Chapter 5: Adlerian Therapy - psychodynamic approach - original student of Freud but deserted him - founded the psychology for individual psychology in 1912 - a significant contributor to Adler's work is Rudolph Dreikurs - Adler was developer of individual psych - individual psych is a term Adler used to describe his emphasis on the uniqueness and unity of the individual - Dreikurs, brought Adler's principles to US, applied them to education, child guidance, and group work - he moved away from Freud because he disagreed with a biological and deterministic point of view - Adler’s point of view is mainly social-psychological, teleological: goal oriented point of view - stressed the unity of personality - we can only be understood as integrated and complete beings - his theory talks about purposeful nature of behavior - emphasizes that we were striving to go is more important than where we come from - he says we are creators of ourselves rather than being shaped by childhood experiences - positive view of human nature - more social than biological focus - people are in control of their fate, not victims of it - individuals create a lifestyle at an early age rather than being shaped by childhood experience - lifestyle: tends to remain relatively constant and defines one’s beliefs about life and how to deal with the tasks of life Key Concepts: - view of human nature - person’s perception of the past and his interpretation of early events - humans related by social-relatedness rather than sexual urges - behavior is purposeful and goal-directed - conscious more than unconscious - stresses choice and responsibility Inferiority Feelings: early determining forces in behavior - source of human striving and creativity - humans attempt to compensate for both imagined and real inferiorities, which help them to overcome handicaps - at around age 6 our fictional vision turns into life goal - the life goal unifies personality and becomes a source of human motivation - from Adlerian perspective, human behavior not determined solely by heredity and environment -- genetics and heredity not as important as what we choose to do with our abilities and limitations a feeling that one is inferior to others in some way. Such feelings can arise from an imagined or actual inferiority in the afflicted person. It is often subconscious, and is thought to drive afflicted individuals to overcompensate, resulting either in spectacular achievement or extremes chizotypal behavior, or both. Unlike a normal feeling of inferiority, which can act as an incentive for achievement (or promote discouragement), an inferiority complex is an advanced state of discouragement, often embedding itself into one's lifestyle, and sometimes resulting in a retreat from difficulties. - So the perpetrators have sever inferiority feelings - probably most likely felt extremely inferior as children themselves to their parents - instead of striving to be the best parents they can be, they stay discouraged and retreat from their personal difficulties by trying to gain medical attention via their children - but our limitations can stop us from doing some things - re-educating individuals and re-educating society - forerunner of a subjective approach to psychology - pioneer of a holistic, social, goal-oriented, systematic, and humanistic approach - first systemic therapist - he said it is essential to understand people within the systems they live Phenomenological: clients’ subject frames of reference - this subjective reality includes individual’s perceptions, thoughts, feelings, values, beliefs, convictions - from an Adler perspective, object reality is less important than how we interpret reality and the meanings we attach to it - therefore, therapists need to understand the subjective views of clients with MBPS Human Personality - he named his approach individual psychology - need to understand whole person - whole person unified by individual’s movement toward a life goal - more emphasis on interpersonal relationships than individual’s internal psychodynamics - Basic assumption of individual psych: we can only think, feel, and act in relation to our perception of our goal - Adlerians are interested in the future - look for continuity by paying attention to themes running through a person’s life - MBPS perpetrators have no positive goal for themselves, their life goal might be getting acceptance in life, something their parents never gave them Fictional Finalism: refers to an imagined central goal that guides a person’s life - image of what people would be like if they were perfect and secure - he later replaced the term with Guiding Self Ideal - perpetrators may have a central goal of being accepted by others, gaining power...may have a warped sense of what it means to be perfect and secure Striving Toward Superiority: a strong inclination toward becoming competent toward mastering the environment and self improvement - goes back to early in life, what we would be like if we were successful and perfect - applied to human motivation Guiding Self Ideal: represents an individuals image of goal perfection Lifestyle: core beliefs and assumptions through which the person organizes his reality and finds meaning in life - our perceptions of self, others, and the world - characteristic way of thinking, acting, feeling - how we strive towards long term goals - unique ways in which people develop a style of striving for competence - roadmap of life - we can reframe childhood experiences and consciously create a new style of living - their childhood experiences made them feel insecure and unwanted, so instead of striving for competence and meaning, they strive for acceptance, care - their unique childhood events cause them to have lifestyles where the only way they can deal with life tasks is to keep seeking medical help via their children who they can have power over Social Interest and Community Feeling - Adler’s most significant and distinctive concepts - refer to individuals’ awareness of being part of the human community and to the individuals’ attitudes in dealing with social world Social Interest: individuals’ positive attitudes toward other people in the world - capacity to cooperate and contribute - includes striving for a better future for humanity - central indicator of mental health - people express it through shared activity and mutual respect - MBPS patients do not have social interest...they see other people as people to gain power over and if they were striving for a better future for humanity, they would not be inducing sickness in their children Individual Psychology: central belief that our happiness is largely related to social connectivity Community Feeling: individual’s awareness of being