Psychoanalytic Therapy

Introduction and Key Concepts

Among other theories on Human Behavior developed by well known pillars in the field
of Psychology, Sigmund Freuds Psychoanalytic Theory, stands up even until today, as
one of the most controversial, as it included terms and concept on sex, the unconscious
and the interpretation of dreams.
The theory nonetheless, had provided a wide breeding ground for developing other kinds
of theories that aim to understand human behavior. Such as Carl Jungs own mix of
Analytical Psychology, and Erik Eriksons Psychosocial Stages of Development, a more
toned down and a greater supplement to Freuds Psychosexual Stages of Development
In terms of contemporary psychotherapy, the practice of Psychoanalysis had radically
changed and properly organized into a more less sensitive method to treat psychological
disorders. By making use of different techniques to conquer the incongruence of the
personality from the unconscious. Psychoanalysis proves to be one of the more useful
techniques when it comes to handling internal psychological conflicts that can alter the
persons perception of reality.
Sigmund Freud
The proprietor and the original initiator of the Psychoanalytic approach on Human
Behavior. Eldest among 8 children, Freud was well known for his utter devotion to
devoting and expanding the borders of his theory.
With the stresses, psychosomatic occurrences, and paranoia about dying that he
experienced in his early 40s led him to discover new ways to understanding how and
why people behave the way they do. He had eventually overcome his stresses and then
began devoting the remaining years of his life developing the Psychoanalytic approach to
discover the unconscious that affects a persons behavior
The proprietor and the original initiator of the Psychoanalytic approach on Human
Behavior. Eldest among 8 children, Freud was well known for his utter devotion to
devoting and expanding the borders of his theory.
With the stresses, psychosomatic occurrences, and paranoia about dying that he
experienced in his early 40s led him to discover new ways to understanding how and
why people behave the way they do. He had eventually overcome his stresses and then
began devoting the remaining years of his life developing the Psychoanalytic approach to
discover the unconscious that affects a persons behavior.

Freud was known to be very creative and productive on his work. He was very dedicated
to his theory, and had very little tolerance to persons who had thought otherwise or
critiqued his school of thought. Because of this, had had dismissed two of his closest
colleagues, Carl Jung and Alfred Adler, who had disagreed on Freuds views, and created
their own theories stemming from Freuds Work.
Sigmund Freud died in September 1939 due to an inoperable cancer of the jaw.
Its General Psychology all over again.
The View of Human Nature
In most cases on his work on Psychoanalysis, Freud has drawn a clear line on two things
concerning Human Nature.
Human nature is Purely Deterministic
Simply put, Human Nature Happens because it happens, there is no point in time in
where we call the shots (or having control over our behavior) because according to
Freud, our behavior is determined by Irrational forces, unconscious motivations and
biological & instinctual drives that are stemmed from repressed childhood memories or
experiences that hold a certain degree of impact to our lives.
Instincts are essential to the Psychoanalytic Approach
Instincts are actively displayed in times of survival. Leaning towards growth,
development and creativity. Freud originally termed this as Libido, comprising of
sexual energy, but then broadened the term to Life Instincts, where all pleasurable
acts serves as a persons goal in life to simply gain pleasure and avoid pain.
Freud also came up with another type of instinct called the Death Instinct, mostly
responsible for the aggressive drive where at times some persons manifest through their
behavior, an unconscious wish to die, or to hurt themselves or to hurt others.
All in all, both Life and Death instincts are powerful determinants to why people act the
way they do.
The Structure of Personality
Well known and commonly taught in the annals of the theory of Psychoanalysis. The
theory illustrates the personality consists of three specific and distinct systems: the Id, the
Ego, and the Superego.
Bear in mind that the three systems dont function as three separate entities, but as one
whole inter-dependent system.

