Psychoanalytic Therapy

Transcription

1 SOCP121 Session 2 Psychoanalytic Therapy Department of Social Sciences Endeavour College of Natural Health endeavour.edu.au 1

2 Psychoanalytic Therapy Session Aim: Introduce students to personality, attachment and human development according to Freud s psychoanalytic theory. Endeavour College of Natural Health endeavour.edu.au 2

3 Psychoanalytic Therapy Learning Objectives: At the end of this session, you should: o Be familiar with developmental models covering childhood, adolescence, and adulthood and how they might relate to a client s presentation in practice. o Be able to describe personality from a Freudian perspective o Develop a basic understanding of some perspectives on human attachment and development Endeavour College of Natural Health endeavour.edu.au 3

4 Psychoanalytic Therapy SIGMUND FREUD I cannot think of any need in childhood as strong as the need for a father's protection (Freud) Neurotics complain of their illness, but they make the most of it, and when it comes to talking it away from them they will defend it like a lioness her young (Freud) Endeavour College of Natural Health endeavour.edu.au 4

5 Introduction to Psychoanalysis A revolutionary approach to understand the mind A model of personality development & a treatment of mental disorders in psychotherapy Key idea: Human behaviour is influenced by the dynamics of the unconscious Emphasis on the role of anxiety How personality develops: through various stages in life As a therapeutic approach: Psychoanalysis believes in bringing the unconscious material to the conscious, focuses on childhood experiences & discussing the past Endeavour College of Natural Health endeavour.edu.au 5

6 Key Figures in Psychoanalysis SIGMUND FREUD ( ) Studied Medicine & graduated from the University of Vienna Dedicated most of his life to the formulation and development of the theory of Psychoanalysis By doing self analysis and exploring the meaning of his dreams, he was able to understand the dynamics of personality development Controversial and rigid in his ideas. He disagreed with collaborators such as Carl Jung and Alfred Adler, and expelled them from the psychoanalytic movement. Jung & Adler funded their own schools. Highly productive: His works fill 24 volumes. Escaped the Nazis in Contracted cancer of the jaw. Died in exile in the UK in Endeavour College of Natural Health endeavour.edu.au 6

7 Sigmund Freud s Research Understanding Psychosomatics Freud noticed that certain disorders such as conversion hysteria (paralysis, blindness, deafness, etc.) had no physical basis He became interested in psychosomatic disorders disorders with no known biological cause As a scientist Freud published papers refuting that psychosomatic disorders had a neurological basis Endeavour College of Natural Health endeavour.edu.au 7

8 Human Development across the Lifespan Continuities and changes in behaviour from infancy through to the last years of life. Life stages are often characterised by key transitions in family, relationships, schooling, work roles, etc. The term stage is used tentatively, because development, is not as strictly characterised by a sequence of time limited experiences as the term implies. Endeavour College of Natural Health endeavour.edu.au 8

9 Life Cycle Transitions As one moves from stage to stage, a life cycle transition is experienced Life cycle transition = Struggles in the process of moving from one stage (biological, psychological or social) and into a new one. Periods of change which often cause conflict and emotional distress. Endeavour College of Natural Health endeavour.edu.au 9

10 Summary of Freud s Stages of Psychosexual Development (1) Freud was a pioneer of the concept that what happens to us in early childhood has profound influence on who we become and how we relate to the world. Consequently he developed a theory of personality development that focused on early childhood Fixation: Excessive gratification or frustration. Overemphasis on psychosexual needs during fixated stage Stage Approx. Age Erogenous Zone Key tasks and experiences Oral Mouth - The mouth is vital for eating, and the infant derives pleasure from oral stimulation - The infant s primary source of interaction occurs through the mouth that s why the rooting and sucking reflex is so important Anal 2-3 Anus Bowel and Bladder control - The infant is entirely dependent upon caretakers - Major conflict at this stage: the weaning process, the child must become less dependent upon caretakers. - If fixation occurs here: the individual would have issues with dependency or aggression. - Oral fixation: can result in problems with drinking, eating, smoking or nail biting. - Major conflict: toilet training the child needs to learn to control bodily needs. Developing this skills leads to a sense of accomplishment and independence - How parents deal with the child s toilet training is crucial. Whether they encourage, praise, punish, ridicule or shame their child for their toilet behaviours will have a direct impact on the child s capacity to become competent, productive and creative. - Anal fixation: if parents are too strict or begin too early with toilet training, the individual might become stringent, rigid, and/or obsessive Endeavour College of Natural Health endeavour.edu.au 10

