1. Psychoanalytic Therapy

2. Levels of Consciousness
Sensations and experiences that the person is aware of any point in time
Preconscious
Memories of events and experiences that can easily be recalled with little effort
Unconscious
The container for memories and emotions that are threatening to the conscious mind and must be pushed away (Sharf, 2004)
Conscious:
1. Examples: awareness of being cold or warm and awareness of pen or book
2. Conscious awareness is a very small part of a person’s mental life
Preconscious:
1. Examples: A phone call to a friend or a favorite desert that was eaten yesterday.
2. The preconscious forms a bridge from the conscious mind to unconscious.
Unconscious:
1. Examples: hostile or sexual feelings toward a parent or forgotten childhood trauma or abuse or needs and motivations of which individuals are unaware
How unconsciousness is important in the therapeutic process?
2. Bringing unconscious material into conscious awareness is a major therapeutic task.

3. The Structure of Personality
Id — (biological and unconscious component)
the pleasure principle
Ego — (psychological component)
the reality principle
Superego — (social component)
the moral principle
ID:
The infant is all id.
The newborn child invests all energy in gratifying its needs (the pleasure principle), which include hunger, thirst, love, comfort….
If caregivers can not meet infant’s needs, infants can form an image of mother’s nipple, pacifier, or secure blanket (called object) to meet their needs. For example, infants may pretend to suck their pacifier to overcome their frustration of unsatisfied needs. This is called primary process.
The primary process is a means for forming an image of something that can satisfy their needs
In adults, the primary process can be seen in the wishful fantasies that appear in dream or other unconscious material.
Ego:
The ego mediates between the world around the infant and the instincts within the infant
Ego follows the reality principle
For example, the young child learns to ask for food rather than to cry immediately when her needs are not met.
This realistic thinking is the secondary process. It is the function of the ego to test reality, to plan, to think logically, and to develop plans for satisfying needs.
So, ego serves to keep us from crying or acting angrily whenever we do not get our way.
Superego:
The superego represents parental values or society’s standard.
As the child incorporates the parents’ values, the ego ideal is formed.
The superego is nonrational, seeking perfection and adherence to an ideal, inhibiting both the id and the ego.
When conflicts among the id, ego, and superego develop, anxiety is likely to arise.
In order to cope with anxiety, the ego must have a means of dealing with situations.

4. Ego-Defense Mechanisms
Are normal behaviors
Help the individual cope with anxiety
Deny or distort reality while operating on an unconscious level
Have adaptive value

5. The Development of Personality
1. Oral Stage (0-1 year): learning to trust others
2. Anal Stage (1-3): learning independence or accepting personal power.
3. Phallic Stage (3-6): how parents respond to child’s sexuality has impacted on later sexual attitudes.
4. Latency Stage (6-12): investing their sexual energy to social acceptable activities.
5. Genital Stage (12-60): the focus of sexual energy is toward members of the other sex.
Oral stage years
Focus on eating and sucking and involves the lips, mouth, and throat.
Infants tend to use mouth and put everything in their mouth in order to explore the world. (watch toys)
Dependency on mother for gratification. Therefore, relationship with mother is very important I this stage
During this stage, a child learns to depend too often on the mother, the child may become too dependent in adult life
If a child experiences anxiety through inattentive or irregular feeding, the child may feel insecure not only at this early stage but also in adult life.
Later personality problems can include mistrust of others, rejecting others, fear of or inability to form intimate relationship.
Anal stage 1.5 to 3
Exploration about their body
If adults respond to them with disgust toward these activities, they may develop a low sense of self-esteem.
Parental discipline patterns and attitudes have significant consequences for child’s later personality development. Conflict around toilet training with parents can develop into personality characteristics such as over-concern with cleanness and orderliness.
Main developmental tasks: learning independence, accepting personal power, and learning to express negative feelings such as rage and aggression.
Phallic stage 3-6
Sexual gratification shifts from the anal region to the genital area.
Anxiety about the fear that his penis may be cut off or removed.
Oedipus complex refers to the boy’s sexual love for his mother and hostility for his father. Then, they eventually learns to identify with the same-sex parent and change from sexual to nonsexual love for the opposite-sex parent.
Latency stage 6-12
1. The sexual energy is repressed and the children apply their energy to school, friends, sports, and bobbies.
Genital stage (12 and above)
The focus of sexual energy is toward members of the other sex other than toward self-pleasure (masturbation).
Although all psychoanalytic theorists accept the importance of the unconscious, and the concepts of id, ego, and superego, they have different opinions about drive theory and psychosexual stages.