The Id
The Id is considered as the primary and original system of personality, the source of
psychic energy, and the seat of instincts. It lacks organization, is blind, and very insistent.
It cannot tolerate tension, and once it does feel tension, it functions to immediately
discharge it. Having ruled by the Pleasure Principle, it always aims to avoid pain and gain
pleasure.
The Ego
Known as the Traffic Cop, it has its touch with reality, controls consciousness and
exercises censorship. It formulates rational and logical decisions and plans for satisfying
needs.
Another duty of the Ego is to keep in check, and balance the demands of the pleasureseeking and unorganized Id, and of the perfectionist-centered and radical moral
objectives of the Superego .
The Superego
The Judicial Branch of the three. Comprised of an individuals moral conduct and the
concept of right and whats wrong given from earlier life experiences and the cultural
mores given from the environment. The Superego holds the Moralistic Principle. It
strives to inhibit the Id and seeking to be Perfect by persuading the ego to replace its
realistic goals for the more perfectionist ones.
Consciousness & The Unconscious
The unconscious can be compared to an Iceberg. The conscious can be on the tip of it, but
underneath sea level is a massive body of the unconscious, where, according to Freud, is
where psychological functioning exists. Experience, memories, repressed material, as
well as needs or motivations that are out of awareness and control.
Considered as one of the primary concepts to understand Human behavior. It cannot be
normally studied under ordinary means, but it can mostly be inferred from a persons
behavior. From Freuds work and clinical evidences, there are six concepts that are
believed to be part of the unconscious

Anxiety
Also known as the feeling of Dread that results from repressed feelings, memories,
desires, and experience that emerge to the surface of awareness. Anxiety usually develops

out of a conflict among the Id, Ego, and Superego over control of the available psychic
energy.
There are 3 kinds of Anxiety
Reality Anxiety. Simply put- it is the fear of danger from the external world
Neurotic Anxiety. The fear that the impulses may cause someone to do something where
the person will be punished.
Moral Anxiety. The fear of ones own conscience. If a person does something contrary to
their moral code, they usually feel bad and guilt-ridden of what they have done
Therapeutic Goals
There are two basic goals when applying Psychoanalytic Therapy. These are:
1) To make unconscious motives conscious, and;
2) To strengthen the Ego to be more aligned with reality and lessen dependence on the
instinctual cravings of the Id or the irrational guilt provided by the Superego.
The Therapists Function and Role

Therapists usually assume an anonymous kind of role, also known as the BlankScreen Approach, where they limit self-disclosure that will then promote a
transference relationship with the client, where the client will pour projections,
where, according to Luborsky, et.al (2008) refers to the transfer of feelings
originally experienced in an early relationship to other important people in a
persons present environment.

In terms of functions, one of the central functions of the therapist is to assist the
client acquire the freedom to love, work, and play, achieving self-awareness,
honesty, dealing with anxiety realistically. In order to do this, the therapist must
first create a working relationship and do the task of listening and interpreting.

Particular attention is given to the clients resistances. The analyst listens, learns,
and decides when to make appropriate interpretations of the gathered unconscious
material from the client through listening, and inferred reports from Free
Association and other techniques.

With the gathered unconscious material, it is then, the therapists role to properly
organize the material to properly formulate the nature of the clients problem, and
then have it interpreted to them, so as to give proper insight, increase their

awareness to change, and thus leading them to having better controls over their
lives.
Summary
The process of psychoanalytic therapy is somewhat like putting the pieces of a puzzle
together. Whether clients change depends considerably more on their readiness to change
than on the accuracy of the therapists interpretations. If the therapist pushes the client too
rapidly or offers ill-timed interpretations, therapy will not be effective. Change occurs
through the process of reworking old patterns so that clients might become freer to act in
new ways. (Luborsky et al., 2008).
The Clients Experience

In the classical approach to Psychoanalysis, Clients must commit themselves to

long and intensive psychotherapy. Face-to-Face sessions with the therapist will be the
starting point in initiating a relationship with the client, and from there, clients will be
then be instructed to lie down on a couch and actively engage Free Association, that is, to
say your inward thoughts without censorship.

