Tuesday, 11 November 2014

Psychoanalytic Psychotherapy

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Psychoanalytic Psychotherapy

Psychoanalytic Psychotherapy is a treatment approach that uses psychoanalytic theory (theories and work of Sigmund Freud who founded the school of thought known as psychoanalysis) for formulation and understanding of the therapy process. Psychoanalytic therapy seeks to understand how early childhood experiences and repressed unconscious thoughts and feelings influence current behavior manifested within the relationship between therapist and patient. Therapy sessions occur once a week.
The efficacy of psychoanalytic psychotherapy has been well documented and it is considered a powerfully curative treatment.
Clinicians who practice psychoanalytic psychotherapy have extensive training.
Many of the known notable theories developed until now originated from Psychoanalysis (Sharf, 2008, p.21). Some of Freud's students deviated from his approach and initiated their own theories, keeping part of the psychoanalytical view, while others completely refused Freud's concepts, building their theories in the opposite way (Sharf, 2008, p.21). Following or rejecting, until these days “we all warm our hands in Freud's fires” (Prochaska, & Norcross, 2010, p.52).

Sigmund Freud was an Austrian neurologist who developed the Psychoanalytic theory of personality (Prochaska, & Norcross, 2010, p.21) and he was the first to state that talking therapy can change the structure of the brain (Rossouw, 2001). He was a genius far ahead of his time.

Freud described his theory of personality in six different aspects encompassing, in part, the following concepts (Prochaska, & Norcross, 2010, p.22). He argued that humans have inherent unconscious “instincts” (Sharf, 2008, p.33) called “eros” (Sharf, 2008, p.33) and “thanatos” (Sharf, 2008, p.33). “Eros” (Sharf, 2008, p.33) produce an energy called “libido” (Sharf, 2008, p.33) and are the forces that drive individuals to seek self-preservation, life and sexual expression (Sharf, 2008, p.33). “Thanatos” (Sharf, 2008, p.33) are aggressive “instincts” (Sharf, 2008, p.33) which drive people to death (Sharf, 2008, p.33). Within the structure of the personality, there is a constant unconscious battle among these unconscious impulses coming from the “id” (Sharf, 2008, p.33), requiring immediate pleasure (Prochaska, & Norcross, 2010, pp.22-29), the “ego” (Prochaska, & Norcross, 2010, p.22), which works with reality and to make the needs of the “id” (Sharf, 2008, p.33) satisfied in an acceptable manner, and also the “superego” (Prochaska, & Norcross, 2010, p.22), which encompasses the social norms that restrain the “pleasure principle” (Prochaska, & Norcross, 2010, p.28) of the “id” (Sharf, 2008, p.33). The “id” (Sharf, 2008, p.33) utilises an illogical, unconscious and atemporal “primary process” (Prochaska, & Norcross, 2010, p.28) in order to manage its “pleasure principle” (Prochaska, & Norcross, 2010, p.28) and decrease internal tension, by imagining the desired object (Prochaska, & Norcross, 2010, pp.22-29). On the other hand, the “ego” (Prochaska, & Norcross, 2010, p.22) uses a logical and conscious “secondary process” (Prochaska, & Norcross, 2010, p.28) to seek a real object to satisfy the “id” (Sharf, 2008, p.33) within its “reality principle” (Prochaska, & Norcross, 2010, p.28).

In order to control the battle between conscious and unconscious contents, as well as the resulting tension, anxiety and guilt, the individual produces an unconscious system of protection called “defenses mechanisms” (Prochaska, & Norcross, 2010, p.23). The intensification of the unconscious battle, which requires an increase in the “defense mechanisms” (Prochaska, & Norcross, 2010, p.22), results in the formation of psychopathology (Prochaska, & Norcross, 2010, p.23). The functioning of these intra-psychic mechanisms is also threatened when the individual faces stressful events” (Prochaska, & Norcross, 2010, p.27). In this case, people may react to a current “stressful event” (Prochaska, & Norcross, 2010, p.27) by utilizing the same unconscious childhood “defence mechanisms” (Prochaska, & Norcross, 2010, pp.26-27). The different types of “defense mechanisms” (Prochaska, & Norcross, 2010, p.27) as well as specific personality attributes, arise during the person's sexual stages of development, named by Freud as “oral” (Sharf, 2008, p.33), “anal” (Sharf, 2008, p.33), “phallic” (Sharf, 2008, p.33), “latency” (Sharf, 2008, p.33) and “genital” (Prochaska, & Norcross, 2010, pp.23-27). How parents deal with their child in the different developmental stages may cause fixations in specific stages (Prochaska, & Norcross, 2010, p.23).

