Psychodynamic and Humanistic Psychotherapies

New Era University

College of Arts and Sciences

Psychology Department

Psychodynamic and Humanistic Psychotherapies 2010 Clinical Psychology

Submitted to:

Dr. Ryan Coroña

Submitted by:

Florida Araño

Rhona Mea Delotavo

Shiela Mae Majomot

Jennelyn Sapiandante

Darwin Trinidad Chapter 7: Psychodynamic and Humanistic Psychotherapies

Objectives of Psychodynamic and Humanistic Psychotherapies

To become familiar with the different approaches to psychotherapy.

To be informed about the ideas of the traditional psychoanalysis.

To become accustomed by the different humanistic approaches including person- centered therapy, Gestalt therapy, and existential therapy and phenomenological treatments.

To become familiar with History and Case Formulation.

To become familiar with Free Association, A way which help a patient recover memories and reveal intrapyschic in the form of wishes, thoughts, and impression arising through their unconscious and will be use by the psychoanalyst by trying to make sense of the emerged bits and pieces.

To become aware with the role of the Therapist.

To become familiar and sensitive with the behavior of the client, during the session or to what happens to client’s reports of activities outside of treatment.

To become familiar with common dream symbols, and to become aware of the role of the dreams, interpretations and great importance of dreams in psychoanalysis

To become familiar with common dream symbols, and to become aware of the role of the dreams, interpretations and great importance of dreams in psychoanalysis.

To become aware of the behaviors that interfere with the analytic process that is considered as a sign of resistance.

To gain an insight into unconscious conflicts through analytic interpretation.

New Era University College of Arts and Sciences 2 1st semester AY 2010-2011 Chapter 7: Psychodynamic and Humanistic Psychotherapies

Activities

A brief example of Freudian therapy session

First, finds a comfortable couch then respond to all questions asked

— THE SESSION BEGINS —

First Mr. / Ms. ______(fill your name here for a closer doctor—patient relationship), please lie down on the couch and make yourself comfortable.

I should tell you that I work with a fifty-minute hour.

That means our session is only fifty minutes but you pay for the full hour.

No, Mr. / Ms. ______, I am not trying to cheat you. A fifty-minute hour is standard.

Now, why don’t you start by telling me a bit about why you are here?

Yes, go on…

What about your mother?

How do you feel about that?

I think we should take a look at that little Freudian slip you just made. Why you do you think you said “Inquisitor” instead of castrator. I’m sorry . . . I meant to say mother?

My job is not to tell you it means, Mr. / Ms. ______, I am here to help you tell your self what it means. NOW CONTINUE!

Your childhood, yes,

Very interesting,

That is very interesting.

How old are you at this point? . . . Your mother was there?

How do you feel about that?

--END--

Psychoanalysis

Traditional psychoanalysis stresses the role of unconscious conflict steaming from early childhood relationships and of psychological stresses against anxiety. In therapy, it is assumed that clients will exhibit signs of these conflicts and defenses, such as by reacting to the therapist in a ways that reflect relationships with parent s and other significant figures from their past. By focusing on the transference of old relationship patterns onto the therapeutic relationship, the therapist can interpret the client’s maladaptive behaviors and the unconscious causes to motivate them. These interpretations, in turn, help the client to develop insight into the historically grounded conflicts and patterns of behavior related to their symptoms.

Sigmund Freud (1856-1939)

The founder of Psychotherapy as we know it today as a one-on-one treatment involving frank discussion of a client’s thoughts and feelings.

Freud gives emphasis on:

Searching for relationships between a person’s developmental history and current problems.

Blockages or dissociations in self-awareness as causes of psychological problems

Talking as an approach to treatment

The therapeutic relationship as a curative factor.

Theoretical Foundations

Freud described mental life as occurring partly at the level of conscious awareness; partly at a preconscious level, which we can become aware of by shifting our attention; and partly at an unconscious level, which we cannot experience without the use of special therapy techniques.

Freud’s Personality Theory and View of Psychopathology

Psychodynamic approaches are based on the proposition that mental life is best understood as an interaction among powerful competing forces within the person, some of which are conscious but most of which are unconscious.

The primitive source of instinctual drives, especially sexual/sensual and aggressive drives.

The self, considered as the aggregate of all the conscious act and state. Developed in response to the physical and social environment.

Superego

The mental agency that incorporates norms from one’s parents, family, and culture. The superego also contains the ego ideal, or how one would like to be.

Defense Mechanism

Defense mechanisms are essentially unconscious mental strategies or routines that the ego employs to ward off the anxiety produced by intrapsychic conflict. While Sigmund Freud discussed defense mechanism, it was his daughter Anna, who most fully developed the idea. She categorized and described defense mechanism, stressing their role in everyday life and in psychoanalytic treatment. Anna Freud applied psychoanalytic concepts to developmental psychology, advancing theories of how psychological problems develop during childhood.