11 Summary of Freud s Stages of Psychosexual Development (2) Freud was a pioneer of the concept that what happens to us in early childhood has profound influence on who we become and how we relate to the world. Consequently he developed a theory of personality development that focused on early childhood Fixation: Excessive gratification or frustration. Overemphasis on psychosexual needs during fixated stage Stage Approx. Age Erogenous Zone Key tasks and experiences Phallic 4-5 Genitals Children start to discover the differences between male and female (masturbating) Latency 6-12 None (sexual feelings are suppressed) Genital Puberty Onward Genitals (being sexually intimate) Major conflict: Identifying with adult role models and same-sex parent Coping with Oedipus and Electra complexes Fixations at this stage could lead to adult personalities that are overly vain, exhibitionistic and sexually aggressive Expanding social contacts The superego continues to develop while the id s energies are suppressed Children develop social skills, values and relationships with peers and other adults The latent stage represents a time of exploration in which the sexual energy is still present, but it is directed into other areas such as intellectual pursuits and social interactions This stage is crucial in the development of social and communication skills and self-confidence Puberty causes the libido to become active again Establishing intimate relationships; contributing to society through working The goal of this stage is to find a balance between the various areas and demands of life. Endeavour College of Natural Health endeavour.edu.au 11

12 Development Problems The role of conflict o Freudian psychoanalytic views these 3 areas of personal & social development as being grounded in the first 6 years of life. love/trust dealing with negative feelings developing a positive acceptance of sexuality o o These early years are the foundation upon which later personality development is built. Each psychosexual stage is associated with a particular conflict that must be resolved before the individual can successfully advance to the next stage Endeavour College of Natural Health endeavour.edu.au 12

13 Development Problems The role of conflict (2) o The resolution of conflicts encountered in each psychosexual stage requires the expenditure of sexual energy and the more energy that is used at a particular stage the more relevant the characteristics of that stage remain with the individual during psychological development. o Freud presented an analogy to explain this: Think of military troops on the march. As the troops advance, they are met by opposition or conflict. If they are highly successful in winning the battle (resolving the conflict) then most of the troops (libido) will be able to move on to the next battle (stage). However, the greater the difficulty encountered at any particular stage, the greater the need for troops to remain behind to fight and so be able to proceed to the next stage Endeavour College of Natural Health endeavour.edu.au 13

14 Psychosomatic Symptoms Freud s interest in psychotherapy arose from his inability to find a neurological basis for psychosomatic symptoms o Modern medicine is now more holistic acknowledges that the mind can affect the body and vice versa (e.g. biopsychosocial model of illness) o Treating the symptoms may not treat the underlying problem Endeavour College of Natural Health endeavour.edu.au 14

15 Psychosomatic Symptoms (cont.) o So what is a very common cause of psychosomatic symptoms? Stress Psychological Biological Medical Condition Stress; Fear of pain Decreased movement to reduce pain results in deconditioning + more pain; Decreased enjoyable activities Back pain Stress Epinephrine High blood pressure Stress Helicobacter pylori Peptic ulcer Stress Immune reaction? Infection? Irritable Bowel Syndrome Stress/Shyness Opiates, Antinarcotics; Neurological mechanisms? Psychogenic urinary retention (shy bladder) Stress/Worry Physical Sensations Hypochondriasis Endeavour College of Natural Health endeavour.edu.au 15

16 Treating Psychosomatic Conditions Class discussion o Symptoms are real symptom relief can be helpful o BUT Symptom relief alone may not bring long term changes Can create new problems --- foster dependence, hopelessness & increased stress, economic burden, etc. o Does the client need a referral? Needs of practitioner (to provide a service, make an income) vs. (needs of client for immediate relief vs. needs of client for long term relief) o What should the role of a Natural Health therapist? Endeavour College of Natural Health endeavour.edu.au 16

17 Freud: Levels of Consciousness Freud believed that individuals are generally not aware of the underlying reasons for their behavior. He assumed that mental activity must occur at 3 levels: 1. The conscious level 2. The preconscious level 3. The unconscious Endeavour College of Natural Health endeavour.edu.au 17

