Interpersonal Psychotherapy (IPT)

[Episode 10] In today's lecture I will will focus on some of the key concepts of IPT, the role of the therapist and client, the structure and goals of IPT - specifically focusing on grief, interpersonal role dispute, role transition and interpersonal deficits, and some of the techniques used in IPT. I'll end with a brief discussion of the applications of IPT, its strengths and limitations.

IPT is a time-limited psychotherapy that was developed in the 1970s and 80s as an outpatient treatment for adults who were diagnosed with moderate or severe non-psychotic, unipolar depression. Over the last 30 years, a number of empirical studies have demonstrated the efficacy of IPT in the treatment of depression. Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults, dysthymia, bipolar disorder, bulimia, anxiety disorders and couples counseling. IPT has its roots in psychodynamic theory, but differs from the latter in that it focuses on improving interpersonal functioning in the present. It is similar to CBT in its time-limited approach, structured interviews and assessment tools, but also differs from CBT in that it focuses on the client's affect, rather than cognitions, and the development of a more supportive social network. And whereas nearly all CBTs use homework as a standard part of treatment, although Brief ITP (ITP-B) uses homework, regular IPT may not.

Gestalt Therapy

[Episode 9] Today we're going to talk about the Gestalt therapy, which is part of the existential-phenomenological tradition. The Gestalt approach can be best summed up by the phrase, “the most important moment in a persons life is right now.” Gestalt is an experiential therapy that uses experiments and specific techniques to bring the client into the here and now. Through the experience of the here and now, the client is able to make contact with their environment. Contact is a fleeting experience, but it is during contact that we are in the here and now, and thus are in the process of self-actualizing. During the process of self-actualization we are able to make changes. In today's lecture I will will focus on some of the key concepts of Gestalt, the role of the therapist, the client’s experience and some of the innovative techniques attributed to Gestalt therapy. I’ll end with a brief discussion of the applications of Gestalt, the contributions and limitations of the approach.

Download MP3 [33:44]



References

Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2005). Theory and practice of counseling and psychotherapy (7th ed). Belmont, CA: Wadsworth/Thomson.

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APA (6th ed) citation for this podcast:

Singer, J. B. (Host). (2007, February 19). Gestalt Therapy [Episode 9]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://www.socialworkpodcast.com/2007/02/gestalt-therapy.html

Person-Centered Therapy

[Episode 8] Today we're going to talk about Carl Rogers and his revolutionary approach to psychotherapy - Person-Centered Therapy. Next to Freud, no other therapist has influenced the practice of therapy more than Carl Rogers. The humanistic assumptions at the core of Person-Centered therapy stand in stark contrast to the problem-centered, expert-oriented approach of what was then the dominant model of psychotherapy - Freudian Psychoanalysis. Rogers gave us an equation that would forever change the concept of therapy...

Existential Therapy

[Episode 7] In today's podcast, I talk about Existential therapy as an intellectual or philosophical approach to working with people. Although some authors have attempted to manualize Existential therapy (see Keshen, A. (2006). A new look at existential psychotherapy. American Journal of Psychotherapy, 60(3), 285-298), the existential approach is not known for specific techniques or procedures. Rather, its influence has been most notable in encouraging clinicians to focus on the ideas of freedom of choice, the responsibility that accompanies choice, and the notion that the inevitability of death is what gives life meaning.


Download MP3 [18:09]

Transcript

Today, we're going to be talking about existential therapy.  Existential therapy is an insight-oriented therapy much like Freudian psychoanalysis or Adlerian personal psychology.  What distinguishes existential therapy from other insight-oriented therapies is that existential therapy is more of a philosophical or intellectual approach to understanding a person’s problems rather than a set of techniques.  Existential therapy emphasizes our freedom to choose what we make of our circumstances and believes that we are free and therefore responsible for our choices and actions.