Clients must also be in a commitment with the therapist and that they must stick with the
procedures of the therapy.

Clients are not recommended to make any radical changes in lifestyle while undergoing
therapy.

Summary
A successful analysis answers a clients why questions regarding his or her life. Clients
who emerge successfully from analytic therapy report that they have achieved such things as an
understanding of their symptoms and the functions they serve, an insight into how their
environment affects them and how they affect the environment, and reduced defensiveness
(Saretsky, 1978).

TECHNIQUES & PROCEDURES

FEATURES (as opposed to traditional psychoanalysis)

The therapy is geared more too limited objectives than to restructuring of ones
personality.

The therapist is less likely to use the couch.

There are probably fewer sessions.

There is more frequent use of supportive interventions and of self-disclosure by the

therapist.

There is more focus on pressing practical issues than in working with fantasy material.

TECHNIQUES

Techniques help to increase awareness. Fostering insights into the clients behavior, and
understanding the meanings of symptoms.

To attain the goals of intellectual and emotional understanding and reeducation, which, it
is hoped, lead to personality change.

6 BASIC TECHNIQUES OF PSYCHOANALYTIC THERAPY

Maintaining the analytic framework

Free association

Interpretation

Dream analysis

Analysis of resistance

Analysis of transference

MAINTAINING THE ANALYTICAL FRAMEWORK

Refers to a whole range of procedural and stylistic factors, such as the analysts relative
anonymity, the regularity and consistency of meetings, and starting and ending the
sessions on time.

Consistent framework is itself a therapeutic factor.

FREE ASSOCIATION

Basic tools used to open the doors to unconscious wishes, fantasies, conflicts, and
motivations. This technique often leads to some recollection of past experiences and, at
times, a releasing of intense feelings that have been blocked off.

The client immediately reports his/her feelings/ thoughts without censorship.

INTERPRETATION

Consists of the analysts pointing out, explaining, and even teaching the client the
meanings of behavior that is manifested in dreams, free association, resistances, and the
therapeutic relationship itself.

DREAM ANALYSIS

An important procedure for uncovering unconscious material and giving the client insight
into some areas of unresolved problems.

During sleep defenses are lowered, and repressed feelings surface.

Dreams are like royal road to the unconscious, for in them ones unconscious wishes,
needs, and fears are expressed.

ANALYSIS AND INTERPRETATION OF RESISTANCE

Resistance: anything that work against the progress of therapy and prevents the clients
from producing previously unconscious material.

People used resistance to defend themselves against the intolerable anxiety and pain that
would arise if they were to become aware of their repressed impulses and feelings.

Prevent the client and therapist from succeeding.

The therapist must point it out and the clients must confront it if they hope to deal with
conflicts realistically.

The therapists interpretation is aimed at helping clients become aware of the reasons for
the resistance so that they can deal with them.

ANALYSIS AND INTERPRETATION OF TRANFERENCE

Through the relationship with the therapist, clients express feelings, beliefs, and desires
that they have buried in their unconscious. Through appropriate interpretation and
working through of these current expressions of early feelings, clients are able to change
some of their long-standing patterns of behavior.

It allows clients to achieve here-and-now insight into the influence of the past of their
functioning.

Enable clients to work through old conflicts that are keeping them fixated and retarding
their emotional growth.

PROCEDURES

Confrontation the first step in analyzing, confrontation is the process of drawing the
patients attention to a particular phenomenon and getting him to recognize something
that he has been avoiding and that will have to be further understood.

Clarification after a phenomenon is brought to the patients attention, the details need
to be elucidated and separated out from other thoughts that the patient is having.

Interpretation Once a phenomenon is elucidated and brought into focus, the therapist
can then interpret its unconscious meanings. To do this, the therapist makes connections
between the patients current behavior (including thoughts, feelings, fantasies, and
dreams) and the patients past history (including childhood experiences, wishes and
fears).

