Counseling and Psychotherapy

Theory and Practice

Chapter 4
Psychoanalytic Therapy

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Objectives
• At the end of the session, you will be able to
answer the following questions:
• What are the key concepts of the Psychoanalytic
Therapy?
• What is the Therapeutic Process?
• What are the Therapeutic Techniques and Procedures?
• What is the evaluation of Psychoanalytic Therapy?

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Counseling
Conceptualization

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Key Concepts
The Freudian View Behavior is
determined by
of human nature is biological and
deterministic. instinctual drives.

Drives evolve through Libido/ life instincts

psychosexual stages motivate behavior for
early in life. survival and growth.

Thanatos/ death
2020 © Department of Psychology, Kidapawan Doctors College, Inc.
 Psychoanalytic Theoretical Principles

•Psychological experience is a product of the

Dynamic energy fluctuations between the Eros and
the Thanatos
Approach •Counseling is an examination of the origin,
aim, object, and intensity of the drives

Topograph •Psychological experience is the transaction

between the conscious and unconscious
ic •Counseling aims to bring the contents of
the unconscious to consciousness
Approach
2020 © Department of Psychology, Kidapawan Doctors College, Inc.
 Psychoanalytic Theoretical Principles

Developm •Psychological experience is a product of

quality of experience in a particular
ental psychosexual stage
•Counseling is the exploration of what the
Approach psychosexual experience is like and its effects

•Psychological experience is a product of the

Structural transactions between the id, ego and
superego
Approach •Counseling is the exploration of the influence
of the three structures on total personality

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Dynamic, Topographic, and Structural
Concepts

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Origins of Psychopathology

Psychopatholog Early childhood

experience (ECE) is
y exists in a the origin of
continuum. psychopathology.

Psychopathological ECE Repetitive and

are not completely dissatisfying patterns
understood, recalled, and exist in relationships
dealt with consciously. from past to present.

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Anxiety
Anxiety

• It is a feeling of dread that results from repressed feelings, memories, desires, and experiences that emerge to
the surface of awareness

Reality Anxiety

• Fear of danger from the external world

• Level is proportionate to the degree of the real threat

Neurotic Anxiety

• Fear that the instincts will go out of hand and cause one to do something that is punishable

Moral Anxiety

• Fear of one’s own conscience; fear of being violating one’s own sense of correctness

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Defense Mechanisms
Defense Mechanisms

• These are behaviors that help the individual cope with anxiety an prevent the ego from being overwhelmed

Repression

• Forgetting an emotionally painful memory

• Involuntary removal of something from consciousness

Denial

• Expressed with more force than repression

• Refusing to recognize the reality of something

Reaction Formation

• Expressing the inverse or opposite of an unacceptable impulse or drive

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Defense Mechanisms
Projection

• Attributing to others one’s unacceptable desires and impulse

Displacement

• Directing energy toward another object or person when the original object or person is inaccessible

Rationalization

• Manufacturing “good” reasons to explain away a bruised ego

Sublimation

• Diverting sexual or aggressive energy into another channel

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Defense Mechanisms
Regression

• Going back to an earlier phase of development when these were fewer demands

Introjection

• Taking in and “swallowing” the values and standards of others

Identification

• Identifying with successful causes, organizations, or people in the hope that you will be perceived as worthwhile

Compensation

• Masking perceived weakness or developing certain positive traits to make up for limitations

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Psychosexual Development

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Counseling Process

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Therapeutic Goals
• To make the unconscious conscious or increase
client awareness
• To help the client develop greater ego-control or
self-control over unhealthy or maladaptive impulses
• To help the client dispose of maladaptive or
unhealthy internalized objects and replace them
with more adaptive internalized objects
• To repair self-defects through mirroring, presenting
potentially idealized object, and expressing empathy
during optimal therapeutic failures

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Therapeutic Basic Rules
• “Say whatever comes to mind” – facilitate the
emergence of unconscious impulses and conflicts
• Optimal conditions for analysis:
• All external stimuli are minimized [blank-screen
approach]
• The analysand’s internal stimuli are minimized
• Cognitive selection or conscious planning is reduced

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Therapist Function and Role
• Use the “blank-screen” approach [therapeutic
anonymity and neutrality]
• Everything that the analysand sees in the analyst is
a mirror reflection of what is in the unconscious
[transference relationship]
• Analyst interprets the client’s narrative using the
frameworks of psychoanalysis
• Analyst educates the client about the insights using
psychoanalytic concepts

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Client’s Experience
• Must be willing to commit to an intensive and long-
term process
• Willing to engage in free association – they say
whatever comes to mind without self-censorship
• Analyst creates a non-judgmental, safe
environment where everything could be talked
about

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Analyst-Analysand
Relationship
• Classical analyst vs relational analyst
• Transference: the client’s unconscious shifting to
the analyst of feelings and fantasies that are
reactions to significant others in the client’s part
• Working-through: the process which consists of
repetitive and elaborate exploration of unconscious
material from childhood
• Countertransference: when the therapist responds
to the client transference based on his/her own
unconscious conflicts or dynamics

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Dealing with Countertransference

