ACCPH Psychoanalytical and Psychodynamic Therapies

Transcription

1 ACCPH Psychoanalytical and Psychodynamic Therapies

2 Psychoanalytical and Psychodynamic Therapies Psychoanalytical and psychodynamic therapies are based on an individual's unconscious thoughts and perceptions that have developed throughout their childhood, and how these affect their current behaviour and thoughts. Jungian Therapy Jungian therapy - or Jungian analysis as it is also known - is a psychoanalytic approach that was developed by leading psychotherapist, Carl Gustav Jung. Along with Freud, Jung is considered one of the pioneers psychology, particularly of the unconscious mind. Jung worked with Freud but they parted due to different theories. Freud asserted that dreams and the unconscious are personal things contained within an individual. Jung believed that the personal unconscious is just part of a much deeper and difficult to control unconscious. This is the inherited part of the human psyche which consists of archetypes common to all humans. To Jungian these archetypes explain why we have habits (addictions), depression and anxiety. To understand the human self we have to analyse these archetypes. Jungian Archetypes The main concept of Jungian psychotherapy is understanding the relationship between the individual and their psyche. Therefore the unconscious archetypes - need to be recognised and understood in the conscious. Jung asserted that the archetypal expectations would collide with real world experiences. This may cause internal conflict through as the ego would try to defend itself. Jung said that the ego must be free from these 'complexes' for someone to lead a fulfilling and meaningful life. Jung identified four major archetypes in all humans.

3 The self - is the unification of the unconscious and conscious parts of the mind and is the central governing archetype of the human psyche. The creation of self is to live life to the full and be true to yourself. Jung called this instinctual process 'individuation'. He also believed when in this state the person could be free of complexes. Jungian therapy to help people to gain individuation. The shadow - is comprised of our repressed darker ideas, instincts, weaknesses faults and desires. Jung believed these are found in all human beings and appear in our dreams; often appearing as a animal or particular event. They often reveal deeper thoughts and/or fears. Some people do not want to accept these as part of themselves so project their shadow onto others. In Jungian analysis, they are encouraged to integrate the shadow and the real self into one. The persona - refers to how we show ourselves to the outside world. This is usually good impression we create but not the real self. For some it is a version of ourselves that we use to manipulate other people. Some people can become confused an think their persona is their true self. Jungian therapy helps people to separate the two. The persona then becomes a distant part of the collective unconscious. The Anima/Animus These are the second most prevalent archetypes. Whilst the anima represents the 'feminine' qualities of the male psyche, the animus represents the 'masculine' qualities in women. Jungian analysis assumes that all men have feminine components in their psyche and vice versa. It is also believed that these archetypes are representations of our true selves - the route to our souls - and the source of all our creativity. It has always been accepted that these archetypes should be suppressed. Men are socially conditioned to curb their femininity and women are told masculine qualities are unattractive. Jungian theory states this will lead to inner conflicts and it aims to help individuals accept their anima/animus - uniting their unconscious and conscious - to help them feel whole. The Jungian therapy method Jungian therapy is a talking therapy, but there are various methods of exploration used throughout the process. Below are some of the common techniques a Jungian therapist will use: Dream analysis According to Freud the analysis of dreams is the royal road to the unconscious. He argued that the conscious mind is like a censor, but it is less vigilant when we are asleep. As a result repressed ideas come to the surface though what we remember may well have been altered during the dream process.

4 As a result we need to distinguish between the manifest content and the latent content of a dream. The former is what we actually remember. The latter is what it really means. Freud believed that very often the real meaning of a dream had a sexual significance and in his theory of sexual symbolism he speculates on the underlying meaning of common dream themes. Word association (free association test) A simple technique of psychodynamic therapy is free association in which a patient talks of whatever comes into their mind. This technique involves a therapist reading a list of words (e.g. mother, childhood etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that fragments of repressed memories will emerge in the course of free association. Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking. On the other hand, the presence of resistance (e.g. an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for. Freud reported that his free associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This is like a "flashback" from a war or a rape experience. Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it would be called a catharsis. Frequently, these intense emotional experiences provided Freud a valuable insight into the patient's problems. Creative activities Jungian therapy often includes; dream journaling, painting, music, drama, dance, sand playing or other creative activities. Jung believed that self-expression help people to engage their active imagination and release inner creative qualities that are inhibited by social values.

