L.5 - The (non)sense of psychoanalysis Flashcards
(67 cards)
1
Q
is there still sense in doing psychoanalysys?
+ objectives of the lecture
A
> there is a lot of nonsense in psychoanalysis, but there is still a lot that we can learn from it
- what is it?
- why does it matter?
- how to listen with a psychoanalytic ear?
- (how) does it work?
- how to understand psychoanalytic theory?
2
Q
What is it (not)?
A
- attempt to create a sphere where the unconscious can be brought to speak and can be listened to
- basic assumption: there is an unconscious (psychoanalytic theory of the unconscious)
- this hypothesis drives all psychoanalyses
- this unconscious tells us something (e.g. throught dreams, jokes, free associations, …)
3
Q
what are the basic principles across different psychoanalytic perspectives?
A
- assumption that all human beings are motivated in part by wishes, fantasies or tacit knowledge that is outside of awareness (unconscious motivation)
- interest in facilitating awareness of unconscious motivations, thereby increasing choice
- an emphasis on exploring tha ways in which we avoid painful or threateming feelings, fantasies and thoughts
- an assumption that we are ambivalent about changing and an emphasis on the importance of exploring this ambivalence
- an emphasis on using the therapeutic relationship as an arena for exploring clients’ self-defeating psychological processes and actions (both conscious and unconscious);
- an emphasis on using the therapeutic relationship as an important vehicle of change
- an emphasis on helping clients to understand the way in which their own construction of their past and present plays a role in perpetuating their self-defeating patterns
4
Q
what do we need for psychoanalysis?
- Analysand
A
- Analysand: someone who is somehow disturbed and puzzled by themselves. They are responsible for showing up and trying to say everything that comes to mind
> at some point the client starts being more honest, but they have to keep showing up
5
Q
what do we need for psychoanalysis?
- Assumption
A
- assumption: something disturbs our normal speaking and our self-constructions (= the unconscious)
> this (the unconscious) is important
> e.g. slip of the tongue shows true intentions
> e.g. when going to therapy I am always late, while usually I am punctual. This might indicate that there is an underlying reason not to want to go to therapy - the unconscious is something unknown, and in psychoanalysis the client speculates as to what it might be
> the psychoanalysis does not know what the unconscious is, they just help the clients find the meaning behind it
> most times neither know what it is, it is just a work in progress to find it
6
Q
what do we need for psychoanalysis?
- Analyst
A
- Analyst: someone responsible for creating a place and time where the unconscious can speak and be heard by the analysand and who protects the analytic settings
> deals with transferrence (e.g. erotic transferrence → when the client catches feelings for the therapist); cannot be part of therapeutic relationship, it can come up in free speech but must be addressed
> they give the client tools to deal with things, and keep their own personal opinions/emotions away from the client
→ there is unconscious in the therapist as well, for example if they start behaving in a way that the client will dislike so that they leave and you don’t have to deal with them
7
Q
what do we need for psychoanalysis?
- Setting
A
- an analytic process requires a space and a time were everything can be said and everything can be listened to
> analytic process: all thoughts can be thought and felt
> couch is a tool that allows client to speak without being observed by client directly, and allows client to be more honest and free
> there has to be an analytic process, which means that all thoughts can be spoken up about
→ e.g. agenda setting and therapy goals are not great for analytic process, as it hinders freedom of speech
8
Q
What are the Basic Concepts?
