Objectives • To be able to define psychoanalysis , psychodynamic and humanistic therapy. • To be able distinguish the difference between psychodynamic, psychotherapy and psychoanalysis. • To be able to identify and define the concept essential Psychodynamic and Humanistic therapies. • To provide information regarding the application of the Psychodynamic and Humanistic Psychotherapy. • To enumerate some of the different Psychodynamic and Psychotherapy approaches
Psychoanalysis • Traditional psychoanalysis stresses the role of unconscious conflict stemming from early childhood relationships and psychological defenses against anxiety in therapy. • In developing psychoanalysis, Freud became the founder of psychotherapy, one on one treatment involving frank discussion of client’s thoughts and feelings.
Theoretical Foundation • Freud described mental life as a occurring partly at the level of conscious awareness; partly at a preconscious level, which we can become aware o f by shifting our attention; and partly at an unconscious level which we cannot experience without the use special therapy techniques.
Some Elements Common toPsychoanalysis and Psychodynamic Psychotherapy
Defense Mechanism • Projection • Splitting • Dissociation • Regression • Identification • Displacement • Intellectualization • Reaction formation • Suppression • Sublimation • Humor • Denial
Denial- denying the existence of external threat or traumatic event. • Projection- involves attributing a disturbing impulse to someone else. • Splitting - compartmentalizing experiences of the self and others so that contradictions in behavior, thought, or affect are not recognized. • Dissociation - disrupting one sense of continuity in the areas of identity, memory, consciousness or perception. • Regression – returning to an earlier phase of development or functioning.
Identification – internalizing the qualities of another person by becoming like him or her. • Displacement – shifting feelings associated with one idea, object or person to another. • Intellectualization – using excessive and abstract ideation to avoid difficult feelings. • Reaction formation – transforming an unacceptable impulse into its opposite.
Suppression – Consciously deciding not to attend to a particular feeling, state or impulse. • Humor – finding the comic and or ironic elements in difficult situations. • Sublimation – transforming socially or internally unacceptable impulses into socially acceptable expression.
Transference • It is common, and even expected, for the client to experience feelings for the psychotherapist that are called a transference reaction; these feelings are really no different than common “love” or hate.
Counter transference • Can be considered the reverse of transference. • The term describes the psychotherapist’s unconsciously activated reactions to the client. • If the counter-transference gets too intense the psychotherapist might have to end the treatment and refer the client to someone else, for the client’s own protection.
Psychic determinism • In psychoanalysis, slips of the tongue and other unexpected verbal associations are presumed to be psychologically meaningful, as are mental images, failures of memory and a variety of other experiences. • If a client suddenly remember something that’s seems trivial or unrelated to the topic of discussions during the therapy session, the therapist assume that there is a reason this material “popped into” the clients head.
Resistance Freud defined resistance as “whatever interrupts the progress of analytic work,” such as being late, missing a session, “holding back” your thoughts in the moment (i.e., refusing to speak about them) or avoiding a particular issue.
The main goals of psychoanalytic treatment are • Intellectual and emotional insight into the underlying causes of the client’s problems • Working through or fully exploring the implications of those insights, and • Strengthening the ego’s control over the id and the superego.
History and Case Formulations • Assessment in psychoanalysis is an ongoing process that occurs over multiple sessions. The following would be especially important for psychoanalytic treatment of clients. • Historical data such as family and developmental history • Mental status, level of distress, ego strengths and deficits, and “psychological mindedness” and • Defense mechanisms, themes, or patterns of attachment difficulties in interpersonal relationships.
Free Associations The client should say anything that comes to mind without editing or censorship. • Clients’ current problems are revealed only gradually and indirectly in the form of memories, feelings, wishes, and impressions arising through free association. • It is the therapist’s task to try to make of these emerging bits and pieces, some of which seem unrelated and even irrelevant.
The Role of the Therapist During therapy sessions, traditional psychoanalysts maintain an “analytic incognito” revealing little about themselves during the course of psychotherapy. • The therapist’s likes and dislikes, problems, hopes, and, so on, remain unknown to the client.
The therapists remain opaque, much like a blank movie screen, so that clients can be free to project onto the therapist the attributes and motives that are unconsciously associated with parents and other important people in their lives. • The therapist may also explore with the client, and perhaps interpret, the motives behind the client’s desire to know more about the therapist. • Is not coldly analytical and unresponsive. Should understand the importance of creating emotional safety in the therapeutic relationship, and so they are frequently emphatic and reflective in their comments.
Analysis of Everyday Behavior • The client’s description of a dream reveals its manifest content or obvious features. • Manifest content often contains features associated with the dreamer’s recent activities.
Analysis of Transference • When the patient-therapist relationship creates a miniature version of the causes of the client’s problems, it is called transference neurosis and becomes the central focus of analytic work
Analysis of Resistance • Client behaviors that interfere with the analytic process are considered signs of resistance against achieving insight.
Making Analytic Interpretations • Through questions and comments about the client’s behavior, free associations, dreams, and the like, the analyst guides the process of self exploration. Thus, if the client shows resistance but also offers an interpretation of what is going on.
HUMANISTIC PSYCHOTHERAPY • Emphasize conscious awareness rather than unconscious conflict • Stress the need for the therapist to seek to understand the experiential worlds of their clients and to communicate that understanding to clients as a way of creating a therapeutic atmosphere and the therapeutic relationship • Stress the importance of clients focusing on their immediate, here-and-now experiences
The goal of the humanistic therapy became to set up the conditions that would enable patients to choose to help themselves, rather than to require a doctor to administer interventions. • Humanistic psychotherapists view humans as creative, growthful beings who, if all goes well, could consciously guide their own behavior towards their fullest potential. • When behavior disorders arise, they are usually seen as stemming from disturbances in awareness or restrictions on existence.
