Practical Modifications

Practical Modifications

Psychoanalytic Approaches

Chapter Two

Biographical Information:
Sigmund Freud

    • Freud’s Early Fascinations:
    • Psychosexual Development
    • Unconscious Sexual Meaning of Many Behaviors


  • Hysteria was the main psychological disorder of Freud’s time.
  • He used hypnosis, which made him feel like a miracle worker
  • He later worked with Breuer and developed the “talking cure.”

Historical Context II

  • The Seduction Hypothesis
  • Child abuse Hysteria


  • Freud’s Controversial Hypothesis

“I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience” (Freud, 1896, cited in Masson, 1984, p. 263).



Historical Context III

    • Recanting the Seduction Hypothesis
    • Freud’s presentation of the Aietology of Hysteria met with an “icy reception.”


  • Seduction Hypothesis Oedipal Theory


  • Freud may have (a) been an astute observer who recanted the seduction hypothesis in favor of the power of fantasy; (b) abandoned his sexually abused clients due to professional pressures; or (c) twisted his clients’ stories and projected his own fantasies onto his clients’ stories.


Theoretical Principles

  • Freudian Theory
  • Is one of the “Giant theories” of developmental Psychology (Miller, 2010).
  • Has been referred to as a museum Theory.
  • Is a one-person intrapsychic model.
  • Includes several different approaches to thinking about human behavior.


Theoretical Principles II

  • The Dynamic Approach
  • AKA drive theory or instinct theory
  • Focuses on shifting mental or psychic energy that comes from two sources:
  • Eros (energy associated with life and sex) libido
  • Thanatos (energy associated with death and aggression)
  • Psychic determinism underlies the dynamic approach (“. . . nothing happens by chance” [Brenner, 1973]).
  • Every impulse has an origin, aim, object, and intensity.
  • Repeated patterns may result in an internal working model or repetition compulsion.


Theoretical Principles III

  • The Topographic Approach
  • Divides the mind into three interrelated regions:


Psychoanalytic Mind


Unconscious Preconscious Conscious





Theoretical Principles IV

  • The Developmental Stage Approach
  • Explains how early childhood experiences influence later adult behaviors
  • Oral birth to 1 year old
  • Anal 1 to 3 years old
  • Phallic 3 to 5 years old
  • Latency 5 to 12 years old
  • Genital adolescence to adulthood






Theoretical Principles V

  • The Structural Approach
  • Involves the interrelationships of:
  • Id: Pleasure principle – primary process
  • Ego: Rational thought – secondary process
  • Superego: Conscience + ego ideal
  • Defense Mechanisms
  • Are automatic and unconscious, ward off unacceptable impulses, and distort reality.


Theoretical Principles VI

  • Repression: Motivated forgetting
  • Denial: “Not me!”
  • Projection: Undesirable traits placed on others
  • Reaction formation: Expressing the opposite
  • Displacement: Shifting the blame
  • Rationalization: Explaining away or justifying
  • Regression: Behavior moving back in time
  • Sublimation: Channeling into productive activities


Theoretical Principles VII

  • Psychopathology and Human Change
  • Early childhood experiences produce psychopathology.
  • There is a normal-abnormal continuum.
  • Given the right stress, we all will break down in predictable ways.

Evolution and Development in Psychoanalytic Theory and Practice

  • Freudian Theory
  • Originally focused on biological/somatic instinctual sexual and aggressive drives, but has evolved
  • Pine (1990) identified four stages:
  • Drive
  • Ego
  • Object
  • Self


Evolution and Development in Psychoanalytic Theory and Practice II

  • Anna and the Ego: Psychoanalytic Ego Psychology
  • Anna studied children directly.
  • She studied their fantasies and dreams.
  • She observed children’s unconscious mental processes through play.
  • Ego psychology focused on how some ego functions were inborn and autonomous of biological drives.


Evolution and Development in Psychoanalytic Theory and Practice III

  • Object Relations
  • Focused very much on pre-Oedipal dynamics.
  • There was conceptual reformulation of psychoanalytic theory.
  • Dynamics and motivation: earlier parent-child relationships
  • Objects are not things.
  • Objects are internalized versions of people.
  • Therapy replaces bad internalized objects with good objects.


