Lecture 5: Psychoanalytic therapy

Question 1

What are the basic principles of psychoanalytic therapy?

Answer 1

1. All human beings are partially motivated by unconscious desires
2. There is an interest in making the individual aware of their unconscious which helps increase choice
3. There is an emphasis on exploring the ways people avoid painful and threatening feelings, fantasies, and thoughts
4. Changing oneself is encountered with ambivalence
5. The therapeutic relationship is an arena for exploring clients’ self-defeating psychological processes and actions
6. The therapeutic relationship is an important vehicle of change
7. There is an emphasis on helping clients understand how their perception of past and present perpetuates self-defeating patterns

Question 2

What does the unconscious consist of?

Answer 2

• area of functioning where certain impulses, wishes and memories outside of awareness. But some ignore the ego as a mediator and actions are compromises between underlying desires and fear of consequences of the desire

Question 3

What is fantasy in the context of psychoanalytic therapy?

Answer 3

Fantasies can regulate self esteem and affect, and the need for safety and mastering trauma

Question 4

What is the role of primary and secondary processes?

Answer 4

Primary processes are a primitive form of psychic functioning, no distinction between timeframes, feelings and experiences. Primary process in dreams and fantasy
Secondary process is linked to consciousness-> more logical and sequential

Question 5

What is the role of defences?

Answer 5

These avoid emotional pain by pushing thoughts, wishes, feelings, fantasies out of awareness like: intelluctionalization (talking about threats but with emotional distance), projection (attributing a threatening feeling or motive to another), reaction formation (deny a threatening feeling but claiming to feel the opposite), splitting (unable to integrate ambivalent feelings into 2 separate representations)

Question 6

Transference

Answer 6

Transferring a template of a significant figure from childhood to another person. Initially seen as impediment but seen as crucial later

Question 7

How has psychanalysis shifted?

Answer 7

From one-person psychology (objective and neutral observer) to two person psychology ( cooperation between therapist and client to deeper understanding)

Question 8

Other systems of psychoanalysis

Answer 8

First system of psychotherapy and extends to social theory and cultural critique. Stemmed from intensive formal training and socially conservative view, viewed critically due to: increasing biology, rise of CBT, arrogance of psychoanalysts, ignoring criticism. Biases like intolerance of ambiguity and instrumental utility marginalize them

Question 9

How has psychoanalysis developed?

Answer 9

• Started due to Charcot’s work on hypnosis and hysteria (due to splitting of consciousness). Talking about painful experiences to help Breuer and her symptoms of hysteria
• development of free association, counterindoctrination through confronting people with uncomfortable truths, seduction theory (sexual trauma underlies psychological problems), constructive view of memory, influences of libido
• Jung’s word association tests to assess response-time latencies and the delay was due to emotional complexes
• tension between Freud and Jung over theoretical differences

Question 10

Pleasure principle

Answer 10

Libido can be activated by internal or external stimuli, which creates a state of tension and energy might need to be discharged. Repeating experiences can induce tension reduction (as part of drive theory)

Question 11

Development of structural theory and ego

Answer 11

Id, ego and superego. This can be harsh and demanding which can lead to self-destructive feelings of guilt and rejection

Question 12

Object relations theory

Answer 12

Developed by British Independents/ Middle group which did not align with Freud so emphasised more flexibility and spontaneity. It focusses on how people develop internal representations of relationships with others

Question 13

Technical guidelines from Freud

Answer 13

1. Therapists should maintain anonymity to function as a blank screen for uncontaminated transference
2. Therapists should remain neutral so their biases would not influence the client
3. Therapists should avoid gratifying the client’s immediate wishes, as these are results of unconscious wishes and fantasies

Question 14

What is the current status of psychoanalysis?

Answer 14

• classical psychoanalysis also ego psychology (psychosexual model, Freud’s drive theory, transference)
• modern conflict theory is conflict between unconscious wishes and defenses against them is the human experience
• Lacanian theory is that ego and sense of self is an illusion from misidentifying ourselves with other’s desires. To found our true self there is a lack which is our subjective experience without language
  -interpersonal psychoanalysis is that human relatedness motivates people so understanding needed for therapeutic relationship-> relational psychoanalysis rejected Freud’s drive theory
• Kohut looks at processes in cohesive sense of self, vitality and self-esteem

Question 15

Conflict theory

Answer 15

Argues that intrapsychic conflict and the compromise from wishes and styles of defence to contribute to different personalities like intellectualization to hide threatening emotions, phobic personality to displace intrapsychic conflict to external objects, hysterical personality desires emotional intimacy against emotionality and seductiveness

Question 16

Internalization

Answer 16

Process of establishing internal objects but can varies

Question 17

Attachment theory

Answer 17

instinctive need to stay to attachment figures, can develop representations of actions to allow them to stay close in comparison to actions that do not help survival through internal working models. This theory stems from interactions, but object relations theory is a combination of experiences and unconscious wishes and fantasies

Question 18

What does Klein argue?

