DBT

MODULE –I
Dialectical Behaviour Therapy was developed by Dr. Marsha Linehan, a Professor of Psychology and adjunct
Professor of Psychiatry and Behavioural Sciences at the University of Washington.
Dr. Linehan approaches her scientific research and development from a perspective that is relatively uncommon in the
sciences: one based in spirituality. She has trained with a number of spiritual leaders and influential thinkers,
including a Zen master.
Stages of DBT
Pre-treatment Stage-Orientation & Commitment
Individual Therapy
Group Therapy
Telephonic Crisis Intervention
Therapists’ Consultation Groups
Individual Therapy
Special attention is provided to self-destructive or potentially self-harmful behaviours.
These behaviours are targeted not only because they are inherently worrisome, but also because they can seriously
disrupt the treatment process and undermine treatment goals.
So the idea is to keep the client alive and safe.
To reduce the behaviours that interfere with the therapy
To improve the quality of life of the client
Behaviors interfere with the therapy Improve the Moment “IMPROVE” Skills
1. Reporting late for the session Imagery;
2. Cancelling the sessions Meaning;
3. Not being prepared for the session Prayer;
4. Avoiding discussing difficult topics Relaxation;
5. Taking phone calls during the session One thing at a time;
6. Therapist pushing the client Vacation;
7. Therapist invalidating the client Encouragement.
Behaviors that interfere with quality of life Emotion-regulation
1. Substance Abuse Identifying and labelling emotions;
2. Financial Difficulties Identifying obstacles to changing emotions;
3.Lack of Social Support Reducing vulnerability to “emotion mind;”
4. Inappropriate housing Increasing positive emotional events;
Treatment targets from highest to Increasing mindfulness to current emotions;
lowest Priority Taking the opposite action;
1. Suicidal Behaviors & Self-harm Behaviors Applying distress tolerance techniques 
2. Behaviors that interfere with the therapy Interpersonal Effective Skills
3. Life –crisis situation Objectiveness Effectiveness “DEAR MAN” Skills
4. Maintaining treatment gains Describe;
5. Other goals that the client identifies Express;
Skill training in the groups Assert;
Distress- tolerance Reinforce;
Emotion Regulation Mindful;
Interpersonal effectiveness Appear confident;
Mindfulness Negotiate.
Distress Tolerance Skills Relationship Effectiveness “GIVE” Skills
Crisis Survival “ACCEPTS” Skills Gentle;
Activities Interested;
Contributing Validate;
Comparisons Easy manner.---relaxed and comfortable.
Emotions Self-Respect Effectiveness “FAST” Skills
Pushing away Fair;
Thoughts Apologies / no apologies;
Sensations Stick to value;
Self-Soothing Skills Truthful.
See Why Mindfulness
Hear Taking Control of your Mind
Smell Improving emotion regulation
Taste Increasing behavior control
Touch Improving concentration and Memory
Engaged in Life
A pattern of Behavioral , emotional and Cognitive instability & dysregulation
Emotional dysregulation gets the reflection in .
a. . Highly reactive emotional responses
b. Relationships are chaotic, intense and marked with difficulties
Behavioral dysregulation
a. extreme and impulsive behaviors
b. Attempts to injure, mutilate or kill themselves
c. Substance abuse
d. Promiscuity
Cognitive dysregulation-
Brief nonpsychotic forms of thought dysregulation-depersonalization, de-realization and delusions
Cognitive rigidity
Poor problem-solving
Sense of self Dysregulation-
Having no sense of Self
Feeling empty
Doesn’t know who he or she is
Patterns in BPD
Emotional Vulnerability-
High sensitivity
High Intensity
Slow return to emotional baseline
Self-invalidation-
Fail to recognize their own emotional responses, thoughts , beliefs and behaviors
Unrealistically high standards and expectations of Self
Intense shame, self-hate and Self-directed anger.
Unrelenting Crises-
Pattern of frequent stressful, negative environmental events (dysfunctional life style as well as inadequate
environment ).
Inhibited Grieving-
Tendency to inhibit negative emotions especially associated with grief and loss
To overcontrol negative emotional responses especially anger (either overexpression or under-expression of anger
Active Passivity –
passive interpersonal problem-solving style
active attempts to solicit problem-solving from others
learned helplessness
Hopelessness
Apparent Competence-
tendency to appear deceptively more competent than they actually are .
Suicidal Attempts –A cry for Help
Suicidal attempts are not manipulative actions but cry for help, reflection of frantic suicidal ideation and ambivalence
over whether to continue with life or not.
Desire to be helped or rescued
Manipulation-a major source of invalidation
Time care and attention
Biosocial Theory
Dysfunctional environment +Biological irregularities
Biological irregularities- Genetic influences (serotonin transporter gene 5-HTT) to disadvantageous intrauterine
events and early childhood environment
Invalidating environments –fail to teach
How to label and regulate emotions
How to tolerate distress
How to trust their own emotional responses as valid interpretation of the events
Interpersonal Therapy
A variant of Cognitive Behaviour Therapy
Given by Gerald Klerman and Myrna Weissman
Successful results for the people suffering from depression or dealing with relationship issues
Techniques of the therapy
Identification of the emotion
Expression of Emotion
Dealing with emotional Baggage
Interpersonal Problem Areas
In IPT, the therapist selects one of four interpersonal problem areas as the focus for treatment.  The four IPT problem
areas are:
Grief or Complicated Bereavement
Role Dispute
Role Transition
Interpersonal Deficits 
Grief is chosen as a problem area when the onset or maintenance of the depressive episode is associated with the
death of a person close to the patient.
Role Dispute is chosen as a problem area when the onset or maintenance of the depressive episode is associated with
an unsatisfying interpersonal relationship characterized by non-reciprocal role expectations between the two parties.
Role Transition is chosen as a problem area when the onset or maintenance of the depressive episode is associated
with difficulty coping with changes in current life circumstances.  Role  transitions  may occur in many domains
including employment, relationship status, physical health, living conditions, socioeconomic status, etc. The transition
is conceptualized as moving from one social role to another social role (i.e., from a student to an employee, from
military to civilian status, from single to married, etc).
Interpersonal Deficits is chosen as a problem area when there is no clear acute interpersonal event associated with
the onset or maintenance of the depressive episode and the individual describes a long standing history of
impoverished or contentious interpersonal relationships. Although many patients seeking IPT treatment have deficits
in interpersonal functioning, the interpersonal deficits category is reserved for cases where no other treatment focus is
apparent.  Not surprisingly, patients with chronic impairment in social functioning who lack the life events on which
IPT focuses fare worse in IPT.
Phases/ Steps of the therapy
Assessment
Initial Session
Middle Session
Terminal Session
Maintenance Session
Structure and Duration of Sessions
12 to 16 one hour sessions that usually occur weekly.
The initial sessions are devoted to information gathering and clarifying the nature of the patient's illness and
interpersonal experience.
The patient's illness is then formulated and explained in interpersonal terms and the nature and structure of the IPT
sessions are explained.
This phase of treatment concludes with the composition of the "interpersonal inventory" which is essentially a register
of all the key relationships in the individual's life.
Sessions 3 - 14 are devoted to addressing the problematic relationship areas and there is little focus upon the specific
illness process apart from enquiries as to symptom severity and response to treatment modalities.
The final sessions 15 - 16 focus upon termination, which is usually formulated as a loss experience.
Techniques
Clarification.
Communication analysis
Interpersonal incidents
Use of affect
Role playing
Problem solving
Homework
Use of therapeutic relationship
Communication analysis.
Help patient – identify their communication pattern – see the contribution they make to difficulties in communication.
Motivate patient to communicate more effectively
BPD
A pattern of Behavioral , emotional and Cognitive instability & dysregulation
Emotional dysregulation gets the reflection in .
a. . Highly reactive emotional responses
b. Relationships are chaotic, intense and marked with difficulties
Behavioral dysregulation
a. extreme and impulsive behaviors
b. Attempts to injure, mutilate or kill themselves
c. Substance abuse
d. Promiscuity
Cognitive dysregulation-
Brief nonpsychotic forms of thought dysregulation-depersonalization, de-realization and delusions
Cognitive rigidity
Poor problem-solving
Sense of self Dysregulation-
Having no sense of Self
Feeling empty
Doesn’t know who he or she is
IPT for Borderline Personality Disorder
Emotional dysregulation – Interpersonal Incidents, Use of affect, Role plays, Communication analysis
Cognitive dysregulation –Problem-solving, clarification, communication analysis,
Behavioral dysregulation- Use of affect, Problem-solving and Role plays
Self dysregulation – Use of affect, Use of therapeutic relationship
IPT for Trauma
Lack of sense of Safety- interpersonal Incidents, Use of affect, Clarification
Lack of Faith in people- interpersonal Incidents, Use of affect, Clarification
Lack of Trust - interpersonal Incidents, Use of affect, Clarification
Emotional dysregulation- Interpersonal Incidents, Use of affect, Role plays, Communication analysis
Cognitive distortions related to the theme of the event- –Problem-solving, clarification, communication analysis,
Clarification
IPT for Anxiety Disorder
Fear of Judgement/ Evaluation
Fear of Unknown/ Uncertainty
Emotionally Overwhelming
Cognitive distortions
Escapism/avoidance-problem-solving, use of affect, communication analysis
Unhealthy Communication –communication analysis, clarification and role plays
IPT for Depression
Cognitive dysregulation - All or nothing Thinking, Maximizing –minimizing, Personalization, Jumping to conclusion,
Overgeneralization –problem solving, clarification and communication analysis, cognitive-error identification,
Homework.
Emotional dysregulation- Sadness, Guilt, Use of affect, interpersonal incidents, Communication analysis, Role-plays,
Homework.
Behavioral dysregulation –Use of Affect, Communication analysis, Role plays, Homework.
Social dysregulation in the form of social withdrawal-Interpersonal incidents ,Use of affect, Relationship-inventory,
Communication analysis, Use of therapeutic relationship, Homework.

MODULE –II
Acceptance and Commitment Therapy
Relational Frame Theory
-the core of human language and cognition is the ability to learn to relate events under arbitrary contextual control.
Suppose a child has never before seen or played with a cat. After learning “C-A-T” → animal, and Now suppose that
the child is scratched while playing with a cat, cries and runs away. Later the child hears mother saying, “Oh, look! A
cat.” Now the child again cries and runs away, even though the child was never scratched in the presence of the
words “Oh, look! A cat.” Indeed, in this example, the oral name never was trained in the presence of the
animal.
Such effects may help explain why, for example, people can have an initial panic attack while “trapped” in a
shopping mall, and soon find that they are worrying about being “trapped” in an open field or on a bridge. What
brings these situations together is not their formal properties in a simple sense, but the verbal/cognitive activities that
relate these events.
Developed by Steven C. Hayes.
ACT has been used effectively to help treat workplace  Stress , exam anxiety, Social anxiety, depression, obsessive
compulsive disorder, chronic pain and substance abuse.  
FEAR
F—Fusion--- with your thoughts
E-Evaluation----of Experience
A-Avoidance– of your Experience
R-Reason---giving reasons for your behaviour
Healthy Alternative is to ACT
ACCEPT--- your reactions and be present
CHOOSE--- a Valued Direction
T- TAKE ACTION- Implementation
Techniques
Cognitive De-fusion
Acceptance
Mindfulness
Observing the Self
Values
Committed Action

Problem-Solving Strategy :STEPS

STOP-Stop long enough to realize that a situation is a problem, and you may need time to find a resolution.
DEFINE- Define the problem in detail.
What is the situation?
Who is involved?
What is happening or not happening that is a problem?
Where did it happen?
When did it happen?
How did it happen?
How often does it occur?
Why does it happen?
How do you feel? What do you do in response?
What do you want to change?
DESCRIBE-Describe how the problem interferes with your goals. If the situation does not interfere with your goals,
it is likely not your problem.
IDENTIFY -Identify all the options/alternatives. It is important to find at least 3 potential solutions in order to avoid
the black/white thinking we were programmed to use.
VIEW CONSEQUENCES- View of the consequences of each option/alternative. Seek additional knowledge if
necessary.
IDENTIFY THE STEPS- Identify the steps needed to resolve/take action. Make a list of when and how the steps will
be taken and then take the required action.
EVALUATE RESULTS- Evaluate results. If the steps taken were successful to resolve the problem, acknowledge
that you successfully solved a problem and give yourself some credit. If the steps taken were not successful to solve
the problem, learn more about what would be needed to solve the problem and follow steps 4-7 again until the matter
is resolved.
PYCHODYNAMICS

MODULE I
Psychotherapy is the treatment given to mentally and emotionally disturbed people through psychological techniques.
It is also called clinical intervention because in this method clinical psychologist use their professional capacity and try
to influence and bring given changes in the behaviors of individuals in concern.
Wolberg (1967): “Psychotherapy is a form of treatment for problems of an emotional nature in which a trained person
deliberately establishes a professional relationship with a patient with the object • of removing, modifying or retarding
existing symptoms, • of mediating disturbed patterns of behaviour, and • of promoting positive personality growth and
development.
(Rotter): “Psychotherapy … is plJennyed activity of the psychologist, the purpose of which is to accomplish changes
in the individual that make his life adjustment potentially happier, more constructive, or both.”
J. D. Frank (1982) elaborates this general theme as follows: “Psychotherapy is a plJennyed, emotionally
J. D. Frank (1982) elaborates this general theme as follows: “Psychotherapy is a plJennyed, emotionally charged,
confiding interaction between a trained, socially sanctioned healer and a sufferer. Psychotherapy also often includes
helping the patient to accept and endure suffering as an inevitable aspect of life that can be used as an opportunity for
personal growth.”
The psychodynamic approach to therapy focuses on unconscious motives and conflicts in the search for the roots of
behaviour (Shedler, 2010). It likewise depends heavily on the analysis of past experience. The roots of this perspective
reside in the original psychoanalytic theory and therapy of Sigmund Freud.
Fisher “Psychotherapy is a plJennyed and systematic application of psychological facts and theories to the alleviation
of large variety of human ailments and disturbances, particularly those of psychogenic origin”.
Objectives of Psychotherapy
Psychotherapy aims towards, changing mal adaptive behaviour pattern.
Minimising or eliminating environmental condition that may be causing or maintaining such behaviour.
Improving interpersonal and other competences.
Resolving handicapping and disabling inner conflicts and alleviating personal distress.
Modifying inaccurate assumption about oneself and one’s world and fostering a clear cut sense of oneself identity and
opening of pathways to a more meaningful and fulfilling existence.
The chief objective of psychotherapy is to rid the patients of symptoms which make his life a burden to him, and it is
the duty of the psychiatrists to help the patients regain his self confidence and to strengthen his personality so that he
can solve his own problems and adjust with the environment.
Goals are the outcomes intend to achieve, whereas objectives are the specific actions and measurable steps that need
to take to achieve a goal. 
The Ultimate goal and some mediate goals of psychotherapy
Ultimate goals- The ultimate goal is what the psychologist wants to achieve at last. Some of the ultimate goals are
Removing the symptoms.
Freeing the person to be self-actualizing.
Restoring earlier level of functioning.
Helping the patient find personal meaning and values.
Mediate goals- They are not less important than ultimate goal. The mediate goals define the needs which are necessary
to move the patient towards ultimate goal.
Releasing pend-up feelings.
Conditioning or reconditioning of particular responses.
Examining ones values and concepts.
Muscular relaxation.
Becoming aware of unconscious impulses.

According to Sundburg and Taylor- The purpose/objective or goal

of psychotherapy:
Strengthen the patient’s motivation to do the right thing.
Reducing emotional pressure by facilitating the expression of feeling.
Releasing the potential for growth.
Changing habits.
Modifying the cognitive structure of the person.
Gaining self-knowledge.
Facilitating interpersonal relations and communication.
Gaining knowledge and facilitating decision making.
Altering or changing the bodily states.
10.Altering states of consciousness.
11.Changing the social environment.
It is helpful to view therapeutic approaches in these terms before considering psychoanalysis, client-centered therapy
and other systems.
These purposes do not correspond in any one-tone fashion with the approaches of different schools.
Rather, they are themes which run through different therapeutic systems, though one or another may be emphasized in
each case.
They also describe different patients or with the same patients at different points in the therapeutic process.
Thus, a therapist attempting to alter the cognitive structures of a person in order for him to rectify distorted perceptions
and beliefs may still find it necessary to encourage emotional release and/or enter directly into attempts to change the
patient’s social environment.