18 Freud: The Conscious o What a person is thinking or experiencing at any given moment Awareness of the moment Perception in real-time Our conscious thoughts flow as water in a stream Endeavour College of Natural Health endeavour.edu.au 18

19 Freud: The Preconscious o Refers to all of a person s stored knowledge and memories that are capable of being brought up to the conscious level o E.g. if I ask you what your phone number is; you are capable of retrieving it from your preconscious even though you were probably not thinking of your phone number as I began to ask the question Endeavour College of Natural Health endeavour.edu.au 19

20 Freud: The Unconscious o Stores all experiences, memories & repressed material. A vast area of irrational wishes, shameful urges, fears, aggressive feelings, anxiety-producing thoughts that have been repressed. Because these feelings are threatening to us, we keep them in the unconscious mind. Examples that show the unconscious are: slips of the tongue, post-hypnotic suggestions, free association, and dreams. When we dream, these feelings are sometimes released, but generally in a distorted way so we will not recognize them. Endeavour College of Natural Health endeavour.edu.au 20

21 Freud: The Unconscious o Needs and motivations that are inaccessible (out of awareness) are also outside the sphere of conscious control o Unlike later theories which base behaviour on choice, control & will, Freud offers a deterministic model of behaviour which is largely dominated by the unconscious Irrational forces, Unconscious motivations, Biological & Instinctual drives According to Freud, most psychological functioning is unconscious: the aim of psychoanalytic therapy is to make the unconscious motives conscious, for only then can an individual exercise choice. Endeavour College of Natural Health endeavour.edu.au 21

22 Levels of Consciousness CONSCIOUS Thoughts Awareness PRECONSCIOUS UNCONSCIOUS Memories Stored Knowledge Irrational Wishes Fears Shameful Urges Aggressive Feelings Anxiety-Producing Thoughts Sexual Desires Selfish Needs Endeavour College of Natural Health endeavour.edu.au 22

23 Structure of Personality The structure of the personality is related to the levels of consciousness: - The Id - The Ego - The Superego Endeavour College of Natural Health endeavour.edu.au 23

24 The Id Primary source of psychic energy Seat of the instincts (unconscious) Contains basic drives for food, water, sex, warmth.. Lacks organisation, infantile Blind, demanding & insistent Illogical, irrational, amoral No direct contact with reality Ruled by the pleasure principle Major function: reducing tension, avoiding pain, gaining pleasure Endeavour College of Natural Health endeavour.edu.au 24

25 The Ego Emerges with physical maturity Using conscious awareness, it governs controls & regulates the personality Mediates between instincts (demands of the Id) and surrounding environment (pressures of reality) Unlike the Id, the Ego does the thinking Seat of intelligence & rationality checks/controls blind impulses of Id Moderates between the Id & Superego* Endeavour College of Natural Health endeavour.edu.au 25

26 The Superego Unlike the Id the Superego does not strive for instinctual pleasure but rather strives for what is morally right Represents the ideal rather than the real Developed from interaction with parents enables the person to fit in with society Both conscious and unconscious Endeavour College of Natural Health endeavour.edu.au 26

27 Personality Iceberg Endeavour College of Natural Health endeavour.edu.au 27

28 Conflict & Anxiety Id, ego & superego are continually in conflict with one another The more developed the superego, i.e., the more internalised societal values become the greater the conflict. This causes anxiety. Endeavour College of Natural Health endeavour.edu.au 28

29 Normality & Wellbeing No clear division between normal and abnormal functioning Considers how maladaptive the current personality formation (e.g. fixation), underlying anxiety/guilt are (e.g. anxiety from unconscious) Based on whether current functioning affects quality of work/life Endeavour College of Natural Health endeavour.edu.au 29

30 Formation of Maladaptive Symptoms (Drive-Defense Model) Failure of ego Ego is ineffective at moderating between drives of the id, and demands of the superego Symptoms Symptoms help prevent awareness of threatening drive defense against unconscious Primary gain Reduction in anxiety Secondary Gain Enable person to escape from responsibilities; allow person to take dependent/childlike role Endeavour College of Natural Health endeavour.edu.au 30

31 Freud s Ego-Defense Mechanisms Psychological processes that: Either deny or distort reality Operate mainly on an unconscious level Help one cope with anxiety & prevent the ego from being overwhelmed Not pathological - ego-defenses are normal behaviours Can have adaptive value if they do not become a style of life to avoid facing reality Defenses used depend on the person s level of development and degree of anxiety Endeavour College of Natural Health endeavour.edu.au 31

