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Psychoanalytic Therapy

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Title: Psychoanalytic Therapy


1
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.

10
Psychoanalytic Theory
  • Human Nature (Freud)
  • Life instincts
  • Survival
  • Gain pleasure
  • Avoid pain
  • Death instincts
  • Aggressive drive
  • Unconscious desire to hurt self or others

11
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

13
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

14
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

16
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

17
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

19
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.

29
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.

30
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?
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