Follow-Up: You continue as stan’s therapist

With each of the 11 theoretical orientations, you will be encouraged to try your hand at applying the prin- ciples and techniques you have just studied in the chapter to working with Stan from that particular perspective. The information presented about Stan from each of these theory chapters will provide you with some ideas of how you might continue working with him if he were referred to you. Do your best to stay within the general spirit of each theory by identifying specific concepts you would draw from and techniques that you might use in helping Stan explore the struggles he identifies.

Psychoanalytic Therapy Applied to the Case of Gwen*

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Questions for Reflection

How much interest would you have in Stan’s early childhood? What are some ways you’d help him see patterns between his childhood issues and his current problems?

Consider the transference relationship that is likely to be established between you and Stan.

How might you react to his making you into a significant person in his life?

In working with Stan, what countertransference issues might arise for you?

What resistances and defenses might you predict in your work with Stan? From a psychoanalytic perspective, how would you interpret and work with this resistance?

Which of the various forms of psychoanalytic therapy—classical, relational, or object relations—

would you be most inclined to apply in working with Stan?

Visit CengageBrain.com or watch the DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes, session 1 (an initial session with stan) and session 2 (on psychoanalytic therapy), for a demonstration of my approach to counseling stan from this perspective. The first session consists of the intake and assessment process.

The second session focuses on stan’s resistance and dealing with transference.

I

n each of the theory chapters, the case of Gwen is used to demonstrate the practical applications of that theoretical approach. Refer to the last section of Chapter 1, where Gwen’s background information and intake session are presented, to refresh your memory of her central concerns.

Gwen show’s up late for her appointment and states she is feeling frustrated with a work project she is behind on.

Gwen: I feel like I am on the edge of falling apart, like nothing is going right and everyone is looking at me like I’m a failure. I am just sad and unable to put the pieces together. I am behind on everything

… and I am scared I will lose it all.

I listen to Gwen with the goal of allowing her to con- nect to what lies beneath the surface of her strong emotions. As a psychoanalytic therapist, I believe the genesis of psychological problems are rooted in the unconscious mind. Issues brought into session often stem from unresolved childhood conflicts and trauma.

Childhood pain and suffering is not necessarily rooted in an extreme or horrific event; children may repress memories of any negative emotional event.

My initial goal is to help Gwen see how her early history is affecting her current habits, feelings, and

behaviors. Once Gwen is able to bring the unconscious material to a conscious level, she can better under- stand her triggers and recurrent emotional conflicts.

In making unconscious material conscious, Gwen can recognize the origins of her behavior, explore some of these patterns, work through early experiences, release dysfunctional behaviors, and begin relating to life from a position of greater clarity and strength.

Gwen continues discussing her frustrations with work and begins to cry. I help Gwen achieve a more relaxed state so she can bypass the conscious mind and find out what is happening at an unconscious level.

My intervention is not the typical free association of traditional psychoanalysis but rather guided association based on familiar emotions.

Therapist: Sit back and relax for a moment. Go back to one of the very first times in life when you felt this same or a similar feeling of frustration. Let yourself go back in time, back to when you were a little girl and you had the sense that nothing was going right and that things were falling apart.

[I prompt Gwen].

You feel yourself getting younger and younger. When you are there, tell me how old you are, who is there with you, and describe the situation.

Psychoanalytic Therapy Applied to the Case of Gwen*

*Dr. Kellie Kirksey writes about her ways of thinking and practicing from a psychoanalytic perspective and applies this model to Gwen.

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I watch as Gwen’s facial expression begins to change.

After a few minutes she begins to speak.

Gwen: I am 5 years old, and I am sitting at the kitchen table crying. I have on a pink dress, and the front of my dress is dirty. My mother had told me to wait for her in the car. Instead of waiting in the car, I started playing in the backyard and got dirty. She hit my legs, and I just cried and cried. She yelled and told me that I always mess everything up. All I wanted to do was to play. I never got to play, I just wanted to kick the ball around and have some fun.

Gwen continues to cry as she tells me about herself as a little girl. I ask her to go to another time in her childhood when she had that same feeling of frustration.

Gwen: I am 12 years old, and I am upstairs in my parent’s room. My little sister had set the bed on fire, and my parents are blaming me because I was supposed to be watching her. I tell them that I was watching her. I keep telling them that it is not my fault, but they don’t listen to me. They put me on punishment for two months, and I overhear them say that I never do anything right.

Therapist: What did that little girl need in those situations?

Gwen: I needed understanding, and someone to tell me it was going to be OK. I needed love, even though I was not the perfect little girl.

I ask Gwen to reflect on what decision she made at that time as a little girl. Gwen pauses and then replies.

Gwen: I decided I had to be perfect in order to be loved.

I ask Gwen to reflect on how often this early decision affects her life now. She sits quietly for a while and then comments that she often feels like that little girl.

