The Freudian view of human nature is basically deterministic.

According to Freud, our

behaviour is determined by irrational forces, unconscious motivations, and biological and
instinctual drives as these evolve through key psychosexual stages in the first 6 years of
life. Instincts are central to the Freudian approach.
Although he originally used the term libido to refer to sexual energy, he later broadened it to
include the energy of all the life instincts. Freud includes all pleasurable acts in his concept
of the life instincts; he sees the goal of much of life as gaining pleasure and avoiding pain.
Freud also postulates death instincts, which account for the aggressive drive. At times,
people manifest through their behaviour an unconscious wish to die or to hurt themselves or
others. Managing this aggressive drive is a major challenge to humanity. In Freud’s view,
both sexual and aggressive drives are powerful determinants of why people act as they do.
The id, the ego, and the superego constitute the structure of personality according to
Psychoanalytic perspectives.
The id is the biological component
the original system of personality; at birth a person is all id. The id is the primary source of
psychic energy and the seat of the instincts. It lacks organization and is blind, demanding, and
insistent. A cauldron of seething excitement, the id cannot tolerate tension, and it functions to
discharge tension immediately. Ruled by the pleasure principle, which is aimed at reducing
tension, avoiding pain, and gaining pleasure, the id is illogical, amoral, and driven to satisfy
instinctual needs. The id never matures, remaining the spoiled brat of personality. It does not
think but only wishes or acts. The id is largely unconscious, or out of awareness.
The ego is the psychological component
The ego has contact with the external world of reality. It is the “executive” that governs,
controls, and regulates the personality. As a “traffic cop,” it mediates between the instincts
and the surrounding environment. The ego controls consciousness and exercises censorship.
Ruled by the reality principle, the ego does realistic and logical thinking and formulates plans
of action fo satisfying needs. What is the relation of the ego to the id? The ego, as the seat of
intelligence and rationality, checks and controls the blind impulses of the id. Whereas the id
knows only subjective reality, the ego distinguishes between mental images and things in the
external world.
The superego is the social component
The superego is the judicial branch of personality. It includes a person’s moral code, the main
concern being whether an action is good or bad, right or wrong. It represents the ideal rather
than the real and strives not for pleasure but for perfection. The superego represents the
traditional values and ideals of society as they are handed down from parents to children. It
functions to inhibit the id impulses, to persuade the ego to substitute moralistic goals for
realistic ones, and to strive for perfection. The superego, then, as the internalization of the
standards of parents and society, is related to psychological rewards and punishments. The
rewards are feelings of pride and self-love; the punishments are feelings of guilt and
inferiority.
Consciousness and the Unconscious
Perhaps Freud’s greatest contributions are his concepts of the unconscious and of the levels
of consciousness, which are the keys to understanding behavior and the problems of
personality. The unconscious cannot be studied directly but is inferred from behavior.
Clinical evidence for postulating the unconscious includes the following:
(1) dreams, which are symbolic representations of unconscious needs, wishes, and conflicts
(2) slips of the tongue and forgetting, for example, a familiar name
(3) posthypnotic suggestions
(4) material derived from free-association techniques
(5) material derived from projective techniques
(6) the symbolic content of psychotic symptoms.
For Freud, consciousness is a thin slice of the total mind. Like the greater part of the iceberg
that lies below the surface of the water, the larger part of the mind exists below the surface of
awareness. The unconscious stores all experiences, memories, and repressed material. Needs
and motivations that are inaccessible—that is, out of awareness—are also outside the sphere
of conscious control. Most psychological functioning exists in the out-of-awareness realm.
The aim of psychoanalytic therapy, therefore, is to make the unconscious motives conscious,
for only then can an individual exercise choice. Understanding the role of the unconscious is
central to grasping the essence of the psychoanalytic model of behavior.
Unconscious processes are at the root of all forms of neurotic symptoms and behaviors. From
this perspective, a “cure” is based on uncovering the meaning of symptoms, the causes of
behavior, and the repressed materials that interfere with healthy functioning. It is to be noted,
however, that intellectual insight alone does not resolve the symptom. The client’s need to
cling to old patterns (repetition) must be confronted by working through transference
distortions, a process discussed later in this chapter.