In essence, as Gerald Corey (2005) writes, we are the authors of our lives. Gerald Corey identifies six key concepts associated with existential therapy.  The first is that we have the capacity for self awareness.  Now, the greater our awareness, the greater our responsibilities for freedom and Corey writes that awareness is realizing that we are finite, that we understand that time is limited.  We have the potential and the choice to act or not to act and that meaning is not automatic that we must seek it.  And finally, that we are subject to loneliness, meaninglessness, emptiness, guilt and isolation.

The second key concept is that because we're basically free beings, we must accept the responsibility that accompanies our freedom.  In other words, because we're free to choose we have to take responsibility for the choices that we make.

A third key concept is that we have a concern to preserve our uniqueness and identity.  We come to know ourselves in relation to knowing and interacting with others.  Our identity is the courage to be.  We must trust ourselves to search within and find our own answers. Corey writes that one of our greatest fears is that we'll discover that there is no core and no self.  Another key concept is that the significance of our existence and the meaning of our life are never fixed once and for all.  Instead, we recreate ourselves through our projects.  Our search for meaning must be pursued obliquely.  This means that finding meaning in life is by necessity a by-product of a commitment that we make to creating, loving and working.

Another way of thinking about this is that we can't directly seek meaning.  Rather, we have to engage in activities and it is through that engagement that we actually find the meaning in our lives.  Viktor Frankl talked about the will to meaning as our primary focus in life.  Frankl said that life in and of itself is not meaningful. The individual must create and discover that meaning.

Now, one of the themes here is that people are creating their own realities and this is a phenomenological approach similar to Adler but very dissimilar to Freud and this phenomenological approach assumes that we are actively involved in the creation of our own realities.  As a therapist, if we understand that our client is creating their own reality, it's therefore important for us to assess and identify what that reality is and the meanings that our client is making of his or her reality.

Final key concepts include anxiety as part of the human condition.  The existentialist believes that anxiety is a basic condition of life and they call this existential anxiety and they consider it to be normal.  In fact, life can't be lived nor can death be faced without anxiety.  Anxiety can be a stimulus for growth as we become aware of and accept our freedom.  We can blunt our anxiety by creating the illusion that there is security in life and if we have the courage to face ourselves in life, we might be frightened, but we will be able to change.

A final concept is that death is a basic human condition and awareness of death gives significance to living.  So, these are the six key concepts that Corey identifies in existential therapy.

One of the criticisms of existential therapy is that its concepts can be vague and hard to understand, so in the attempt to make it a little bit more clear what existentialist stand for I'm going to compare and contrast the existential approach to therapy with Freud’s psychodynamic approach.

Existentialism believes that we are free to make our choices and we're not hindered by the past or by biological drives.  In contrast, Freudian psychoanalysis believes that freedom is restricted by unconscious forces, irrational drives and past events.  In existentialism, anxiety can be useful.  In psychodynamic theory, anxiety or neurosis is not useful and is in fact pathological and something that needs to be addressed.

In existentialist therapy, techniques are antithetical to truly being there for the client.  This is one of the reasons why existential therapy is more of an approach rather than a prescription for therapy.  In Freudian psychoanalysis, techniques are essential to making the unconscious conscious and these techniques can include dream analysis, transference, counter-transference, interpretation, very specific things and it's specific because the therapist is considered the expert in interpretation and understanding the objective world of the client.

Now both existential and psychodynamic are insight orient.  In existential therapy, treatment is based on the here and now and explorations of the past seek to identify the origins of the world view.  Again, there we have this idea that our clients are constantly creating the way that they understand the world, so explorations of the past are simply a way of better understanding how our clients came to view the world that they do.

In psychodynamic therapy, change occurs by exploring the past.  In existential treatment, dream analysis sheds light on possibilities.  Dreams are commonly understood to mean I don’t know what's happening to me.  In contrast in Freudian psychoanalysis, dream analysis identifies unconscious content that symbolizes conscious issues.  This is a very different approach because again you have symbols that have objective meanings in psychodynamic frameworks
such as a cigar is sometimes not a cigar.