Working Through The complex and extended process of gradual change reflecting the
efforts of insight, practicing, recognizing behaviors, future insight, and further new
behavior. Working through is how one gets from just having new insight to having new
behavior.

Current Trends on Psychoanalysis Therapy

Object Relations Theory and the Growth of the Psychodynamic Perspective
We first learn how to interact with people as children. And depending on those
experiences, it will guide our expectations for how future relationship interactions will go.
In recent years a number of new psychoanalytic frameworks have emerged to explain personality
development and dynamics. The most important of these is object relations theory. (In
psychoanalytic language, the term object refers to a person, so object relations theory is really
something more like interpersonal relations theory.)
Object relations theory contends that personality can be understood as reflecting the
mental images of significant figures (especially the parents) that we form early in life in response
to interactions taking place within the family (Kernberg, 2004;Wachtel, 1997). These mental
images (sometimes called introjects) serve as templates for later interpersonal relationships
almost like relationship blueprints or scripts. So if you internalized positive introjects early in
life (for example, a mental image of mom or dad as warm and accepting), thats what you expect
to occur in later relationships as well. If you internalized a mental image of mom or dad as harsh
and judgmental, you might instead become a self-critical person, and feel that you can never live
up to other peoples standards . . . or your own (Luyten & Blatt, 2013).
Empirical Research on Psychodynamic Theories
Empirical research assessing psychoanalytic concepts has produced mixed results, with
some concepts receiving good empirical support, and others not faring as well. For example, the
notion that we express strong sexual feelings from a very early age, as the psychosexual stage
model suggests, has not held up to empirical scrutiny. On the other hand, the idea that there are
dependent, control-oriented, and competitive personality typesan idea also derived from the
psychosexual stage modeldoes seem useful.

Many ideas from the psychoanalytic perspective have been studied empirically. Luborsky
and Barrett (2006) reviewed much of this research; other useful reviews are provided by
Bornstein (2005), Gerber (2007), and Huprich (2009). For now, lets look at three
psychodynamic hypotheses that have received strong empirical support.
Unconscious processes influence our behavior as the psychodynamic perspective
predicts. We perceive and process much more information than we realize, and much of
our behavior is shaped by feelings and motives of which we are, at best, only partially
aware (Bornstein, 2009, 2010). Evidence for the importance of unconscious influences is
so compelling that it has become a central element of contemporary cognitive and social
psychology (Robinson & Gordon, 2011).
We all use ego defenses and they help determine our psychological adjustment and
physical health. People really do differ in the degree that they rely on different ego
defensesso much so that researchers now study each persons defense style (the
unique constellation of defenses that we use). It turns out that certain defenses are more
adaptive than others: Rationalization and sublimation are healthier (psychologically
speaking) than repression and reaction formation (Cramer, 2006). Denial is, quite
literally, bad for your health, because people who use denial tend to ignore symptoms of
illness until its too late (Bond, 2004).
Mental representations of self and others do indeed serve as blueprints for later
relationships. Dozens have studies have shown that mental images of our parents, and
other significant figures, really do shape our expectations for later friendships and
romantic relationships. The idea that you choose a romantic partner who resembles mom
or dad is a myth, but its true that you expect to be treated by others as you were treated
by your parents early in life (Silverstein, 2007; Wachtel, 1997).
Psychoanalysis and Culture
One of Freuds lifelong goals was to use psychoanalytic principles to understand culture
and improve intergroup relations (he actually exchanged several letters with Albert Einstein prior
to World War II, in which they discussed this issue). During the past several decades, as society

has become increasingly multicultural, this effort has taken on new importance; psychoanalysts
have been active in incorporating ideas and findings regarding cultural influences into their
research and clinical work. For example, studies have shown that individuals raised in
individualistic, independence-focused cultures (for example, the United States, Great Britain)
tend to define themselves primarily in terms of personal attributes (like attitudes and interests),
whereas individuals raised in more sociocentric, interdependent cultures (for example, Japan,
India) are more likely to describe themselves in terms of interpersonal relations and connections
with others (Oyserman, Coon, & Kemmelmeier, 2002). Our self-representations are, quite
literally, a product of our cultural milieu (Markus & Kitayama, 2010).
The Opportunities and Challenges of Neuroscience
Fifteen years ago, Nobel Laureate Eric Kandel (1998) articulated a vision for an
empirically oriented psychoanalytic perspective firmly embedded within the principles and
findings

of

neuroscience.

