Psychoanalytic Therapy

 EDCE 655
 Theories Techniques II

2
Sigmund Freud Chronology

 Born May 6, 1856 in Freiberg (Czech Republic)

 1860 Move to Vienna
 1873 Enters Vienna University
 1881 Qualifies as a doctor of Medicine
 1882 1883 works at Theodor Meynerts
Psychiatric Clinic
 1886 Married Martha Bernays
 1887 Becomes interested in hyptnotherapy
 1893 Works with Josef Breuer on Studies in
Hysteria

3
Sigmund Freud Chronology

 1895 Freud analyzes one of his own dreams (this

is a first)
 1900 First Copies of The Interpretation of
Dreams
 1901 Begins analysis with 18 yr old Dora
 1906 Carl Jung begins correspondence with Freud
 1908 1st Congress of Freudian Psychology in
Salzburg
 1910 Founded International Psychoanalytical
Association

4
Sigmund Freud Chronology

 1911 Adler resigns from the Vienna

Psychoanalytic Society
 1913 Break with Carl Jung
 1914 WWI Begins
 1918 Loses entire fortune in Austrian Bonds
 1923 First signs of oral Cancer detected
 1924 Conflict with Otto Rank over meaning of
birth trauma.
 1930 heart attack forces Freud to give up
smoking

5
Sigmund Freud Chronology
  1933 Hitler becomes the Reichs Chancellor
Freud corresponds with Einstein on the question
Why War?
 1935 Elected Honorary Member of British Royal
Society of Medicine
 1938 Austria is annexed to German Reich on
March 13 persecution breaks out / Freud
searched Anna held by Gestapo for questioning.
 1939 September 23 Freud Dies in London

6
Freud (Age 50) in 1906

 Always holding his cigar

 He sent this photograph to Jung with Jung asked
for a photograph (in admiration)

7
The Secret Committee (1912-1927)

 After conflict with Jung in 1912 Freud formed

the Secret Committee
 Members Freud, Otto Rank, Karl Abraham, Max
Etingon, Ernest Jones, Sandor Ferenczi, Hanns
Sachs.
 Purpose monitor activities of the psychoanalytic
movement (Watch Jungs activities)
 Jung Freud Break Jung rejected the belief that
sexuality was the source of all neuroses
 Jung was one said to be the crown prince heir
to the psychoanalytic movement

8
The Secret Committee (1912-1927)
9
Anna Dad in 1927 Talking About Death

 Picture taken after last (16th) operation for

cancer of the jaw
 Picture taken after discussion with Schur
(Freuds personal physician) re when Freud
thinks he is dying Schur would administer
Morphine
 In Sept 1939 Freud asked Schur to relieve his
pain.

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Psychoanalytic Theory

 Human Nature (Freud)

 Life instincts
 Survival
 Gain pleasure
  Avoid pain
 Death instincts
 Aggressive drive
 Unconscious desire to hurt self or others

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Psychoanalytic Theory

 Components of Personality (Freud)

 ID
 Instinctive
 Pleasure principle
 EGO
 executive
 Regulative function
 SUPEREGO
 Judicial branch of personality
 Moral code

12
Psychoanalytic Theory

 Anxiety
 Reality
 Fear of external danger
 Neurotic
 Fear of uncontrollable instincts
 Moral
 Fear of ones own conscience

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Ego-Defense Mechanisms

 Repression
 painful, threatening thoughts excluded from
awareness
 Denial
 Closing ones eyes to existence of threatening
reality
 Reaction Formation
 Expressing the opposite impulse
 Projection
 Attributing ones desires to others
 Displacement
 Directing energy (i.e., anger) to a safer target
 Rationalization
 Explaining away failures or losses

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Ego-Defense Mechanisms
  Sublimation
 Diverting sexual or aggressive energy into other
channels
 Regression
 Reverting to a form of previously outgrown
behavior
 Introjection
 Accepting values and standards of others
 Identification
 Identifying oneself with successful people or
organizations
 Compensation
 Developing positive traits to make up for
perceived limitations

15
Development of Personality

 Oral Stage (0-1)