In contrast in existential therapy, dreams are seen more as close as to the meaning that people have made for themselves.  So, one clarifying example is that if we imagine that we're working with a war vet and the vet meets criteria for posttraumatic stress disorder, is having difficulty focusing on family relations, difficulty holding a job, has exaggerated sterile response, is increasingly focused on issues related to current conflicts around the world as presented on the TV and radio.

Psychoanalysis might say that the war experiences have triggered repressed pre-sexual experiences for the vet and that the impulses are in conflict with the super ego.  In contrast, in existential approach to therapy, you must say that without the focus on the Vietnam and posttraumatic symptomology, the vet’s world would be revealed as pointless and absurd.  If there were specific issues around building a family or future orientation that the vet was having a hard time addressing, existential therapy would probably say this is because the vet is not considering the future as viable and instead understanding that the imminence of death is causing serious questions as to the point of life.

Now, the therapist-client relationship is considered to be collaborative.  In fact, Corey describes it as a journey taken by the therapist and the client together.  The relationship demands that the therapist be in contact with his or her own phenomenological world.  That is, the therapist must be aware of the way that he or she is constructing their own world so that they understand that their client is constructing his or her own world and that those worlds are necessarily going to be somewhat different.

The core of the therapeutic relationship is respect and faith and the client’s potential to cope and sharing reactions with genuine concern and empathy.  Now, some therapeutic goals in existential therapy include giving attention to the client’s immediate ongoing experience with the aim of helping them to develop a greater presence in their quest for meaning and purpose.

Another goal is to recognize factors that block freedom.  A third goal is to challenge clients to recognize that they are doing something that they formally thought was happening to them.  So, again, this addresses the concept of freedom and responsibility.  If your client believes that child protective services is something that is happening to them, it's important for you to help them understand that in fact they are active participants in this world in this situation and that their choices and their decisions are components of the current situation that they're in.

No judgment on whether or not a confirmed case of abuse has merit, but I'm just saying that in existential theory that the important thing is to focus on helping your client understand their own action as being part of their world.  And finally, the goal – the final goal is to accept freedom and responsibilities that go along with that action.

The phases of counseling can be broken down into the initial, the middle and final.

In the initial phase, you really want to see how your client understands their world. Again, this is the phenomenological viewpoint.  In the middle phase, you can explore how your clients develop that view of the world and how that view of the world is affecting what's currently going on with them, how that emphasize or how that influences what it is that they see as their responsibilities, their actions, what they have choices over.  And finally, the last phase of counseling is geared towards understanding how clients can take what they’ve learned in making their lives more purposeful, intentional and grounded in meaning.

Some of the things to do during the assessment phase is to identify existential themes and these are themes related to responsibility, mortality, isolation and meaningless.  These are the big four that Yalom discussed in his classic 1980s text “dreaming like waking is a mode of existence or being in the world and special attention is paid to themes and dreams in making sure not to place emphasis on the therapist’s interpretation.”

So whereas in Freudian psychoanalysis, really it's the therapist that’s responsible for ultimately interpreting what a dream means not because the client is unconscious of the meaning.  In existential approaches, it's really the client that ultimately determines what a dream means.  Some assessment techniques are the use of objective and projective tests such as the Rorschach and the thematic apperception test, the purpose of life test.  This addresses individuals’ views of life goals, their world and their death and the experiencing scale which looks at feelings and self-awareness.

Because there are no specific techniques in existential therapy, application really looks like incorporating techniques and approaches that you as a therapist are comfortable using.  Just remember that as you use your techniques, the primary emphasis is on understanding the client’s current experience.  As you adapt interventions that you're really focusing on these issues of choice, freedom and responsibility and ultimately you're guided by the philosophical framework about what it means to be human.

