Structures Of Subjectivity For Explorations In Psychoanalytic

Stages and Techniques of Psychoanalytic Therapy

Discuss about the Structures of Subjectivity for Explorations in Psychoanalytic.

Sigmund Freud, one of the forefathers of psychology is the founder of psychoanalysis. He developed several theories (Freud, 2012) that have formed the basis of "Psychoanalytic therapy." There is a growing incidence of mental health problems in the present world necessitating the implementation of psychotherapeutic approaches as they make deep-seated changes in emotional and personality development (Strupp, 2013). This therapy is the effective choice for patients with specific emotional concern. In this context; the essay explains the psychoanalytic therapy for Peter, a 40 years old single male, who is currently seeking the psychoanalytic therapist to end his struggle with interpersonal conflicts. The essay explains the process of psychoanalytic therapy in the context of the case study, the stages and techniques of therapy, and the goals of therapy. The essay further presents the critique of psychoanalytic therapy. It briefly explains the key contributions of the psychoanalytic therapy and its limitations. The paper also provides recommendations on how psychoanalytic therapy can further evolve to improve its efficacy in therapy. Lastly, the essay elaborates the applications of other models that can overcome the limitations of psychoanalytic therapy.

According to Lionells et al., (2014), there are three stages of psychoanalytic therapy identified which are the "initial, middle and the late stage." During the initial phase, the therapist tends to know about the patient and establish a therapeutic relationship. In the context of Peter, the therapist may tend to know his characterological style, dangerous situation ruling his behavior and his defensive maneuvres. The therapist may note client’s initial resistance to the process and early transferential process for using it in future when the better understanding of the client’s past life will shed light on the "present transferential responses." During the middle stage, the therapist tends to learn the feelings of the visitor for a significant person in the childhood. The two main techniques used at this stage are “analysis of transference” and “analysis of resistance” (Stolorow et al., 2014). At this stage, the resistance to the treatment and the transference process becomes more pronounced and vital part of therapy. At this stage, the therapist can explain and relate between the "the inner unconscious conflicts or desires and disease." Therefore, it will help Peter to realize and comprehend thereby allowing him to experience wider choices in life. At this stage, Peter's present decision-making could no longer be a cloud by his past distortions. It is at this stage of treatment where Peter will be made to work through his conflicts. This may have the good effect on the client. In the late stage of psychoanalytic therapy also called as resolution stage, there is a consolidation of new changes in the client. The therapist understands the client’s old pattern in the context of past and old memories that were repressed. Also, at this stage, interpersonal conflicts resulting in maladaptive behavior are resolved in the therapeutic situation. This stage may include repetition of transference and hence the therapist reveals some of the client’s problems and helps them to face reality. The treatment is terminated when the patient can solve the transference independently (Peterfreund, 2016). 

Goals of Psychoanalytic Therapy

In this essay, we will emphasize more on the middle stage of psychoanalytic therapy and its goals. The ultimate goal of any psychotherapy is the improvement and enhancement in patient’s physical and mental health to their sense of well-being. The aim is to help patients to manage their life more effectively (Dreher & Sandler, 2013). The goal of the psychoanalytic therapy is to analyze the components contributing towards Peter’s interpersonal conflict and the way these components are effecting his relationship with himself and with others (Hall, 2013). The therapist then intends to study the patient by bringing out the characteristic through selective inattention. Further, the treatment goal is to focus on how Peter is maintaining is relationship with others as well as his behaviour and tendencies (Lionells et al., 2014). After analysing these components the goal of the therapist is to determine the reason contributing to his current behaviour and factors causing him to hold onto it (Peterfreund, 2016).

The two main techniques used at this stage are “Free association”, “dream analysis”, “analysis of transference” and “analysis of resistance” (Atwood & Stolorow, 2014). During free association, Peter will be encouraged to speak everything that is in his mind. The therapist may start with an investigation, which may include in-depth questions allowing the client to reflect on himself. The therapist will analyze the responses as patterns and deduce the cause of interpersonal conflict by exploring, rephrasing and summarizing the patient’s narrations. The process of reflection will allow the therapist to understand Peter and alter his perception by the process called as “Reframing” Barker, (2013). During dream analysis, the therapist investigates the repressed feelings that are expressed in dreams uncovering the unconscious material (hidden motives and fears). This technique helps to provide insight into a “peter’s present functioning”.

At this stage, the goal is to alter the perception that is damaging to Peter and contributing towards interpersonal conflict. The therapist intends to help the client in healthy decision-making. The client is assisted to make healthy choices and act accordingly without external influences and anxiety. The importance of overcoming anxiety is because "anxiety and depression" are resultant of past interactions and are the cause of conflict between the conscious and unconscious (Dreher & Sandler, 2013). While analysing transference, the therapist identifies the feelings to be resolved. It requires confrontation of Peter’s wishes, guilt and defenses and any discrepancies in client’s conversation. At this stage, the treatment goal is to analyse the conflicts contributing to resistance. For example, Client’s resistance towards revealing behavior patterns, fantasies to the therapist and are manifested as cancelling appointments or avoiding consideration. Therefore, the goal of therapy is to identify and eliminate the resistance using countertransference. At this stage, the goal is to identify the best treatment approach. This is continued until a stage is attained where the client will have “cathartic experience” indicating he can be cured (Benecke et al., 2016).

