INSIGHT THERAPIES

• We begin our discussion of professional psychotherapy with

traditional psychoanalysis and its modern counterpart,
psychodynamic therapy.
• Then we explore cognitive, humanistic, group, and family therapies.
• Although these therapies differ significantly, they’re often grouped
together as insight therapies because they seek to increase insight
into clients’ difficulties.
• The general goal is to help people gain greater control over and
improvement in their thoughts,feelings, and behaviors.
How can gaining insight into one’s
unconscious change behavior?
• How can gaining insight into one’s unconscious change behavior?

• Freud explained that becoming aware of previously hidden conflicts

permits a release of tension and anxiety called catharsis.

• He observed that when his patients relived a traumatic incident, the

conflict seemed to lose its power to control the person’s behavior.
PSYCHOANALYTIC TECHNIQUES
• Traditional versus modern psychoanalytic therapy
• Traditional psychoanalytic therapy
• Typically referred to as ‘psychoanalysis’
• Therapist is the expert analysing a patient to treat neurosis
• Modern psychoanalytic therapy
• Not often referred to as psychoanalysis, but instead described as
‘psychodynamic therapy’ or a more specific term (Kleinian, Freudian,
brief psychodynamic, etc.)
• Therapist is working collaboratively with the client to solve problems
MODERN PSYCHOANALYSIS
• Modern psychoanalysis, often referred to as psychodynamic therapy, or
short-term dynamic therapy, is evident in many different forms.
• Such therapies are consistent with the views of Freud and the
psychoanalytic approach.
• These newer therapy approaches continue to rely on the therapist’s
interpretations of the client’s feelings and behavior,and identifying
instances of transference and resistance.
• However, these therapies tend to focus less on the client’s past than
traditional psychoanalysis does.
• Current problems and the nature of interpersonal relationships are seen as
more important in improving the client’s behavior.
Modern psychodynamic therapy
• In Modern psychodynamic therapy, treatment is briefer, the patient
is treated face to face (rather than reclining on a couch), and the
therapist takes a more directive approach (rather than waiting for
unconscious memories and desires to slowly be uncovered).
• Also, contemporary psychodynamic therapists focus less on
unconscious, early childhood roots of problems and more on
conscious processes and current problems.
• Such refinements have helped make psychoanalysis more available
and more effective for an increasing number of people (Knekt et al.,
2008; Lehto et al., 2008; Lerner, 2008)
• Freud’s method of treatment is called psychoanalysis.
• From the time his theory and method became known and used by
others (starting from about 1900) his ideas have been continually
modified and developed by other writers on and practitioners of
psychoanalysis.
The main distinctive features of the
psychodynamic approach are:
1) An assumption that the client’s difficulties
have their ultimate origins in childhood
experiences.

2 )An assumption that the client may not be

consciously aware of the true motives or
impulses behind his or her actions.

3) The use in counselling and therapy of

interpretation of the transference relationship.
Transference and the nature of the therapeutic
relationship
• Transference is a term which – in psychodynamic literature – refers to
the client’s emotional response to the counsellor.
• Clients’ emotional responses are, of course, highlighted in all the
theoretical approaches, but the concept of transference is especially
significant in the psychodynamic model.
• Freud was the first person to identify the phenomenon; while working
with his colleague Breuer he witnessed it at first hand and later
described it both in lectures and in his writing (Freud, 1909).
TRANSFERENCE
• During psychoanalysis, patients disclose intimate feelings and
memories, and the relationship between the therapist and patient
may become complex and emotionally charged.
• As a result,patients often apply (or transfer) some of their unresolved
emotions and attitudes from past relationships onto the therapist.

