PSYCHODYNAMIC THERAPIES

MODULE 2
First add from assignment
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Freudian Techniques

1. Free Association
Free association is a practice in psychoanalytic therapy. In this practice, a
therapist asks a person in therapy to freely share thoughts, words, and anything
else that comes to mind. The thoughts need not be coherent. But it may help if
they are authentic.
Freud adopted the method of free associations during 1892-1898, starting from
several criteria. The method was to replace the use of hypnosis in the exploration of
neurotic antecedents in his patients. It relied on Freud's belief in psychic
determinism. According to that perspective, psychic activity is not subordinated to
free choice. All our mind produces has an unconscious root we can reach by means of
free associations, following the model provided by the adage "all roads lead to
Rome".

Working
Lying on a couch (a position imposing a certain state of relaxation), the patient
speaks freely of anything that may cross his/her mind, without searching for some
specific subject or topic. The flow of his/her thoughts is free, and followed with no
voluntary intervention. The important thing is that the critical mind does not
intervene to censor spontaneous thoughts. 
Later analysis of thoughts produced by means of the above-mentioned method
reveals certain repetitive topics indicative of psychic complexes of emotional charge.
These complexes are unconscious. They are autonomously activated by chance verbal
associations, and influence conscious psychic life in a frequently dramatic manner.
The task of psychoanalysis is to bring such complexes to the surface of conscious
mind, and integrate them into the patient's life.
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.

Limitation
The main criticism of free association has been that people may overproduce
associations. This can be caused by pressure from a therapist. Someone in
therapy may struggle to say as many random words and thoughts as possible.
Difficulty can occur even if the person is not actually thinking about these topics.
Associations may also be random and unrelated to a person’s psyche. For
example, someone may start by recalling a memory of their mother. They may
remember song lyrics associated with the memory and then begin naming
musical artists. This could create the appearance of associations and memories
that do not actually exist.
 2. Analysis of Resistance
Resistance, in the context of the field of psychoanalysis, refers to oppositional
behavior when an individual's unconscious defenses of the ego are threatened by an
external source. For example, if a client in psychotherapy is uncomfortable talking
about his or her father, they may show resistance around this topic. While the client
may be comfortable talking about other family members, they might change the
subject every time their father comes into the conversation. If the therapist continues
to probe this topic, the client may even show resistance by missing therapy
appointments or discontinuing therapy. However, a counselor’s analysis of resistance
can help clients gain insight into it as well as other behaviors. If resistance is not
dealt with, the therapeutic process will probably come to a halt.

Forms of resistance
a. Repression
Repression is the form of resistance where the ego pushes offensive memories, ideas,
and impulses down into the unconscious. Essentially, the patient is unconsciously
hiding memories from the conscious mind.
b. Transference
Typically, unconscious, transference is when the patient allows past experiences to
affect present relationships. In therapy, this may come about if the therapist reminds
the patient, either consciously or unconsciously, of someone in their past who may
have had an early impact on their life. Subsequently, the patient may suddenly tend
to regard the therapist in either a positive or negative manner, depending upon the
nature of the past influence.
c. Ego-resistance
This form of resistance is a neurotic regression to a proposed state of childlike safety.
Usually, it involves the patient's attempts to gain attention and sympathy by
emphasizing minor medical symptoms (i.e. headaches, nausea, and depression).
d. Working-through
Derived from the id, this form of resistance reflects the unconscious desire for
consistency in a manner that is based upon the pleasure principle. Since the id is an
innate portion of human instinct, interpretation of the conscious is an insufficient
method, thus the psychoanalyst must first be able to surmount resistances by the
means of deduction of patients' unconscious defenses that are presented through
exploitation of the mechanism of transference.
e. Self-sabotage
The weakest form of resistance that reflects the moralistic sentiments of the
superego. Essentially, it is a manifestation of internal guilt that prompts personal
punishment by the means of self-imposed impediment.
Limitation
Psychologists remain divided with regard to the concept of resistance. Since Freud
first developed his theory of resistance, he has been significantly criticized for using
personally favourable and unfalsifiable methodology. For example, if a patient were
to agree with a psychoanalyst's inference about themselves, it is a confirmation that
there is something they are repressing. However, if the patient disagrees, it is also a
sign they are engaged in repression, which means the psychoanalyst is correct in
either scenario. Additionally, many psychologists believe that the success of
psychoanalysis is not due its various explanatory systems or its reasoning for
repression, but rather simply due to the process of communication.

3. Analysis of Transference
From assignment
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(add to the types of transference)
Some of the more common types of transference include:

 Paternal transference, when an individual looks at another person

as a father or an idealized father figure. The person may be viewed as powerful,
wise, and authoritative, and an individual may expect protection and sound
advice from this person.
 Maternal transference occurs when an individual treats another person as
a mother or idealized mother figure. This person is often viewed as loving and
influential, and nurture and comfort is often expected from them.
 Sibling transference can occur when parental relationships are lacking or
when they break down. Unlike parental transference, this type of transference
is generally not represented by leader/follower behavior, but by peer or team-
based interactions.
 Non-familial transference can be seen when individuals treat
others according to an idealized version of what they are expected to be rather
than who they actually are. Stereotypes can form in this manner. For example,
priests may be expected to be holy in everything they do, while policemen may
be expected to uphold the law at all times, and doctors may be expected to cure
any ailment.