Anxiety
According to Psychoanalytic perspective Anxiety is a feeling of dread that results from
repressed feelings, memories, desires, and experience that emerge to the surface of
awareness. It can be considered as a state of tension that motivates us to do something. It
develops out of a conflict among the id, ego, and superego over control of the available
psychic energy. The function of anxiety is to warn of impending danger.
There are three kinds of anxiety
Reality anxiety is the fear of danger from the external world, and the level of such anxiety is
proportionate to the degree of real threat. Neurotic and moral anxieties are evoked by threats
to the “balance of power” within the person. They signal to the ego that unless appropriate
measures are taken the danger may increase until the ego is overthrown.
Neurotic anxiety is the fear that the instincts will get out of hand and cause one to do
something for which one will be punished.
Moral anxiety is the fear of one’s own conscience. People with a well-developed conscience
tend to feel guilty Moral anxiety when they do something contrary to their moral code. When
the ego cannot control anxiety by rational and direct methods, it relies on indirect ones—
namely, ego-defence behaviour.
Ego-defence Mechanisms
Ego-defence mechanisms help the individual cope with anxiety and prevent the ego from
being overwhelmed. Rather than being pathological, ego defences are normal behaviours that
can have adaptive value provided they do not become a style of life that enables the
individual to avoid facing reality. The defences employed depend on the individual’s level of
development and degree of anxiety. defence mechanisms have two characteristics in
common:
They either deny or distort reality
They operate on an unconscious level.

The Therapeutic Process I

Therapeutic Goals
Two goals of Freudian psychoanalytic therapy
 Make the unconscious conscious
 To strengthen the ego so that behaviour is based more on reality and less on
instinctual cravings or irrational guilt

Successful analysis is believed to result in significant modification of the individual’s

personality and character structure. Therapeutic methods are used to bring out unconscious
material. Then childhood experiences are reconstructed, discussed, interpreted, and analysed.
The process is not limited to solving problems and learning new behaviours. Rather, there is a
deeper probing into the past to develop the level of self-understanding that is assumed to be
necessary for a change in character. Psychoanalytic therapy is oriented toward achieving
insight, but not just an intellectual understanding; it is essential that the feelings and
memories associated with this self-understanding be experienced.
Therapist’s Function and Role
In classical psychoanalysis, analysts typically assume an anonymous stance, which is
sometimes called the “blank-screen” approach. They engage in very little self-disclosure and
maintain a sense of neutrality to foster a transference relationship, in which their clients will
make projections onto them. This transference relationship, which is a cornerstone of
psychoanalysis, “refers to the transfer of feelings originally experienced in an early
relationship to other important people in a person’s present environment” (Luborsky,
O’Reilly-Landry, & Arlow, 2008, pp. 17–18). If therapists say little about themselves and
rarely share their personal reactions, the assumption is that whatever the client feels toward
them will largely be the product of feelings associated with other significant figures from the
past. These projections, which have their origins in unfinished and repressed situations, are
considered “grist for the mill,” and their analysis is the very essence of therapeutic work.
One of the central functions of analysis is to help clients acquire the freedom to love, work,
and play. Other functions include assisting clients in achieving self-awareness, honesty, and
more effective personal relationships; in dealing with anxiety in a realistic way; and in
gaining control over impulsive and irrational behavior. The analyst must first establish a
working relationship with the client and then do a lot of listening and interpreting. Particular
attention is given to the client’s resistances. The analyst listens, learns, and decides when to
make appropriate interpretations. A major function of interpretation is to accelerate the
process of uncovering unconscious material. The analyst listens for gaps and inconsistencies
in the client’s story, infers the meaning of reported dreams and free associations, and remains
sensitive to clues concerning the client’s feelings toward the analyst.
Organizing these therapeutic processes within the context of understanding personality
structure and psychodynamics enables the analyst to formulate the nature of the client’s
problems. One of the central functions of the analyst is to teach clients the meaning of these
processes (through interpretation) so that they are able to achieve insight into their problems,
increase their awareness of ways to change, and thus gain more control over their lives.
