Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 2. Psychoanalytic Therapies

2. A Sketch of Sigmund Freud • 1856 -1939 • MD from University of Vienna in 1891 • Trained in neurology • Founder of psychoanalysis • Vienna Psychoanalytic Society • A prolific pioneer in multiple areas • Probable case of physician-assisted suicide

3. Theory of Personality • Topographic • Dynamic • Genetic • Economic • Structural • Adaptive

4. Theory of Psychopathology A conflict model • Largely at unconscious level • Motivating forces are Eros & Thanatos • Conflicts lead to defense mechanisms • Type of defense mechanisms are dependent on psychosexual stage

5. Psychosexual Stages • Oral stage (birth - 18 months) • Anal stage (18 months - 3 years) • Phallic stage (3 - 6 years) • Latency stage (6 years & up) • Genital stage

6. Therapeutic Processes Primarily Consciousness Raising • Free association • Confrontation & clarification • Interpretation • Working through Other Change Processes

7. Therapeutic Content Intrapersonal Conflicts • Anxieties & defenses • Self-esteem • Responsibility Interpersonal Conflicts • Intimacy & sexuality • Communication • Hostility • Control

8. Therapeutic Content (cont.) Indivduo-Social Conflicts • Adjustment versus transcendence • Impulse control Beyond Conflict to Fulfillment • Meaning of life • Ideal individual

9. Therapeutic Relationship 3 interrelated components • Working alliance • Transference • Countertransference

10. Practicalities of Psychoanalysis • 99% of analysts & 90% of psychoanalytic therapists have undergone personal therapy • Analysts see analysands between 3 to 5 times a week • Classical analysis lasts 3 to 4 years

11. A Major Alterative: Psychoanalytic Psychotherapy Anna Freud (1895-1982) • Expanded and systematized understanding of defense mechanisms • The Ego & the Mechanisms of Defense Franz Alexander (1891-1963) • Corrective emotional experience

12. A Major Alterative:Lacanian Analysis • Jacques Lacan (1901-1981) • Variable session lengths • Rejection of countertransference, Jouissance • “Return to Freud” • Human psyche • The Imaginary • The Symbolic • The Real

13. A Major Alternative: Relational/Intersubjective Model • Transference is an interactive process between patient & therapist • Accept countertransference as source of information • Focus on desires, not only sexual or aggressive drives • Locus of change is between people, not inside patient’s mind • More concerned & active therapist stance

14. Effectiveness of Psychoanalytic Therapies • Many clinical surveys, entailing retrospective, uncontrolled studies in naturalistic settings • Psychoanalytic goals not particularly amenable to quantification • No RCT’s on classical, relational psychoanalysis, or Lacanian analysis • Several controlled outcome studies on long-term psychoanalytic psychotherapy • Psychoanalysis has proven more effective than credible placebo therapy

15. Criticisms of Psychoanalysis • From a Cognitive-Behavioral Perspective (dearth of controlled research, too subjective and unscientific) • From an Existential Perspective(too theoretically objective, dehumanizing) • From a Cultural Perspective (neglects social context, too much focus on intrapsychic, sexist) • From an Integrative Perspective (outdated, inflexible, ineffective)

16. Freud’s Legacy • Unconscious is alive & powerful • Origins of many behavioral disorders are rooted in childhood • Humans are in internal conflict & tend to produce compromise solutions • Mental representations of self & relationships profoundly impact our daily functioning

17. Future Directions • Is psychoanalysis dead? • Future is probably psychoanalytic therapy, not psychoanalysis Future is… • Interpersonal • Integration

18. Key Terms anal personality anal stage analysand castration anxiety compromise formation corrective emotional experiencing countertransference defense mechanisms denial displacement dynamic view fixation free association genetic view genital personality genital stage the Imaginary, the Symbolic, the Real incorporation insight instincts intellectualization interpretation Intersubjective Jouissance Lacanian analysis latency stage latent content manifest content meta-analysis neuro-psychoanalysis neurosis oedipal conflict

19. Key Terms (cont’d) oral personality oral stage phallic personality phallic stage primal anxiety primary-process thinking projection psychic determinism psychoanalysis psychoanalytic therapy psychosexual stages reaction formation relational psychoanalysis resistance secondary-process structural change structural view sublimation transference transference neurosis unconscious undoing working alliance working through

20. Recommended Websites • American Psychoanalytic Association: www.apsa.org, www.apsa.org/content/teaching-psychoanalysis • APA Division of Psychoanalysis: www.apadivisions.org/division-39/ • International Association for Relational Psychoanalysis and Psychotherapy: www.iarpp.net/ • Sigmund Freud and the Freud Archives: www.freudarchives.org • World Association of Psychoanalysis (Lacanian): www.wapol.org/en/Template.asp