Counseling & Psychotherapy

Counseling & Psychotherapy
Lecture 1 Overview of Counseling and Psychotherapy in Hong Kong Introduction to the Psychoanalytic Theory Bonny Ip

The aim of this module is for students to gain an insight into the main theories underpinning the different approaches taken in counseling and psychotherapy and how these relate to practice. To provide students with a broad based knowledge of counseling techniques & therapy To familiarize students with the core skills of counseling and therapy To familiarize students with cross cultural issues relevant to the practice of counseling & therapy To increase students’ awareness of ethical issues related to the practice of counseling and therapy

Module Learning Outcomes
To understand the main theories & approaches in counselling & psychotherapy How these relate to practice By engaging successfully with this module a student will be able to: Compare and contrast the different approaches taken in counselling and psychotherapy Critique the main theories underpinning the different approaches Explain how the key methods used in the different approaches relate to their theoretical underpinnings

Administrative details: Course Topics
Major areas of study The module focuses on three main approaches in counseling and therapy Psychodynamic/Psychoanalytic Approach (unconscious motivations) Cognitive - Behavioral Approach (interplay between emotions, behavior, thought and physical symptoms) Humanistic Approach (inner capacity for growth)

Administrative details: Staff
Lecturer-in-charge/ module coordinator: Mrs. Bonny Ip Room: P6707 Phone No: Lecturer-in-charge: Dr. Audrey Yeung Room: P6705 Phone No:

Assessment Tasks Essay 1 30% - 1500 words
Self-awareness is one of the key elements for a counsellor. Based on the following therapeutic approaches, choose ONE to discuss your own personal experiences on how it facilitates you to understand your thoughts, behaviors and feelings? a. Psychoanalytic Approach b. Individual Psychology Approach (Adlerian Approach) c. Cognitive Behavioral Approaches d. Humanistic Approach (Carl Rogers) Deadline for submission : 8 March 2016 (To be confirmed)

Assessment Tasks Essay 2 70% - 3,000 words
There are four cases provided, just choose one of the cases supplied, relate it to a specific approach (Psychoanalytic approach, Individual psychology Approach, Cognitive Behavioral approaches, Humanistic approach) and discuss the questions. You can find the questions in the related case background. There are a total of four cases: choose only one to answer Deadline for submission : 15 March 2016 (To be confirmed)

Overview What is Guidance? What is Counseling?
What is Therapy/Psychotherapy? Who does Therapy/Psychotherapy? Understanding the historical development of counseling theories

Accreditation

Counseling is a therapeutic activity designed to help people: usually comprising 2 people: the client and the counselor / therapist Counseling is usually carried out by people who have undergone training (qualifications) Counseling invariably takes place in a confidential setting, enabling the client to feel free to talk about any issues that concern them

Counseling involves a process with ‘predictable sequence’ that is ‘characterized by movement toward identifiable outcomes’ The ultimate purpose of counseling is to facilitate the client to initiate and achieve certain kind of planned change that he/she considers satisfying. It possesses a quality of working relationship which is conducive to client’s change and growth. It entails the application of counselor’s knowledge in assessing the client’s needs and problem, and in planning and implementing a purposeful intervention for change. It demands the active participation of the client in self-disclosure, self- reflection and self-monitoring which is facilitated through the interaction between him/her and the counselor. Counseling is an intensive working relationship between counselor and counselee. Counseling is an ethical practice where counselor and counselee have to observe a standard code of behavior that are officially set by relevant professional associations, bodies or legislation.

The British Association for Counseling & Psychotherapy (BACP) defines counseling
The term ‘counseling’ includes “work with individuals and with relationships which may be developmental, crisis support, psychotherapeutic, guiding or problem solving. The task of counseling is to give the client an opportunity to explore, discover and clarify ways of living more satisfying and resourcefully”

The Identity of Counseling in Hong Kong
Counselors and Counseling – The need for a stronger professional identity Has more than 30 years of development as a helping discipline, but has yet to consolidate its place among various helping professionals Counseling viewed as strategies shared by many helping professionals A significant overlap among different helping professionals

Recent Development Increase in training opportunities
Awareness that counseling can fill societal needs (in education and social service) Professionalization of helping professionals The development of counseling and psychotherapy in China and around the world

Immediate Concerns A rapid increase in the number of individuals who have received training in counselling: Who is competent to practice? Who can call themselves professional counselors? How should counselors be trained? What can be done if a counsellor is not practicing in an ethical manner?