The process of psychoanalytic therapy is somewhat like putting the pieces of a puzzle
together. Whether clients change depends considerably more on their readiness to change
than on the accuracy of the therapist’s interpretations. If the therapist pushes the client too
rapidly or offers ill-timed interpretations, therapy will not be effective. Change occurs
through the process of reworking old patterns so that clients might become freer to act in new
ways (Luborsky et al., 2008).
Client’s Experience in Therapy
Clients interested in traditional (or classical) psychoanalysis must be willing to commit
themselves to an intensive and long-term therapy process. After some face-to-face sessions
with the analyst, clients lie on a couch and engage in free association; that is, they say
whatever comes to mind without self-censorship. This process of free association is known as
the “fundamental rule.” Clients report their feelings, experiences, associations, memories, and
fantasies to the analyst. Lying on the couch encourages deep, uncensored reflections and
reduces the stimuli that might interfere with getting in touch with internal conflicts and
productions. It also reduces clients’ ability to “read” their analyst’s face for reactions and,
hence, fosters the projections characteristic of a transference. At the same time, the analyst is
freed from having to carefully monitor facial clues.
What has just been described is classical psychoanalysis. Psychodynamic therapy emerged as
a way of shortening and simplifying the lengthy process of classical psychoanalysis
(Luborsky et al., 2008). Many psychoanalytically oriented practitioners, or psychodynamic
therapists (as distinct from analysts), do not use all the techniques associated with classical
analysis. However, psychodynamic therapists do remain alert to transference manifestations,
explore the meaning of clients’ dreams, explore both the past and the present, and are
concerned with unconscious material.
Clients in psychoanalytic therapy make a commitment with the therapist to stick with the
procedures of an intensive therapeutic process. They agree to talk because their verbal
productions are the heart of psychoanalytic therapy. They are typically asked not to make any
radical changes in their lifestyle during the period of analysis, such as getting a divorce or
quitting their job. The reason for avoiding making such changes pertains to the therapeutic
process that oftentimes is unsettling and also associated with loosening of defences.
Psychoanalytic clients are ready to terminate their sessions when they and their analyst
mutually agree that they have resolved those symptoms and conflicts that were amenable to
resolution, have clarified and accepted their remaining emotional problems, have understood
the historical roots of their difficulties, have mastery of core themes, and can integrate their
awareness of past problems with their present relationships. Successful analysis answers a
client’s “why” questions regarding his or her life. Clients who emerge successfully from
analytic therapy report that they have achieved such things as an understanding of their
symptoms and the functions they serve, an insight into how their environment affects them
and how they affect the environment, and reduced defensiveness (Saretsky, 1978).
The Therapeutic Process II
Relationship Between Therapist and Client
Classical analyst: The classical analyst stands outside the relationship, comments on it, and
offers insight producing interpretations.
Contemporary relational psychoanalysis: The therapist does not strive for a
detached and objective stance. Instead, the participation of the therapist is a given, and he or
she has an impact on the client and on the here-and-now interaction that occurs in the therapy
context (Altman, 2008). Contemporary psychoanalytic theory and practice highlights the
importance of the therapeutic relationship as a therapeutic factor in bringing about change
(Ainslie, 2007). Through the therapeutic relationship “clients are able to find new modes of
functioning that are no longer encumbered by the neurotic conflicts that once interfered with
their lives” (p. 14). According to Luborsky, O’Reilly-Landry, and Arlow (2008), current
psychodynamic therapists view the emotional communication between themselves and their
clients as a useful way to gain information and create connection.
Transference
Transference is the client’s unconscious shifting to the analyst of feelings and fantasies that
are reactions to significant others in the client’s past. Transference involves the unconscious
repetition of the past in the present. “It reflects the deep patterning of old experiences in
relationships as they emerge in current life” (Luborsky et al., 2008, p. 46).
