A brief introduction to Psychoanalytic Psychotherapy

1. Dr.V.Veera Balaji Kumar

2. Psychoanalysis
 Developed by Freud

3. Basic Concepts
Determinism encompasses the idea that
psychological events are causally
related to each other and to the
individual’s past.
The elements that occur in
consciousness are not random and
unrelated.

4. Basic Concepts
Dynamics
There is an interplay of forces in the mind
which act in unison or opposition.
These elements ultimately express
themselves through compromise.

5. Basic Concepts
Topography
Individual psychic elements are layered in
consciousness.
A sort of layering of mental contents
according to the criterion of accessibility
to awareness.

6. Basic Concepts
Genetics –
There is an enduring influence of the past on our
present mental activity.
It recognizes the extent to which the past is embedded
in the present and shapes current thoughts,
behavior and feelings.
In accordance with psychoanalytic theory the genetic
principle asserts that the past influences the
present

7. Basic Concepts
The pleasure principle
The idea that human psychology is
governed by a tendency to seek
pleasure and avoid pain.
According to Freud the behavior of a
newborn is dominantly controlled by the
pleasure principle

8. Basic Concepts
 An instinct is a stereotyped response
(e.g., animal instinct) while a drive is a
state of central excitation in response
to a stimuli

9. Other Systems
Theorist Emphasis
Freud (Unconscious drives)
Jung (Cultural symbols)
Adler (Societal Pressures)
Erikson Social interaction
Ellis, Beck, & (Covert and overt behavior)
Behavioral Theorists
Common bond is creation of a setting in which
patients can express their thoughts/feelings
to an objective observer.

10. Carl Jung
 Carl Jung had serious differences with
Freud’s theory of drives
 Carl Jung emphasized the transmission of
mythic themes, i.e. a collective
unconscious, which is consistent with
Freud's discussion of primitive universal
fantasies
 While the main emphasis of psychoanalysis is
a focus on unconscious drives, in contrast the
Jungian approach is focused on cultural
symbols

11. Adlerian Therapy
 Alfred Adler believed that Freud
overemphasized sexual drive (the libido)
and underestimated the role of social
and political pressures shaping
personality.

12. Other Systems
 As part of the psychoanalytic situation,
the analyst listens patiently,
emphatically, uncritically, and
receptively. This technique forms the
core of Carl Roger’s Person-Centered
Therapy.

13. Other Systems
 In REBT Albert Ellis teaches patients to
challenge their irrational, guilt producing
self statements. Psychoanalytic theory
would see the patient's identification with
the values of the therapist as altering
their superego

14. History
 1856 Freud is born (oldest of 6 siblings)
 1873 – Medical school
 1877 – Josef Breuer (pt. Anna O.)
 1885 – Began using hypnosis
 1896 – Freud starts self-analysis
 1900 – Published The Interpretation of Dreams
 1902 – Formed Psychological Wednesday Society
(Adler & Rank)

15. History
 1904 – Freud and Jung met in Vienna
 1907 – Forms Vienna Psychoanalytic Society
 1908 – Forms International Psychoanalytical Society
with Carl Jung as its first President
 1923 – Develops structural model of id, ego, and
superego
 1933 – Nazi’s burn his books in Berlin
 1938 – Leaves Vienna for London
 1939 – Sept 26 . Died in London

16. History
The Interpretation of Dreams (1900)
 Freud's view of the individual psychic
elements of the mind as layered in
consciousness is known as topography
 Freud's earliest theory of mental
functioning described it in layers referred to
as conscious, preconscious, and
unconscious and was called topographic
theory

17. Topographical Model
 Freud's topographical model of the mind
proposed conscious, preconscious,
and unconscious.

18. Conscious
Preconscious
Unconscious

19. Topography of the psyche
(unconscious, pre-conscious,
conscious)
Using an iceberg metaphor,
 The unconscious is understood to be the large
part of the mind, which is hidden from view.
 The pre-conscious is represented by the
waterline - but it is the zone in which there are
fleeting glimpses of the unconscious,
"flickering" across the screen of
consciousness.
 Finally, the relatively small part of the iceberg
which sticks of the water is seen as equivalent
to the small amount of conscious awareness
that the human experiences.

20. Freud also believed that if there was
information that was too painful for the
conscious part to bear, that defense
mechanisms would act to push it down it
into the unconscious part of the mind.