• Effective therapists prevent acting out and are

aware of and manage their countertransference in
a way that benefits the therapeutic work
• The ability of therapists to gain self-understanding
and to establish appropriate boundaries with
clients are fundamental
• Personal therapy and clinical supervisor for
therapists would be most helpful in gaining
understanding of their own complexes

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Interpretation: the Key Technique

• The technique involves looking at the material that

the client brings to the counseling from the
perspective of dynamic, topographic,
developmental, or structural approaches
• Offering different perspectives to the client about
the motivation of his/her behavior to foster insight
about self

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Preparing for an Interpretation

• Developing a therapeutic alliance: the analysand must

trust the analyst enough to lower down their self-
censor and to accept any offered interpretation
• Role induction: the analyst must be clearly informed
about what the psychoanalysis entails
• “Sa atong counseling, naay mga panahon nga makakita ko
ug pattern sa imung ginashare. Pwede nga kani nga
pattern naay connection sa imung naagian tong bata pa ka
o sa atong counseling relationship. Okay ra ba nga sultian
taka usahay kung naa koy manotice nga pattern aron mas
pwede nato ni mahisgutan ug mas masabtan unsay epekto
ani sa imung kinabuhi karon.”

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Preparing for an Interpretation

• Timing: if the interpretation is delivered before the

client is ready, there might be resistant. If the
interpretation is delivered late, then it might be
confusing.
• Watch out when the client is just a step away from
becoming aware of something new
• Wait for the client to show positive regard for you
• Wait until you can say the interpretation clearly and
articulately
• Wait until you have enough data to support your
interpretation

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 What to Interpret?

• The Triangles of Insight: using the different

approaches, the interpretation could be delivered
using the triangle of insight format

Wish/ Aim Observations

Conflict- Transference-
based based insight
Insight

Threat Defensive Contemporary Childhood

Compromise Relationship relationship

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Conflict-based Insight

• Clients wish, aim, drive vs imagined or real threat

that might result = defensive compromise
• Wish: she wants to be angry with her father who
raped her for the betrayal of her trust
• Threat: she can’t express anger-hate because the
father provides for her and a part of her loves him
• Defensive compromise:
• Repression of the memory of the rape
• Reaction formation of excessive love and attachment to
the father

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Conflict-based Insight

• Clients wish, aim, drive vs imagined or real threat that

might result = defensive compromise
• Wish: she wants to be angry with her father who raped
her for the betrayal of her trust
• Threat: she can’t express anger-hate because the father
provides for her and a part of her loves him
• Defensive compromise:
• Repression of the memory of the rape
• Reaction formation of excessive love and attachment to the
father
• Psychological consequence: anxiety and depression

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Transference-based Insight

• [A] Observed relationship patterns + [B] early

childhood relationship = [C] effect on current
relationship
• [A] Usahay mabantayan nako nga maglisod ka ug open-
up sa imung mga gibati diri sa atong counseling. [B]
Makadumdum ko sa gi-share nimu sa una nga ang imung
mama kanunay mangasaba sa imu nga ang mature nga
tao kabalo mutago sa iyang mga gibati. [C] Paminaw
nako murag naay connection ang naagian nimung
batasan sa imung mama ug sa kung unsa ka diri sa atong
counseling.”

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Other Techniques in Psychoanalysis

• Maintaining an analytical framework: thinking that

what the client says could be different from what their
unconscious means
• Free Association
• “Kani nga technique ginatawag nga free association. Sama
sa akong ingon, parte sa atong psychoanalysis counseling
ang maghisgut sa kung unsa man ang naa sa imung huna-
huna. Samtang nagapaminaw ko, atong tan-awon kung naa
ba tay makuha nga insight sa kung nganu ing-ani ka karon.
Sa pagsugod nato, tagaan taka ug time nga magsulti bisan
unsa pa ang musulod sa imu huna-huna. Kung pwede, dili
nimu pugngan basta istorya lang nimu sa ako.”

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Other Techniques in Psychoanalysis

• Analysis of resistance: resistant is anything that

works against the progress of therapy and prevents
the client from producing previously unconscious
material
• The Royal Roads to the unconscious: dreams and
parapraxes/ Freudian slips
• Dreams: latent content vs manifest content
• Parapraxes: unintentional utterances that give cue about
impulses

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 Jungian Psychoanalysis

• Therapeutic Goal is achieving Individuation:

awareness and harmonious integration of the
conscious and unconscious aspects of personality,
the yin and yang, the dark and the light.
• Exploration of the archetypal material in dreams
• Prospective dreams: they help us prepare for the
experiences and events they anticipate in the near
future
• Compensatory dreams: they try to balance the opposite
experience

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 Limitations and Criticisms

• Empirical evidence is not as robust as other

therapies
• It is mostly long-term, expensive, and trained
psychoanalysts are few
• Therapists might come off as distant, withdrawn,
and cold
• Psychoanalysis has been accused of being
misogynistic and biased against women

2020 © Department of Psychology, Kidapawan Doctors College, Inc.

 “The aim of psychoanalysis is to
relieve people of their neurotic
unhappiness so that they can be
normally unhappy.”

Sigmund Freud

2020 © Department of Psychology, Kidapawan Doctors College, Inc.