Psychoanalytic Therapy

COURSE
PSYCH 321
NUMBER
(ADJUST SHADINGS BASED ON YOUR
INSERT RELATED PICTURE HERE OWN PROGRAM’S IDENTIFIED COLOR)
COURSE LEARNING OUTCOMES

At the end of the course, you should
be able to:
1. Distinguish between the different
therapeutic approaches.
2. Recognize the goals of therapy
responsive to the unique needs of the
client.
3. Evaluate psychological
difficulties more accurately to
determine appropriate intervention.
4. Demonstrate accuracy in
person-perception for future clinical
assessment.
5. Apply psychotherapeutic
constructs in preparing a program for
intervention.
6. Display self-awareness to
enhance one’s competency in
practice.
ABNORMAL 7. Practice diligence in one’s
PSYCHOLOGY II work/studies and adhere to ethical the

guidelines for psychologists
8. Show concern, objectivity and
empathy for persons with emotional
and behavioral difficulties.
1. Distinguish between the different
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COURSE INTRODUCTION
Abnormal Psychology II deals with Clinical Psychology. This is a 3-unit course that
would deal with the second part of the whole field of Abnormal Psychology. It is an
applied field in psychology where concepts in Psychopathology (Abnormal
Psychology I) are understood within the context of treatment and prevention.
Special attention is given to the different techniques in clinical assessment. Likewise,
various practices of therapy relative to behavioral, personality and mental disorders
will be explored considering the different Biological Therapies and basic
Psychotherapies. The techniques in Psychotherapy come from the different
frameworks in Psychology. Special topics on marriage, group counseling and
encounter movements will also be dealt with.
MODULE 7: PSYCHOANALYTIC THERAPY
This module will discuss the nature and elements of psychoanalytic therapy, also known as
Talk Therapy. It will focus on how to uncover the unconscious content of a client's psyche in
order to alleviate psychic tension.
Topic Learning Outcomes:
1. Demonstrate comprehension of the key concepts and processes of psychoanalytic

therapy.
2. Apply psychoanalytic therapy techniques and processes to assist clients in difficulties.
3. Critically evaluate the strengths and limitations of psychoanalytic therapy, particularly
with respect to the applicability of the therapy to different client populations and the
problems presented.
Engage: Recap of some of Freud’s important Key Concepts

Explore: Personal Reflection
Explain: Psychoanalytic Therapy Approach
Elaborate: Modified Psychoanalytic Therapies
Evaluate: Summative Quiz ((discretion of Faculty)
ENGAGE
Let’s have a short recap of some of Freud’s important key concepts!
TOPOGRAPHICAL MODEL
1. Conscious
1. Considered to be the “tip of the iceberg” or, as Freud would say, a thin slice of the
human mind.
2. Preconscious
A. Contains all memories and information that can be brought to the conscious
3. Unconscious
b. Contains all information, experiences, drives and other repressed materials. This portion
is considered to be the least accessible.
STRUCTUAL MODEL OF PERSONALITY

⮚ Id (Pleasure Principle)
2. It is considered as the original system of personality. At birth, the only structure present
is the id. It contains our drives and impulses; biological component
⮚ Ego (Reality Principle)
B. The structure that is in contact with reality. Moreover, it is the one that governs, controls
and regulates personality.
⮚ Superego (Conscience, Ego-ideal)
c. It is considered as the judicial branch of personality. It includes the person’s sense of
what is right and wrong. It inhibits the id’s impulses, and persuades the ego to put
morals above anything else and to strive for perfection.
In Freud’s theory, a “stable personality” is where there is balance, and the ego is able to
mediate the demands of the id, superego and reality.
Super-
Id
ego
“Stable personality”
Ego
However, if the ego fails to mediate the demands of the three, this may lead to several
outcomes.
May lead to restricted personality or

behaviors (eg. OCD, OCPD)
Ego
May lead to pleasure-seeking

Ego personality or behavior
EXPLORE
Personal Reflection
Some clients come for help because they see themselves

repeating past mistakes over and over again – choosing
partners who have problems with addictions or working for
a mean boss in every job they take. How do you see your
own history repeating itself in some aspect of your life?
What are the ongoing personal struggles that you have
faced? These could involve difficulties with intimacy,
authority figures, or poor self-esteem, among others.
What are some possible sources in your early life that