There are THREE FUNDAMENTAL PROCESSES in psychotherapy that will facilitate reaching these goals.
To develop trust or a “therapeutic alliance" with r therapist. During this period the treatment goals are defined and
mutually agreed upon. The purpose at this point is to fashion a method of doing therapy that fits best with r
personality.
In the second phase or “working through" process, the emphasis is on resolving confusions about past experience, and
developing ideas about what want and who are. The desired outcome is to trust r intuitive process, feel unobstructed
about the direction r life is taking, and to advance r efforts to enjoy a more healthy and productive life. The expected
outcome from psychotherapy should be that feel more “at home" in the world, more accepting of themself and with
their life choices.
The third or termination phase of therapy is to evaluate progress, solidify what have learned, resolve any remaining
conflicts, and hopefully feel satisfied with life and themself.
All three phases are essential to maintaining the psychological gains.
The more interested and involved clients are in therapy the more positively it will progress.
Psychotherapy can at times evoke anxiety, fear, anger, frustration, loneliness and dependency feelings.
Unpleasant realities if faced, can be worked through.
The emphasis is in replacing fantasy, myth, and untruths with reality.
Reality and truth can at times, be painful, but will ultimately lead to more personal happiness and healthier
relationships. The goal of psychotherapy is not to change , change is a choice, but it is to build awareness, compassion,
understanding, respect, empathy and acceptance toward themself and others.
Different approaches to psychotherapy
Psychologists generally draw on one or more theories of psychotherapy.
A theory of psychotherapy acts as a roadmap for psychologists: It guides them through the process of understanding
clients and their problems and developing solutions.
Approaches to psychotherapy fall into five broad categories:
Psychoanalysis and psychodynamic therapies. This approach focuses on changing problematic behaviors, feelings, and
thoughts by discovering their unconscious meanings and motivations. Psychoanalytically oriented therapies are
characterized by a close working partnership between therapist and patient. Patients learn about themselves by
exploring their interactions in the therapeutic relationship. While psychoanalysis is closely identified with Sigmund
Freud, it has been extended and modified since his early formulations.
What is psychodynamic therapy used in?
anxiety
panic disorders
post-traumatic stress disorder
personality disorders, such as borderline personality disorder
stress-related physical ailments
physical symptoms that lack a physical basis
persistent feelings of isolation and loneliness
prolonged sadness
sexual difficulties
Long term abuse (Physical/ mental)
Cognitive therapy. Cognitive therapy emphasizes what people think rather than what they do.
Cognitive therapists believe that it's dysfunctional thinking that leads to dysfunctional emotions or behaviors. By
changing their thoughts, people can change how they feel and what they do.Major figures in cognitive therapy
include Albert Ellis and Aaron Beck.
Humanistic therapy. This approach emphasizes people's capacity to make rational choices and develop to their
maximum potential. Concern and respect for others are also important themes.
Humanistic philosophers like Jean-Paul Sartre, Martin Buber and Søren Kierkegaard influenced this type of therapy.
Three types of humanistic therapy are especially influential. Client-centered therapy rejects the idea of therapists as
authorities on their clients' inner experiences. Instead, therapists help clients change by emphasizing their concern,
care and interest.
Gestalt therapy emphasizes what it calls "organismic holism," the importance of being aware of the here and now and
accepting responsibility for rself.
Existential therapy focuses on free will, self-determination and the search for meaning.
Integrative or holistic therapy.
Many therapists don't tie themselves to any one approach. Instead, they blend elements from different approaches and
tailor their treatment according to each client's needs.
Who can be considered for Psychodynamic therapies?
Depression with reactive affect (Reactive depression describes symptoms of depression that occur in response to an
external problem or stressor. There are a range of “normal” responses to stressful situations, but reactive and
situational depression often describe emotional difficulties that exceed this range. In some cases, people with these
symptoms are diagnosed with an adjustment disorder, which is a generalized condition used to define mental health
symptoms believed to be stress-related.)
Somatisation (Somatisation is a maladaptive functioning of an organ system, without underlying tissue or organ
damage, or where the symptoms are disproportionate to the underlying structural cause. It occurs as a result of
complex psychosocial factors, and symptoms are not under voluntary control. Throwing up from anxiety, having a
headache due to stress, or feeling physically weak after trauma are all examples of somatization. But these instances
are typically situational and temporary. Somatization becomes a clinical issue when it causes prolonged and severe
distress.)
Personality disorders (works best for Narcisstic, dependent type personality )(excluding Paranoid personality disorder,
Antisocial personalities, Borderline, schizotypal)
Not for Psychotic disorders
high risk situations (comorbid ones etc)
Psychodynamic therapies are good for gaining insight
Note that: if dynamic psychotherapy is successful, initially , the patient usually becomes worse before they become
better.
The psychodynamic processes are ‘painful’. Also termed as “ Psychosurgery”.
Psychosurgery as this therapy is about changing the patients on fundamental basis. So they can confronted with their
unconscious sense and deliberately pull it out to the conscious self.
This therapy is for : * Insight generation .* ; *Someone to talk to*, *Understanding oneself, * exploring themselves
*intrapsychic
pertaining to impulses, ideas, conflicts, or other psychological phenomena that arise or occur within the psyche or
mind
extrapsychic
pertaining to that which originates outside the mind or that which occurs between the mind and the environment.
INTRAPSYCHIC CONFLICT :Opposing forces and the clash of them within the psyche, it is a psychoanalytic theory
such as wishes, agencies or conflicting drives. It is also called inner conflict. Conflict among id-ego-superego
NEUROTIC CONFLICT : neurotic conflict is intrapsychic conflict which leads to persistent maladjustment and
emotional disturbance.
id : Pleasure principle, ex: infant crying for food. This remains infantile throughout the person’s lifetime irrespective
of increasing age.Operated in the unconscious mind
ego: Part of ego that has been modified wrt the outer world. Reality principle.
superego:emerges around 5 years of age. Internalisation of parental and societal rules.Civilizes person’s behaviour.
The intrapsychic process refers to affect, cognition, and conation, as outlined by Freud in his early works (Arieti
1967). In his early writings, Freud assigns significant responsibility to affects as powerful and dynamic forces. ... An
additional aspect of the intrapsychic process relates to cognition.
The clash of opposing forces within the psyche, such as conflicting drives, wishes, or agencies. Also called inner
conflict; internal conflict; intrapersonal conflict; psychic conflict.
An example of negative intrapsychic process might be stress over social responsibilities, conflict with social
rules/regulations, conflict of morals, or a crisis of faith.
Say a father was a being an adult during the Great Depression of the 1930s. ... Such a person often destroys himself in
the process, because if his parents observe him being successful in spite of drinking, this would exacerbate the conflict
in his parents and destabilize them.
Psychodynamic therapy is based on the following key principles:
Unconscious motivations — such as social pressure, biology, and psychology — can affect behavior.
Experience shapes personality, which can, in return, affect an individual’s response to that experience.
Past experiences affect the present.
Developing insight and emotional understanding can help individuals with psychological issues.
Expanding the range of choices and improving personal relationships can help people address their problems.
Freeing themselves from their pasts can help people live better in the future.
Types of Psychotherapies
Cognitive-Behavioural Therapy (CBT): CBT assists to identify and challenge thinking patterns that are unhelpful
which may be contributing to unpleasant emotions. Providing strategies that help in the management of emotions is at
the core of CBT.
Interpersonal Therapy (IPT): IPT is designed to help manage interpersonal difficulties. This can help r family and by
helping all in achieving effective communication. IPT can also help to develop social well-being. This works by
putting the focus on unresolved grief, role conflicts, role transitions and social isolation.
Long Term Psychodynamic Psychotherapy. Sometimes the above short term approaches don’t work because the
problems are more deeply rooted. In such cases psychoanalytic psychotherapy might be recommended. Learn more
about psychoanalytic psychotherapy.
Mindfulness Based Cognitive Therapy: Mindfulness is all about changing r state of mind, so instead of focusing on
future worries or past regrets, opening r mind to the present moment with openness, curiosity and flexibility. Easier
said than done! Mindfulness is a skill that can be developed through practice; meditation is just one way amongst
many of cultivating mindfulness.
Acceptance and Commitment Therapy (ACT): ACT is a new form of cognitive and behavioural therapy which can
assist to better manage negative emotions and help to live a more meaningful life.
What is Counselling
Counselling, which is also known as talk therapy, consists of a single conversation or a series of conversations, taking
place between a psychologist and his client. It is a broadly used term in psychiatry, which goes hand in hand with
treatments used for the enhancement of mental health.
Counselling is also considered to be a specific kind of therapeutic approach, which will help an individual to overcome
unnecessary emotions and behavioural patterns.
The main objective of counselling is to make the client expose his distressing issues to a professional who has a deep
knowledge about the human mind so that the client receives support to adjust himself in order to perform day to day
activities in a normal and efficient manner
According to some health professionals, counselling should mainly focus on one problem at a time, thereby finding
solutions in a logical way of thinking. In this case, a counsellor must show empathy towards the client, so that the
client will feel comfortable to expose his true feelings, which will be very important in finding the most appropriate
mode of therapy.
What is Psychotherapy
Psychotherapy, in contrast, is an evolutionary procedure which will support the client to develop a rational and clear
vision about his long-standing attitudes, recurrent emotions, ways of thinking, behaviour, and personality, which might
have resulted in current issues, in the quality of life and relationships with others.
Psychotherapy is also known to go deep into a particular matter in order to reveal the root cause that causes the related,
disturbed perspective of life.  Ultimately, the client will relieve himself by taking the control of his life to himself and
developing self-awareness, rather than getting triggered by unconscious impulses and simulations.
Psychotherapists are also aware of the individual’s inner beliefs, body and inner child, which might have made a
negative impact on troublesome experiences.
However, all these methods of revealing a person’s past life and his nature will eventually result in an effective and
healing relationship between the client and psychotherapist which will be beneficial in creating a mentally healthy
person.
Corey keyes ‘ Dual continuum model’
Difference Between Counselling and Psychotherapy
Time
Counselling: Counselling is a short term process, which focuses on one individual issue at a time, thereby finding a
process to overcome it.
Psychotherapy: Psychotherapy is a long-term process, which involves long periods of working with clients in order to
uncover the foundation of the problem and address it in the most efficient direct or indirect mJennyer.
Patients
Counselling: Counselling usually deals with clients with good coping skills who are fit enough to think rationally and
find solutions to their problems by themselves when a little supporting hand is provided by the counsellor.
Psychotherapy: Psychotherapy mainly involves individuals who are dependent on the psychotherapist to gain control
over their personality, mind, emotions and behavioural patterns. They might also need therapy from time to time with
breakthrough periods, depending on the condition.
Methods
Counselling: Counselling also addresses issues in a less in-depth manner
Psychotherapy: Psychotherapists have intense and extensive knowledge about psychological theories and modalities of
treatments. They will make clients dig into their past experiences, in order to understand their human development,
cognitive and behavioural patterns, thereby enabling them to explore themselves, identify as strong individuals and get
rid of negative senses, self-believes, and external stimulations.
Similarities
There are many similarities between counseling and psychotherapy, and even with the distinction, counseling often
includes some psychotherapy and psychotherapy often includes some counseling. Similarities include:
Development of a healing, safe, and therapeutic relationship between a therapist and an individual
Effectiveness for a wide range of people, both adults and children
Understanding a person's feelings and behaviors, and addressing issues with the goal of improving a person's life
A psychotherapist may be a better option if:
problems that are significantly impacting your life and relationships
coping with past trauma, or if you believe situations in the past may be playing a role in your current issues
present issues are chronic or recurring concerns
chronic medical condition (such as autoimmune disease, cancer, etc.) that is affecting your emotional well-being
diagnosed mental health condition such bipolar disorder or a major anxiety disorder
one has seen a counselor and their issues aren't improving even though they have been actively working on solutions

MODULE II
History of Psychoanalytic Therapy
Freud initially suggested that mental health problems arise from efforts to push inappropriate sexual urges out of
conscious awareness (Freud, 1895/1955).
Later, Freud suggested more generally that psychiatric problems are the result of tension between different parts of the
mind: the id, the superego, and the ego.
The Case of Anna O
The case of 21 year old, pseudo named Anna O (real name Bertha Pappenheim) marked a turning point in the career of
Sigmund Freud. It even went on to influence the future direction of psychology as a whole. Psychoanalysis was on the
verge of beginning.
Anna O. suffered from hysteria, a condition in which the patient exhibits physical symptoms (e.g., paralysis,
convulsions, hallucinations, loss of speech) without an apparent physical cause. Her doctor (and Freud's teacher) Josef
Breuer succeeded in treating Anna by helping her to recall forgotten memories of traumatic events.
Her symptoms were, language disorders, visual impairments, hallucinations,right sided paralysis, Neuralgia(facial
muscular impairments), hydrophobia,speech problems.
During discussions with her, it became apparent that she had developed a fear of drinking when a dog she hated drank
from her glass. Her other symptoms originated when caring for her sick father.
She would not express her anxiety for her his illness but did express it later, during psychoanalysis. As soon as she had
the opportunity to make these unconscious thoughts conscious her paralysis disappeared.
Free association came into being after Anna/Bertha decided (with Breuer's input) to end her hypnosis sessions and
merely talk to Breuer, saying anything that came into her mind. She called this method of communication "chimney
sweeping" and "talking cure" and this served as the beginning of free association.
Tranference : Transference: A phenomenon characterized by unconscious redirection of feelings and desires from one
person to another, especially of those unconsciously retained from childhood toward a new object. In psychotherapy,
free association was used to identify transference, which aided in revealing the hidden unconscious.
Josef Breuer successfully treated her by helping her identify forgotten memories of traumatic events which caused fear
and anxiety – a phobia of drinking due to a feared dog who once drank from her glass, an anxiety of illness from
caring for her ill father. After identifying these causes, symptoms subsided. Sigmund Freud, a friend of Joseph Breuer,
was fascinated by this, and so investigated the case, eventually writing Studies in Hysteria (1895). In it, he proposed
the three levels of the human psyche, and revolutionized psychology. However, Freud was not just advancing an
explanation of a particular illness. Implicitly he was proposing a revolutionary new theory of the human psyche itself.
In Studies in Hysteria , book by Freud (1895), Freud proposed that physical symptoms are often the surface
manifestations of deeply repressed conflicts.
Historical records since showed that when Breuer stopped treating Anna O. she was not becoming better but
progressively worse.[2] She was ultimately institutionalized: "Breuer told Freud that she was deranged; he hoped she
would die to end her suffering".
In contrast, Lucy Freeman reports that Anna O.-Bertha P. made a remarkable recovery following her treatment. Their
talking therapy had helped her rid herself of every symptom manifesting from repressed events and emotions. Breuer
left Ms. Pappenheim on the eve of their final session convinced she was completely cured. 
She later recovered over time and led a productive life. The West German government issued a postage stamp in
honour of her contributions to the field of social work.
Free association is a technique used in psychoanalysis which was originally devised by Freud out of the hypnotic
method of his mentor and coworker, Josef Breuer. The importance of free association is that the patients spoke for
themselves, rather than repeating the ideas of the analyst; they work through their own material, rather than parroting
another's suggestions.
Transference: A phenomenon characterized by unconscious redirection of feelings and desires from one person to
another, especially of those unconsciously retained from childhood toward a new object. In psychotherapy, free
association was used to identify transference, which aided in revealing the hidden unconscious.
Psychoanalysis before Freud:
Franz Anton Mesmer (1734–1815) :Because of his rather unusual techniques, Mesmer strongly opposed by the
medical establishment. Mesmer is widely regarded as the father of hypnosis, a state in which extremely suggestible
subjects sometimes appear to be in a trance.
Jean Charcot (1825–1893) studied hypnosis and influenced Sigmund Freud to consider psychosocial approaches to
psychological disorders.
In 1885 a young man named Sigmund Freud came from Vienna to study with Charcot. After returning from France,
Freud teamed up with Josef Breuer (1842–1925), who had experimented with a somewhat different hypnotic
procedure. While his patients were in the highly suggestible state of hypnosis, Breuer asked them to describe their
problems, conflicts, and fears in as much detail as they could. Breuer observed two extremely important phenomena
during this process.
First, patients often became extremely emotional as they talked and felt quite relieved and improved after emerging
from the hypnotic state.
Second, seldom would they have gained an understanding of the relationship between their emotional problems and
their psychological disorder. In fact, it was difficult or impossible for them to recall some details they had described
under hypnosis. In other words, the material seemed to be beyond the awareness of the patient.
A close second was their discovery that it is therapeutic to recall and relive emotional trauma that has been made
unconscious and to release the accompanying tension. This release of emotional material became known as catharsis.
A fuller understanding of the relationship between current emotions and earlier events is referred to as insight.
INSIGHT:
The Psychoanalytic Insight ,By Ioan Lungu ; insight means : "the ability to see and understand clearly the inner nature
of things, especially by intuition".
significance of the sentence "inner nature of things’
In psychoanalysis, the "insight" is a sort of "clear understanding", but this is related to a kind of a feeling of liberation
as from a psychical burden.
This "psychical burden" represents what we could call a psychological inner fact.
Clarifying this inner psychological fact is the task of psychoanalysis, more precisely of the interpretation of the
symptoms.
‘Freud’s Iceberg Theory’ uses the imagery of an iceberg to separate these ‘3 levels of consciousness’ :Three levels of
the human mind
Conscious Surface-level thoughts, consisting of those thoughts that are the focus of our attention now. We are aware
of these thoughts. In the iceberg model, this level is seen as the visible part above water -- the tip of the iceberg.
Preconscious : The preconscious consists of all which can be retrieved from memory. We will or can become aware of
these thoughts through accessible memory, as these thoughts move from sub-conscious to conscious mind. In the
iceberg model, this level is the segment just beneath the surface of the water, ready to rise up above the surface at any
time.
Unconscious: The most significant level of the mind, the place of deep- seated motives that are most responsible for
shaping behavior and personality. Acts as a repository of primitive wishes and impulse kept at bay and mediated by
the Pre-conscious. A primary assumption of Freudian theory is that the unconscious mind governs behavior to a
greater degree than the individual suspects. Indeed, the goal of psychoanalysis is to make the unconscious conscious.
Conscious: I am feeling angry right now.
Preconscious: I must be angry because I lost my tennis match yesterday.
Unconscious: My culture has instilled in me the belief that winning is part of being successful in life.
conscious mind :awareness of something, being able to call it to mind, it would seem simple enough to qualify only
those events we can recall as the activities of the human mind.
The two functions that the capabilities of the conscious mind can address are:
Its ability to direct focus.
Its ability to imagine which is not real
subconscious is the storage point for any recent memories needed for quick recall, such as what your telephone
number is or the name of a person you just met. It also holds current information that you use every day, such as your
current recurring thoughts, behavior patterns, habits, and feelings.
subconscious mind serves as the minds random access memory (RAM)
The unconscious mind is where all of our memories and past experiences reside. These are those memories that have
been repressed through trauma and those that have simply been consciously forgotten and no longer important to us
(automatic thoughts). It’s from these memories and experiences that our beliefs, habits, and behaviors are formed.
Theoretical Background
The Id : primary component of personality.
The id is the only component of personality that is present from birth.
This aspect of personality is entirely unconscious and includes instinctive and primitive behaviors.
The id is driven by the pleasure principle, which strives for immediate gratification of all desires, wants, and needs.
If these needs are not satisfied immediately, the result is a state anxiety or tension. For example, an increase in hunger
or thirst should produce an immediate attempt to eat or drink.
The id is very important early in life because it ensures that an infant's needs are met. If the infant is hungry or
uncomfortable, they will cry until the demands of the id are satisfied. Growinng infants are ruled entirely by the id,
there is no reasoning with them when these needs demand satisfaction.
However, immediately fulfilling these needs is not always realistic or even possible.
If we were ruled entirely by the pleasure principle, we might find ourselves grabbing the things that we want out of
other people's hands to satisfy our own cravings.
This behavior would be both disruptive and socially unacceptable.
According to Freud, the id tries to resolve the tension created by the pleasure principle through the use of primary
process thinking, which involves forming a mental image of the desired object as a way of satisfying the need.
*Although people eventually learn to control the id, this part of personality remains the same infantile, primal force
throughout life.
*It is the development of the ego and the superego that allows people to control the id's basic instincts and act in ways
that are both realistic and socially acceptable.
The Ego :Reality Principle “I”
According to Freud, The ego develops from the id and ensures that the impulses of the id can be expressed in a
mAnner acceptable in the real world.
The ego functions in the conscious, preconscious, and unconscious mind.
The ego is the component of personality that is responsible for dealing with reality.
The ego operates based on the reality principle, which strives to satisfy the id's desires in realistic and socially
appropriate ways.
The reality principle weighs the costs and benefits of an action before deciding to act upon or abandon impulses.
In many cases, the id's impulses can be satisfied through a process of delayed gratification—the ego will eventually
allow the behavior, but only in the appropriate time and place.
As a metaphor, Freud compared the id to a horse and the ego to the horse's rider. The horse provides the power and
motion, while the rider provides direction and guidance. Without its rider, the horse may simply wander wherever it
wished and do whatever it pleased. The rider gives the horse directions and commands to get it to go where the rider
wants it to go.
The ego also discharges tension created by unmet impulses through secondary process thinking, in which the ego tries
to find an object in the real world that matches the mental image created by the id's primary process.
Imagine that are stuck in a long meeting at work. Find yourself growing increasingly hungry as the meeting drags on.
While the id might compel to jump up from your seat and rush to the break room for a snack, the ego guides to sit
quietly and wait for the meeting to end.
**Instead of acting upon the primal urges of the id, spend the rest of the meeting imagining yourself eating a meal.
Once the meeting is finally over, can seek out the object were imagining and satisfy the demands of the id in a
realistic and appropriate manner.
The Superego “ above I”
The last component of personality to develop is the superego.
According to Freud, the superego begins to emerge at around age five.
The superego holds the internalized moral standards and ideals that we acquire from our parents and society (our sense
of right and wrong).
The superego provides guidelines for making judgments.
**The superego has two parts:
The ego ideal includes the rules and standards for behaviors that the ego aspires to.
The conscience includes information about things that are viewed as bad by parents and society. These behaviors are
often forbidden and lead to bad consequences, punishments, or feelings of guilt and remorse.
If There Is an Imbalance?