Standards and Criteria Used as References
British Association for Counselling and Psychotherapy (BACP) National Board for Certified Counselor (NBCC) in the U.S. The American Counseling Association (ACA) Hong Kong Professional Counselling Association (HKPCA)

Certify counselors in Hong Kong Recommendations made by HKPCA
Individuals who seek to become a “HKPCA Certified Counselor” should have at least a Master’s degree in counseling or counseling-related field In order to qualify for professional membership in HKPCA, the individual should enroll in a master-level degree program (or its equivalent) with a clear “theory” and “practice” component The total number of contact hours in the academic program, including both the theory and practice components, should aggregate to about 320 hours (exact hours to be decided)

Pre-Degree 450 hours of Supervised practice (150 hours have to be post-degree) Supervised Practice Post-Degree 100 supervision hours (50 hours have to be post-degree)

Counselling Psychotherapy Focus
Developmental – fosters coping skills to facilitate development and prevent problems. Remedial – aimed at helping clients overcome existing problems such as anxiety and depression. Clients’ Problems Clients tend to have “problems of living” such as relationship difficulties, or need assistance with specific problems such as career choice. Client’s problems are more complex and may involve using formal diagnostic procedures to determine if there is a mental disorder. Goals The focus is more on short-term goals (resolution of immediate concerns) The focus is on short- and long-term goals. Long-term goals an involve processes such as helping the client overcome a particular mental disorder. Treatment Approaches The treatment program can include preventative approaches and various counselling strategies to assist with the client’s concerns. Psychotherapeutic approaches are complex. They utilize strategies that relate to conscious and unconscious processes. Setting Counselling services can be provided in a variety of settings such as schools, churches and mental health clinics. Psychotherapy is typically offered in settings such as private practice, mental health centres, and hospitals.

Theory as a map of understand the past and realizing the future
Counselling Theories Theory as a map of understand the past and realizing the future Theory as procedural steps Theory as a network of ideas Theory with different principles

Types of Psychotherapy
Insight Therapies Psychodynamic therapies Freudian psychoanalysis Neo-Freudian therapies Humanistic Therapies Cognitive therapies Behavior Therapies Therapies based on operant conditioning Therapies based on observational learning Therapies based on classical conditioning Counselling Theories Types of Psychotherapy

1950s : The Professionalization of Counseling Profession
General History Pre-1950s : An Infant Stage 1950s : The Professionalization of Counseling Profession 1960s to 1970s : Stormy stage 1980s : Mature stage 1990s and onwards : An Era of Diversity and Challenge

Broad Purpose of Counseling
The general purpose of counseling is to assist people to make choices, changes or reduce confusion in their work, relationship or aloneness Essential qualities characterizing an effective counselor are understanding, acceptance, sincerity, expertise and qualifications Different theories, different orientation and focuses

Personality Theories Views on human nature
Good / Bad Free Will / Determinism Nature / Nurture Past / Present Uniqueness / Universality Equilibrium / Growth Optimistic / Pessimistic What are your goals of counselling?

The Psychoanalytic Approach Learning Outcomes
Understand what is meant by the psychoanalytic method Understand the Freudian conception of human nature and human motivation Develop an understanding of the way that psychoanalysis attempts to understand human behaviour Be aware of the way Freud structured personality and how he saw it developing Appreciate some of the clinical applications of Freudian theory Know how to critically evaluate the work of Freud

Psychodynamic Theory A broader set of concepts that includes psychoanalytic theory Psychoanalytic theory refers specifically to Freud’s theory and orientation Freud is the most influential Nowadays: neuroscience brought about unconscious into mainstream psychology Associated with its founder Freud are Ernest Jones, Alfred Adler, Erik Erikson, Karen Horney, Melanie Klein, Harry Stack Sullivan

The Life of Sigmund Freud 1856 - 1939
Significant childhood events Born in Freiburg, Czechoslovakia Freud’s Family background Vienna General Hospital Study hysteria with Dr Joseph Breuer

Recalled childhood sexual feelings towards his mother: the basis of the Oedipus Complex
Freud acknowledge the hostility he felt for his father

Freud the Neurologist Love and Marriage Investigating the mind
The case of Anna O Freud’s Children End of life

The word psychoanalysis used for the first time in 1896
Psychoanalysis is a method for the investigation of mental processes inaccessible by other means. At the same time psychoanalysis is also a therapeutic method for neurotic disorders (

Psychoanalytic view of Human Nature
Most human behavior is irrational, driven by unconscious Behavior is determined by irrational forces, unconscious motivations and biological and instinctual drives as these evolve through key psycho-sexual stages in the first 5 years of life

The Concept of Unconscious
Freud did not discover the unconscious; he rediscovered it and gave it status Father Johann Gassner( ), an exorcist, founder of this concept From Philosophy From Psychophysics From Hartman ( )

Levels of Consciousness
Mind is composed of three levels: Conscious thought,preconscious thought; and the Repression, all ideas start in the Unconscious Manifest and latent content of dreams Primary and secondary processes thinking The pleasure principle Instincts unconscious thought