21.  The process by which mental elements
are barred from consciousness is
termed Repression

22. Freud’s Topographical Model

23. Id, Ego, Superego
 Freud described a structural model of
mental functioning consisting of the id,
ego and superego.
 These structures were repetitive,
organized mental functions serving
separate roles in intra-psychic
conflict

24. Id, Ego, Superego
 Id – Instinctual Pressures (e.g.,
aggression and sexual)
 Ego – Orients us toward the external
world (Mediates the internal and
external)
 Superego – Individual’s moral voice

25. Id, Ego, Superego
 THE ID — The Demanding Child
(biological component,
unconsciousness)
 Ruled by the pleasure principle
 THE EGO — The Traffic Cop
(psychological component)
 Ruled by the reality principle
 THE SUPEREGO — The Judge
(social component)
 Ruled by the moral principle

26.  The ego is a psychic apparatus which
balances internal and external
realities

27. Personality Development
1. ORAL STAGE Birth – 18 months
Gratification - Feeding, reduces tension and induces sleep
2. ANAL STAGE 18 mths – 3 years
Gratification - Toilet training, reaction formation may lead to
compulsive meticulousness
3. PHALLIC STAGE Ages 3-6
Gratification – Genitals, Males -Oedipus Complex and
Females - Electra Complex
4. LATENCY STAGE Ages 6-12
A time of socialization
5. GENITAL STAGE Ages 12 on
Gratification - sex
Puberty and continues into adulthood

28. Example
 Tommy was toilet trained by age 3.
During the training his parents would
often make him feel shameful if he
accidentally soiled himself.
 Tommy's apartment is now meticulously
clean and he is quite rigid in his views
and a perfectionist.
 This represents reaction formation

29. Example
 A male child's erotic impulses for his
mother and feelings of hostility toward
his father constitute what Freud called
the Oedipus complex

30. Erik Erikson Psychosocial
Perspective
• Unlike Freud's theory of
psychosexual stages,
Erikson's theory described
the impact of social
experience across the
whole lifespan.
• Erikson was interested in
how social interaction and
relationships played a role
in the development and
growth of human beings.

32. Psychosocial Stages
1. Infancy (1st year): Trust vs. Mistrust
2. Early childhood (1-3): Autonomy vs.
shame and doubt
3. Preschool age (3-6): Initiative vs. guilt
4. School age (6-12): Industry vs. inferiority
5. Adolescence (12-18): Identity vs. role
confusion
6. Young adulthood (18-35): Intimacy vs.
isolation
7. Middle age (35-60): Generativity vs.
stagnation
8. Later life (60+): Integrity vs. despair

41. Personality Development
Life instincts - Eros
-encompasses sexual energy and all
pleasurable acts
-maximize pleasure and minimize pain
Death instincts - Thanatos
-aggressive drive
-unconscious wish to die or to hurt self
or others

42. Onset of Neurosis
 Psychoanalytic theorists would
hypothesize that neurosis occurs due to
an imbalance between drives and
defenses

43. Onset of Neuroses
 Unable to cope/develop
 Disappointment, defeat, loss, physical illness
 Current reality is misperceived in terms of
childhood conflict, and the individual responds as
he or she did in childhood, by forming symptoms.
 Intra-psychic conflicts occur when the mental
components of the mind are incongruent

44. Ego-Defense Mechanisms
 Ego-defense mechanisms:
 Are normal behaviors which operate on
an unconscious level and tend to deny
or distort reality
 Help the individual cope with anxiety and
prevent the ego from being overwhelmed
 Have adaptive value if they do not
become a style of life to avoid facing
reality

45. Ego-Defense Mechanisms
Repression Regression
Denial Introjection
Reaction formation Identification
Projection Compensation
Displacement
Rationalization
Sublimation

46. Psychotherapy
Three Types of Anxiety
Reality – fear of danger from external
world
Neurotic – fear of instincts overthrowing
ego
Moral – fear of one’s own conscience
(guilt)

47. Process of Psychotherapy
 Transference – Patient responds to
therapist based on past experience
 Countertransference – Therapist
responds to patient based on past
experience

48. Process of Psychotherapy
 The major portion of the therapeutic
work in psychoanalysis is thought to
occur in a phase called development of
transference

49. Example
 If a therapist finds himself/herself
reacting to a patient in a manner similar
to a previous person in their life, this is
known as counter-transference
 A psychoanalyst begins to react irritably
to comments made by a female patient
who reminds him of his mother. This
phenomena is referred to as counter-
transference

50. Example of Transference
 Jill becomes agitated with her
psychoanalyst's interpretations,
perceiving the comments as judgmental,
which reminds her of feelings
experienced in interactions with her
father. This is an example of
transference

51. Process of Psychotherapy
 Goals
 Tactical goals involve analysis of the
immediate presenting material in terms of
some conflict, usually involving the analyst
 Strategic goal is to explain the unconscious
fantasy and demonstrate many ways in
which it affects the patient’s current life.