32 Defense Mechanisms - Repression o This is a major defense mechanism o Threatening or painful thoughts & feelings are excluded (repressed) from awareness o Involuntary process o Early painful life events are repressed yet these events do influence later behaviour e.g. Repressing childhood abuse, repressing loss of a loved one e.g. A traumatized soldier has no recollection of the details of a close brush with death. Endeavour College of Natural Health endeavour.edu.au 32

33 Defense Mechanisms - Denial o Unlike repression, denial works at the conscious level o Denial of reality is one of the simplest of all the self-defense mechanisms o Distortion of the individual s thoughts, feelings or perception in a traumatic situation o Defending against anxiety by closing one s eyes to the existence of the threat e.g. A person learning that they have a chronic illness may use denial to distort the reality and lessen the anxiety. (Non acceptance) Endeavour College of Natural Health endeavour.edu.au 33

34 Defense Mechanisms - Projection o Attributing one s own unacceptable desires & impulses onto others o Displacing these shadow aspects of one s behaviour onto others in an attempt to lower one s anxiety o Believing that the other possesses these undesirable aspects rather than oneself e.g. Anger with a partner. Someone may be angry with a partner and in an attempt to minimise the anxiety associated with that anger, projects this onto the other person, identifying them as the angry person. Endeavour College of Natural Health endeavour.edu.au 34

35 Defense Mechanisms - Introjection o Opposite of projection o Internalisation of the beliefs, ideas and values of others without first checking if they are congruent with one s own beliefs, etc. o This could relate to, for instance, politics, religion or other social values/standards. e.g. a person could introject religious cult ideas, beliefs, values when they don t match their own beliefs or when their own beliefs are non-existent. Endeavour College of Natural Health endeavour.edu.au 35

36 Defense Mechanisms - Displacement o Reduces anxiety by altering (displacing) the object of the impulse o Discharging impulses by shifting from a threatening object to a safer target o Directing energy toward another object or person when the original object or person is inaccessible e.g. An employee intimidated by his/her boss comes home and displaces (unloads) inappropriate hostility onto this/her partner, children, pets, neighbours, onto property (fist through door) Endeavour College of Natural Health endeavour.edu.au 36

37 Defense Mechanisms - Rationalisation o Manufacturing good reasons to explain away a bruised ego. o Helps justify behaviours, softens the blow connected with disappointments. e.g. A client did not get the job they applied for. They think of logical reasons why they did not succeed and try to convince themselves that they did not want the job anyway. e.g. A student watches TV instead of studying, saying that additional study wouldn t do any good anyway. Endeavour College of Natural Health endeavour.edu.au 37

38 Defense Mechanisms - Regression o Reverting to a form of behaviour that a person has outgrown: an earlier phase of development where the demands are not so great. o Occurs often in times of severe stress or extreme challenge. e.g. An adolescent feeling insecure may revert to more childish speech mannerisms (tone of voice, topic of conversation, non-verbal behaviour). e.g. An adult has a temper tantrum when they don t get their own way. Endeavour College of Natural Health endeavour.edu.au 38

39 Defense Mechanisms - Identification o Mental operation where one attributes to oneself, either consciously or unconsciously, the characteristics of another person or group. o Used to enhance self-worth and protect one from a sense of being a failure. e.g. A person who feels inferior may seek and identify with a person of affluence and power in an attempt to boost their self-esteem and sense of worth. e.g. An insecure young person joins a fraternity to boost their self-esteem. Endeavour College of Natural Health endeavour.edu.au 39

40 Freud s Ego Defense Mechanisms o Please visit the following web page. Have fun with the mock test and check your understanding of the defense mechanisms: Can you identify these defense mechanisms? Endeavour College of Natural Health endeavour.edu.au 40

41 Psychodynamic Therapeutic Goals To strengthen the ego as the reality principle of the personality (as opposed to the id instincts - and superego conscience), through the process of uncovering unconscious material. To help clients: Have more freedom to love, work, and play Achieve self-awareness and honesty Find better ways of dealing with anxiety and relationship problems Endeavour College of Natural Health endeavour.edu.au 41

42 Psychodynamic Therapeutic Goals Restoration through Anxiety Reduction Client develops maladaptive behaviours due to anxieties Client possesses many ways to reduce anxiety (defense mechanisms) and when these fail client uses illness as a defence To cure illness, need to pull anxieties from the unconscious to the conscious and help the patient beyond the blockage. Endeavour College of Natural Health endeavour.edu.au 42