A
- the Unconscious
- Fantasy
- Primary and Secondary Processes
- Defenses
- Transference
- One vs two-person psychologies
9
Q
The Unconscious
A
Freud:
- the unconscious is an area of psychic functioning where we are not aware of our impulses, wishes and memories
- because either the associated emotion is too intense, or their content is considered unacceptable
- ego & id
In general:
(1) our experience and actions are influenced by psychological processes that are not part of our conscious awareness
(2) these unconscious processes are kept out of awareness in order to avoid psychological pain
10
Q
Fantasy
A
- people’s fantasies play a role in their psychic funtioning and in how they relate to external experience (esp. in relationships with others)
- vary from daydreaming, to deep unconscious
- covers the need for regulation of self-esteem, need for safety, need for regulating affect and need to master trauma
- motivate our behavior and shape experiences
11
Q
Primary and Secondary processes
A
Primary process:
- raw, primitive psychic functioning that begins at birth and continues unconsciously throughout lifetime
- no past, present and future
Secondary process:
- functioning associated with consciousness
- logical, sequential and orderly (rational and reflective thinking)
12
Q
Defenses
A
- process that aims to avoid emotinoal pain by pushing throughts,… out of awareness
> Intellectualization
→ distracting from the feeling
→ keep emotional distance while speaking about something threatening
> Projection
→ attributino to someone else
> Reaction formation
→ denial and affirming the opposite
> Splitting
→ Kleinian theory
→ splitting the representation of the other person in 2, so that the good part is not contaminated
→ especially kids with their moms (not able to have ambivalent interpretation of the mom)
→ it’s part of the development and you usually learn to integrate the two; if not, then it becomes problematic
13
Q
Transference
A
- patients transfering past dynamics with important figures (esp. parents) to their relationship with the therapist
- Freud first thoughts it was an impefiment to treatment, but later saw it as an indispensable part of the therapeutic process
→ it heps us see & exp;ain how past dynamics affect the present
14
Q
One vs Two-person Psychologies
A
There has been a shift from one to two-person psychologies
One:
- the therapist is an objective blank screen onto which the client can project
Two:
- the client & therapist collaborate & co-participate, influencing each other on conscious and unconscious levels
!! in order for the therapist to understand the client, they need to understand themselves & the way they affect and interact
→ self-exploration from the therapist, which also helps in dealing with the client’s resistance
15
Q
what is the analytic unconscious NOT?
A
1- it is not everything that is not conscious
> not all implicit associations and mindless actions are analytic unconscious, it is just something we don’t know about ourselves
2- not localized in the brain (or psyche) or anywhere else
> it is something that disturbs us, mainly we inspect it when we are uncertain
3- it is not the really deep true self
> not who we really are
> if you peel an onion layer by layer, you don’t find a true onion/self, there is not a core of us that we have to find
16
Q
what is the analytic unconscious?
A
Core assumption:
1. our experience and actions are influenced by processes that are not part of our conscious awareness
2. these unconscious processes are kept out of awareness in order to avoid psychological pain
- this is an umbrella definition that includes many different conceptualizations as proposed in the rich analytic tradition
> in ll psychoanalytic theories you have an unconscious, and it is about not wanting to know difficult things about oneself
> there are a lot of different traditions (freud, …); all of these are speculations and theory as to what the unconscious is
- analytic unconscious is not something we don’t know or that we forget, it is a motivated forgetting, it is things we try not to think about
> e.g. after trauma you try to forget about trauma not to suffer too much
> e.g. pretending to be equal with authority figure in order not to feel submissive; this anger then transfers to other situations (e.g. very angry at spouse after meeting with superior)
17
Q
Why does it matter?
A
- analysis moves our thinking beyond the borders of our current “self-evident” conscious constructions of ourselves and our world
- you are not what you think you are, we don’t know who we actually are
- psychoanalysis questions who we are
18
Q
why wouldn’t we do it?
A
- old fashioned
> this is just an image, it is actually still important and used worldwide
> there is a lot of current development and new research that has moved on from Freud - it is difficult
- … confusing
> human beings are confused/confusing themselves - … slow & inefficient
> not a quick fix - … complicated and no clear guidelines
> it has some guidelines (“you are going to tell me everything that pops into your mind) - dangerous and anxiety provoking
> you will be able to make everything out of this unconscious, the authority figure is big, transferrence is dangerous
> can give you a lot of anxiety (both for client and therapist); both will want to move away from it, which will undermine scope of therapy - more questions than answers
> also true, you learn to have questions - ethical doubts
19
Q
but why then?