Defense Mechanisms

Example of Primitive Defenses Description Denial Avoiding awareness of aspects of external reality that are difficult to face. Projection Perceiving and reacting to unacceptable inner impulses as through they were outside the self, typically in another person.

Splitting Compartmentalizing experiences of the self and others so that contradiction in behavior, thought, or affect are not recognizable. Dissociation Disrupting one’s sense of continuity in the areas of identity, memory, consciousness, or perception. Regression Returning to an earlier phase of development of functioning.

Examples of Higher-Level Defenses Identification Internalizing the qualities of another person by becoming like him or her. Displacement Shifting feelings associated with one idea, object, or person to another. Intellectualization Using excessive and abstract ideation to avoid difficult feelings.

Reaction Formation Transforming an unacceptable impulse into its opposite.

Examples of Mature Defenses Suppression Consciously deciding not to attend to a particular feeling state or impulse. Humor Finding the comic and/or ironic elements in difficult situations. Sublimation Transforming socially or internally unacceptable impulses into socially acceptable expression.

Transference and Countertransference

Transference

Transference reactions are distortion in the client’s reactions to the therapist. These distortions come about because the client’s past relationships-especially early, significant past relationships such as those with one parents-create a set of expectations and anticipatory reactions for future relationships. To put it another way, each new relationship is understood be reference to old relationships. For example, a client who is conflicted over aggressive impulse may begin to feel that the therapist is aggressive or punitive. Assuming that the therapist is not truly being aggressive, the client’s reactions are a demonstration of his or her habitual, internalized and unconsciously motivated adoptions to relationship conflicts.

Countertransference

When therapist reaction to clients are based on the therapist’s personal history and conflicts. Countertarnsferense can impair the progress of therapy if the therapist begins to distort the therapeutic interaction on the basis of his or her own conflicts and defenses. The inevitability of countertransference reactions is one reason psychoanalytically oriented clinicians believe that therapists should undergo psychoanalisis as part of the training.

Psychic Determinism

In psychoanalysis, slips of the tongue and other unexpected verbal associations are presumed to be psychologically meaningful, as are mental images, failures of memory, and a variety of other experiences. If a client suddenly remembers something that seems trivial or unrelated to the topic of discussion during a therapy session, the therapist assumes that there is a reason this material “popped into” the client’s head. By asking the client to elaborate, rather than ignoring the material, the therapist looks for clues that might reveal the unconscious connection.

Resistance

As the psychoanalytic therapy progresses, the therapist and client often get closer to a client’s core unconscious conflicts and emotions. The client may begin to experience increasing anxiety. He or she may consequently begin to “forget” appointments, experience panic, become overly intellectual and emotionally detached in discussing topics, or engage in other activities that appear to take the focus away from his or her conflicts. Psychoanalysts expect these or a variety of other resistance reactions as treatment focuses more intently on the client’s core conflicts.

Interpretation, Working Through, and Insight

Interpretation

Interpretation involves the analyst suggesting connections between patients’ current experiences and their historically based conflicts. In simpler terms, interpretation is a way of pointing out how the past intrudes on the present. Interpretations can be based on material or reactions a client reveals in therapy or on reports of the client’s experiences outside the therapy situation.

Insight

If the explanation makes cognitive and emotional; sense to the client, he or she may see a particular behavior pattern or problem in a new way.

Goals of Psychoanalysis

Intellectual and emotional insight into the underlying causes of the client’s problem.

Working through or fully exploring the implications of those insights

Strengthening the ego’s control over the id and the superego.

Clinical Applications

History and Case Formulation

Traditional psychoanalyst do not stress the use of structured assessment instruments, especially to make differential diagnostic classification, but psychoanalyst are more likely rely on interview data and sometimes on projective tests to develop an understanding of the client. Assessment in psychoanalysis is an ongoing process that occurs over multiple sessions.

The following would be especially important for psychoanalytic treatment of clients.

A. Historical data such as family and developmental history (to identify information related to early conflicts or trauma)

B. Mental status, level of distress, ego strengths and deficits and “psychological mindedness” (to asses the client’s intellectual and emotional ability to engage in psychoanalytic treatment)

C. Defense mechanism, themes, or patterns of attachment difficulties in interpersonal relationship (to identify transference patterns)

Free Association

Psychoanalysis proper begins with the explaining to the client that therapy requires following a single fundamental rules: The client should say everything that comes to mind without editing or censorship. Free association evolved from Freud’s search for a nonhypnotic way to help his patient recover memories and reveal intrapsychic associations. It is assumed that when the constraints of logic, social amenities, and others rules are removed, unconscious material will surface more easily.

Because of the operation of the defense mechanism, thought it is more common that the unconscious bases for client’s current problems are revealed only gradually and indirectly in the form memories, feelings, wishes, and impression arising through free association. It is the therapist’s task to try to make sense of these emerging bits and pieces, some of which seem unrelated and even irrelevant.