 Oral-incorporative behavior, involving
pleasurable stimulation of the mouth
 Anal Stage (1-3)
 Anal zone becomes of major significance in
formation of personality
 Phallic Stage (3-6)
 Conflict centers on unconscious incestuous
desires that child develops for parent of
opposite sex Oedipus Electra complex
 Latency Stage (6-12)
 Child turns outward and forms relationships with
others
 Genital Stage (12)
 Trend away from narcissism and toward altruistic
behavior and concern for others

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Other Contributors of the Psychoanalytic Theory

 Alfred Adler
 Colleague of Freud
 Thought Freud underestimated the role of social
political pressures
 The Encounter Movement / Primal Scream
 2 forms of therapy that centrally emphasize
emotional catharsis
 Albert Ellis (Rational Emotive)
 Moderating the influence of the superego on the
total psychological balance
 Carl Rogers (Person Centered)
 Having its roots in uncritical, empathetic
relationship between client patient

 Carl Jung
  Colleague of Freud broke with him over
differences in drives
 Emphasis on human development particularly
midlife symbolic representations (Freud
emphasized dev. Processes)
 Prominent Neo-psychoanalytic analysts
 Harry Stack Sullivan (1953) interpersonal
relationships
 Karen Horney (1940) social, cultural factors
 Erik Erikson (1968) life cycle personality
changes

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Counselors Role Function

 Blank Screen approach

 Counselor is anonymous
 Very little self disclosure
 Transference
 Relationship is attempted
 Clients makes projections onto the counselor
 Assist clients in achieving
 Self-awareness
 Honesty
 More effective personal relationships
 Gaining control over impulsive and irrational
behaviors

18
Therapeutic Process

 Clients Experience
 Intensive Long term
 Fundamental Rule
 Free association

 Relationship between counselor client

 Transference relationship is explored
 Working through unconscious material defenses
from early childhood
 Countertransference
 Counselors reactions to clients may interfere
with process

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Psychoanalytic Techniques Procedures

 Free Association
 Client reports any thought which comes to mind
 Opens door to unconscious wishes, fantasies,
conflicts
 Interpretation
  Counselor teaches client the meanings of given
behaviors
 Interpretation of resistance and transference
 Dream Analysis
 Latent content hidden, symbolic meaning
 Manifest content dream as appears to dreamer

20
Psychoanalytic Basic Concepts

 Conflict is at the heart of psychoanalysis

 Psychoanalysis reflects the primal struggle of an
individual as both a biological animal a social
being
 The pleasure principle assumes that human psych.
is governed by a tendency to seek pleasure and
avoid pain
 This principle operates throughout life but is
dominant in the first few years of existence and
plays a crucial role in shaping each individuals
psychic structure

21
Significant Workings of Freud

 Studies of Hysteria (1895) summary of Freud

Joseph Breurers work with Anna O. other
clients. Symptoms of hysteria were the result of
undischarged emotion connected with a very
painful childhood memory.
 Interpretation of Dreams (1900) second phase
of Freuds understanding of the psyche. Dreams
symptoms were both the end product of a
compromise between 2 sets of conflicting forces.
 Papers on Metapsychology (1915) mental
process in all of its aspects, dynamic,
topographical, and economic.
 Dual Instinct Theory (1920) put forth the
notion of 2 instincts libido aggression
 Structural Theory (1923) grouped mental
functions according to the role they played in
conflict. The 3 major divisions are the id, ego,
and superego.

22
Psychoanalytic Key Terms

 Abreaction emotional release resulting from

recalling and reliving painful repressed
experiences
 Anal Stage the 2nd stage of psychosexual
development at which time pleasure is derived
from retaining and expelling feces
 Catharsis the release into awareness of
repressed material from the unconscious
venting!
  Countertransference counselors unconscious
emotional responses to a client that are likely
to interfere with objectivity unresolved
conflicts of the counselor that are projected
onto the client
 Ego part of the personality that is the
mediator between external reality and inner
demands
 Ego-defense Mechanisms intropsychic processes
that operate unconsciously to protect the person
from threatening therefore anxiety producing
thoughts, feelings, impulses