The relational model of psychoanalysis regards transference as being an interactive process
between the client and the therapist. A client often has a variety of feelings and reactions to a
therapist, including a mixture of positive and negative feelings. When these feelings become
conscious, clients can understand and resolve “unfinished business” from these past
relationships. As therapy progresses, childhood feelings and conflicts begin to surface from
the depths of the unconscious. Clients regress emotionally. Some of their feelings arise from
conflicts such as trust versus mistrust, love versus hate, dependence versus independence, and
autonomy versus shame and guilt. Transference takes place when clients resurrect from their
early years intense conflicts relating to love, sexuality, hostility, anxiety, and resentment;
bring them into the present; reexperience them; and attach them to the analyst. For example,
clients may transfer unresolved feelings toward a stern and unloving father to the analyst,
who, in their eyes, becomes stern and unloving. Angry feelings are the product of negative
transference, but clients may also develop a positive transference and, for example, fall in
love with the analyst, wish to be adopted, or in many other ways seek the love, acceptance,
and approval of an all-powerful therapist. In short, the analyst becomes a current substitute
for significant others.
If therapy is to produce change, the transference relationship must be worked through. The
working-through process consists of an exploration of unconscious material and defences,
most of which originated in early childhood. Working through is achieved by repeating
interpretations and by exploring forms of resistance. It results in a resolution of old patterns
and allows clients to make new choices. Effective therapy requires that the client develop a
relationship with the analyst in the present that is a corrective and integrative experience. By
experiencing a therapist who is engaged, caring, and reliable, clients can be changed in
profound ways, which can lead to new experiences of human relationships (Ainslie, 2007).
Clients have many opportunities to see the variety of ways in which their core conflicts and
core defences are manifested in their daily life. It is assumed that for clients to become
psychologically independent they must not only become aware of this unconscious material
but also achieve some level of freedom from behaviour motivated by infantile strivings, such
as the need for total love and acceptance from parental figures. If this demanding phase of the
therapeutic relationship is not properly worked through, clients simply transfer their infantile
wishes for universal love and acceptance to other figures. It is precisely in the client–therapist
relationship that the manifestation of these childhood motivations becomes apparent.
Regardless of the length of psychoanalytic therapy, traces of our childhood need and traumas
will never be completely erased. Infantile conflicts may not be fully resolved, even though
many aspects of transference are worked through with a therapist. We may need to struggle at
times throughout our life with feelings that we project onto others as well as with unrealistic
demands that we expect others to fulfil.
It is a mistake to assume that all feelings clients have toward their therapists are
manifestations of transference. Many of these reactions may have a reality base, and clients’
feelings may well be directed to the here-and-now style the therapist exhibits. Not every
positive response (such as liking the therapist) should be labelled “positive transference.”
Conversely, a client’s anger toward the therapist may be a function of the therapist’s
behaviour; it is a mistake to label all negative reactions as signs of “negative transference.”
Counter Transference
The notion of never becoming completely free of past experiences has significant
implications for therapists who become intimately involved in the unresolved conflicts of
their clients. Even if the conflicts of therapists have surfaced to awareness, and even if
therapists have dealt with these personal issues in their own intensive therapy, they may still
project distortions onto clients. The intense therapeutic relationship is bound to ignite some of
the unconscious conflicts within therapists. Known as counter transference, this
phenomenon occurs when there is inappropriate affect, when therapists respond in irrational
ways, or when they lose their objectivity in a relationship because their own conflicts are
triggered. In a broader sense, countertransference involves the therapist’s total emotional
response to a client. Hayes (2004) refers to countertransference as the therapist’s reactions to
clients that are based on his or her unresolved conflicts. Gelso and Hayes (2002) indicate that
research has shed light on specific causes of countertransference within the therapist such as
conflicts revolving around the therapist’s family experiences, gender roles, parenting roles,
and unmet needs.
It is critical that therapists become aware of the countertransference so that their reactions
toward clients do not interfere with their objectivity. For example, a male client may become
excessively dependent on his female therapist. The client may look to her to direct him and
tell him how to live, and he may look to her for the love and acceptance that he felt he was
unable to secure from his mother. The therapist herself may have unresolved needs to nurture,
to foster a dependent relationship, and to be told that she is significant, and she may be
meeting her own needs by in some way keeping her client dependent. Unless she is aware of
her own needs as well as her own dynamics, it is very likely that her dynamics will interfere
with the progress of therapy.