part of human community - feeling connected to all humanity - making the world a better place - many of the problems we experience are related to fear of not being accepted by the groups we value - if our sense of belonging is not fulfilled, anxiety is the result - we must master 3 life tasks: 1. Building friendships (social task) 2. Intimacy, (love, marriage task) 3. Contributing to society (occupational task) - Dreikurs added 2 other tasks to lists - Self acceptance - Developing our spiritual dimension - aim of therapy is to assist clients in modifying their lifestyle choices so that they can more effectively navigate one of these life tasks - these 3 tasks must never have been accomplished in MBPS perpetrators - intimacy is the task that these individuals have certainly never accomplished since they cannot provide what their children need or even love their children Birth Order and Sibling Relationships - special attention given to relationships between siblings and psychological birth order - birth order: one’s position in the family 5 types: 1. Oldest child: receives good amount of attention, hardworking, strives to get ahead 2. Second child: behave as if they were in a race with first child, can see competitive struggles, opposite to first born often 3. Middle child: often feels squeezed out, life is unfair, cheated, can become a problem child, but also can become a peacemaker and try to hold things together 4. Youngest child: always the baby of the family, tends to be most pampered, tend to get their own way 5. Only child: shares some of characteristics of oldest child (high motivation), but may have trouble sharing and cooperating with other kids, often pampered, and may become dependent on one or both of parents - not deterministic, but does increase an individual’s probability of having a certain set of experiences - actual birth order is less important than individuals interpretation of his place in the family - MPBS perpetrators could be any of these, but they probably felt more like middle children and not receiving attention or the proper care they needed *this is why Adler observed kids in same families -certain personality traits begin in child as a result of sibling rivalry Therapeutic Process - rests on collaborative arrangement between client and counselor - holistic psychological investigation of lifestyle assessment - disclosing mistaken goals and faulty assumptions - followed by re-education of the client toward useful side of life - aim of therapy is to develop client’s sense of belonging and to assist in behaviors that promote community feeling and social interest - accomplished by increasing client’s self-awareness and challenging or modifying fundamental life goals or basic concepts - view the client as not being sick - favor a growth model instead - counseling process focuses on providing info, teaching, guiding, and encouragement - encouragement is most powerful method available for changing a person’s beliefs, building self esteem, and building courage Therapist’s Function and Role - therapists look for faulty assumptions - lack of ambition - non-pathological perception - do not label clients with diagnosis - assist clients in changing and understanding “life story” - major function is to make comprehensive assessment of client’s functioning Family Constellation: social and psychological structure of family system, included birth order, individual perception of self, and parental relationships - each person forms his or her own unique sense of self, others, life through family constellation Early Recollections: defined as stories of events that a person says occurred before he was 10 years of age - ERs are specific incidents that clients recall about their childhood - people retain these memories as summaries of their present philosophy of life - it is possible to understand mistaken notions, present attitudes, social interests, and possible future behavior - makes you feel a certain way about yourself - after these are summarized, therapist looks at successes and mistakes in a clients life - ERs are useful as functional assessment devices - part of gathering early memories is also part of a lifestyle assessment - memories of neglect and not feeling loved are the early memories of MPBS perpetrators so their lifestyle assessment is not strong or healthy enough to achieve the life tasks Lifestyle Assessment: learning to understand goals and motivations of client - after this assessment, client and therapist have targets for therapy - Adler viewed dreams as a rehearsal of possible future courses of action - dreams suggest possible answers to client’s problem Client’s Experience in Therapy - clients explore Private Logic Private Logic: basic convictions and assumptions of the individual that underlie lifestyle pattern - explains how behaviors fit together to provide consistency - involves convictions and beliefs that get in way of social interest - clients problems arise because conclusions based on private logic often do not conform to requirements of social living - so their private logic is that nobody cares about them and that they need to use their kids to get the attention they want Relationship Between Client and Therapist - goal alignment: congruence between client and counselor’s goals and collaborative effort of two persons working together - good relationship is one based on equals Therapeutic Techniques and Procedures - 4 central objectives: - not linear - not produced in rigid steps 1. establish proper therapeutic relationship Phase 1: - works in collaborative way to define goals - help clients become aware of assets and strengths rather than only dealing with liabilities - positive relationships created by listening, responding, respect - more attention to subjective experiences of clients than they use techniques - during initial phase of counseling: attending and listening with empathy, following objective experience of client as closely as possible, identifying and clarifying goals, suggesting initial hunches about purpose in a client’s symptoms and actions - counselors are generally active especially during initial sessions - assist clients to define personal goals Phase 2: - explore individual’s psychological dynamics - assessment - understand individual’s lifestyle - focus on individual’s social and cultural context - proceeds from 2 interview forms a. subjective interview: counselor helps client tell his life story - treat clients as experts in their own lives - extract a pattern in person’s life to see what’s going on - toward end of interview, therapist asks if there is anything else he should know to understand client’s concerns - Dreikurs: he calls this The Question The Question: used in