A
1- it has to be something that the patient wants to do, it cannot be forced
2- experience of something lacking in academic psychology
> who humans are is something that is missing from what we study in university
3- the unconscious is a crucial concept
> it can teach us a lot about who we are, and changes how we perceive things
4- it provides a place for desire
5- it takes seriously our fantasies, dreams, odd ideas, slips and jokes
> the full human experience without censoring out the parts that we do not yet understand
> get a full picture of what humans are (nonsense must be taken into account)
6- it speaks and thinks from the point where other theories tend to stop, beyond what we can clearly understand, imagine, predict and control
7- it asks important questions and expands the range of possible answers
8- the psychoanalytic tradition is very rich; it provides a complex langauge in which you can express things that cannot be expressed without it
9- with this language and the clinical tradition you start to see, hear and feel things that you would otherwise miss
10- can be used to improve therapeutic skills
11- its concepts are very useful for therapy, for thinking about therpeutic processes and your own therapeutic work
12- concepts can be very useful in diagnostic thinking, in particular when concerned with issues of identity and intersubjectivity
20
Q
how to listen with a psychoanalytic ear?
A
- in speaking and acting people say much more than they intend to
1. anxiety
> this is the first thing present in the dynamic; both client and clinician at first are anxious
> where do I find anxiety in the speech of my client?
> usually presents as resistance
2. identification
> people identify themselves with characters (e.g. I am a teacher)
> what words and images does the person identify with?
3. transference
> how does transference develop?
> what does the client make of me? when the client enters the room, the clinician is already something to them (based on previous experiences, …)
> things can be transfered from earlier relationships to you as a therapist
4. associations
> how do associative chains develop? what do you associate?
> focus on what the real meaning of what is being said is
5. desire
> where does desire (dis)appear?
6. repetition
> what is being repeated?
21
Q
- where is anxiety, resistance and defence?
A
- at which moments in speech is something left out or talked over?
- which words by the therapist cannot be heard by the patient? what do they not want to hear?
- where does it seem that something is avoided by cheap words, laughing it away, etc?
22
Q
- What words and images does the person identify with?
A
- What words and images of the “self” recur in the narrative?
- Where do these words come from? From whom? How did the patient come to identify with these words?
> Kamran case: he was told that if he succeeds in life, everyone in the family succeeds
→ he then identifies with the person that has to succeed, but it may conflict with other things in his life
→ he might have wanted to become a painter, but this doesn’t fit with image of himself - Conflict: may these words and images be in conflict with lust, other fantasies, bodily urges and needs or other identifications?
> e.g. homosexual feelings in christian community
23
Q
- How does (counter) transference develop?
A
(counter transference: from the side of the therapist)
- how does the patient position the therapist? and himself?
> not in immediate awareness
- how does the therapist position the patient? and himself?
> this starts counter transference, as the therapist bases himself on who the patient is and what he wants
- what fantasies and desires may transpire in that unconsciously?
> point of analysis
> patients sometimes start having assumptions that if they do what clinician says, they will get better; this means that they take therapist as someone with the solutions, so if advice doesn’t work they become angry at the therapist, as if it was their fault
- what does the patient fantasize that the therapist desires from him? and viceversa?
- to what extent do memories, experiences and fantasies from the past recur in this?
> experience of new authority figures is based on experiences with previous authorities
> this is why parents are so important in shaping expectations that we have of people and other authority figures (e.g. trust, boundaries, …)
24
Q
- what associative chains develop?
A
- in speech, people follow paths of thoughts without being fully aware why they choose them
> things pop-up in their minds and make them think of other things
→ this is an associative chain, which interacts with the logical chain of thoughts - what kind of associations and paths of thinking can you hear?
- where does someone make a slip or an unintended association move?
- what words, phrase, associations come to mind to the therapist? by using these they stimulate associative paths
→ these are exercises to think beyond the first meaning of what we say
25
5. what is being repeated?
- are there repetitions of certain words or phrases?
- can you recognize something that is being repeated in interpersonal situations? Ways of relating that recur over and over?
> if someone keeps speaking about all relationships as they are a victim → will you betray me to? (that is the implicit question to the therapist)
- Is there something that is being repeated in the therapeutic relation?
26
6. where does desire appear and disappear?
- can we recognize (unconscious) desire in speaking?
- is desire being cast aside out of fear?
> how are we pushing it away?
- is desire being killed as it does not fit with the demands of identifications?