Critique of Psychoanalytic Therapy

The psychoanalytic therapy is in use since a century and has generated a great body of research about its key contribution. Psychoanalysis has contributed to basic understanding of the maladaptive and adaptive psychological development as per Eysenck, (2013). It continues to contribute towards an understanding of "depression and its treatment."  According to Strupp, (2013) a major meta-analysis of psychoanalysis indicates positive outcomes in 80% of the clients treated with psychotherapy. A significant statistics is available on the benefits of psychotherapy, which indicates a long lasting effect of psychoanalytic therapy on the clients. The study released by "American Psychological Association" in the field of mental health has shown similar results in 2010 (). With the review of 16 meta-studies on the effectiveness of talk therapy used in psychoanalysis, it was concluded that 90% of the people who underwent psychoanalysis have benefited and it lasted long after the termination of treatment. These contributions of psychoanalytic therapy are note worthy and indicate the strength of the therapy. By virtue of this approach, several people with range of difficulties such as interpersonal conflict, addiction, anxiety and depression, relationship based problem and hidden emotional concerns were successfully treated with this technique (Summers, 2013). The technique was also successful when used for patients with personality disorder, learning disabilities, eating disorders, insomnia, and various types of phobias (Wampold & Imel, 2015).

In addition to its strength, the psychoanalytic therapy is subjected to several limitations. The key limitation is the “cost and length of treatment” (Wright, 2013). This therapy is comprised of several sessions and is not covered by health insurances. This may limit the accessibility for those with financial difficulties. The psychoanalysis consumes several weeks and months depending on the severity of the mental illnesses which may be difficult for working clients to stick to the schedule which defeats the purpose of the treatment method used.  Further, there is a lack of consensus of the effectiveness of psychoanalysis among the practitioners. The Psychiatrists and other mental health professionals continue to practice psychoanalysis although it is less common today than in the years past. This is due to the criticism of both Freud and psychoanalysis in extreme terms. The criticism towards psychoanalytic approach relates to the changes that have taken place in “mental health care” and “psychoanalytical diagnosis" over time (Schmidt & Schimmelmann, 2013). Wright, (2013) Criticized that the psychoanalytical theories are heavily based on the clinical case studies. It is criticized that these theories are not enough for experimental research and is regarded as pseudoscience. Atwood & Stolorow, (2014) Argued that theory of psychoanalysis are falsifiable. There is a lack of clinical evidence supporting the casual claims of psychoanalysis as mentioned by (Freud, 2012). This constitutes the major limitation of psychoanalysis.

Recommendations for Improving Efficacy

Various alternate models have been suggested to overcome the limitations of the psychoanalysis psychotherapy. According to the paper “The Efficacy of Psychodynamic Psychotherapy” published by "American Psychological Associations" Cognitive Behavioural Therapy or CBT have scientific base and its benefits are as large as any other psychotherapies (Tasca et al., 2014). According to Hofmann et al., (2012) more than 160 studies have concluded CBT to be only evidence-based options. This psychodynamic model has been scientifically proven to be effective in alleviating interpersonal distress and emotional conflicts. Using the elements of CBT in psychotherapy will improve its efficacy as this is the form of behavioral treatment, which is problem-focussed and allows the concerned individual to see the relationship between feelings, thoughts and beliefs and subsequent actions.  It includes combination of other therapies such as "dialectical therapy", and "rational emotive behaviour therapy" (Summers, 2013).

Therefore, it is recommended to collate the psychoanalytic therapy with CBT to minimize the downside of psychoanalytic approach. It combines the principles of "behavior and cognitive psychology" (Benecke et al., 2016). The factor that distinguishes CBT from the former therapy is the greater focus on the concerned individual rather than the past (Schmidt & Schimmelmann, 2013). CBT places importance on thinking. It helps the client to overcome dysfunctional assumptions and automatic thoughts to gain perspective that is more realistic. Unlike the psychoanalytic therapy, CBT tends to be of short duration even for serious emotional problems. Similar to psychoanalytic therapy, CBT has long lasting effect on the client even after the termination of the sessions. It introduces the patient in this case- Peter to set of principles that he can apply at any time and point of his life (Hind et al., 2014). In the given case study, Peter can be provided with collaborative treatment including both CBT and psychoanalytical approach that may help him resolve his interpersonal conflicts.

Another alternate treatment option considering Peter’s case study is "patient-centered therapy" developed by Carl Rogers. This therapy includes humanistic approach and deals with individual’s perception about himself or herself consciously Rogers, (2013). In contrast to psychoanalytic therapy, this client-centred counselling does not emphasize on how the therapist can interpret the client's unconscious ideas and thoughts. Instead, this technique, the counselor understands the patient’s experiences from their point of view while being open and genuine. This therapy has been found effective in facilitating the relationships and personal growth of the individuals by enhancing their inner strength, self-awareness and identity (Morgan & Yoder, 2012). This therapy is applicable in the range of cognitive difficulties such as personality disorders, alcohol addictions and eating disorders. Also, this therapy, allows the client to have control over the content and pace of sessions. Using the elements of person-centered therapy in psychotherapy will improve its efficacy and hence is recommended for resolving interpersonal conflicts of Peter. The other advantage of this therapy is its non-directive form of communication where the therapist treats clients being non-judgmental.

Key Contributions of Psychoanalytic Therapy

Conclusively, the author agrees that the psychoanalytic therapy is a beneficial approach keeping aside the cost and time limitations. The use of techniques such as “free association and dream analysis” ensures positive results to the clients.  However, the limitations of this therapy may overcome by incorporating the elements of "patient centered therapy" developed by Carl Rogers and CBT. No matter what therapy is used it is essential to incorporate “empathy” to understand the client’s current predicament. Care and compassion fasten the problem solving method to achieve a good positive result for the client.

References

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