The basic dilemma of all human existence is that each element of the makes demands upon us that are incompatible
with the other two. Inner conflict is inevitable
Ego failing to balance id and superego:intrapsychic conflict
Freud’s conflict model
Self in not unified. Self is not a single entity
Self is not rational
They components (id, ego, super ego) may be in conflicting position with one another
They will compete during events in life
In cases of Neurosis and psychosis, the severity of intrapsychic conflict is enormous and severe with rumination
patterns.
Id (irrational + emotional + demanding+ strong)
Ego (Rational+ Real + delay gratification) (ego develops from the id during  3 – 5 years during the phallic stage of
psychosexual development.)
Superego ( Morality + ego ideal + conscious ) (develops during early childhood 5- 6 years ,when the child identifies
with the same sex parent)
(Superego steps in when Mom or cops (authoritative figure) aren’t around)

Id is dominant : Self absorbed trait , Not caring about others, Unempathetic

Ego is dominant: distant, cold, unemotional, rational, efficient
Superego is dominant: Guilt ridden , belief of being morally superior to other people
When there is a conflict between the goals of the id and superego, the ego must act as a referee and mediate this
conflict. The ego can deploy various defense mechanisms (Freud, 1894, 1896) to prevent it from becoming
overwhelmed by anxiety.
According to Freud, the key to a healthy personality is a balance between the id, the ego, and the superego
If the ego is able to adequately moderate between the demands of reality, the id, and the superego, a healthy and well-
adjusted personality emerges. Freud believed that an imbalance between these elements would lead to a maladaptive
personality.
For example, an individual with an overly dominant id might become impulsive, uncontrollable, or even criminal.
Such an individual acts upon their most basic urges with no concern for whether their behavior is appropriate,
acceptable, or legal.
On the other hand, an overly dominant superego might lead to a personality that is extremely moralistic and
judgmental. A person ruled by the superego might not be able to accept anything or anyone that they perceive to be
"bad" or "immoral."
Resolving intrapsychic conflict
Acceptance
Awareness
Restructuring personality traits
Insight awareness
Repressed memories in to the conscious mind and resolve
Healthy defense mechanism
Active listening (therapist’s skill )
Techniques used for resolving
Hypnosis
Dream analysis
Free association
Word association
Interpretation of resistance and transference
Rorshach inkblot
Defense Mechanisms
Sigmund Freud (1894, 1896) noted a number of ego defenses which he refers to throughout his written works
Defense mechanisms are psychological strategies that are unconsciously used to protect a person from anxiety arising
from unacceptable thoughts or feelings.
Why do we need Ego defenses?
We use defense mechanisms to protect ourselves from feelings of anxiety or guilt, which arise because we feel
threatened, or because our id or superego becomes too demanding.
Defense mechanisms operate at an unconscious level and help ward off unpleasant feelings (i.e., anxiety) or make
good things feel better for the individual.
Ego-defense mechanisms are natural and normal.  When they get out of proportion (i.e., used with frequency),
neuroses develop, such as anxiety states, phobias, obsessions, or hysteria.
Denial :Denial is a defense mechanism which involves a refusal to accept reality, thus blocking external events from
awareness.
If a situation is just too much to handle, the person may respond by refusing to perceive it or by denying that it
exist.As might imagine, this is a primitive and dangerous defense - no one disregards reality and gets away with it for
long! It can operate by itself or, more commonly, in combination with other, more subtle mechanisms that support it.
Many people use denial in their everyday lives to avoid dealing with painful feelings or areas of their life they don’t
wish to admit. For example, A student may refuse to recognize their obvious lack of preparedness for an exam!
Repression : Repression is an unconscious defense mechanism employed by the ego to keep disturbing or threatening
thoughts from becoming conscious. Thoughts that are often repressed are those that would result in feelings of guilt
from the superego.
This is not a very successful defense in the long term since it involves forcing disturbing wishes, ideas or memories
into the unconscious, where, although hidden, they will create anxiety. Repressed memories may appear through
subconscious means and in altered forms, such as dreams or slips of the tongue ('Freudian slips’).
Example: Memories of childhood abuse are often repressed. An individual may not remember the abuse in adulthood,
but it can lead to anxiety and difficulty in forming relationships as an adult.
Repression examples:
Phobias, such as the fear of certain animals, are likely the result of a painful encounter with those animals in
childhood. The person may not remember the experience, but continues to have an inexplicable fear.
Slips of the tongue, known as “Freudian slips,” when people accidentally say something when they want to say
something else, may possibly reflect repressed thoughts.
Repression of emotions, on the other hand, often happens because expressing them may be perceived as unacceptable
behavior socially and culturally. For instance, in many cultures, men are discouraged from expressing sadness or fear,
because they are seen as signs of weakness. Anger is a negative emotion that is often repressed.
Repression of memories is thought to happen because they are too overwhelming and distressing to process and come
to terms with. Also known as dissociative amnesia, repression of memories may happen because an individual
dissociates themselves while undergoing trauma, to be able to survive through it
Psychological abnormalities occur because of:
Intrapsychic conflict : ego failing to balance id and superego
Overuse of defense mechanism
Fixation during psychosexual development
Psychosexual Stages of Development.
Important Characteristics and Experiences in Psychoanalysis
Free association. The therapist listens while the client talks about whatever comes to mind, without any censorship or
filtering. The therapist then tries to interpret these free associations, looking for unconscious causes of symptoms.
Dream analysis. The therapist listens while the client describes his or her dreams and then analyzes the symbolism of
the dreams in an effort to probe the unconscious thoughts of the client and interpret their significance.
Insight. An understanding by the patient of the unconscious causes of his or her symptoms.
Interpretation. The therapist uses the patient’s expressed thoughts to try to understand the underlying unconscious
problems. The analyst may try out some interpretations on the patient and observe how he or she responds to them.
Resistance. The patient’s use of defense mechanisms to avoid the painful feelings in his or her unconscious. The
patient might forget or miss appointments, or act out with hostile feelings toward the therapist. The therapist attempts
to help the patient develop insight into the causes of the resistance.
Transference. The unconscious redirection of the feelings experienced in an important personal relationship toward the
therapist. For instance, the patient may transfer feelings of guilt that come from the father or mother to the therapist.
Freudian techniques
In psychoanalysis, the "insight" is a sort of "clear understanding", but this is related to a kind of a feeling of liberation
as from a psychical burden. This "psychical burden" represents what we could call a psychological inner fact.
Clarifying this inner psychological fact is the task of psychoanalysis, more precisely of the interpretation of the
symptoms.
insight is the gaining of increased awareness or experience of a persons mental condition, leading to a greater
perception and understanding than was originally the case.
The term can apply equally to therapists gaining increased insight into the clients situation or condition as well as the
client becoming more aware of their own difficulties.
Psychoanalyst uses various techniques as encouragement for the client to develop insights into their behavior and the
meanings of symptoms, including inkblots, free association, interpretation (including dream analysis), resistance
analysis and transference analysis.
therapist plays this role by encouraging the client to talk about the emotions they are feeling and helping the client to
identify recurring patterns in their thoughts, emotions, and behaviors  and discovering the effects they exert upon the
client.
One of the most important roles of the therapist is to probe the client’s past. Discussion of the client’s childhood and
early life experiences will likely take up a large portion of psychodynamic sessions, as this form of therapy assumes
these experiences have a significant impact on the client’s current issues.
Psychoanalysis
The basic assumptions of this approach include:
Psychological problems are rooted in the unconscious.
Treatments focus on bringing the repressed conflict to consciousness.
Personality is largely influenced by childhood experiences.
Individuals employ defense mechanisms against threatening information from the unconscious.
The mind is composed of the id, ego, and superego.
Dreams are the royal road to the unconscious.
All tension is due to the increase of libido and that all pleasure is derived from its discharge.
Free Association
Free association may be the single most important and most used tool for psychodynamic therapists. This technique is
simple and often effective.
In the context of psychodynamic therapy, there are two meanings attached to “free association:” the more official
therapy technique of free association, and the general method of in-session discussion driven by the client’s free
association between topics.
What is Free association?
Technique used in psychoanalytic therapy to help patients learn more about what they are thinking and feeling in their
unconscious . It was created to show hidden and repressed memories and bring them to the surface. Therapist analyses
their client’s thoughts and figure out which pieces of the puzzle were missing so they can put everything together and
find a solution.
The more formal technique involves the therapist reading a list of words and the client responding immediately with
the first word that comes to mind. This exercise can shed light on some of the associations and connections the client
has hidden deep below the surface.
This technique may not be as useful to a client who is resistant to the exercise or to sharing intimate details with the
therapist. However, therapists should not assume that a client who pauses before responding is resistant—it may
indicate that the client is getting closer to a repressed or highly significant connection.
Free association may provoke an especially intense or vivid memory of a traumatic event, called an abreaction. This
can be extremely distressing for the client, but it can also lead to a healing experience of catharsis if the client feels
like it helped them work through a significant problem (McLeod, 2014).
What does a free association session look like?
Step 1: therapist will encourage client to relax. Client can keep your eyes open, but free association can feel easier to
do with your eyes gently shut.
Step 2: The client is asked to say out loud the first things that come to mind, without any kind of judgment or worry
about whether it sounds weird, illogical, or unacceptable. The client shouldn’t try to make any linear, understandable
story out of what they are saying.They just keep saying what comes to their mind.
Step 3: therapist will listen very carefully for things said that could relate to the conflict in client’s life. After, when
client naturally stops speaking and it seems he/she has finished, both of you them discuss what the therapist noticed.
Client can together work to recognize how it might connect to what is going on for them lately.
a therapist asks a person in therapy to freely share thoughts, words, and anything else that comes to mind.
Another form of free association is when the therapist mentions a single word and the patient spontaneously responds
with the first word that comes to mind. For example, the therapist says, 'mother' and the client immediately responds
with ‘slap’.
‘Happy’ with playing
‘Rain’ with sadness
Free-association test
A test in which participants are offered a stimulus word and are expected to respond as quickly as possible with a word
they associate with the stimulus.
Let’s say that Yuvi have been seeing an old friend gracy, a lot lately as she has recently left her husband. A few weeks
ago Yuvi told therapist about how she was irritated with her(gracy) for no reason, which made her feel terrible.
Perhaps, during free association a few weeks later, after saying words like, sandbags, tight heart, hungry… Yuvi
suddenly said things like, betrayal, feeling used, distrust.
Discussing the associations with therapist afterward, she might be sure that it’s about a colleague at work who keeps
asking Yuvi for advice on his projects and is Annoying her.
But Yuvi’s therapist might gently bring her attention back to this old friend.She suddenly realised that  she feels gracy
is using her, and that Yuvi is angry that when she was married she made no time for her but now she’s divorcing she
wants to be Yuvi’s best friend.
An example of how free association can solve a conflict
Using this new understanding of how Yuvi truly feels about the situation and her friend, therapist can discuss useful
new behaviours and action steps. Such as Yuvi might commit to meeting her for a coffee and honestly sharing how she
feels with her(gracy)
This might end up improving their relationship with your work colleague. He was really the subject of projection(ego
defense mechanism), where you put your tension with your friend onto him.
**Master of listening or being aware of inner dialogues during mind exercise
**As the client pays attention to emotional and sensations that are arising from their certain thoughts/ experiences/
imagining certain people : that is point of awareness and acceptance
How does therapist reaches to the depth of unconscious mind?
The patient is asked to get to a relaxed lying position and feel comfortable. Consequently the patient will speak freely
about whatever passes his/her mind, without focussing/or searching any specific topic or subject. The flow of his/her
thoughts has to free with no voluntary intervention.
Additional Techniques and ways in Free Association
Questionnaire tests : Filled with bunch of random questions that are not very personal but hidden inside are deeper
questions.To do this correctly the patient must answer the questions spontaneously so that they cAnnot think too much
and thus, are not able to filter the information.
Rorscharch inkblot test : A test where the patient’s perception of inkblot patterns are recorded and analysed. Some
psychologists also use this test to examine the personality characteristics and emotional functioning. It is very useful
especially in cases where patients are reluctant to describe their thinking processes openly.
The benefits of free association
Loosen the hold of your controlling conscious mind
Override defense mechanisms like repression and denial
Experience a space free of self-judgement
Identify what you really think and feel
Understand the contrast between what you tell yourself, and what is true for you
Recognise your true inner conflicts
Empower yourself to make choices that resolve your conflict over avoid it
Gain clarity on what new behaviours can now help client move forward.
Possible Limitations /problems of using free association
When a client might feel pressured to produce associations. This might be especially true if one have a codependent
personality. In your effort to please therapist, one could say things that didn’t really come naturally as free association.
When client can end up going really off track and into memory instead of associations. If client finds it hard to relax
and let go and have a very controlling mind, then one might also control the association.
This will be evident in things like making lists, reciting song lyrics, or saying too many things in a row that are clearly
very organised.
It is possible to create false memories. Client could blurt out something from imagination and worry it’s a memory.
A well-trained and experienced therapist should be able to help you differentiate.
Not all psychologists and therapists believe in free association as an effective tool. From the beginning Freud had
detractors who felt free association was putting too much pressure on the client. Others feel that the ability to free
associate is something that should come naturally, as a sign the client is progressing and healing, not be something a
client is forced to do. In fact nowadays classical Freudian free association is mostly just offered by psychoanalysts.
But the concept of free association has infiltrated most forms of therapy. This can look like a therapist asking you to
share the first word that comes to mind when thinking of a situation or person, asking you to quickly recall a situation
without judging what comes out, or maybe asking you to free-form journal about an experience.
Dream analysis
*Analysis of repressed memories, feelings and experiences which become surfaced in dreams
**This is because humans cAnnot consciously filter the dream content as well as context
**Defenses are lower during sleep
Dream contents: Latent ( constituting of wishes, motives, fears) + manifest (as they are manifested or appeared in
dream Like stories)
Dream analysis and free association gives interpretation of dreams
Transference
Transference  is an occurrence in which an individual redirects emotions and feelings, often unconsciously, from one
person to another. This process may occur in therapy, when a person receiving treatment applies feelings toward—or
expectations of—another person onto the therapist and then begins to interact with the therapist as if the therapist were
the other individual. Often, the patterns seen in transference will be representative of a relationship from childhood.
Generally, Transference often occur in therapy, but it does not necessarily imply a mental health condition.
Transference can also occur in various situations outside of therapy and may form the basis for
certain relationship patterns in everyday life
Paternal transference, when an individual looks at another person as a father or an idealized father figure. The person
may be viewed as powerful, wise, and authoritative, and an individual may expect protection and sound advice from
this person.
Non-familial transference can be seen when individuals treat others according to an idealized version of what they are
expected to be rather than who they actually are. Stereotypes can form in this mAnner. For example, priests may be
expected to be holy in everything they do, while policemen may be expected to uphold the law at all times, and
doctors may be expected to cure any ailment.
A person is easily Annoyed by a classmate who looks a bit like their often-irritating younger sibling.
A young person treats a much older female coworker with tenderness because she brings back memories of that
person’s now-deceased mother.
Transference and Psychoanalysis
Transference is somehow advantageous as it allows the patient to relieve their repressed emotions at a current time
state.
A person’s social relationships and mental health may be affected by transference, as transference can lead to harmful
patterns of thinking and behavior.
When transference occurs in a therapeutic setting, a therapist may be able to better understand an individual by gaining
knowledge of the projected feelings and, through this new understanding, help the person in therapy achieve results
and recovery.
By understanding how transference is occurring, a mental health professional may be better able to understand both a
person’s condition and/or aspects of the person’s early life that affect them in the present.
**Transference works in favour of:
Exploring transference can open discussion for a topic which the client is trying to filter/ avoid so as not to disclose
deliberately
Influence of past in client’s current functioning
This give birth to ‘Resistance
Idealized Mother Transference
I love my therapist like a Mother. It feels so warm and safe being in the session with her; I don't want it to ever end.
(Richards's example) (feelings just for the therapist)
Idealized Father Transference
My therapist is like a father I never had. He's so strong and sure of himself. I want to absorb all his goodness.
Negative Transference
My therapist is so cold and distant. I don't think she cares at all. I'm just a number to her. (Tanya's example)
Transference involves a wide range of emotions. All of them are valid.
Negative emotions of transference include:
anger
disappointment
frustration
hostility
fear
frustration
Positive emotions of transference include:
attentiveness
idealization
love
affection
attachment
How is transference different from projection?
https://peace-inthestorm.blogspot.com/2015/02/transference-vs-projection-whats.html
Transference takes place when someone transfers another person's qualities, feelings, behaviors, etc., to a different
person and then reacts to the different person as if he/she were the other person.
It takes at least three people to have a transference scenario. ‘anticipate’ The patient might anticipate and expect the
therapist’s response to be similar to that of past persone( childhood caregiver , parent etc)
For patients ‘transference is like looking at a person but seeing someone else’
Projection is based on the belief that the best form of defense is attack.
Projection occurs when you attribute a behavior or feeling you have about a person onto them. Then, you may begin to
see “evidence” of those feelings projected back at you.
For example, projection occurs when you realize you aren’t too fond of the new co-worker two cubicles over. You
aren’t sure why, but you get that feeling. Over time, you begin to convince yourself that they’re showing signs of
dislike for you. Individual behaviors act as “proof” of your theory.
The attributed emotions may be both positive (love, adoration, worship) or negative (hostility, aggression, jealousy).
They can also grow as your feelings toward the person grow.
Resistance
Definition of resistance
It became evident that the work of uncovering what had been pathogenically forgotten had to struggle against a
constant and very intense resistance. The critical objections which the patient raised in order to avoid communicating
the ideas which occurred to him, and against which the fundamental rule of psycho-analysis was directed, had
themselves already been manifestations of this resistance.
A consideration of the phenomena of resistance led to one of the corner-stones of the psycho-analytic theory of the
neuroses - the theory of repression. It was plausible to suppose that the same forces which were now struggling against
the pathogenic material being made conscious had at an earlier time made the same efforts with success. (Sigmund
Freud: An Outline of Psychoanalysis, 1940.)
Resistance in a psychoanalytic context is anything that works against the progress of therapy and prevents the patient
from accessing unconscious material.
Resistance then is any idea, attitude, feeling, or action that gets in the way of potential change. During free association,
a patient may show an unwillingness to relate to certain thoughts or experiences. Freud views resistance as an
unconscious process that people use to protect themselves against intolerable anxiety and pain that might result if they
became aware of the repressed feelings.
In therapy, resistance blocks both the patient and therapist from gaining insight into the processes of the unconscious.
The analytic therapist's role is to point out resistance when it is observed in hopes that the patient will acknowledge the
block and deal with the conflict.
Resistance in psychoanalytic therapy is not something to be rid of, but something that must be dealt with. The anxiety
that causes the resistance will not lessen unless the resistance is faced.
Having said this, it is important that the analytic therapist respects the resistances of clients and assists them in
working therapeutically with their defenses. When handled properly, resistance can be one of the most valuable tools
in understanding the patient.
It can be :
resistance to the recognition of feelings, fantasies, and motives; 
resistance to revealing feelings toward the therapist;
resistance as a way of demonstrating self-sufficiency;
resistance as clients' reluctance to change their behavior outside the therapy room
Analysing the Resistance
Resistance can take many forms in psychotherapy and affect a client's behavior in many ways. The following is a list
of some forms of resistance which a client may use to keep from dealing with certain topics with their therapist.
Silence or minimal discussion with the therapist
Wordiness or verbosity
Preoccupation with symptoms
Irrelevant small talk
Preoccupation with the past or future
Focusing on the therapist or asking the therapist personal questions
Discounting or second-guessing the therapist
Seductiveness
False promises or forgetting to do what is agreed upon
Not keeping appointments
Failing to pay for appointments
In ego terms, resistance refers to the customary and automatic ways in which clients both reveal and keep hidden
aspects of themselves from the other, especially as these occur in their relationship with the therapist.
It is a way of avoiding and yet expressing unacceptable drives, feelings, fantasies, and behavior patterns. However, it
is also how clients assert their healthy human need to be autonomous and separate from others, or to protect their sense
of self in an adaptive fashion
Analysis of Transference and resistance
Interpretation
Clarification
Confrontation
Transference interpretation is classically defined as making something conscious to the patient that was previously
unconscious—specifically, that the patient's attributions of certain qualities to the therapist derive from past figures
The techniques of analysis (Analyzing resistance/ transference)
Confrontation – the first step in analyzing, confrontation is the process of drawing the patient’s attention to a particular
phenomenon and getting him to recognize something that he has been avoiding and that will have to be further
understood. Examples: “I notice that each time your boss praises your work, you become disinterested in your job and
think about quitting.” “It seems that you often become angry with me right before I go on vacation.”
Clarification – after a phenomenon is brought to the patient’s attention, the details need to be elucidated and separated
out from other thoughts that the patient is having. Example: “You’ve mentioned feeling anxious in sessions recently,
but it now seems clear that this started right after you mentioned to me that you were having difficulty with your
wife.”
Interpretation – Once a phenomenon is elucidated and brought into focus, the therapist can then interpret its
unconscious meanings. To do this, the therapist makes connections between the patient’s current behavior (including
thoughts, feelings, fantasies, and dreams) and the patient’s past history (including childhood experiences, wishes and
fears). Examples: “Despite your wish to remain close to your husband, you are pushing him away just as you felt that
your mother pushed you away” “Your anxiety at the 4 prospect of having to work on this project with your junior
colleague stems from your fear that she, like your younger sister, will be perceived as more talented than you are”.
Two types of interpretation include i. Dream Interpretation ii. Transference Interpretation
Working Through – The complex and extended process of gradual change reflecting the efforts of insight, practicing,
recognizing behaviors, future insight
Catharsis
Why is it important to express emotions?
Society often exerts a repressive role on emotions. It is considered bad to express any specific emotion, that way is
encouraged their repression, which leads us to bury them in the depths of the unconscious.
However, emotional expression is part of a mature and balanced “ego”. Every emotion that we experience and express
is part of our essence.
Emotions act as compasses that instantly indicate reactions of pleasure or rejection, so they should never be repressed,
it is only necessary to learn to express them assertively.
A repressed emotion will end up generating a conflict that will be encased in the unconscious, simply because we have
not processed the message of that emotion and we have not used it adaptively. On the contrary, assimilating emotions,
especially “negative” ones, will allow us to understand and use them in our favor to grow.
Catharsis
The theory of catharsis is one popular and authoritative statement that venting one’s anger will produce a positive
improvement in one’s psychological state. The word catharsis comes from the Greek word katharsis, which literally
translated means a cleansing or purging. According to catharsis theory, acting aggressively or even viewing aggression
is an effective way to purge angry and aggressive feelings.
Catharsis theory predicts that rumination works best, but empirical evidence is lacking. Catharsis is the process of
releasing strong emotions; catharsis is associated with relieving unconscious conflicts.
He defined catharsis as “The process by which we reduce or eliminate a conflict by activating it in the consciousness
and allowing it to express itself”.
Examples of Catharsis
Though little research has supported the efficacy of catharsis, here are some examples of it being put into practice,
some of which you might even find familiar:
Bill and Rosa have noticed their son has been violent with his younger sister so they buy him a violent video game so
he can get rid of his aggression that way.
Julia is angry because her mother will not allow her to go to the party, so she goes to her bedroom, slams the door, and
punches her pillows.
Therefore, emotional catharsis:
Makes client feel better by releasing negative emotions and,
Leads client to a positive change in “ego” allowing them to integrate these repressed contents.
Catharsis : Process of venting out aggression , release aggression and get rid of emotions
According to this theory, repressed feelings build up as pressure if not vented out , This can be compared to a balloon
which bursts because of pressure , if the air is filled continuously.
Contradictory studies support that venting out aggression might not relieve it, it may increase the aggressiveness
The studies backing the advantage of catharsis are not sufficient
Contradiction study for catharsis
The physical ventilation of emotions can help and have a small cathartic effect but it is necessary to go a step further.
If mere physical catharsis were a constructive practice, the work of psychologists would be much simpler. To heal and
resolve conflicts it is not enough to act and experiment, it is necessary to work at the conceptual level with the image
of the “ego”.
In this study, angered participants hit a punching bag and thought about the person who had angered them (rumination
group) or thought about becoming physically fit (distraction group). After hitting the punching bag, they reported how
angry they felt. Next, they were given the chance to administer loud blasts of noise to the person who had angered
them. There also was a no punching bag control group. People in the rumination group felt angrier than did people in
the distraction or control groups. People in the rumination group were also most aggressive, followed respectively by
people in the distraction and control groups. Rumination increased rather than decreased anger and aggression. Doing
nothing at all was more effective than venting anger. These results directly contradict catharsis theory.
Catharsis theory predicts that venting anger should get rid of it and should therefore reduce subsequent aggression.
The present findings, as well as previous findings, directly contradict catharsis theory (e.g., Bushman et al., 1999;
Geen & Quanty, 1977). For reducing anger and aggression, the worst possible advice to give people is to tell them to
imagine their provocateur’s face on a pillow or punching bag as they wallop it, yet this is precisely what many
psychologists advise people to do. If followed, such advice will only make people angrier and more aggressive.
Is catharsis always beneficial? PHYSIOLOGY AND CATHARSIS
A study conducted at the University of Illinois found that catharsis causes changes at the physiological level that can
help us find emotional balance more quickly.
These psychologists appreciated that ventilating emotions generates a decrease in blood pressure and changes the
rhythm of breathing, which could help calm us down. In fact, when we are angry we breathe at a different rate than
when we are calm or sad.
Each emotion has its breathing rhythm, so that when our mental state changes, our breathing changes immediately.
Therefore, by regulating our breathing we can also control emotions.
Indications and contraindications of catharsis
people who are having trouble with stress, anger, and their emotions, and many people have relied on it to successfully
release these feelings.
catharsis triggers more thoughts and emotions of the same nature. For example, if you are angry and you start shouting
and throwing things, you activate more aggressive thoughts, emotions, and behaviors
it often justifies overreacting and hurts our psychological health. Overreacting to many things per day can lead to, and
at the same time result from, anger issues
catastrophizing is the process , of seeing events much more serious than they objectively are can be a result of
rumination of emotions as catharsis
Hypnosis
Hypnosis is a therapeutic technique in which clinicians make suggestions to individuals who have undergone a
procedure designed to relax them and focus their minds.(APA)
Although hypnosis has been controversial, most clinicians now agree it can be a powerful, effective therapeutic
technique for a wide range of conditions, including pain, anxiety and mood disorders. Hypnosis can also help people
change their habits, such as quitting smoking.
Hypnosis, also referred to as hypnotherapy or hypnotic suggestion, is a trance-like state in which you have heightened
focus and concentration. Hypnosis is usually done with the help of a therapist using verbal repetition and mental
images. When you're under hypnosis, you usually feel calm and relaxed, and are more open to suggestions.
A trance is a state of mind in which someone seems to be asleep and to have no conscious control over
their thoughts or actions, but in which they can see and hear things and respond to commands given by other people.
The process typically includes three steps:
Hypnotic Induction: Clients first go through a process to reach hypnosis, called the hypnotic induction. In general, the
client would be seated in a chair (or lying on a couch, bed, or anywhere comfortable) with eyes closed. Client may also
use controlled breathing techniques and/or a script to relax and focus. People can follow a memorized script, a
recording, or they can be induced by a professional hypnotherapist.
Hypnotic State: Following induction, hypnotic state is reached. In the hypnotic state, client feel mentally and
physically relaxed, calm and focused, and experience heightened awareness.
Hypnotic Suggestion: Once in hypnosis, the patient receives hypnotic suggestions. These suggestions are designed to
replace and update subconscious thoughts. Suggestions can be formed in different ways. Traditional hypnosis for
example uses direct commands or metaphors.
** Hypnotic suggestibility is a trait-like, individual difference variable reflecting the general tendency to respond to
hypnosis and hypnotic suggestions. 
Hypnotherapy techniques:
Visualization: For relaxation
Suggestions: ‘Suggestion’ in hypnotherapy means an idea given to the deeper part of your mind – the subconscious –
to help change your thinking so that you are more likely to whatever you are seeking to achieve.
direct suggestion: ‘You now allow yourself to appreciate your strengths.’ Obviously, this is a straightforward request
that you think in a certain way.
Anchoring:Have you ever turned on a radio, and heard an old song that brought back feelings or memories you
experienced a long time ago? Have you ever felt an automatic reaction to a certain look someone gives you, or a tone
of voice?
If so, you have experienced the effect of an "anchor“.Anchors work like a shortcut icon on your computer to access
different states, or bring to mind ideas and concepts. Anchoring is a process that on the surface is similar to the
“conditioning” technique. Anchoring enables us to do this by linking a simple action or event, to a time when we were
in that useful state.  Then, when we want to bring that resourceful state back, we can use the action to evoke it once
more.
Anchor example: "Whenever I bring my thumb and index finger together in this manner, my mind and body
automatically adjusts to a level of awareness where I am calm, focused and in control."
Mental Rehearsal
We can use the process of visualization for another purpose – to mentally rehearse something. Again, the mind will
respond as though you really were rehearsing, and so you could, for example, imagine practising your golf, thereby
improving your actual performance
Hypnotherapy has been shown to be effective for a number of unconsciously motivated conditions. Some of the most
common include:
Phobias and fears – Hypnosis reframes the fear and untangles the associations that keep that fear in place. Hypnosis
can help with: Fear of flying, driving, heights, the doctor or dentist, insects, intimacy or success.
Habits – Habits are deeply embedded in our thinking due to repetition and reinforcement. Smokers have numerous
triggers: Stress, mealtimes, driving, and boredom, to name a few. Hypnosis allows people to examine these
unconscious triggers and get rid of them. Hypnotherapy can help with: Smoking, substance abuse, gambling,
overeating and procrastination.
Worrisome Thinking: Worries, often times, are irrational and they can get in the way of life. Hypnosis helps us
examine our worries, and provide new information that can help us establish more positive associations. Hypnosis can
help with: General anxiety, social anxiety, exam anxiety, stage fright, performance anxiety, and public speaking.
Negative Self-Talk: Our subconscious minds control our perceptions of ourselves. And when negative thoughts are
formed, they can impact our confidence. Hypnosis seeks to reframe these negative self-thoughts and update them with
positive information. Hypnosis helps with: Self-criticism, self-confidence, self-esteems, self-awareness, body
dysmorphia, negativism, indecision and insecurity.
Health Conditions: Many general health conditions stem from negative subconscious thoughts. For example,
insomniacs may have a fear or worry that they won’t fall asleep. By examining and reframing these thoughts,
insomniacs can begin to reverse the thinking behind their condition. Hypnosis can help with: Stress, hypochondria,
headaches, chronic pain management, agoraphobia, impotence, and insomnia.   
Hypnosis : Indications
treatment of pain (pain due to burns, cancer, childbirth, irritable bowel syndrome, fibromyalgia, dental procedures and
headaches.)
depression
anxiety and phobias; stress; habit disorders; gastro-intestinal disorders; skin conditions; post-surgical recovery; relief
from nausea and vomiting; childbirth
post-traumatic stress, obsessions, trauma, grief, bulimia, anorexia, weight loss, smoking, alcoholism, drug addiction,
other addictions.
Improving mental performance, lack of concentration and loss of memory, shyness, tendency to blush, public
speaking, passing exams, change of life, self-confidence, stuttering
The two main types of stuttering are:
Developmental stammering - this is the most common type and happens in early childhood when language skills are
developing.
Acquired/late-onset stammering - this is more rare, occurring in older children and adults as a result of stroke, a head
injury of a progressive neurological condition. It can also happen as a result of certain drugs or medication and trauma.
In other cases, stuttering starts after the developmental stage. This can happen after a head injury, a stroke or due to a
neurological condition. It’s also believed that trauma and times of intense stress can lead to the development of a
stutter.
Interiorised stuttering
Interiorised stammering can happen when you have strong negative feelings about your stammer. You may have high
levels of fluency when you talk, but also avoid situations that could trigger your stammer or make it worse.
hypnotherapy can be used to explore when your stutter first started and analyse what happened and why it may have
triggered your stutter. Therapist help change your beliefs about the situation and desensitize your reactions to the
memory.
Hypnotherapy can also help you develop strategies to cope better with your day-to-day triggers too (for example in
social situations or public speaking
deeply relaxed state where your unconscious is more open to suggestion. Here, the therapist can offer ‘suggestions’ to
ease stress, reduce anxiety and build confidence
Hypnotherapy can be an effective method for coping with stress and anxiety. In particular, hypnosis can reduce stress
and anxiety before a medical procedure
Hypnosis has been studied for other conditions, including:
Pain control. Hypnosis may help with pain due to burns, cancer, childbirth, irritable bowel syndrome, fibromyalgia,
temporomandibular joint problems, dental procedures and headaches.
Hot flashes. Hypnosis may relieve symptoms of hot flashes associated with menopause.
Behavior change. Hypnosis has been used with some success in the treatment of insomnia, bed-wetting, smoking, and
overeating.
Cancer treatment side effects. Hypnosis has been used to ease side effects related to chemotherapy or radiation
treatment.
Mental health conditions. Hypnosis may help treat symptoms of anxiety, phobias and post-traumatic stress.
Adverse reactions to hypnosis are rare, but may include:
Headache
Drowsiness
Dizziness
Anxiety or distress
Creation of false memories
Hypnosis : Indications and Contraindications, Limitation
Hypnosis is a trance-like mental state in which people experience increased attention, concentration, and
suggestibility. While hypnosis is often described as a sleep-like state, it is better expressed as a state of focused
attention, heightened suggestibility, and vivid fantasies. People in a hypnotic state often seem sleepy and zoned out,
but in reality, they are in a state of hyper-awareness.
While there are many myths and misconceptions, hypnosis is a very real process that can be used as a therapeutic tool.
Hypnosis has been shown to have medical and therapeutic benefits, most notably in the reduction of pain and anxiety.
Between 10% to 15% of people are very responsive to hypnosis.
Approximately 10% of adults are considered difficult or impossible to hypnotize.
Children tend to be more susceptible to hypnosis.
People who can become easily absorbed in fantasies are much more responsive to hypnosis.
Hypnotherapy activates a deep relaxation response in your body. This relaxation response reduces sympathetic
nervous system activity, decreases blood pressure, slows heart rate,  and accelerates healing.
Hypnosis : Contraindications and Limitations
Hypnosis is not recommended for people with psychotic disorders: psychotic subjects in an acute phase of
schizophrenia, paranoia or mania; some borderline persons and presenting a mental retardation.
HYPNOSIS LIMITATIONS
Hypnotherapy might not be appropriate for a person who has psychotic symptoms, such as hallucinations and
delusions, or for someone who is using drugs or alcohol
Hypnosis cAnnot repair congenital damage or genetic problems.
Patients may find it both painful and unpleasant to discover memories that they have repressed, sometimes for many
years.
It is not an appropriate treatment for some mental health problems, such as schizophrenia and bipolar disorder.
It can be both expensive and lengthy, so it requires a deep level of commitment from both patient and therapist.
Indications of Psychoanalytic therapy
Conditions and disorders for which psychoanalytic psychotherapy appears to be indicated include personality
disorders (except antisocial personality disorder); post traumatic stress disorders; symptom neuroses or neurotic
conflicts; adjustment disorders; and mood, anxiety disorders, somatoform, sexual and gender identity, eating,
substance abuse and dissociative disorders
In addition, psychoanalytic psychotherapy is often employed in treating patients who present with relational problems
and with history of  abuse or neglect
certain impulse disorders and when psychological problems are affecting or are the result of their primary medical
illnesses.
Using the principles of psychoanalytic theory, an analyst provides therapy. During the therapy sessions, the
psychoanalyst listens as the patient discusses fantasies and dreams and narrates experiences. The therapist searches for
recurring patterns or events from the past that may play a role in the patient’s current problems. A psychoanalyst also:
Meets with patients individually
Holds sessions approximately four times a week for 50 minutes or longer each session
Encourages patients to self-identify their emotional states
Helps patients understand the subconscious factors that drive their behavior
Maintains patient confidentiality
Keeps detailed notes of each session
MODULE III

