D Brown Zoo Attachment Psychodynamic Session Defenses Free Association

Gaze 2.48 https://www.youtube.com/watch?v=apzXGEbZht0
D Brown Zoo Attachment Psychodynamic Session Defenses Free Association Psychodynamic Explanation roots Transference Counter Transference Psychodynamic / CBT Psychodynamic what to expect transference begins 10.56 Jo – Susie Orbach

Introduction to Psychodynamic Counselling
Course Code PC402 pm

Administration The Building

Health & Safety At the start of the course, please ensure that students understand what to do in the event of a fire. The assembly point for any evacuation is in KEAN STREET Take the laminated room number sign from the classroom wall and instruct students to assemble with you, using the room number as your ‘flag’. If students have mobility problems, direct them to the student lounge on that floor and someone should wait with them until a Fire Marshal arrives to assist them to safety (via the fire-fighting lift) There is a full set of guidelines in each room

First Aid Telephone 2801 to contact a first-aider via the internal telephones in the student lounges or in room 218 Second Floor rooms 206 and 210 have First Aid Boxes.

Ladies: floors G,1,3,4,6 Gents: floors G, 2, 5 Disabled: Each level
Toilets Ladies: floors G,1,3,4,6 Gents: floors G, 2, 5 Disabled: Each level

Student Administration
Signing the electronic register Completing Feedback Forms at the end of the Day

Adrian Scott MSc Senior MBACP Accredited www.counsellingme.co.uk

Paper Free! pdf files on website Background
Please respect the copyright – Do not share

My Experience MBACP Senior Accredited Counsellor
MBACP Senior Accredited Supervisor for Individuals and Groups Managed Counselling services in Voluntary Sector Bereaved, Homeless, Mental health, Carers

Expert Not a guru or psychodynamic expert Do not know everything
Ideas to be Debated / Challenged

Other City Literary Courses
Introduction to the Unconscious Day Working with Bereavement Day Living through Bereavement Day Psychology of Attachment 6 Fridays 6-9pm

Morning Session 10.40 Introduction 11am Icebreaker Exercise
12.00 Theory of the Psychodynamic Counselling 1pm Lunch

Afternoon Session 2 pm Assessment Exercise 3pm Break
3.15pm Theory of the Psychodynamic Counselling 3.45pm Case Examples 4.15pm Round Up / Administration 4.30pm End

Your Experience, Ideas & Examples

Audio Visual Jan Gale – Clinical Assessment Tavistock Clinic
Susie Orbach - Radio Case Studies Cardiff Primary School – Organisational Case Study Tavistock Clinic

Learning Outcomes An Understanding of some of the History of the Psychodynamic An Understanding of some of the Theory of the Psychodynamic An Understanding of some of your own Psychodynamics!

The Day Wide range of skills in the room
Hope you all get something out of it I am not an expert on the Psychodynamic Approach Encourage you to have your own view

Boundaries Look after yourselves the Psychodynamic Approach can be a difficult and emotive subject Do not say anything you do not want to say. This is not a therapy group! Confidentiality Agreement - All personal information should be kept to this room and with this group of people.

Living a Psychodynamic Life
Be Sceptical (Greek for Inquiry) Hidden Unconscious Relate to Parental / Family experience in childhood Presenting Past Aware of Repeat Defenses Compulsion Resistance Stages of development Anal, Oral ………… Stuck not completed Attachment How? Why? Bereavement Childhood Relationships

Parts of a whole -relating to one another Transference

Limited Love Choices / Career choices / Parenting style Common Unhappiness "transform neurotic misery into common unhappiness“ Sigmund Freud Rearrange the Furniture / Unable to change the furniture

Icebreaker Exercise Ask Your Colleague: 1. What brought you here?
2. What is your interest and experience of the subject? 3. What do you want from the day? You will be asked to briefly and concisely to report back what your colleague has told you to the group, and check with your colleague how you did!

What do you want from the Day?
Are there any Topics, Issues, that you would like to focus or discuss today? Write on flip chart

10-15 minute Break

Theory of the Psychodynamic Approach

Our Relationship to Theory

The Theory Tool Guide

The Theory of Psychodynamic Counselling
Setting the Scene – Vienna in 1880s Hypnotized Example Childhood Example Neurology - The nervous system Conscious/ pre conscious / unconscious Psychoanalysis / Psychodynamic Free Association / Interpretation of Dreams /Unconscious Superego ego id Defense Mechanisms Transference / Counter transference Critique

Theory has its place Not thinking of theory in the room with the client Being with the client Theory - In supervision? So Theory is there for us to pick and choose Theory is there to help and support the being with

Vienna in 1880 Rise of New National States
Rapid Increase of progress in Science, Industry, and Commerce. Exploration of remaining area of the world Deep-rooted security in Europe – Hapsburg Empire Universal stable values – men, women, family, class, hierarchy

Vienna in 1880 Strong emphasis on male domination
World shaped for men by men. Male virtues of ambition, aggressiveness, and toughness seen as positive. Education, family life was authoritarian Laws were repressive: corporal punishment the norm.