The Role of the Therapist

During the therapy sessions, traditional psychoanalysts maintain an “Analytic Incognito” revealing little about them during the course of psychotherapy.

This orientation is aided by the office arrangements –the client lies on a couch and the therapist sits at its head, largely out of sight.

The therapist likes and dislikes, problems, hopes, and so on, remain unknown to the client. If clients ask personal questions, the therapist usually reminds them that the session is for their benefit and that while the exchange of personal information is appropriate in other circumstances, it does not benefit psychoanalysis. In other words, the therapist remains purposely opaque, much like a blank movie screen, so that clients can be free to project onto the therapist the attributes and motives that are unconsciously associated with parents and other important people in their lives.

Of course, the ideal psychoanalyst is not coldly analytical and unresponsive. Psychoanalyst understands the importance of creating emotional safety in the therapeutic relationship, and so they are frequently emphatic and reflective in their comments. They may use direct questions or encouraging phrases to help the client more deeply explore perceptions, emotions, motivations, and the like.

Analysis of Everyday Behavior

Psychoanalyst is as attentive to client’s reports of activities outside of treatment as they are to what happens during the treatment sessions. The analyst tries to maintain an “evenly divided” or “free-floating” attention to trivial as well as momentous events, to purposeful acts and accidental happenings, to body language as well as spoken language. Mistakes in speaking or writing (so called “Freudian Slips”) accidents, memory losses, and humor are seen important sources of unconscious material.

Analysis of Dreams

Because unconscious material is believed to be closer to the surface in dreams than during waking consciousness, great importance is attached to them in psychoanalysis. For psychoanalytic purposes, the most interesting aspect of dreams is their Latent Content: the unconscious ideas and impulses that appear in disguised form. The process of transforming unacceptable material into acceptable manifest content is called Dream Work.

So most manifest dream content is viewed as being symbolic of something else –the specifics of which differ among people and among dream, in spite of popular belief that certain dream symbols (e.g. snake) always mean something (e.g. penis) Freud believed dreams must be interpreted more flexibly.

A common analytic procedure is to ask the client to free associate to a dream’s manifest content. In the process, unconscious material may be revealed. Frequently, a series of dreams is explored in an analysis as a way of finding patterns of latent content and of not

New Era University College of Arts and Sciences 11 1st semester AY 2010-2011 Chapter 7: Psychodynamic and Humanistic Psychotherapies overemphasizing the importance of single dreams. In other words, dreams provide ideas for further probing more often than they provide final answer.

Did you know. . . .

The nightmare (Painting by Henry Fuseli, painted in 1783 and said to have decorated Freud’s office) highlights what seems to be one of the difficulties of Freud’s dream Theory. If all dreams are wish fulfillments, what accounts for nightmares? According to Freud, they are often dreams in which the latent dream is not sufficiently disguised. The forbidden wish is partially recognized, anxiety breaks through, and the sleeper suffers a nightmare.

COMMON DREAM SYMBOLS Symbol Possible Meaning Train entering tunnel Sex Volcanic eruption Sex Entering a room Sex Leaving a room Leaving after sex Rocket launch Sex Eating Chocolate Sex Playing the accordion Kinky sex Banana Penis Doughnut Who cares? Jackhammer Sex Having sex Your dreaming Reading a book Broken TV Sausage Breakfast Dogs playing poker Sex Monkey wearing fez Anxiety Wanting a corvette Wanting a larger penis Vacuuming Sex

Watching TV Lack of sex Surfing the internet Sex Changing a light bulb Thirsty Drinking water Dirty dishes But sausage Washing dishes Tired Grocery shopping Sex Sleeping Failure Old Faithful Total failure Geometry Sex

Did you know . . . .

Dreams and Symbolism, The 1972 German silent film The secrets of a soul By Georg Pabst, tried to depict a case in psychoanalytic terms. Its subject was a middle aged man suffering from impotence. The film portrays several of the patient’s dreams. In this one, he tries to plant a tree, a symbol for impregnating his wife.

Analysis of Transference

When the patient–therapist relationship creates a miniature version of the causes of the client’s problem, it is called the transference neurosis and becomes the central focus of analytic work. This reproduction of early unconscious conflicts allows the analyst to deal with important problems from the past as they occur in the present.

Transference and transference neurosis must be handled with care as analyst try to decode the meaning of their client’s feeling towards them. If an analyst respond “normally” to a client’s loving or hostile comments, the client would not learn much about what those comments reflects. Instead, the goal is to understand the meaning of the client’s feeling for the therapist. If this can be done, the transference neurosis will be resolved and, with it, the client’s main unconscious conflicts.

Analysis of Resistance

Client behaviors that interfere with the analytic process are considered sign of resistance against achieving insight. Psychoanalyst tries to help clients overcome resistance by pointing out its presence in obstructed free associations, distorted dream reports, missed appointments, lateness for treatment sessions, and avoidance of certain topics, failure to pay the therapist’s bill or a variety of other behaviors.