initial assessment to gain understanding of the purpose that symptoms or actions a person has in one’s life - how would your life be different and what would you do differently if you didn’t have this problem - use The Question to help therapists uncover a life task, faulty thought - if client reports nothing would be different, the problem may be organic and require medical intervention b. objective interview - conduct psychological assessments and offer interpretations - seeks to discover information about how problems began (medical history, social history, reasons for seeking therapy) Phase 2 continued: - counselors interpret person’s early memories to understand meaning in which they attach life experiences - lifestyle assessment seeks to develop holistic narrative of person’s life to make sense with life tasks and to uncover private logic that they use - considered family origin as having central impact on individual’s personality - where person formed his unique view of self, others, and life - ER: assessment of person’s convictions about self, assessment of client’s stance and relation to counseling sessions, verification of coping strategies, individual strengths, assets, interfering ideas - family constellation - end of second phase: wrap up with integration and summary, looking for 5 basic mistakes -- different summaries prepared for the client on strengths, weakness, and strengths Basic Mistakes: myths about yourself that are influential in shaping personality - people have myths about themselves that they are unloved and weak Phase 3: encouraging self, understanding, and insight - insight, referring to understanding of motivations that operate a client’s life - self understanding only possible when hidden purposes of goals and behaviors are made conscious - special form of awareness that facilitates meaningful understanding and acts as a foundation for change - insight is a means to an end, not an end itself Interpretation: deals with a client’s underlying motives or behaving the way they do in the here and now - in this process, clients eventually come to understand their motivations and how they are contributing to their behavior Phase 4: re-orientation and re-education - final stage of therapeutic process - putting insights into practice Reorientation: shifting rules of interaction, process, and motivation Encouragement: most distinctive Adler procedure, it is central to all phases of counseling and therapy -- literally means to build courage -- entails showing faith in people, expecting them to assume responsibility for their lives, valuing them for who they are -- universal therapeutic invention for Adlerian counselors - fundamental attitude rather than technique - discouragement is basic condition that prevents people from functioning - areas of application: --prevention services in mental health, Adler was advocate for individual psych in families and schools -- because it’s growth model, it is very applicable - Deirkus spread Adlerian theory throughout schools - application to parent education - parents are taught how to recognize mistaken goals of children and to use natural consequences to guide children toward better behavior - application to couples counseling: designed to assess a couple’s beliefs and behaviors, educate them to meet relationships goals -- not who’s at fault, but the interaction of 2 different lifestyles -- emphasis into given if they want to maintain relationship and if so what changes need to be made - application to family counseling: increase awareness of individuals within the family system - application to group counseling: Deirkus: unique characteristics of groups for them to handle change in effective ways -- Adler created guidance centers in Vienna - mistaken values can surface in a group - rationale for group counseling based on premise that our problems are mainly of a social nature and group provides social community - multicultural perspective: -- strengths: importance of multicultural context --health over pathology, holistic perspective, freedom within social context, flexible - shortcomings: can focus too much on self, other cultures have different concepts, emphasis on self could be problematic 2. explore psychological dynamics operating in client (assessment) 3. encourage development of self understanding (insight into purpose) 4. help client make new choices (re-orientation, re-education) - Drekuirs: approach has been elaborated into Adlerian Brief Therapy (ABT) Chapter 6: Existential Theory - existential therapy is more a way of thinking than a style of practicing - neither independent or a separate school of therapy and is not defined model with specific techniques - can best be described as philosophical approach that influences a counselor’s practice - it rejects deterministic view of human nature - basic premise: we are not victims of circumstance, we are what we choose to be - a major aim of therapy is to encourage clients to reflect on life and recognize range of alternatives - another aim: to challenge people to stop deceiving themselves regarding their lack of responsibility over their life - it’s not a medical model - it’s not designed to cure people - designed to help people develop a greater quest for meaning and purpose - therapists basic task: to encourage clients to explore their options for creating a meaningful existence - we are not passive victims of our circumstances, but instead can consciously become architects of our lives Background Existential Tradition: balance between recognizing the limits and the dimensions of human experience and the possibilities and opportunities of human life MBPS perpetrators do not have any balance, they do not see other possibilities of how to improve their lives and keep themselves limited by neglecting their own children Historical Background - not founded by any one group - many thoughts contributed - came from different parts of Europe - to resolve dilemmas of contemporary life like alienation, isolation, and meaninglessness - early writers focused on individual’s experience of what they called being alone in world and facing anxiety of that situation People - Soren - Kierkegaard (1813-1855), Danish philosopher -- concern around angst: a combo of dread and anxiety - addressed role of anxiety and uncertainty in life - without the experience of angst, we may go through life as sleepwalkers - becoming human is a project and our task is to discover who we are and “create” ourselves Fredrich Neitzsche (1844-1900) - German philosopher - counterpart to Kirky - emphasized importance of subjectivity - he wanted to prove that the def. of humans as rational was entirely misleading - we are more creatures of will than impersonal intellect - kirky and nitche together: they are the originators of existential perspective Martin Heidegger (1889-1976) - developed human experience being phenomenological - reminds us that we exist IN the world - we should not try to think of ourselves from being apart from the world - our moods include anxiety and death, are a way of if we are living authentically or whether we are being inauthentic in constructing our life Phenomenology: uses subjective human experiences to focus - provides view of human history that does NOT focus on past events, but motivates individuals to look forward to authentic experiences that are yet to come - other believers: Adler, person-centered (Rogers), Gestault Gene Paul Sartre (1905-1980) - our values are what we choose - the existence of space (nothingness) between whole of our past and the NOW - the now frees us to choose what we will - calles excuses “bad faith” - no matter where we have been, we can make choices - his view was that at every moment by our actions, we are choosing who we become - our existence is never finished, always growing - MBPS have “bad faith” in that they make excuses Martin Buber (1878-1965) - from Israel - humans live in a kind of “betweeness” - there is never just an “I”, but always an “other” - changes depending on whether the “other” is an “it” or “thou” - we make msitakes and reduce other person to status of mere object, then relationship becomes an “it” - importance of presence: 3 functions 1. enables the “I”, “thou” 2. allows for meaning to exist in a situation 3. enables an individual to be responsible in the present - when this relationship is fully mutual, we become dialogic and have a human condition Ludwig Binswanger (1881-1966) - proposed holistic model of the self that addresses relationship b/w person and environment - used phenomenological approach - accepted Heidegger’s notion of being “thrown” into the world -- the throwness does not release us from responsibility of our choices or for planning for the future Existential Analysis (Dasein Analysis): emphasizes subjective and spiritual dimensions of existence - Binswanger said crises in therapy were major choice points for the client - MBPS might consider themselves “thrown”, make excuses that their children really are sick so that they can continue on inducing sickness and getting medical attention - so they have no control and are “thrown” into the situation Meddard Boss (1903-1991) - made reference to Dasein - commonly referred to “being in the world” which pertains to our ability to reflect on life’s events and attrivute meaning to them - major professional interest: applying Heidegger’s notions to therapeutic process Key Figures in Contemporary Existential Psychotherapy - all developed therapy approaches from existential and human philosophy Viktor Frankl - central figure in Europe - brought it to U.S. - influenced by Freud and Adler, and Niche (“That which does not kill me, makes me stronger”) Logotherapy: therapy through meaning - philosophical model: what it means to be fully alive - fully alive: find meaning in suffering - central theme is life has meaning under all circumstances - central motivation for living is the “will to meaning” - the freedom to find meaning in all that we think - the modern person has the means to live but often has no meaning to live for - the therapeutic process is aimed at challenging indivuduals to find meaning and purpose through suffering, work, and love - MBPS perpetrators have no meaning in their lives, no purpose, they try to get attention...they may have suffered bad childhoods, but never found meaning through their experiences, which has led them to their mental health issues today Rolo May - also influenced by Freud, Adler - key figure for bring existentialism to U.S. and translating key concepts into psychotherapeutic process - book: Existence: A New Dimenson in Psychiatry and Psychology - it takes courage to “be” - our choices determine the kind of person we become - constant struggle within us - struggle is between security of dependence and delights of pain and growth James Bugental - approach to depth therapy - based on existential concern with an individuals immediate - help clients examine how they have answered life’s existential questions and to revise their answers to live authentically - illustrates the here and now in the therapeutic relationship Iriving Yalom - acknowledges the - focues on 4 “givens of existence”, or ultimate human concerns 1. death 2. freedom 3. responsibility 4. existential isolation 5. meaninglessness - all of these themes deal with client’s “being” in the world Concepts View of Human Nature - cruel significance of existential movement is that it reacts tendency to use a set of therapeutic techniques - therapy is based on understanding what meaning “human” means - stands for respect for the person - exploring new aspects of human behavior - methods for understanding people Existential Tradition: seeks a balance between recognizing the limits and tragic dimensions of human existence -- limits and tragic dimensions in one hand, and other hand possibilities and opportunities of human life - grew out of dilemma of contemporary life - current focus is on individual’s experience of being in the world alone and facing the anxiety of the isolation - basic dimensions of human condition is: 1) capacity for self awareness, - as human being capable of self awareness - as we expand our awareness we increase capacity to live - we are finite and we have limited time - we have potential to take action or not to - we choose our actions and create our own destiny - meaning: the product of discovering how we are “thrown” or situated in the world - we are subject to loneliness, meaninglessness, emptiness, and guilt and isolation - we are basically alone, yet we have an opportunity to relate to other beings - we can choose to either expand or restrict our consciousness - expanding= fundamental human growth Increasing Self Awareness: includes awareness of alternatives, motivations, and goals is the aim of all counseling 2) freedom and responsibility, - people are free to choose among alternatives and therefore have a large role in shaping their destiny - we all long for freedom and try to escape from our freedom - possible to avoid choosing freedom by making excuses - bad faith: Sartre- inauthenticity of not accepting personal responsibility EX: since that’s the way I am made, I can’t help what I did Freedom: we are responsible for our lives, actions, failures to take action Existential Guilt: being aware of having evaded a commitment or having chosen not to choose Authenticity: implies that we are living by being true to our own evaluation of what is valuable