Examples of Humanistic Approaches: • Gestalt therapy • Existential therapy • Focusing-oriented psychotherapy
Themes unifying the goals and techniques associated with humanistic treatments: • humanistic therapists assume that their clients’ lives can be understood only from the viewpoint of those clients. • many humanistic therapists view human beings as naturally good people able to make their own choices and determine their own destinies
humanistic therapists view the therapeutic relationship as the primary vehicle by which therapy achieves its benefits 4. many humanistic therapists emphasize the importance of experiencing and exploring emotions that are confusing or painful
Person-Centered Therapy • developed by Carl Rogers • also called Client-centered therapy/ nondirective counseling • began to take shape after Rogers’ discovery of Otto Rank’s treatment approach: “client…is a moving cause, containing constructive forces within, which constitute a will to health…the therapist as a human being who is the remedy, not his technical skill…” • therapy as an “if…then” proposition: If the correct circumstances are created by the therapist, then the client—driven by an innate potential for growth—will spontaneously improve.
Rogers’ Personality Theory and View of Psychopathology • Phenomenology – teaches that behavior is totally determined by the phenomenal field of the person • Phenomenal field – everything experienced by the person at any given point in time • Phenomenological theory : the basic human urge is to preserve and enhance the phenomenal self
Self – represents the experiences the person recognizes as “me”; includes values, images, memories, behavior patterns and especially current experiences - real self and ideal self - awareness of one’s being and functioning • Self-actualization – refers to the tendency of all human beings to move forward, grow, and reach their fullest potential. • Members of the client-centered movement rely heavily on self-reports as the premiere source of information rather than on inferences from test data/ related observations
The Self and Conditions of Worth • Children’s self-concept, as they grow, develop not in isolation but in the context of relationships with other’s especially parents • Unconditional positive Regard – ideal situation in which parents are successful at communicating their acceptance (if not approval) of all of the child’s behavior and experiences.
Conditions of Worth – when parents communicate disapproval or rejection of some of the child’s behaviors and experiences, the child may experience love as conditional • the child comes to believe that acceptance depends on thinking and acting in certain ways • the ideal self is not immediately experienced as “me” but as what the child believes he/she should be
Incongruence • the discrepancy between the real self and ideal self • the conditions of worth force people to distort their real feelings or experiences
The Goal of Person-Centered Therapy • person-centered therapists do not set treatment goals for their clients instead, clients are free to select their own goals • key aim: to make clients more authentically aware of their moment-to-moment experiences
Unconditional Positive Regard • the therapist cares about the client, accepts the client, and trusts the client’s ability to change • nonpossessive caring: ideal form of unconditional positive regard; genuine positive feelings are expressed in a way that makes the clients feel valued but still free to be themselves • the therapist’s willingness to listen is an important manifestation
Rogerian therapists (patient, warm and interested in what the client has to say) do not interrupt the client or change the subject or give other signs that they would rather be doing something else • Unconditional aspect: therapist’s willingness to accept clients as they are without judging them
Therapist must separate the client’s worth as a person from the worth of the client’s behavior • Positive component: therapist’s trust in the client’s potential for growth and problem solving
Empathy/Empathic understanding • The therapist must try to see the world as the client sees it • Externalframe of reference: therapist’s observation of the client from the outside and applying their values or psychological theories to what the client says • Reflection : serves the purposes of (a) communicating the therapist’s desire for understanding & (b) making clients more aware of their own feelings : involves distilling and playing back the clients feelings : consists of paraphrasing and/or summarizing what a client has just said
Some Therapist Thoughts that Reflect Internal vs. External Frames of Reference
Congruence • The therapist’s feelings and actions should be congruent/ consistent with one another • Refers to the therapist's openness and genuineness—the willingness to relate to clients without hiding behind a professional facade.
The Sequence of Progress Therapy sessions are usually scheduled once a week. More frequent sessions, extra sessions, and phone calls are discouraged since these can lead to dependency. 7 Stages that the Client Undergoes 1. unwillingness to reveal self; own feelings not recognized; rigid constructs; close relationships perceived as dangerous 2. feelings sometimes described but person is still remote from own personal experience
3. still externalizes heavily but begins to show some recognition that problems and conflicts exist 4. free description of personal feelings as owned by the self; dim recognition that long-denied feelings may break into the present; loosening of personal constructs; some expression of self-responsibility; begins to risk relating to others on a feeling basis 5. free expression of feelings and acceptance of them; previously denied feelings, although fearsome, are clearly in awareness; recognition of conflicts between intellect and emotions; acceptance of personal responsibility for problems; a desire to be what one is
6. acceptance of feelings w/o need for denial; a vivid, releasing sense of experience; willingness to risk being oneself in relationships w/ others; trusts others to be accepting 7. individual now comfortable w/ experiencing self; experiences new feelings; little incongruency; ability to check validity of experience
The Nature of Change in Person-Centered Therapy Rogers argued that as clients experience empathy, unconditional positive regard, and congruence in a therapeutic relationship, they become more self-aware and self-accepting, more comfortable & less defensive in interpersonal relationships, less rigid in thinking, more reliant on self-evaluation than on evaluation of others and better able to function in a wide variety of roles.
Case Formulation A person-centered therapist would not be inclined to seek personal/ family history, neither to assign a DSM diagnosis. More important to the therapist is the client’s internal perspective