Not all countertransference reactions are detrimental to therapeutic progress. Indeed,
countertransference reactions can provide an important means for understanding the world of
the client. According to Gelso and Hayes, countertransference can greatly benefit the
therapeutic work, if therapists study their internal reactions and use them to understand their
clients. What is critical is that therapists monitor their feelings during therapy sessions, and
that they use their responses as a source for understanding clients and helping them to
understand themselves.
A therapist with a relational perspective pays attention to his or her countertransference
reactions and observations to a client and uses this as a part of therapy. The therapist who
notes a countertransference mood of irritability, for instance, may learn something about a
client’s pattern of being demanding. In this light, countertransference can be potentially
useful if it is explored in therapy. Viewed in this more positive way, countertransference can
become a key avenue for helping the client gain self-understanding.
The client–therapist relationship is of vital importance in psychoanalytic therapy. As a result
of this relationship, particularly in working through the transference situation, clients acquire
insights into the workings of their unconscious process. Awareness of and insights into
repressed material are the bases of the analytic growth process. Clients come to understand
the association between their past experiences and their current behaviour. The
psychoanalytic approach assumes that without this dynamic self-understanding there can be
no substantial personality change or resolution of present conflicts.
Therapeutic Techniques:
Psychoanalytic therapy, or psychodynamic therapy (as opposed to traditional
psychoanalysis), includes these features:
The therapy is geared more to limited objectives than to restructuring one’s personality.
The therapist is less likely to use the couch.
There are fewer sessions each week.
There is more frequent use of supportive interventions—such as reassurance, expressions
of empathy and support, and suggestions—and more self-disclosure by the therapist.
The focus is more on pressing practical concerns than on working with fantasy material.
The techniques of psychoanalytic therapy are aimed at increasing awareness, fostering
insights into the client’s behaviour, and understanding the meanings of symptoms. The
therapy proceeds from the client’s talk to catharsis (or expression of emotion) to insight to
working through unconscious material. This work is done to attain the goals of intellectual
and emotional understanding and re-education, which, it is hoped, leads to personality
change.
The six basic techniques of psychoanalytic therapy are
(1) Maintaining the analytic framework
(2) Free association
(3) Interpretation
(4) Dream analysis
(5) Analysis of resistance
(6) Analysis of transference
Maintaining the Analytic Framework
The psychoanalytic process stresses maintaining a framework aimed at accomplishing the
goals of this type of therapy. Maintaining the analytic framework refers to a whole range of
procedural and stylistic factors, such as the analyst’s relative anonymity, the regularity and
consistency of meetings, and starting and ending the sessions on time. One of the most
powerful features of psychoanalytically oriented therapy is that the consistent framework is
itself a therapeutic factor, comparable on an emotional level to the regular feeding of an
infant. Analysts attempt to minimize departures from this consistent pattern (such as
vacations, changes in fees, or changes in the meeting environment).
Free Association
Free association is a in psychoanalytic therapy, and it plays a key role in the process of
maintaining the analytic framework. In free association, clients are encouraged to say
whatever comes to mind, regardless central technique of how painful, silly, trivial, illogical,
or irrelevant it may be. In essence, clients flow with any feelings or thoughts by reporting
them immediately without censorship.
As the analytic work progresses, most clients will occasionally depart from this basic rule,
and these resistances will be interpreted by the therapist when it is timely to do so. Free
association is one of the basic tools used to open the doors to unconscious wishes, fantasies,
conflicts, and motivations. This technique often leads to some recollection of past
experiences and, at times, a release of intense feelings (catharsis) that have been blocked.
During the free-association process, the therapist’s task is to identify the repressed material
that is locked in the unconscious. Blockings or disruptions in associations serve as cues to
anxiety-arousing material. The therapist interprets the material to clients, guiding them
toward increased insight into the underlying dynamics.