6. View of human nature Deterministic:
Behavior is determined by unconscious motivation and biological instinctual drives.
The first 6 years of life determined your personality
Libido: a source of motivation and energy

7. Therapeutic Goals Make the unconscious conscious
Strengthen the ego, so that behavior can apply to reality
Explore the past to increase self-understanding and gain insight about oneself
Conduct a successful analysis in order to change a person’s personality

8. Therapist’s function and role
Foster a transference relationship
Help clients gain insight and understand “why” for their symptoms
make unconscious conscious
Build relationship, listen, interpret, and pay attention on resistances
Assess the client’s readiness to change

9. Therapeutic Relationship
Understanding the old pattern, connecting to current issues, and making new choices
Working through the transference relationship
Therapist’s reaction is not equal to transferences
Counter-transference reaction as a therapeutic tool to understand the world of the clients
Working through:
One or two experiences of insight about one’s conflict is not sufficient to bring about change. Analysis of the transference has to be continued many times and in many different ways.
The process of working through involves analysis of transference and overcoming childhood experiences.
Usually the experiences of successfully analysis of a transference phenomenon is followed by the recall of memory of some important past events or fantasy from the patient’s past.
Resolution of transference: 1.

10. Psychoanalytic Techniques
Free Association
Dream Analysis
Interpretation
Transference
Counter-transference
Resistance

11. Free Association Client reports whatever comes to mind
It opens doors to unconscious wishes, fantasies, conflicts, and motivation.
Content may be bodily sensations, feelings, fantasies, thoughts, memories, recent events, and the therapist.
Lie on a couch rather than sit in a chair is likely to produce more free-flowing associations
Assume that unconscious material affects behavior and that is can be brought into meaningful awareness by free expression.
Content or material in free association cab be anxiety provoking

12. Dream Analysis Dreams provide insights for unresolved issues
Wishes and fears can be revealed in dreams
Unacceptable wishes or memories are often expressed in dreams
Dream is a compromise between repressed id and the ego defenses
Dream is a way to uncover unconscious material and provide insight for unresolved issues.
Through the process of dream interpretation, wishes, needs, and fears can be revealed
Some motivations or memories are so unacceptable to the ego that they are expressed in symbolic forms, often in dreams
Dream is a compromise between repressed ID impulses and the Ego defenses.

13. Interpretation
Therapist points out, explains, and teaches the meanings of whatever is revealed
Guidelines
Close to conscious awareness
Consider clients’ readiness
Go only as deep as the client is able to go
Point out resistance or defense before interpreting the emotion or conflict that lies beneath it
Material that arises from free association, dreams, symptoms, or transference must be interpreted to the patient.
Consider patients’ readiness to accept the material
If interpretation is too deep, the patient ma not be able to accept it and bring it into conscious awareness.

14. Transference
The client reacts to the therapist as he did to an earlier significant other
This allows the client to experience feelings that would otherwise be inaccessible
Analysis of transference allows the client to achieve insight from the influence of the past
If there was an emotional conflict in which the patient at age 3 or 4 was angry at her mother, then anger may be transferred to the therapist. It is the task for therapist to help patients work through their early feelings toward parents as they expressed in the transference.

15. Counter-transference
The reaction of the therapist toward the client that may interfere with objectivity
Different kinds of counter-transference
The irrational reactions of therapists toward the patients
Therapists’ reactions
Three different kinds of countertransference
The irrational reactions of therapists toward the patients
The therapist’s entire feelings toward the patient, conscious or unconscious (therapist should not assume that all their thoughts and feelings during therapy hour reflect the patients’ inner world.
The feelings of the patient affect those of the therapist and vice versa. Therapists might think “Am I feeling the way my patient;s mother may have felt?”

16. Resistance
Anything that works against the progress of therapy and prevents the production of unconscious material
Working alliance increased when resistance decreased (Patton, Kivlighan, & Multon, 1997)
Examples?
Being late for appointment, forgetting appointments, losing interest in therapy, or having difficulty in remembering or free-association during the therapy hour.
Resistance could be shown outside therapy by acting out other problems through excessive drinking or having affairs.
Resistance could be transference resistance. Transference resistance is a means of managing the relationship with the therapist so that a wished or feared interaction with the therapist can take place.
Client: I sensed you were angry with me last time. I could tell by your voice.
Therapist:
4. Listening for resistance is very important in this approach.

17. Analysis of resistance
Helps client become aware of the reasons for the resistance (e.g., avoiding pain or anxiety)
Helps the client see that resistance (e.g., canceling appointments) is a way of defending against anxiety
Resistance interferes with the ability to accept changes

18. Contribution to multicultural counseling
Help clients to build ego and cultural identity
Help therapists become aware of their own source of counter-transference, bias, prejudices, and stereotypes.

19. Limitations for multicultural counseling
Cost, Upper- and middle-class values
Ambiguity (vs. Asian prefers structured and concrete solution)
Blame clients vs. blame external factors (social, cultural, or political factors)