27
Recurrent case: Kamran (41)
- panic, depressive symptoms, emotional outbursts
- guilt
- responsability "as a man"
- "when you succeed, we all succeed"
→ could a psychoanalytic approach be useful for Kamran?
→ why (not)? what would it look like?
→ how would it differ from other approaches?
28
Could a psychoanalytic approach be useful for Kamran?
- yes, he would realize that all his hard work and pressure comes from the fact that the parents made him feel like he had the responsability of succeeding for the family
- by knowing this, he can adjust his expectations of himself and realize that he is working hard for the wrong reasons
- often just realizing something is not enough for the liberation effect
> opens door to change, and it makes us ask ourselves if we want to live this way
- as a therapist, you would pick up certain things from the client, and then you can approach situation and ask "I have noticed this, ... ?"
> best when client discovers it on their own
- other approaches (e.g. CBT) might be an escape from the analysis ("if I do my exercises I will be better")
29
video clip of walter
- he moves things around, takes control...
→ what is the control needed for?
- "is that what you think I am thinking?"
> great transference question
... "no no definitely not"
→ in this case, this is a defense mechanism of denial
- Walter wants control, he wants to be in power of the situation while in reality he needs support
> this is hard for the therapist, because if the therapist takes up position he will become threatening, but if he takes down position Walter will not trust that he can help him
30
How does psychoanalysis work?
Therapy vs Analysis
- there is evidence that using analytic concepts in therapy can help to improve outcomes in terms of symptoms and social functioning
Therapy
- attempts to attain therapeutic goals by speaking: function better, be more happy, have less symptoms
Analysis
- aims to create a sphere where the unconscious can speak and be listened to
- the analyst does not have other aims than that and does not know what is good or bad for the analysand
! these are ideal types, in clinical practice the two are always mixed
31
using analysis in theraapy
- Psychoanalytic therapy
> analytic process sustained be therapeutic interventions
> boundaries as to how long it can be, limited therapeutic interventions
- Psychodynamic therapy
> derived from psychoanalysis, but primarlily aimed at improving focused problems
- Common EBTs for PD
> often incorporate psychoanalytic ideas and concepts
> e.g. Schema therapy has a lot of influence from analysis
- basic psychoanalytic concepts are very useful in almost all therapies
> reflecting on the experience and desire of the therapist
> reflecting on (disturbances in) the therapeutic relation
> conceptualizing why some treatmetns are not proceeding according to plan
> developing ideas on difficult to understand ways of speaking and acting of a patient
32
Evidence for psychoanalytic psychotherapy
- much evidence for short-term psychodynamic therapy
- much evidence for EBTs of PDs
- quite some evidence for the effectivity of long-term psychoanalytic therapies for complex mental disorders
- naturalistic studies on open-ended psychoanalysis show positive results
33
how to understand psychoanalytic theory?
- analytic concepts are attempts to capture something from previous analytic experiences, in order to provide and orientation for other analysts and therapists
> not a clear and simple description of the world, they are tool to understand what is going on with the person
34
From the Book...
Learning Objectives
(picture on whatsapp)
Basic Themes
1. the unconscious
2. fantasy
3. primary and secondary processes
4. defense
5. transference
6. one vs two-person psychologies
Models
1. Conflict Theory (p.34)
2. Object Relations Theory (p. 35-37)
3. Developmental Theory (p.37)
Concepts concerning therapeutic interactions
1. Transference
2. Countertransference
3. Resistance
4. Intersubjectivity
5. Enactment
Material to be read but not learnt in detail
(see picture on whatsapp)
35
In conclusion...
I. Analysis is an attempt to create a sphere where the unconscious can be brought to speak and be listened to
II. Analysis moves our thinking beyond the borders of our current ‘self-evident’ constructions of our selves and our world.