“the mind is like an iceburg - mostly hidden”
The Unconscious “the mind is like an iceburg - mostly hidden” Conscious Awareness small part above surface (Preconscious) What’s on the surface i.e. logic, reality Unconscious What lies deep, below the surface i.e. (drives, instincts thoughts, feelings, wishes, memories) Pre-conscious

Levels of Consciousness
Mind is composed of three levels: Conscious thought,Preconscious thought; and the unconscious thought Repression, all ideas start in the Unconscious Manifest and latent content of dreams Primary and secondary processes thinking The pleasure principle Instincts

Slips of the tongue and forgetting, e.g. a familiar name
Clinical evidence for postulating the unconscious: Slips of the tongue and forgetting, e.g. a familiar name Posthypnotic suggestions Material derived from free-association Material derived from projective techniques Symbolic content of neurotic symptoms

Dreams – a direct route into the unconscious mind
Clinical evidence for the unconscious: Dreams – a direct route into the unconscious mind Dreams: manifest content (actual events); latent content (symbolic meaning) Dreams can be triggered by internal stimuli, such as fever or upset stomach “The Interpretation of Dreams” – Freud described more than 40 of his own dreams

The Nature of Human Beings and the Source of Human Motivation
Libido (life instinct – for reproduction and life-preserving) Thanatos (death instinct – self- destructive) Infantile sexuality Sexual drives

The Structure of Personality Topographical Model
Ego Super Id THE ID “das Es”—The Demanding Child Ruled by the pleasure principle THE EGO— “das Ich” The Traffic Cop Ruled by the reality principle THE SUPEREGO “das Uber-Ich”—The Judge Ruled by the moral principle

Defense Mechanisms reduce/redirect anxiety by distorting reality
Id Behavior is energized by the conflicts created by the interaction of id, ego and superego. These conflicts created anxiety, and we all use defense mechanisms to help deal with this anxiety There are 3 types of anxiety Reality Neurotic Moral Ego protects itself via Defense Mechanisms

Common Defense Mechanisms

Defense Mechanisms Rationalization – “to act rationally”, generate self-justifying explanations to hide the real reasons for one’s action Projection - attributes threatening impulses to others Reaction Formation – to conceal a motive from oneself by giving strong expression to its opposite Intellectualization – to gain detachment from an emotionally threatening situation Suppression – a process of self-control Regression - retreating to earlier stage of fixated development Displacement - divert impulses toward a more acceptable object Sublimation - transform unacceptable impulse into something socially valued

“personality forms during the first few years of life”
Psychosexual Development - Personality develops through 5 distinct stages “personality forms during the first few years of life” Psychosexual Stages Oral (0-18 months) - centered on the mouth Anal (18-36 months) - focus on bowel Phallic (3-5 yrs) - focus on genitals/“Oedipus Complex” (Identification & Gender Identity) Latency (5-puberty) - sexuality is dormant Genital (puberty on) - sexual feelings toward others

Theory of Infantile Sexuality
We are Born bisexual There is a sexual/sensual drive (triebe not instinct), driven by the energy called libido, that steers towards its aim of satisfaction This drive takes many forms and has many objects, some of which do not resemble the objects of normal sexuality, hence it is polymorphously diverse and it’s nature is more sensual than sexual.

Theory of Infantile Sexuality
The object of satisfaction changes with age. The sequence of changes is universal and is shared by all individuals across all cultures The changes occur in stages. Each stage is characterized by a specific part of the body (erogenous zone) where libido is derived and where sensual gratification is obtained The extent of gratification form each zone leaves a mark on one’s personality.

The Oral Stage First year of life Erogenous zone: mouth and lips
Sensual gratification: sucking of nipple Psychological impact: the breast = the external world, “not-me”, blissfulness from being at-one with a nurturing world or another person; readiness to “take in” (introject) what the world or another person has to offer.

The Oral Stage If not properly gratified:
Over-indulgent leads to oral dependency (immaturity, dependence, Manipulation, gullibility, etc.) Frustration leads to oral aggressiveness (gum-chewing, oral aggression, sarcasm, obesity, etc.) Weaning marks the development of ability to delay gratification, accepting the part of reality that one cannot control, and Self-Other differentiation (Ego boundary)

The Anal Stage 2-3 Erogenous zone: anus and urinary sphincter
Sensual gratification: control of urinary and bowel movement Psychological impact: confidence in own control of impulses tat derive pleasure; recognition of own contribution to the world; artistic creativity.

The Anal Stage Toilet training represents reality’s demand on a child’s ability to control urges, builds confidence in self-control and structure, as well as courage and flexibility to break rules when necessary If training is too harsh: becomes anal retentive (controlling, obsessional, rigid, stingy, stubborn) If training is too lenient: becomes anal expulsive (disorganized, careless, reckless, impulsive, reliant on external structure).