In the “oral stage” (Sharf, 2008, p.33), the child's mouth is the oral zone and the child seeks satisfaction by sucking objects (Prochaska, & Norcross, 2010, p.23). If the child's needs are frustrated during this period, the future adult can become immature, distrustful, jealous, passive, not believing that their desires can be met, as well as developing denial, incorporation and projection as defense mechanisms (Prochaska, & Norcross, 2010, p.23). From the age of two to three, is the “anal stage” (Sharf, 2008, p.33) and the anus is the libidinal zone (Prochaska, & Norcross, 2010, pp.24-25). How parents manage toilet training may produce defenses called “reaction formation” (Prochaska, & Norcross, 2010, pp.24-25), “undoing” (Prochaska, & Norcross, 2010, pp.24-25), and isolation” (Prochaska, & Norcross, 2010, pp.24-25). Personality characteristics of fixation in this phase are: avarice, inflexibility, disorganization, slowness, or the opposite of these (Prochaska, & Norcross, 2010, pp.24-25). The “phallic stage” (Sharf, 2008, p.33) happens from three to six years of age, where sexual desire is oriented to the genitalia (Prochaska, & Norcross, 2010, p.26). Through the unconscious “Oedipus and Electra conflicts” (Prochaska, & Norcross, 2010, p.26), the boy or girl represses unconscious desires of incest, identifying themselves with the same sex parent (Prochaska, & Norcross, 2010, p.26). Arrogance, pretension, impertinence, or the inverse of those, are some of the personality features that originate from fixation in this phase (Prochaska, & Norcross, 2010, p.26). From six to thirteen years, sexual needs are repressed (Prochaska, & Norcross, 2010, p.27). The “genital stage” (Prochaska, & Norcross, 2010, p.27) starts from thirteen years of age, when the sexual interest returns toward the genitals (Prochaska, & Norcross, 2010, p.27). There is a need for love and work in this stage (Prochaska, & Norcross, 2010, p.27).

Stages        Ages            Zones                      Activities                            Tasks 
  Oral         0 - 1.5      Mouth/thumb            Sucking/biting                      Weaning
  Anal        1.5 - 3             Anus               Retaining/Expelling             Toilet Training
Phallic         3 - 6       Penis/Clitoris             Masturbating                     Identifying
Latency      6 - 13            None                     Repressing                     Sublimating
Genital         13 +      Penis/Vagina     Sex intimacy/Sublimation      Loving/Working

The ultimate goal of psychoanalysis is to increase awareness of the client's unconscious conflicts and defense mechanisms, to facilitate change (Prochaska, & Norcross, 2010, pp.28-29). The therapeutic relationship is crucial and is based on the establishment of the therapeutic alliance with the healthy part of the client's ego, so as to promote the client's trust and collaboration, along with the encouragement of the client's free association of ideas, recall of dreams and childhood events (Prochaska, & Norcross, 2010, pp.28-37). In a confidential and safe space, past unconscious relationship patterns and feelings are transferred to the current relationship with the psychoanalyst, which become content to be analyzed (Prochaska, & Norcross, 2010, pp.28-37).

The psychoanalyst's role is to explore the client's free association of ideas, insights, resistance and “transference reactions” (Prochaska, & Norcross, 2010, p.36), by undertaking four procedures including “confrontation” (Prochaska, & Norcross, 2010, p.30) and “clarification”(Prochaska, & Norcross, 2010, p.30), in which the psychoanalyst brings awareness of the client's attitudes or episodes which are brought to the analysis (Prochaska, & Norcross, 2010, pp.28-37). Then, the psychoanalyst's interpretations reveal more of the client's unconscious contents and meanings (Prochaska, & Norcross, 2010, pp.28-37). The “working through” (Prochaska, & Norcross, 2010, p.31) is the slow path of facilitating client's insights coming from the psychoanalyst's interpretations of the client's “transference reactions” (Prochaska, & Norcross, 2010, p.36) and “resistances” (Prochaska, & Norcross, 2010, pp.28-37). Immature defenses are not removed, instead, they are replaced by more rewarding ones (Prochaska, & Norcross, 2010, pp.28-37). The client abandons symptoms and immature defences, learning more appropriate means of dealing with impulses (Prochaska, & Norcross, 2010, pp.28-37). Some of the psychoanalyst's necessary personal characteristics include: cordiality, genuineness, empathy, a non-judgmental attitude, congruency, “unconditional neutral regard”(Prochaska, & Norcross, 2010, p.37), and awareness of their counter-transference (Prochaska, & Norcross, 2010, pp.28-37).

