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Presented by: Group 4

Florida ArañoRhona Mea DelotavoShiela Mae Majomot

Jennelyn SapiandanteDarwin Trinidad

Psychodynamic and Humanistic Psychotherapies

Psychodynamic and Humanistic Psychotherapies

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Psychoanalysis

In therapy, it is assumed that clients will exhibit signs of these conflicts and defenses, such as by reacting to the therapist in a ways that reflect relationships with parent s and other significant figures from their past. By focusing on the transference of old relationship patterns onto the therapeutic relationship, the therapist can interpret the client’s maladaptive behaviors and the unconscious causes to motivate them. These interpretations, in turn, help the client to develop insight into the historically grounded conflicts and patterns of behavior related to their symptoms.

Freud gives emphasis on

Searching for relationships between a person’s developmental history and current problems.

Blockages or dissociations in self-awareness as causes of psychological problems

Talking as an approach to treatment The therapeutic relationship as a curative

factor.

Theoretical Foundations

Freud described mental life as occurring partly at the level of conscious awareness; partly at a preconscious level, which we can become aware of by shifting our attention; and partly at an unconscious level, which we cannot experience without the use of special therapy techniques.

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SuperegoSuperegoId Ego

The primitive source of instinctual drives, especially sexual/sensual and aggressive drives.

The self, considered as the aggregate of all the conscious act and state.

The mental agency that incorporates norms from one’s parents, family, and culture.

Freud’s Personality Theory and View of Psychopathology

Defense Mechanism

Defense mechanisms are essentially unconscious mental strategies or routines that the ego employs to ward off the anxiety produced by intrapsychic conflict.

Defense Mechanisms

Example of Primitive DefensesDenial Avoiding awareness of aspects of external reality

that are difficult to face.Projection

Perceiving and reacting to unacceptable inner impulses as through they were outside the self, typically in another person.

Splitting Compartmentalizing experiences of the self and others

so that contradiction in behavior, thought, or affect are not recognizable.

Defense Mechanisms

Example of Primitive Defenses

Dissociation

Disrupting one’s sense of continuity in the areas of identity, memory, consciousness, or perception.

Regression

Returning to an earlier phase of development of functioning.

Examples of Higher-Level Defenses

Identification

Internalizing the qualities of another person by becoming like him or her.

Displacement

Shifting feelings associated with one idea, object,

or person to another.Intellectualization

Using excessive and abstract ideation to avoid difficult feelings.

Reaction FormationTransforming an unacceptable impulse into its opposite.

Examples of Mature Defenses

Suppression

Consciously deciding not to attend to a particular feeling state or impulse.

Humor

Finding the comic and/or ironic elements in difficult situations.

Sublimation

Transforming socially or internally unacceptable impulses into socially acceptable expression.

Transference

Transference reactions are distortion in the client’s reactions to the therapist. These distortions come about because the client’s past relationships-especially early, significant past relationships such as those with one parents-create a set of expectations and anticipatory reactions for future relationships.

Countertransference

When therapist reaction to clients are based on the therapist’s personal history and conflicts. Countertarnsferense can impair the progress of therapy if the therapist begins to distort the therapeutic interaction on the basis of his or her own conflicts and defenses.

Transference and Countertransference

In psychoanalysis, slips of the tongue and other unexpected verbal associations are presumed to be psychologically meaningful, as are mental images, failures of memory, and a variety of other experiences.

Psychic Determinism

The client may begin to experience increasing anxiety. He or she may consequently begin to “forget” appointments, experience panic, become overly intellectual and emotionally detached in discussing topics, or engage in other activities that appear to take the focus away from his or her conflicts. Psychoanalysts expect these or a variety of other resistance reactions as treatment focuses more intently on the client’s core conflicts.

Resistance

Interpretation

In simpler terms, interpretation is a way of pointing out how the past intrudes on the present. Interpretations can be based on material or reactions a client reveals in therapy or on reports of the client’s experiences outside the therapy situation.

Insight

If the explanation makes cognitive and emotional; sense to the client, he or she may see a particular behavior pattern or problem in a new way.