What is Psychoanalytic?
(Principles)
Psychological problems are rooted in the unconscious.
Treatments focus on bringing the repressed conflict to consciousness.
Personality is largely influenced by childhood experiences.
Individuals employ defense mechanisms against threatening information from the unconscious.
The mind is composed of the id, ego, and superego.
Dreams are the royal road to the unconscious.
All tension is due to the increase of libido and that all pleasure is derived from its discharge.
Advantages and Disadvantages of Psychoanalytic Therapy
Psychoanalysis was once the only type of psychotherapy available, but presently the number of therapists practicing
this approach is decreasing around the world. Psychoanalysis is not appropriate for some types of patients, including
those with severe psychopathology or mental retardation. Further, psychoanalysis is often expensive because treatment
usually lasts many years.
Perhaps the greatest disadvantage of psychoanalysis and related approaches is the lack of empirical support for their
effectiveness. The limited research that has been conducted on these treatments suggests that they do not reliably lead
to better mental health outcomes (e.g., Driessen et al., 2010).
And, although there are some reviews that seem to indicate that long-term psychoanalytic therapies might be
beneficial (e.g., Leichsenring & Rabung, 2008), other researchers have questioned the validity of these reviews.
Nevertheless, psychoanalytic theory was history’s first attempt at formal treatment of mental illness, setting the stage
for the more modern approaches used today.
Difference between Psychodynamic and Psychoanalytic
Theorists
Psychoanalytic perspective refers to theories and therapeutic methods which are based on the original works of Freud,
who coined the term “psychoanalysis” in 1896. On the other hand, psychodynamic perspective refers to the therapeutic
approach and theories developed by Freud and supported by his followers such as the neo-Freudians (Jung, Adler,
Horney, Erikson, Klein, etc.).
Focus
Psychodynamic perspective generally deemphasizes ‘libodo ‘ and gives more importance to the influence of social
environment. On the contrary, the psychoanalytic perspective gives more importance to the influence of the libido.
Therapy 
Psychodynamic therapy is an in-depth form of talk therapy which is usually delivered once a week (APA, 2017).
Aside from looking into the unconscious and past experiences, this approach also considers the impact of the external
world. This is also known as “insight-oriented therapy” which is the oldest type of modern therapy (Embogama,
2016). In comparison, psychoanalytic therapy usually takes place several times a week with the patient on a couch
(APA, 2017). It is based on Freud’s psychoanalytic theories and is  generally more intensive and lasts longer than
psychodynamic therapy. 
What is Psychodynamic? 
Psychodynamic perspective refers to the therapeutic approach and theories developed by Freud and supported by his
followers such as the neo-Freudians (though they disagreed with some of his concepts); they generally deemphasized
sex and gave more importance to the influence of social environment. Some of them are: 
Carl Jung
Jung was a Swiss psychiatrist who was Freud’s protégé.  His theory is called “Analytical Psychology”; he met Freud
in 1907, they were impressed with each other’s work and developed a close friendship.  In fact, Freud viewed Jung as
his intellectual heir. However, Jung broke away from Feud in 1913 due to their differing concepts.  He thought that
Freud’s theory of the unconscious was too negative and incomplete. For instance, Jung proposed that there was a
deeper and transpersonal form of unconscious called the “collective unconscious” which is manifested by universal
symbols. Freud then dismissed Jung’s interest in myths as being unscientific. 
Alfred Adler 
Adler was an Austrian psychiatrist, his theory is called “Individual Psychology”. He was the first president of the
Vienna Psychoanalytical Society; hence, he was a part of Freud’s inner circle of colleagues. Instead of sexual and
aggressive urges, Adler believed that we are driven by feelings of inferiority in childhood and that people should be
studied as a whole. Because of his disagreements with Freud, Adler left the society, taking one third of the members
with him. 
Karen Horney
Horney was a German psychoanalyst who also questioned some of Freud’s theories. She is credited for her feminist
psychology
When the International Psychoanalytical Association formed in 1910 Jung became president at the request of Freud.
However in 1912 while on a lecture tour of America Jung publicly criticized Freud’s theory of the Oedipus
complex and his emphasis on infantile sexuality. The following year this led to an irrevocable split between them and
Jung went on to develop his own version of psychoanalytic theory.
Alfred Adler (1870-1937), world renowned philosopher and psychiatrist, stressed the need to understand individuals
within their social context. During the early 1900's, Adler began addressing such crucial and contemporary issues as
equality, parent education, the influence of birth order, life style, and the holism of individuals. Adler believed that we
all have one basic desire and goal: to belong and to feel significant.
Adler developed the first holistic theory of personality, psychopathology, and psychotherapy that was intimately
connected to a humanistic philosophy of living. His lectures and books for the general public are characterized by a
crystal clear common sense. His clinical books and journal articles reveal an uncommon understanding of mental
disorders, a deep insight into the art of healing, and a great inspiration for encouraging optimal human development.
The expressive therapies are based on the assumption that people can heal through the various forms of creative
expression. Expressive therapists share the belief that through creative expression and the tapping of the imagination,
people can examine their body, feelings, emotions, and thought process.
Expressive Therapy
A therapeutic garden is a plant-dominated environment purposefully designed to facilitate interaction with the healing
elements of nature. 
Horticultural therapy techniques are employed to assist participants to learn new skills or regain those that are lost.
Horticultural therapy helps improve memory, cognitive abilities, task initiation, language skills, and socialization. In
physical rehabilitation, horticultural therapy can help strengthen muscles and improve coordination, balance, and
endurance. In vocational horticultural therapy settings, people learn to work independently, problem solve, and follow
directions. Horticultural therapists are professionals with specific education, training, and credentials in the use of
horticultural for therapy and rehabilitation.
Experience-based evidence
There is clear, usage-based evidence of the positive effects of expressive therapies in helping treat children and adults
who've experienced trauma, cancer patients, people with post-traumatic stress disorder (PTSD), dementia and more.
Creative therapies have also been shown to improve concentration, lower anxiety and possibly prevent suicide.
Some form of creative therapy has been practiced by cultures throughout the ages as a way to provide relief from acute
emotional distress.
As neuroscience unfolds more about the mind/body connection, practitioners point to the benefits of engaging in a
creative process that helps promote healing. Studies tracking brain changes during these engagements point to an
alteration in brain function, which may contribute to the relearning of key skills and mental, emotional, and physical
healing.
THE ORIGINS OF FORMAL ART THERAPY
The formal practice of art therapy has its origins in the mid-20th century Europe, with the coining of the term being
attributed to British artist Adrian Hill in 1942.
At a time where thousands suffered in sanatoriums from tuberculosis, it was observed that drawing and painting was a
creative outlet for patients that provided them the freedom their confines did not.(A sanatorium (or sanitorium) is
a medical facility for long-term illness, most typically associated with the treatment of tuberculosis (TB) in the late-
nineteenth and early-twentieth century before the discovery of antibiotics.)
The practices in art therapy soon spread to mental hospitals through the work of Edward Adamson, who observed and
further studied the connection between artistic expression and emotional release. The British Association of Art
Therapists was founded in 1964.
Goals of Expressive Therapies
The goal of Expressive therapy is to promote healing and reveal hidden conflicts in a patient
Providing insight
Representation of verbal description through art, dance and music. 
The focus of treatment is getting to know the feelings that are associated with the patient's aesthetics being that
auditory and visual stimuli are often used as a mental and emotional outlet.
The art symbolizes the client’s experiences, such as trauma or fear
The goal isn't to diagnose the final product but allow the patient to express themselves in a manner that they are
comfortable with.
individual has no obligations in analyzing their own work because the goal is to help them by discussing the art in a
non-judgmental manner and supportive setting.
When is Expressive Therapy Used?/Indications
Expressive Therapy is a broad category and can be used to treat various conditions by helping the patient familiarize
themselves with their own emotions and expressions. Treatment may be used when a patient is dealing with
depression, anxiety, stress, self esteem issues, interpersonal relationship conflicts, learning problems and eating
disorders. The outlet can help clients who have been diagnosed with dementia, Alzheimer's, chronic conditions,
trauma and addiction.
The sessions vary depending on the outlet type. If it is art therapy the client will either draw or paint images that
reflect their thoughts. Music therapy consists of singing, writing songs or playing instruments.
Clients may also listen to music to bring out positive emotions being that sounds can help many cope with depression
and worry. Sessions may consist of poetry and writing in which the individual can express their emotions on paper
instead of verbally. If the session is a form of dance it will help people cope with any physical or mental illnesses
through movement. This is a way to improve physical health as well. Drama therapy consists of improvising or acting
for the purpose of expressing emotion and coping
ART THERAPY
Techniques used in art therapy can include:
Collage
Coloring
Doodling and scribbling
Drawing
Finger painting
Painting
Photography
Sculpting
Working with clay
As clients create art, they may analyze what they have made and how it makes them feel. Through exploring their art,
people can look for themes and conflicts that may be affecting their thoughts, emotions, and behaviors.
RESEARCH AND INNOVATION IN THE FIELD
It’s been widely studied and observed how art therapy is effective to treat trauma, abuse, grief, anxiety, and eating
disorders. It is a helpful tool to alleviate stress through major life transitions and eases pain and suffering associated
with mental, physical and emotional diseases.
By working to bring the conscious, unconscious and subconscious into expressive and tangible forms, the creative
processes involved in art therapy have been praised for their ability to encourage personal growth, mindfulness, and
self-discovery.
Students’ response
When was the last time you picked up a paintbrush or a colored pencil?
Maybe it’s been a while, but what about the last time you doodled on your notebook during a meeting/ class?
For many of us, when we think of art, we tend to think it’s not for us. Perhaps we think we aren’t very creative, but
there’s more to it than merely being ‘good at drawing.’
Allowing our brains the freedom for free expression, even by doodling, can have a wonderful impact on how we
process, retain, and share information.
Naumburg wrote several influential books on the topic of art therapy, believing that when creative pursuits are seen as
another form of expression, they can be used in conjunction with traditional communication to unearth repressed and
unconscious memories and emotions.
Her work led others to begin exploring the field, building its reputation within the psychological community,
including:
Florence Cane,((1882-1952) was a Progressive art educator who worked to release the inner artist in each child) an art
educator who began to use teaching methods that encouraged artistic expression and emotional creativity.
Edith Kramer (Edith Kramer (1916–2014) was an Austrian social realist painter, a follower of psychoanalytic theory
and an art therapy pioneer) who developed a more process-oriented art therapy approach based on psychotherapy
ideas of the ego and that promoted the development of identity.
Elnor Ulman (Elinor Ulman, 81, adjunct professor emeritus of art therapy at George Washington University)
established the first journal in the United States dedicated to art therapy, alongside one of the first training programs
for psychologists wishing to train in art therapy.
A Brief History of Art Therapy
history of art therapy For centuries, art and drawing have been used all over the world as tools for communication,
storytelling, self-expression, and social interaction.
As far back as there have been humans, there has been art. Just think of the original cave drawings.
Art as a therapy practice was only accepted more recently. The term ‘Art Therapy’ was coined in 1942 by Adrian Hill,
a British artist, who attributed painting and drawing to his recovery from tuberculosis. However, the benefits of the
practice of art for emotional health go back further than this.
In 1915, Margaret Naumburg, often referred to as the Mother of Art Therapy, established the Walden School in New
York. Naumburg believed that children should be allowed creative freedom and that allowing them to pursue subjects
that interested them would enable healthy development.
Indications of ART therapy
Effective use in PTSD and beyond
PTSD is defined as “an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened." PTSD affects all aspects of a person's life, from jobs to relationships.
Children who suffer from PTSD can have difficulty in school and experience behavioral issues, isolation, and phobias.
In a study of PTSD sufferers, Joshua Smyth, PhD, at Pennsylvania State University, related the need for, and evidence
of, results with what he calls “alternative therapies” that provide access to sufferers’ experiences without directly
recalling these experiences verbally. 
reducing the severity of depression (which often accompanies PTSD), and/or improving quality of life. The
documented impact of the creative arts therapies on symptoms of trauma and post-traumatic stress disorder has
inspired two national summits on arts and health in the military
Claire reflects on her experience of art therapy, adolescent trauma and emotional dysregulation
At the age of 17 years old, Claire accessed art therapy for approximately 9 months. Claire started art therapy within a
community service, after being discharged from several consecutive Inpatient Units...
Individual art therapy session
Art therapy postcard activity
Most people would probably agree that it’s easier to express or recognize hurts and regrets when there’s the distance
between yourself and the problem. This is why the postcard activity can be a good self-discovery exercise that helps
answer the question, “What would I say to someone if I didn’t have to do it face-to-face?”
This activity can be used in one-to-one or group therapy sessions. Here’s how to conduct the activity:
Print out the postcard by following the link above or simply create a postcard-style template to use. One side can be
completely blank for drawing, and one side can be laid out with some lines for writing.
Ask participants to reflect on a situation or person they feel or felt frustrated, angry, upset, or sad about. Spend a
moment simply thinking about and reflecting on what happened, how it felt, and what they would like to let the person
know about how the experience made them feel.
On the blank side of the postcard, ask participants to draw or create a visual representation of how they felt or still feel
about the experience. Explain that there is total freedom with this, and they can create anything they like with any
materials.
On the lined side of the postcard, participants can write what they would like to say if they could.
Use what they draw and write to explore their emotions further and discuss how they might begin to work toward a
healing resolution.
Color your feelings
This set of three worksheets includes exercises for children to express their emotions or define the things they care
about. It’s a very quick and easy exercise that can help participants create helpful visual representations of the things
they value.
The worksheets include an empty outline of a heart.
Here’s how to use it.
You will need:
The printed worksheets
Markers and colored pencils
Glitter, sequins, and glue (if desired)
Process:
Ask participants to take a moment to reflect on the things that make their heart happy. What things make them feel
good? What words would they use to describe these things? What images and colors come to mind when they think
about these things?

2. Provide participants with the worksheets and ask them to fill the heart with what they have just been thinking and
talking about. They can create these in any way they like, focusing on one thing or filling the heart with as many
things as they want.