Kandels

vision

ultimately

led

to

the

development

of neuropsychoanalysis, an integration of psychoanalytic and neuropsychological concepts that

has enhanced researchers understanding of numerous aspects of human behavior and mental
functioning (Solms & Turnbull, 2011). Some of the first efforts to integrate psychoanalytic
principles with findings from neuroscience involved sleep and dreams, and contemporary models
of dream formation now incorporate principles from both domains (Levin & Nielsen, 2007).
Neuroimaging techniques such as functional magnetic resonance imagery (fMRI) have begun to
play an increasingly central role in this ongoing psychoanalysisneuroscience integration as well
(Gerber, 2007; Slipp, 2000).

Case Studies
A Case with a Legacy
By I.D. Hora

Ours is the case of a lady we shall call Amelia, about 35, married and the mother of a 10-year
old; she works for an important company in X. The woman complains of a troublesome
symptom: persistent insomnia. "persistent", as it defies any kind of conventional treatment.
"Night after night, I make desperate efforts to sleep". She succeeds towards dawn, when, actually
exhausted, she finally falls asleep.
To her sleeplessness, there adds a weird mood of apprehension, an uneasiness psychoanalysts use
to call anxiety. My question is:
- What brings about this condition?
- Something like an anticipation; as if I were expecting something and were not sure what...
- Would you please try to remember some circumstance when you experienced the same thing? I
insist.
- Exams, maybe, when I was at school? Or, Christmas Eve rather, when I used to wait for Santa.
Or, why not, when I would plan a trip or a celebration and would eagerly count every minute to
it...
- Any trouble at work, I ask, any tests, exams for a higher position or things like that?
- None, came the unwavering reply, nothing special.
I then inquire about Amelia's economic standing. I find both she and her husband earn enough to
make a decent living. There would be room for some additional income, though. "You know how
it goes", she adds, " the more you have, the more you want".
I consider the associations Amelia has made concerning her anxiety. Exams, Christmas, Santa,
family celebrations and reunions with friends etc. Anxiety is obviously a state of anticipation,
just like when you are looking forward to an extremely important event you crave for. But what
could that event be? Let us also keep in mind her insomnia, suggesting the same powerful,
irrepressible experience. Sleeplessness and anxiety go hand in hand. Both are indicative of an
intense concentration of emotions towards a certain direction we expect a lot from...
Psychoanalysts often need moments of insight, more precisely the feeling they know what a
certain case is about. Theirs is an intuitive job (which we also call empathy). That
"clairvoyance" urges us to articulate it and, obviously, ask patients the key question giving
instant clarification to the nature of their disturbance. In this case, the question I asked was:
- Do you happen to have a dying relative, are you looking ahead to some inheritance?
The answer was immediate, betraying Amelia's bewilderment:
- Yes! It's my uncle, she assured me, he's over 80 and he's awfully rich!
- Are you his heiress?
- His one and only heir!, she specified.
- Your case is solved then, I replied. Your eagerness to get the inheritance is to blame for both
your insomnia and your anxiety. Given your uncle's age, you think the long dreamed-of moment
for getting your heritage is drawing nearer by the day. Hence your anxious anticipation and

sleeplessness, betraying your wish for this moment to arrive as soon as possible, just as you used
to eagerly wait for your Christmas presents.
Note.
Not all cases are solved on the first session. The case above was a "fortunate one", which is a
rare occasion. But let us keep one thing in mind: although aware of her own wish (to lay hands
on the inheritance), the patient was unable to relate it to her symptoms; hence her concern for her
own health.
The meaning of her symptoms clarified, Amelia was reassured (the enigma of the disease itself is
reason for concern) and she was finally able to get back her wholesome sleep.

