference: In this type, the client looks to another person  as a father or idealized
father figure (e.g., wise, authoritative, powerful);
• Maternal transference: The client looks to another person as a mother or an idealized mother
figure (e.g., comforting, loving, nurturing);
• Sibling transference: This type may occur when parental relationships break down or are
lacking; instead of treating another person as a parent (in a leader/follower type relationship),
the client transfers a more peer-based relationship onto the other person;
• Non-familial transference: This is a more general type of transference in which the client treats
others as idealized versions of what the client expects them to be, rather than what they truly
are; this type of transference can lead the client to form stereotypes (Good Therapy, 2015).
EXAMPLES OF WAYS IN WHICH A CLIENT MAY RESIST
CHANGE IN TREATMENT INCLUDE:
• Silence or minimal discussion with the therapist;
• Preoccupation with symptoms;
• Irrelevant small talk;
• Preoccupation with the past or future;
• Focusing on the therapist or asking the therapist personal questions;
• Discounting or second-guessing the therapist;
• Seductiveness;
• False promises or forgetting to do what is agreed upon;
• Not keeping appointments;
• Failing to pay for appointments (Lavoie, n.d.).
A PSYCHOANALYST VS. A PSYCHOTHERAPIST: IS
THERE A DIFFERENCE?

• In case the descriptions above didn’t make it clear, there is certainly a difference
between a psychoanalyst and a psychotherapist.
• A psychoanalyst has a particular set of skills gained from specific psychoanalysis training.
• While psychotherapists may practice multiple types of therapy (although they often
specialize in a certain type of therapy or in treating a particular mental health issue),
psychoanalysts generally stick to practicing only psychoanalysis.
• In fact, a psychoanalyst is often considered to be a type of psychotherapist, just one who
specializes in psychoanalysis. With that in mind, every psychoanalyst is also a
psychotherapist, but not every psychotherapist is a psychoanalyst.
USEFUL YOU-TUBE VIDEOS

• Psychoanalysis: Unlocks the past, Informs the Present, Expands the Future
• https://www.youtube.com/watch?v=hg3l3Z2DBZk
• Psychodynamic Therapy Role-Play - Defense Mechanisms and Free Association
• https://www.youtube.com/watch?v=z9fF9F5w1cI
• Sample Psychoanalysis Session
• https://www.youtube.com/watch?v=tQZPd7e8lXw