Even client’s desire to address troubling symptoms rather than intrapsychic conflicts or their request for evidence of the value of treatment, might be identified by psychoanalysts as an effort to divert attention from the unconscious causes of their problems.

Making Analytic Interpretations

Analysis wants clients to gain insights into unconscious conflicts, but they don’t want to overwhelm the potentially frightening material before they are ready to handle. This where analytic interpretation comes in, through questions and comments about the client’s behavior, free associations, dreams and the alike, the analyst guides the process of self-exploration. Thus, if the client shows resistance to seeing the potential meaning of some event, the therapist not only points out the resistance but also offers an interpretation of what is going on.

As interpretations help clients understand and work through the transference, the therapeutic relationship changes, clients not only see how defense and unconscious conflicts caused problems, they learn to deal differently with the world, beginning with the therapist. They also learn that forces from their past no longer need to dictate their behavior in the present. Ideally, this emotional understanding will liberate the client to deal with life in a more realistic and satisfying manner than before.

Did you know ......

A psychoanalytic Interpretation of Little Red Riding Hood, a little red riding hood is the story of a pretty young girl who is sent on an errand through the forest. Her mother tells her to walk decently, without ever leaving the path. On her trip, she meets a wolf who persuades her to run off the path and pick some beautiful flowers in the forest. According to psychoanalyst, the wolf stands for male sexuality, and Little Red Riding Hood is torn between resisting temptation (staying on the right path) and giving in to it (picking the flowers).

Psychodynamic Psychotherapy

Many theorists have advocated changes in Freudian psychoanalysis, ranging from minor alterations to wholesale rejection of certain fundamental principles. Most of today’s psychodynamically oriented clinicians employ treatments that although based on psychoanalysis. Differ from it in that they involve:

1. Less emphasis on sexual and aggressive id impulses 2. Greater attention to the adaptive functioning of the ego 3. Greater attention to the role of close relationships, and 4. Flexibility to the degree to which the therapists analyze and interpret versus offer empathy and emotional support.

 Psychodynamic psychotherapies – therapies that share certain basic assumptions with psychoanalysis but significantly change others.

Variations on Psychoanalytic Theory and Practice

Approach Theories Emphasis Early Alternatives to Freudian Psychoanalysis

Individual Psychology Alfred Adler Striving to overcome feelings of inferiority; importance of social motives and social behavior Analytical Psychology Carl Jung Reconciliation of opposites(anima, animus)in personality, personality orientations of introversion and extroversion, personal and collective unconscious Will Therapy Otto Rank Client choice; therapist humanity that technical Skill

Most Recent Psychodynamic Alternatives

Ego Psychology Anna Freud, Focus on ego functioning and establishment of Heinz Hartman, firm identity and intimacy David Rapaport Object Relations Theory Melanie Klein, Modifying mental representations of Otto Kernberg, interpersonal relationships that come from early David Winnicott, attachments W.R.D. Fairbairn Self-Psychology Heinz Kohut Closely related to object relations theory but stresses development of autonomous self Interpersonal Relations School Harry Stack Sullivan, Interpersonal context of disorders and Clara Thompson treatment Relational and Postmodern Steven Mitchell, Strong emphasis on relationships with Approaches Robert Stolorow, caretakers and exploration of the “intersubjective George Atwood space” created jointly by client and therapist Short-term Psychodynamic Wilhelm Stekel, Coping strategies stressed over historical Approaches Hans Strupp interpretation PSYCHOANALYTICALLY ORIENTED PSYCHOTHERAPY New Era University College of Arts and Sciences 15 1st semester AY 2010-2011 Chapter 7: Psychodynamic and Humanistic Psychotherapies

Therapists whose psychoanalytic procedures depart only slightly from the guidelines set down but Freud are said to employ psychoanalytically oriented psychotherapy.  Not every patient is seen for the standard five sessions per week

Treatment:

The patient may be seen every day; later, sessions may take place less often. Alexander even suggested that temporary interruptions in treatment could be beneficial by testing the patient’s ability to live without therapy and reducing reliance on the therapist.

ALFRED ADLER’S INDIVIDUAL PSYCHOLOGY

Alfred Adler

An early follower of Freud who was the first to detect from the ranks of orthodox psychoanalysis. He deemphasized Freud’s theory of instincts, infantile sexuality, and the role of unconscious in determining behavior. His treatment methods focused on exploring and altering misconceptions (maladaptive lifestyles, as he called them)

 In Adlerian Analysis, client and therapist sit face to face in similar chairs, the feelings and relations expressed toward the therapist (transference) not as reflecting unconscious childhood conflicts but as the client’s habitual style of dealing with people like the therapist.

 View resistance as a sample of how the client usually avoids unpleasant material, and dreams are interpreted not as symbolic wish fulfillment but as a “rehearsal” of how the client might deal with problems in the future.