The Phallic Stage 4-5 Erogenous zone: genitalia
Sensory gratification: interest in watching, touching, exploring own and others’ genitals, masturbation Psychological impact: realization of sexual anatomy and gender differences.

The Oedipus Complex Boy longs to be with mother, the source of sensual gratification Sees father as a competitor, hates father But discovers father has a larger penis, fear of being punished (castration fear) Resolution: identified with father (identification with the aggressor), takes on societal male role, becomes heterosexual Formation of Superego.

The Oedipus Complex Girl longs to be with mother, the source of sensual gratification See father a competitor, hates father Discovers that father has a penis but not she, longs to have a penis (penis envy) Desires union with father so as to acquire penis, takes on societal female role, becomes heterosexual and interested in childbirth Formation of Superego Termed Elektra Complex by Jung

The Latency Period 6 to Puberty
No erogenous zone, hence not a psycho-sexual stage Sensual drive temporarily dormant Consolidation of previous ego development Focus on development of language and intellect (Ego Strength)

The Genital Stage Puberty to Adulthood Erogenous zone: the genitalia
Sensory gratification gradually takes on a mature nature, where object-love, mutuality, and symbolism become important Failures lead to inability to participate in mature, consensual sexual relationships, sexual dysfunctions, deviation, promiscuity.

Sexual Instinct or Drive
Reactions to the idea of sexual instincts in children Freud used the German world “triebe” which should be translated as “drive”, instead of “instinct” Although Freud talked about sexuality in children, he was referring to their sensuality. Try re- interpreting Freud’s “sexual instinct” in children as sensual drive” in children.

The END

Lecture 2 Psychoanalytic Therapy Individual Psychology Analytic Psychology
Sigmund Freud Alfred Adler Carl Jung Mrs. Bonny Ip

Theory of Psychoanalysis & Psychoanalytic Therapy
What does psychotherapy look like? S. Freud “ Psychotherapy transforms neurotic misery into ordinary unhappiness.” Dimen(2010), “Good treatment restores vitality, not happiness” A. Freud - Psychoanalysis is about finding the truth about oneself. It is for those who are able and willing to tolerate the pain

Common Principles of Psychoanalytic Psychotherapies
acknowledgement of unconscious motivations; interest in becoming aware of unconscious motivations and thus increasing conscious choice; emphasis on exploring ways by which painful feelings and threatening thoughts and fantasies are avoided; emphasis that people are ambivalent about changing and the importance of exploring this ambivalence; emphasis on using the therapeutic relationship as an arena for exploring the clients unconscious and a vehicle for change; emphasis on helping clients understand how their constructed past affect their patterns of behavior.

The Psychoanalytic Stance
helping clients understand their unconscious motivation; refraining for giving advice and being directive; avoiding influencing client with own beliefs and values; maintaining a certain degree of anonymity; maintaining neutrality and objectivity and refrain from becoming a fully engaged participant; maintaining a seating arrangement with the use of the couch and analyst sitting behind the client.

The Goals of Psychoanalysis Therapy
Help client to move from UNCONSCIOUS to CONSCIOUS Work through unresolved developmental stages Gain insight Resolve client’s problems to enhance client’s personal adjustment and ability to cope with life changes Cope more effectively with the demands of the society in which client lives in

Theory of Psychoanalysis & Psychoanalytic Therapy
Freud pointed to repression, and other Defense Mechanisms, that lead to compromises and derivatives that help address these conflicts. As Id drives continue to seek gratification, these derivatives compulsively repeat themselves, forming symptoms Resolution of these conflicts involves bringing both sides of the conflict to Cs. The goal of Psychoanalysis is to make the unconscious side of conflict conscious, or turning Id material into Ego The Ucs. Material can be accessed by uncensored talking and the analysis of dreams and parapraxes.

Freud’s Psychoanalysis
Under a rigidly framed and yet unstructured situation, uncensored talking leads to Transference, which allows the core conflict to manifest itself in the therapeutic relationship Discussion and interpretation of the Transference becomes the centerpiece of Psychoanalysis, by which insight is developed When insight is achieved, patient becomes conscious of both legs of the conflict, and can choose freely between them, much like making any choice in Life.

Development of insight Knowledge of self essential for the process of change Enables the client to assume control over inner feelings and reactions Provided by counselor’s observations, feelings and hunches about clients Intellectual and emotional Insight Person-situation reflection Pattern-dynamic reflection Development reflection

The Freudian Couch Where is the Psychoanalytic space, within the intrapsychic space (drives, defenses, conflicts) or in the relationship between analyst and analysand (the clinical process)? Freud: could not stand being stared at for long; did not want own non-verbal expressions to affect the analysand; to deter analysand’s wish for looking (sopophilia); to facilitate development of transference. Freud’s choice of using the couch was both a personal necessity and a universal technical element required for psychoanalytic work. Can it be modified?