• The therapist uses this process of transference to help the patient

“relive” painful past relationships in a safe, therapeutic setting so that
he or she can move on to healthier relationships.
• Transference is the process by which client expresses strong emotions toward the
therapist because the therapist substitutes for someone important in the client's
life, such as the client’s mother or father.
• Freud believed that the main part of therapy involved working through the
transference—that is, resolving the emotional feelings that the client has
transferred to the therapist.
• Freud said that if the feelings involved in transference were not worked out,
therapy would stall and treatment would not occur.
• For this reason, Freud believed that one of the major roles of the analyst was to
help the client deal with, work through, and resolve the transferred feelings.
Identifying the process of transference, which occurs in many therapee-tic
relationships, is considered one of Freud’s greatest insights (Eagle,
TRANSFERENCE
• Clients may ‘transfer’ to counsellors feelings which are either positive or
negative.
• These feelings stem from childhood emotional responses to parents, and
are therefore not based on any real relation between counsellor and
client. Transference feelings operate at an unconscious level, so the client
is unaware that responses to the counsellor may be in appropriate or out
of date.
• Evidence of the client’s early emotional life is, therefore, often clearly
seen in the counselling relationship. This has obvious advantages for the
client, since (with help) he will be able to identify the cause of some of
his current difficulties. The following case study illustrates this last point.
CASE STUDY TRANSFERENCE
• A twenty-six-year-old client became angry because his counsellor had
gone into hospital for a minor operation.
• The client (Colin) had been told in advance that the counsellor would be
away for a week, but this notice did little to reassure him.
• During a subsequent counselling session he discussed his reaction with
the counsellor. At first he was puzzled by the strength of his own
reaction, but he later identified some earlier experiences which had
some bearing on his heightened emotional response to the counsellor’s
absence.
• Colin’s parents had divorced when he was five years old, and shortly
afterwards his father had been ill with allergy problems.
CASE STUDY TRANSFERENCE
• No one had taken time to talk to the small child, nor had he been taken to
visit his father in hospital.
• One consequence of this was that, for many years, Colin blamed himself for
his father’s illness and departure.
• Once he was able to explore all these issues, Colin understood why he
became angry and frustrated when the counsellor left to go into hospital.
• The feelings which he had transferred to the counsellor were really feelings
stemming from the past and his relationship with his parents.
• In exploring them, however, he was able to look more realistically at his
childhood experience of loss and at the burden of blame he had carried for
so many years.
TRANSFERENCE
• The process of transference also is a clue to a client’s unconscious conflicts.
• Freud(1949) believed that at some point during therapy, clients would
unconsciously react to the therapist as if the therapist was his or her parent,
friend, sibling, or lover.
• Freud termed this unconscious reaction transference because the client was
unknowingly transferring feelings and emotions toward a loved one onto the
therapist.
• Transference is a form of projection. Recall that projection is an ego defense
mechanism in which a person attributes feelings and emotions to one person that
they really feel toward another.
• The psychoanalyst can explore such instances of transference to reveal how the
dynamics of clients’ relationships may be influencing their behavior.
TRANSFERENCE
• A key phenomenon in psychoanalytic therapy, as we have seen, is
transference.
• To some degree, transference is operative in most individual forms of
verbal psychotherapy.
• It occurs when the patient reacts to the therapist as if the latter
represented some important figure out of childhood.
• Both positive and negative feelings can be transferred.
• In short, conflicts and problems that originated in childhood are
reinstated in the therapy room.
• This provides not only important clues as to the nature of the
patient’s problems but also an opportunity for the therapist to
interpret the transference in an immediate and vital situation.
• Many characteristics of the psychoanalytic session—the patient is
seated on a couch facing away from the analyst, the analyst does not
give advice or reveal personal information—serve to encourage the
establishment of transference.
Positive transference
• Positive transference is often responsible for what appears to be
rapid improvement at the beginning stages of therapy.
• Being in a safe, secure relationship with a knowledgeable authority
can produce rapid but superficial improvement.
• Later, as the patient’s defenses are challenged, this improvement is
likely to fade, and marked negative transference may intrude.
Free Association
• Free Association:Tell Me What’s on Your Mind Free association involves
freely talking about a subject with- out censoring any thoughts.
• The client is fully awake and is asked to talk about a specific topic. Any
and all thoughts are stated. The client says whatever comes to his or her
mind.
• According to Freud (1949), we routinely censor or hide unpleasant or
socially inappropriate desires and thoughts.
• Through free association, these unconscious urges are revealed. The
psychoanalyst makes very few comments during free association, instead
focusing on important themes or issues that may be revealed.
• Freud encouraged patients to relax, sit back, or lie down on his now-
famous couch and engage in something called
• free association.Free association is a technique that encourages
clients to talk about any thoughts or images that enter their heads;
the assumption is that this kind of free-flowing, uncensored
talkingwill provide clues to unconscious material.
Dream Analysis
• Dream Analysis:
• Revealing the Unconscious As we saw in Chapter 4 (p. 168), Freud (1911) believed
that dreams represented a path way to the unconscious mind.
• Therefore, dream analysis is a tool used by some psychoanalysts to reveal
unconscious conflicts (Pesant & Zadra, 2004).
• Recall as well that dreams do not directly represent unconscious conflicts but
rather are comprised of symbols that reflect these underlying unconscious
impulses.
• It is the psychoanalyst’s job to decipher the true meaning or latent content of
these dreams and thereby reveal important unconscious issues.
• Recall that one of Emily’s therapists was very much interested in the content of her
dreams and would attempt to find the themes embedded within them.
Dream Analysis
• Freud listened to and interpreted his patients’ dreams because he
believed that dreams represent the purest form of free association.
• Dream interpretation is a psychoanalytic technique based on the
assumption that dreams contain underlying, hidden meanings and
symbols that provide clues to unconscious thoughts and desires.
• For example, here is one of the best-known dreams in psychoanalytic
literature. !is dream was told to Freud by a 23-year-old patient who
was later named Wolf-Man because he had a phobia of wolves and
other animals (P. Buckley, 1989).
Interpretation
• Interpretation:“I Believe That Means . . .”
• Free association and dream content provide the psychoanalyst with a
lot of informationon the unconscious workings of the client’s mind.
The psychoanalyst takes this information and makes interpretations to
the client. Interpretations are the psychoanalyst’s views on the
themes and issues that may be influencing the client’s behavior. These
interpretations may help the client gain insight into his or her
problems. On the other hand, if the client is not psychologically ready
to deal with these issues, he or she may resist these interpretations.
Resistance
• Resistance occurs when a client behaves in such a way as to deny or avoid certain
topics or issues.
• A client may resist a psychoanalyst’s interpretation because it is too close to the
truth and therefore creates anxiety in the client. Clients may express resistance in
other ways as well.
• For example, clients may miss appointments or arrive late as away of resisting the
revealing nature of the therapy session.
• Clients may laugh or joke about certain topics that are actually quite painful for
them. These resistant behaviors provide an additional clue to the psychoanalyst
as to the unconscious conflicts affecting the client.
• A psychoanalyst may have interpreted Emily’s continued silence in her initial
therapy sessions as a form of resistance.
Resistance
• For most patients, working out transference and achieving insight into
their problems are long and difficult processes.
• One reason for the difficulty is that the client has so many defenses
against admitting repressed thoughts and feelings into
consciousness. !ese defenses lead to resistance.
• Resistance is characterized by the client’s reluctance to work through
or deal with feelings or to recognize un-conscious conflicts and
repressed thoughts.
• Resistance may show up in many ways:
• Clients may cancel sessions or come late, argue continually, criticize
the analyst, or develop physical problems.
• For example, the patient named X constantly complained of severe
constipation.
• Freud said that Wolf-Man used constipation as an obvious sign that
he was resisting having to deal with his feelings.