Traditional psychoanalytic approaches are costly, and psychoanalytic therapy is generally perceived as being based on upper- and middle-class values. All clients do not share these values, and for many the cost of treatment is pro- hibitive. Another shortcoming pertains to the ambiguity inherent in most
psychoanalytic approaches. This can be problematic for clients from cultures who expect direction from a professional. For example, many Asian American clients may prefer a more structured, problem-oriented approach to counseling and may not continue therapy if a nondirective approach is employed. Further- more, intrapsychic analysis may be in direct confl ict with some clients’ social framework and environmental perspective. Psychoanalytic therapy is more concerned with long-term personality reconstruction than with short-term problem solving.
Atkinson, Thompson, and Grant (1993) underscore the need for therapists to consider possible external sources of clients’ problems, especially if clients have experienced an oppressive environment. The psychoanalytic approach can be criticized for failing to adequately address the social, cultural, and po- litical factors that result in an individual’s problems. If there is no balance be- tween the external and internal perspectives, clients may be held responsible for their condition.
There are likely to be some diffi culties in applying a psychoanalytic ap- proach with low-income clients. If these clients seek professional help, they are generally concerned with dealing with a crisis situation and with fi nding solu- tions to concrete problems, or at least some direction in addressing survival needs pertaining to housing, employment, and child care. This does not imply that low-income clients are unable to profi t from analytic therapy; rather, this particular orientation could be more benefi cial after more pressing issues and concerns have been resolved. On this topic, Smith (2005) contends that psycho- therapists’ willingness and ability to work with low-income clients is compro- mised by unexamined classist attitudes and that these attitudes constitute a signifi cant obstacle for practitioners’ success in working with the poor. Smith makes a case for considering alternative therapeutic models such as psychoed- ucation, counseling, preventive psychology, or community psychology rather than traditional analytic psychotherapy for people who are in a low socioeco- nomic situation. Another alternative is for therapists to do pro-bono work for some clients.
Summary and Evaluation
Some major concepts of psychoanalytic theory include the dynamics of the un- conscious and its infl uence on behavior, the role of anxiety, an understanding of transference and countertransference, and the development of personality at various stages in the life cycle.
Building on many of Freud’s basic ideas, Erikson broadened the develop- mental perspective by including psychosocial trends. In his model, each of the eight stages of human development is characterized 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
In each of the chapters in Part 2, the case of Stan is used to demonstrate the practical applications of the theory in question. To give you a focus on Stan’s central concerns, refer to the end of Chapter 1, where his biography is given. I also recommend that you at least skim Chapter 16, which deals with an integrative approach as applied to Stan.
In Chapters 4 through 14 you will notice that Stan is working with a female therapist. Given his feelings to- ward women, it may seem odd that he selected a woman for his therapist. However, knowing that he had diffi culty with women, he consciously made this choice as a way to challenge himself. As you will see, one of Stan’s goals is to learn how to become less intimidated in the presence of women and to be more himself around them.
The psychoanalytic approach focuses on the uncon- scious psychodynamics of Stan’s behavior. Considerable attention is given to material that he has repressed. At the extreme Stan demonstrated a self-destructive ten- dency, which is a way of infl icting punishment on him- self. Instead of directing his hostility toward his parents and siblings, he turned it inward toward himself. Stan’s preoccupation with drinking could be hypothesized as evidence of an oral fi xation. Because he never received love and acceptance during his early childhood, he is still suff ering from this deprivation and still desperately searching for approval and acceptance from others.
Stan’s gender-role identifi cation was fraught with dif- fi culties. He learned the basis of female–male relation- ships through his early experiences with his parents.
What he saw was fi ghting, bickering, and discounting.
His father was the weak one who always lost, and his mother was the strong, domineering force who could and did hurt men. Stan generalized his fear of his mother to all women. It could be further hypothesized that the woman he married was similar to his mother, both of whom reinforced his feelings of impotence.
