Psychoanalytic & Psychodynamic

Treatment

Urwah Ali
Assistant Professor, Clinical Psychologist
(MSc, Mphil, PMDCP, PhD Research Scholar)
 Therapeutic Goals
There are two basic goals when applying Psychoanalytic
Therapy. These are:

1) To make unconscious motives conscious, &

2) To strengthen the Ego to be more aligned with reality

& lesser dependence on the instinctual cravings of the
Id or the irrational guilt provided by the Superego.
 The Therapist‘s Function & Role
• Therapists usually assume an
anonymous kind of role, also
known as the ―Blank-Screen With the gathered unconscious
Approach, where they limit self- material, it is then, the therapist‘s
disclosure that will then promote a role to
transference relationship‘ with the • properly organize the material
client, where the client will pour
• properly formulate the nature of
projections
the client‘s problem &
• have it interpreted to them, so as
• One of the central functions of
to give proper insight, increase
the therapist is to assist the client their awareness to change & thus
acquire the freedom to love, work leading them to having better
& play, achieving self-awareness, control‘s over their lives.
honesty, dealing with anxiety
realistically.

• In order to do this, the therapist

must first create a working
relationship
Freud’s Methods
• Only worked
with adults,
usually middle &
upper-class
women

 Tried to be a
neutral, objective
listener
 Psychoanalytic Techniques

• Dream Analysis & Interpretation

• Free Association
• Analysis of Transference & Counter-transference
• Analysis of Resistance
 Free Association

• Client reports whatever comes to mind

• “ Listening with the third ear” - hear not only the surface
content but also the hidden meanings.

• It opens doors to unconscious wishes, fantasies, conflicts

& motivation.

• Content may be bodily sensations, feelings, fantasies,

thoughts, memories, recent events & the therapist.
• Freud reported that his free associating patients
occasionally experienced such an emotionally intense &
vivid memory that they almost relived the experience. 

• This is like a "flashback" from a war or a rape

experience. 

• Such a stressful memory, so real it feels like it is

happening again, is called an abreaction. 

• If such a disturbing memory occurred in therapy or with

a supportive friend & one felt better--relieved or
cleansed--later, it would be called a catharsis.
Freud proposed the technique helped prevent three
common issues in therapy:

• Transference. The process of transferring feelings one

has for one person to a different person.

• Projection. The process of projecting one’s own

qualities onto someone else.

• Resistance. The practice of blocking out certain

feelings or memories.
 Free Association Analysis
• Uncensored reporting of any thoughts that come to mind

• After listening to his patient's random thoughts, Freud

would analyze the information to find the hidden
meaning.

• The psychologist must use their expertise to go beyond

the words spoken to discover the unconscious meaning.

• Freud's thinking was that once you understood what was

causing you to think or behave in ill-adaptive ways, the
problem would naturally resolve for you.
 ▫ Resistance – blocking from unconsciousness anxiety-
laden material during therapy
 Example stuttering, omitting or forgetting events, pausing,
changing the subject, ending a session

• By analyzing the patient’s resistances, both the therapist

& the patient can understand how the patient deals with
anxiety-provoking material.
 Freudian Slip & Free Association
• Freud, himself, referred to these slips as Fehlleistungen
(meaning "faulty functions", "faulty actions" or
"misperformances" in German);

• A Freudian slip, also called parapraxis (in Greek) is an

error in speech, memory, or physical action that occurs
due to the interference of an unconscious subdued wish
or internal train of thought.

• Classical examples involve slip of the tongue, but

psychoanalytic theory also embraces misreadings,
mishearings, mistypings, temporary forgettings & the
mislaying & losing of objects.
 Examples
• She: 'What would you like—bread & butter, or cake?' He:
'Bed and butter.‘

In the above, the man may be presumed to have a sexual feeling or

intention that he wished to leave unexpressed, not a sexual feeling or
intention that was dynamically repressed. His sexual intention was
therefore secret, rather than subconscious, & any 'parapraxis' would
inhere in the idea that he unconsciously wished to express that
intention, rather than in the sexual connotation of the substitution.
• During a Vatican sermon in 2014, Pope Francis accidentally used
the Italian word cazzo (which translates to "F***) instead of
"caso" (which means "example"). The Pope quickly corrected
himself, but not before the slip posted on dozens of websites, blogs,
and YouTube videos.

• During a televised speech on education, Senator Ted Kennedy

meant to say that "Our national interest ought to be to encourage
the best & brightest." Instead, Kennedy accidentally said breast - his
hands even cupping the air as he said the word. While he quickly
corrected his gaffe & continued, the slip of the tongue seemed
revealing considering his hand gestures & the family's reputation for
womanizing.

• At a Washington D.C. dinner party, Condoleezza Rice, then National

Security Advisor to President Bush stated, “As I was telling my husb
—as I was telling President Bush.” The Freudian slip seemed to
reveal perhaps some hidden feelings the unmarried Rice might hold
toward her boss.
 Free Association Activity
▫ Write 5 minutes whatever come to your mind for the
following topic
1. Free association about your dream OR
2. Pick up an animal (e.g., Bird) and then write any
thoughts in you mind

▫ Any themes?
Different Functions of Free Association
 THE DEVELOPMENT OF TRANSFERENCE
• The development & analysis of transference constitute an important
therapeutic phase.

• Transference analysis refers to “the systematic analysis of the

transference implications of the patient’s total verbal & nonverbal
manifestations in the hours as well as the patient’s direct & implicit
communicative efforts to influence the analyst in a certain
direction” (Kernberg, 2016).