Vienna in 1880 Class society – Rigid divide between rich and poor
Every bourgeois family had domestic servants Relationship between master and servant was unsentimental and authoritarian White mans’ domination of the world was unquestioned

Vienna in 1880 Stars involved in public quarrels, and then making up all in public view. Vienna was - Authoritarian and Rigid culture Women were domestic servants Lots of Leisure time

Vienna in 1880 Public obsession with love Love was a prime concern to men and women People were in love with the idea of love Which set the scene for Hysteria – attributed to women Theory of Sex

Birth of Sexual Psychology
In Vienna Sex was Taboo Homosexuality banned Inappropriate relationships with children Sexually deviant behaviour rife Idea that Psychological reasons are at the root of sexual perversions gained ground

Vienna in 1880 Science was used as entertainment. People would go to see famous magicians and scientists performing tricks and doing experiments Hypnotism was performed at shows and was popular entertainment

Drama Audience Theatrical Showman

Hypnosis Example Awake Person is Hypnotised
Person given suggestion Trigger - clap hands when hypnotised person hears “Hello” Hypnotiser says “Hello” Person hears command “Hello” and claps their hands Person Woken Up – unaware of Trigger

Hypnosis “Trick” Awake Person who is unaware of what has happened / Trigger Hypnotiser says “hello” Hypnotised person claps hands Audience Applause

How? How is the brain able to be hypnotized?
Where is the dormant information or trigger stored for future re-activation? Is this the unconscious? Is the unconscious a place where certain thoughts stay separate from the conscious?

Parallel to Hypnosis – Childhood Example
Awake child Has a painful experience Child “forgets / stores” experience (suggestion /command /trigger) At later stage in adulthood - “forgotten experience” is remembered by (suggestion /command /trigger ) Adult relives childhood pain

Childhood Teaching Example
Child bitten by dog on a hill walk with family Dog Lover Parent blames child. Child hurt. Child “forgets” painful experience Later in life “forgotten experience” is remembered by (suggestion /command/trigger) Adult dislikes hill walking / dogs

Turning Point

Concept of a person 1900s

Concept of a person Post 1900s

“In the modern age we have come to understand our own selves as composites often contradictory, even internally incompatible. We understand that each of us is many different people. Our younger selves differ from our older selves; we can be bold in the company of lovers and timorous before our employers; principled when we instruct our children and corrupt when offered some secret temptation; we are serious and frivolous, loud and quiet, aggressive and easily abashed. The 19th century concept of the integrated self has been replaced by the jostling of I’s and yet unless we are damaged or deranged we usually have a relatively clear sense of who we are. I agree with my many selves to call all of them “me”. Salman Rushdie – Midnight’s Children

Link to Psychodynamic “ I don’t feel myself today”
“ I don’t like that side of myself ” “ It just came over me, & I felt so cross with myself ” So the phrase “I felt so cross with myself” becomes I reminds the person of when their parents were actually cross with them. of the fantasy that their parents would be cross with them if they knew of the frustration of the person who might be cross with them of the illustration of the punitive part of the self called the super ego or conscience.

Arrival of Freud!

Sigmund Freud Freud studied medicine and neurology at the University of Vienna under Josef Breuer, a Viennese physician. From 1882 to 1886 Freud worked at the General Hospital, and experimented among others with cocaine, also using it himself. He went to Paris in 1885 to study under Jean Martin Charcot at the Salpetriere Hospital. There the hypnotic treatment of women, who suffered from a medical state called ‘hysteria’, led Freud to take an interest in psychiatry.

