Psychoanalytic Therapy

Classic Psychoanalysis: Sigmund Freud

• Key Concepts

  • Biological Processes: Attachment + Development

    • People go through predictable stages (psychsexual) and struggle to balance sexual urges with acceptable behavior 

    • He recognized the importance of context aligning with current multicultural competencies 

  • Personality structure

    • Id: biological component: instincts

      • Present at birth

      • Encompasses all instinct and mostly unconscious 

      • In close touch with needs and messages of the body

      • Subjective and emotional, not moderated by external world

      • Wants what it wants when it wants it

      • Pleasure principle: intolerant of pain and discomfort 

    • Eg0: psychological component: meditation 

      • Aware of both pressures of id and superego and wants to moderate both

      • Reality principle

    • Superego: social component: conscience 

      • Seen as opposite the Id

      • Rigid conscience that internalizes rule and guidelines

      • External messages from people and society shape the superego 

  • Life and Death Instincts

    • Life instincts reflect needs of Id and pleasure seeking

      • Libido: sexual drive and more broadly zest for life

    • Death instincts don’t have a lot of support, however, it Freud's way to explain the human tendency toward destruction 

  • Stages of Development

    • Oral Stage: first year of child's life 

      • Mouth is most important part of the body for baby

      • Sucking and eating provide substance and nurturance to baby

      • Biting is way for baby to express aggression

      • Developmental problems in this stage result in swallowing things, overeating, and argumentativeness (oral aggression)

    • Anal Stage: 18 to 36 months

      • Focus on social pleasure to impress and phsycial pleasure of elimination

      • Potty training phase

      • Developmental problems in this stage result in compulsion, withholding, ana retentiveness

    • Phallic Stage: 3 to 6 years 

      • Strongly related to adult sexual relationships

      • Feelings of pleasure become associated with genitals

      • Oedipus and electra complexes

    • Latency Stage: 6 to puberty

      • Sexual drives become less important but social interest increases

      • Successful navigation of this phase results in empowerment and initiative 

    • Genital Stage: puberty to death

      • Solidify personal identities, develop relationships

  • Levels of Consciousness

    • We have three levels of consciousness which explain why many don’t have memories pre age 3 and sometimes we just don’t remember

      • Conscious: always available to you

      • Preconscious: holds info not part of current awareness but easily accessed

      • Unconscious: memories that are highly charged include repressed feelings. Holds more than the other two and can be brought to conscious through therapy

    • Freudian slip: a misstatement that reveals unconscious wish or feeling

  • Defense Mechanisms

    • Ways of thinking or behavior that protect us

    • Healthy and adaptive defense mechanisms

      • Affiliation, altruism, anticipation, humor, sublimation, conscious suppression

    • Unhealthy and maladaptive defense mechanism

      • Acting out, avoidance, displacement, denial, intellectualization, projects, rationalization, repression, splitting (not comprehensive)

• The Therapeutic Process

  • Historically it is a long and intense process meeting 2-5x/wk for 3-5 years

  • Therapeutic Goals

    • Overall goal is to achieve equilibrium between id and superego

      • The ego is transformed by ‘working through’ or exploring the unconscious and defense mechanisms 

    • Other main goal is to bring the unconscious into the conscious

  • Therapist Function & Role

    • Typically take the ‘blank screen’ approach 

    • Want to facilitate transference

  • Relationship between Therapist and Client

    • Transference is a super important aspect of the therapeutic relationship

    • Once transference develops and is established, dysfunctional patterns are revealed and the origins of the behavior are understood and ego feels free

• Therapeutic Techniques and Procedures 

  • Free association: people should say whatever comes to their mind with no censoring or judging 

    • Therapists look for continuity of emotions and behaviors 

    • 3 ways to assess

      • Discrepancies 

      • Omissions

      • Excesses 

  • Analysis and Interpretation: both are fundamental to Freud's psychotherapy 

    • Analysis: understanding resistance, transference, and dream

    • Interpretation: comment or statement that brings an unconscious process to the clients attention 

      • Can be shared directly, indirectly, using the relationship, and revealing the therapist perspective 

  • Dream Analysis

    • Manifest content: actual content of the dream

    • Latent content: underlying pattern and meaning of content interpreted 

  • Abreaction

    • Recalling a painful experience that has been repressed and working through it by reliving the the experience and emotions 

  • Dealing with Resistance

    • Clients ceasing to discuss, address, think about, or accept an interpretation from a therapist

    • You can use this obstacles as an opportunity to learn about internal dynamics of the client and bring unconscious obstacles closer toward the conscious 

• Application & Current Use

  • Traditional psychoanalysis is best suited for those with a moderate ego strengths who have some achievement in their relationships and occupations 

  • Counseling Applications

  • Application to Multicultural Groups

    • Emphasis on talk, analysis, and uncovering is a western Eurocentric approach that isn’t suited for more collectivist cultures

• Evaluation 

  • Limitations

    • Lengthy and costly 

    • Not designed to address urgent concerns, for those in crisis, those who want a more active experience, or those who don’t align with Freud's take on sexuality

    • His emphasis on penis envy, castration anxiety, the Oediupus complex suggest that having a penis is the core of a masculine identity 

  • Strengths + Contributions

    • Freud’s influenced so many other thinkers with his ideas the therapeutic relationship

    • We now acknowledge the importance of childhood experiences, understand the role sexuality plays in development,  and recognize the significance parents play in our lives

    • We accept the existence of the unconscious