• The client's feelings for the therapist, who has become a significant
figure in the client's life, are used to demonstrate how the client
perceives, interprets, & responds to the present in the same ways he
or she responded to significant persons in the past.
 Types of Transference
• Paternal Transference: 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
 Signs of Transference
• Client frequently asks you personal questions
• Client calls you at home (despite stated policies)
• Calls at irregular intervals
• Client is overly complimentary of your work
• Client keep bargaining for reduce fee rate
• Client develops a “crush” on you
• Is overly attached
• Client brings you a gift
• Client requests you to accommodate his schedule by changing your
own schedule
• Concomitant to the analysis of transference, the therapist
must be aware of the possibility of countertransference:

The therapist's unresolved feelings for significant others may

be transferred to the client.

• Any counter transferences must be analyzed & worked

through.
Signs of countertransference include:

• impatience with the length of a session or resentment at having to

terminate it
• doing special out-of-the-ordinary things for selected patients
• dreaming about a patient
• making opportunities to socialize with the patient / desiring a social
relationship with the client
• sexual fantasies about the patient
• unexplained anger at the patient
• boredom with the patient
• impulses to act out with the patient
• Rejecting a client
• refusal to terminate when planned goals have been achieved
• Being over protective with the client
• Needing constant reinforcement & approval
• Give advice compulsively
In order to become sensitized to one’s own neurotic manifestations
when they appear, all therapists should subject themselves to self-
examination throughout the course of therapy. Such questions as the
following are appropriate:

1. How do I feel about the patient?

2. Do I anticipate seeing the patient?
3. Do I overidentify with, or feel sorry for the patient?
4. Do I feel any resentment or jealousy toward the patient?
5. Do I get extreme pleasure out of seeing the patient?
6. Do I feel bored with the patient?
7. Am I fearful of the patient?
8. Do I want to protect, reject, or punish the patient?
9. Am I impressed by the patient?
The therapist may ask why such attitudes & feelings exist.

• Is the patient doing anything to stir up such feelings?

• Does the patient resemble anybody the therapist knows or has

known, & if so, are any attitudes being transferred to the patient
that are related to another person?

• What other impulses are being mobilized in the therapist that

account for these feelings?
 THE RESOLUTION OF TRANSFERENCE &
COUNTERTRANSFERENCE
• When the client & the therapist believe that the client's
major conflicts have been worked through, a date is set
for termination of the therapy.

• The purpose of this phase is to resolve the client's

neurotic attachment to the therapist.
• Countertransference may result in therapeutic failure, it must
be handled as soon as possible.

• Where recognized, the therapist may be able to exercise some

control over it.

• A therapist who has undergone successful personal psychotherapy

or psychoanalysis will still be subject to countertransference from
time to time.

• Nevertheless, one should, by virtue of one’s training, be capable of

detecting & of managing troublesome reactions as soon as they
develop.

• One way of acquiring this skill is to examine oneself honestly rather

than defensively when attacked or criticized by a patient.
 Psychotherapy Resistance
• Resistance in psychotherapy involves a client's unwillingness to
change & grow within therapy.

• There are countless reasons why clients can be resistant within a

therapeutic relationship.

• People of all cultures, natures & personalities visit psychologists, each

with their own reasons for entering therapy. Some people may be
ordered or referred by a third party to enter therapy. Since they are not
there of their own will, these clients are often reluctant to be there &
can show very obvious resistance to the process.

• Resistance of any kind coming from free association, gets into the way
of progress.
 Examples of Resistance
Resistance can take many forms in psychotherapy & affect a client's behavior
in many ways.

The following is a list of some forms of resistance which a client may use to
keep from dealing with certain topics with their therapist.

• Silence or minimal discussion with the therapist

• Wordiness or verbosity
• 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
 Analysis of Resistance
As soon as the therapist realizes that resistance is interfering
with therapy, it is necessary to concentrate on the resistance to
the exclusion of all other tasks. This may be done in a number
of ways.

• Therapist must avoid being judgmental, instead allow him to

address what makes him anxious

• Therapist must make client understand of their own

thought, feelings & actions

• Helps the client to see that canceling appointments, fleeing

from therapy prematurely etc. are ways of defending against
anxiety
Identifying the Resistance & Exploring Its
Manifestations

• Calling the patient’s attention to the resistance itself &

exploring its manifestations are essential procedures.

Pointing Out Possible Reasons for the Resistance

• Where patients are cognizant of their resistance but do
not recognize its purpose, the therapist should point out
various possibilities for the resistance.

• The patients may be shown that their resistance protects

them against the threat of change. Thus, a patient
hesitates repeatedly during a session; the periods of
silence are not broken by the usual interview techniques.
Reassuring Tactics
• Reassuring the patient in a tangential way about that
which is being resisted necessitates an understanding by
the therapist of the warded-off aspects.

• For instance, a woman with an obsessional neurosis comes

into a session with symptoms of exacerbated anxiety. She
has no desire to talk about anything but her suffering.

• This seems to me a sign of resistance. When I inquired

about dreams that she may have had, the patient reveals
one that, in a disguised way, indicates murderous attitudes
toward her offspring. The idea occurs to me that she is
attempting to suppress & repress thoughts about her
children.
Focusing on Material Being Resisted

• Bringing the patient’s attention to the material against

which the resistance is being directed must be done in a
very diplomatic way, preferably by helping the patients
to make their own interpretation or by a tentative
interpretation.