3. Use what they create as a discussion point to help them better understand the things that make their heart happy.
How often do these things happen for them? How can they and you work together to create more of these happy
moments?
Drama therapy
Drama therapy is the intentional use of drama and/or theater processes to achieve therapeutic goals.
Drama therapy is an embodied practice that is active and experiential. This approach can provide the context for
participants to tell their stories, set goals and solve problems, express feelings, or achieve catharsis. Through drama,
the depth and breadth of inner experience can be actively explored and interpersonal relationship skills can be
enhanced.
How Does Drama Therapy Work?
Drama therapy uses play, embodiment, projection, role, story, empathy, distancing, witnessing, performance, and
improvisation to help people make meaningful change. 
A drama therapist first assesses a client's needs and then considers approaches that might best meet those needs.
Drama therapy can take many forms depending on individual and group needs, skill and ability levels, interests, and
therapeutic goals. Processes and techniques may include improvisations, theater games, storytelling, and enactment.
Many drama therapists make use of text, performance, to enrich the therapeutic and creative process. The theoretical
foundation of drama therapy lies in drama, theater, psychology, psychotherapy, anthropology, play, and interactive and
creative processes.
Who Can Benefit from Drama Therapy?
Drama therapy is for everyone across the lifespan. You do not have to be “good” at acting to benefit from drama
therapy!
Client populations may include persons recovering from addiction, dysfunctional families, developmentally disabled
persons, abuse survivors, prison inmates, homeless persons, people with AIDS, older adults, behavioral health
consumers, at-risk youth, and the general public.
Drama therapists work in a variety of mental health and community settings. Below are some possible examples of
locations where drama therapists can be found:
Mental Health Clinics
Schools
Hospital Medical Units
Hospital Mental Health Units
Substance Abuse Treatment Centers
Adult Day Treatment Facilities
Correctional Facilities
Community Centers
After School Programs
Programs for Older Adults
College Counseling Centers
Research studies
A Drama Therapy Approach with Female Prisoners Recovering from Addiction, Wesley et al.
Female prisoners in recovery may anticipate defeat when projecting possibilities for their future hopes and dreams.
These clients often identify with and attach to the role of prisoner and addict. This article describes a 12-week group
treatment program, titled by the author as “Prayerformance.” In this work, female prisoners in recovery have an
opportunity to connect spiritually and psychologically by using techniques like role play, improvisation, spontaneity
training, storytelling, character development, mask work, and movement.
Dramatherapy for mentally disordered offenders: changes in levels of anger , Riess et al.
The aim of this study was to examine changes in levels of anger associated with a therapeutic theatre project. The
population consisted of mentally disordered patients in a maximum security hospital, all of whom had a history of
major violence. The subjects were being treated on a ward that specializes in psychotherapeutic interventions. Twelve
young adult male patients, defined by structured interview for personality disorder and clinical diagnosis for mental
illness, participated in a week-long dramatherapy project. They were evaluated using self-report questionnaires both
before and after the week, as well as at three-month follow-up. Levels of anger significantly reduced from before to
after the theatre week. This improvement was maintained at three-month follow-up. There was an associated increase
in the frequency of attempts to control the expression of anger. It is concluded that a dramatherapy project within a
psychotherapeutic environment may be an effective therapeutic modality for reducing anger levels in young mentally
disordered offenders. 
Music Therapy
Music therapy is the use of music to address the physical, emotional, cognitive, and social needs of a group or
individual. It employs a variety of activities, such as listening to melodies, playing an instrument, drumming, writing
songs, and guided imagery.
Music Therapy is the clinical & evidence-based use of music interventions to accomplish individualized goals within a
therapeutic relationship by a credentialed professional who has completed an approved music therapy program. Music
therapy interventions can address a variety of healthcare & educational goals:
Promote Wellness
Manage Stress
Alleviate Pain
Express Feelings
Enhance Memory
Improve Communication
Promote Physical Rehabilitation
Types of music therapy
Cognitive behavioral music therapy (CBMT): This approach combines cognitive behavioral therapy (CBT) with
music. In CBMT, music is used to reinforce some behaviors and modify others. This approach is structured, not
improvisational, and may include listening to music, dancing, singing, or playing an instrument.
Community music therapy: This format is focused on using music as a way to facilitate change on the community
level. It’s done in a group setting and requires a high level of engagement from each member.
Vocal psychotherapy: In this format, you use various vocal exercises, natural sounds, and breathing techniques to
connect with your emotions and impulses. This practice is meant to create a deeper sense of connection with yourself.
The Bonny method of guided imagery and music (GIM): This form of therapy uses classical music as a way to
stimulate the imagination. In this method, you explain the feelings, sensations, memories, and imagery you experience
while listening to the music.
How is Music therapy session progressed
During a music therapy session, you may listen to different genres of music, play a musical instrument, or even
compose your own songs. You may be asked to sing or dance. Your therapist may encourage you to improvise, or they
may have a set structure for you to follow.
You may be asked to tune in to your emotions as you perform these tasks or to allow your feelings to direct your
actions. For example, if you are angry, you might play or sing loud, fast, and dissonant chords.
You may also use music to explore ways to change how you feel. If you express anger or stress, your music therapist
might respond by having you listen to or create music with slow, soft, soothing tones.
Music therapy is often one-on-one, but you may also choose to participate in group sessions if they are available.
Sessions with a music therapist take place wherever they practice, which might be a:
Clinic
Community health center
Correctional facility
Hospital
Private office
Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening
interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive
syndromes, and quality of life on neurological patients.Effects of music and music therapy on mood in neurological
patients (Raglio et al. 2015)
Some other forms of expressive therapies:
Dance/movement therapy: Dance therapy is based on the notion that the mind and body are related. It uses
psychotherapeutic movement as a process that helps to improve the emotional, physical, and cognitive integration of
the person in treatment.
Play therapy: Play therapy uses therapeutic play to help people resolve psychological difficulties and achieve optimum
development.
Some other forms of expressive therapies:
Sand play therapy: This is a creative form of therapy that uses a sandbox and miniature models to help clients explore
deeper layers of their own inner personal beings. Clients construct a series of “sand pictures” to integrate various
aspects of their personality and emotional functioning.
An integrated arts approach (also known as intermodal or multimodal therapy): This approach combines two or more
of the above expressive therapies to encourage psychological growth and the development or facilitation of personal
relationships
Therapeutic Effects of Expressive Therapies
Expressive therapies use the creative process as a means of therapeutic intervention or change. The creative process
can be utilized through creation, interpretation, reflection, discussion, and so forth. Individuals who actually create art,
poetry, music, or are involved in dance or play therapy are not evaluated on the quality of their final product but
instead are expected to use the creative process to foster change and to help reach therapeutic goals.
Several aspects of the creative process associated with expressive therapies contribute to this process, such as:
Self-expression: All of the expressive arts activities/strategies/techniques encourage individuals to engage in self-
exploration through self-expression.  Some sources  suggest that using the arts as a part of therapy may actually speed
up the process of self-exploration and allow individuals to experience themselves from a different perspective point.
Expressing oneself through dance, poetry, art, etc. may help to make sense of one’s past experience and act as a
catharsis (a term used in therapy for self-realization and the release of emotional burdens). Self-expression in most of
these techniques typically involves the use of some form of verbal expression or reflection; however, it can also
involve body movement as in dance, visualization as in painting or sculpting, and even tactile/real expression during
play.
Therapeutic Effects of Expressive Therapies
sense of active participation: These methods are all action-oriented methods by which clients explore issues and
communicate their feelings and thoughts. These are not passive techniques. These techniques require individuals to
invest energy in them and be committed to experiencing them. They are also sensory in nature in that they utilize
different sensory modalities.
The establishment of mind-body connections: These techniques are designed to facilitate the capacity of the mind to
influence body functions and symptoms, and vice versa. These forms of expression are effective in helping to cope
with stress and in establishing meaningful ways of communicating one’s issues. In addition, some of them are physical
forms of expression, such as dance and play, and have the benefit of promoting health and wellness.
Imagination: According to the book Foundations of Expressive Arts Therapy: Theoretical and Clinical
Perspectives expressive therapies are founded on the notion that imagination is a healing agent inherent to all forms of
self-expression. Often, the word creativity is used to describe the function of expressive therapies, and this includes the
notion of imagination.
Improvisation
How Do Expressive Therapies Assist in Substance Use Disorder Treatment?
There are a number of specific effects found for different types of expressive therapies used as adjunctive therapies in
the treatment of substance use disorders. According to the book The Use of Creative Therapies with Chemical
Dependency Issues:
Expressive therapies may be useful in decreasing denial in individuals with substance use disorders.
Expressive therapies are potentially useful in reducing opposition to treatment for individuals with alcohol use
disorders and other substance use disorders.
Expressive therapies help to disseminate issues with shame and regret that are associated with past substance usage.
Expressive therapies have been shown to help individuals engage in seeking and participating in treatment.
Expressive therapies are useful in developing communication skills, self-esteem, and personal insight, and they offer
variety in the therapeutic process.
Expressive therapies can be used to help motivate individuals to change.
There are several considerations involved with choosing to use expressive therapies as an intervention in
psychopathology or specifically as a substance use treatment program:
First, it is important to understand that the use of any techniques or materials in expressive therapy should be practical
for the individuals involved and should be appropriate for the age, maturity level, and ability of the people using them.
Many individuals may not feel artistic or may not feel that activities, such as acting, are appropriate for them, and
these people should not be forced into using these techniques.
Using any form of interpretive process discussion regarding any individual’s performance or work in a group setting
with the person’s peers should be undertaken with great care.
The goal is not to criticize someone’s artwork, acting, etc. but to discuss the creative process and the experiences that
went into the expression. It is extremely counterproductive to critique a person’s art, acting, etc.
Those who do not wish their work to be viewed by others should have their wishes respected by therapists.
Expressive therapies can only be administered by individuals trained specifically in the type of expressive therapy
being used.
Contraindications to using expressive therapies
There are some contraindications to using expressive therapies. Individuals with severe cognitive issues
severe psychological issues such as psychosis
physical disabilities, or neurological problems may not be appropriate to involve in expressive therapies and may not
benefit from them.
Patients at the disorganized end of the diagnostic spectrum, such as neurotic patients may have  inability to integrate
their thought processes; behavior disorganization manifests as self-contradictory or inconsistent behavior
Clients who are unable to emotionally integrate the cognitive awareness
No one should ever be coerced/compelled into participating in expressive therapies.
These therapies should not be used by individuals who are not specifically trained and certified in their use, and this
includes licensed therapists. Licensed therapists should only use these techniques if they have been specially trained in
them.
Criticisms of Expressive Therapy
There isn't a guarantee that creative therapies help treat those who suffer from Post-Traumatic Stress Disorder because
there isn't enough controlled trials that have been conducted.
Studies haven't revealed what type of patient suffering from trauma would benefit the most from aesthetic therapy.
Some experts believe that there isn't enough consistency in terms of art therapy and symptoms that are related to
trauma.
Some researchers believe that the studies lack controlled conditions although the majority of the patients in the group
improve.
On the upside Expressive Therapy conducts safe and controlled interactions. The interactions may not be fully
explained because there is a lack of a controlled condition.
Many experts criticize treatment because it isn't always clear as to what components of therapy lead to success.
MODULE IV
Psychodynamic individual psychotherapies are described as a continuum that extends from supportive to expressive
psychotherapies (Gabbard, 2005)
Psychoanalysis, includes approaches that accomplish personality change by analyzing the relationship between the
therapeutic couple and insights derived from the exploration of unrecognized feelings, thoughts and conflicts
(Luborsky, 1984)
the aim of supportive psychotherapy is not to change the patient’s personality but to help the patient cope with
symptoms, conscious conflicts or transient problems
Several authors have suggested different definitions of supportive intervention, but all agree that this kind of treatment
helps to improve patient self-esteem, maximizes patient adaptive skills, and restores ego functions, maintaining or
reestablishing a consistent level of functioning, given the patient’s personality and life circumstances (Dewald, 1971;
Ursano & Silberman, 1996).
Although in real clinical practice, psychodynamic therapists use a mix of supportive and expressive approaches, there
are substantial differences regarding the indications for use of supportive therapy. They range from the classical view
that supportive therapy should be prescribed for “low functioning” patients, to the view that this intervention should be
used with “high functioning patients” to scaffold ego functions
supportive therapies help the patient see things more clearly by sustaining reality, and testing and challenging
unrealistic ideas. The clinician must help the patient to regulate a wider range of affects, and to talk about his/her inner
life in a more consistent way.
Therapeutic actions need to be characterized by affective mirroring and interpersonal warmth (Markowitz, 2008).
The supportive intervention should help the patient socialize better with others by strengthening control over socially
unacceptable behavior and encouraging more consistent ways of relating to others (Misch, 2000)
Supportive Psychotherapy
Supportive psychotherapy can serve as the first bridge out of social isolation and marginalization and addresses
personality issues, such as deficits in character structure and defense mechanisms.
Supportive psychotherapy occurs in almost every doctor-patient encounter and is the psychotherapy provided to the
vast majority of patients who are seen in psychiatric clinics and mental health centers. 
Intra and extra psychic
In the late 19th century, Freud began to develop the techniques of psychoanalysis, which served as a foundation for all
the other psychotherapeutic modalities
Most of Freud’s patients were members of the upper classes of society and had significant ego strengths, and their
problems were mainly intra-psychic.
In contrast, many of the patients seen by psychiatrists and residents today suffer from extra-psychic problems, such as
poverty, social and political oppression, and abuses of power in relationships that threaten to overwhelm their coping
capacities.
For these patients, supportive therapy is the treatment of choice.
Supportive psychotherapy is a dyadic (of or consisting of a dyad; being a group of two) treatment that uses direct
measures to ameliorate symptoms and to maintain, restore, or improve self-esteem, ego functions, and adaptive skills.
It was developed in the early 20th century, and its objectives are more limited than those of the psychodynamic
therapies.
This therapeutic modality focuses especially on developing adaptive capacities that take into account the patient’s
limitations, including:
Personality issues, such as deficits in character structure and defense mechanisms
Native ability (eg, impaired reality testing, decreased cognitive functioning, lower IQ, learning disabilities)
Problems associated with life circumstances (eg, lower levels of education, low socioeconomic status, limited social
support systems, problems related to migration)
The connection between mental illness and poverty
There is a 2-way connection between mental illness and poverty. Poverty increases the risk of mental illness, and
mental illness is often a person’s path into poverty. In 1965, the sociologist Oscar Lewis published the controversial
document “The Culture of Poverty,” in which he argued that to adapt to their environment, people who live in poverty
for a long time develop a series of coping mechanisms that become engrained and paralyzing and that affect the
individual, the family, the slum community, and the community in relation to society.
Supportive therapy can serve as the first bridge out of social isolation and marginalization, since the 2 most important
elements of supportive therapy are the therapeutic alliance, which allays(diminishes) anxiety, helps support the
patient’s healthy defenses, and enhances adaptive skills; and conversational style.
This style avoids analytic abstinence and engages the patient in a collaborative discussion that decreases the power
differential.
Supportive therapy is also the treatment of choice in individuals with severe personality disorders, at least in the initial
phases of treatment.
Many individuals with personality disorders resent and fear the power differential that results from a more analytic
stance, given that many of them have experienced abuses of power in early life.
If the power differential is not addressed early in the treatment, it can destroy the therapeutic relationship.
Power differential means the difference in power between persons in positions of authority and those individuals in
subordinate positions that result in a vulnerability on the part of the subordinate.
5 Goals of SP
Directing client to make a better adjustment to reality.
In expressive psychotherapy (EP), this is done by strengthening the ego. In contrast, SP accepts the ego more or less as
it is and aims to improve adaption by modifying the demands made upon the ego
clients are encouraged to expose themselves to less stressful situations (external reality), to be less self-critical (super
ego) and wherever possible to repress instinctual demands.
SP aims at symptom reduction, reduction of anxiety, enhances self-esteem, by encouraging positive transference
SP focus on the conscious material, with avoidance of regression during the therapy and encouragement of use of
mature defense mechanisms and adaptive coping mechanisms.
Positive transference in SP
in psychoanalysis, a patient’s transfer onto the analyst or therapist of those feelings of attachment, love, idealization,
or other positive emotions that the patient originally experienced toward parents or other significant individuals during
childhood
negative transference
in psychoanalysis, a patient’s transfer onto the analyst or therapist of feelings of anger or hostility that the patient
originally felt toward parents or other significant individuals during childhood.
Setting and Plan of action
Flexible sessions : one time /week or less
As per need of the patient :Short / intermittent sessions or Long term
Face to Face sessions
Formation of therapeutic alliance
Analysis of transference contraindicated
Focus on conscious external events
Regression in patients discouraged
Patient Population for Supportive Psychotherapy
Character disorders(Character disorder/ Personality disorder --characterized by socially undesirable behavior, as poor
control of impulses or inability to maintain close emotional relationships, and by absence of anxiety or guilt.)
Latent or manifest psychoses ( affecting a person's ability to tell what is real and not real, to act normal, and to think
clearly )
Acute crises
Physical illness
Requisite in patients suitable for SP : Some degree of motivation is needed to enable therapeutic alliance
Basic Goals
Reintegration of self and ability to cope
Stabilization or restoration pf preexisting equilibrium
Strengthening of defenses
Better adjustment and acceptance of pathology
Symptom relief and environmental restructuring as primary goal
Goals of SP
In terms of ingredient, the common factors of psychotherapy, such as affective arousal, providing holding
environment, feeling understood by the therapist, being nonjudgmental, framework of understanding, therapeutic
alliance, optimism in improvement, and success experiences contribute to improvement.
SP basically involves respecting the clients with compassion, empathy, and commitment, irrespective of the fact that
therapist agrees or disagrees with the clients behaviors and thoughts. Basically, the supportive psychotherapist treats
the client, way they want to be treated.
Goals of SP
Another important aspect to understand is the spectrum of psychotherapy, which is considered to extend from SP to
EP, with supportive–expressive and expressive–SP
Clients who are most impaired are usually the candidates for SP, whereas those who are least impaired are considered
for EP.
Moderately impaired clients, who form the major bulk of the clinical load, are usually the candidates for supportive–
expressive and expressive–SP. In clinical practice, it is suggested that most clients will require supportive–expressive
psychotherapy.
Understanding supportive psychotherapy
Supportive psychotherapy stands in contrast to expressive therapies that seek to accomplish personality change
through analysis of the relationship; exploration of previously unrecognized feelings, thoughts, needs, and conflicts;
and development of insight.
The therapist takes into account the patient’s cognitive abilities, reality testing, thought process, capacity to organize
behavior, affect regulation, and capacity to relate to others in order to determine the patient’s location on the
continuum.
Understanding supportive psychotherapy