*Freudian – offer interpretations designed to promote insight into the past causes of current problems.

*Adlerian – interprets in order to promote insight into the patient’s current lifestyle.

 Adlerian therapists are more involved in advising and encouraging their clients to change than the Freudians.

EGO PSYCHOLOGY

 They argued, for example. That Freud’s preoccupation with sexual and aggressive instincts (id) as the basis for behavior and behavior disorder is too narrow. They said that behavior is determined to a large extent by the ego, which can function not just to combat id impulses or to referee conflicts but also to promote learning and creativity.

 Ego-analytic techniques differ from classical analytic techniques in that therapists focus less on working through early childhood experiences and more on working through current problems.  Therapists assess and bolster the client’s ego strengths (reality testing, impulse control, judgment, and the use of more “mature” defense mechanisms such as sublimation).  The therapeutic relationship remains important, but less for its distorting transferences than for its supportive and trusting functions.

OBJECTS RELATION AND SELF-PSYCHOLOGY

 Object relations expanded the role of relationships, especially early relationships, in psychodynamic thought.  Focuses on the nature of interpersonal relationships that are built from very early infant – because these early relationships acts as prototypes for later relationships, disruptions in them can have profound consequences later in life.

*In contrast to classical psychoanalysts, object relations theorists view the therapeutic relationship not as transference to be analyzed but as a “second chance” for the client to obtain in a close relationship the gratification that was absent during infancy. This emphasis on ego support, acceptance, and psychological “holding” of damaged selves has made object relations therapies among the most popular versions of psychoanalysis, because they allow a friendly, naturally human stance toward the therapeutic relationship which many therapists prefer to traditional Freudian neutrality.

*Self-psychology focuses more on the self or self concept while object relations approaches, views the analyst’s task as providing the type of empathetic responding and nurturing that the client is assumed to have missed as an infant.

RELATIONAL PSYCHODYNAMIC PSYCHOTHERAPY

 Psychodynamic theory stresses relationships with caretakers.  Relational theorists stress the importance of early relationships of early as templates for later ones.

 Pointed out that relationships have an objective dimension (the events that actually happen) and a subjective dimension (the way the relationship is mentally represented or perceived by the persons involved).  Sullivan, the father of interpersonal perspective, believed that theorists should use their observations of the client’s current and past interpersonal relationships to clarify for them how their typical cognitions and behavior interfere with successful living. However, Sullivan and other later relational therapists cautioned against assuming that the therapist’s view of the therapeutic relationship was objectively correct. Because the client and the therapist both work from their own subjective viewpoints.  Relational therapists believe that neither perception can be objectively validated.

*Intersubjectivisim, constructivism, postmodernism – intellectual trends that are compatible with relational psychodynamic approach which made it achieved popularity in the United States in the past decade.

*Central to this trend is the idea that no objective authority can judge whether one view of reality is “correct”.

*Relational Psychodynamic Therapists view the shared conceptual and interpersonal understanding that develops between client and therapist as a psychological system in its own right, one worthy of analysis. For this reason, relational psychodynamic therapies are sometimes called “two-person theories”

SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY

Its approaches emphasize pragmatic goals that can be obtained in relatively few sessions, typically 20 or less. Therapists focus on helping clients cope with a current crisis or problem rather than helping them work through early relationships or to reconstruct the personality. They stress the information a working therapeutic alliance as quickly as possible and then help clients adopt coping strategies within specific domains. They might focus on anxiety management or coping within a problem relationship at work because the pace of therapy is accelerated. They may use traditional techniques of psychoanalysis, but they also might assign homework, refer client to self-help groups, or adopt other techniques not typically associated with psychodynamic treatment.

There are several models for short term dynamic therapy (manuals for treating specific disorders; Interpersonal psychotherapy(IPT), a treatment typically used for persons with depressive disorders)

COMMON FEATURES AND VARIATIONS IN PSYCHODYNAMIC THERAPIES

A useful way of thinking about all the psychodynamic variations that have been discussed is to categorize them along a continuum according to their similarity to psychoanalysis.

 Psychoanalysis – psychoanalytically oriented psychotherapy = treatments based on ego psychology, self-psychology and interpersonal psychology = relational and postmodern versions of psychodynamic psychotherapy.

*All of them share core beliefs about the psychological importance of a. Intrapsychic conflict b. Unconscious processes c. Early relationships d. Ego functioning and e. the client-therapist relationship

They differ largely in matters of emphasis and in how these concepts are best applied during treatment.

 The length of treatment is shorter than that of traditional psychoanalysis

-Long-term psychodynamic psychotherapy lasts 6 months or longer and involves sessions usually lasting 45 to 50 minutes once or twice per week.

-Psychodynamic psychotherapy that is designed to be more supportive varies depending on the client’s needs but can be as short as one 25-minute session once or twice per month or as frequent and long as long-term psychodynamic treatment.

