Psychoanalytic Psychotherapy Flashcards
If there is no psychoanalytic theory of personality or treatment, what is there?
A host of different theories and treatment models that have developed over more than a century
Freud- 1856
Rise of Nazism
Cultural norms and expectations around gender roles and expression of sexuality that heavily influences his work
Anna O.
Attractive, doing well in life, but she was caring for her father who was sick
Caused paralysis in her hands and legs, experienced intermittent deafness and aphasia where she was unable to speak
Her symptoms were called “hysteria”
Defined as someone who is overcome with emotion, even if they are not conscious of these emotions, they will come out physically
Diagnosis was frequently given to women
Breuer
Memories of painful and traumatic experiences that they were trying to push away
The pain of these memories would re-emerge physically in the body
Hysteria is now called…
Fuctional neurological disorders when they aren’t sure where the problems are coming from
What do fMRI studies show?
Poeple who have functional neurological disorders have more connectivity from amygdala to motor cortex
“The talking cure”
One of the firt proposals was talking therapy
Emphasis on trying to bring in Psychology and psychotherapy into a scientific realm
Freud Ideas
Hysteria resulted from trauma
Therapy attemps to uncover painful emotions
painful memories should be brought to the surface so that people can release them and have catharsis
Emphasized scientific rigor and wanted therapy to be in the pursuit of truth
Free Association
Freud
Patient should say whatever is coming to mind
Manifest content
Surface material
They will take in what the person said on the surface
Latent content
Deeper level
Patient will be more interested in the underlying/behind what that person said
Drive Theory
Libido produces states of tension
Pleasure Principle
We are driven to repeat experiences that release tension
Stages of Psychosexual development
- Oral (0-18 months)
Feeding, sucking, etc. - Anal Phase
Potty training and controlling bowels - Phallic
Genital control - Latency period
Internalizing societal norms as sexuality and puberty and the ideas that society has from us - Genital Phase- Gratification comes from sexuality
Ego Psychotherapy
Structure to how the unconscious functions
Distinct compartments that deduce who you are and how you behave
Id
Psychosexual
Libido
All instinctual things that you go for
Freud- aggression, sexual pleasure
Ego
Concerns of reality
Emerges as we grow up and as we are socialized into society
Primary function- delay gratification, try to find a way to satisfy the desires of the id in a way that is suitable for the situation around us
Superego
Moral compass, internalized set of morals coming from society
usually it is overly harsh and demanding
Black or white
Opposite of id
Builds tension between id and ego
Only a small amount of personality that is above the water that we are conscious of
Under the surface is where most of the stuff is happening
Tension playing out where the drives of the id, desires of the ego, and demands of the superego play out
How do we find the pieces that are underneath the water? Primary and secondary processes
Primary Processes
Begin at birth and operate unconsciously
Raw/primitive functioning
Ways we think about our desires, needs, fantasies, wants, etc.
Bubble up to the surface through dreams or fantasies, but they are sort of diffuse
Typically, people aren’t able to distinguish between past, present, or future
Secondary Processes
Functioning associated with consciousness
Logical, sequential, orderly
Ability to reflectively think (own thoughts and ideas)
Building of tension between unconscious drives and how we think rationally about ourselves and society
Jung
Initially studied under Freud
Experimental studies of the unconscious
Measuring the amount of time it takes a person to answer a question might be an indication of an emotional charge
Reflect unconscious complexes
Complex
You have something repressed because you see it as emotionally threatening
Analytical/Jungian Psychology
Collective unconscious idea
Unconscious has creative and growth-oriented components
Understand unconscious through observing complexes
Less emphasis on sexuality’s role in motivation
Collective unconscious
There is a vast and hidden resource shared by all humans that we pull from and our personal experience modify what we pull out of the collective unconscious to create who we are individually
British
Freudian Psychoanalysis
Kneilian
Independent/middle group
US
Ego psychology –> classical psychoanalysis
Main one we use is drive theory - idea that we have unconscious drives that create libidinal tension that must be released
Common Principles of Psychoanalytic Perspectives
Humans are motivated by wishes and fantasies that are unconscious
Humans are ambivalent (hesitant/unsure) about changing
Therapy should help clients understand how their own construction of the past and present plays a role in perpetuating patterns
Conflict Theory
Childhood neurosis common and expressed through anxiety
Conflict between unconscious wishes
Example- Defense mechanism
Children may have over or underdeveloped superegos causing neurosis
Why does neurosis occur during adulthood?
