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Psychoanalytic

Approaches
Loren P. Tubongbanua
Rochen Roan
What is
Psychoanalytic
Psychotherapy?
Psychoanalysis Psychodynamic Psychotherapy
the term to describe Freud’s refers to approaches that emphasize
approach and classical Freudian unconscious behavior patterns and
psychoanalytic theory is his use insight as a primary therapeutic
theoretical model. tool for psychological change.

Classical Freudian Modern psychoanalytic


psychoanalytic theory approaches
a one-person intrapsychic model
where the psychotherapist acts as a treat therapy as a two-person field,
blank slate and listens for where the psychotherapist’s and
unconscious conflicts and client’s unconscious, intrapsychic,
motivations that underlie repetitive, and relationship interactions are
maladaptive patterns of behavior. used to shed light on interpersonal
patterns that are troubling the client.
Psychoanalytic Psychodynamic
refers to the perspective and theoretical ideas that refers to the ideas and perspective that came from
Definition
were originated by Sigmund Freud Sigmund Freud and his followers
Psychoanalysis is solely founded by Sigmund Psychodynamic theories are founded by Freud and his
Theories
Freud followers.
Psychodynamic approach also focuses on the human
Psychoanalysis focuses on the psyche,
Focus mind and personality and tries to broaden the
unconscious, dreams, etc.
understanding
Sigmund Freud, Carl Jung, Alfred Adler, Melanie Klein,
The main contributor or the founder was Sigmund John Bowlby and Mary Ainsworth are some psychologist
Contributors
Freud s who have contributed to the development of
Psychodynamic approach.
Sigmund Freud
•Born 1856 in Freiberg, Moravia (now Pribor, Czech Republic)
•First born of Jacob and Amalie (had 7 other children)
•Father was strict and authoritarian, Mother was protective and nurturing.
•Jean Martin Charcot & Paris – Hypnosis & Hysteria
•Josef Breuer – Catharsis & Case of Anna O.

Hysteria
various unexplained symptoms, including, but not limited to, numbness, paralysis, and tremors.

Catharsis
expression of emotions that is expected to lead to the reduction of disturbing symptoms
Seduction Hypothesis
•Repression of early childhood sexual abuse caused hysteria
•Presented a paper titled “ The Aetiology of Hysteria”.
•18 cases ( 12 women, 6 men), all of which included childhood sexual abuse.
•2 year self analysis lead to the idea of Oedipus Complex

Freud’s seduction hypothesis included the following components:


1. Very early “premature” sexual experiences causes hysteria
2. At the time of the abuse, there are no hysterical symptoms; the
sexual memories are repressed
3. Unconscious memory are “aroused after puberty”
4. Hysterical symptoms (fainting, paralysis) are manifest
5. Psychoanalysis can address symptoms of hysteria

Oedipus Complex
Wherein a boy holds unconscious wishes to have sexual relations with his mother
Theoretical
Approaches
Dynamic Approach Topographic
Approach

Development Stage Structural Approach


Approach
Dynamic Approach
•Also called Drive theory or instinct theory
•Mental or Psychic energy fills and energizes humans.
•Comes from two sources:
Eros- defined as energy associated with life and sexual instincts.
(Libido)
Thanatos- defined as externally and internally directed aggression.
•Psychic determinism- There’s an underlying psychological
motivation or explanation for every emotion, thought, impulse, and
behavior.
Dynamic Approach
•Every impulse has an origin, aim, object and intensity.
•Origin- the region of the body in a state of excitation or tension
•Aim- to seek pleasure by removing that excitation or reducing the
tension
•Object- the person or thing that serves as the means through
which the aim is satisfied
•Intensity/Impetus- the amount of force it exerts
•Internal working model- is a repetitive impulse– energy–
relationship pattern that informs individuals about what to expect
and how to react to the world.
Dynamic Approach
For example, in very young children, most pleasure (or libidinal)
impulses arise from the oral region. This is why young children
put everything into their mouths. Their aim (or goal) is oral
gratification. If we stay with a small child example, the dynamic
approach might look like this:

• Origin of impulse: baby experiences physical hunger sensations.


• Aim of impulse: get food! (gratification).
• Object of impulse: breast or bottle (caregiver).
•Intensity of impulse: strength of hunger sensation varies.
Dynamic Approach
As a baby and toddler, Katie was consistently deprived of food and
repeatedly experienced hunger and distress.