Interpretation, Working Through, and Insight

Intellectual and emotional insight into the underlying causes of the client’s problem.

Working through or fully exploring the implications of those insights

Strengthening the ego’s control over the id and the superego.

Goals of Psychoanalysis

History and Case Formulation

Traditional psychoanalyst do not stress the use of structured assessment instruments, especially to make differential diagnostic classification, but psychoanalyst are more likely rely on interview data and sometimes on projective tests to develop an understanding of the client. Assessment in psychoanalysis is an ongoing process that occurs over multiple sessions.

Clinical Applications

The following would be especially important for psychoanalytic treatment of clients.

Historical data such as family and developmental history (to identify information related to early conflicts or trauma)

Mental status, level of distress, ego strengths and deficits and “psychological mindedness” (to asses the client’s intellectual and emotional ability to engage in psychoanalytic treatment)

Defense mechanism, themes, or patterns of attachment difficulties in interpersonal relationship (to identify transference patterns)

Psychoanalysis proper begins with the explaining to the client that therapy requires following a single fundamental rules: The client should say everything that comes to mind without editing or censorship. Free association evolved from Freud’s search for a nonhypnotic way to help his patient recover memories and reveal intrapsychic associations. It is assumed that when the constraints of logic, social amenities, and others rules are removed, unconscious material will surface more easily.

Free Association

During the therapy sessions, traditional psychoanalysts maintain an “Analytic Incognito” revealing little about them during the course of psychotherapy.

This orientation is aided by the office arrangements –the client lies on a couch and the therapist sits at its head, largely out of sight.

The therapist likes and dislikes, problems, hopes, and so on, remain unknown to the client. If clients ask personal questions, the therapist usually reminds them that the session is for their benefit and that while the exchange of personal information is appropriate in other circumstances, it does not benefit psychoanalysis.

The Role of the Therapist

Psychoanalyst is as attentive to client’s reports of activities outside of treatment as they are to what happens during the treatment sessions. The analyst tries to maintain an “evenly divided” or “free-floating” attention to trivial as well as momentous events, to purposeful acts and accidental happenings, to body language as well as spoken language. Mistakes in speaking or writing (so called “Freudian Slips”) accidents, memory losses, and humor are seen important sources of unconscious material.

Analysis of Everyday Behavior

For psychoanalytic purposes, the most interesting aspect of dreams is their Latent Content: the unconscious ideas and impulses that appear in disguised form. The process of transforming unacceptable material into acceptable manifest content is called Dream Work.

Analysis of Dreams

When the patient–therapist relationship creates a miniature version of the causes of the client’s problem, it is called the transference neurosis and becomes the central focus of analytic work. This reproduction of early unconscious conflicts allows the analyst to deal with important problems from the past as they occur in the present.

Analysis of Transference

Psychoanalyst tries to help clients overcome resistance by pointing out its presence in obstructed free associations, distorted dream reports, missed appointments, lateness for treatment sessions, and avoidance of certain topics, failure to pay the therapist’s bill or a variety of other behaviors.

Analysis of Transference

Analysis wants clients to gain insights into unconscious conflicts, but they don’t want to overwhelm the potentially frightening material before they are ready to handle. This where analytic interpretation comes in, through questions and comments about the client’s behavior, free associations, dreams and the alike, the analyst guides the process of self-exploration.

Making Analytic Interpretations

Differ from it in that they involve:

Less emphasis on sexual and aggressive id impulses

2. Greater attention to the adaptive functioning of the ego

3. Greater attention to the role of close relationships, and

4. Flexibility to the degree to which the therapists analyze and interpret versus offer empathy and emotional support.

Psychodynamic Psychotherapy

Therapists whose psychoanalytic procedures depart only slightly from the guidelines set down but Freud are said to employ psychoanalytically oriented psychotherapy.

Not every patient is seen for the standard five sessions per week

Treatment:

The patient may be seen every day; later, sessions may take place less often. Alexander even suggested that temporary interruptions in treatment could be beneficial by testing the patient’s ability to live without therapy and reducing reliance on the therapist.

PSYCHOANALYTICALLY ORIENTED PSYCHOTHERAPY

An early follower of Freud who was the first to detect from the ranks of orthodox psychoanalysis.