The Psychoanalytic Interview
Aim: To ascertain whether interviewee requires treatment, and if yes, what type Objective: allow interviewee the greatest freedom to show himself as he is; find out what the interviewee knows and is conscious of; see how the interviewee functions, not how the says he functions; seek information that he does not know.

Define the location and duration beforehand (Field) Be a participant observer and let the interviewee take initiative (for his benefit) rather than an interrogator (for the interviewee’s benefit) or an investigator (for third party benefit) Observe the emergence of anxiety and how the interviewee handles it. A. Beginning anxiety (and ambivalence); B. Crisis anxiety – the issue and mental structure needing help; C. Separation anxiety – rupturing of relationship.

Interviewer does not deliberately reduce the anxiety (through reassurance or suggestion), or enhance it (through excessive ambiguity). No interpretation made Ask simple fact-finding questions to give some information on Ego Strength (education, work, relationships, impulse control, use of logic, judgment etc.) When interviewee presents his current problem, notice the words used, the narrative style, ability to self-reflect, and curiosity for the unknown. Notice how he “discharges” his anxiety about the current problem within the interview, e.g. characteristic style of defense mechanism.

Identify the vital crisis or conflict, and the unconscious and infantile elements associated with it Conduct the interview in two sessions (inform interviewee first) so as to observe his ability to repair ruptured relationships (cf, Bowlby’s work) Feedback: succinctly – A. if interviewee suitable, continue to set up the Contract; B. if not suitable, refer (one or more therapists?) Who chooses whom for therapy?

The Psychoanalytic Frame
A temporary spatial temporal frame that marks off the special kind of reality of psychoanalytic session. It is a set of constants that mark the boundary within which the psychoanalytic process takes place (such as Transference) It is a contract between therapist and client as to what each can expect, what is allowed, what cannot be allowed. It represents the ground rules for the analytic space Physical setting: same room, quiet with no interruption, same furniture, couch or no couch, no personal pictures Etiquette: same professional attire, professional courtesy, punctuality, no divergence of personal information The frame also extends to outside of the sessions.

The Contract Analyst and client enter into a contract about treatment. Details of the contract can be different for different for different clients Agree on frequency and duration of sessions, logistics of contact, holidays, fees, method of payment Termination of treatment should be by mutual agreement. When only one party decides to end, it is called interruption of the analysis. This usually carried out by the client, but occasionally by the analyst as well Contract is formulated not to seek compliance, but to see how the client behaves in the face of it. It is the spirit of the agreement between two mature Egos that is important.

The Psychoanalytic Process
However, only a part of the client’s Ego (the Defensive Ego) regresses while the remaining Ego (the Autonomous Ego) maintains its relations with analyst This Regression in the service of the Ego enables secondary process to give way to primary process temporarily within the session This brings the client back to a narcissistic stage where he compulsively repeats previous unresolved conflicts with significant others onto the analyst (Transference Neurosis) As real participants in therapy, the analyst acts as a “container” that holds the emotions that are thrown at him.

The Analysis of Dreams Psychoanalysis (Freud) Analytic Psychology (Jung) Gestalt Psychotherapy (Perls) Existential Analysis (Boss)

Dream Analysis Dreams are fulfillment of unconscious drives that are disguised so they do not disturb sleep; they are “protectors of sleep” The Id impulse is often activated by event during the day preceding the dream (the day residue) The “latent content” of the dream is disguised into the “manifest content” which is more tolerable by the Ego (Dream Work) A. Condensation – one dream object stands for several ideas or associations (dream thoughts); B. Displacement _ the emotional significance is transferred form the real object to a different one in the dream; C. Visualization – a thought is transformed into a visual image; D. Symbolism – a symbol replaces a person, action or idea.

Dream Analysis Dreams are never solicited. They are offered
Nightmares are failures of Dream Work Dream Interpretation is the opposite of Dream Work Freud’s view: Completely disregard connections between elements in the manifest content. Ask client to freely associate to every element in the dream. The collection of associations will point one to the latent content Later view: there is no latent content, the manifest content IS the dream. The reported dream is symbolic of the relationship with the analyst. Its meaning can be deciphered through understand Transference and Countertransference issues.

Projective Story-Telling
Client is presented with a set of ambiguous picture cards and is asked to create a story to each Making use of one’s natural tendency to make sense of ambiguity, the client unconsciously projects own “readiness to perceive” onto the cards (Apperception) In each story, there is a “hero”, meaning the figure that the client unconsciously identifies with. The story is interpreted form the viewpoint of the “hero” Repeated themes across the stories reflect the client’s emotional issues Everyday events as picture cards.