could be responsible for these personal struggles? What have you suffered previously that
continues to plague you today?
EXPLAIN
PSYCHOANALYTIC THERAPY APPROACH
Goal of Therapy
The goal of psychoanalytic therapy is to help the client achieve insight. In a more elaborated
term, it aims to help the client uncover the resistance that opposes self-knowledge, and to
make the unconscious conscious. Uncovering the unconscious determinants of irrational
thoughts, feelings and behavior may lead to confrontation and understanding of these
determinants, which in turn, may lead to the disappearance of neurotic symptoms and
defense mechanisms.
Psychoanalysis directs itself to the maladaptive neurotic behavioral problems. The

development of neurosis consists of:
- Precipitating factors (eg. Harsh childhood experience)

- Failure in the solution of actual problems which may lead to regression.
- In turn, this may revive the primary conflict, followed by the futile struggle to
solve them.
- Substitute gratification and self-punishment expressed in symptoms
- Resulting in secondary conflict
- These will further result to the impoverishment of the ego. To protect itself, it will
turn to defense mechanisms.
Therefore, neurosis is seen as the failure of the ego to mediate the demands of the id,
superego and the environment (reality). This failure, then, pushed the ego to resort to
defense mechanisms. That’s why, as mentioned, psychoanalysis aims to help the client to
extend the integrative capacity of the ego over the impulses that have been repressed. This
will result in a greater adaptability and flexibility of the client. If the ego has been
strengthened, the client’s behavior will be based more on reality (of course, with proper
consideration of other factors) and less on the instinctual cravings and/or irrational guilt.
Therapeutic Processes
Therapist’s function and roles

In classical psychoanalysis, the therapist assumes a neutral stance (sometimes referred to as
the blank-screen approach). This reverses the process of repression. The therapist reacts
differently from the way the client’s parents reacted. Remaining in a neutral stance sends
the client a message that the therapist is not judging and evaluating him/her. Through this,
the client learns that the therapist does not condemn him, and, as a result, the client will be
able to freely express his/her thoughts, feelings and desires. Thus, the unconscious becomes
conscious as an indispensable part of the therapy.
Since a sense of neutrality must remain, therapists must avoid self-disclosure. This is to foster
a transference relationship, in which the client will make projections onto them. The
repressed attitudes of the client are directed towards the therapist. That is, the attitudes that
are originally directed towards the parents are transferred to the therapist. This emotional
experience is an important aspect of the process. This provides an opportunity for the ego
to confront the situations in a new setting, with a person who does not react in a way as the
parents did. This leads to the client’s realization of how his/her reactions are no longer
relevant or suited to the present.
The recognition of the inappropriateness of his behavior is not only an intellectual insight, but
a corrective emotional reaction. This experience is the central therapeutic agent in the
process of change -- it consists of a series of corrective emotional experiences.
These 3 factors: a) emotional abreaction (expression of repressed emotions), b) intellectual

insight, and c) appearance of repressed memories are interrelated and interdependent.
Without emotional abreaction, insight is ineffective. Recollection of repressed memories is
also important because it is a part of insight.
If therapy is to produce change, then, transference (discussed on the latter section) must be
worked through. The working-through process consists of repetitive and elaborate
exploration of the unconscious (drives, motives, defense mechanisms, etc.), which may have
its roots in early childhood.
Implementation of the Psychoanalytic process

Orthodox (Traditional) Psychoanalysis insists of
an intense frequency of 50 minutes of analytic
sessions with a minimum of four sessions a
week. The frequency of the sessions propels
analytic work because that which is begun in
one session is quickly followed up in the next
as the stream of associations continues to
flow. Long intervals between sessions tend to
thicken the resistance and allow for repression
of material already uncovered.
Newer trends in psychoanalytic therapy are