Purely supportive interventions are chosen for patients with disorganized behavior, thought disorder or cognitive
impairment, limited intelligence, and lower levels of education and socialization and for patients with personality
disorders.
With less impaired patients, expressive therapies are used. It is important for the therapist to be hopeful that the
impaired patient can eventually move across to more psychodynamic supportive therapy and beyond.
Major techniques
Free association contraindicated
Suggestion predominates
Abreaction useful ( expression and consequent release of a previously repressed emotion)
Confrontation : Leaman (1978) defined confrontation as “a direct technique in which the counselor challenges clients
to face themselves realistically.” This view of confrontation as an assertive counselor directed technique that is used to
force the client to look at their lives in an accurate and honest manner 
Clarification a therapist's formulation, in clear terms and without indicating approval or disapproval, of a client's
statement or expression of feelings.
Interpretation in here and now
Psychoeducation
ADJUNCT treatment of SP is recommended during Family rehabilitative therapy ,hospitalization ,Patients prescribed
psychotropic drug (antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers.)
Supportive psychotherapy practice (techniques)
In contrast to more psychodynamic-oriented therapies, one must be careful not to be incisive(analytical/ direct) when
practicing supportive therapy with more vulnerable or regressed patients.
Clarifications, interpretations, and confrontations may embarrass the patient, increase the patient’s anxiety to a level
that he or she is incapable of modulating, and may reawaken memories of abuse. These interventions are more
appropriate for treating patients with neurotic defenses that are analyzed and examined and the conflicts underlying the
defenses identified.
A strong therapeutic alliance is fostered by conveying to the patient acceptance, interest, respect, and admiration for
his or her accomplishments, thus supporting the patient’s self-esteem. Conscious problems are addressed, and defenses
are questioned only when they are maladaptive. The patient is treated with honesty and respect.
Supportive psychotherapy practice (techniques)
Other important techniques used in supportive psychotherapy include behavior goal setting, encouragement, positive
reinforcement, shaping behavior, and modeling.
For change to take place in therapy, interpretive work needs to occur with the patient’s increasing capacity for self-
reflection, but modeling by the therapist provides some of the first and most fundamental building blocks for change.
Supportive therapy may include educating the patient and family members about the illness and about the patient’s
potential and limitations, establishing realistic goals, addressing issues in the life of the patient that will reduce stress
and anxiety, and helping the patient and the family improve their adaptive skills. It may also include limit setting and
appropriate reward and punishment with children, and helping the patient, the family, and others involved to
understand the patient’s functional and cognitive limitations.
Supportive psychotherapy
Indications
MODULE V
Brief Psychodynamic Psychotherapy
Psychodynamic therapy focuses on unconscious processes as they are manifested in the client's present behavior. The
goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on present
behavior.
In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that
arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances.
The theory supporting psychodynamic therapy originated in and is informed by psychoanalytic theory. There are four
major schools of psychoanalytic theory, each of which has influenced psychodynamic therapy. The four schools are:
Freudian, Ego Psychology, Object Relations, and Self Psychology.
Freudian psychology is based on the theories first formulated by Sigmund Freud in the early part of this century and is
sometimes referred to as the drive or structural model. The essence of Freud's theory is that sexual and aggressive
energies originating in the id (or unconscious) are modulated by the ego, which is a set of functions that moderates
between the id and external reality. Defense mechanisms are constructions of the ego that operate to minimize pain
and to maintain psychic equilibrium.
Ego Psychology derives from Freudian psychology. Its proponents focus their work on enhancing and maintaining ego
function in accordance with the demands of reality. Ego Psychology stresses the individual's capacity for defense,
adaptation, and reality testing
Object Relations psychology was first articulated by several British analysts, among them Melanie Klein, W.R.D.
Fairbairn, D.W. Winnicott, and Harry Guntrip. According to this theory, human beings are always shaped in relation
to the significant others surrounding them. Our struggles and goals in life focus on maintaining relations with others,
while at the same time differentiating ourselves from others. The internal representations of self and others acquired in
childhood are later played out in adult relations.
Self Psychology was founded by Heinz Kohut, M.D., in Chicago during the 1950s. Kohut observed that the self refers
to a person's perception of his experience of his self, including the presence or lack of a sense of self-esteem. The self
is perceived in relation to the establishment of boundaries and the differentiations of self from others (or the lack of
boundaries and differentiations)  
Kohut postulated that persons suffering from substance abuse disorders also suffer from a weakness in the core of their
personalities--a defect in the formation of the "self." Substances appear to the user to be capable of curing the central
defect in the self.
Psychoanalysis and Psychoanalytic Psychotherapy
Differences and similarities
Therapeutic situation. Patients in analysis lie on a couch with the analyst seated behind out of the patient’s field of
vision. In psychoanalytic psychotherapy, patients and analysts are seated face-to-face.
Basic rule ‘free association’. Both psychoanalysis and psychoanalytic psychotherapy employ the basic rule of free
association whereas, for example, counselling does not. Patients are asked to communicate whatever thoughts,
imaginings, memories occur to them and whatever feelings may be aroused in them during each session.
Frequency. Psychoanalysis has a frequency of three to five sessions per week. Psychoanalytic psychotherapy has a
frequency of one to three sessions per week. Frequency is a function of the depth and intensity of the therapeutic work
needed.
Transference. Transference consists of the repetition of neurosis generating conflicts with parents and siblings in the
patient’s relation to the therapist. It occurs in and is useful therapeutically in both psychoanalysis and psychoanalytic
psychotherapy.
Non-judgemental evenly suspended attention. Analysts and psychoanalytic psychotherapists are non-judgemental.
Their orientation is one of attentive listening to the patient no matter where the patient’s associations may lead and
whatever the patient’s transference thoughts and feelings may be. The patient’s sexual and aggressive feelings and
emotions are especially important.
6.Interpretation. Analysts and psychoanalytic psychotherapists seek to improve their patient’s self-understanding by
interpreting psychological defences that inhibit their ability to become aware of the motivations of their attitudes,
beliefs, relations and actions – the inner sources of their symptoms, inhibitions and moods. Analysts and
psychoanalytic psychotherapists interpret these motivations to facilitate their becoming less conflicted and more
maturation.
Psychoanalysis and Psychoanalytic Psychotherapy
Freud’s discovery and development of psychoanalysis as theory and therapy of psychological disorders was
historically ground breaking. The psychodynamic psychotherapies derive from psychoanalysis. There are differences,
but there are significant similarities.
Psychoanalysis in particular has two meanings. First, it is a theory for understanding clinical presentations, and
perhaps even people in general. It is also used to describe a form of intensive psychotherapy in the most classic sense,
which involves long-term treatment, often for years. The treatment takes place several times a week, with the patient
on a couch and conducted by a therapist who is a certified psychoanalyst.
Theoretical
Classical Freudian theory is the mainstream orientation though modified
These theoretical differences do not alter the basic clinical similarities between psychoanalytic psychotherapy and
psychoanalysis: free associations, transference, non-judgmental attention and their interpretation.
The differences have to do with frequency, duration and the therapeutic set-up.
Psychoanalytic theory, in part developed based on the intensive form of therapy ,guides the practice of psychodynamic
therapy to a large extent, but not completely.
Psychodynamic therapy is psychoanalytic for the most part and makes assumptions about how the mind works that are
based on psychoanalytic theory. It entirely omits the concept of ‘ libido’ from its structure.
It is mostly delivered once per week and takes place face-to-face. The therapist may not be a certified psychoanalyst,
but is someone who trained in psychoanalysis or psychodynamic therapy and considers that his or her therapeutic
orientation.
Practitioners of brief psychodynamic therapy believe that some changes can happen through a more rapid process or
that an initial short intervention will start an ongoing process of change that does not need the constant involvement of
the therapist. A central concept in brief therapy is that there should be one major focus for the therapy rather than the
more traditional psychoanalytic practice of allowing the client to associate freely and discuss unconnected issues
(Malan, 1976).
In brief therapy, the central focus is developed during the initial evaluation process, occurring during the first session
or two. This focus must be agreed on by the client and therapist. The central focus singles out the most important
issues and thus creates a structure and identifies a goal for the treatment.
In brief therapy, the therapist is expected to be fairly active in keeping the session focused on the main issue. Having a
clear focus makes it possible to do interpretive work in a relatively short time because the therapist only addresses the
circumscribed problem area
Types / Models of Brief psychodynamic psychotherapy
10 major approaches to short-term psychodynamic psychotherapy are used.
These approaches differ depending on the extent to which they
use expressive or supportive techniques,
focus on acute or chronic problems,
have a goal of symptomatic change or personality change, and
pay attention to intrapsychic or interpersonal dynamics.
Types / Models of Brief psychodynamic psychotherapy
Mann's Time-Limited Psychotherapy (TLP)
Davanloo's Intensive Short-Term Dynamic Psychotherapy (ISTDP)
SE Psychoanalytic Psychotherapy
The Vanderbilt Approach to Time-Limited Dynamic Psychotherapy (TLDP)
Sifneos' Short-Term Anxiety-Provoking Psychotherapy (STAPP)
The Vanderbilt Approach to Time-Limited Dynamic Psychotherapy (TLDP)
Short-Term Dynamic Therapy of Stress Response Syndromes
Brief Adaptive Psychotherapy (BAP)
Dynamic Supportive Psychotherapy
A Self-Psychological Approach
Interpersonal Psychotherapy (IPT
Mann's Time-Limited Psychotherapy (TLP)
The goal of treatment in TLP is to diminish as much as possible the client's negative self-image through resolution of
the central issue (Mann, 1991). Symptoms are reduced or eliminated as a byproduct of the process.
TLP works via two main components of the treatment: the therapist's identification of the central issue and the setting
of the termination date at the start of treatment.
The central issue is always conceptualized in terms of the client's chronic and presently endured pain, resulting from
painful life experiences. This pain is a privately held, affective statement about how the client feels about himself.
Change comes about through the identification and exploration of the painful feelings about himself and through the
feelings of loss surrounding termination. This model has a set treatment length of 12 sessions and promotes working
through of termination issues.
Bullying is a significant, damaging, and common event in children's school and home life (Maxwell & Carroll-Lind,
1996; Farrington, 1993; Olweus, 1993; Rigby, 1997; Slee, 1993). As a phenomenon, it began to be investigated in the
1970s when Professor Dan Olweus in 1978 surveyed schools in Scandinavia in response to several children suiciding
reportedly as a result of being bullied (Farrington, 1993; Peters, McMahon, & Quinsey, 1992; Tattum, 1993; Rigby,
1996). Since then studies conducted in many countries have investigated the phenomena of school children's bullying
including Spain, Portugal, Scotland, Holland, Ireland, Canada, USA, France, Japan, Australian and New Zealand
(Farrington, 1993; Byrne, 1994). Recent studies have shown that bullying directly effects 15% to 50% of school
children around the world (Farrington, 1993; Olweus, 1993; Clark & Kiselica, 1997). Australasian figures are among
the highest with 10% of New Zealand school children being bullied a week (Maxwell & Carroll, 1996) and
approximately one in every seven Australian children being bullied weekly (Rigby, 1997; Healey, 1995; Nott &
Connor, 1990). Bullying behaviour occurs in all schools globally, regardless of the composition of students or type or
location of school (Tattum, 1993). Children's reactions to bullying differ depending on age, gender or the child's own
coping skills - but the more frequent the bullying the more affected children are likely to be (Rigby, 1997). Studies
clearly show that bullying effects can last into adulthood. Adults who were bullied as children tend to display much
lower self-esteem and higher levels of depression than adults who were not bullied (Olweus, 1993; Clark & Kiselica,
1997). Sem-4/MACLP20C/2021-2022/Even/188298 **Based on above excerpt, what do you think is a suitable choice
of therapeutic intervention?
Oedipus complex
The following are some examples that could be a sign of the complex: a boy who acts possessive of his mother and
tells the father not to touch her. a child who insists on sleeping between parents. a girl who declares she wants to marry
her father when she grows up
Sifneos' Short-Term Anxiety-Provoking Psychotherapy (STAPP)
STAPP is a focal, goal-oriented psychotherapy that is usually practiced in 12 to 15 sessions and sometimes fewer
(Nielsen and Barth, 1991).
During the first session, the therapist and client agree on a clear psychodynamic focus, rather like a treatment contract.
The foci that respond best to STAPP are unresolved Oedipal conflicts, separation issues, and grief may also be
acceptable.
Change comes about through the client's learning to resolve an emotional core problem, essentially problemsolving.
Resolving the problem promotes a feeling of well-being and a corresponding positive change in attitude
Davanloo's Intensive Short-Term Dynamic Psychotherapy (ISTDP)
In ISTDP, therapeutic techniques are used to provoke emotional experiences and, through this, to facilitate corrective
emotional experiences or the positive reenactments, in therapy, of past conflictual relationships (Laikin et al., 1991).
Change comes about by bringing to consciousness these past unresolved conflicts through intense emotional
experiences, reexperiencing them in a more cognitive way, and linking them to current symptoms and problematic
interpersonal patterns.
Extensive use of analysis of the transference relationship also helps to bring the unresolved conflicts to the client's
consciousness so that they can then be explored and resolved.
the ISTDP therapist is an active advocate of change rather than a neutral observer as in traditional analysis. The
attitude of the ISTDP therapist is that the patient's time is irreplaceable and comprehensive change is possible in a
reasonable, cost-effective time frame.
ISTDP has common roots with classical psychoanalysis aimed at treating patients with psychoneurosis
(environmentally acquired mental illness). Both treatments focus on unconscious mental processes (perceptions, past
events, feelings about events, and distorted beliefs) as the cause of neurotic disorders. What distinguishes practitioners
of ISTDP is that we believe that psychological treatment should be both:
Comprehensive and efficient-- (usually under 40 hours) to
Remove symptoms
Change character traits when necessary
Brief Psychodynamic psychotherapy
time limit exerts pressure on the therapy process and creates an expectancy effect, which can have both positive and
negative consequences. Additionally, time limits can be associated to therapists taking on a more directive role in
therapy. Results show that a time limit is anything but a neutral intervention; it is a technique that complexly interacts
with therapy processes on multiple grounds.
Techniques in Brief Psychodynamic psychotherapy ( and Psychodynamic therapies)
Formulation
Transference and resistance interpretations
Offering support
Central issue
current relevance
(b)past issue
Transference interpretation
Clarification
Confrontation of defenses for underlying beliefs ( despite emergence of anxiety)
Explore past conflicts
Explore ego defenses
Explore resistances
CCRT core conflictual relationship theme  (SE brief psychodyn. Therapy)
Formulation: A psychodynamic formulation is an hypothesis about the way a person thinks, feels, and behaves, which
considers the impact and development of unconscious thoughts and feelings. Psychodynamic formulations do not offer
definitive explanations; rather, they are hypotheses that we can change over time.
The problems that bring people to mental health treatment are often caused by thoughts and feelings that are out of
awareness – that is, that are unconscious. This is called a psychodynamic frame of reference. A news story gives a
report
of what happened; a psychodynamic formulation offers an hypothesis of why things happened
Construction of psychodynamic formulations by using three steps:
DESCRIBING the patient’s problems and patterns
REVIEWING the patient’s developmental history
LINKING the problems and patterns to the history using organizing ideas about development
Why is she behaving this way?
Why does he think that about himself?
Why is she responding to me like this? Why is that his way of dealing with stress?
Why is she having difficulty working and enjoying herself?
What is preventing him from living the life he wants to lead?
we use this understanding to help patients develop capacities that were not fully formed during their earlier years:
Example: Ms B, a brilliant student, is unable to think highly of her accomplishments. Raised in foster care, she never
received praise for her talents.
Understanding this, her therapist is able to help her to believe that her perception of herself is not always aligned with
her abilities.
Over time, she is able to develop new ways of managing her self-esteem.
Transference interpretation is classically defined as making something conscious to the patient that was previously
unconscious—specifically, that the patient's attributions of certain qualities to the therapist derive from past figures
Find transference during a case:
“Ms. A,” a 23-year-old single female with borderline personality disorder, came to her therapist’s office and reported
an embarrassing episode in which she had shouted at a clerk in a retail store because he would not accept her credit
card as payment for the merchandise she wished to buy. She noted that everyone was staring at her when she shouted,
and she felt that she had made a spectacle of herself. She said she would not have shouted except that the clerk was
rude with her.
*Her psychotherapist asked for clarification: “Was it a policy of the store not to accept credit cards, or was it a matter
that he would not accept your credit card?”
The patient felt that the therapist was suggesting she had overreacted and became furious at him: “What difference
does it make? Even if it was the policy of the store and not directed at me, he still should have been courteous!”
The patient’s irritation then escalated to an explosion of rage in which she screamed at him, “You’re not interested in
empathizing with my feeling of being humiliated—only in figuring out how I caused the whole incident! It’s clear that
you don’t care about me, and you’re only interested in getting all the money you can from my trust fund! Sometimes I
think you try to make me worse by irritating me just so you can keep me in treatment longer!”
The therapist attempted to explain that he was not suggesting that she was to blame for anything, but only asking for
information about the details of the situation.
The therapist paused for a minute and said, “It seems to me that the same thing that happened in the store is happening
here with me. You’re attributing to me some malevolent (negative) intent that isn’t at all where I’m coming from. You
make yourself miserable by reading things into interactions that aren’t really there.”
He is encountering intense transference anger based on what he feels is a misperception on the part of the patient.
Some research demonstrates that patients with borderline personality disorder, in contrast with comparison subjects,
attribute negative qualities to neutral faces, which they may regard as threatening
Analysis of Resistance
The word resistance is most commonly recognized when talking about the flow of electrical current or a military or
political movement. In psychology, specifically in psychotherapy, resistance has a very similar meaning. Resistance in
psychotherapy is often defined differently by different counseling and therapeutic psychologists, but ultimately
involves a client's unwillingness to change and grow within therapy.
There are countless reasons why clients can be resistant within a therapeutic relationship. People of all cultures,
natures, and personalities visit psychologists, each with their own reasons for entering therapy. Some people may be
ordered or referred by a third party to enter therapy.
Since they are not there of their own will, these clients are often reluctant to be there and can show very obvious
resistance to the process.
Most clients begin therapy on their own, for physical health reasons, mental health reasons, and general wellness.
Regardless, many clients show some sort of resistance to the emotional pain that change demands.
Clients can be unwilling and opposed to change even if it is what they desire, as change can be difficult, emotionally
painful, or scary.
Analysis of Resistance
Resistance is loosely defined as a client's unwillingness to discuss a particular topic in therapy.
For example, if a client in psychotherapy is uncomfortable talking about his or her father, they may show resistance
around this topic. While the client may be comfortable talking about other family members, they might change the
subject every time their father comes into the conversation. If the therapist continues to probe this topic, the client may
even show resistance by missing therapy appointments or discontinuing therapy.
Analysing the Resistance
Resistance can take many forms in psychotherapy and affect a client's behavior in many ways. The following is a list
of some forms of resistance which a client may use to keep from dealing with certain topics with their therapist.
Silence or minimal discussion with the therapist
Wordiness or verbosity
Preoccupation with symptoms
Irrelevant small talk
Preoccupation with the past or future
Focusing on the therapist or asking the therapist personal questions
Discounting or second-guessing the therapist
Seductiveness
False promises or forgetting to do what is agreed upon
Not keeping appointments
Failing to pay for appointments
Dealing with Resistance
In psychotherapy, resistance is considered a normal, and sometimes helpful, process. All psychologists and licensed
therapists are trained to deal with the different forms of resistance in their clients. Therapists consider it important to
detect resistance to psychotherapy and interpret why it is occurring. If the therapist can detect and deal with resistance,
they can use it to diffuse the resistance.