Empiric validated effectiveness with longing lasting results in changing the structure of personality is the major strength of psychoanalysis (Prochaska, & Norcross, 2010, p.41). In addition, for its credibility, psychoanalytical concepts are utilized for most of the integrative approaches (Prochaska, & Norcross, 2010, p.45). 

                                "We all warm our hands in Freud's fires." 
                                                                             Prochaska & Norcross  

Mrs Glaucia Barbosa,
PACFA Reg. Provisional 25212 
MCouns, MQCA(Clinical)  
ABN: 19 476 932 954

Recent literature and articles addressing the evidence based for the effectiveness of the Psychoanalytic Psychotherapy:
Lazar, S. (2010). Psychotherapy is Worth It; A Comprehensive Review of Cost Effectiveness, American Psychiatric Publishing.
Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy, American Psychologist, 65, 98-109. http://www.apsa.org/portals/1/docs/news/JonathanShedlerStudy20100202.pdf
Summers, R., Barber, J. (2009). Psychodynamic Psychotherapy: A Guide to Evidence Based Practice. The Guilford Press. 

American Psychoanalytic Association. Retrieved from: http://www.apsa.org/About_Psychoanalysis
Beutel, M. E. (01/09/2003). "The emerging dialogue between psychoanalysis and neuroscience: neuroimaging 
        perspectives". Journal of the American Psychoanalytic Association (0003-0651), 51 (3), p. 773-801. DOI:

Bifulco, Antonia; Thomas, Geraldine (2012). Understanding adult attachment in family relationships : research, assessment 
        and intervention. Retrieved from http://www.eblib.com

Cutler, J. L. (2014). Psychiatry. New York, USA: Oxford University Press.

(Diamond, M. J., & Christian, C. (2011). The second centure of psychoanalysis. Evolving perspectives on therapeutic
        action. London, UK: Karnac Books Ltd)

Draguns, J. G. (2007). Review of neuropsychotherapy: how the neurosciences inform effective psychotherapy and
        neuropsychotherapie (Neuropsychotherapy). [Review of the books Neuropsychotherapy: How the Neurosciences
        Inform Effective Psychotherapy. & Neuropsychotherapie (Neuropsychotherapy). K. Grawe & K. Grawe].

        Psychotherapy: Theory, Research, Practice, Training, 44(1), 118-120. doi:10.1037/0033-3204.44.1.118
Eagle,M. N. ( 2013). Attachment and psychoanalysis: theory, research, and clinical implications. Ney York, USA: The Guilfor

Fisher, J., & Silber, E. S. (1998). Analysing the different voice: feminist psychological theory and literary texts. UK: Rowman
        & Littlefield Publishers, Inc.

Forgash, C., & Copeley, M. (2008).The heart of trauma and dissociation with EMDR and ego state therapy.New York,USA:
        Springer Publishing Company, LLC.

Grawe, K. (2007). Neuropsychotherapy. how the neuroscience inform effective psychotherapy. New York-USA: Taylor and
        Francis Group.

Hofmann, S. G. & Dibartolo, P. M. (2010). Social anxiety. Clinical, developmental, and social perspectives.UK: Academic

Morin, C. M.,& Espie, C. A. (2012). The oxford handbook of sleep and sleep disorders. New York, USA: Oxford University

Orsillo,S. M., & Roemer, L. (2011). The mindful way through anxiety. Break free from chronicworry and reclaim your life. New
        York, USA: The Guilfor Press.
Prochaska, J. O., & Norcross, J. C. (2013). Systems of psychotherapy. A transtheoretical analysis. Stanford-USA: Cengage

Rossouw, P. J. (2011). Neuropsychotherapy-origins and directions. Neuropsychotherapy News.Mediros Clinical Solutions.
        Edition 6

Sharf, R. S. (2008). Theories of psychotherapy & counselling: concepts and cases.USA: Brook/Cole, Centage Learning, Inc.
                   (Preedy,V.R., Patel,V. B. ,& Le, L. A. (2013). Handbook of nutrition, diet and sleep. Wageningen, The
                   Neatherlands: Wageningen Academic Publishers.

Walter, H., Berger, M., & Schnell, K. (2009). Neuropsychotherapy: conceptual, empirical and neuroethical issues. European
        Archieves of Psychiatry and Clinical Neuroscience.V.259(2), 173-182.

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