not at all enthusiastic about this high
frequency of sessions. They claim that too frequent sessions tend to gratify the client’s
dependency needs more than is desirable or reduce his emotional participation since the
sessions become routine. The optimum frequency varies from case to case according to the
intensity of the impulses to be built up to the point at which the client can become aware
of them. Moreover, long and deep regressions should be avoided as they are not always
needed in order to reach the objective of the therapy and in order to lessen the burden
(financial and otherwise) of the client and the therapist. “The primary concern in therapy is
not the recovery of the past, but the discovery of solutions for present problems.” – C.H.
Patterson
In the classical analytic procedure, the client reclines on a couch and is made as
comfortable as possible. The therapist sits out of direct line of vision of the client. In this
arrangement, the client is better able to fantasize and to regress, to project and displace
upon the therapist feelings and attitudes towards figures from the past, that is, to form
transference. The supine position also minimizes motor activity, thus encouraging
verbalization rather than action. Verbalization not only facilitates remembering, but it is also
conducive to the establishment of higher levels of object relations. Acting out on the other
hand, blocks remembering by bypassing the ego, thus lessening opportunity of insight. It
permits temporary discharge without therapeutic gain, whereas verbalization is instrumental
to ego-building.
At the outset, the therapist gives the client some understanding of the general method of
procedure and of the purpose and aims of the therapy. The client is acquainted with the
fact that some of his behaviors and attitudes may be dependent upon emotional factors of
which he is unaware and that the task of the therapist is to trace back these associations to
unconscious motivations. As these unconscious strivings are elevated to the conscious plane
and interpreted and understood, they may be assimilated into the personality and lose their
potency for disturbing his integrated activity.
Therapeutic Techniques and Procedure

The therapist regards the symptoms of neurosis and maladaptive behaviors as manifestations
of the conflict between the id, ego, superego and the demands of reality. In other words,
the symptom indicates an unconscious conflict that needs resolution.
The psychoanalytic process stresses maintaining a particular framework aimed at

accomplishing the goals of this type of therapy. Maintaining the analytic framework refers
to a whole range of procedural and stylistic factors, such as the therapist maintaining
neutrality and objectivity, regularity and consistency of meeting, and starting and ending of
sessions on time.
Over the years, numerous techniques have been developed to achieve the goal of therapy.
Nonetheless, the basic emphasis on the dissolution of repressions through the re-analysis of
past experience remains. Think of it as having various routes, but leading to the same
destination. Despite the numerous techniques that exist, all are made to achieve the same
goal.
The following sections will discuss some of the techniques commonly used.
✔ Free Association
A cardinal rule is let the client say anything and
everything that comes to mind. The client is to put
all his thoughts, memories, and feelings into words.
It is up to the client to choose whatever topic or
subject matter he wants to talk about. However,
the client is instructed to report everything that
passes through his mind, irrespective of whether he
thinks it is relevant or important. In fact, he is
specifically interdicted from trying to construct a
consistent and logical narrative as he might under
ordinary circumstances and instead is told to follow his thoughts wherever they may lead,
even if they do not seem to make any sense.
Allowing the client to talk about anything will eventually lead to the repressed memories and
emotions. The therapist assumes that one association will lead to another. As the process
continues, one gets closer to the unconscious thoughts and urges. Some associations may
not be clear, or may appear irrelevant. However, over the course of therapy, patterns of
associations will start to emerge, and the therapist can integrate these to “create a
complete picture”.
It is important to keep in mind that a client’s thoughts are influenced by four determinants
✔ External stimuli
✔ Visceral-somatic stimuli
✔
Conscious intentions (for example, what he wants to say, which requires the
suppression of other thoughts that might interfere)
✔ Unconscious or repressed ideas that seek discharge and interfere with conscious
intentions.
As the psychotherapist, we are interested in exposing this last group (unconscious or
repressed). Hence, we try to minimize the effects of the other three as much as possible, in
order that the latter may become more recognizable. External stimuli during the
psychoanalytic hour are therefore reduced to a minimum and are held relatively constant.
Internal physical distress cannot be controlled, but when present, it interferes with the
analytical work. The main object of the fundamental rule is to eliminate the client’s conscious
intentions and goals. When these are excluded, presumably what determines the client’s
productions are the remaining unconscious and irrational impulses from within.
✔ Resistance
As the client proceeds with his free associations, there will be

many indications that he is unable to bring forward important
material. Resistance is the inability to remember any important
past events or to talk about anxiety-charged subjects.
Resistance can be seen as a defense against anxiety. Resistance