As analytic therapists listen to their clients’ free associations, they hear not only the surface
content but also the hidden meaning. This awareness of the language of the unconscious has
been termed “listening with the third ear” (Reik, 1948). Nothing the client says is taken at
face value. For example, a slip of the tongue can suggest that an expressed emotion is
accompanied by a conflicting affect. Areas that clients do not talk about are as significant as
the areas they do discuss.

Interpretation
Interpretation consists of the analyst’s pointing out, explaining, and even teaching the client
the meanings of behavior that is manifested in dreams, free association, resistances, and the
therapeutic relationship itself. The functions of interpretations are to enable the ego to
assimilate new material and to speed up the process of uncovering further unconscious
material.
Interpretation is grounded in the therapist’s assessment of the client’s personality and of the
factors in the client’s past that contributed to his or her difficulties. Under contemporary
definitions, interpretation includes identifying, clarifying, and translating the client’s
material.
In making an appropriate interpretation, the therapist must be guided by a sense of the client’s
readiness to consider it (Saretsky, 1978). The therapist uses the client’s reactions as a gauge.
It is important that interpretations be well timed; the client will reject ones that are
inappropriately timed.
General rule
Interpretation should be presented when the phenomenon to be interpreted is close to
conscious awareness.
Interpretation should always start from the surface and go only as deep as the client is
able to go.
Best to point out a resistance or defense before interpreting the emotion or conflict
that lies beneath it.
Dream Analysis
Dream analysis is an important procedure for uncovering unconscious material and giving the
client insight into some areas of unresolved problems. During sleep, defenses are lowered and
repressed feelings surface. Freud sees dreams as the “royal road to the unconscious” for in
them one’s unconscious wishes, needs, and fears are expressed. Some motivations are so
unacceptable to the person that they are expressed in disguised or symbolic form rather than
being revealed directly.
Dreams have two levels of content: Latent content and Manifest content
Latent content consists of hidden, symbolic, and unconscious motives, wishes, and fears.
Because they are so painful and threatening, the unconscious sexual and aggressive impulses
that make up latent content are transformed into the more acceptable manifest content, which
is the dream as it appears to the dreamer. The process by which the latent content of a dream
is transformed into the less threatening manifest content is called dream work. The therapist’s
task is to uncover disguised meanings by studying the symbols in the manifest content of the
dream.
During the session, therapists may ask clients to free associate to some aspect of the manifest
content of a dream for the purpose of uncovering the latent meanings. Therapists participate
in the process by exploring clients’ associations with them. Interpreting the meanings of the
dream elements helps clients unlock the repression that has kept the material from
consciousness and relate the new insight to their present struggles. Dreams may serve as a
pathway to repressed material, but they also provide an understanding of clients’ current
functioning.
Analysis and Interpretation of Resistance
Resistance, a concept fundamental to the practice of psychoanalysis, is anything that works
against the progress of therapy and prevents the client from producing previously
unconscious material. Specifically, resistance is the client’s reluctance to bring to the surface
of awareness unconscious material that has been repressed. Resistance refers to any idea,
attitude, feeling, or action (conscious or unconscious) that fosters the status quo and the client
may evidence an unwillingness to relate certain thoughts, feelings, and experiences. Freud
viewed resistance as an unconscious dynamic that people use to defend against the intolerable
anxiety and pain that would arise if they were to become aware of their repressed impulses
and feelings.
As a defense against anxiety, resistance operates specifically in psychoanalytic therapy to
prevent clients and therapists from succeeding in their joint effort to gain insights into the
dynamics of the unconscious. Because resistance blocks threatening material from entering
awareness, analytic therapists point it out, and clients must confront it if they hope to deal
with conflicts realistically.
The therapists’ interpretation is aimed at helping clients become aware of the reasons for the
resistance so that they can deal with them. As a rule, therapists point out and interpret the
most obvious resistances to lessen the possibility of clients’ rejecting the interpretation and to
increase the chance that they will begin to look at their resistive behaviour.
Resistances are not just something to be overcome. Because they are representative of usual
defensive approaches in daily life, they need to be recognized as devices that defend against
anxiety but that interfere with the ability to accept change that could lead to experiencing a
more gratifying life. It is extremely important that therapists respect the resistances of clients
and assist them in working therapeutically with their defences. When handled properly,
resistance can be one of the most valuable tools in understanding the client.