23
Psychoanalytic Key Terms

 Ego Psychology psychosocial approach of Erik

Erikson emphasis on development of the ego or
self at various stages in life
 Electra Complex unconscious sexual desire of
the female child for her father, along with
feelings of hostility toward her mother
 Fixation condition of being arrested or stuck
at one level of psychosexual development
 Free Association a primary technique consisting
of spontaneous and uncensored verbalization by
the client, which gives clues to the nature of
the clients unconscious conflicts
 Genital Stage final stage of psychosexual dev.
Usually attained at adolescence, in which
heterosexual interests and activities are
predominant
 Id part of personality, present at birth, that
is blind, demanding, insistent functioning to
discharge tensions and return to homeostasis

24
Psychoanalytic Key Terms

 Identity Crisis developmental challenge,

occurring during adolescence, whereby the person
seeks to establish a stable view of self to
define a place in life
 Latency Stage period of psychosexual
development following the phallic stage that is
relatively calm before the storm of adolescence
 Libido instinctual drives of the Id and the
source of psychic energy
 Narcissism extreme self-love, as opposed to
love of others A narcissistic personality is
characterized by a grandiose and exaggerated
sense of self-importance and an exploitive
attitude toward others, which hides poor
self-concept
 Object-Relations Theory newer versions of
psychoanalytic thinking, which focus on
predictable developmental sequences in which
 early experiences of self shift in relation to an
expanding awareness of others
 Oedipus Complex unconscious sexual desire of
the male child for his mother, along with
feelings of hostility and fear toward his father

25
Psychoanalytic Key Terms

 Oral Stage initial stage of psychosexual dev.

During which the mouth is the primary source of
gratification a time when the infant is
learning to trust or mistrust the world
 Phallic Stage - 3rd stage of psychosexual
development, during which the child gains maximum
gratification throught direct experience with the
genitals
 Psychodynamics interplay of opposing forces and
intropsychic conflicts providing a basis for
understanding human motivation
 Psychosexual Stages the Freudian chronological
phases of developmetn, beginning in infancy
each is characterized by a primary way of gaining
sensual and sexual gratification
 Psychosocial Stages Eriksons critical turning
points, from infancy through old age each
presents psychological and social tasks that must
be mastered if maturation is to proceed in a
health fashion

26
Psychoanalytic Key Terms

 Reaction Formation defense mechanism against a

threatening impluse, involving actively
expressing the opposite impulse
 Repression ego-defense mechanism whereby
threatening or painful thoughts or feelings are
excluded from awareness
 Resistance clients reluctance to bring to
awareness threatening unconscious material that
has been repressed
 Superego aspect of personality that represents
ones moral training striving for perfection
not pleasure
 Transference clients unconscious shifting to
the counselor feelings fantasies, both positive
and negative, that are displacements from
reactions to significant others from the clients
past

27
Psychoanalytic Key Terms

 Transference neurosis the point in classical

psychoanalysis when the patients fantasies about
the counselor are at their peak, at which time
 the therapeutic relationship becomes the focus of
therapy
 Unconscious the aspect of psychological
functioning or of personality that houses
experiences, wishes, impulses, and memories in an
out-or-awareness state as a protection against
anxiety
 Working-through a process of resolving basic
conflicts that are manifested in the clients
relationship with the counselor, achieved by the
repetition of interpretations and by exploring
forms of resistence

28
Tim A child molester

 Assume that you are working in a state mental

hospital for the rehabilitation of mentally
disordered sex offenders. The psychiatrist who is
the head of your ward, also your supervisor,
maintains that a psychoanalytic perspective is
most useful for understanding the dynamics of the
child molesters on the ward. Although she
realizes full well that most members of the Tx
staff are limited both in time available skill
in using psychoanalytic techniques, she also
believes that the staff can draw on
psychoanalytic concepts to guide the therapy with
their patients. She contends that you can think
in psychoanalytic terms, even though you do not
practice in strict psychoanalytic ways. With this
in mind, she presents a case study at a staff
meeting, giving some summary details of the
psychological development of a client named Tim.