How? Freud was the first person to attempt to create and record a theory that reaches the unconscious

Freud created Theory of Psychoanalysis

The Theory of Psychoanalysis
AIM: Make the Unconscious Conscious How? Patient – lies down Free Association Interpretation of Dreams Unconscious Defense Mechanisms Childhood link to Adulthood Objects Relations Theory

The Psychoanalyst Own analysis 5-10 years
Comfortable and familiar with their own unconscious? Analysis and Interpretation of Resistance Transference and Countertransference Working with defences – repression Anxiety

Psychoanalysis & Archaeology
Freud’s Desk

Psychoanalysis Realising the unconscious is like an archaeological dig
Brush away the earth to reveal another layer Repeat unconscious ideas to patient at each level - Directions to Jerusalem

Psychoanalysis Psychological theory conceived 19th / early 20th
Psychoanalysis has expanded, been criticized and developed in different directions, Mostly by some of Freud's students, such as Alfred Adler, Carl Jung, Wilhelm Reich Later by neo-Freudians such as Erich Fromm, Karen Horney and Jacques Lacan

Psychoanalysis Development is determined by events in early childhood by irrational drives; Drives are largely unconscious Making person aware of meets resistance called defense mechanisms Conflicts between conscious and unconscious (repressed) Liberation from the effects of the unconscious is done by making it conscious with a psychoanalyst

Psychoanalysis Patient lies on the couch and talks
Analyst - Blank Screen / does not speak Unconscious brought to light by Free Association Dreams Transference / Counter Transference

Defense Mechanisms Repression: blocking of memories, emotions, ideas form the conscious Denial Refusal to accept external reality because it is too threatening Splitting: denying parts of the self that are perceived as unpleasant Delusion, Distortion, Identification, Acting Out, Idealisation, Somatising, Projection, Passive Aggression, Projective Identification, Intellectualising, Regression, Disassociation, displacement, fantasy.

Psychoanalysis Transference
Unconscious redirection of feelings from one person to another The inappropriate repetition in the present of a relationship that was important in a person's childhood Redirection of feelings and desires and especially of those unconsciously retained from childhood toward a new object Copying of emotions relating to repressed experiences, especially of childhood, and the substitution of another person ... for the original object of the repressed impulses Better understanding of the patient's feelings

Transference can form a relationship of Erotic Feelings Rage / Hatred Mistrust Parent / Extreme dependence Putting therapist in a god-like or guru status

Psychoanalysis Counter-Transference
Psychoanalyst’s feelings towards the transference / patient Emotional entanglement with a patient. Psychoanalyst’s familiarity with own countertransference is as critical as understanding the transference Valuable insight into what patients are attempting to elicit in psychoanalyst

Counter -Transference Example
Psychoanalyst who is attracted to a patient Understand the countertransference aspect (if any) of the attraction, and look at how the patient might be eliciting this attraction. When the countertransference feelings are identified the therapist can ask the patient what his or her feelings are toward the therapist, Can explore how those feelings relate to unconscious motivations, desires, or fears.

Carl Jung 1875 –1961 Both Jung and Freud had profound belief in the unconscious Jung emphasised the role of symbolism Fell out: Freud not flexible enough to further Jung’s work Drew on Mythical and anthropological to illuminate (not prove) his theory

Jung / Freud Differences
Freud – Scientific Psychoanalysis Theory Instincts Sexuality Conscious/Unconscious /Free A./Dreams Jung – Unscientific Analytic Psychology Archetypes Collective Unconscious, Literature, Myths and Legends

Carl Jung Archetypes The Self (ego) - archetype of wholeness
Shadow – generally negative projected onto less favoured groups and indivduals Persona – the face shown to others

Carl Jung Archetypes Anima – In men feminine aspect of man
Animus – In women masculine aspect of of women Function as opposites in the unconscious Influence relations of men and women to each other

Carl Jung Sources Symbols from mythology, religion, fairy tales, alchemic texts Symbols shared be everyone …. Collective Unconscious – pool of experience accessible to all

Jung - Complex A Complex is a personal unconscious - core of emotions, memories, perceptions Complexes are part of the psyche, source of all human emotions Complexes act autonomously Interfere with the will, disturbing memory and the conscious Complexes are not negative, but their effects can be

Carl Jung Jungian Analysis
Goal - Analysand’s wholeness Come to terms with the Unconscious Establish on-going relationship between consciousness and the unconscious Examine relationship between unconscious and everyday life

Carl Jung Diagram of Psyche
Conscious Personal Ucs Collective Ucs Self Complexes

Carl Jung Clips Transference and Archetypes - 10 minutes
Collective Unconscious – 5 minutes Transference and Archetypes – 10 minutes Fantasy and the Unconscious - 5 minutes Jung on Freud and the Unconscious – 4 minutes

Psychoanalysis to Psychodynamic
Freud and the Unconscious Psychoanalysis Jung Psychoanalytic Psychotherapy Psychodynamic Psychotherapy Psychodynamic Counselling