operates in the therapy to prevent the client and therapist from
succeeding in gaining insight. An assumption of analytic
treatment is that clients will want both: to change and gain insight,
and at the same time, to remain in the old world and cling to the
familiar (and unhealthy) pattern.
Resistance can come in various forms. Clients who begin to talk

less, have longer pauses, or those who report that their minds are “blank” are manifestations
of resistance. Resistance may also be in a form wherein the client will endlessly talk about
the same thing over and over again. The handling of resistances calls for the greatest skill
and experience in the therapist and attention to resistances take precedence over all other
therapeutic maneuvers.
One thing to know about resistance is that it is not something to be overcome. The therapist
must recognize and work with resistance. It is crucial that the therapist respects the
resistance, and assists the client in working with their defenses. When handled properly,
resistance may be extremely helpful in further understanding the client.
✔ Dream Analysis
Another technique is the analysis of dreams. Dreams are believed to be manifestations of

the unconscious. It is the impulses and desires of the client disguised as symbols. Dreams are
seen as symbolic wish fulfillment, that provide important
clues to childhood wishes and feelings.
Dreams have 2 main components: a) Latent, which

consists of hidden, symbolic and/or unconscious motives,
and fears; b) Manifest, which are objects that appear in
the dream
Many things are represented by their opposites. The
dream is the result of a compromise between two
opposing forces –the wish to express a desire or relieve
tension and the tendency to reject the desire. Painful
dreams, from which the dreamer awakes in terror,
represent the failure of the dream work to disguise the objectionable content sufficiently, or
are the result of a guilty conscience.
In order to analyze and uncover the meaning of the client’s dreams, the client will engage
in free association with regard to the manifest content. With the assistance of the therapist,
the latent elements are discovered. The free association and the therapeutic situation lessen
the client’s unconscious censorship, so that the pressure of the repressed wish breaks
through. Certain dream elements are common symbols of universal human experience.
However, certain problems may arise when conducting dream analysis. For instance, while
it’s true that free association will help, the meaning of one dream will not always be apparent
and cannot simply be uncovered via free association. The real meaning of the dream may
only become apparent from the analysis of a whole series of the dreams. Another potential
problem is the client’s tendency to distort the manifest content. Not only that the therapist
must exert extra effort in finding the symbolic meaning, there is also the need to handle the
client’s defenses that interfere with the process.
✔ Transference
Transference is unavoidable in the process.

Transference manifest itself when the client projects
on to the therapists everything that is originally for the
parents (or any significant figure from the client’s
childhood). During transference, both fantasies and
real experiences will be reenacted and emotions of
love, hate, fear, anxiety, and resentment will be
projected on the therapist.
Transference is valuable since it provides the client a

space to re-experience a variety of feelings that would otherwise be inaccessible. Moreover,
it provides the therapist an opportunity to interpret the transference that would further help
to gain a better understanding of the client.
Transference can either be positive or negative, depending on what is being projected.

When the emotions directed toward the therapist are those of affection and dependence,
the transference is positive. Positive transference is often responsible for what appears to be
rapid improvement at the beginning stages of therapy. In contrast, if a hostile attitude is
dominant, the transference is negative.
However, it is important to keep in mind that not all feelings that the client is expressing are
manifestations of transference. Many of these may be based on reality, not on the past. Not
all positive responses, such as liking the therapist, should be labeled as positive transference.
Likewise, a client’s anger toward the therapist may be because of something that the
therapist did or said that may have offended the client; it is a mistake to label all negative
feelings as negative transference.
Like resistance, transference can take many forms. It may be reflected in the client’s
comments about the therapist’s clothing, talking, or even the layout of the counseling room.
It may take in the form of a direct comment of dislike, anger or an attack on the therapist's
efficacy. It may also contain direct comments of admiration or love. Regardless of the form
and content of the comment, it is important to remember that these do not reflect realities,
but are rooted in the client’s unresolved issues during childhood.
Handling transference is an important skill that a therapist should learn. A therapist must be
able to meet the transference boldly but treat it as something unreal. Success in the analysis
depends upon the passive direction of the transference to understanding the client’s
resistance.
It is important to recognize that the transference, which is the heart of the psycho-analytic
method, is not entirely a one-sided affair. The therapist needs to constantly be on guard for
indications of counter-transference.
Thought Questions
Bring to mind the image of someone you don’t like very