He deemphasized Freud’s theory of instincts, infantile sexuality, and the role of unconscious in determining behavior.

His treatment methods focused on exploring and altering misconceptions (maladaptive lifestyles, as he called them)

ALFRED ADLER’S INDIVIDUAL PSYCHOLOGY

In Adlerian Analysis, client and therapist sit face to face in similar chairs, the feelings and relations expressed toward the therapist (transference) not as reflecting unconscious childhood conflicts but as the client’s habitual style of dealing with people like the therapist.

View resistance as a sample of how the client usually avoids unpleasant material,

and dreams are interpreted not as symbolic wish fulfillment but as a “rehearsal” of how the client might deal with problems in the future.

ALFRED ADLER’S INDIVIDUAL PSYCHOLOGY

They argued, for example. That Freud’s preoccupation with sexual and aggressive instincts (id) as the basis for behavior and behavior disorder is too narrow. They said that behavior is determined to a large extent by the ego, which can function not just to combat id impulses or to referee conflicts but also to promote learning and creativity.

Ego-analytic techniques differ from classical analytic techniques in that therapists focus less on working through early childhood experiences and more on working through current problems.

Therapists assess and bolster the client’s ego strengths (reality testing, impulse control, judgment, and the use of more “mature” defense mechanisms such as sublimation).

The therapeutic relationship remains important, but less for its distorting transferences than for its supportive and trusting functions.

EGO PSYCHOLOGY

Object relations expanded the role of relationships, especially early relationships, in psychodynamic thought.

Focuses on the nature of interpersonal relationships that are built from very early infant – because these early relationships acts as prototypes for later relationships, disruptions in them can have profound consequences later in life.

OBJECTS RELATION AND SELF-PSYCHOLOGY

Psychodynamic theory stresses relationships with caretakers.

Relational theorists stress the importance of early relationships of early as templates for later ones.

Pointed out that relationships have an objective dimension (the events that actually happen) and a subjective dimension (the way the relationship is mentally represented or perceived by the persons involved).

OBJECTS RELATION AND SELF-PSYCHOLOGY

Sullivan, the father of interpersonal perspective, believed that theorists should use their observations of the client’s current and past interpersonal relationships to clarify for them how their typical cognitions and behavior interfere with successful living. However, Sullivan and other later relational therapists cautioned against assuming that the therapist’s view of the therapeutic relationship was objectively correct. Because the client and the therapist both work from their own subjective viewpoints.

Relational therapists believe that neither perception can be objectively validated.

OBJECTS RELATION AND SELF-PSYCHOLOGY

Intellectual trends that are compatible with relational psychodynamic approach which made it achieved popularity in the United States in the past decade.

Intersubjectivisim, constructivism, postmodernism

Its approaches emphasize pragmatic goals that can be obtained in relatively few sessions, typically 20 or less.

Therapists focus on helping clients cope with a current crisis or problem rather than helping them work through early relationships or to reconstruct the personality.

They stress the information a working therapeutic alliance as quickly as possible and then help clients adopt coping strategies within specific domains.

They might focus on anxiety management or coping within a problem relationship at work because the pace of therapy is accelerated.

SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY

They may use traditional techniques of psychoanalysis, but they also might assign homework, refer client to self-help groups, or adopt other techniques not typically associated with psychodynamic treatment.

There are several models for short term dynamic therapy (manuals for treating specific disorders; Interpersonal psychotherapy(IPT), a treatment typically used for persons with depressive disorders)

SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY

A useful way of thinking about all the psychodynamic variations that have been discussed is to categorize them along a continuum according to their similarity to psychoanalysis.

Psychoanalysis – psychoanalytically oriented psychotherapy = treatments based on ego psychology, self-psychology and interpersonal psychology = relational and postmodern versions of psychodynamic psychotherapy.