Links Psychoanalysis & Psychodynamic
Freud Psychodynamic Dreams Interpersonal Interpretation Making Links Free Association Presenting Past Lying Down Sitting Up

Characteristics of the Psychodynamic
The Frame Face to face talking Transference / Counter transference Resistance Childhood / Parental Attachments

Freud and the Unconscious
An iceberg is often used to provide a visual representation of Freud’s theory that most of the human mind operates unconsciously. Conscious mind - ego Unconscious mind Further divided into the id - instincts and drive and the superego – conscience

Iceberg picture here

Iceberg Model "The soul is like an iceberg; it contains a conscious part and an unconscious part” - Sigmund Freud To reach the Unconscious we have to find out about it

Characteristics of the Unconscious
Uses Disguise Opposites / Parallels / Symbols / Metaphors Usually some connection to original idea

Mental Iceberg

Unconscious diagram Conscious Pre- Conscious Unconscious

Unconscious Terms Conscious - everyday awareness
Preconscious - thoughts which are unconscious, but not repressed, able to recall Unconscious – repressed hurts and pain, not able to recall

Diagram of the Unconscious

Unconscious Terms Ego (I) Mediator/Reality Testing / Personal Identity
Id (It) Instinctive part Unconscious hereditary Innate & Repressed / Acquired through experience – in conflict with ego Super ego (Over-I) Judge censor Formation of ideals Parental prohibitions and denials

Jokes and The Unconscious
Freud theorises that jokes emerge from an unconscious aggression as a way of bypassing the internal censor Joking is about laughter replacing anxiety and fear A way of expressing unconscious thoughts particularly in public and social situations

Diagram of the Unconscious

Freud started his work as a Neurologist
Thoughts have energy Stimuli or instincts coming from the inside rather than the outside The nervous system is a body organ which wants to remain neutral The instincts or stimuli from the thoughts bombard the nervous system and prevent it from remaining neutral So it pushes the stimuli off unwittingly giving it more energy

Diagram of the Nervous System
Happy Thoughts Neutral Unhappy Thoughts Energy

Nervous System Happy stimuli reached the nervous system – no reaction remains in a neutral state. An unhappy stimuli provokes a greater reaction with more energy needed to keep it away. Stimuli of anxious energy are repelled by the nervous system only to constantly return and to be again repelled.

Nervous System So stimuli with a command and energy to move your arm, hits the nervous system and discharges its energy through the physical movement of the arm: the nervous system returns to neutral eg: punching Unhappy thought and feelings keep being repelled by the nervous system and returning to it.

The Nervous System Happy stimuli reached the nervous system – no reaction remains in a neutral state. Unhappy stimuli provokes a greater reaction with more energy needed to keep it away. Unhappy stimuli are repelled by the nervous system only to constantly return and to be again repelled. Unhappy thought and feelings keep being repelled by the nervous system and returning to it.

Summary of the Nervous System
The Nervous System wants to remain NEUTRAL Happy Energy / Thoughts are neutral Unhappy energy / thoughts have ENERGY are not tolerated by the nervous system Bounce off the nervous system to go where?

Summary of the Nervous System - Baby
9 months in the womb At 2 years old – Rapid development Personality set Attachment style formed

Summary of the Nervous System – Growth

Critique of Freud

Critique of Freud Feminism – patriarchal White / Eurocentric
Religion like psychoanalysis – hierarchical Science – not evidenced

Tavistock Organisation Case Study
Deprived Area in Cardiff – Child abuse What is unspoken? Reality v. Wish Expert – worked us all out Older Man & Younger women – family Saying no Absence Change Repeating Patterns

Critique of Psychodynamic

Critique of Psychodynamic
Not person centred - cold Directive, making interpretations Long contracts, more expensive Relationship to past ignores present? Male approach?

Psychodynamic Counselling 10 Key Points
1. Counsellor-Client Relationship 2. The Environment: Boundaries/Space/Time/Frequency / Continuity/Sole Relationship/ Payment 3. Confidentiality / Counsellor Non- disclosure 4. Reflecting…Empathising 5. Listening / Hearing 6. Acceptance/Trust 7. Resistance: Change, Status Quo 8. The Presenting Past /The Unconscious 9. Transference/Counter transference / Negative Transference / Erotic 10. Own Therapy / Supervision

Objects Relations Theory
Object relations theory is a psychodynamic theory describing process of how a person develops in relation to others in an environment – particularly family. We relate to people and situations as adults based on the way we experienced our parents when we were infants Melanie Klein developed the theory further Good object / Bad object (breast) - Splitting

Attachment Theory John Bowlby
Bereaved can become stuck in the mourning process. Freud described this as melancholia - a reaction to a love object. Mourning is a reaction to the loss of a loved one: whereas melancholia described something being lost in the bereaved devaluing themselves The object loss was transformed into an ego loss. This led to the Object Relations Theory being put forward by Klein.