Sometimes, transference is seen in everyday situations, such as when:

 One is easily annoyed by a classmate who looks a bit like one’s often-irritating

younger sibling.
 A young person treats a much older female coworker with tenderness because
she brings back memories of that person’s now-deceased mother.
 An individual begins to mistrust a romantic partner simply because a previous
partner cheated.

Transference may be positive or negative. Both types can benefit therapy in different
ways. Positive transference can lead the person in therapy to view the therapist as
kind, concerned, or otherwise helpful. Negative transference might cause a person in
therapy to direct angry or painful feelings toward the therapist, but the therapist may
be able to use these emotions to help the person achieve greater understanding.
Transference in Therapy
When transference occurs in a therapeutic setting, a therapist may be able to come to
a better understanding of an individual through an understanding of the projected
feelings and, through this understanding, help the person in therapy to
achieve results and recovery. By understanding how transference is occurring, a
mental health professional may be better able to understand both a person’s
condition and/or aspects of the person’s early life that affect that person at present.
A therapist might also educate a person in treatment on the identification of
various situations in which transference may be taking place. Techniques such
as journaling can allow a person in therapy to identify possible patterns in both
thought and behavior, through the review and comparison of past entries. When
examples of problematic transference become more recognizable, a person in therapy
may be able to explore reasons why the transference occurs and help prevent its
recurrence.

No Limitations available

4. Countertransference
Just as transference is the concept of a client redirect feelings meant for others onto
the therapist, countertransference is the reaction to a client's transference, in which
the counselor projects his or her feelings unconsciously onto the client. How
countertransference is used in therapy can make it either helpful or problematic.
Countertransference is present whenever a therapist brings in their own experiences
to the extent they lose perspective of yours. It is there when their emotions from their
own past and life colour their response to you, or they let their personal opinions
stop them from being objective. It involves a therapist mistakenly prioritising his or
her emotions and needs over yours. 

This includes when a therapist does the following:

 takes out a bad mood on you, being snappy for no particular reason
  shares too many stories about themselves (over-identifying with your stories)
 offering sympathy instead of just empathy (again, over-identifying)
 issues judgements related to their perspective not yours, such as a therapist
going through a divorce making negative comments about your spouse when you
tell a story of her/him
 offering a lot of advice instead of just listening and reflecting and letting you
decide on your next actions
 pushes you to take an action you don’t feel ready for
 is too worried about you as if they want to ‘save’ you

Addressing Countertransference
Once countertransference is recognized, it is important that the therapist
acknowledge and work through those feelings. This can take on many shapes, some
more problematic than others. A counselor enamored by a client's appearance may
avoid challenging that client, due to his or how own desire to be admired and liked by
the client. A therapist who is under financial stress, or just had an argument with
their spouse, may in turn allow those emotions to carry over into the counseling
session with an unknowing client.

It is important for the therapist to understand the role that of transference and
countertransference, and deal with those emotions in such a way that the core of the
counseling relationship is not shattered by these feelings.

When Countertransference can be helpful

It can help in the following ways:
 the client and therapist understand each other better
 it allows trust to grow (the client does not sense the therapist is hiding things)
 clients can gain a clearer perspective of their affect on other people
 new ideas can grow about how the client can interrelate affectively with
friends and family
In summary, unlike unhelpful countertransference that is geared to the therapist’s
needs, useful countertransference is carefully geared to the client and intended to
positively assist their growth. 

No Limitations

5. 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.
Types of Dreams
There are many types of dreams, such as the following:
 Night terrors: a dream where the dreamer screams, experiences great
fear, and flails while they are asleep. Typically, this type of dream is more
common in children.
 Night mares: a disturbing dream that is comprised of negative
emotions, such as fear or anxiety. This type of dream is more common in
children but teens and adults also experience them.
 Lucid dreams: a dream where the dreamer knows they are dreaming
and they are able to control the experiences within the dream. Some
believe you can learn how to experience these types of dreams by learning
specific dream induction techniques.
  Normal dreams: a dream where the dreamer is not aware they are
dreaming and where the experience of the reality of the dream does not
provoke fear or anxiety.

Techniques used in Dream Analysis

 Free association is a psychoanalytic technique whereby the client speaks
(or writes) freely about whatever comes to mind without censoring the
content. This is a powerful way of understanding the latent content of a dream,
by revealing any associated meaning that we might have been unaware of.
 Amplification is a technique that’s rooted in Jungian dream analysis.
This technique uses universally accepted or historical meanings of the symbols
in the dream to make sense of the symbols. The individual’s interpretations
are explored within the context of widely accepted beliefs about the symbol. In
this way, the meaning of seemingly obscure symbols is clarified.
 “Take the Part of” refers to a technique used in Gestalt dream analysis.
The client is asked to record everything they can remember about the dream.
The therapist then asks the client to act out parts of the dream, playing
different roles and developing a dialogue.