existence for ourselves, be true to ourselves - being free and human are identical - 2 central tasks of the therapist are inviting clients to recognize how they have allowed others to decide for them and to encourage them to step forward in their choices 3) creating one’s identity and establishing meaningful relationships with others - we’re concerned about proving our own uniqueness, yet we want to relate to other people - each of us wants to discover ourselves and create a personal identity - we have sought direction and answers from other people’s beliefs, rather than trust in ourself - Paul Tillich: the courage to “be” - part of human condition is experience of loneliness -- we can get strength from looking into ourselves and sensing separation - isolation comes when we recognize that we cannot depend on anyone else from our own confirmation - we alone must give a sense of meaning to life - we alone decide how we will live - must have relationship with ourselves Experience of Relatedness - humans depend on relationships with others - we want our relationships to be based on fulfillment and not deprivation - a function of therapy is to help clients distinguish between neurotic dependence attachment - a therapist points out that you must find your own answers 4) search for meaning, purpose, values, and goals, - the struggle for a sense of significance and purpose in life -- why am I here? - therapy provides framework for helping clients find meaning in their lives - one problem in therapy: clients may disgard traditional/imposed values without finding other ones to replace them Meaninglessness: - can lead to emptiness or hollowness - according to Frankl: Existential Vacuum: condition is often experienced when people do not busy themselves with routine or with work - people feel trapped and empty Creating new meaning: logotherapy: designed to help clients find meaning in life - meaning is created out of an individual’s engagement of what is valued and this commitment provides the purpose that makes life worthwhile 5) anxiety as a condition of living, 6) awareness of death and non-being - anxiety arises from one person’s striving to maintain one’s being Anxiety: condition that results from having to face choices without clear guidelines and without knowing what the outcome will be Existential Anxiety: an unavoidable result of being confronted with the “givens of existence” (death, freedom, choice, isolation, and meaninglessness) - we experience anxiety as we become increasingly aware of our freedom and the consequences of accepting or rejecting freedom - therapists differentiate between normal and neurotic anxiety - see anxiety as potential source for growth Normal Anxiety: appropriate response to an event being faced Neurotic Anxiety: out of proportion to the situation, tends to immobilize a person - awareness of death and non-being: -- does not view death negatively, but holds that awareness of death as a basic human condition gives significance to living - the ability to grasp the reality of the future and death - Frankl: death provides motivation for us to live and take advantage of opportunity - Yalom: therapists should talk to clients about reality of death, confronting this fear can be factor that helps us transform an inauthentic mode of living into an authentic one - explore the degree to which clients are doing things they value Therapeutic Process - goals: - best considered as an invitation to clients to recognize how they are not living authentically and make choices accordingly - aim of therapy is to assist clients in moving forward toward authenticity and learning to recognize when they are deceiving themselves - no escape from freedom as we will always be held responsible - if we relinquish our freedom, it is the ultimate inauthenticty - aims at helping clients face anxiety and engage in action that is based on authentic purpose of creating worthy existence May: people come to therapy with self-serving illusions that they are inwardly enslaved to - the task of therapy is to teach clients to what they already know about themselves Bugental: therapy is process of bringing out latent aliveness -- identifies 3 main tasks: 1. assist clients in recognizing they are not fully present in the therapy process 2. support clients in confronting anxieties that they have sought to avoid 3. help clients redefine themselves and their world so they can foster greater genuineness of contact of life - increased awareness is central goal of existential therapy Therapists Function and Role - primarily concerned with understanding subjective world of clients to help them understand and create new options Restricted Existence: a state of functioning with a limited degree of awareness of one’s self and being vague about the problem- therapist may hold up a mirror, so client can see themselves Client’s Experience in Therapy - client is encouraged to take seriously their own subjective experience in the world - client challenged to take responsibility for how they now choose to be in the world - they are expected to go out into world and decide how they will live differently - another aspect of experience of being a client: confronting ultimate concerns rather than coping with immediate problems Major themes for therapy sessions: - Anxiety, free, and responsibility - search for identity - isolation, alienation, death - living authentically Relationship Between Therapist and Client - quality of person-person encounter in therapeutic situation is stimulus for positive change - therapists believe their basic attitudes toward client and their own personal characteristics are what they have to offer - I/It (time and space) and I/Thou (connecting to self and spirit): Buber - create equal, non-distant relationships with client - core of relationship is respect, and faith in client’s potential to cope authentically with their troubles Therapeutic Techniques and Procedures - unlike most other therapies in that it is not technically oriented - de-mphasis on technique and priority - given to understand a client’s world - philosophical views on basis of human nature and existence - prefer description, understanding, explanation over diagnosis, treatment, prognosis Phases of Existential Counseling Initial: - therapists assist clients in identifying and clarifying their assumptions about the world - counselor teaches them how to reflect on their own existence and to examine their role in their problems in living Middle: self-exploration - restructuring of values and attitudes Final: - learning about themselves and putting that into action - clients discover their strengths and living a purposeful existence Client Appropriate for this Approach - good for people who