The baby’s fantasy is that his sadistic feelings towards the mother will push her away abandoning him. He is able to overcome these feelings when the mother doesn’t fulfill the baby’s fantasy by leaving, but remains a stable influence guaranteeing the baby’s security. John Bowlby believed the Freud and Klein’s theories influenced by the instincts of sex and feeding were not the only factors.

Bowlby developed his own Attachment Theory when he noticed in a study of rhesus monkeys that when given the options of mother: one a soft dummy without food: or a hard dummy with food that the monkeys always preferred the soft mother Baby’s emotional world was not only formed by innate instincts but from early parental relationships. Emotional warmth between mother and baby could influence the whole attitude of the infant right into adult life.

Mother’s / main carer’s emotional state before and after the birth of the baby. If mother / main carer is depressed she is less likely to be open and responsive to the baby’s needs. For the baby to detach from the mother successfully a good process of attachment (being cared for and loved) has to occur

Winnicott D.W.Winnicott studied a lot of mother baby interactions: and arrived at the idea of potential space. He watched how babies tend to use their fingers and thumbs in stimulation of the mouth (Freud’s Oral Phase). After a few months babies become fond of playing with objects which they can become addicted to. He called these transitional objects to help the baby move from the oral phase to the true object relationship.

Mother and Baby D.W.Winnicott
Studied a lot of mother baby interactions Potential space How does primary relationship enable separation to be tolerated by the baby? Transitional Object Must be allowed to have rights over the object Good enough parenting and mothering Play negotiation between inner psychic reality and outer worldly reality Culture originating in Potential Space as relationship of experience

Winnicott This transitional object can become very significant throughout childhood and maybe returned to at times of stress. Qualities of the relationship : the child must be allowed to have rights over the object; the object is loved; Good enough parenting allows a good relationship to form between mother and baby so that he is able to deal with his own frustration. This leads to the idea of play; a negotiation between inner psychic reality and outer worldly reality.

Winnicott Play allows the parent and child to be creative and develop a sense of self. Winnicott expanded these ideas: describing culture originating in Potential Space as the relationship of experience to tradition and separateness to union.

Brazelton & Cramer Still face studies conducted by Brazelton & Cramer between mother and baby The mother is asked to interact lovingly for three minutes Leaves and returns with a mask like expression on her face. The baby tries to gain the mother’s attention Then the baby’s expression becomes more serious Body curls over and his head falls. All this happens within three minutes. Tries to ignore the need to look at his mother Cuts off from his environment for comfort This distancing and cutting off from feelings in counselling

Bowlby Conclusions Counsellor applies attachment theory sees their role as being one of providing the conditions which his client can explore representational models of himself and his attachment figures with a view of reappraising and restructuring them in the light of new experiences he has in the counselling relationship.

Bowlby Conclusions Has to provide a secure base of time, place, frequency sympathise. Assist clients to explore relationships by considering how they are engaged with: also unconscious traits that influence their choice of intimate relationship. Flag up relationship between the counsellor and the client themselves Counsellors sanctions possible ideas and feelings that would before be unthinkable and unimaginable.

Bowlby Conclusions Reflect on the accuracy and adequacy of these images. Counsellor has to be able to make the client feel safe: Winnicott described this as “holding” and Bion as “ containing”. In providing this secure base the counsellor is playing the role of the mother with her baby. The counsellor remains attentive and responsive to the client’s needs to see and feel the client’s world through the client’s eyes.

Influence of earlier experiences on the transference relationship
Client is very apprehensive of the counsellor because he feels he will criticise or reject him. Client holds a favourable picture even though everything else points to the contrary. Family maintains that they have given the child constant affection and that it is the child’s fault for not accepting it. The client can feel totally unaware of these feelings The client in his early years have developed an anxiously avoidant pattern of attachment of being detached and emotionally self-contained The dread that the counsellor will trap him in a relationship to serve his own ends – the child has the care giving role for the parent. Client shifts from treating the counsellor as one of his parents to treating him in the same way that he was treated by his parents During childhood client learns two ways of behaving: the child interacting with the parent; and the way each parent interacts with him. Positive Transference / Negative Transference. Threats to not love the child / threats to abandon the child / threats to commit suicide.