COMMON FEATURES AND VARIATIONS IN PSYCHODYNAMIC THERAPIES

All of them share core beliefs about the psychological importance of:

a. Intrapsychic conflict b. Unconscious processes c. Early relationships d. Ego functioning and e. the client-therapist relationship

COMMON FEATURES AND VARIATIONS IN PSYCHODYNAMIC THERAPIES

The length of treatment is shorter than that of traditional psychoanalysis

Long-term psychodynamic psychotherapy lasts 6 months or longer and involves sessions usually lasting 45 to 50 minutes once or twice per week.

-Psychodynamic psychotherapy that is designed to be more supportive varies depending on the client’s needs but can be as short as one 25-minute session once or twice per month or as frequent and long as long-term psychodynamic treatment.

Contemporary psychodynamic psychotherapies seek to create an emphatic and supportive atmosphere in which the client feels cared for and understood. Many believed that this atmosphere creates a corrective emotional experience for the client and is a healing factor independent insight.

The Supportive – Expressive Dimensions

Variations of techniques where psychodynamic psychotherapists can then practice interventions that range from the analytical ones advocated in psychoanalysis to the more supportive interventions stressed by interpersonal and relational approaches.

Supportive – expressive continuum

Classical psychoanalysis is practiced by only about 2% of the clinicians.

Psychodynamically oriented variations continue to be practiced by a large number of clinicians and taught as a dominant orientation by several graduate and professional schools.

Psychodynamically oriented research publications are also easy to find.

THE CURRENT STATUS OF PSYCHODYNAMIC PSYCHOTHERAPY

Along with cognitive-behavioral and eclectic approaches, the psychodynamic approach is among the three most popular in clinical psychology.

Psychodynamic approach has evolved and remains a significant force in clinical psychology.

THE CURRENT STATUS OF PSYCHODYNAMIC PSYCHOTHERAPY

In the humanistic psychotherapies, clients are encouraged to understand themselves and grow personally. In contrast to psychodynamic therapies, humanistic therapies emphasize conscious thoughts rather than unconscious thoughts, the present rather than the past, and growth and fulfillment rather than curing illness.

Two main forms of the humanistic psychotherapies are Person-centered therapy

and Gestalt therapy.

HUMANISTIC PSYCHOTHERAPY

The most prominent of the humanistic approaches developed by Carl Rogers in which the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and encourage the client to gain insight about problems.The therapy was initially called client-centered therapy but later changed as the applications expanded.

Person-centered therapy

Rogers’s Personality Theory and View of Psychopathology

Rogers distinguished between the real self—the self as it really is a result of our experiences and the ideal self, which the self we would like to be. The greater the discrepancy between the real self and the ideal self, the more maladjusted we will be.

The Self and Conditions of Worth

Their self concept expands through their relationships with others. The self is a whole, consisting of one’s self-perceptions (how attractive I am, how will I get along with others) and the values we attach to these perceptions (good-bad, worthy-unworthy).

The unconditional positive regard is a situation in which parents are successful at communicating their acceptance of all of the child’s behavior and experiences. The child will naturally incorporate those experiences into his or her real self-concept. Rogers strongly believed that unconditional positive regard elevates a person’s self-worth.

Unconditional positive regard

This is the discrepancy of the real self and the ideal self. The more a person experiences his or her positive regard dependent upon acting and feeling in ways consistent with what other people value, the more the real self and ideal self become separated.

Incongruence

Clients are the ones who set their own goals. The therapist promotes such awareness by providing an interpersonal relationship that could reduce incongruence and further personal growth.

The Goals of Person-Centered Therapy

What the therapists provide to achieve more fully functioning and more self-actualized individuals:

Unconditional positive regard. It is a non-possessive, caring, love,

acceptance of the person. This is in contrast to conditional positive regard/conditions of worth

Empathy

To understand a client’s behavior and help the client understand it as well, the therapist must try to see the world as the client sees it.

Congruence openness, honesty in the relationship with

another being completely oneself in the relationship,

without pretending or putting up facades

To provide an atmosphere in which the client can explore his thoughts and feelings about the things that troubled him.

       The therapist done this done being nondirective, he must listens emphatically, responds reflectively, and models genuineness in his own behavior towards the client.

       As therapy provides an atmosphere of acceptance, warmth and genuineness, clients become more accepting of their own experiences.