The techniques of analysis (Analyzing resistance/ transference)

Confrontation – the first step in analyzing, confrontation is the process of drawing the patient’s attention to a particular
phenomenon and getting him to recognize something that he has been avoiding and that will have to be further
understood. Examples: “I notice that each time your boss praises your work, you become disinterested in your job and
think about quitting.” “It seems that you often become angry with me right before I go on vacation.”
Clarification – after a phenomenon is brought to the patient’s attention, the details need to be elucidated and separated
out from other thoughts that the patient is having. Example: “You’ve mentioned feeling anxious in sessions recently,
but it now seems clear that this started right after you mentioned to me that you were having difficulty with your
wife.”
Interpretation – Once a phenomenon is elucidated and brought into focus, the therapist can then interpret its
unconscious meanings. To do this, the therapist makes connections between the patient’s current behavior (including
thoughts, feelings, fantasies, and dreams) and the patient’s past history (including childhood experiences, wishes and
fears). Examples: “Despite your wish to remain close to your husband, you are pushing him away just as you felt that
your mother pushed you away” “Your anxiety at the 4 prospect of having to work on this project with your junior
colleague stems from your fear that she, like your younger sister, will be perceived as more talented than you are”.
Two types of interpretation include i. Dream Interpretation ii. Transference Interpretation
Working Through – The complex and extended process of gradual change reflecting the efforts of insight, practicing,
recognizing behaviors, future insight, and further new behavior. Working through is how one gets from just having
new insight to having new behavior.
**Resistance is a common occurrence in psychotherapy. A therapist is trained not only to handle resistance, but to
expect it. When a person exhibits resistance in psychotherapy, such as skipping appointments and making small talk,
do you think that the client is conscious of his or her resistance?
Is this something that a person is doing knowingly or is this occurring outside the conscious awareness of the client? 
CCRT (SE= supportive expressive psychody. Brief therapy)
core conflictual relationship theme, or CCRT, is an analytic tool developed in the late twentieth century by Lester
Luborsky, as an aid both to brief psychotherapy in the psychodynamic tradition, and to researching its efficacy.
CCRT is generally employed within the context of a time-limited therapy (perhaps involving 16 or 24 sessions).
a method of research, case formulation, and psychodynamic psychotherapy that emphasizes central relationship
patterns in clients’ stories. Three components are analyzed: *1. the wishes, needs, or intentions of the client with
regard to another person;
**2. the other person’s expected or actual reaction to these;
** 3. the client’s emotion, behavior, or symptoms as they relate to the other person’s reaction.
The CCRT assesses interpersonal narratives in three components:
the wishes, needs, motivations or intentions of a subject (W);
the response of others to the subject’s wishes (RO); and
the response of the subject to others’ response (RS).
Brief Psychodynamic therapy stages
Stages
First: Therapist establishes rapport with the client and encourages him / her to tell about the main symptoms or
problems by free association. —
In second stage therapist analyses the dreams /recurring thought issues of the client so that the unconscious material
can be analyzed which assumed as the cause of the symptoms.
In third stage, therapist encourages positive transference by the client by developing trust.
In Forth stage Therapist do global interpretation of the unconscious determinants of problems of the client to develop
the insight in the client to solve his/her problems.
In last stage therapist gradually lesson the sessions and lastly end up the therapy
The healing and change process envisioned in long-term psychodynamic therapy typically requires at least 2 years of
sessions. This is because the goal of therapy is often to change an aspect of one's identity or personality or to integrate
key developmental learning missed while the client was stuck at an earlier stage of emotional development.
Practitioners of brief psychodynamic therapy believe that some changes can happen through a more rapid process or
that an initial short intervention will start an ongoing process of change that does not need the constant involvement of
the therapist.
A central concept in brief therapy is that there should be one major focus for the therapy rather than the more
traditional psychoanalytic practice of allowing the client to associate freely and discuss unconnected issues .
In brief therapy, the central focus is developed during the initial evaluation process, occurring during the first session
or two. This focus must be agreed on by the client and therapist. The central focus singles out the most important
issues and thus creates a structure and identifies a goal for the treatment.
In brief therapy, the therapist is expected to be fairly active in keeping the session focused on the main issue. Having a
clear focus makes it possible to do interpretive work in a relatively short time because the therapist only addresses the
circumscribed problem area.
When using brief psychodynamic approaches to therapy for the treatment of substance abuse disorders, the central
focus will always be the substance abuse in association with the core conflict. Further, the substance abuse and the
core conflict will always be conceptualized within an interpersonal framework.
Brief psychodynamic therapy characteristics
Characteristics
There is a rapid assessment in all brief psychodynamic therapies. It is clarified to the client that the sessions would be
limited in 6 to 25 sessions and the changes would visible.
The therapy has a concrete aim remove worst symptoms and to make the client adaptive to his environment.
It emphasis more in recent experiences and behaviors rather than his past experiences.
In this therapy encourages positive transference which influence the client to accept the suggestions and directions of
the therapist.
There is a common belief in BPP, that the client is not being treated fully but he is re-educated to be adaptive by this
he can cope with their stress and anxiety
Limitations
The treatment by brief psychodynamic therapy is not permanent and most of the cases can relapse due to its short
period of treatment. —
It is only beneficial in emergency situations but not in general and severe conditions because by this reconstruction of
the personality is not possible.
Types of brief psychodynamic psychotherapy
Mann’s Time limited psychotherapy
Nielsen and Barth: Short term anxiety provoking psychotherapy
Luborsky : SE (supportive – expressive psychotherapy)
Davanloo's Intensive Short-Term Dynamic Psychotherapy (ISTDP)
Sifneos' Short-Term Anxiety-Provoking Psychotherapy (STAPP)
Malan’s Brief focal Psychotherapy
Vanderbilt Time-Limited Dynamic Psychotherapy (Binder and Strupp)
Interpersonal Psychotherapy (Klerman)
SE Psychoanalytic Psychotherapy
This model of dynamic therapy can be offered as an open-ended or a time-limited approach (Luborsky,
1984; Luborsky and Mark, 1991).
The term "supportive" refers to the techniques aimed at directly maintaining the client's level of functioning--that is,
"supporting" the client.
The term "expressive" refers to techniques that intend to facilitate the client's expression of problems and conflicts and
their understanding.
Therapists using SE Psychoanalytic Psychotherapy will:
Develop a good therapeutic alliance
Formulate and respond to central relationship patterns
Understand and respond to how the symptom fits into the central relationship pattern
Attend to and respond to concerns about separation (therapy termination)
Make interpretations that are appropriate to the client's level of awareness
Recognize the client's need to test the therapeutic relationship (in transference terms)
Frame the symptoms as problem-solving or coping attempts
Change comes about through three curative factors: a positive helping relationship, gains in self understanding, and
internalization of these gains
Interpersonal Psychotherapy (Klerman)
HUMANISTIC, EXISTENTIAL & GESTALT THERAPY (20% EACH MODULE)
Credit Units: 3