are coping with developmental crises - grief and loss, confronting death - facing major life decision - suited to individuals experiencing a lack of sense of identity Application to Brief Therapy - possible for time-limited approach - get clients to become involved in therapy Application to Group Counseling - existential group can be described as : 1. enabling members to become honest with themselves 2. widening their perspective on themselves to the world around them 3. clarifying what gives meaning to their present and future - open attitude is essential - Yalom says the group provides optimal conditions for work on responsibility Multicultural perspective: Strengths - broad perspective, good - great cross-cultural counseling Shortcoming - individualistic - ignore social factors that cause human problems - highly focused on philosophy - many clients want structured approach to counseling, not found in this approach - counselors need to provide direction, but not run the show - NEED TO OUTLINE THIS FOR MBPS Chapter 4: Psychoanalytic Therapy - Freud’s psychoanalytic system is a model of personality development and approach to psychotherapy - gave psychotherapy a new look, calling attention to psychodynamic factors that motivate behavior - unconscious - developed first therapeutic procedures for understanding and modifying the structure of one’s basic character Key Concepts: - view of humanistic nature : deterministic - irrational forces, unconscious motivations, biological/instinctual drives, evolve through psychosexual stages in first 6 years of life - instincts are key - libido: refers to sexual energy -- broadened it to include the energy of all which he termed “life instincts” -- libido is all about gaining pleasure and avoiding pain - death instincts which account for aggressive drive - Freud’s view: both sexual and aggressive drives are powerful determinants of why people act as they do Structure of Personality - 3 systems: id, ego, superego - they all work together as a whole - id is a biological component, ego is a psychological component, and superego is a social component ID: with you when born, relies on pleasure principle - it never matures and is largely unconscious EGO: traffic cop, it mediates between the instincts and the surrounding environment, it is conscious and ruled by the reality principle reality principle: the ego does realistic and logical thinking and formulates plans of action for satisfying needs SUPEREGO: person’s moral code, represents traditional values handed down from parents to children, related psychologically to rewards and punishments - consciousness and unconciousness: keys to understanding problems about personality - unconscious not studied directly, but can be by: 1. dreams: symbolic representations on needs, wishes, conflicts 2. slips of the tongue and forgetting 3. posthynotic suggestion 4. material derived from free association 5. material derived from projective techniques 6. symbolic content of psychotic symptoms - unconscious stores all memories, experiences, and repressed material - aim of psychoanalytic theory is to make unconscious conscious - unconscious process is at root of all neurotic symptoms and behaviors - cure is based on uncovering the meaning of symptoms, causes of behavior, repressed material that interfere with healthy functioning - note: intellectual insight does not solve the problem - the clients need to cling to old patterns (repetition) must be confronted by working through transference distortions Anxiety - a feeling of dread that results from repressed feelings, memories, desires, and experience that emerge to surface of awareness - it develops out of a conflict among the id, ego, superego - 3 kinds of anxiety: 1. reality: fear of danger form external world, level of anxiety is proportionate to degree of real threat 2. neurotic: evoked by threats to balance of power within a person, fear that instincts will get out of hand and fear that one will be punished 3. moral: evoked by threats to balance of power, fear of one’s on conscience - when the ego cannot control anxiety, it relies on indirect ones (ego defense mechanisms) Ego Defense Mechanisms - help individual cope with anxiety and prevent the ego from being overwhelmed - 2 characteristics in common: a) either deny or distort reality b) they operate on unconscious level 1. Repression: threatening or painful thoughts are excluded from awareness -- use of behavior: an involuntary removal of something from consciousness 2. Denial: closing one’s eyes to the existence of a threatening aspect of reality -- simplest of all defense mechanisms -- distorts way individual thinks and operates at a preconscious and conscious level 3. Reactive Formation: actively expressing the opposite impulse when confronted with threatening impulse -- developing conscious attitudes and behaviors that are diametrically opposed to disturbing ideas -- in this way people do not have to face the anxiety that would result Ex: individuals conceal hate with facade of love, be nice when they harbor negative reactions 4. Projection: attributing our own unacceptable thoughts, feelings, behvaiors, and motives to others -- mechanism of self-deception -- Example: Those people are out there, but not me 5. Displacement: directing energy toward another object of person when original object is absent -- way of coping with anxiety that involves discharging impulses by shifting from a threatening object to a safer target Example: husband hits wife instead of boss 6. Rationalization: manufacturing good reasons to explain a bruised ego -- helps justify our behaviors and aids in softening the blow connected with disappointments 7. Sublimation: diverting sexual/aggressive energy into other channels -- energy diverted into socially acceptable/admirable channels -- example: athletics 8. Regression: going back to earlier phase of development -- cling to immature or inappropriate behavior 9. Introjection: taking in and swallowing the values and standards of others -- comes positive (parental values), negative (accepting values of an enemy) 10. Identification: identifying with successful causes, organizations, or people in the hope you will be perceived worthwhile -- it can enhance self worth -- children learn gender role behaviors 11. Compensation: masking perceived weaknesses or developing certain positive traits to make up for limitations -- direct adjustive value -- don’t see the ways in which I am inferior, but see me and my accomplishments Development of Personality Psychosexual stages: - Freudian chronological phase of development - each characterized by primary way of gaining sensual and sexual gratification Oral stage: inability to trust one’s self and others, resulting