Stages of Analysis Stage 1: Beginning at first session and lasts for about 2-3 months. Client and analyst try to understand and adjust to each other’s expectations and style. Trust/mistrust and hope are the most prominent emotions Stage 2: Least systematized and most unpredictable, longest and most creative stage, begins with client accepting the ways of analysis and ending with resolution of Transference Neurosis Stage 3: Termination of analysis, not long compared to Stage 2, joy (of completion), sorrow (for loss), and uncertainty (about future) prominent.

The Opening Stage No more than 2-3 months for a neurotic client, may last longer for more disturbed clients (e.g. borderlines, psychotics, psychopaths, etc.) Clients talks about relationships outside of therapy (floating transferences) until the focus shifts to what transpires within the session. The “floating transferences” then have gathered to form the Transference Neurosis Analyst should refrain form interpreting the Transference until it has matured. Nothing needs to done except to give the client time to crystallize the Transference.

The Middle Stage Freud: Remembering -> Repeating -> Working Through The middle stage starts when the client finishes remembering and starts repeating the pattern of relating within the session. This is also the time when the client’s problem improves outside of therapy, and shows itself within therapy as Transference Neurosis. The stage when Transference and Countertransference are played out. No Fixed duration, and most divergence among therapists. Focus on containment and interpretation.

The Ending Stage Termination must be decided mutually, as opposed to interruptions of treatment The therapeutic relationship runs naturally into a state of “exhaustion” and dies, after “cure” is reached. However, what is considered “cure” varies with different schools Usually the client senses the desire to end treatment first. This is usually accompanied by sadness, anxiety, and fear about losing the therapist. The analyst picks up such feelings and may concur with termination Then a date for ending is agreed on. But analytic treatment ends only after the last session, when the client, now alone and free, decides that it has ended.

Facilitating free association
Rule of maintaining silence and encourage the client to say whatever comes to mind, such as past history and dreams Rule for the client is to look at oneself realistically Physical setting encouraging free association, counselor sitting behind and out of sight

The Countertransference
Plays a key role in Psychoanalytic Therapy Starts when client decide to take up therapy and counselor gets the referral Entering counseling usually precipitates an attachment crisis Counselor needs to aware who he/she is at any moment in the counseling session e.g. a parent, a sibling, or a partner The Countertransference The counselor unconsciously see qualities in the client that remind him or her of someone he or she knows in the past Countertransference can interfere with the counselor’s objectivity and destroy the therapeutic process

Freud’s Transference Freud first mentioned the concept of Transference in Studies on Hysteria, published with Breuer in 1895 Client’s projection of feelings associated with past significant figures onto the analyst. Such feelings may be anger, mistrust, jealousy, dependence, etc., but most often they are feelings of an erotic nature (Oedipal conflict) The feelings form a “false connection” joining the past with the present through transferring the original object onto the present one. This is unconscious and irrational, and it confuses past and present, a result of primary process Transference is an aspect of the psyche, not the treatment. It occurs both within out outside of analysis.

Neurotic & Psychotic Transference
Neurotics have a strong enough Ego to de-cathect libido from the original object and re-cathect it to a new object in analysis (the analyst), distorting their internal reality They relate to the analyst as if he/she is the parent and re-enacts the Oedipal situation (neurotic transference). Interpretation brings awareness to what the client is doing and experiencing Clients who withdraw their libido from the external world and cathect it in their internal reality do not form strong enough transference or transference that an be interpreted They take the analyst as a real parent (psychotic transference). Psychotic transference appears early on in treatment in full blown force and is not open to interpretation.

Positive & Negative Transference
Freud distinguished between positive and negative transference, which can exist together Transference of positive affections for childhood onto the analyst is “admissible to consciousness and unobjectionable”. It is the basis of the therapeutic alliance, the “vehicle of success” in analysis. In this condition, the analysand is remembering the childhood experiences that have been impacting him In the beginning of analysis (honeymoon phase), analysands usually report an improvement in symptoms in reality However, there may be negative affections from childhood that are repressed and are transferred to the analyst. The analysand will be reluctant to confront and admit to these feelings.

Identifying Transference
Transference is NOT the total relationship between client and therapist. There is a part that is rational and emerging for genuine contact between the therapist and the client. This part is known as the therapeutic alliance How do we distinguish what is Transference and what is coming from the genuine relationship between client and therapist? The relationship between client and therapist, though genuine, exists solely for the reason of helping the client resolve his/her problems. It should have no other reason to exist When the client places more interest in the current relationship with the therapist than in the issue(s) that brought him/her into therapy, then Transference is occurring.