Gwen is surprised by the feelings and insights that have surfaced.

Gwen: I had not thought about those early times in ages. I can’t believe those situations still bother me.

I had not realized that.

In that moment Gwen recognizes the power of the unconscious and how bringing the unconscious material to the surface can serve as a healing force in her

life. I tell Gwen that as an adult she is now able to give that little girl aspects of herself: love, acceptance, and attention.

Gwen tells me that loving the little girl aspects of her sounds a bit strange, but she is open to being gen- tler with herself—just as she wanted her parents to be easier on her and love her as she was.

Gwen: I never imagined that those spankings and getting yelled at stuck with me all these years. So now I see that everything seems to be connected, and all that I have ever experienced is still affecting me today. Wow! I have to go home and sit with all of this.

As Gwen leaves my office, I tell her to pay attention to her dreams and keep a dream journal for the next week so we can continue to explore the unconscious material through the symbols in her dreams. Gwen smiles and says she had no idea therapy would be like this. I remind her that psychoanalytically oriented therapy is a long journey and that she is not alone.

It is important for me to be aware of transference (Gwen’s unconscious reactions to me). My awareness of transference can facilitate Gwen’s deepening con- nection to her past. It is also important for me to be aware of countertransference (my unconscious reactions to Gwen). As Gwen spoke of getting spanked as a child, I could relate to her pain and felt her sadness.

I could have told countless stories of pain inflicted upon me during my childhood, but it is not my session. However, I can use my countertransference in a productive way by deepening my therapeutic relationship with Gwen and showing empathy for the hurt child that she was. I examine the feelings and sensa- tions that came up for me in the session, and I chal- lenge myself to seek supervision or peer consultation when necessary to avoid engaging in behavior that is not therapeutically beneficial.

Questions for Reflection

What interventions did the therapist make to help Gwen begin to see how her early experiences have an impact on her present behavior?

What therapeutic value do you see in facilitating Gwen’s exploration of early childhood pain?

If you were counseling Gwen, what potential countertransference issues might surface for you?

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Summary and Evaluation

Summary

Some major concepts of psychoanalytic theory include the dynamics of the

unconscious and its influence on behavior, the role of anxiety, an understanding of transference and countertransference, and the development of personality at various stages in the life cycle.

Erikson broadened Freud’s developmental perspective by including psychosocial trends. In his model, each of the eight stages of human development is charac- terized by a crisis, or turning point. We can either master the developmental task or fail to resolve the core struggle (Table 4.2 compares Freud’s and Erikson’s views on the developmental stages).

Psychoanalytic therapy consists largely of using methods to bring out unconscious material that can be worked through. It focuses primarily on childhood experiences, which are discussed, reconstructed, interpreted, and analyzed. The assumption is that this exploration of the past, which is typically accomplished by working through the transference relationship with the therapist, is necessary for character change. The most important techniques typically employed in psychoanalytic practice are maintaining the analytic framework, free association, interpreta- tion, dream analysis, analysis of resistance, and analysis of transference.

Unlike Freudian theory, Jungian theory is not reductionist. Jung viewed humans positively and focused on individuation, the capacity of humans to move toward wholeness and self-realization. To become what they are capable of becoming, indi- viduals must explore the unconscious aspects of their personality, both the personal unconscious and the collective unconscious. In Jungian analytical therapy, the therapist assists the client in tapping his or her inner wisdom. The goal of therapy is not merely the resolution of immediate problems but the transformation of personality.

The contemporary trends in psychoanalytic theory are reflected in these general areas: ego psychology, object-relations interpersonal approaches, self psychology, and relational approaches. Ego psychology does not deny the role of intrapsy- chic conflicts but emphasizes the striving of the ego for mastery and competence throughout the human life span. The object-relations approaches are based on the notion that at birth there is no differentiation between others and self and that others represent objects of need gratification for infants. Separation–individuation is achieved over time. When this process is successful, others are perceived as both separate and related. Self psychology focuses on the nature of the therapeutic relationship, using empathy as a main tool. The relational approaches emphasize what evolves through the client–therapist relationship.

Contributions of the Classical Psychoanalytic Approach

I believe therapists can broaden their understanding of clients’ struggles by appre- ciating Freud’s many significant contributions. It must be emphasized that compe- tent use of psychoanalytic techniques requires training beyond what most therapists are given in their training program. The psychoanalytic approach provides practi- tioners with a conceptual framework for looking at behavior and for understanding the origins and functions of symptoms. Applying the psychoanalytic point of view LO14

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to therapy practice is particularly useful in (1) understanding resistances that take the form of canceling appointments, fleeing from therapy prematurely, and refus- ing to look at oneself; (2) understanding that unfinished business can be worked through, so that clients can provide a new ending to some of the events that have restricted them emotionally; (3) understanding the value and role of transference;

and (4) understanding how the overuse of ego defenses, both in the counseling relationship and in daily life, can keep clients from functioning effectively.