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Background on Tim A child molester

 Tims mother was overprotective overpossessive

controlled him with guilt. Even now she reminds
him of all she have sacrificed of how he was
a difficult child from birth on. She almost
died delivering him, she tells him that she has
been suffering because of him for many years. Tim
was the only boy in a family of 5 children.
Psychosexually, he eventually decided to become a
neuter in an effort to become what he thought his
mother wanted of him. He became quite overweight,
developed a very passive unassertive style
(especially with women), has avoided developing
lasting relationship with women for 50 years.
 Tim saw his father as being extremely weak
uncaring. He reports that he cannot remember any
events in which he his father did anything
together. His father showed no interest in him,
his typical way of dealing with Tim was to ignore
him. Tims father was controlled by Tims mother
his grandmother (who lived with the family).
Tim recalls tension between his mother his
grandmother (the mother of Tims father) each
fighting to run the house in the way she saw fit.
 They had very different ideas about how the
family should be, so conflict was a continual
pattern in the home. Things Tim did to please his
mother often upset his grandmother, the reverse
happened when he tried to please the older woman.
 As a child Tim envied his sisters because he
thought they were treated more fairly than he
was. Eventually, the discriminatory Tx he felt he
was receiving changed his envy to resentment. He
grew to fear females who were older than he, for
he continually felt that they could would
dominate him. His relationship with others have
been inadequate, he has never been able to form
maintain satisfactory relationships with adults
of either sex.
 Tim discovered that he felt relatively
comfortable around small children, especially
boys. They seemed to take a liking to him, they
did not make demands on him, he did not feel
inadequate around them. For a while during his
early adult life he worked as a teachers aide in
an elementary school. He began his pattern of
molesting your boys in this job. He would invite
some of these children to climb onto his lap,
he would then stroke their hair cuddle them.
Eventually, he progressed with several boys to
the point of touching their genitals he also
encouraged them to touch him. His pattern
continued, eventually he was arrested.
 During the rest of his adult life he has been in
out of state hospitals for sex offenders a
number of times. When he finishes his time as
stipulated by the court, he is released, goes
into the community, then reoffends. He feels
that he never hurts his victims that he is
typically very nice kind to them. He even
rationalizes that they often enjoys the attention
physical affection he demonstrates. Yet at
times he also feels that what he does is wrong,
he feels guilty over his deeds. Tim does not
think that his actions are normal, yet he worries
about how he will deal with the impulses he might
feel toward certain children. He has made
resolutions to control himself, yet he has often
acted on his impulses. Tim says he would like to
learn to control his desires be able to relate
well with adults.

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Questions for Reflection (Tim A child molester)

 By attempting to think psychoanalytically, show

how you might proceed in your contacts with Tim
by addressing yourself to these questions
 What value do you see in knowing Tims
developmental history, family background,
experiences as a child adolescent in school,
work history, other key adult experiences? Do
you think that knowing this information will help
you be a more effective counselor? How might you
proceed differently with him if you had no prior
knowledge about his past instead simply relied
on what you could learn about him through your
 contacts with him on the ward observing his
behavior? What advantages disadvantages do you
see in having prior knowledge about a client?
 From the summary notes about Tim alone, how might
you react to a person like him? What reaction
does it evoke in you when you think about a
middle-aged man who has a pattern of sexual
molestation of children? In what ways can you
predict that your own reactions to a person such
as Tim could affect your ability to work with him
therapeutically? How might you be able to deal
with your own feelings so that they would not be
a barrier between you him?
 Tim says that he feels guilt sorrow over what
he recognizes are his offenses also that he
would like to learn how to control his impulses.
How might you be able to tell the degree to which
this is so? Might he be saying what he feels he
is expected to say so that he will obtain a
release from the hospital? How do you think that
either your belief or lack of belief in what he
is saying will affect your work with him?
 Do you think that Tim can change (stop his
child-molesting behavior) without gaining insight
into the cause of his problems? How much
importance might you put on factors such as his
understanding of his early childhood? His
resolutions of psychic conflicts with his mother
grandmother? A resolution of his feelings
toward his father? If you see value in focusing
on the above issues, how might you do this within
the limited time that you would have to work with
him?
 Do you see Tim as a victim of his early
experiences? Or do you see that, even though he
has had adverse experiences in growing up, he
could do something to change his behavior now?
Again, how do your answers to the above questions
determine how you will work with him in
counseling?
 As you proceed with Tim, what would be your major
goals for him? Merely stopping his antisocial
behavior? Changing his basic personality
structure? Merely seeing that he has a choice in
doing something about the problem that keeps him
in the hospital?