in fear of loving and forming close relationships -- the initial phase of psychosexual development where mouth is primary source of gratification -- 0-1 years Anal stage: second stage, pleasure is derived from retaining and expelling feces -- inability to recognize and express anger leading to denial of one’s own power as a person and a lack of a sense of autonomy -- 1-3 years Phallic stage: third stage, child gains maximum gratification through direct experience with genitals -- inability to fully accept one’s sexual feelings and to accept one’s self as a man or woman -- Oedpius: males, mother is love object of boys -- Elektra: females, father is striving for father’s approval -- 3-6 years 6-12: latency stage, sexual interests replaced by social activities Genital stage: old themes of phallic stage are revived -- 12-18 years - begins in puberty and lasts through life until senility sets in Erik Erikson Psychosocial perspective - built on Freud’s ideas and extended them - his theory holds that psychosexual growth and psychosocial growth take place together - each stage of life, we face the task of establishing equilibrium between ourselves and our social world - development in terms on the entire lifespan, divided by specific crisis - crisis: equivalent to a turning point in life when we have the potential to move forward or to regress - classical psychoanalysis: grounded on ID psychology, holds that insticnts are intrapsychic conflicts - contemporary psychoanalysis: based on EGO psychology, which emphasizes striving for ego mastery and competence throughout human lifespan - Erikson has 8 stages 1. First year of life - infancy: trust versus mistrust -- significant others provide basic physical and social needs -- basic needs not met, get an attitude of mistrust toward the world, especially interpersonal relationships 2. 1-3 Early Childhood - autonomy vs. shame and doubt -- basic struggle between sense of self reliance and sense of self doubt -- kids test limits 3. 3-6 Preschool Age - initiative vs. guilt -- achieve competence and sense of initiative -- let kids make their own decisions or else they will develop guilt over taking initiative 4. 6-12 School Age - industry vs. inferiority -- child needs to expand understanding of the world -- develop gender role identity -- also basics needed for success in school -- obtaining personal goals -- failure to do so: sense of inadequacy 5. 12-18 Adolescence - identity vs. role confusion -- transition between adulthood and childhood - life goals and life meaning 6. 18-35 Young Adulthood - intimacy vs. isolation -- task is to form intimate relationships -- failure to do so can lead to isolation 7. 35-60 Middle Age - generativity vs. stagnation -- goes beyond self and family in helping next generation 6. Age 60+ Later Life - integrity vs. despair -- look back on life - by combining psychosocial and psychosexual, counselors have framework for understanding developmental issues - key needs and developmental tasks along with challenges inherited at each stage provide model for understanding core conflicts Therapeutic Goals - 2 goals of Freudian therapy 1. make unconscious conscious 2. strengthen the ego so that behavior is based more on reality and less on instinctual cravings Therapist Function and Role - classical psychoanalysis: analysts typically assume anonymous stance: blank screen - little self disclosure - transference relationship: client’s unconscious shifting to the therapist of feelings and fantasies, both positive and negative that are displacements from reactions to significant others from their past Client’s Experience in Therapy - free association: primary technique consisting of spontaneous and uncensored verbalization by the client which gives clues to the nature of the client’s unconscious conflicts -- also known as the “fundamental rule” - classical psychoanalysis: the traditional Freudian approach to psychoanalysis based on long term exploration of past conflicts, many of which are unconscious and an extensive process of working through earlier wounds Differences between classical analysis and relational analysis - classical analyst: therapist stays outside of relationships, comments on it, offers insight and interpretations - contemporary relational psychoanalysis: therapist is not detached -- impact on client in a here and now interaction Transference - relational model of psychoanalysis: transference is interactive process between client and therapist - relational analysis: analytic model based on assumption that therapy is an interactive process between client and therapist - interpersonal analyst assumes that countertransference is a source of information - if therapy is to produce change, must have working through -- working-through: exploration of unconscious material and defenses originated in early childhood -- resolving basic conflicts that are manifested in client’s relationship with the therapist ---achieved by repeating interpretations and by exploring forms of resistance - countertransference: therapists’ unconscious, emotional response to client that is likely to interfere with objectivity -- unresolved conflicts of therapist projected onto client -- not all countertransference reactions are detrimental Example: working on yourself may make you understand client deeper - can be key for helping client gain self-understanding Application - psychoanalytically therapy or psychodynamic therapy includes following features: Psychodynamic 1. therapy geared more toward limited perspectives than restructuring personality 2. less likely to use the couch 3. fewer sessions per week 4. more supportive 5. therapist more self disclosing 6. focus more on pressing, practical concerns rather than fantasy material - therapy proceeds from catharsis: expression of emotion to insight to working through unconscious material - 6 basic techniques of psychoanalytic 1. maintain analytic framework: refers to range of procedures where the analyst remains anonymous as a structure of therapy 2. free association: clients are encouraged to say whatever comes to mind, basic tool that opens doors to unconscious, often leads to catharsis 3. interpretation: consists of analyst pointing out, explaining, teaching client’s meanings of behavior from dreams, free association, resistances -- function is to enable ego to assimilate new material and speed up process of uncovering unconscious material 4. dream analysis: important for uncovering unconscious material, two levels: latent and manifest content -- latent: hidden, symbolic motives and fears -- manifest: the dream as it appears to the dreamer 5. analysis of resistance: anything that works against process of therapy and prevents clients from producing