Evolution and Development in Psychoanalytic Theory and Practice IV

  • Self Psychology
  • Formulated by Heinz Kohut.
  • Focused on the development of healthy narcissism within individuals.
  • Mirroring is an important therapy concept.
  • Retraumatization is the central client fear that leads to resistance and the therapist’s interpretation of resistance.
  • Therapists are imperfect, and clients retreat from intimacy.
  • Making “optimal failures” and then working toward empathy is seen as the basic therapeutic unit leading to new self structure.


Evolution and Development in Psychoanalytic Theory and Practice V


  • Contemporary Movements
  • Theoretical development has been less than linear.
  • There are many different psychoanalytic or psychodynamic approaches.

The Relational Psychoanalytic Movement

  • Relational psychoanalysis is also referred to as:
  • Intersubjectivity
  • Two-person psychology
  • It emphasizes that the psychoanalyst is always subjective.
  • Emotional involvement and countertransference reactions are used to facilitate therapy.

Attachment-Informed Psychotherapy

    • Attachment theory is a psychoanalytically oriented approach.


  • John Bowlby focused on:
  • Internal working models based on
  • Real parent-caretaker interactions (not fantasies!).

Attachment-Informed Psychotherapy II

  • Mary Ainsworth elaborated on attachment dynamics or styles in her strange situation experiments.
  • She studied children as they were separated from mothers, reacting to strangers, and were then reunified with mother
  • She identified three attachment styles:

Secure attachment

Anxious resistant insecure attachment

Anxious-avoidant insecure attachment

  • Disorganized/disoriented attachment style was added by Mary Main.


Practical Modifications: Short-Term and Time-Limited Psychoanalytic Psychotherapy

  • There have long been efforts to shorten the treatment duration.
  • Sandor Ferenczi (1920, 1950)
  • Therapy is more or less suggestive.
  • Be more active to shorten treatment duration.
  • Alexander and French (1946) wrote about the corrective emotional experience where therapists adopted a compensatory role.

The Practice of Psychoanalytic Therapy

  • Goals include:
  • Make the unconscious conscious or increase client awareness.
  • Help clients develop greater self-control over maladaptive impulses.
  • Help clients rid themselves of maladaptive or unhealthy internalized objects, and replace them with more adaptive internalized objects.
  • Repair self-defects through mirroring, presenting a potentially idealized object, and expressing empathy during optimal therapeutic failures.


The Practice of Psychoanalytic Therapy II

  • Assessment Issues and Procedures
  • Psychoanalysts use:
  • Clinical interviewing
  • Projective testing (or generative assessment)
  • Rorschach Inkblot Test
  • Thematic Apperception Test
  • Free association to specific words
  • Human figure drawings
  • These approaches have been strongly criticized by some.


The Practice of Psychoanalytic Therapy III

  • The Basic Rule
  • Is also known as free association and involves the process of:
  • “Say whatever comes to mind.”
  • Through free association, unconscious impulses can rise more closely toward consciousness.


The Practice of Psychoanalytic Therapy IV

  • Psychoanalytic approaches include the following concepts and procedures:
  • Interpretation
  • Developing a therapeutic alliance
  • Role induction
  • Timing
  • Transference
  • Countertransference
  • Triangles of insight
  • Dream interpretation

The Practice of Psychoanalytic Therapy V

  • Triangles of Insight: There are two types:


  • Aim, wish, drive
  • Threat
  • Defensive compromise


  • Transference observations
  • Early childhood patterns
  • Contemporary relationship patterns

Cultural and Gender Considerations

  • Psychoanalytic approaches have historically not been friendly to women and feminist perspectives.
  • There is often blaming of mothers.
  • There is often insensitivity or lack of focus on social explanations for behavior.
  • Psychoanalytic treatment can also be very sensitive to individual differences.

Evidence-Based Status

  • Research on psychoanalytic approaches is very challenging.
  • Evidence is accumulating to support psychoanalytic approaches.
  • Some studies have weak or flawed methodologies.
  • The allegiance effect may explain why cognitive and behavioral therapies are sometimes found to be more effective.

Evidence-Based Status

  • Shedler (2010) stated:


“. . .the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as ‘empirically supported’ and ‘evidence based’. . . Finally, the evidence indicates that the benefits of psychodynamic treatment as lasting and not just transitory and appear to extend well beyond symptom remission.” (Shedler, p. 107).

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