Billy's Dream
Billy is a 25 year old young man, a skilled worker in an economic unit. He has had a girlfriend
for about 5 years and wants to marry her. He is a straight, modest man, gifted with a native
intelligence.
He approached me about a dream he wanted me to interpret. He knew I was dealing with
psychoanalysis, that I interpreted dreams and wanted my help from the bottom of his soul. He
was observing for a while, some alarming changes in his life, in his way of being. From a
courageous guy, proud of his physical power, he became a coward, a depressed and very
confused person. The dream, he thought, must have something to do with this behavioral change.
The dream, actually a short visual impression, was the following: Billy was helplessly watching
a torrent of blood flooding the room through the window. It made him all wet, while he was just
standing still, not knowing what to do!
We have already observed that the blocking feelings encountered at the end of the dream are also
found in the awareness state. Billy became an undecided, confused man in the most common life
situations. We conclude that the dream refers to his behavioral change.
I ask him about the wave of blood, about its meaning. (1) He does not know what to say. He has
no suggestion about this scene. It seems that our interpretation does not stand a chance. We have
no association from the real life to Billy's dream. After some free discussions I find out that Billy
has wanted, for a long while, to have a child with his girlfriend. For him the child is a symbol of

his virile force. I also find out he could not have had this child up to now. As I insist on the
subject, he tells me that he recently had again the confirmation he was not to be a father: her
girlfriend had her period.
So here is the interpretation of the dream: the wave of blood is an allusion to his girlfriend's
period, and, implicitly, to the fact that Billy did not make her pregnant.
I find out more details about his intimate problems. The fact that the blood spreads over him
emphasizes the idea that he would be to blame for the negative result. (I was to find out later on,
that Billy's girlfriend was to blame.) This imaginary guilt is at the bottom of his behavioral
change. Billy, as many other men, associated virility with fertility. This is the reason why he lost
all his self confidence and self esteem from the moment he had again the proof that he would not
have a child. It was as he had to admit he was not a man!
I published this dream with the purpose of illustrating the use of the dream analysis in the
psychoanalytical work. We thus observe that Billy's dream is determined by the feelings of fear
concerning his virility. But the object of this fear - the idea of virility was repressed and the
anxiety related to it remained suspended and lived as a feeling without any meaning. Unrelated
to anything in particular, it is difficult, if not impossible, to remove it. But the dream and the
analysis brought us up front in its cause and thus we could work on it.

Conclusion: psychoanalysis approaches its cases starting from the principal of the analysis of the
unconscious. The feelings, the experiences, the ideas as well as other repressed psychical
contents can come back in the shape of neurotic symptoms and disorders. Also, many behavioral
disorders, as it is the case here, find their roots in repression.
Psychoanalysis approaches the repressed and asks the patient to integrate consciously what it is
rejected from his conscious mind. The analysis of dreams is a big step in the work of integration
of the unconscious, repressed, material.
Notes:
1. When we work with dream in the analytical procedure, we usually collect the associations of
the dreamer.

REFERENCES:
http://nobaproject.com/modules/the-psychodynamic-perspective
http://www.freudfile.org/psychoanalysis/case_study_1.html
http://www.freudfile.org/psychoanalysis/dream_cure.html
http://atheisme.free.fr/Biographies/Freud_e.htm
Theories and Practice of Counseling and Psychotherapy Fifth edition by Gerald Corey

Psychoanalysis

Students:
KarlMarx Vladimir
Patrick Dave Babor
John Alfred Amigo
Joshua Balanquit

Prof. Rodrigo Lopiga