Due to conflict between unconscious wishes and defenses = intrapsychic conflict
not only are we in conflict with ourselves, but also how we experience others
Object Relations Theory
Internal representations guide perceptions and actions
Attachment theory
Humans build internal working models of caregivers that allow them to maintain proximity
Form these objects in our mind of who different people are and the characteristics and expectations we hold of them and interact in accordance with those
Internal Working Models
Maintaiuning proximity to the caregiver to stay alive and internalize what a caregiver is
Psychological problems are due to caregivers’ failure to provide a “good enough” environment
Can’t be too perfect or bad
Infants believe they are omnipotent and their wishes are fulfilled by the mother
Think they know everything
Gender roles and expectations coming along with the time frame
In order to actually become a healthy person as you grow, you need to have a level of optimal disillusionment
Optimal disillusionment
Need to have a parent who fails
Baby cries, caregiver changes their diaper even though they were hungry
Must accept the limitations of others
Why good enough is the best
If we have a caregiver who is perfect and never fails, that infant will never grow up to recognize that other people have limitations
False Self
Another problem- if the caregiver fails too often
Child will learn that their needs don’t matter
Should always go with what other people want, and shouldn’t listen to their own needs
We have unconscious desires/drives and if we develop a false self, it will be even harder to access those because we work even harder to keep those drives away from us
No cohesive understanding of who you are as an individual
Defense Mechanisms
Concept introduced by Freud
Intrapsychic process an dis a function to destroy pain
Something will be uncomfortable/painful, if we allow the thought, wish, hope, etc. to come into conscious above the water area, then we have to feel that pain so instead we push it back under the water
Defensive styles
Impact our physical and mental health
Have implications for treatment
Sublimation
Conflicted (negative) emotion into something productive
Conflict into physical outlets
Engaging in physical activity
What Defense Mechanism is this?
Sublimation
Stress cleaning
What defense mechanism is this?
Sublimation
Repression
Forgetting something that is unwanted
Seen in day to day life, we try not to remember things we don’t want to
No conscious awareness of what’s being depressed
Remembering you got robbed in the morning, but trying not to think about it.
What defense mechanism is this?
Repression
Regression
Going back to a child/emotional state
No attempt by the ego to control/hold in the emotion
A 12-year-old boy wets the best if overwhelmed.
What defense mechanism is this?
Regression
Projection
Occurs when we are taking a belief and putting it onto another person in an expectation that we blame the other person
Taking own threatening feeling and saying someone else is expressing that
Thinking two laughing people are laughing at you. What defense mechanism is this?
Projection
Denial
Being aware of something, but not wanting to believe its true
A loved one dies and you hear and understand what they have said, but you don’t believe it because you don’t want to accept it. What defense mechanism is this?
Denial
Splitting
Inability to recognize someone can be good and bad at the same time
someone can have good or bad attributes
It’s possible to have negative feelings about someone temporarily while still understanding they are generally good
“My last therapist was awful, they were the worst”. What defense mechanism is this?
Splitting
Intellectualization
Don’t connect with emotions
Talk about a traumatic event in the third person
Suzy underwent surgical intervention (orthopedic trauma, car accidents, etc.), when asking people what happened, Suzie wouldn’t say what happened to her personally, she said what happened in general.
What defense mechanism is this?
Intellectualization
Rationalization
Trying to explain something away; explaining something in a way that changes
Making excuses for a bad test grade. “I failed because my teacher hates me.” What defense mechanism is this?
Rationalization
Displacement
Taking the feelings we have about a specific person and putting that anger on someone who is more helpless
Marshall’s boss yells at him, but Marshall can’t yell back so he goes home and yells at his wife for something else. What kind of defense mechanism is this?
Displacement
One Person Psychology
Therapist is a blank slate
neutral observer
They would be completely impartial and just interpret what the therapist said
Two-person Psychology
The therapist brings in their own past experiences into the room
Impossible for us to feel biased from our own experiences
Interaction between patient-therapist is not just driven by the patient, but the therapist as well
Transference
What is the patient bringing outside and putting on me? Patient will come in with schema’s based on early life experiences and they act as filters as they shape the way we perceive the world and will automatically change how you view your therapist
You may see the therapist as a parental figure
seeing the therapist as someone who will not meet my needs so I will never ask them for anything because they won’t give it to me - what is this an example of?
Transference
Patient will talk about the therapist and will make sure the therapist is ok so that they don’t have to talk about themselves. What is this an example of?