Now, existential therapy has been applied to multiple areas.  Clients who are seeking personal growth are great candidates for taking an existential approach, career or marital failure, retirement, grief work and any transition from one stage of life to another.  Existential approaches are wonderful for working with teenagers and for whom the questions of what is my purpose, what is the meaning of my life, how am I to live the best life I can, all of these questions are classic teenage angst questions.

A final area of application is helping those who are struggling to find meaning in life and facing the anxiety of their eventual death.  An obvious group for this is older adults.  Existentialist philosophy and existential therapy have contributed a lot to social work practice and clinical work in general.  One of the big ones is that existential theory contributed the concepts of self-determination and personal responsibility.  It provided a perspective for understanding the value of anxiety and guilt and the role and meaning of death in treatment.

The existential approach really enables clients to examine the degree to which their behavior is influenced by social and cultural conditioning.  In his 2005 text, Gerald Corey in fact argues that the existentialist approach is perhaps the most culturally competent approach because it provides social workers with a framework for understanding the universal issues of freedom, choice, life and death and because it's not technique-bound there are no cultural limitations on how this approach is practiced.

However, one of the limitations of an existentialist approach is that it lacks systematic statements of principles and practices of therapy.  It uses vague and global terms and abstract concepts that can be very difficult to grasp such as the will to meaning.  Finally, it's not been subjected to scientific research as a way of validating its procedures.

Now, in a recent article, Aaron Keshen acknowledged the limitations of existential therapy primarily in its lack of empirically testable techniques or approaches.  In a 2006 article, he attempts to operationalize existential techniques.  If you want more information on his approach, his article can be found in the American Journal of Psychotherapy, volume 60, issue 3 and the article is called “A New Look at Existential Psychotherapy” and in this article he attempts to operationalize the issues of your actual purpose or your substituted purpose in life and then he applies those to issues of mental illness, substance abuse, personality disorders, things like that.


So, in conclusion, existential therapy is really a philosophical or intellectual approach that provides the therapist with a framework to understanding their client’s problems rather than providing a set of techniques for actually addressing the problems the clients come in with.  The main issues that existential approaches address are issues of freedom, the freedoms that we have to choose and the responsibilities that come with those choices.  The other main issues that are significant are issues of the meaning of life and the reality and acceptance of death.

References

Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed). Belmont, CA: Wadsworth/Thomson.

Keshen, A. (2006). A new look at existential psychotherapy. American Journal of Psychotherapy, 60(3), 285-298.

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APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2007, February 12). Existential therapy [Episode 7]. Social Work Podcast [Audio podcast]. Retrieved from http://socialworkpodcast.com/2007/02/existential-therapy.html

Adlerian Psychotherapy

[Episode 6] In this lecture, I discuss key elements of Adler's Personal psychology and how this approach contrasts with Freud's theory. The contrast between Adler's and Freud's approaches can best be summed up in the quote "We are pulled by our goals, rather than pushed by our drives."

Download MP3 [15:02]

References

Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed). Belmont, CA: Wadsworth/Thomson.

Rychlak, J. F. (1981). Introduction to personality and psychotherapy (2nd ed.). Boston: Houghton Mifflin Company.

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APA (6th ed) citation for this podcast:

Singer, J. B. (Producer). (2007, February 5). Adlerian psychoanalysis [Episode 6]. Social Work Podcast [Audio podcast]. Retrieved from http://socialworkpodcast.com/2007/02/adlerian-psychotherapy.html

Freudian Psychoanalysis

[Episode 5] In this lecture, I discuss key elements of Freud's theory of personality and how that translated into his approach to therapy. The central goal of Freudian psychoanalysis is to make the unconscious conscious.

Transcript

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In today’s podcast, we're looking at two of the major figures in psychodynamic therapy:  Sigmund Freud and Alfred Adler. Sigmund Freud, of course, the father of psychoanalysis and Alfred Adler, developer of individual psychology. These two men had a lot in common, as did their approaches to therapy. In fact, the most common element to their therapies is that they were insight-oriented. These men believed that insight into why you do things is actually the key to making changes and living a happier, more successful life.  The way that these men conceptualize change was very different and that’s what we'll be talking about in today’s podcast.