43 Therapeutic Process Therapist Function and Role A more passive approach, maintaining an anonymous or blank screen approach, using very little self-disclosure, i.e., remaining neutral to help foster transference (bring the client s projections onto the therapist). Whatever the client feels towards the therapist will largely be the product of feelings associated with other significant people from the past e.g. A client s anger is expressed onto the therapist. This is reflective of their unfinished business and anger associated with their parent. Create a therapeutic environment which allows the client the opportunity to speak openly so that unconscious or repressed material can be uncovered Endeavour College of Natural Health endeavour.edu.au 43

44 Therapeutic Process Therapist Function and Role (cont.) o After establishing rapport the therapist s function is largely listening & interpreting. o Attention given to resistances. A client may resist (deny, avoid, minimise, divert) their anger. o Role includes: listening for gaps & inconsistencies in the client s story offering the meaning of reported dreams & free associations remaining sensitive to clues regarding the client s feelings towards the therapist. Endeavour College of Natural Health endeavour.edu.au 44

45 Therapeutic Techniques/Procedures The 6 basic techniques are: 1. Maintaining the analytic framework 2. Free association 3. Interpretation 4. Dream analysis 5. Analysis of resistance 6. Analysis of transference Endeavour College of Natural Health endeavour.edu.au 45

46 Maintaining the Analytic Framework o Refers to procedural and stylistic factors o Therapist assumes an anonymous stance o The regularity & consistency of meetings Endeavour College of Natural Health endeavour.edu.au 46

47 Free Association o This technique is used to uncover unconscious material. The therapist asks the client to respond with the first word that comes to mind e.g. A season like Spring Response might be flowers, warm weather, grass growing, love. e.g. A colour like yellow or black Endeavour College of Natural Health endeavour.edu.au 47

48 Interpretation o Explaining, Suggesting, Teaching the meanings of behaviour that is manifested in dreams, free associations, resistances and the therapeutic relationship itself. e.g. The therapist suggests to a client that their dream of drowning could relate to feeling overwhelmed by an unrealised emotional burden. Endeavour College of Natural Health endeavour.edu.au 48

49 Dream Analysis o Involves uncovering the hidden/ latent content of dreams which may not be apparent to the dreamer. e.g. A client describes a dream where the wedding plans are disorganised, chaotic & problematic. The therapist analyses the dream enquiring whether there may be some concern or anxiety about getting married. Endeavour College of Natural Health endeavour.edu.au 49

50 Analysis & Interpretation of Resistance o During therapy, the client may evidence an unwillingness to relate certain thoughts/feelings & experiences, a certain unwillingness to change. o Resistance can be related to the client s defense against anxiety that would arise if they were to become aware of their repressed impulses or feelings. As a defense against anxiety, resistance operates specifically in psychoanalytic therapy to prevent clients and therapists from succeeding in their joint effort to gain insights into the dynamics of the unconscious. Resistances are designed to protect individuals against anxiety and fear of change (Corey, 2013, p. 81) Endeavour College of Natural Health endeavour.edu.au 50

51 Analysis & Interpretation of Resistance o Therapist s interpretation is aimed at helping clients become aware of the reasons for the resistance so that they can deal with them. e.g. A client free associates or talks about their disgust about bullying & physical abuse. The therapist works with the client to facilitate exploring the strength of their feelings about bullying and physical abuse. The client may be resistive based on their own personal history. Endeavour College of Natural Health endeavour.edu.au 51

52 The concept of Secondary Gain A secondary gain can be understood as the benefits people get from NOT changing and not overcoming an emotional issue. According to Freud, it is considered the reason why neurotic symptoms are so difficult to give up. For many people who feel stuck in any emotional experience, secondary gains are an important mechanism in why they stay stuck. Endeavour College of Natural Health endeavour.edu.au 52

53 The concept of Secondary Gain Secondary gains are often unconscious, people are not aware of them e.g.: a person might not be manipulative in a conscious way, or faking a distress/anxiety/illness. They are often real. The secondary gain does not mean the problem is positive for the person, just that there are some benefits to it. The unhelpful behaviour or illness, DOES serve a purpose, meet a need, and is emotionally fitting, somehow Endeavour College of Natural Health endeavour.edu.au 53