Analysis and Interpretation of Transference
As was mentioned earlier, transference manifests itself in the therapeutic process when
clients’ earlier relationships contribute to their distorting the present with the therapist. The
transference situation is considered valuable because its manifestations provide clients with
the opportunity to reexperience a variety of feelings that would otherwise be inaccessible.
Through the relationship with the therapist, client’s express feelings, beliefs, and desires that
they have buried in their unconscious. Through appropriate interpretations and working
through of these current expressions of early feelings, clients can become aware of and to
gradually change some of their long-standing patterns of behaviour. Analytically oriented
therapists consider the process of exploring and interpreting transference feelings as the core
of the therapeutic process because it is aimed at achieving increased awareness and
personality change.
The analysis of transference is a central technique in psychoanalysis and psychoanalytically
oriented therapy, for it allows clients to achieve here-and now insight into the influence of the
past on their present functioning. Interpretation of the transference relationship enables
clients to work through old conflicts that are keeping them fixated and retarding their
emotional growth. The effects of early relationships are counteracted by working through a
similar emotional conflict in the therapeutic relationship.
Guest Lecture by Abdul?
Brief Psychoanalytic Therapy
Psychoanalysis may require four or five sessions per week over 3 to 8 years (or longer) and
psychoanalytic psychotherapy requires meetings at least once a week for several years. Hence
there was a growing need among the Psychoanalyst to have a briefer version of the
Psychoanalysis. The popularity of brief psychoanalytic therapy is indicated by a variety of
approaches (Bloom, 1997; Messer & Warren, 1995). The impetus for brief approaches to
psychoanalytic psychotherapy has been the work of Malan (1976) in England. In using a
short-term approach, Malan had to deal with issues such as how to select patients, what goals
to choose for therapy, and how long treatment should last.
In general, most current short-term psychoanalytic psychotherapies are designed for people
who are neurotic, motivated, and focused rather than for those with severe personality
disorders as described by Kernberg and Kohut. The treatment length is usually about 12 to 40
sessions, with several time-limited approaches specifying limits of 12 to 16 sessions. To work
in such a short time frame, it is necessary to have focused goals to address. Although short-
term therapists use diagnostic or conceptual approaches that are like those of long-term
therapists, their techniques are not. Where psychoanalysts and psychoanalytic therapists make
use of free association, short-term therapists rarely use this technique; rather, they prefer to
ask questions, to restate, to confront, and to deal quickly with transference issues.
Lester Luborsky’s Core Conflictual Relationship Theme Method:
This is a specific method for understanding transference and can be used for short-term
psychotherapy (Luborsky & Crits-Christoph, 1998), as well as for difficult issues such as
borderline disorder (Drapeau & Perry, 2009) and chronic fatigue (Vandenbergen, Vanheule,
Rosseel, Desmet, & Verhaeghe, 2009). This method has three phases, all of which deal with
the therapist’s understanding of the Core Conflictual Relationship Theme.
To determine a patient’s Core Conflictual Relationship Theme, a therapist must listen to the
patient’s discussion or story of Relationship Episodes. Often, the therapist writes down the
three important components of a Relationships Episode. These include a Wish, a Response
from the Other, and the Response from the Self (Luborsky, 1984). A patient’s wish refers to a
desire that is expressed in a Relationship Episode. This is determined by listening to what the
patient’s actual response from the Other person will be (or an anticipated response). The
therapist also listens to what the response to the relationship situation will be from the
individual (Response from the Self). Sometimes the relationship discussed is a daydream, or
it can be an actual situation. A Core Conflictual Relationship Theme is communicated to the
patient when the therapist has discussed five to seven Relationship Episodes with the patient.
Brief Psychoanalytic Therapy through the case of Brown
The goal of the first phase, usually the first four sessions, is to help the patient become aware
of how the Core Conflictual Relationship Theme plays a role in the patient’s relationships.
The patient becomes curious about why she may expect others to respond to her in a certain
way or why others tend to respond to her in a certain way. For example, Mrs. Brown often
kept her accomplishments to herself, believing that others might find them silly or
unimportant. Because of this, she tended to distance herself from others in relationships and
often felt overlooked and disappointed in her relationships with others.