Limitations
Although research indicates that there are benefits to dream analysis, some
limitations do exist. Some believe that dreams are purely biological
phenomena and therefore contain no symbolic meaning. The activation-
synthesis hypothesis, coined by psychiatrists Allan Hobson and Robert
McCarley, states that dream content is created by commands sent from the
brain that never get carried out. In other words, dreaming is simply another
form of thinking that happens while we sleep. This point of view calls into
question how much “unconscious material” is truly contained in dreams.

When used in conjunction with psychoanalysis, dream analysis is subject to

the same limitations as Freudian theory. One major critique of psychoanalysis
is that the theory is based on case studies, the results of which are hard to
generalize to a larger population. Another criticism is that the theory does not
meet scientific standards. For example, the idea that dreams are based on wish
fulfillment has not been backed by research. Another complaint about
psychoanalytic theory is its negative and deterministic view of humanity,
asserting that humans are inevitably driven by unconscious forces. This belief
does not account for free will, a central concept in humanistic theories. 

6. Catharsis
From assignment…….kaafi hai

INDICATIONS AND CONTRAINDICATIONS OF PSYCHOANALYSIS

Borrowed from traditional medicine, the notions of indications and

contraindications have been very much present in the writings of Freud and his
medical following from the very beginnings of psychoanalysis. Moreover, the
indications and contraindications for psychoanalysis have changed in the course of
theoretical and practical developments that have profoundly altered attitudes toward
psychoanalytic treatment.

In Studies on Hysteria (1895d), Sigmund Freud and Josef Breuer listed certain

conditions for applying the cathartic method: "The procedure is not applicable at all
below a certain level of intelligence. . . . The complete consent and complete attention
of the patients are needed, but above all their confidence.
Freud specified further indications and contraindications: "Chronic cases of psycho-
neuroses without any very violent or dangerous symptoms are the most favourable
ones for psycho-analysis: thus in the first place every species of obsessional neurosis,
obsessive thinking and acting, and cases of hysteria in which phobias and abulias
play the most important part; further, all somatic expressions of hysteria whenever
they do not, as in anorexia, require the physician to attend promptly to the speedy
removal of the symptoms. . . . 
The patient must be capable of a psychically normal condition; during periods of
confusion or melancholic depression nothing can be accomplished even in cases of
hysteria. . . . Deep-rooted malformations of character, traits of an actually degenerate
constitution, show themselves during treatment as sources of a resistance that can
scarcely be overcome. . . . If the patient's age is in the neighbourhood of the fifties the
conditions for psycho-analysis become unfavourable" 
As time went on, efforts were made to separate the issue of indications from medical
categories and traditional diagnostic procedures, in order to create a suitable
framework for understanding the metapsychological factors underlying the demand
for treatment and a suitable framework allowing prediction of its results. Otto
Fenichel (1945) included in his contraindications, in addition to advanced age and
unfavorable life conditions, the "absence of a reasonable and cooperative ego" and
the existence of significant secondary gains derived from symptoms.
The issue of indications and contraindications has acquired another dimension with
the notion of "analyzability," especially after the Twenty-Fifth International Congress
of Psychoanalysis
As a result of a growing interest in the role of the psychoanalyst's counter-
transference, whether psychoanalysis is indicated has come to mean considering the
analyst's particular capacities for empathy and tolerance for various kinds of
pathologies in a candidate patient. In 1945 Otto Fenichel noted that analysis could be
counterindicated with a given analyst for reasons other than the analyst's sex or prior
relationship with the candidate analysand. Robert Barande has also discussed
"analyst indication."
Finally, it is appropriate to recall what Freud wrote to Ludwig Binswanger on May
28, 1911: "Truthfully, there is nothing that man's organization makes him less apt for
than psychoanalysis" (2003).

CRITICAL EVALUATION OF PSYCHOANALYSIS

Psychoanalysis: Limitations and Effectiveness

As with any therapy, psychoanalysis has both advantages and disadvantages. Some of
the benefits of this therapeutic method include:

 Psychoanalysis gets to the basic cause of the problem rather than simply
addressing its symptoms.
 People who don’t respond to conventional therapy or medications sometimes
respond to psychoanalysis.
 Provides an in-depth insight into the origins of certain thoughts, feelings, and
behaviors.
 Biological research supports at least a portion of Freud’s claims.
 A broad examination of the self, such as that offered by psychoanalysis, can
lead to positive growth over time.

Some of the potential drawbacks of psychoanalysis include:

 Certain ideas, such as “penis envy,” are outdated.

 Patients may find it both painful and unpleasant to discover memories that
they have repressed, sometimes for many years.
 It is not an appropriate treatment for some mental health problems, such as
schizophrenia and bipolar disorder.
 It can be both expensive and lengthy, so it requires a deep level of
commitment from both patient and therapist.