In Freudian psychoanalysis, which is also called Id Psychology, the goal of treatment is to make the unconscious conscious. For example, let's say you're working with a man who has a confirmed case of physical abuse against his children. His explanation as to why he beat his children is that they deserved it. However, during your treatment you discovered that this man hates his boss. He also hates his abusive father. It becomes clear that his boss reminds him of his abusive father.

But your client was unaware of this connection. That is, he was not conscious of the connection between his emotions towards his father and his boss. Although his boss certainly has some characteristics of his father, you're able to point out to him that he’s employing a defense mechanism called displacement, where he is redirecting his feelings about his father to his boss. However, because he cannot act out his aggression towards his boss for fear of losing his job, he then displaces his anger on his children.

Freud would say that he is displacing his anger as a way of protecting himself, ultimately against addressing his deep-seated anger towards his father. In this example, by making your client aware of his unconscious anger, he’s able to gain insight into his behaviors and thereby he’s able to make not only situation-specific changes, but more importantly, changes in his personality. Now, this concept is key in understanding Freudian psychoanalysis.

Without a belief in the existence of an unconscious, Freud’s techniques and his approaches to treatment really make no sense. So, we're going to start out by talking about the topographical model: that is the conscious, the pre-conscious and the unconscious. Freud believed that the mind was divided into three layers.

You have the conscious layer, which was just a thin sliver on top and these were thoughts and ideas that we're aware of. So for example, if you ask me for a telephone number and I'm able to bring it up and say: “Oh yeah, the telephone number is 555-1212.” That telephone number is in my conscious. If you ask me for a phone number and then I have to think about it for a little bit, but I eventually come up with it, then Freud would have said that that phone number was in my pre-conscious (that was somewhere in between the conscious and the unconscious). I knew that it was pre-conscious and not unconscious because I was consciously able to recall it.

Information or data that we’re consciously able to recall can't be unconscious in Freud’s structure. By unconscious, I mean that these are things we're not aware of, also known as repressed material. The clinical evidence that Freud used for postulating the existence of the unconscious included: dreams, slips of the tongue, post-hypnotic suggestion, material derived from free association, material derived from projective techniques (such as ink blots, Rorscharch’s, things like that) and the symbolic content of psychiatric symptoms.

In Freudian theory, personality development hinges on the successful resolution of each phase of development. Erikson shares this concept with Freud, but for Freud it is psychosexual development and particularly inadequate resolution of a particular phase of psychosexual development can lead to neurotic behaviors, such as phobias. Now, in adulthood, the inadequate resolution of particular [00:05:00] phases is directly linked to unconscious wishes and impulses that seek to satisfy conflicting internal drives.

The structure of the personality, as it develops, starts out with the id. The id is the demanding child and is ruled by the pleasure principle. An easy way to think about the id is to think of a 1-year-old, somebody in the oral stage. That child is ruled entirely by: what feels good, what's going to soothe it, what's going to make it full, what's going to allow it to go to sleep, what's going to calm it. The 1-year-old child doesn’t think too much about: "Well, maybe I should give mom a break because I kept her up all night screaming."

The 1-year-old child is interested in getting fed when he wants to get fed or going to the bathroom when she wants to go to the bathroom. So people who are ruled by pleasure principles are considered to be dominated by the id. That is their personality is dominated by the id. In contrast to the id, the super ego is the judge and this is the part of our personality that’s ruled by the moral principle. The moral principle is: do what's right.  And the moral principle isn't necessarily good for us.

That is if we rule (if we lived entirely by the moral principle), then we wouldn’t necessarily be any better off than somebody who lives entirely by the id or the pleasure principle. So in order to have a balance between the id and the super ego, Freud postulates that there is the ego (sometimes thought of as a traffic cop) and the ego is ruled by the reality principle. This is where the ego takes into consideration some of the pleasure principle, some of the impulses of the id as well as some of the ideas of what's just and moral (imposed by the super ego) and then takes all that information into consideration and compares it to what is necessary in this situation in a realistic manner.