In the first phase of therapy, the therapist focuses on identifying the patient’s Core
Conflictual Relationship Theme as it relates to her everyday life. Thus, the patient becomes
consciously aware of relationship themes in her life that she was not aware of previously. She
now will be able to have control over previously unconscious behaviour.
During the second phase, usually the 5th through the 12th sessions, the patient works through
the Response from Others. This is the major phase of treatment, and during it, the childhood
roots of the transference-driven Response from Others are worked through. Here, the
therapist interprets how the patient’s expectations of Responses from Others are affected by
attitudes, feelings, and behaviors that were learned from others in the past. The patient learns
how unconscious attitudes from the past affect relationships in the present. In the case of Mrs.
Brown, the therapist helped her to understand how her current relationships were affected by
her earlier relationship with her father. She had wanted to be praised by her father but rarely
received praise or recognition from him. As she realized this, she more willingly shared her
achievements with co-workers and family.
Termination is the focus of the third phase, usually the 13th to 16th sessions. This phase
allows the therapist and patient to discuss universal themes such as fears of abandonment,
separation, and loss. The therapist may also discuss the patient’s worries that gains that were
made in treatment will not continue. This phase also gives the therapist an opportunity to
work through the Core Conflictual Relationship Theme again. Returning to Mrs Brown, the
therapist observed that she was late for her 11th and 12th sessions and was less talkative.
After discussing this, the patient and therapist found that Mrs. Brown was acting as if the
therapist were losing interest and more interested in the patient who would replace her. This
gave the therapist the opportunity to return to the Core Conflictual Relationship Theme that
could be related to her father’s dismissiveness of her and similar early experiences. In this
way, the therapist dealt with transference issues so that Mrs. Brown would be freer to share
her achievements with others and be less distant in relationships.
Limitations of Psychoanalysis
In general, considering factors such as time, expense, and availability of trained
psychoanalytic therapists, the practical applications of many psychoanalytic techniques are
limited. This is especially true of methods such as free association on the couch, dream
analysis, and extensive analysis of the transference relationship. A factor limiting the
practical application of classical psychoanalysis is that many severely disturbed clients lack
the level of ego strength needed for this treatment.
A major limitation of traditional psychoanalytic therapy is the relatively long time
commitment required to accomplish analytic goals. The emergence of brief, time-limited
psychodynamic therapy is a partial response to this criticism. Psychodynamic psychotherapy
evolved from traditional analysis to address the need for treatment that was not so lengthy
and involved.
A potential limitation of the psychoanalytic approach is the anonymous role assumed by the
therapist. This stance can be justifi ed on theoretical grounds, but in therapy situations other
than classical psychoanalysis this stance is unduly restrictive. The classical technique of
nondisclosure can be misused in short-term individual therapy and assessment. Yalom (2003)
contends that therapist anonymity is not a good model for effective therapy. He suggests that
appropriate therapist self-disclosure tends to enhance therapy outcomes. Rather than adopting
a blank screen, he believes it is far better to strive to understand the past as a way of shedding
light on the dynamics of the present therapist–client relationship.
Yalom (2003) contends that therapist anonymity is not a good model for effective therapy.
He suggests that appropriate therapist self-disclosure tends to enhance therapy outcomes.
Rather than adopting a blank screen, he believes it is far better to strive to understand the past
as a way of shedding light on the dynamics of the present therapist–client relationship. This is
in keeping with the spirit of the relational analytic approach, which emphasizes the here-and-
now interaction between therapist and client.
From a feminist perspective there are distinct limitations to several Freudian concepts,
especially the Oedipus and Electra complexes. In her review of feminist counselling and
therapy, Enns (1993) also notes that the object-relations approach has been criticized for its
emphasis on the role of the mother–child relationship in determining later interpersonal
functioning. The approach gives great responsibility to mothers for deficiencies and
distortions in development. Fathers are conspicuously absent from the hypothesis about
patterns of early development; only mothers are blamed for inadequate parenting.