Hypnotised Person diagram
Conscious Pre- Conscious Action Repression Distortion Repression Distortion Setting up of experiment Physician’s Order Unconscious

The Unconscious is full of energy from unpleasant feelings Always wants to escape to the Conscious Always held back by the Pre Conscious and Conscious

The Unconscious cannot remain unconscious How does it escape into the conscious? How does it pass by the guards of the pre-conscious and conscious?

Unconscious diagram 2 Conscious Pre- Conscious Unconscious

Unconscious diagram 3 Conscious Pre- Conscious Unconscious Repression
Distortion Repression Distortion Unconscious

Unconscious diagram 4 Conscious Actions Pre- Conscious Unconscious
Body movements Pre- Conscious Receive from external world and Internal sources Repression Distortion Knowledge, Memories Accessible to conscious Repression Distortion Setting up of experiment Physician’s Order Unconscious

Dreams Interpreting a dream means putting meaning to it
Fits the course of mental events in the dream To a scientist Dreams were just a biological process

Dreams Lap opinion was confused and undecided – thought it had significance but did not know what Freud thought every dream had a meaning Hidden and parallels some other process of thought Just undo the substitutions to reveal it meaning

Dreams Two ways of interpreting Dreams
1. Simplistic – close rel. to Dream content Used to predict the future 7 fat kine, 7 lean kine who ate the 7 fat kine prediciting famine in Egypt:

Intro to Kate Woman in temporary accommodation
In rel. with violent boyfriend / friends don’t like him He disappeared with her flat keys Stays with him when he is asleep in the day: does not leave flat 30 minutes late to sessions

Kate Conscious Pre- Conscious Unconscious Repression Distortion
Afraid to question herself / or allow others to question Conscious Pre- Conscious Fractured isolated life style Repeating pattern /men abusing her, provoking violence towards herself Repression Distortion She senses that something is wrong: leading a life she doesn’t want Repression Distortion Unconscious Anger/Ideas/Energy satisfied to maintain status quo by entering conscious in a distorted state

Kate 2 Conscious Pre- Conscious Unconscious Fear Pain Repression
Afraid to question herself / or allow others to question Conscious Pre- Conscious Angry at boyfriend attracts violence Trusts and believes him, so attracts violence Repeating pattern Repression Distortion 1 2 Has access to feelings of not trusting, not believing 4 3 Repression Distortion Anger turned back by repression Unconscious Angry trying to reach conscious Unsatisfied anger gaining energy Angry situation censored Fear Pain

Dreams 2. Method of decoding Dream allowed to have different meanings
depending who is decoding it Freud noticed splitting up the Dream made the interpretation fragmented and confused!

Dreams Freud believed that a pathological idea can be traced back to patient’s inner life where it came from Give up censoring thoughts – Free Association Patient must be aware of inner world: lying down eyes closed and relaxed

Dreams Exercise: try having a thought that is not censored!
Difference between reflecting and self observation. Reflection uses a censoring part of the self – something is left behind

Dreams Freud wanted the patient to relax
Like dropping off to sleep / being hypnotised So involuntary ideas would come to patients’ mind These thoughts not dreams but still retain dream like character

Dreams Difficult for patients – met with violent resistance – Reason P.177 When Freud asked patient to comment on whole dream – blank Focusing on part of the dream – patient had more to say

Dreams Freud felt the best way to illustrate this was to use on of his own dreams He is “normal” Knows the context of the Dream – himself

The conscious resists unconscious thoughts The unconscious wants to be conscious The unconscious is where psychic activity begins and whether it gets into the conscious is determined by strength of resistance. The unconscious thoughts have to undergo a change / distortion / disguise to get into the conscious Unconscious thoughts want to be conscious

Bullet Points of Psychodynamic Theory
Psychodynamic links counselling and psychotherapy with psychoanalysis. Psyche includes intellectual processes, emotions and feelings. sychodynamic refers to thoughts & feelings, as active. Psychodynamic: activity takes place in relation to itself Clients love, hate, or fear part of themselves and other people Dynamic going on within the psyche. Freud described the parts as the: Id Ego Super ego Jung Shadow Anima Animus Winnicott Self False Self Transactional Analysis Parent Adult Child

Bullet Points of Psychodynamic Theory
* Psyche formed over long years of child development * Influences more than memory: live inside of us. * Psychodynamic emphasises experiences/ feelings in the clients’ past. * Child’s feelings become fantasies about primary relationships. * Child’s fantasies are internalized during stressful parental situations. * Become internal relationships: become active self-motivated. * Psyche not waiting to eat, defecate or have sex: recognizes the complexity of the different parts of the person. * Psychodynamic interested in the object relations - or personal relationships. * Psyche is constantly active: particularly in times of stress or agitation,. Psychodynamic alert to activity in the way the client talks in the past and present, and in the counselling relationship.