52. Example
 A therapist points out the similarities
between her female patient's current
anger at a female boss and the
childhood anger she felt towards her
mother when she was ignored by her
father.
 The goal of psychoanalysis this
illustrates is: tactical

53. Process of Psychotherapy
 Freud viewed the main task of therapy
as catharsis, which he referred to as a
release of emotion connected with
painful experiences which had not been
naturally discharged.

54. Process of Psychotherapy
 The principle goal was to make
conscious the content of the
unconscious
 The goal of therapy is to make the
unconscious conscious, for only then
can the individual exercise choice

55. Process of Psychotherapy
 The unconscious cannot be studied
directly but is inferred from behavior
 In utilizing hypnosis, free association,
dream analysis and other techniques
Freud's therapeutic goal centered
primarily on making unconscious
events conscious

56. Process of Psychotherapy
 Clinical evidence for postulating the
unconscious:
 Dreams
 Slips of the tongue
 Posthypnotic suggestions
 Material derived from free-association
 Material derived from projective techniques
 Symbolic content of psychotic symptoms
○ NOTE: consciousness is only a thin slice of
the total mind

57. Traditional Vs Neo-
Analytical
The most significant difference
between traditional psychoanalysis
and current psychoanalysis is …
 One-person psychology – understanding the
patient exclusively
 Two-person psychology – understanding the
interaction between the two (patient and
analyst)

58. Process of Psychotherapy
 The controversial concept of
intersubjectivity in psychoanalytical
therapy refers to amount of personal
information an analyst reveals to a
patient

59. Resistance
 Distractions by the patient which impede
psychoanalytic progress are referred to as
resistance
 It is the client’s reluctance to bring to the
surface of awareness unconscious material
that has been repressed.
 It refers to any idea, attitude, feeling or action
(conscious or unconscious) that fosters the
status quo and gets in the way of change.

60. Process of Psychotherapy
Appropriate candidates for
psychoanalysis must be
able to accept the
parameters of the
psychoanalytical
situation

61. Process of Psychotherapy
The Psychoanalytic Situation
 The patient lies down on a couch, facing
away from the analyst, and is asked to
report, without criticism as far as
possible, the thoughts that come to his
or her mind.
 Basic premise – bring the unconscious
conflicts into awareness

62. Process of Psychotherapy
The Psychoanalytic Situation
 Under these standard conditions, the flow of the
patient’s thoughts is considered free
association, representing the moment to
moment fluctuations of interplay of the forces in
conflict.
 Ernst Kris defined psychoanalysis as human
nature viewed from the point of conflict
 Free association allows the analyst to view the
conflict and compromise formation

63. Process of Psychotherapy
The Psychoanalytic Situation
 In free association there are various levels of
relevance of the data obtained within the
psychoanalytic situation.
 Observation (the order of material)
 Interpretation (relationship to behavior)
 Generalization (accumulated data is generalized)
 Theory (clinical theory is formulated)

64. Mechanism of
Psychotherapy
1. The Opening Phase
2. The Development of Transference
3. Working through
4. Resolution of Transference

65. Process of Psychotherapy
1. Opening Phase
 3-6 months
 Patient reveals information at their pace
 Structured, formalized interview discouraged
 Analyst remains ultra aware of patient’s actions
and words and notes issues of significance
 Analyst sketches out general outline of patient’s
conflicts and resistance to identify

66. Process of Psychotherapy
2. Development of Transference
 Major portion of therapeutic work
 Overlaps with “Working Through” phase
 Patient unconsciously reenacts childhood
memories and fantasies and develops
transference with the analyst
 Transference seen as a process in which
repetition in action replaces event in
recollection
 By analyzing transference Psychoanalyst
assists patient in understanding how the past
affects their interactions in the present

67. Process of Psychotherapy
3. Working Through
 Multiple experiences of insight are needed to
understand the nature of one’s conflicts
 Analysis of the transference facilitates memory
recall
 Evidence builds to support which events
occurred versus which were fantasized
 Patient develops an in-depth understanding of
how childhood events impacted them
psychologically.

68. Process of Psychotherapy
4. Resolution of the Transference
 Termination phase of treatment
 Analyst focuses on assisting the patient in
resolving an unconscious neurotic attempt to
continue the therapeutic relationship
 Often symptom intensification occurs due to an
unconscious attempt to continue the
therapeutic relationship
 Ultimately treatment focus is redirected to the
future.

69. Applications of Psychoanalysis
 Motivated
 Openly disclosing
 Willing to self-scrutinize
 Committed to investing time and money
 Able to accept the parameters of psychoanalytic situation
 Not for minor problems given the huge investment
 Anxiety (phobias, panic), depression, Axis II Disorders, and
sexual disorders often respond well
 Empirical support is difficult to obtain
 The most effective way to evaluate the benefits of
psychoanalysis likely is case studies
 Evaluation is global (pre/post treatment)