Often, she had to wail and cry very loudly and forcefully to have her oral
needs for sustenance fulfilled. This pattern involved her (a) physical need for
food, (b) impulse (and strategy) to obtain impulse gratification, and
(c) eventual gratification. This pattern was repeated so many times that it
became internalized. For Katie, it became an internal working model for
how relationships and gratification patterns work around hunger and food.
Dynamic Approach
When, at age 22, Katie arrives for psychotherapy, she’s experiencing distress
over the repetition compulsion of the pathological impulse–relationship cycle
that’s continuing to manifest itself in her life.

Several of her hunger/ food-related behaviors are causing problems in


her new romantic relationship. Among other patterns, to avoid
experiencing intense distress, Katie began hoarding food.
Her food hoarding behavior is minor, but her emotional distress to having it
interrupted is extreme. Given her current life situation, her response to lack of
food availability constitutes an over-reaction; she recognizes this, but feels
unable to break the pattern … and the pattern is causing conflict in her
relationship.

In psychoanalytic therapy, Katie comes to understand these patterns and


their origins. She is then able to develop more positive coping responses
Topographic Approach
•Unconscious- The unconscious contains all those drives, urges,
or instincts that are beyond our awareness but that nevertheless
motivate most of our words, feelings, and actions.
•Preconscious- The preconscious level of the mind contains all
those elements that are not conscious but can become conscious
either quite readily or with some difficulty
•Conscious- defined as those mental elements in awareness at
any given point in time.
•Purpose of psychoanalysis is to make the unconscious conscious
Developmental Stage Approach

Genital

Latency puberty to
adulthood
Phallic 5 or 6 to puberty
(12)
Anal
3 to 5 or 6 years
Oral old
1 to 3 years old

birth to 1 year old

Fixation or complex
an unresolved unconscious conflict (aka dysfunctional internal working model).
Structural Approach

Id
•seat of biological desire
•functions on the pleasure principle
•immediate gratification
•primarily unconscious
•view id impulses via dreams, fantasies, and powerful pleasure
seeking urges
•Primary process thought- another facet of id functioning,
characterized by hallucination-like images of fulfilled sexual or
aggressive desires (Childlike thinking by which the id
attempts to satisfy the instinctual drives)
Structural Approach

Ego
•individual's conscious decision making processes;
•steers behavior in more safe and adaptive directions (reality princi
ple)
•ego functions include memory, problem-solving abilities and logical
thought these are also labeled as the secondary thought processes
(Mature thought processes needed to deal rationally with the extern
al world).
Structural Approach

Superego
•the moral aspect of personality; the internalization of parental and
societal values and standards
•develops when children resolve their Oedipus or Electra issues.
•2 parts of the superego
•conscience- behaviors for which the child has been punished.
Develops from parental prohibitions. Inner source of
punishment.
•ego-ideal- the moral or ideal behaviors for which a person
should strive.
Repression Involves unconscious denial of the existence of something that causes anxiety

Denial Involves denying the existence of an external threat or traumatic event

Reaction Involves expressing an id impulse that is the opposite of the one truly driving the person
Formation
Projection Involves attributing a disturbing impulse to someone else
Regression Involves retreating to an earlier, less frustrating period of life and displaying the childish and
dependent behaviors characteristic of that more secure time
Rationalization Involves reinterpreting behavior to make it more acceptable and less threatening
Displacement Involves shifting id impulses from a threatening or unavailable object to a substitute object that
is available
Sublimation Involves altering or displacing id impulses by diverting instinctual energy into socially
acceptable behaviors

Defense Mechanisms
are designed to ward off unpleasant anxiety feelings associated with internal conflicts among id, ego, and superego.
Case Presentation
Andrew

Wachtel (2010) described his psychoanalytic work with Andrew, a


male client who was struggling with feelings of disconnection in his
marriage.

This case is integrated with an abbreviated treatment plan based


on a four-point outline:
• The Problem List (or Goal List).
• Problem Formulation (the theory-based explanation for what
creates and/or sustains the client’s problem).
• Interventions.
• Outcomes Assessment.
Andrew

Wachtel (2010) initially described Andrew’s problems and provided


case formulation information.