III. In speaking and acting people say much more then they intend to
IV. Analytic concepts are attempts to capture something from previous analytic experiences in order to provide an orientation for other analysts and therapists
V. There is evidence that using analytic concepts in therapy can help to improve outcomes in terms of symptoms and social functioning. Ye this is not the primary goal of an analysis itself
36
Other systems
- overview of psychoanalysis and its decline
- psychoanalys is the first modern western therapy, and most others derive from it
- it is a worldvide, not just a form of therapy
> heavily influenced in western culture, hard to compare with other therapies
- the marginalization of p.a. based on valid criticism, but also on unhealthy contemporary biases
> emphasis on pragmatism
> quick fixes
> optimism (that can undermine the complexity of humans)
- its decline depended on many causes:
> tendency for psychology to become biological
> rise of CBT & evidence-based treatment
> public's negative reaction to the presumed attitude of arrogance and criticism + poor receptiveness to valid criticism and research in psychoanalysis
37
Theory of Personality
! it's not a specific theory, but informed by many schools of thought through which we can view human experience and development
- Conflic theory
- Object Relations Theory
- Developmental Arrest Models
38
Conflict Theory
- intrapsychic conflic plays a central role in the development of an individual's personality
→ result of compromise between core wishes and defenses used to manage them
> e.g. th obsessional individual is typically involved in a conflict between obedience and defiance
39
Object Relations Theory
- internal object relations = internal representations
- Internal object relations influence the way we
> perceive others
> choose people to develop relationships with
> shape those relationships
→ through history there have been different conceptualization about this, and how internal objects become established (internalization)
// attachment theory (Bowlby)
// projective identification (Klein)
// Fairabairn
40
Attachment theory (Bowlby)
- humans have a natural motivational system that makes them crave proximity with their caregivers (for survival)
> this is called Attachment system
- infants develop representations of their interactions with their attachment figures that allow them to predict what type of actions will increase the possibility of maintaining proximity versus what type of actions will threaten the relationship
> representations = Internal working models
- infants develop dissociating feelings (aggression, anger) relating to those actions that threaten the relationship
→ developmental models and attachment theory assume these come from real interactions; object relations theory sees it as a combo of real interactions + wishes and unconscious fantasies
41
Projective Identification (Klein)
- people are born with instinctual passions related to both love and aggression that are linked to unconscious images about relationships with others
> these unconscious fantasies serve as the scaffolding for the perception of others and for actual relationships
- own instinctual aggression is perceived as unacceptable, so they are fantasized as coming from the other (e.g. mother)
→ Projective identification
> feelings that originate internally are experienced as originating from the other
> split (to differentiate between good and bad)
42
Fairbairn
- internal objects are established when the child withdraws from external reality because the caregiver is unavailable, frustrating or traumatizing
> they create and acceptable alternative reality
→ these fantasized relationships become important building blocks for one's experience of the self (the self is always experiences in relationsihp to others, whether in fantasy or reality)
- the depriving and traumatizing aspect stays as a part of the origin of the fantasy, and influences internal structures
- overall, we build models to predict and act with and towards what we know
43
Developmental Arrest Models
- psychological issues arise as a result of the failure of caregivers to provide a good enough environment
- because of this, the child goes into developmental arrest
! this leads to a feeling of subjective omnipotence ("the mother will satisfy all needs")
> the mother will inevitably fail the infant, and the subjective omnipotence is lost as a result of the dissonance between fantasies and reality
(a) the child might become overadaptive to others' needs, and develop a false self (which will result in feeling alienated from oneself)
(b) if the process is gradual enough, the infant can accept the other's limitations
→ optimal disillusionment
! attunement to the child's needs is important for them to develop a cohesive sense of self
44
Theory of Psychotherapy
- psychoanalysis vs psychodynamic therapy
- core aspects of psychoanalysis
- in the past, clear distinction between psychoanalysis and psychoanalytic/psychodynamic theory
> psychoanalysis: specific kind of therapy
- psychodynamic therapy: treatment based on psychoanalytic theory, but lack some defining characteristics of psychoanalysis
- core aspects of psychoanalysis:
> long term, intensive and open ended
(1) emphasis on helping clients become aware of their unconscious motivation
(2) refraining from giving the client advice or being overly directive
(3) attempting to avoid influencing the client by introducing one’s own belief and values