The Supportive – Expressive Dimensions

Contemporary psychodynamic psychotherapies seek to create an emphatic and supportive atmosphere in which the client feels cared for and understood. Many believed that this atmosphere creates a corrective emotional experience for the client and is a healing factor independent insight.

 Supportive – expressive continuum – variations of techniques where psychodynamic psychotherapists can then practice interventions that range from the analytical ones advocated in psychoanalysis to the more supportive interventions stressed by interpersonal and relational approaches.

Therapists offering more supportive interventions typically seek to help clients with coping, stress reduction, and day-to-day functioning. In practice, these clinicians may be more active than they are in expressive therapy. The idea is that the therapeutic relationship provides a stable context in which to form plans for progress that can be tested in real life.

How does a clinician decide whether to offer more supportive or more expressive interventions? The table below lists some of the factors that influence the clinician’s decision.

Indications for Expressive or Supportive Emphasis in Psychodynamic Psychotherapy Expressive Supportive Strong motivation to understand Significant ego detects of a chronic nature Significant suffering Severe life crisis Ability to regress in the service of the ego Low anxiety tolerance Tolerance for frustration Poor frustration tolerance Capacity for insight (psychological mindedness) Lack of psychological mindedness Intact reality testing Poor reality testing Meaningful object relations Severe impaired object relations Good impulse control Poor impulse control Ability to sustain a job Low intelligence Capacity to think in terms of analogy and metaphor Organically based cognitive dysfunction Reflective responses to trial interpretations Tenuous ability to form a therapeutic relationship

THE CURRENT STATUS OF PSYCHODYNAMIC PSYCHOTHERAPY

Classical psychoanalysis is practiced by only about 2% of the clinicians.

Psychodynamically oriented variations continue to be practiced by a large number of clinicians and taught as a dominant orientation by several graduate and professional schools.

Psychodynamically oriented research publications are also easy to find.

Along with cognitive-behavioral and eclectic approaches, the psychodynamic approach is among the three most popular in clinical psychology.

Psychodynamic approach has evolved and remains a significant force in clinical psychology.

HUMANISTIC PSYCHOTHERAPY

In the humanistic psychotherapies, clients are encouraged to understand themselves and grow personally. In contrast to psychodynamic therapies, humanistic therapies emphasize conscious thoughts rather than unconscious thoughts, the present rather than the past, and growth and fulfillment rather than curing illness. Two main forms of the humanistic psychotherapies are Person-centered therapy and Gestalt therapy.

Person-centered therapy is the most prominent of the humanistic approaches developed by Carl Rogers in which the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and encourage the client to gain insight about problems.The therapy was initially called client-centered therapy but later changed as the applications expanded.

Rogers became uncomfortable with the idea of therapists who searched relentlessly for unconscious conflicts. He felt that there had to be a better clinical work and an alternative began when he discovered a treatment approach advocated by Otto Rank. He then incorporated these ideas and the relationship between the therapist and the person is an important aspect of Rogers’s therapy. He began to see the therapy as an “if…then” proposition: If the correct circumstances are created by the therapist, then the client—driven by an innate potential for growth—will spontaneously improve.

 Rogers’s Personality Theory and View of Psychopathology

Rogers distinguished between the real self—the self as it really is a result of our experiences and the ideal self, which the self we would like to be. The greater the discrepancy between the real self and the ideal self, the more maladjusted we will be.

 The Self and Conditions of Worth

Their self concept expands through their relationships with others. The self is a whole, consisting of one’s self-perceptions (how attractive I am, how will I get along with others) and the values we attach to these perceptions (good-bad, worthy-unworthy).

The unconditional positive regard is a situation in which parents are successful at communicating their acceptance of all of the child’s behavior and experiences. The child will naturally incorporate those experiences into his or her real self-concept. Rogers strongly believed that unconditional positive regard elevates a person’s self-worth.

However, the child may experience love as conditional when he or she experiences disapproval or rejection from his or her parents. Example, a parent who says, “You’re so stupid!” communicates a different message from one who says, “I love you, but it makes me angry when you do that.” This situation is called conditions of worth—the positive regard we receive from others has strings attached. We usually do not receive love and praise unless we conform to the standards and demands of others. The ideal self is immediately experienced by a child when this situation happens.

 Incongruence

This is the discrepancy of the real self and the ideal self. The more a person experiences his or her positive regard dependent upon acting and feeling in ways consistent with what other people value, the more the real self and ideal self become separated.

The Goals of Person-Centered Therapy

Clients are the ones who set their own goals. The therapist promotes such awareness by providing an interpersonal relationship that could reduce incongruence and further personal growth.

What the therapists provide to achieve more fully functioning and more self-actualized individuals:

 Unconditional positive regard. o It is a non-possessive, caring, love, acceptance of the person. This is in contrast to conditional positive regard/conditions of worth

Expressing unconditional positive regard does not require approving of all the things a client says or does but merely accepting them as part of a person whom the therapist cares about.