Andrew … experienced his wife as “controlling” him, though a


broader look at the pattern between them made it clear that her
“control”—as is often the case—was in good measure a function of
his own acquiescence. Put differently, part of what happened was
that Andrew—both because of his concerns about his daughter
and because of his own guilt over his wish to pull back from his
wife—often went out of his way to be compliant with Jane’s wishes,
and then felt intruded on and “controlled.”
The Problem List

Andrew reports feeling controlled. Wachtel noted he acquiesces or


backs down from speaking about his personal needs. Additionally,
Andrew experiences depressive and anxious symptoms associated
with his perception of being trapped in an unhappy marriage.

The problem list for Andrew’s treatment plan might look like this:
• Difficulty speaking up (aka sub assertiveness).
• Anxiety (associated with speaking up and associated with feeling
trapped).
• Depression (and related feelings of hopelessness linked to his
perception of being trapped in an unhappy relationship).
The Problem List

Instead of saying that Jane’s comment had felt intrusive


(though it did, and though that would certainly have also been an
empathically responsive comment), I said that it felt like Jane had
been “overtracking” his experience. His [Andrew’s] eyes lit up,
and he said, excitedly: “Yes, that’s exactly it. I love that word,
overtracking, that’s it!”

Wachtel used overtracking because it fit with attachment


theory dynamics.
The Problem List

The babies of mothers who undertrack tend to be insecure in the


fashion that is called ambivalent or resistant in the attachment
literature. They keep flailing about trying to get their mothers to
be more responsive.

But the babies of mothers who overtrack, who are too in sync,
seem to have difficulties too; they tend to be insecure in the
fashion that is described as avoidant. They withdraw from
contact in order to have any room for autonomy at all.
The Problem Formulation

Psychoanalytic case formulations have interpersonal


Foundations

These foundations are built on repeated child–caretaker


interactions, subsequently internalized, that later manifest thems
elves in clients’ daily lives.

Consequently, Andrew’s depressive and anxiety symptoms are


traced to early childhood interpersonal experiences (or
perceptions), observed within the therapy relationship
(transference), and triggered in his contemporary interpersonal
relationships (i.e., using the transference- based triangle of
insight).
The Problem Formulation
From an attachment-informed psychoanalytic perspective,
Andrew’s difficulty speaking up and associated anxiety
and depression are created and maintained by an unconscious
internalized working model. Specific relational interactions with his
wife trigger this dynamic.

If Andrew becomes aware of his part in this interpersonal dynamic,


•then he can proactively and intentionally deal with his underlying
fears (of being emotionally suffocated)
•develop new behaviors that allow him to initiate more desirable
interpersonal patterns in his marriage.
•This will help him address his needs for autonomy in a way that
doesn’t trigger anxiety over rejection or abandonment (being alone)
Intervention
•Wachtel was developing a relationship with Andrew that respected
Andrew’s anxiety around closeness.
•Wachtel provided emotional space, Andrew started having insights
that allowed him to begin taking greater responsibility for his
relationship behaviors.
•as Wachtel acknowledged, because of Andrew’s sensitivity to too
much closeness, he (Wachtel) needed to avoid too much early
interpretation as it might be viewed as “overtracking.”

Similar to corrective emotional experience (Alexander and


French (1946))
Intervention
Wachtel described how he carefully offered an indirect suggestion
for Andrew to consider.

Later in the session I suggested that what he wished was … to be


able to talk to [ Jane] and not have to be gazing into her eyes at
every moment, to be able to know that she is there and listening,
but that he can glance over at the mail or do something else while
talking to her. … Andrew was enthusiastically receptive to this
comment, saying that yes, it captured very well what he longed for,
and it seemed to create at least a small opening for him to imagine
a way of approaching Jane rather than having to retreat from her in
order to prevent himself from feeling invaded.
Intervention
Binder (2004) described the typical change process in
psychodynamic psychotherapy as including four parts:

1. Cognitive insight (usually of a repeating maladaptive


interpersonal pattern).
2. Practice in detecting maladaptive mental and interpersonal
patterns.
3. Creating new and more satisfying interpersonal experiences
4. Internalization of new and more satisfying interpersonal
experiences and the consequent modification of interpersonal
schemas and corresponding internal working
models of interpersonal relations
Outcomes Assessment
It’s not enough for psychoanalytic approaches to base their proof
on case studies and anecdotal reports.
Contemporary psychodynamic outcome researchers generally use
a combination of symptom-oriented measures and interpersonal
process measures that can be used to predict positive treatment
Outcomes or in session therapy alliance.

In his work with Andrew, Wachtel could use the CALPAS and/or the
BDI-II to track process and symptom change every session or less
often, depending upon what they collaboratively agree on as a
means of monitoring progress.