(4) maintaining a certain degree of anonymity (by reducing the amount of information one provides about one’s personal life or one’s feeling and reactions in the session)
(5) maintain the stance of the neutral and objective observer (not fully engaged participant in the process)
(6) a seating arrangement in which the client reclines on a couch and the therapist sits upright and out of view
! now the distinction is not so clear, and the distinction has more to do with politics and professional elitism
45
Theory of psychotherapy
1) therapeutic alliance
2) transference
3) countertransference
4) resistance
5) intersubjectivity
6) enactment
46
1) Therapeutic Alliance
- the concept originated in early psychoanalytic theory
> collaborative, good relationsihp is fundamental
→ based on the client's rational perception of the therapist, and not on transference (distorted)
- its strength depends on the quality of bond and agreement to all goals
47
2) Transference
- more likely to happen with the therapist because they take on the helper role
> authority, parental figure
- early experiences establish schemas that shape the perception of people in the present
- client can gain insight into how their experiences with significant figures in the past have resulted in unresolved conflicts, that influence their current relationships
48
3) Countertransference
- the therapist's counterpart to the client's transference
- Freud: therapist's feelings and reactions to the client's transference, reflection of therapist's own unresolved conflicts
- for Freud they posed a problem, and therapist should work on it
- now, defined as totality of therapist's reactions to the client, and can be considered somewhat beneficial
! always take into consideration the unique combination of both feelings and reactions
49
4) Resistance
- tendency to resist change / undermine the therapeutic process
> it is the manifestation of defensive processes in therapy sessions
- it's an important insight on the patient's functioning (often self-protective)
→ therefore, not inherently negative
50
5) Intersubjectivity
- analysing the client's & therapist's perspective may be limiting
> the meeting of the two results in the analytic dyad (new third product)
- the therapist does not uncover the truth of the client's reality
> instead they construct one together
- client learns that human relationships are flexible, and that it's possible to recognize the vaildity of the other person without feeling invalidated
- ongoing negotiation about the meaning and substance of reality
- ongoing implicit and explicit negotiation about what is taking place in the therapeutic relationship, who is doing what to whom, and what both the client and therapist are really experiencing
> e.g. therapist can take client's phrase as transference or accept it as the truth, and client can accept the confrontation or redefine the situation
> necessary for Intersubjectivity
→ ability to hold onto own experience while acknowledging another as the center of their subjectivity
→ the client learns to do this while in therapy
51
6) Enactment
- because the client and therapist influence each other constantly, they enact complementary roles (enactments) in relational scenarios, of which they are not fully aware
- the therapist needs to own this and take part in the client's enactments
→ this gives them the opportunity to play out scenarios with other people in their lives
- Enactment happens when both the therapist and the client unconsciously act out old relationship patterns during therapy. They influence each other—often without realizing it—and end up playing roles in these emotional "scenes" based on their past experiences and expectations in relationships
- The client's and therapist's personal relationship styles (called relational schemas) affect how these enactments unfold
- By exploring these patterns together, the client can begin to see how their old ways of relating to people affect current relationships
- This can help the client change those patterns and develop healthier ways of connecting with others
- If therapists tried to avoid these emotional interactions, they'd miss the chance to truly understand what their clients' inner world feels like
- Being part of these enactments helps therapists feel what it’s like to be “inside” the client’s world
- Sometimes, what a client can’t say in words is expressed through actions. By experiencing and reflecting on these actions, the therapist can help the client understand parts of themselves they didn’t know about
52
Process of Psychotherapy
1) Empathy
2) Interpretation
3) Classification, support and advice
4) Termination
53
1) Empathy
- the most fundamental intervention
- ability to identify with clients and immerse in their experience
> this helps the therapeutic alliance
- we also communicate our understanding to them
> empathetic conjectures are helpful too, you don't have to be super accurate
54
2) Interpretation
- therapist's attempt to help the client become aware of aspects of their experience and unconscious relational patterns
- attempt to convey something that is outside of the client's awareness
- accuracy & quality/usefulness
> it can be accurate without being useful
- dependent on the therapeutic alliance:
> timing: is the client ready? right context?
> depth: is it close to awareness or deeply unconscious?
> emphatic quality: is it sensitive to the client's self-esteem?
