Counseling and Psychotherapy. Группа авторов
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engages the client in exposing the unconscious motivation behind the individual’s defense mechanisms by welcoming all transferred attitudes, feelings, impulses, and desires that were generated in early life by adults whom the client considers important (Thomas, 2008). In addition to analyzing transference, the counselor also analyzes the resistances observed from the client during sessions with the intent to expose, or bring into consciousness, the underlying causes for those resistances. Resistance is interpreted as an instinctual reaction to uncomfortable situations that clients attempt to keep hidden from themselves and the counselor (Weiss, 2014).
In modern psychodynamic theory, counselors use therapeutic immediacy to address transference and resistance within the therapeutic relationship (Luyten et al., 2015). Therapeutic immediacy involves any discussion in the therapy session about the relationship between counselor and client that occurs in the here and now, and it processes what is occurring in the here-and-now client-counselor relationship. Examples of therapeutic immediacy include exploring parallels between external relationships and the therapeutic relationship; expressing in-session emotional reactions; inquiring about the client’s reactions to therapy; exploring the counselor’s comments on the client; supporting, affirming, and validating the client’s feelings in the therapeutic relationship; and expressing gratitude (Luyten et al., 2015). Ultimately, the counselor uses therapeutic immediacy to work on improving interpersonal functioning and to create a corrective emotional experience in the here and now (Luyten et al., 2015).
Examining Life and Death Instincts
In his book Beyond the Pleasure Principle, Freud (1920/1955) stated that “the goal of all life is death” (p. 38). He noted that after people experience a traumatic event, they often reenact the experience, and these reenactments contradict the presentation of the life instincts. If we apply this in a contemporary context, the counselor may recognize this concept as a foundation for eye movement desensitization and reprocessing and other trauma-informed counseling techniques. Within a current psychodynamic view, self-destructive behavior is an expression of the energy created by the death instincts that a therapist may recognize as anxiety, depression, and suicidal thoughts. When this energy is directed inward, it appears as masochism and self-loathing, and the therapist may recognize symptoms of anxiety and suicidal thoughts. If directed outward onto others, it is expressed as aggression and violence. Understanding this concept helps the client illuminate the relationship between life, death, and meaning (Georgescu, 2011), which aligns with existential theoretical components.
Analysis of Transference
Conscious awareness is helpful but is only effective in a strong, stable, and safe therapeutic relationship. For many clients diagnosed with a serious mental illness, symptoms and concerns need to be addressed early and proactively, and counselors need to be acutely aware of their own feelings during these interactions. Seligman and Reichenberg (2014) noted that countertransference may be useful in understanding these clients, as reactions may enhance understanding of reinforcing social interactions beyond the session. Countertransference reactions should be examined using psychodynamic techniques in a supportive, empathic manner. The counselor is responsible for modeling a healthy ego, and the relationship with the counselor is internalized by the client representing healthy relational interaction (see Sidebar 3.1).
Analysis of Resistance
In addition to analyzing transference, the counselor also analyzes the resistances observed from the client during sessions with the intent to expose, or bring into consciousness, the underlying causes for those resistances. One of the most important tasks of the therapeutic alliance is to overcome resistance through remembering, reenacting events, and working through negative feelings. A psychodynamic counselor interprets resistance as an instinctual reaction to uncomfortable situations that clients attempt to keep hidden from themselves and the counselor. It is a way of avoiding the expression of feelings, fantasies, and drives that the client’s subconscious has learned over time to repress and defend.
Sidebar 3.1 Transference-Focused Psychotherapy
Transference-focused psychotherapy is a developing approach that researchers suggest as an evidence-based treatment for narcissistic personality disorder. This approach integrates contemporary object relations theory and attachment theory and focuses on the interpretation of devalued and idealized representations of self and others. These are key components of this approach, and the aim is to expose the underlying reasons for the profound sense of vulnerability and imperfection that results in the hallmark compensatory grandiosity associated with narcissistic personality disorder. Randomized clinical trials suggest that this is a promising innovative combination of psychoanalysis and object relations for improving symptomatic functioning in clients with identified attachment disruptions stemming from trauma (Diamond & Meehan, 2013).
Free Association and Dream Analysis
Free association is synonymous with Freud and the traditional psychoanalysis approach. In free association, clients are invited to relate whatever comes into their mind during the session without self-censorship. The counselor uses clarification and confrontation to help the client analyze unconscious or latent content in dreams, fantasies, or enactments that appear in the expressed content (Lothane, 2009). Freud addressed the method of free association heavily in his dream analysis work. Traditional psychoanalysis places a strong emphasis on dreams as keys to the unconscious and wish fulfillments shown in the mind as symbols. The manifest content of the dream is the dream as it is recalled by the client, and the latent content is the actual meaning of the dream once analyzed (Diena, 2014).
Free association and dream work are still evident techniques in modern psychodynamic approaches, although they are applied differently. For example, the psychodynamic counselor discusses the importance of the client paying attention to and suspending judgment of self while the counselor resists understanding too quickly (Scarfone, 2018). One way a modern psychodynamic counselor may do this is by asking the client to journal. Journaling has been widely used for its therapeutic aspects; however, modern psychodynamic counselors utilize journaling for its stream of consciousness, flow writing and free writing, expressive writing, and dream exploration (Haertl, 2008). Within a modern psychodynamic approach, the counselor and client work collaboratively and focus on developing insight. By using journaling as a means of free association and dream analysis, modern psychodynamic counselors gain rich sources of information about the client’s psyche and perception that counselors will use in the here and now (Haertl, 2008).
Brief Intervention Strategies
Brief Psychodynamic Theory
Traditional psychoanalytic theory focuses on unconscious processes as they are manifested in the client’s present behavior. Psychodynamic approaches additionally emphasize client self-awareness and understanding of the influences of the past on present behavior, and the correction of the client’s distortions is often the primary focus of therapeutic treatment (Thomas, 2008). In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships that manifest themselves in maladaptive needs and desires. The primary goal is to estimate what may have happened in the past that created a current issue. There is generally one major focus in the sessions, and although free association is not used so that the generation of additional topics is avoided, clients are still encouraged to explore issues that have tangential relation to the primary problem (Haggerty, 2013).
The two primary aims of this approach are (a) to help the client understand the connection between their presenting symptoms and what is happening in their relationships by identifying a core, unconscious, repetitive pattern of relating that becomes the focus of the therapy; and (b)