unconscious material -- when handled properly, can be one of most value tools in understanding a client 6. analysis of transference: central technique Application for group counseling - works - countertransference can me useful tool in group therapy Jung - coined analytical psych: an elaborate explanation of human nature that combines ideas from history, mythology, anthropology, religion - big advances in personal development, esp. middle age - he places central importance on psychological changes assoc. with midlife - in midlife we need to let go of many of our values and behaviors that guided first half of life and confront the unconscious - developed spiritual approach that places emphasis on being impelled to find meaning in life, opposite from Freud’s psychological and biological forces - Freud more about past, but Jung believed we are shaped by the past as well as our future - individuation: harmonious integration of the conscious and unconscious aspects of personality - shadow: primitive impulses - collective unconscious: deepest level of psyche containing accumulation of inherited experiences of humans - archetypes: universal experiences contained in collective unconscious -- important ones: persona (mask or public face we wear), animus/anima (biological/psychological aspects of masculinity and femininity, coexist in both sexes), and shadow (our dark side) - Jung said dreams have 2 purposes -- are prospective, help people prepare themselves for the future, serve as a compensatory factor working to bring balance to the opposites within a person -- they were an attempt to express Contemporary trends Object- Relations Theory/ **More psychoanalytic theory for my paper - newer version of psychoanalytic theory which focuses on developmental sequences - individuals go through phases of normal symbiosis and separation, culminating in stage of integration - object relations: interpersonal relationships as they are represented interpsychically - development is seen as individuals separating and differentiating themselves from others - based on the notion that at birth there is no difference between others and self - others represent objects of need-gratification - goal here is self individualization, which is achieved over time - when this process is successful, others are perceived as both separate and related Eminson (2000) postulates that many cases are of highly enmeshed parent-child relationships, which create a gray area in the psychological boundaries between parent and child. When the perpetrator’s child arrives at a particular developmental stage, it will evoke unresolved memories and reactions from the same stage in a perpetrator’s own development. Eminson relates back to Freud in that the unresolved conflicts triggered by age-specific developmental signals from the child can be unbearable for an adult to bring to his or her own consciousness. In projective identification, an uncontainable feeling is “placed” onto another person and is experienced as actually emanating from the other person. Therefore, the parent then confuses his or her child with him or herself as a child. He or she abuses the child, in attempts to get the medical care and attention her or she never got from his or her own parents. This activates the anger and ambivalence he or she felt toward his or her own parents in the context of their abuse and this can introduce ambivalence into their current parental behavior. As a result, the child starts to feel disorganized and truly symptomatic under the circumstances and that confuses the picture because then the child is clearly presenting illness to the doctors. Similar to the psychoanalytic view, Hotchkiss (1997) states that a MBPS caregiver’s ego development is still merely at a pre-oedipal level, where infantile aggression, the splitting of the ego, and the need for a transitional object to manage separation from the mother dominate the clinical picture. Never mastering the oedipal stage causes the caregiver to not operate on the reality principle and may not even know what reality is. Lastly, Rocha (2004) suggests a theory of etiology about the idea of a false self, which relates to the object-relations theory. The true self develops in the child out of a genuine and flexible attachment, but when needs are focused on mother and not the child, an overly compliant false self will develop. Therefore, it is out of her own needs that the mother seeks treatment for her child. Self psychology - Heinz Kohut - how we use interpersonal relations to develop our own self - focuses on the nature of the therapeutic relationship, using empathy as the main tool Relational - interactive process between client and therapist - people search for relationships that match patterns established by earlier experiences - Margaret Mahler: influenced contemporary object relations -- symbiotic relationship with maternal figure toward separation and individualization -- normal infantile autism: in first 3 or 4 weeks of life, infant doesn’t know you’re a person (just breast, hands, mouth) -- symbiosis: third month to 8th month, infant is dependent on mother or primary caregiver -- separation-individualization: 4-5 months, child experiences separation from sig. others, but still turns to them for comfort - Example of toddler taking steps - narcissism comes from not separating from parents - narcissistic personality: grandiose, exaggerated self importance - borderline personality disorder: rooted in period of separation-individualization -- moved into separation process, but have been stopped by parental rejection for their individualization, you can separate from me, but you can’t be different -- instability, irritability, impulsive anger, self destructive acts, occasional euphoria - Mahler’s final subphase (36 month): involves mood toward consistency of the self Treating Borderline/Narcissistic - rooted in trauma and developmental problems in separation and individualization phase - trend toward brief psychodynamic therapy: applies principles of psychodynamic theory to treating selective disorders with a pre-established time limit of 10-25 sessions -- marked use of concepts such as psychosexual, psychosocial, object relations -- existence of unconscious process - usefulness of interpretation - importance of working through - therapist assumes active role - time-limited dynamic therapy: goal is symptom reduction and changing client’s ingrained, repetitive patterns of interpersonal relatedness -- major goal: client to have new relational experience - psychoanalytic therapy from a multicultural perspective: -- Erikson’s psychosocial approach good for people of color -- psychoanalytic approaches not great for diversity (upper middle class values)