Countertransference Freud defined CT as an unconscious reaction to transference from the client, the latter’s influence on the unconscious feelings of the analyst. It is an obstacle to therapy just as transference is, and it would not have exited if the analyst was fully analyzed Nowadays, CT is sometimes used to refer to the totality of the therapists reactions to the client As Transference slowly became the vehicle for analysis, CT also turned from an obstacle to an aid to understanding the client It is impossible to conceive of an analyst without an Unconscious. The analyst’s Ucs. Would react to the unconscious projections for the client ( transference). Through attending to his own unconscious reactions, the therapist could better understand the client’s unconscious motives for the projection.

Detecting Countertransference
CT is present when strong feelings are aroused in the therapist that lead to changes in his usual behavior, which ultimately interfere with the communication in the therapy dyad Irrational liking or dislike for the client An over-emotional reaction to client’s hostility (arguing): Dread of sessions with the client Fantasies about own responses to the client in session Repeatedly running late for sessions or running over time Compelled to give advice or suggestions to client Making special efforts for the client Thinking of client outside of session.

Concept of Interpretation
Different from: a. Information – something about the external reality (not the client) that the client should know and does not, and which is influencing the client and the issue at hand (e.g. medical information) b. Clarification – helping the client organize information about himself (not the reality) that he already knows but not clearly (cf. empathic reflection). Interpretation is special way of informing, to the client only, something that belongs to the client but which he does not consciously know Information (Cs); Clarification (Pcs); Interpretation (Ucs).

Qualities of Interpretation
The information about the client delivered by interpretation has to be true in the eyes of the therapist Therapist should be disinterested in how the client receives or makes use of he information. The therapist job is to dispense knowledge and no more. (We cannot dictate client’s thinking or conduct) The interpretation should be delivered at a point when the client and therapist are in contact with the material. The aim is to produce Insight, although the client determines whether Insight is going to develop or not.

Kinds of Interpretation
Transference Interpretation: - focusing on the similarity of the therapeutic relationship with client’s relationships outside of therapy - Focusing on the here and now of the therapeutic relationship, hence carrying an immediate and experiential quality to it. Extra-transference Interpretation: - Interpreting an event in the client’s relationships outside of the therapy situation - may lead to purely intellectualized understanding of the issue; - must be delivered carefully with respect to time and context - client must be genuinely experiencing confusion, and the interpretation has to facilitate more exploration than to reduce it.

Kinds of Interpretation
Genetic Transference Interpretation: - offering the hypothesis that client’s current conflicts in relationships are shaped by experiences in the past - that a solution for a conflict in the past has become an obstacle in current relationships - helps to replace confusion and perplexity, and offer some sense of meaning and understanding - however, could result in a form of intellectualized understanding without real change - may lead to tendency/reluctance to blame others.

Termination of Interpretation
Termination of therapy is often compared to birthing (client being born into a new life) or weaning (leaving a nurturing mother to be on one’s own) Feelings of hope and happiness, also sorrow due to loss With classical Psychoanalysis, the first idea of termination appears around 4-5 years into treatment with adults, and 2-3 years for children. The process of termination lasts for about 2 years The early signs are fear of abandonment, of being alone without protection, and the need to denigrate the analyst.

Summary of Psychoanalysis Therapeutic Techniques
Find clinical evidence and listening to the unconscious communication Dreams Slips of the tongue and forgetting, e.g. a familiar name Posthypnotic suggestions Material derived from free-association or from projective techniques The most important analytic procedure is making interpretations Confrontation and clarification

Empirical Support Problem; Psychoanalysis as Therapy and as Theory
Freud: wished that Psychoanalysis can be remembered for the truths (depth psychology) it yields than for its therapeutic effectiveness. But these truths are told only to patients in a therapy setting Should research be directed to its accuracy as a theory, or its usefulness as a treatment method? “Psychodynamic concepts and treatments lack empirical support.” Biases in this conclusion.

Evaluation of Freudian Theory
Description – described a wide range of phenomena Explanation – stronger on the explanation of pathology; the most valuable explanation was defence mechanisms Empirical validity and testable concepts Research on the unconscious Research on the component structures of personality Research on defense mechanisms Dream content Comprehensiveness – fairly comprehensive; addressed both normal and abnormal behaviours Parsimony – too restricted on sex and death instincts Heuristic value - an enormous impact for nearly 70 years Applied value – forerunner of all the current approaches to counseling and therapy; totally ignored the social world

The Life of Alfred Adler (1870 – 1937)
Family background - 2nd of six children 5 yrs – pneumonia Worked hard to overcome his handicaps – became outgoing & social graduated from medical school 1895 Study psychiatry in 1900’s 1897 – married and had four children Psychiatry in the 1900’s and in1902 – joined Freud’s Analytical Psychology group Organized child guidance clinics in the Viennese school system Published more than 100 books and journals