5 Psychoanalysis Psychoanalysis focuses on a person's unconscious and deep-rooted thoughts. The concept is that what we do, think and feel is directly influenced by our childhood and past experiences. These can become repressed and manifest as depression or other negative problems. Developed by Sigmund Freud, it is used to help clients understand how these unconscious factors affect them in the present. Clients can learn how to interpret buried and complex memories or experiences and work through them to lead a better and happier life. It is usually very long-term therapy and requires a significant amount of commitment from the client. Clients are usually required to attend regular sessions for several years - depending on their individual needs and personal circumstances. Regular sessions allow for in-depth exploration and interpretation of these unconscious patterns. It is the delivery time frame that sets psychoanalysis apart from psychoanalytic and psychodynamic therapies - two branches of counselling which share similarities in approach but are generally short-term. How does psychoanalysis work? There are four key assumptions that guide the process of psychoanalysis: Psychological problems are rooted in the unconscious mind. Manifest symptoms are the result of latent (hidden) disturbances. Unresolved issues or repressed trauma are typical causes. Treatment is designed to bring the repressed conflict into consciousness, so a client can make the necessary changes to overcome them. A core process of psychoanalysis is "transference". Transference takes place when the client freely talks about his/her feelings and thoughts towards important people in their life - essentially living out his/her unconscious dynamics through the connection to the therapist. As their difficulties gradually begin to appear, the therapist helps to clarify them. In turn, the client refines, corrects, rejects or adds further thoughts and feelings. Over the course of therapy the client and therapist will collaboratively analyse these insights - a process which creates a real-time sense of the client's unconscious dynamics. Eventually the client will be able to start modifying life patterns and removing limiting symptoms.

6 Methods used in psychoanalysis A range of techniques will be employed in psychoanalysis to enable the client and therapist to interpret and make sense of deeply buried memories and experiences that are expressed during therapy. Dream analysis According to Freud the analysis of dreams is the royal road to the unconscious. He argued that the conscious mind is like a censor, but it is less vigilant when we are asleep. As a result repressed ideas come to the surface though what we remember may well have been altered during the dream process. As a result we need to distinguish between the manifest content and the latent content of a dream. The former is what we actually remember. The latter is what it really means. Freud believed that very often the real meaning of a dream had a sexual significance and in his theory of sexual symbolism he speculates on the underlying meaning of common dream themes. Word association A simple technique of psychodynamic therapy is free association in which a patient talks of whatever comes into their mind. This technique involves a therapist reading a list of words (e.g. mother, childhood etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that fragments of repressed memories will emerge in the course of free association. Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking. On the other hand, the presence of resistance (e.g. an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for. Freud reported that his free associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This is like a "flashback" from a war or a rape experience. Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it would be called a catharsis. Frequently, these intense emotional experiences provided Freud a valuable insight into the patient's problems. Projective tests In some cases, psychoanalysts will present clients with a series of abstract images, and will invite them to explain what they see, or create a story based on the images. Freud believed this technique allows the unconscious to become conscious - helping clients to unlock their inner thoughts and desires. A

7 common projective test used in psychoanalysis today is the blot test. Invented by Hermann Rorschach in 1928 this involves ten specially-designed ink blot images. Para praxes 'Freudian slips' On the surface, slips of the tongue may be viewed as simple mistakes or accidents. In a psychoanalytic sense, however, they are symbols that have much deeper personal significance. Freud believed that when a person utters something other than what they really intended to say, it is no accident but rather their unconscious thoughts which have broken through the censorship of the mind and emerged into consciousness. For example, a woman who calls her boyfriend by an ex s name might be viewed as secretly desiring her ex, while a person who mistakenly refers to President Obama as President Osama might be viewed as harbouring negative feelings toward him. Although slips of the tongue are the errors most popularly believed to carry hidden meanings, Freud s original use of the term para praxis included a wider range of mistakes in daily behaviour errors in reading and writing, forgetting someone s name, mislaying an object, or failing to perform a particular action. Freudian slips, however, are the most commonly occurring form of para praxis and are often used as a source of humor in movies and television shows. The following video clip shows a set of Freudian slips that actually occurred on live television. As you will see, these slips are often sexual in nature but who would expect anything less of a phenomenon associated with Freud? Who can benefit from psychoanalysis? The therapy can help clients of all ages and can even benefit those who are just curious to know a bit more about themselves and how their mind works. Essentially though, it is for people who have concerns that interfere with the way they want to live their lives. Psychoanalysis allows them to address their internal conflicts and increase self-understanding and freedom from latent thoughts and patterns of behaviour that are limiting life satisfaction.