Although there is little to be gained from blaming the past for the way a person is now or from dwelling on the past, considering the early history of a client is often useful in understanding and working with a client’s current situation. The client can use this awareness in making significant changes in the present and in future directions. Even though you may not agree with all of the premises of the classical psychoanalytic position, you can still draw on many of the psychoanalytic concepts as a framework for understanding your clients and for helping them achieve a deeper understanding of the roots of their conflicts.

Contributions of Contemporary Psychoanalytic Approaches

If the psychoanalytic (or psychodynamic) approach is considered in a broader context than is true of classical psychoanalysis, it becomes a more powerful and useful model for understanding human behavior. Although I find Freud’s psychosexual concepts of value, adding Erikson’s emphasis on psychosocial factors gives a more complete picture of the critical turning points at each stage of development. Integrating these two perspectives is, in my view, most useful for understanding key themes in the development of personality. Erikson’s developmental schema does not avoid the psychosexual issues and stages postulated by Freud; rather, Erikson extends the stages of psychosexual development throughout life. His perspective integrates psychosexual and psychosocial concepts without diminishing the importance of either.

Therapists who work from a developmental perspective are able to see continu- ity in life and to see certain directions their clients have taken. This perspective gives a broader picture of an individual’s struggle, and clients are able to discover some significant connections among the various life stages.

The contemporary trends in psychoanalytic thinking contribute to the understanding of how our current behavior in the world is largely a repetition of patterns set during one of the early phases of development. Object-relations theory helps us see the ways in which clients interacted with significant others in the past and how they are superimposing these early experiences on present relationships. For the many clients in therapy who are struggling with issues such as separation and individuation, intimacy, dependence versus independence, and identity, these newer formulations can provide a framework for understanding how and where aspects of development have been fixated. They have significant implications for many areas of human interaction such as intimate relationships, the family and child rearing, and the therapeutic relationship.

In my opinion, it is possible to use key concepts of a psychodynamic framework to provide structure and direction to a counseling practice and at the same time to draw on other therapeutic techniques. I find value in the contributions of those writers who have built on the basic ideas of Freud and have added an emphasis on the social and cultural dimensions affecting personality development. In contemporary psychoanalytic

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practice, more latitude is given to the therapist in using techniques. The newer psychoanalytic theorists have enhanced, extended, and refocused classical analytic techniques. They are concentrating on the development of the ego, are paying attention to the social and cultural factors that influence the differentiation of an individual from others, and are giving new meaning to the relational dimensions of therapy.

Several meta-analyses have found that the quality of the therapeutic relationship and the therapeutic alliance are critical to the outcomes of analytic therapy, and research attests to the overall helpfulness of psychoanalytic treatments. McWilliams (2014) admits that psychoanalytic therapies are difficult to investigate through randomized controlled trials because they are more complex, individualized, and unstructured than many other therapy approaches. However, the professional com- munity needs to appreciate the value of process research, qualitative research, case studies, and accumulated clinical wisdom. McWilliams cites some literature on evidence-based psychodynamic therapy and adds that literature is emerging that supports the efficacy of psychodynamic therapies. There is also extensive empirical literature on attachment, emotion, defenses, personality, and other areas that sup- port the theoretical models and clinical experiences of psychoanalytic therapists.

Although contemporary psychodynamic approaches diverge considerably in many respects from the original Freudian emphasis on drives, the basic Freudian concepts of unconscious motivation, the influence of early development, transference, countertransference, and resistance are still central to the newer psychodynamic approaches. These concepts are of major importance in therapy and can be incorporated into therapeutic practices based on various theoretical approaches.

Limitations and Criticisms of Psychoanalytic Approaches

There are a number of practical limitations of psychoanalytic therapy. 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. Contemporary psychoanalytically oriented therapists are interested in their clients’ past, but they intertwine that understanding with the present and with future goals. The emergence of brief, time-limited psychodynamic therapy is a partial response to the criticism of lengthy therapy. Psy- chodynamic psychotherapy evolved from traditional analysis to address the need for treatment that was not so lengthy and involved (Luborsky et al., 2011).

A potential limitation of the psychoanalytic approach is the anonymous role assumed by some therapists. This stance can be justified on theoretical grounds, but in therapy situations other than classical psychoanalysis this stance is unduly restric- tive. The newer formulations of psychoanalytic practice place considerable emphasis on the interaction between therapist and client in the here and now, and therapists can decide when and what to disclose to clients. Yalom (2003) suggests that appro- priate therapist self-disclosure tends to enhance therapy outcomes. Rather than

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Dalam dokumen Gerald Corey - Theory and Practice of Counseling and Psychotherapy-Brooks Cole (2016) (Halaman 109-118)