Case Study Example of a beginning: First Session:
Pat 31yr old woman presenting with a history of bulimia and her partner committing suicide last February. Father left family when she was 2 years old. Didn’t know how it all went. Wanted to say things about herself but did not know how. Lot of silence and awkwardness. Kept busy a lot of the time. Stared me down wanting something from me. Talked of her awkwardness, and how people did not know what to say. Left the room at one point; this was a place she could not go. Session2 Talked about having a male counsellor: not her preferred choice. Aware of cutting off her feelings. I talked about her father, how there was a lot of loss around men about. Said she felt no loss for her father. Asked for female counsellor to avoid pain of loss. Should she wait for a female counsellor – I said this was fine. See you next week. Session Missed the session. Wrote a letter. Session4 Came in saying that she had got soaked cycling into the session. Had been ill with flu last week so she could not stay. I went for it. Talked about feeling caught: if she stayed she would be ill; if she went we could not engage. I said I felt there was a lot of anger about and perhaps she was communicating her ambivalence towards the sessions and me. Said she had to go before she caught a chill. Session5 Talked about the difficulty of being here. I said why should she trust me so quickly I was still unknown to her. I said I wanted to respect the fear she had about talking about her feelings. Left 20 minutes early couldn’t take it. Session6 Missed the session. Wrote a letter. Session7 Different person. Came in saying that she had got the letter. Then asked me if she had made it last week!! Talked about being overwhelmed by her feelings. Started talking about the Xmas break and how she was going to miss her partner ……..

Case Study Case Study The client felt that she could not remember anything that the counsellor told her. She wept and castigated herself for not remembering as far as she could see without any rational reason. She revealed that four years before her own birth her elder sister had died aged three. The mother was very depressed about this, was hospitalised and then committed suicide. She had had an over-protective and over-anxious relationship with her mother, with a remote, domineering father. She married at 28 and became very dependent on her husband which was masked by her incessant hen picking of him. Five years later after the death of her aunt who she felt was like a mother to her: she became even more clinging and dependent to her husband. The attachment process was distorted by the mother’s grief and depression around the death of her daughter. The loss was compounded into a psychosis by the mother’s suicide reminding of her parenting loss and the actual loss of her mother along with the death of her aunt a surrogate mother. The mourning process had not be completed or worked through by the mother. The birth of the client was used to act her feelings of loss and grief by not being able to respond to her baby’s needs but only her own needs which led to her over protecting the baby in a troubled anxious way. In counselling she managed uncover her strong feelings from the past which had never been expressed. She had been so angry but unable to express the anger because she was so afraid of upsetting her already upset parents. When this anger was expressed to the counsellor and was seen as not destroying the counsellor the depression lessened.

Freud’s Dream July 23rd -24th 1895

Dream: Freud’s Situation
Inventor of new system of diagnosis: psychological = neurosis, hysteria Diagnosing traditional organic symptoms with new outcomes Diagnosis of organic symptoms was well established and acceptable Freud made mistakes Freud was a threat and in competition with organic medicine

Interpretation of Freud’s Dream
The hall – numerous guests, who we were receiving Bellevue House - anticipation of wife’s birthday with guests including Irma Freud writing up real case of Irma’s condition This scenario had moved from day to dream

I reproached Irma for not having accepted the solution; I said ‘if you still get pains , its your own fault’ Freud might have actually said this to her Freud had informed the patient of the symptoms so he was not responsible (he realised he was wrong) Success depended on patient accepting his hidden meaning: Freud not responsible for this In the dream Freud was very anxious not to be responsible for the pains

Irma’s complaint: pains in her throat and abdomen and stomach; it was choking her These symptoms were not prominent in real life diagnosis: more nausea and disgust Freud wondered why he chose these symptoms: no explanation at the moment

She looked pale and puffy My patient always had a rosy complexion Freud suspected a substitution

I was alarmed at the idea I had missed an organic illness Freud specialist in hysteria: attributing symptoms to neurosis, not like other physicians attributing symptoms to organic Alarm not genuine? If symptoms were organic, he could not be blamed as this was not what he treated Wishing there was a wrong diagnosis so he could not be blamed?