8 Psychoanalytic therapy Psychoanalytic or psychodynamic psychotherapy draws on theories and practices of analytical psychology and psychoanalysis. It is a therapeutic process which helps patients understand and resolve their problems by increasing awareness of their inner world and its influence over relationships both past and present. It differs from most other therapies in aiming for deep seated change in personality and emotional development. Psychoanalytic and psychodynamic psychotherapy aim to help people with serious psychological disorders to understand and change complex, deep-seated and often unconsciously based emotional and relationship problems thereby reducing symptoms and alleviating distress. However, their role is not limited only to those with mental health problems. Many people who experience a loss of meaning in their lives or who are seeking a greater sense of fulfilment may be helped by psychoanalytic or psychodynamic psychotherapy. Sometimes people seek help for specific reasons such as eating disorders, psychosomatic conditions, obsessional behaviour, or phobic anxieties. At other times help is sought because of more general underlying feelings of depression or anxiety, difficulties in concentrating, dissatisfaction in work or inability to form satisfactory relationships. It may benefit adults, children, and adolescents. It can help children who have emotional and behavioural difficulties which are evident at home or school. These can include personality problems, depression, learning difficulties, school phobias, eating or sleeping disorders. Psychoanalytic or psychodynamic psychotherapy provides an effective treatment for a range of psychological disorders, both as a treatment in its own right and as an adjunct to other forms of treatment. It can contribute significantly to patient's mental and physical health, to their sense of well-being and to their ability to manage their lives more effectively. Whether psychoanalytic or psychodynamic psychotherapy is the treatment of choice for a particular individual depends on a variety of factors. It is often helpful to have one or more preliminary consultations with an experienced psychotherapist before deciding whether psychoanalytic psychotherapy is an appropriate treatment for the person concerned. Occasionally, the treatment might be of short duration but generally speaking psychoanalytic psychotherapy is best considered as a long-term treatment involving considerable commitment for both patient and therapist. The relationship with the therapist is a crucial element in the therapy. The therapist offers a confidential and private setting which facilitates a process where unconscious patterns of the patient's inner world become reflected in the patient's relationship with the therapist (transference). This process helps patients gradually to

9 identify these patterns and, in becoming conscious of them, to develop the capacity to understand and change them. Assumptions of psychoanalytic therapy Psychoanalysts work on the following assumptions: Psychological problems are rooted in the unconscious. Manifest symptoms are caused by hidden or 'latent' disturbances. Typical causes for psychological upset include unresolved issues during development or repressed trauma. Treatment looks to bring repressed conflicts to the surface where individuals can deal with it. By working through and understanding conflicts, this type of therapy aims to change the participant on a deeper level. How does psychoanalytic therapy work? The psychoanalyst will listen to your concerns and look out for patterns or certain events that may hold significance. In this type of therapy it is believed that unconscious feelings and childhood events play a key role in mental distress. As well as listening to you discuss your experiences, your therapist may use other techniques to help identify potential causes for your concerns. Such techniques may include: Word association A simple technique of psychodynamic therapy is free association in which a patient talks of whatever comes into their mind. This technique involves a therapist reading a list of words (e.g. mother, childhood etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that fragments of repressed memories will emerge in the course of free association. Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking. On the other hand, the presence of resistance (e.g. an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for. Freud reported that his free associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This

10 is like a "flashback" from a war or a rape experience. Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it would be called a catharsis. Frequently, these intense emotional experiences provided Freud a valuable insight into the patient's problems. Therapeutic transference In a therapy context, transference refers to redirection of a patient's feelings for a significant person to the therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status. When Freud initially encountered transference in his therapy with patients, he thought he was encountering patient resistance, as he recognised the phenomenon when a patient refused to participate in a session of free association. But what he learned was that the analysis of the transference was actually the work that needed to be done: "the transference, which, whether affectionate or hostile, seemed in every case to constitute the greatest threat to the treatment, becomes its best tool". The focus in therapy is the therapist and patient recognising the transference relationship and exploring the relationship's meaning. Interpretation A key element of psychoanalytic therapy is interpreting and 'reading between the lines'. While your therapist is likely to stay relatively quiet and allow you to talk freely, they will occasionally interject with thoughts or interpretations of the topics you discuss. Your psychoanalyst may also ask you about your dreams; Freud wrote a lot on the subject of dream analysis and believed that dreams were important resources for understanding the unconscious. Applications of psychoanalytic therapy Psychoanalytic therapy can be used by those with a specific emotional concern as well as those who simply want to explore themselves. Understanding why we are the way we are often brings with it a sense of well-being and a stronger sense of self. As psychoanalytic therapy is considered one of the more long-term therapy types, it is perhaps less useful for those seeking quick, solution-focused therapies.