The opportunity to develop a transference rela- tionship and work through it is the core of the therapy process. An assumption is that Stan will eventually re- late to his therapist as he did to his mother and that the process will be a valuable means of gaining insight into the origin of his diffi culties with women. The ana-
lytic process stresses an intensive exploration of Stan’s past. The goal is to make the unconscious conscious, so that he will no longer be controlled by unconscious forces. Stan devotes much therapy time to reliving and exploring his early past. As he talks, he gains increased understanding of the dynamics of his behavior. He be- gins to see connections between his present problems and early experiences in his childhood. Stan explores memories of relationships with his siblings and with his mother and father and also explores how he has generalized his view of women and men from his view of these family members. It is expected that he will reexperience old feelings and uncover buried feelings related to traumatic events. From another perspec- tive, apart from whatever conscious insight Stan may acquire, the goal is for him to have a more integrated self, where feelings split off as foreign (the id) become more a part of what he is comfortable with (the ego).
The relationship with his therapist, where old feelings have diff erent outcomes from his past experiences with signifi cant others, can result in deep personality growth.
The therapist is likely to explore some of these questions with Stan: “What did you do when you felt unloved?” “As a child, what did you do with your nega- tive feelings?” “Could you express your rage, hostility, hurt, and fears?” “What eff ects did your relationship with your mother have on you?” “What did this teach you about all women?” Brought into the here and now of the transference relationship, questions might in- clude “When have you felt anything like this with me?”
and “What are you learning from our relationship about how relationships with women might go?”
The analytic process focuses on key infl uences in Stan’s developmental years, sometimes explicitly, sometimes in terms of how those earlier events are being relived in the present analytic relationship. As he comes to understand how he has been shaped by these past experiences, he is increasingly able to exert control over his present functioning. Many of Stan’s fears become conscious, and then his energy does not have to remain fi xed on defending himself from unconscious feelings. Instead, he can make new
Psychoanalytic Therapy Applied to the Case of Stan
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decisions about his current life. He can do this only if he works through the transference relationship, however, for the depth of his endeavors in therapy largely deter- mine the depth and extent of his personality changes.
If the therapist is operating from a contemporary psychoanalytic orientation, her focus may well be on Stan’s developmental sequences. Particular atten- tion is paid to understanding his current behavior in the world as largely a repetition of one of his earlier developmental phases. Because of his dependency, it is useful in understanding his behavior to see that he is now repeating patterns that he formed with his mother during his infancy. Viewed from this perspec- tive, Stan has not accomplished the task of separation and individuation. He is still “stuck” in the symbiotic phase on some levels. He is unable to obtain his confi r- mation of worth from himself, and he has not resolved the dependence–independence struggle. Looking at his behavior from the viewpoint of self psychology can help the therapist deal with his diffi culties in forming intimate relationships.
Follow-Up: You Continue as Stan’s Psychoanalytic 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 per- spective. 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 identify- ing specifi c concepts you would draw from and tech- niques that you might use in helping him explore the struggles he identifi es. Here are a series of questions to provide some structure in your thinking about his case:
• 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 signifi cant person in his life?
• In working with Stan, what countertransference issues might arise for you?
• What resistances might you predict in your work with Stan? From a psychoanalytic perspective, how would you interpret and work with this resistance?
See the online and DVD program, Theory in Practice: The Case of Stan (Session 1, an initial session with Stan, and Session 2, on psy- choanalytic therapy), for a demonstration of my approach to counseling Stan from this perspec- tive. The fi rst session consists of the intake and as- sessment process. The second session focuses on Stan’s resistance and dealing with transference.
analyzed. The assumption is that this exploration of the past, which is typically accomplished by working through the transference relationship with the thera- pist, is necessary for character change. The most important techniques typi- cally employed in psychoanalytic practice are maintaining the analytic frame- work, free association, interpretation, 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, individuals must explore the unconscious aspects of their person- ality, 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 prob- lems but the transformation of personality.
The contemporary trends in psychoanalytic theory are refl ected in these general areas: ego psychology, object-relations approaches, self psychology, and relational approaches. Ego psychology does not deny the role of intra- psychic confl icts but emphasizes the striving of the ego for mastery and com- petence 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 gratifi cation for infants.
Separation–individuation is achieved over time. When this process is success- ful, 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–thera- pist relationship.