So it's not realistic to do everything you want all the time nor is it realistic to act god-like. We have to be real and that’s how we connect with other people. Now, ego defense mechanisms are defense mechanisms that are used by the ego. They're normal behaviors, which operate on an unconscious level, which tend to deny or distort reality. These defense mechanisms help individuals cope with anxiety and they prevent the ego from being overwhelmed.

So for example, denial is a classic defense mechanism. Denial is when the ego says: “No, that didn’t really happen.” Then you have the most fundamental defense mechanism of repression. And repression is literally when material is pushed into the unconscious so that we're not even aware of it. Now, it's common for people to say: “Oh, I totally repressed that.” But that’s actually an inaccurate use of the Freudian concept of repression. If we're conscious of repressing something, then it can't be unconscious. Instead what we're actually talking about is suppression: “I suppressed the memories of the party from the other night.” That would be suppression.

Finally, ego defense mechanisms can have adaptive value if they do not become a style of life to avoid facing reality. The therapeutic goals for Freudian psychoanalysis are to make unconscious motives conscious, because only then can an individual exercise choice. And when that happens, this ego can be strengthened so that behavior is based more on reality and less on instinctual cravings (that will be the id) or irrational guilt (which would be the super ego).

Essentially, psychoanalytic treatment revolves around uncovering and interpreting unconscious impulses and defending against them. Now Freud is famous for his psychoanalytic techniques and the reason why these techniques are so important is that in psychoanalysis the therapist, [00:10:00] the analyst, is the expert. The analyst is the expert in interpreting the material that the client brings up. And the reason why the analyst has to be the expert is because by theory the client is not aware of what it is that they're doing.

So for example, if I'm sitting in my therapist’s office and I'm free associating (which is one of Freud’s famous psychoanalytic techniques) and I'm talking about my work and I list a whole string of words that I associate with work and a whole bunch of ideas, I'm not necessarily going to be able to identify what unconscious material is being brought up. It is up to the therapist to say: “Uh-huh, it seems like this is what's going on.” And that’s the interpretation piece of psychoanalysis.

For this reason, classically trained psychoanalytic therapists had to go through their own psychoanalysis. So some of these psychoanalytic techniques include free association, (which I was just talking about) and this is when the client reports immediately without censoring any feelings or thoughts. Another technique is interpretation. In an interpretation, the therapist points out, explains and teaches the meanings of whatever is revealed.

Now Freud believes that we can only get in touch with the unconscious by interpreting what it seems to be indicating in our dreams, waking fantasies, slips of the tongue and so on. Freud believed that you could communicate on two levels at the same time, the conscious and the unconscious. For example, if you're having a professional conversation (that would be a conscious act) and engaging in intimate body language (that could be unconscious flirting) then you're accessing both your conscious and your unconscious simultaneously and only a trained psychoanalyst could point out what the unconscious material is. That’s why the traditional therapeutic relationship had to be expert-driven rather than collaborative.

A third psychoanalytic technique is dream analysis and dream analysis is called “the royal road to the unconscious.” During your dreams: images appear, ideas, scenes out of a movie will pop up in your head. And Freud believed that these were not realistic in the sense that, if I'm driving a car, it doesn’t actually just mean that I'm driving a car. There is important information in these images that are symbolic of something that’s going on in my unconscious.

Freud also believed that certain symbols were universal. For example, bodies of water always represented the unconscious in Freudian theory. So, if I was floating on a lake, I would be floating on my unconscious and that lake could be calm or it could be choppy and these would mean things in Freudian psychoanalysis.

Now transference is when the client reacts to the therapist as she does to an earlier significant other. Transference allows the client to experience feelings that would otherwise be inaccessible. In the analysis of transference, the therapist is able to achieve insight into the influence of the client’s past.