11 Psychoanalytic therapy is a gradual process that takes time, however the results can be life changing. Some believe due to the nature of the therapy, psychoanalytic work is better suited to more general concerns such as anxiety, relationship difficulties, sexual issues or low self-esteem. Phobias, social shyness and difficulties sleeping are further examples of areas that could be addressed within psychoanalytic therapy. Critics have pointed out that the therapy may not be as useful to those with more specific or obsession-based concerns such as obsessive compulsive behaviour, as you may be too concerned by your actions to participate fully.

12 Psychodynamic therapy Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. In this way, it is similar to psychoanalysis. It also relies on the interpersonal relationship between client and therapist more than other forms of depth psychology. In terms of approach, this form of therapy uses psychoanalysis adapted to a less intensive style of working, usually at a frequency of once or twice per week. Principal theorists drawn upon are Freud, Klein and theorists of the object relations movement, e.g. Winnicott, Guntrip, and Bion. Some psychodynamic therapists also draw on Jung or Lacan. It is a focus that has been used in individual psychotherapy, group psychotherapy, family therapy, and to understand and work with institutional and organisational contexts. In psychiatry, this is considered a treatment of choice for adjustment disorder, as well as posttraumatic stress disorder (PTSD). Whilst it shares the same core principles of psychoanalysis, psychodynamic counselling is typically far less intensive - focusing primarily on immediate problems and attempting to find a quicker solution. It does however tend to provide the same benefits - helping people with a range of psychological disorders to make significant changes to how they make decisions and interact with others. How does psychodynamic therapy work? Although psychodynamic psychotherapy can take many forms, commonalities include: An emphasis on the centrality of intra-psychic and unconscious conflicts, and their relation to development. Seeing defences as developing in internal psychic structures in order to avoid unpleasant consequences of conflict. A belief that psychopathology develops especially from early childhood experiences. A view that internal representations of experiences are organized around interpersonal relations. A conviction that life issues and dynamics will re-emerge in the context of the client-therapist relationship as transference and counter-transference. Use of free association as a major method for exploration of internal conflicts and problems. Focusing on interpretations of transference, defence mechanisms, and current symptoms and the working through of these present problems.

13 Trust in insight as critically important for success in therapy. In order to help the client understand what their unconscious disturbances are and how their mind works, psychodynamic therapists will draw on similar techniques used in psychoanalysis and psychoanalytic therapy. These are listed below: Free association, Therapeutic transference, Interpretation (See text on earlier pages) Ultimately, it is up to the therapist to help clients learn new patterns of behaviour and ways of thinking that promote personal development and growth - helping them to overcome any limitations caused by unconscious feelings. Generally this process tends to be quick and solution-focused, and sessions will take place once a week, lasting for around 50 minutes. Psychodynamic therapy seeks to resolve more immediate problems. Short-term psychodynamic therapy The healing and change process envisioned in long-term psychodynamic therapy typically requires at least 2 years of sessions. This is because the goal of therapy is often to change an aspect of one's identity or personality or to integrate key developmental learning missed while the client was stuck at an earlier stage of emotional development. Practitioners of brief psychodynamic therapy believe that some changes can happen through a more rapid process or that an initial short intervention will start an ongoing process of change that does not need the constant involvement of the therapist. A central concept in brief therapy is that there should be one major focus for the therapy rather than the more traditional psychoanalytic practice of allowing the client to associate freely and discuss unconnected issues. In brief therapy, the central focus is developed during the initial evaluation process, occurring during the first session or two. This focus must be agreed on by the client and therapist. The central focus singles out the most important issues and thus creates a structure and identifies a goal for the treatment. In brief therapy, the therapist is expected to be fairly active in keeping the session focused on the main issue. Having a clear focus makes it possible to do interpretive work in a relatively short time because the therapist only addresses the circumscribed problem area.

14 Who can benefit from psychodynamic therapy? The psychodynamic approach is designed to help individuals with a wide range of problems, but tends to be most effective in treating more specific issues such as anxiety disorders (i.e. phobias and obsessive compulsive disorders). There does however tend to be a certain type of individual who responds particularly well to psychodynamic therapy.