CLIENT: That was the semester my brother died and everything seemed to be going down the tubes. I knew how important it was to my parents that I get into medical school, but I also knew that my grades would be lousy that year unless I did something. To make the long story short, I bought a term paper and cheated on almost every exam that semester.

THERAPIST: It was a really rough time for you.

 Empathy To understand a client’s behavior and help the client understand it as well, the therapist must try to see the world as the client sees it.

 Congruence o openness, honesty in the relationship with another o being completely oneself in the relationship, without pretending or putting up facades

CLIENT: I just feel so hopeless. Tell me what I’m doing wrong in my life.

THERAPIST: I guess when you are feeling this bad, it would be nice if someone could come along and tell you what is going wrong and how you can put everything right again. I wish I could do all that, but I can’t. I don’t think anyone else can either.

Nature of Change in Person-Centered Therapy

As clients experience empathy, unconditional positive regard, and congruence in a therapeutic relationship, they become more self-aware and self-accepting, more comfortable and less defensive in interpersonal relationships, less rigid in their thinking, more reliant on self- evaluation than on evaluations by others, and better able to function in a wide variety of roles.

The Role of the Therapist:

To provide an atmosphere in which the client can explore his thoughts and feelings about the things that troubled him.

The therapist done this done being nondirective, he must listens emphatically, responds reflectively, and models genuineness in his own behavior towards the client.

As therapy provides an atmosphere of acceptance, warmth and genuineness, clients become more accepting of their own experiences.

Irrational behavior is often rational from the client’s perspective and the person-centered therapists seek to expand the client’s perspective rather than change the client’s behavior.

Bohart calls the client’s growing interest in exploring his internal perspective “mobilizing the client’s critical intelligence”. This mobilization allows the client to more fully experience emotions that were only vaguely experienced before.

The client’s greater recognition and acceptance of internal perspective allows him to try out new behaviors because the fear of failure has been reduced.

The process of person-centered therapy is designed to develop a greater sense of self trust. As clients get better at listening to their feelings, they become less likely to misread them, become less self-critical, and their sense of efficacy develops.

Other Humanistic Approaches

Gestalt Therapy

Frederick (Fritz) and Laura Perls – developed the gestalt therapy which is probably the best known humanistic treatment.

Gestalt therapy aims at enhancing client’s awareness in order to free them to grow in their own consciously guided ways.

Gestalt therapist seeks to reestablish client’s stalled growth process by helping them: a. become aware of feelings they have disowned but that are a genuine part o them b. recognized feelings and values they think are a genuine part of themselves but in fact are borrowed from other people.

One of the key differences between person-centered therapy and Gestalt therapy is that Gestalt therapist are much more active and dramatic than in person-centered treatment.

Did you know. . . .

The Gestalt Prayer

I do my thing and you do your thing. I am not in this world to live up to your expectations, and you are not in this world to live up to mine. You are you, and I am I, and if by chance we find each other, it's beautiful. If not, it can't be helped.

Focus on the Here and Now

Gestalt therapist believes that therapeutic progress is made by keeping clients in contact with their feelings as they occur in the here and now.

Perls expressed this belief in a conceptual equation where now = experience = awareness = reality.

Did you know. . . .

In Africa he wrote Ego Hunger and Aggression, which contained "Concentration Therapy" exercises, a forerunner to his later work.

Role Playing

Through role-plating or part-taking clients explore inner conflicts and experience the symptoms, interpersonal games, and psychological defenses they have developed to keep those conflicts and various other aspects of their genuine selves out of awareness.

Gestalt therapist also turn the role-playing into extended “conversations” between various parts of the client including between the clients superego (what Perls called “topdog”) and the part that is suppressed by “should” and “ought’s” (the “underdog”).

Using the Empty Chair Technique, the therapist encourage clients to “talk” to someone they imagined to be seated in a nearby chair.

Using the Unmailed Letter Technique, the clients are asked to clarify and released feelings towards significant people in their lives. They write but do not send a letter in which they express important but previously unspoken feelings.

Role- Played Reversals are also used to enhance awareness of genuine feelings.

Frustrating the Client

Suppose that a client begins a session by saying ‘I’ve really been looking forward to having this session, I hope you can help me” a Gestalt therapist would focus on the manipulative aspect of the statement which seems to contain the message “I expect you to help me without my having to do much”. The therapist might say “How do you think I could help you?”. From here the therapist would continue to frustrate the client’s attempt to get the therapist to take responsibility for solving the client’s problem.

Use of Nonverbal Cues

Gestalt therapist pay attention to what clients say and what they do, because the nonverbal channel often contradicts the client’s words.

For example, if a client says that she is nervous and clasp her hands, the therapist might wonder what the clasped hands meant.

Existential and Other Humanistic Approach

Existential Psychotherapy

Existential therapist helps clients to explore fully what it means to be alive.