54 The concept of Secondary Gain Class discussion (Option 1) o o It s common to assume that a client wants to get better Freud pointed out that an illness can provide some secondary gains, beyond reducing psychic anxiety Perks of being ill, such as special favours or treatment, sympathy, being cared for and looked after, positive attention, an excuse not to do things they don t want to do, etc. Or dependence on being ill, including emotional, physical, and financial dependence o o How might these lead to resistance to treatment? How would you, as a practitioner, overcome this resistance? Endeavour College of Natural Health endeavour.edu.au 54

55 The concept of Secondary Gain Class activity (Option 2) o Please watch this video of an NLP therapist applying the Freudian concept of Secondary Gain in a way that it s easy to relate to your own daily experiences. Share your thoughts and comments with the rest of the class afterwards, please Endeavour College of Natural Health endeavour.edu.au 55

56 The Client/Therapist Relationship Transference & Counter-Transference Transference: The client s unconscious shifting to the analyst of feelings and fantasies that are reactions to significant others in the client s past. It involves the unconscious repetition of the past in the present. It reflects, the deep patterning of old experiences in relationships as they emerge in current life (Corey, 2009, p. 71). This process represents the core of the relationship, where the client transfers emotions about past and present significant people in his/her life, onto the therapist. Counter-transference: The therapist s reactions to clients that are based on his or her unresolved conflicts (Corey, 2009, p. 73). It is the process where client s issues cause unconscious conflicts in the therapist which may be transferred onto the client and cause the therapist to lose objectivity in the counselling process. Endeavour College of Natural Health endeavour.edu.au 56

57 Analysis & Interpretation of Transference o Clients often react (transfer) to their therapist as they did to a significant person. o Interpretation of the transference relationship enables clients to work through old conflicts that are keeping them fixated and retarding their emotional growth. e.g. The client has a domineering parent and often reacts to the therapist in the same passive way that they related to that parent. o This allows the client to have greater self-awareness and provides opportunity for choices/ways to change. Endeavour College of Natural Health endeavour.edu.au 57

58 Psychoanalytic Therapy Contributions Freudian structure of Personality: Id, Ego, SuperEgo The first comprehensive theory of personality - that could explain behavior - and an structured method for psychotherapy Concepts of the conscious, preconscious and unconscious An approach that help us understanding resistances (such as a client frequently cancelling appointments, terminating therapy suddenly or not willing to take responsibility and self reflection) Provided an understanding of the role of transference and countertransference between client and therapist Explained the possible reasons behind the overuse of ego defense mechanisms Explained how most adulthood problems might be related to early childhood/developmental difficulties Recommended to those who want to understand underlying roots of problems Endeavour College of Natural Health endeavour.edu.au 58

59 Psychoanalytic Therapy Some Limitations Time consuming: a therapy that requires a long time commitment Costly Limited availability of highly trained psychoanalytic therapists Limited applicability to diverse client populations Questionable (and unmeasurable) benefits Anonymous role of the therapist a blank screen Feminists criticism: the emphasis on the role of the motherchild relationship in determining dysfunctional behavior. Mother are seen as the main responsible for deficiencies in early development. According to some critics, psychoanalytical therapy is irrelevant to contemporary society. Only appropriate to elite, highly educated clients. Endeavour College of Natural Health endeavour.edu.au 59

60 Revision Questions o o o o o How do humans develop and their needs change over the lifecycle, and how might this affect treatment? Define the id, the ego and the superego. What are some potential issues that might interfere with the relationship between client and therapist (transference, countertransference)? What are some common barriers which may interfere with clients moving from their current position to a state of higher wellbeing (defense mechanisms)? What does Freud say about the unconscious? Why is so important in our behaviour and health outcomes? Endeavour College of Natural Health endeavour.edu.au 60

61 References Corey, G. (2015). Theory and practice of counselling and psychotherapy (10 th ed.). Boston, MA: Brooks Cole Cengage Learning. Sandler, J., Dare, C. & Holder, A. (1992). The patient and the analyst: The basis of the psychoanalytic process (2 nd ed.). London: Karnac. Wolitzky, D.L. (1995). The Theory and Practice of Traditional Psychoanalytic Psychotherapy. In A.S. Gurman & S.B. Messer (Eds.), Essential Psychotherapies. New York: Guilford Press. Endeavour College of Natural Health endeavour.edu.au 61