! the client's interpretation of the therapist's questions depends on whether the client trusts / feels cared for by him or not
55
3) Classification, Support and Advice
- while you should promote the client's trust in themselves, sometimes advice and support are fundamental (reassurance, suggestions, ... → can help therapeutic process)
- concern: do our opinion excessively influence the client and harm their autonomy?
> our opinions influence them anyways through everything we do and say, so might as well be honest and direct so that they can truly evaluate us and disagree if needed
56
4) Termination
- one of the most important phases of treatment
> can consolidate gains of negatively affect the process
- we must balance appropriately between holding onto a client and fail to adequately explore underlying reasons for termination
- useful: establish a number of final sessions to terminate well and conscioulsy, review changes, express feelings about termination, ...
- sometimes the client will want to terminate but will be too afraid to do so, so we must look out for cues
57
Mechanisms of Psychotherapy
1) Making the unconscious conscious
2) Emotional insight
3) Creating meaning and historical reconstruction
4) Increasing and appreciating the limits of agency
5) Containment
6) Rupture and repair
58
1) Making the unconscious conscious
- change involves becoming aware of instinctual impulses and wishes and learning to deal with them in a rational way
- no more self-deception: +agency (less controlled by unconscious), +choice available to us
59
2) Emotional insight
- combining the conceptual with the affective
> this way the client's new understanding has an emotionally immediate quality to it, and doesn't only rely on intellectual understanding (which doesn't have any impact on daily life)
- use transference interpretations, the client observe themselves as an agent and see how they construct their experience
60
3) Creating meaning and historical reconstruction
- clients often come to therapy with difficulty in the construction of meaningful narratives about their lives
> this could be because they don't have proper events that explain their complaints, or because they have constructed maladaptive narratives to make sense of their experiences
- therapy provides usually normative psychological explanations for symptoms or pain, so that a cohesive and meaningful narrative about one's life is constructed
- understanding how maladaptive tendencies developed and why they were once adaptive helps client reduce blame and pain
> the client can become more tolerant and accepting toward themselves and develop new coping strategies
+ explore one's values to understand what is meaningful to them
61
4) Increasing and appreciating the limits of agency
- help client gain a greater appreciation of the connection between their symptoms, their ways of being and their contributions to their patterns
> allows them to see themselves as agents rather than victims
! experiental, not only conceptual
- more appreciation and acceptance of limits of agency
> you can't have it all and that's okay
62
5) Containment
- as a therapist, learn how to handle own emotions in a nondefensive fashion
→ how can we help clients with despair when we feel it too? (etc)
- how do clients evoke powerful and dissociating feelings in therapists?
(1) it is not uncommon for people to experience the nonverbal aspects of emotion in the absence of conscious awareness
(2) people are remarkably good at reading and responding to other people’s emotion displays without conscious awareness
63
6) Rupture and repair
- in mother-infant face-to-face interactions, there is a constant transition from coordinated to uncoordinated affective states
- this helps the infant understand how both parties play a role in regarding disruptions
> understanding how to work through misunderstandings and disruptions in clinet-threapist relationship can change the clien't implicit relational knowledge (!)
- the therapist's failures to connect provide a chance to repair
64
Applications
- Who can we help?
- psychoanalysis is most appropriate for clients who are neurotic, have a strong and cohesive ego, and high capacity for self-reflection
- if psychoanalysis in broader sense, (general framework), then it can address more clients
> different interventions and mechanisms can be used flexibly
65
Treatment
- theories and techniques can be applied in a wide raneg of settings and integrated with theories and techniques from other approaches
> despite psychoanalysis' prevalence has declined, it shaped the culture we live in
66
Evidence
- short-term dynamic psychotherapy is effective, even compared to cognitive therapies
- long term is particularly effective for complex mental disorders
> PDs, chronic m.h. issues, ...
- can be compared to CBT for a range of problems
- the impact of psychoanalytic therapy keeps increasing after termination (more than CBT)
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Psychotherapy in a multicultural world
- emphasis on the role of unconscious biases about race, culture and class play a role in shaping our daily interactions
- internalized attitudes play a key role in the transference - countertransference matric for both client and therapist
> fundamental to be aware and explore it