Existential humanistic therapist tries to understand the client’s inner world, frames of reference, and flow o experiences. The concept of personality has limited usefulness. New Era University College of Arts and Sciences 26 1st semester AY 2010-2011 Chapter 7: Psychodynamic and Humanistic Psychotherapies

The therapist stress freedom, experiential reflection, and responsibility.

Rollo May, one prominent existential therapist, regarded the therapeutic process as the clients struggle between freedom and the limits imposed by destiny.

Viktor Frankl – founder of Logotherapy, was oriented toward helping clients: a. take responsibility for their feelings and actions. b. find meaning and purpose in their lives.

The focus of this therapy is on the struggle for the meaning of existence, worked out one client at a time, but the method is eclectic or integrative.

Postmodern Humanistic Approaches

Postmodernist philosophies reject the idea of objective, absolute, or perceiver independent truth. Also called constructivist or intersubjective approaches, these philosophies suggested that people live, psychologically speaking not in an objective reality but in a reality or teach.

The emphasis of the therapy is on helping clients “reauthor heir life narratives or experiment with new constructions of the self and relationship that afford more hopeful possibilities for the future.

The main difference between the psychodynamic postmodern approaches and the humanistic ones is the allegiance to certain core theoretical principles:

Psychodynamic theorist still think in terms of unconscious process, personality structures, defenses and repetition of past relationship patterns while humanistic theorist think in terms of conscious decision making, personality process, alienation from the self and lack of awareness.

The Current Status of Humanistic Psychotherapy

Humanistic approaches are generally more popular in counseling psychology programs (11%) that in clinical psychology programs (56%).

Only 1% of clinical psychologists identify themselves as Rogerian or Gestalt

One criticism of humanistic psychotherapy revolves around its insistence on not “pathologizing” clients as seeing even bizarre behavior as understandable from the client’s point of view.

Evaluation:

1. One-on-one treatment involving frank discussion of a client’s thoughts and feelings.

2. The mental agency that incorporates norms from one’s parents, family, and culture.

3. Compartmentalizing experiences of the self and others so that contradiction in behavior, thought, or affect are not recognizable.

4. Disrupting one’s sense of continuity in the areas of identity, memory, consciousness, or perception.

5. Shifting feelings associated with one idea, object, or person to another.

6. Evolves from Freud’s search for a nonhypnotic way to help his patients recover from memories and reveal intrapsychic associations.

7. When the patient–therapist relationship creates a miniature version of the causes of the client’s problem, it is called the.

8. Client behaviors that interfere with the analytic process are considered sign of resistance against achieving insight.

9. For psychoanalytic purposes, the most interesting aspect of dreams is called?

10. The process of transforming unacceptable material into acceptable manifest content is called?

11. A therapy that share certain basic assumptions with psychoanalysis but significantly change others.

12. The client and therapist sit face to face in similar chairs, the feelings and relations expressed toward the therapist (transference) not as reflecting unconscious childhood conflicts but as the client’s habitual style of dealing with people like the therapist.

13. Focuses more on the self or self concept while object relations approaches, views the analyst’s task as providing the type of empathetic responding and nurturing that the client is assumed to have missed as an infant.

14. The father of interpersonal perspective.

15. Relational psychodynamic therapies are sometimes called what?

16. The therapy which clients are encouraged to understand themselves and grow personally.

17.This is the discrepancy of the real self and the ideal self. The more a person experiences his or her positive regard dependent upon acting and feeling in ways consistent with what other people value, the more the real self and ideal self become separated.

18. It is a non-possessive, caring, love, acceptance of the person. This is in contrast to conditional positive regard/conditions of worth

19. Being completely oneself in the relationship, without pretending or putting up facades.

20.To understand a client’s behavior and help the client understand it as well, the therapist must try to see the world as the client sees it.

21.A therapy which is designed to develop a greater sense of self trust.

22.They developed the gestalt therapy which is probably the best known humanistic treatment. 23.The clients explore inner conflicts and experience the symptoms, interpersonal games, and psychological defenses they have developed to keep those conflicts and various other aspects of their genuine selves out of awareness.

24.The therapy which helps clients to explore fully what it means to be alive.

25.One prominent existential therapist regarded the therapeutic process as the clients struggle between freedom and the limits imposed by destiny.

Answers

1. Psychotherapy 14. Sullivan

2. Superego 15. Two-person theories

3. Splitting 16. Humanistic psychotherapies

4. Disassociation 17. Incongruence

5. Displacement 18. Unconditional positive regard

6. Free Association 19. Congruence

7. Transference Neurosis 20. Empathy

8. Analysis of Resistance 21. Person-Centered Therapy

9. Latent Content 22. Frederick (Fritz) and Laura Perls

10. Dream Work 23. Role playing

11. Psychodynamic Psychotherapies 24. Existential therapist

12. Adlerian Analysis 25. Rollo May

13. Self-Psychology

New Era University College of Arts and Sciences 30 1st semester AY 2010-2011