       Irrational behavior is often rational from the client’s perspective and the person-centered therapists seek to expand the client’s perspective rather than change the client’s behavior.

The Role of the Therapist

Gestalt Therapy

            Frederick (Fritz) and Laura Perls – developed the gestalt therapy which is probably the best known humanistic treatment.

            Gestalt therapy aims at enhancing client’s awareness in order to free them to grow in their own consciously guided ways.

Other Humanistic Approaches

Gestalt therapist seeks to reestablish client’s stalled growth process by helping them:

a. become aware of feelings they have disowned but that are a genuine part o them

b. recognized feelings and values they think are a genuine part of themselves but in fact are borrowed from other people.

One of the key differences between person-centered therapy and Gestalt therapy is that Gestalt therapist are much more active and dramatic than in person-centered treatment.

Gestalt therapist believes that therapeutic progress is made by keeping clients in contact with their feelings as they occur in the here and now.

          Perls expressed this belief in a conceptual equation where now = experience = awareness = reality.

Focus on the Here and Now

Through role-plating or part-taking clients explore inner conflicts and experience the symptoms, interpersonal games, and psychological defenses they have developed to keep those conflicts and various other aspects of their genuine selves out of awareness.

Gestalt therapist also turn the role-playing into extended “conversations” between various parts of the client including between the clients superego (what Perls called “topdog”) and the part that is suppressed by “should” and “ought’s” (the “underdog”).

Role Playing

            Using the Empty Chair Technique, the therapist encourage clients to “talk” to someone they imagined to be seated in a nearby chair.

            Using the Unmailed Letter Technique, the clients are asked to clarify and released feelings towards significant people in their lives. They write but do not send a letter in which they express important but previously unspoken feelings.

            Role- Played Reversals are also used to enhance awareness of genuine feelings.   

Role Playing

Suppose that a client begins a session by saying ‘I’ve really been looking forward to having this session, I hope you can help me” a Gestalt therapist would focus on the manipulative aspect of the statement which seems to contain the message “I expect you to help me without my having to do much”. The therapist might say “How do you think I could help you?”. From here the therapist would continue to frustrate the client’s attempt to get the therapist to take responsibility for solving the client’s problem.

Frustrating the Client

Gestalt therapist pay attention to what clients say and what they do, because the nonverbal channel often contradicts the client’s words.

 For example, if a client says that she is nervous and clasp her hands, the therapist might wonder what the clasped hands meant.

Use of Nonverbal Cues

Existential Psychotherapy

            Existential therapist helps clients to explore fully what it means to be alive.  

            Existential humanistic therapist tries to understand the client’s inner world, frames of reference, and flow o experiences. The concept of personality has limited usefulness.

Existential and Other Humanistic Approach

Rollo May, one prominent existential therapist, regarded the therapeutic process as the clients struggle between freedom and the limits imposed by destiny.

Viktor Frankl – founder of Logotherapy, was oriented toward helping clients:

a. take responsibility for their feelings and actions.

b. find meaning and purpose in their lives.

Postmodernist philosophies reject the idea of objective, absolute, or perceiver independent truth. Also called constructivist or intersubjective approaches, these philosophies suggested that people live, psychologically speaking not in an objective reality but in a reality or teach.

            The emphasis of the therapy is on helping clients “reauthor heir life narratives or experiment with new constructions of the self and relationship that afford more hopeful possibilities for the future.

Postmodern Humanistic Approaches

Humanistic approaches are generally more popular in counseling psychology programs (11%) that in clinical psychology programs (56%).

            Only 1% of clinical psychologists identify themselves as Rogerian or Gestalt

            One criticism of humanistic psychotherapy revolves around its insistence on not “pathologizing” clients as seeing even bizarre behavior as understandable from the client’s point of view.

The Current Status of Humanistic Psychotherapy

Humanistic approaches are generally more popular in counseling psychology programs (11%) that in clinical psychology programs (56%).

            Only 1% of clinical psychologists identify themselves as Rogerian or Gestalt

            One criticism of humanistic psychotherapy revolves around its insistence on not “pathologizing” clients as seeing even bizarre behavior as understandable from the client’s point of view.

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