Countertransference is the reaction of the therapist towards the client that may interfere with objectivity. And remember in Freudian psychoanalysis, the analyst is considered to be a blank slate and objective, so these ideas of transference and countertransference are really key and very important. And I believe that these are two of the concepts that are actually most useful to draw on from traditional Freudian psychoanalysis.

For example, if you're working with the client and they start to talk to you as if you are their father or you are their grandson or possibly you are their girlfriend, they're somebody other than who you are, then Freud would say that they are transferring unconscious material onto [00:15:00] you.

Now one easy explanation for why this happens is because most of the time therapists do not spend a lot of time talking about themselves, in their lives, in the therapy room and so clients have to do something. They have to create some image of the therapist and when this happens, oftentimes they project information from their own lives. Now, this can be really useful if you're working with, say a woman who’s been in an abusive relationship, and she starts to interact with you as if you are an abuser. Now assuming that you're an ethical clinician and you are in fact not abusive, you can use this material to work in the moment with the client about these feelings and really work on these issues in a here and now way.

Although this isn't traditionally psychoanalytic, it is a modern adaptation of the concept of transference. If however, you're working in a session with a client and you find yourself looking at her as if she’s your daughter or perhaps your mother or even possibly if she were your lover, then that could suggest countertransference, reactions that you're having towards your client. And unless you're aware of these and are dealing with these actively, they can certainly interfere with your ability to provide a professional service to your client.

The last psychoanalytic technique that I'll talk about is resistance; and this is anything that works against the progress of therapy and prevents the production of unconscious material. These days in social work we don’t necessarily think of clients as being resistant. Resistant clients were traditionally conceptualized as clients who are actively trying to sabotage treatment. Today, if a client says: “That treatment is not working for me “or “I don’t want to do that,” we first look to ourselves and find out if we're doing a poor job of treatment matching for our clients.

The assumption is that if we find the right thing, if we've done our job at collaborating with our clients on identifying goals and developing treatment plans, then our clients will actually engage in the treatment, rather than saying that they don’t want to do it. In contemporary psychoanalysis, the relationship tends to be collaborative and although problems are grounded in the past, the focus is on alleviating current problems. Contemporary psychoanalysis also incorporates modern therapy techniques.

A modern day adaptation of Freud’s individual psychoanalytic therapy is psychoanalytic family therapy. Rather than emphasizing instincts and drives, the focus is on attachment objects and their role in individuation and personal growth. Now, the contributions of Freudian psychoanalysis are almost immeasurable. The concepts and ideas are so interwoven into our everyday lives that it's hard to really distinguish what is psychoanalytic and what is just the way we think about things.

For example, it's not uncommon to hear somebody complaining of somebody having an anal personality. It's also not uncommon to hear jokes that refer to some of the core concepts that Freud developed, as in this joke about Freudian slips. This joke was told to me by a British friend of mine:

Patience says to his doctor: “Doctor, I had a Freudian slip last night. I was eating dinner with my mother-in-law and I meant to say: ‘Please pass the butter.’ But instead I said ‘You silly cow, you’ve completely ruined my life.’”

Now what's true is that even though our everyday speech is full of concepts developed and popularized by Freud, Freudian psychoanalysis (or at least the traditional form of psychoanalysis) has fallen out of favor in contemporary psychotherapy. Although it was the dominant model through the 1970s, it is a long-term, insight-oriented therapy that doesn’t fit with our contemporary understanding of what people’s problems are, what solutions they're looking for, and perhaps most importantly, how managed care pays for services.

Even still, Freudian psychoanalysis (and particularly its modern day derivatives) contains ideas that are useful to anyone who’s involved in a therapeutic relationship, including those ideas of transference, countertransference and defense mechanisms.

In the next section of this podcast, we're going to talk about Alfred Adler, who took a very different approach to understanding people’s problems and therefore [00:20:00] what the solutions to those problems are.

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