I took her to the window to look down her throat . She showed some recalcitrance like women with false teeth. I thought to myself that really there was no need for her to do that Substitution of another case were patient looked well, but when he looked in her mouth she was ill Replaced patient with a friend who he saw in front of the window in her house diagnosed with organic symptoms She suffered from hysterical choking (Freud also thought she was a hysteric)

Substitution also more favourable to Freud Other patient more intelligent than Irma Irma was foolish not to accept Freud’s solution

What I saw in her throat: a white patch and turbinal bones with scabs on them Reminded Freud of his own daughter’s similar illness Also reminded him of his own state of health Frequent use of cocaine, which had brought him trouble – lack of professionalism? Friend recently died of misuse of cocaine

I at once called in Dr M, and he repeated the examination Freud had patient who died due to his mistreatment Same name as his daughter Collecting incidents to evidence his own lack of medical conscientiousness

Dr. M was pale, had a clean shaven chin and walked with a limp Like older brother who lived abroad, had pain in his hip and walked with a limp Both Dr M and his Brother had rejected suggestion on an other matter made by Freud

My friend Otto was now standing beside the patient and my friend Leopold was examining her and indicated that there was a dull area low down on the left Leopold and Otto both competitors One was slow the other quick Freud struck by Leopold’s thoroughness, favoured him like he favoured the friend over Irma

Dysentery Freud had discussed a patient with Dr M who had Dysentery. Diagnosed as organic Freud diagnosed it as hysteria Freud deriding organic diagnosis of doctors

Trimethylamin Substance related to sexual metabolism Sexuality at root of all nervous disorders

Injections of that sort ought not to be made so thoughtlessly Otto thoughtless Freud thought Otto was thought less as he was disagreeing with him Reminded him of freind who had died from injecting cocaine

Freud’s Dream Conclusions
Freud is free of any responsibility and blame for Irma’s condition by showing it was due to whole series of other factors Dream was a fulfilment of a wish, and its motive was a wish

Defence of man who charged neighbour with returning his kettle damaged
Defence of man who charged neighbour with returning his kettle damaged. The neighbour’s defence was:- Firstly that he had given it back undamaged, Secondly that the kettle had a hole in it when he had borrowed it Thirdly that he had never borrowed the kettle in the first place Only one line of defence need for acquittal!!

Freud is human good/bad Insecure, fearful, afraid of his new ‘invention’ Up against huge competition medical and social Having to prove himself

Psychoanalysis Psychological theory conceived 19th / early 20th
Psychoanalysis has expanded, been criticized and developed in different directions, Mostly by some of Freud's students, such as Alfred Adler, Carl Jung, Wilhelm Reich Later by neo-Freudians such as Erich Fromm, Karen Horney and Jacques Lacan

Psychoanalysis Development is determined by events in early childhood by irrational drives; Drives are largely unconscious Making person aware of meets resistance called defense mechanisms Conflicts between conscious and unconscious (repressed) Liberation from the effects of the unconscious is done by making it conscious with a psychoanalyst

Psychoanalysis Patient lies on the couch and talks
Analyst - Blank Screen / does not speak Unconscious brought to light by Free Association Dreams Transference / Counter Transference

Psychoanalysis & Archaeology
Freud’s Desk

Psychoanalysis Realising the unconscious is like an archaeological dig
Brush away the earth to reveal another layer Repeat unconscious ideas to patient at each level - Directions to Jerusalem

Unconscious redirection of feelings from one person to another The inappropriate repetition in the present of a relationship that was important in a person's childhood Redirection of feelings and desires and especially of those unconsciously retained from childhood toward a new object Copying of emotions relating to repressed experiences, especially of childhood, and the substitution of another person ... for the original object of the repressed impulses Better understanding of the patient's feelings

Transference can form a relationship of Erotic Feelings Rage / Hatred Mistrust Parent / Extreme dependence Putting therapist in a god-like or guru status

Psychoanalysis Counter-Transference
Psychoanalyst’s feelings towards the patient Emotional entanglement with a patient. Psychoanalyst’s familiarity own countertransference is as critical as understanding the transference Valuable insight into what patients are attempting to elicit in them.

Counter -Transference Example
Psychoanalyst who is sexually attracted to a patient Understand the countertransference aspect (if any) of the attraction, and look at how the patient might be eliciting this attraction. When the countertransference feelings are identified the therapist can ask the patient what his or her feelings are toward the therapist, Can explore how those feelings relate to unconscious motivations, desires, or fears.