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Theory and Design in Counseling and Psychotherapy
Susan X Day , Iowa State University and University of Houston
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CHAPTER 4: Psychoanalytical and Psychodynamic
Approaches
Chapter Review
Early in the twentieth century, Sigmund Freud introduced seminal concepts including the primacy of developmental stages in childhood that determine adult character and the existence of unconscious dynamics that influence all human behavior. The unconscious distributed a limited amount of energy between three subparts, the id, ego, and superego. Conflicts between the id's pleasure seeking and the superego's moralistic perfectionism created anxiety that was managed by the ego. Developmental stages in Freudian theory followed patterns reflective of the workings of the unconscious. A major influential pattern was the Oedipal/Electra complex where sexual desires for opposite sex parents was redirected to embrace appropriate sex role identities. Psychoanalysis, as a therapy, was designed to uncover such unconscious patterns so that the patient could consciously acknowledge hidden desires. Making the unconscious conscious was expected to release anxiety from internal conflicts, and to free up energy for the ego to deal with external realities. Interpretations were based on the transference and countertransference relationship, as well as patient's free associations and dreams. In therapy, psychoanalysts presented a blank slate so patients could project past relationships onto the therapist.
Psychodynamic approaches built on Freudian concepts, de-emphasizing some aspects of the original theory and adding new concepts. In ego psychology, Anna Freud added social influences and theorized that the ego had its own purposes such as creativity and mastery. Therapy based on ego psychology examined the ego's defenses revealing patients' underlying fears and loosening the unconscious patterns. Therapists were more engaged with patients than psychoanalysts.
In Object Relations theory, development is based on interaction patterns between the child and parents, and less on the internal dynamics of unconscious energy. The child forms unconscious ways of viewing others as objects. In healthy development, the child starts with a dependent relationship on the mother object who provides for all needs. Children grow to a point of independence where the self-concept is constant and interactions have stability, even when others do not always meet their needs. Therapy helps those who have experienced ineffective parenting and who have developed unreliable object representations. Pathological object relations are conceptualized as the basis for narcissistic, borderline, or schizoid personality disorders. To transform the client's internal structure, the therapist provides a positive parental object. Therapists forgo full interpretations of the transference relationship allowing the client to vent anger without reacting. After anger is released, patient and therapist examine the experience, and the client learns alternative ways of feeling and relating.
Self psychology is a branch of object relations theory emphasizing the self concept as an internal object. For a positive self-image, parents reflect back to the child their accurate reading of the child's activities and efforts, providing a mirror image of the child to the child. Such mirroring, along with praise and empathic comments, promotes a grandiose self object where the children see themselves as perfect and the center of attention. In healthy development, young children also idealize parents and internalize an ego ideal that serves as both a conscience and an image of the perfect outcome for strivings. When effective internal objects are not developed in childhood, they cannot be refined for adult maturity; and with such deficits, adults continually seek relationships to provide mirroring and/or idealized individuals who will convey worth or power. Therapy seeks to change internalized objects through an empathic relationship. Clients gain the corrective emotional experience of being parented anew. Clients gain better self-images learning to deal with reality and to pursue healthy goals.
Jungian analytic psychology adds another function for the unconscious. In addition to a personal unconscious, Jung described the collective unconscious that contains knowledge of historically universal experiences shared by people across all cultures. Within the collective unconscious are archetypes, characters playing roles in dramas common to the human condition and relayed to people through religious writings, spiritual rituals, and different forms of art. Although Jung emphasized a humanistic psychology of growth and self-actualization, he also described human struggles. Jung wrote that people project a positive persona to display the best aspects of themselves and hide their shadows, or the socially unacceptable parts. In therapy clients confess the secrets hidden from public view and accept interpretations of transference and countertransference. Dreams are also interpreted to reveal the client's unconscious dilemmas, archetypal enactments, and solutions to current issues. The progress of therapy can be determined by the changing themes of dreams. The healing counseling relationship relieves unconscious turmoil and helps the client to become self-actualized.
In the initial stage of analytic and dynamic therapy, the transference relationship is established and interpreted as the therapist makes inferences from client statements, behavior, and feelings. Much of the content of early clinical sessions involves examining childhood experiences. Which interpretations are shared with the client depends on the therapist's clinical judgment as to what the client can accept and what would be therapeutically useful. When an analytical conclusion appears close to the conscious surface, an interpretation is termed a confrontation. Clients may defend against the analysis by denying interpretations or employing ways to avoid the material, and such resistance will also be interpreted. As the relationship develops and resistances weaken, therapy enters the middle stage when clinical material is reprocessed and worked through. Progress is indicated by the client's willingness to understand interpretations and implications, gaining insight, and adjusting attitudes and perspectives. When the psychological work approaches completion, the termination stage takes place. Termination takes a number of sessions to allow plenty of time for client and therapist to review client changes, the progress of their relationship, and to provide closure.
The primary critique of psychoanalysis and psychodynamic therapies is the lack of evidence from controlled studies that would prove that they are effective. However, many concepts from psychoanalytic thought have been supported by experiments. Other criticisms include sexist attitudes, consistent blame of mothers, and insensitivity to marginalized cultural groups and sexual orientations.
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