much, someone who really gets underneath your skin. This
may be a person who once betrayed you, someone who
rejected you, or someone who has been repeatedly
abusive toward you.
Now imagine that a new client comes in to see you who

bears a striking resemblance to your nemesis, either in
appearance or mannerisms. How do you suppose you would feel working with this individual
who reminds you of another person whom you despise? Do you think there is any way
possible that your strong feelings would not affect your relationship with this client?
✔ Interpretation
As gradually unconscious elements surface
through free associations, resistances, dream
content and transference, the therapist tries to
deduce the meaning that lies behind the
client’s words and feelings. This procedure of
deducing what the client actually means and
telling it to him at the proper time is called
interpretation.
Interpretations are not offered to provide

solutions, but rather to clear the path of the associations and to provide new ways for the
development of understanding. The therapist acts like a translator, an interpreter.
Interpretation is hardly ever a single and final pronouncement by the therapist.

Interpretations should be viewed as being tentative and intermediary. They take place in a
series of incomplete interpretations. Further associations will have to either confirm, reject or
modify these tentative interpretations.
Proper timing of the interpretations is very important. The golden rule is that no interpretation
is given until the client is close upon it himself. Interpretations may not be given too early.
Premature interpretations are either unacceptable to the client and will provoke greater
resistances on his part, or may offer some temporary relief that will cause him to stop sharing
(which may affect the process)
Interpretations may not be given too late because interpretation facilitates further therapy.
The longer the client is exposed to material which puzzles him, which seems strange and
appears to him as a foreign body, the longer the analysis will be retarded and the
appearance of new unconscious material blocked.
Interpretation is the basic tool of the therapist. All steps in the analytic therapy lead to
interpretation. The therapist is in a position to offer interpretations both because of his great
experience and because he occupies the position of detached on-looker. In addition, he
has an understanding of the difficult language of symbols, some of which have individual
meanings and some of which have universal significance.
Terminal stage of therapy

The analysis cannot be considered complete until the transference situation has been
resolved. The terminal phase of treatment, therefore, consists in the breaking of the
transference and the establishing of a normal therapist client relationship. Clients are ready
to terminate their sessions when they and their therapist mutually agree that they have
resolved the symptoms and core conflicts.
As the transference is dissolved, the client may begin to show concern over the danger of
separation and may react with new symptoms, fantasies, and resistances that must briefly
be worked through.
The progress of the analysis is determined primarily by the degree of successful analysis of
the instinctual urges and of the ego.
Other indicators for approaching the terminal phase of analysis are: clearing up of childhood
memories that have been used as resistances for important libidinous drive, the lack of new
material, evidence of an altered attitude toward life, marked changes in the client’s social
relations, plans for the future, and lessened dependence on the analyst.
INDICATIONS AND CONTRA-INDICATIONS FOR PSYCHOANALYTIC THERAPY
There are certain factors that need to be considered when conducting psychoanalytic
therapy.
1. One of the aims of psychoanalysis is to strengthen the ego by confronting and

resolving deep-seated conflicts. Hence, psychoanalysis works best for clients who are high-
functioning (eg. Intelligent, educated and reasonable individuals who are anxious to get
well).
2. Motivation should also be considered. Psychoanalysis is a lengthy, intense process.

Hence, it will require strong motivation and this must be sustained.
3. Financial considerations must be made. Therapy can be expensive, and often times,
the client is charged per session. As we have mentioned, psychoanalysis can involve
numerous sessions. That’s why financial considerations cannot be ignored.
4. Psychoanalysis is not for emergency procedures, and is not for those individuals with
acute and dangerous symptoms that require immediate action. Other forms of therapy
might be more useful in situations like this.
5. Careful evaluation of the therapist must be done to find out how far the client can
afford to have his conflicts “written out”. The client’s ego may be too weak or his life situations
may be very difficult that an analysis may make the client feel more unhappy and miserable
than his neurosis.
ELABORATE
MODIFIED PSYCHOANALYTIC THERAPIES
Over the years, modifications in traditional psychoanalysis has taken place. While the basic
system and tenets of psychoanalysis were preserved, modifications were introduced.
Alternate systems of analytic therapy
We have the neo-Freudian systems:

1. Individual Psychotherapy by Alfred Adler
2. The analytical framework of Carl Jung
3. The Will therapy of Otto Rank.
There are also neo-Freudian systems based on the cultural emphasis:

1. Holistic approach by Karen Horney
2. Interpersonal relation school of H.S Sullivan
3. Cultural approach of Erich Fromm
Other modifications and applications of psychoanalysis were also introduced. These include:
1. Brief psychodynamic therapy (BFT) which aims to shorten the duration.
2. Analytic group therapy
3. Analytic play therapy
EVALUATE
Summative Quiz (discretion of Faculty)
REFERENCES:
Corey, G. (2017). Theory and Practice of Counseling and Psychotherapy (10th edition).
Cengage Learning.
Trull, T. & Prinstein, M. (2013). Clinical Psychology (8th edition). Belmont, CA: Cengage
Learning.
Saint Louis University. Clinical Psychology Manual (Psych 25).
Wetherick, F.K. (2018). Advanced Counseling and Psychotherapy [Class Lecture].
Psychology, Saint Louis University, Baguio City.
Images:
All images were obtained from various sources, but are under Creative common license.
✔ Image 1 (“Session with a therapist”)

Link: https://commons.wikimedia.org/wiki/File:A_session_with_a_psychotherapist_(751707089).jpg
✔ Image 2 (“Woman talking”)

Link: https://blog.inkforall.com/difficult-words
✔ Image 3 (“Angry boy”)

Link: https://creazilla.com/nodes/37316-seth-man-is-angry-clipart
✔ Image 4 (“Dreaming”)
Link: https://pixabay.com/illustrations/sleep-bed-dream-thought-bubble-5655423/
✔ Image 5 (“Transference”)
Link: https://www.psychiatrictimes.com/view/critical-moment-psychiatry-need-meaningful-
psychotherapy-training-psychiatry
✔ Image 6 (“Puzzle piece”)

Link:https://www.pikist.com/free-photo-staxt

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COURSE

COURSE LEARNING OUTCOMES

PSYCHOLOGY II work/studies and adhere to ethical the

1. Distinguish between the different

Topic Learning Outcomes:

1. Demonstrate comprehension of the key concepts and processes of psychoanalytic

Engage: Recap of some of Freud’s important Key Concepts

Let’s have a short recap of some of Freud’s important key concepts!

STRUCTUAL MODEL OF PERSONALITY

May lead to restricted personality or

May lead to pleasure-seeking

Some clients come for help because they see themselves

What are some possible sources in your early life that

PSYCHOANALYTIC THERAPY APPROACH

Psychoanalysis directs itself to the maladaptive neurotic behavioral problems. The

- Precipitating factors (eg. Harsh childhood experience)

Therapist’s function and roles

These 3 factors: a) emotional abreaction (expression of repressed emotions), b) intellectual

Implementation of the Psychoanalytic process

Newer trends in psychoanalytic therapy are

Therapeutic Techniques and Procedure

The psychoanalytic process stresses maintaining a particular framework aimed at

As the client proceeds with his free associations, there will be

Resistance can be seen as a defense against anxiety. Resistance

Resistance can come in various forms. Clients who begin to talk

Another technique is the analysis of dreams. Dreams are believed to be manifestations of

Dreams have 2 main components: a) Latent, which

Transference is unavoidable in the process.

Transference is valuable since it provides the client a

Transference can either be positive or negative, depending on what is being projected.

Bring to mind the image of someone you don’t like very

Now imagine that a new client comes in to see you who

Interpretations are not offered to provide

Interpretation is hardly ever a single and final pronouncement by the therapist.

Terminal stage of therapy

INDICATIONS AND CONTRA-INDICATIONS FOR PSYCHOANALYTIC THERAPY

1. One of the aims of psychoanalysis is to strengthen the ego by confronting and

2. Motivation should also be considered. Psychoanalysis is a lengthy, intense process.

Alternate systems of analytic therapy

We have the neo-Freudian systems:

There are also neo-Freudian systems based on the cultural emphasis:

Summative Quiz (discretion of Faculty)

✔ Image 1 (“Session with a therapist”)

✔ Image 2 (“Woman talking”)

✔ Image 3 (“Angry boy”)

✔ Image 6 (“Puzzle piece”)

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