Answer 18

Instinctual passions of love and aggression related to unconscious fantasies about relationships. Projective identification is that infants can’t tolerate own aggression and stems from others. Splitting develops and then more emotional maturity

Question 19

What does Fairbairn argue?

Answer 19

Internal objects form when individual withdraws from external reality due to an unavailable, frustrating, traumatizing caregiver. Fantasized relationships become part of sense of self, and can project old relationships onto others

Question 20

Developmental arrest models

Answer 20

Psychological problems arise due to caregivers failure to provide an optimal envionment, can lead to developing false sense of self. Optimal disillusionment is frustrating the omnipotence so no problems arise and infant accepts the change. Goal is to mimic this relationship in therapy to make this change

Question 21

Difference between psychoanalysis and psychodynamic psychotherapy

Answer 21

Psychoanalysis: long-term, intensive, open-ended, Freud’s guidelines
Psychodynamic: short-term, less intensive, pre-planned

Question 22

Therapeutic alliance

Answer 22

Distinguish between distorted aspects due to transference and the actual alliance based on rational and undistorted thinking. Strength depends on tasks and goals. Therapeutic bond is degree of trust in therapist

Question 23

Countertransference

Answer 23

Therapist’s feelings and reactions to the client’s transference stemming from unresolved conflicts, as based on Freud’s ideas. Today, countertransference is seen as all the reactions the therapist shows to the client. This can be seen as a useful source of information for the therapist

Question 24

Resistance

Answer 24

Resists change or undermine, seen as main way for defenses to show themselves. Client should not be blamed for not cooperating, should be seen as intrinsic part of psychic functioning

Question 25

Intersubjectivity

Answer 25

The ability to see your experiences and another’s experiences as subjective. Client’s and therapist’s interactions for an analytic dyad which constructs meaning in experiences and show the flexibility of human relationships.

Question 26

Enactments

Answer 26

relational scenarios where client and therapist end up playing complementary roles, schemas play a role in this. Collaboration allows for exploring of schemas. Unable not to enact due to nonverbal influences and lack of transparency

Question 27

What is the process of psychotherapy?

Answer 27

• empathy
• interpretations to bring to surface intrapsychic experiences and unconscious relational patterns-> categorized by accuracy and usefulness, timing, depth, empathic quality
  -giving advice can influence the client or contribute to transparency
• well-timed termination can lead to gains for the client and needs to be decided cooperatively and gradually over a few sessions

Question 28

What are the mechanisms of psychotherapy?

Answer 28

• making the unconscious conscious
• conceptual revelation to affective to improve daily functioning (emotional insight)
• creating meaning through a culturally normative explanation based on symptoms and pain experienced-> maladaptive behaviours in certain contexts
• reduced personal agency by not seeing roles and contributions to conflict patterns, so experiencing agency important here
• containment is learning how to tolerate and process painful feelings without becoming defensive. usually was projected to parents as a child
• interactive disruption and repair arises from relational knowing that both parties repair disruptions and seen as an important element of change

Question 29

Who can we help?

Answer 29

Not those who have little capacity for self-reflection, too disorganized or disturbed or for those who do not have guidance and structure, those without interest, time, financial or psychological resources. Most effective for neurotic clients, with high ego and cohesiveness and capacity for self-reflection

Question 30

What has evidence found regarding psychoanalytic therapy?

Answer 30

• found to be equally effective to CBT
• In complex personality disorders, comorbid disorders, or chronic disorders, long-term psychodynamic therapy was shown to be more effective than short-term approaches
• substantial effect sides for efficacy or short-term dynamic psychotherapy and can increase at long-term

Question 31

Psychotherapy in a multicultural world

Answer 31

Developed for Western Europeans suffering from neurosis, but open to all cultures and unconscious biases and stereotypes can shape daily interactions. Some cultures may not encourage self-reflection. Careful about disowning experiences and qualities in themselves and devalue clients-> interventions to overcome this