Adler’s View on Human Nature
Creative, active and decisional Understand the individual and the world Client is not “sick” but use self-defeating behaviors to protect oneself

Individual Psychology of Alfred Adler
Inferiority feelings often serve as the wellspring of creativity, motivating people to strive for mastery, superiority & perfection help the individual to develop positive capacities and to live fully in society Example of a one-armed man, a blind person’s acute hearing

Personality development in Adlerian terms Parents play key roles in the child’s development of a distinctive style of life The style of life is established in early childhood between the ages of 3 and 5 Adler concluded that there are three basic concerns that we all have to address in life – work, friendship and love. Adler was the first theorist to stress the interactional nature of all relationships Importance of both fathers and mothers Good parenting from good role models is critical for the child to develop an appropriate style of life

The Effect of Birth order Each child is treated uniquely within the family depending on their order of birth Family relationships change with each additional child

Adler’s Conceptualisation of the Effects of Birth Order

Characteristics of the neurotic personality Inaccurate in their own self-evaluations, either under- or over-evaluating themselves Adapt defensive strategies to cover themselves

Adlerian Personality Types – the difference between healthy and unhealthy individuals

Therapeutic Goals Counselor not an expert therapist, equal status with client A collaborative effort between client and counselor Help client develop socially useful goals such as feeling a sense of equality with others

Adlerian treatment approaches
Position of the child in the birth order Childhood disorders Day and night dreams The nature of the exogenous (external) factor that caused the illness

Adlerian Treatment Approaches Four Phases of Therapy
Phase 1: Establishing and strengthening the relationship between the counselor and client Nature - Supportive, mutual respect, educational, encouraging process Person-to-person contact to help the client identify his/her problems Help client build awareness of his or her strengths

Phase 2: Exploring the Individual’s Psychological Dynamics Specific and unique lifestyle assessment of the client Subjective interview Objective interview Family constellation – birth order Early recollections – examine childhood experience - Explore basic life tasks like social, love-intimacy, occupational and spiritual life situation

Phase 3:Encouraging Self-understanding Interpret the findings of the assessment Hidden goals and purposes of behavior are made conscious Counselor offers interpretations to help clients gain insight into their lifestyle Some specific techniques employed are attending, encouragement, confrontation, summarization

One special feature - Encouragement
Instill self confidence by expecting clients to assume responsibility for their lives and embrace the fact that they can make changes Powerful method for changing a person’s belief The power to choose and act differently

Phase 4:Reorientation and Re- education Action-oriented – reorganize their mistaken beliefs; reorganize and correct faulty lifestyles Useful vs. unhelpful – responsible for their choices in life vs. not responsible for their choices of life

Evaluation of Adler’s Individual Psychology Theory
Description – good description of both normal and abnormal behaviours in personality development Explanation – useful explanations on the interactional nature of parent-child relations Testable concepts and their empirical validity Comprehensiveness – a very comprehensive theory Parsimony – global not specific Heuristic value – first theorist to emphasize the importance of self Applied value – STEP (Systematic Training for Effective Parenting) founded the first child clinic in Vienna - many Adler’s key concepts are found in other theories like brief therapies - published the journal of Individual Psychology

The Life of Carl Jung (1875 – 1961)
Born in Kesswil, Switzerland Study medicine in the University of Basel 1900 Become a psychiatrist in Zurich Married and have five children, have several marital affairs, include at least 2 with patients Developed his own theories and founded the modern system of analytical psychology Able to integrate religion, mythology, archeology, literature, history and philosophy into the study of psychology Extensive collective work

Carl Jung and Analytic Psychology
Psyche Life-process energy Principle of opposites Teleology Self-realization Principle of equivalence Principle of entropy

Jung’s Structures Within the Psyche

Examples of Jungian Archetypes

Jungian Personality Types

The Development of the Personality and the Neurotic Personality

Jung’s Treatment methods
Dream analysis Word association tests to explore the client’s imbalance Paintings Four stages in therapy 1. confession – admit mistakes 2. elucidation – understand the nature of his or her problems 3. education – gain more satisfaction in life 4. transformation

Evaluation of Jung’s Theory
Description – personality in middle age achieve self- realization and personality development - complex explanation of behaviours - many obscure references from Ancient Greek to Eastern culture

Explanation - Not clear cut - Concept of shadow rarely touched on by other theorists Empirical validity - difficult to test Comprehensiveness- a huge of phenomena like relations, religion, education, cultural issues, coverage superficial

Parsimony – a whole range of concepts and structures not well related Heuristic value – Jung’s work has not stimulated a lot of research but his work is influential in areas like art, history, literature, and religious studies Applied value – influential in many discipline other than psychology e.g. the development of MBTI; in clinical work his word association test has proved to be a useful tool for exploring the unconscious.

THE END

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