Transference
Countertrasference
Reaction to transference
Therapist reaction specifically to the transference - not necessarily reactive, can exist on its own
When you see a client that looks like someone who you really don’t like and your reaction to the patient could affect the session. What is this called?
Countertransference
The patient and therapist have to be able to trust each other and have a therapeutic alliance
True
Resistance in Therapy
Intrapsychic conflict between drives and ego (conscious)
People will be ambivalent, they want to change but change is hard and uncomfortable
Hard to let go of the defense mechanisms that stop them from getting hurt SO you know that you will see some resistance show up in the therapy room
Is resistance an obstacle?
NO, its an expected part of therapy
How do you get rid of the defense mechanisms that help in the short term but make things worse in the long term?
Identify them by making the UNconscious –> CONSCIOUS
Cathartic release of emotion
Empathy
Feeling emotions for someone else
Being able to view something through someone else’s eyes
Opens a conversation - opening for a therapist to make an interpretation about how the client is feeling and clarify their viewpoint
How a therapist communicates their empathy to their viewpoint and interpreting what they think might be happening unconsciously
Attempting to convey what might be going on outside of the patient’s conscious awareness
Do I expect that they will have a reaction to it that will be helpful and convey to them that the psychotherapist is trying to step into their world
What is this sentence an example of?
“I imagine if I were in your shoes, I would feel ___”
Empathy
Methods of Psychoanalytic therapy
- Empathy
- Clarification
- Interpretation
- Support/Advise
Clarification
Therapist asks clarifying question
Departes from free association
Much more transactional and interactional and they will ask questions of their patient to help mold and deepen and strengthen their interpretations
When there is a good therapeutic alliance, the patient feels comfortable clarifying for the therapist when they feel the therapist’s conjectures are inaccurate
Therapist will look out to see if the client is actually correcting their feelings OR is it just a defense mechanisms
“It sounds like you were really angry” – “no, I was disappointed” – “oh, clarify what you mean by disappointed”
What is this conversation an example of?
Clarification
Interpretation
Why is it they undertook that action or fewlt that certain way and they will make interpretations about why that may have happened
the accuracy of the interpretations depends on how much you know about someone
more - more accurate
If I make this interpretation, is the person ready to hear it
Support/Advise
When people come into therapy, they are looking for advise
psychoanalytic path
Opening –> Developmental –> working through –> Termination
Opening
Therapist goal is to get information from the patient
Let the patient move a little at their own pace
Therapist wasn’t grilling her but beginning to identify to themselves the themes for what is taking place for this patient and will begin to outline for themselves the intrapsychic conflicts the patient might be going through
In what ways is the patient being resistant? Etc.
Will see the empathic conjectures and clarifications to keep them talking during the opening phase
Development of transference
See the development of transference where the patient will react to their schemas, unconscious memories they have, and will see the therapist as a stand in for a caregiver and the therapist will be on the lookout for this and the therapist will see it and begin working
Working through
Pointing out the enactment that’s taking place in the room
Getting the patient to see what the patient is doing in the room
Analyzing the transference and looking out for how these schemas are playing out in the room
Could take a long time and could last for years
Push towards short term psychodynamic therapy (<40 sessions) which is not long to them
Termination
Occurs when the patient is ready and the working through seems to be done
The more insightful we become, the more conscious we become, the easier it is to define them
Cathartic emotional release is achieved, and the therapist is ready to terminate by exploring the motivation to leave treatment
Is this due to resistance? Is there a lot more to do?
Therapists must be aware of their own countertransference due to their own schemas
Termination is negotiated between therapist and client and seen through the therapeutic change
Termination is sometimes determined by the outset
What is the key to psychoanalytic theory?
Making the unconscious conscious
Mechanisms of Change
Making the unconscious conscious
Emotional insight
Cathartic release of emotions
Creating Meaning and Historical Reconstruction
Increasing and Appreciating Limits of Agency
Seeing them as an agent in their own lives rather than a victim
Containment
Help them tolerate their past experiences
Patients have more room to express what they didn’t otherwise
Rupture and Repair
Just like optimal disillusionment, the therapist will make mistakes and there are times where the alliance will rupture, the therapist will use those failures as part of the way they work through
What are qualities of a good candidate?
Motivated
Openly disclosing
Willing to self-scrutinize
Not in need of immediate crisis intervention
“Problems in living” reflected in stress
Personality disorders
Evidence base
Short term dynamic (less than 40 sessions that are uncontrolled/lack control groups) vs. long term psychoanalytic (Not rigorously studied)