Module I (Introduction to Humanistic Psychology)

Introduction
Theory in humanistic psychology
Development of the field
Social issues & humanistic psychology

The definition of humanism is a belief that human needs and values are more important than religious beliefs or any
ideology . An example of humanism is the belief that the person creates their own set of ethics.
Humanism is, instead, more of a pragmatic philosophy — humans are not necessarily good or evil but they do have
the capacity to do both. It is important then that our social, political, and philosophic institutions be set up in such a
way that we can encourage the good while discouraging the evil

Humanists believe that human experience and rational thinking provide the only source of both knowledge and a
moral code to live by. They reject the idea of knowledge 'revealed' to human beings by gods, or in special books.
Humanism stresses the importance of human values and dignity. It proposes that people can resolve problems through
the use of science and reason. Rather than looking to religious traditions, humanism instead focuses on helping people
live well, achieve personal growth, and make the world a better place
Four characteristics of humanistic psychology
Curiosity – stoic philosophy, the Greek tragedies
A free mind – imaginative , creative , flow ,experimentation .
Belief in moral goodness –The diary of Anne frank , kafka . Camus and Sartre .
Belief in the human race- social issues abolitionists , anti colonial movement , race and gender issue, Franz Fanon –
wretched of the earth .
Humanistic psychology rejects a rigorous scientific approach to psychology because it sees it as dehumanizing and
unable to capture the richness of conscious experience.
As would be expected of an approach that is 'anti-scientific', humanistic psychology is short on empirical evidence.
Humanism is a philosophy or a way of thinking about the world. Humanism is a set of ethics or ideas about how
people should live and act. Humanists prefer critical thinking and evidence (rationalism and empiricism) over
acceptance of dogma or superstition.
Maslow's theory argues that humans have a series of needs, some of which must be met before they can turn their
attention toward others. Certain universal needs are the most pressing, while more “acquired” emotions are of
secondary importance.
There is little evidence that need structures are organized as Maslow proposed, that unsatisfied needs motivate, or that
a satisfied need activates movement to a new need level.
The major problem with Maslow's hierarchy-of-needs theory is that it cannot be verified empirically, because there is
no proper method to measure accurately how satisfied one level of need must be before the next higher need becomes
operative.
Maslow considered only a narrow segment of the human populationThe theory assumes that all people experience
these needs in the same order, failing to recognize cultural and individual differences. In collectivist societies, for
example, social needs may be considered more important than physiological needs.
Maslow's hierarchy of needs continues to be widely popular and mostly well-accepted, but the available evidence does
not necessarily support Maslow's theory.
Importance of the individual in humanistic psychology
The leading question in this case is "What does it mean to be existing as a human being?" This question leads out in a
number of directions.
There is a pressing question concerning what is right and wrong in a world of moral chaos.is it relative ?
There is the daunting issue of what constitutes a meaningful way of life in a world in which all talk of purposes has
become obscure.
There is a realization that the human concerns and human experience count in a world that has proven to be mostly
unknowable. This corresponds to a suspicion of the reductionistic and over-confident ways of science, philosophy, and
metaphysics and also expresses continuity with the instincts of literature, poetry, and art.
The imperative to "be an individual!" takes on great importance as a way of orienting human life in a world described
by these other considerations.
How did humanistic psychology affect the world view?
It changed the way people viewed their life and work – man is not capital
Being rebellious – antiauthoritarian , cults , extreme life styles , movements , experimentation with drugs
Becoming spiritual , holistic , and compassionate
It shows them that they can not be restrained to their social class
They learned that they can achieve a personal best ,their optimal potential .
Humanistic therapy in education
Humanistic teaching believe that knowledge and feelings go hand-in-hand in the learning process. Story
telling ,awareness education ,
Cognitive and affective learning are both important to humanistic viewpoint .
Lessons and activities should focus on the whole student and their being and emotions , not one or the other.
Education vs training
the courage to be – Paul Tillich
Tillich’s formulation expresses this point beautifully: he speaks of our anxiety due to the "threat of non-being." The
forms of non-being are many and various and each prefigures the ultimate loss of being that is death and the ultimate
contingency of being that is birth. Both the chance events and extreme situations of life make evident the threat of
non-being and cause of anxiety.
Being human is finding oneself "thrown" (Heidegger) into a world with no clear logical, ontological, or moral
structure.
We hide from death, from uncertainty, from ourselves, from Being-Itself (Tillich) with enormous creativity but with
self-destructive consequences.
Extreme situations make our hiding impossible and so they often become the focus for philosophical and literary
reflection on human anxiety.
Importance of choice
We see this preeminently in Kierkegaard and Nietzsche. But it is perhaps most colorfully expressed by Karl Rahner
who described human beings as one giant decision (in his case, for or against God).
We are constituted by our decisions.
We cannot appeal to systems of law or convention or tradition as decisively furnishing instructions for life choices;
every choice has to be personally appropriated.
In fact, being human sometimes involves decisions that transcend the realm of moral and conventional concerns.
Views of Eric Fromm
Neo-Freudian and humanistic psychoanalyst
Ran away from Nazism and came to united states in 1933
Social factors in determining personality
Dialectical humanist
Marxist influence in his writing - Mixing Marxism with psychoanalysis creates a strange combination
Later Eastern influences in his writing came into prominence
According to Eric Fromm, man has only one problem “How to overcome his separateness ,how to achieve
union ,how to transcend one’s individual life and find oneness. theme in all major religions and myths .
We all encounter a terrible sense of isolation that we can not escape from as we begin to experience ourselves as
a separate being and feels a deep need to unite himself with his fellow men and the world .ex. In every culture
ostracism and tankhaiya
Parallel between developmental of the individual and the human race. both begin with a sense of deep peace and
belongingness.
The individual felt it with mother. The race feels protected as long as it feels a part of nature .western man under
wing of church s primary ties were not disrupted .

The human situation

Man is in a unique situation because of being part animal and part human .both are at conflict with each other .
Man has to confront two dichotomies –historical and existential in his evolution .
Social and cultural tragedies –riots, genocide , migration , violence
/existential dichotomies that are immutable –death, disease ,
The goal of therapy “is to orient and root himself in the world and find security in other ways than those which
were characteristic of his pre individualistic existence .”
Individual can not change the paradox inherent in the human situation
But man can face it by halting the process of individuation ,regressing and throwing away his freedom and getting in
to new bondage
The only route out for him is to regain his shattered sense of unity and being born again (rebirth ), contributing to
his culture and society .
Fromm identifies five intrinsic human needs
Relatedness ,a feeling of unity with himself -flow
Transcendence –rising above the biological part within him.
Rootedness – where he belongs –land , home . nature
identity –accepting his personal uniqueness
Orientation –a reference point from which to maintain a stable perception of himself . ( That is me )
unproductive orientation
Fear of separation and aloneness is so intense that man thinks of escape -he builds up withdrawl and grandiose
fantasies
Three major escape routes for all of us
Authoritarian solution - lives through someone external to himself –by living a symbiotic life-
Destructive solution –Eliminate the source of perceived stress .remove all standards against which we are
compared .
Automaton solution –adapt and become like others around him.
different ideas of love by eric fromm
As there is one human problem , there is one constructive resolution. potentialities for resolution inherent in each
man .
Human beings have an inner potential , a genius for realizing that goal and making that resolution .
Different levels of love
brotherly love ,
Motherly love
Erotic love –lowest form of love ,deceptive in nature
Self love –narcissistic
Love for God .agape
Attainment of the last one is the answer to human dilemma .man can become God like if he wishes .

Allport contributed to the trait theory of personality, and is known as a "trait" psychologist. He did not believe that
people can be classified according to a small number of trait dimensions, maintaining that each person is unique and
distinguished by peculiar traits.In one of Allport's own articles, Concepts of Trait and Personality (1927), Allport
states that traits are "habits possessed of social significance" and become very predictable, traits are a unit of
personality. Allport states that the personality of a person is the single most unique thing about a person.

Allport's three-level hierarchy of traits

1. Cardinal trait - These traits are rare but is the trait that dominates and shape a person's behavior. These are the ruling
passions/obsessions, such as a need for money, fame, etc.
2. Central trait - These traits are general characteristics found in some degree in every person. These are the basic
building blocks that shape most of our behavior although they are not as overwhelming as cardinal traits. They
influence but do not determine behavior. An example of a central trait would be honesty.
3. Secondary trait - These traits are the bottom tier of the hierarchy and are not as apparent as central traits. Secondary
traits are characteristics seen only in certain circumstances (such as particular likes or dislikes that a very close friend
may know). They must be included to provide a complete picture of human complexity.

Proprium according to Allport.

A concept of the self—which is consistent, unique, and central in the individual—that was developed by Gordon W.
Allport .
The proprium incorporates body sense, self-identity, self-esteem, self-extension, rational thinking, self-image,
propriate striving, and knowing.

stages of development

1.Sense of bodily "me" (first year)

It is perceived when infants can understand themselves through sensations and figure out what makes them and what
does not.
2. Sense of self-identity (second year)
Though understanding whom they are by having a significance in their name has. This can then give them a sense of
how they are and what that can mean socially.
3. Sense of self-esteem (third year)
With having a sense of who they are in this stage, they want to have a form of independence that can be stepped away
from adult supervision
4. Sense of self-extension (Fourth year)
In this stage, the child can see their bodies and extend to toys. The words that seem to be stated in their mind is mine.
Emergence of self-image (fourth to the sixth year)
There seems to be an awareness of the good me and the bad me for the children that can bring up what they expect
others to expect from them. In this stage, certain goals they see for themselves are brought up.
Emergence of self as a rational coper (sixth to twelfth year)
At this stage, it is brought to the awareness that thoughts can help solve problems in which they tend to think a lot
about their thinking.
Emergence of proproate striving (twelfth year through adolescence)
In this stage, it is believed that future goals are built to give a sense of meaning to one's life. Allport viewed a healthy
person to create problems by making future goals that can be seen as unattainable in many cases. This sense of
creating these long-term goals is set to differentiate from other stages and even from having a healthy or sick
personality.
8.Emergence of self as knower (adulthood)
In this final stage, the self is seen as a knower who can be aware of and surpass the seven other propriate functions.
When gone through all stages, you appear to use several or even all in daily tasks and experiences

Personality and motivation

Patterned individuality – a specific term on what is everyone’s uniqueness not recognized by others . An Idea of
Emerson
Personality is the unique way in which the person works out his survival .it is not frozen but a static or complete
but remains a dynamic entity throughout life
Self is the central point of focus in the psychology of personality .
Self develops in stages by developing from child’s short term to long term goals of the adult .
Proprium – a concept that distinguishes the animal from the man , child from adult and healthy from the sick”
Traits – chief units of personality structure . Have actual existence. More generalized than a habit .
Mature personality according to Allport
Has a unified philosophy of life
Lives with zest and autonomy
Has a greatly extended sense of self and is accepting of others
Cooperation ,not competition is the essence of life

Functional autonomy - controversial concept

Functional autonomy 1961-an acquired system of motivation in which the tension involved are not the same as
antecedent tension from which the system developed .
Functional autonomy seeks present motives rather than past ones one in which the person is said to be dependent
upon
Met with considerable resistance at that time from orthodox psychoanalysts .
Wide range of motives including interests ,abilities ,intentions ,plans, habits and attitudes .
Gave birth to ego psychology
mental illness as functional autonomy of another kind which requires depth analysis

Gordon W. Allport
People it seems are busy leading their lives in the future ,,whereas psychology for the most part is busy tracing
them into the past .

Humanistic therapy is a mental health approach that emphasizes the importance of being your true self in order to lead
the most fulfilling life. ... Humanistic therapy also involves a core belief that people are good at heart and capable of
making the right choices for themselves.

Some essential characteristics of humanistic therapy

Negotiation of a contract by formally or informally asking, “ you and I can work through it together .”"Where do we
go from here?"
Empathic understanding of the others frame of reference and subjective experience. ross
Respect for the client's cultural values and freedom to exercise choice .
Exploration of problems through an authentic and collaborative approach to helping the client develop insight,
courage, and responsibility .
Exploration of goals and expectations, including articulation of what the client wants to accomplish and hopes to gain
from therapy .
Clarification of the helping role by defining the therapist's role but respecting the self determination of the client
Assessment and enhancement of client motivation as choice . Both collaboratively and authentically
Demonstration of authenticity by setting a tone of genuine, authentic encounter
Humanistic therapy is a mental health approach that emphasizes the importance of being your true self in order to lead
the most fulfilling life. It's based on the principle that everyone has their own unique way of looking at the world. This
view can impact your choices and actions.
One of the greatest strengths of humanistic psychotherapy is that it emphasizes individual choice and responsibility.
Humanistic psychology satisfies most people's idea of what being human means because it values personal ideals and
self-fulfillment.
Carl Rogers 3 core conditions- The first three conditions are empathy, congruence and unconditional positive regard.
These first three conditions are called the core conditions, sometimes referred to as the 'facilitative conditions' or the
'client's conditions’.
Jayne & Ray's (2015) findings, it is safe to say that therapists can show they are being empathetic to their client by
matching the client's body language and mirroring their verbal style, as well as allowing the client to speak in a way
such that they feel they are really being listened to.
Incongruence is a humanistic psychology concept developed by Carl Rogers which suggests that unpleasant feelings
can result from a discrepancy between our perceived and ideal self. The perceived self is how an individual views
themselves and the ideal self is how an individual wishes they were.
unconditional positive regard-According to Rogers, unconditional positive regard involves showing complete support
and acceptance of a person no matter what that person says or does. The therapist accepts and supports the client, no
matter what they say or do, placing no conditions on this acceptance.

Module II (Humanistic Therapy): Viewpoint, goals, techniques and limitations

People have capacity for self awareness and choice.We have a potential to make healthy meaningful relationship
and choices in the interest of self and others
People need to free themselves from limiting ,disabling assumptions and led fuller lives
Growth and self actualization rather than curing diseases or alleviating disorders .
Conscious rather than unconscious processes
Not being one’s true self is the source of all problems.
The therapeutic relationship is a vehicle for growth .
Everything in life is optional – Milton Erikson
Penetrate at a deeper level to issues to create deeper choices . some controversial issues in humanistic
psychotherapy .Are conditions like schizophrenia a choice that a patient makes to deal with facing a intolerable
situation ?Are psychopathic personalities have some goodness inside and can be reformed ? Can serial killers ,
pedophiles have a good ness in them that can be reached through therapy ?Could people like Hitler , pol pot , mao
tse tung and Stalin be made to show compassion ? How do you explain evil in modern world ?

An example of different types of congruence A critique of being human - Dr Angus Fletcher

“To be human is to wonder why? As in ,Why are we here ?what is the purpose of our hours ? Does this life mean
anything ? To be human is to have irrational desires ,uncontrollable passions and griefs that splits us into pieces .or
to put it in psychological language , to be human is to be saddled with the problem of having a human brain .a brain
fueled by emotions, that propel us forward but also causes us to crave things that harm and to fear things that
don’t exist and to rage against death and parts of our nature that cant be escaped .
As scientists have discovered ,this isn’t unique to humans .our animal relatives share pieces of our neural
circuitry . That is why chimps suffer anxiety , elephants lament their dead ,dogs get lonesome ,and antelopes
spook . yet the singular sophistication of our brain tells us that this is a particularly profound problem. Man can
have unprecedented success and still feel life is meaningless .we can have a thousand friends and still feel that
we are overwhelmed by loneliness .we can walk in day light’s brightest gold and still feel that life is grey .
So deep , so sprawling and so intangible is this problem that it is beyond the grip of any technology .this is the
problem that philosophers , psychologists have tried to answer through out the ages . Drawing on the power of
stories ,parables , religion, they have tried to answer these existential doubts in the mind of man . we turn inward
to grapple with this problem of surviving as ourselves , to answer who we really are, as man existing on a planet
that was alien to him .
Brotherly love
Motherly love
Erotic love – lowest form of love, deceptive in nature
Self love – narcissistic
Love for a higher self within. Altruistic love. agape
Attainment of the last one is the answer to human dilemma. Man can become God like if he wishes.

Module III (Existential Therapy) : Viewpoint, goals, techniques and limitations

Existential therapy
Existentialism emphasizes action, freedom, and decision as fundamental to human existence; and is fundamentally
opposed to the rationalist tradition and to positivism. That is, it argues against definitions of human beings as
primarily rational.

The two main figures responsible for the development of existential therapy are Viktor Frankl and Rollo May. Frankl
and May were strongly influenced by existential philosophy. Both Frankl and May believed that there is a meaning to
all things in life.
Later RD Laing came and elaborated with his work on schizophrenia and mental disorders .

Existential therapy focuses on the anxiety that occurs when a client confronts the conflict inherent in life. The role of
the therapist is to help the client focus on personal responsibility for making decisions, and the therapist may integrate
some humanistic approaches and techniques.
Existential therapy tries to help people find meaning and purpose in their lives. It seeks to end the fear of the
unknown.
A therapist actively encourages patients to use their capacity to make choices and to develop their lives as a way to
maximize their existence, or their reason for being.
Existentialism as a therapy –main features
Hostility to abstract theory for obscuring the roughness and untidiness of daily life
Oscillates between religious thought and atheism
Introduced subjectivity when philosophers emphasized essentialism , objectivity and rationality as a reaction to
medieval ages
freedom
Authenticity
The others

According to existentialism
No difference between essence and existentialism
Man must create his own essence
Father of existence is nothingness
There is no God and no absolute standard of ethical conduct
Each human being must chose what we all must chose to be
Ensoi – existence of something which exists in itself and poursoi –the existence of human beings who project
themselves to values and aims
A branch of knowledge characterized by the fundamental character of subjective processes
to delimit the entire realm of human experiences –perception , fantasy
All beliefs in truth of any kind are suspended
Human being are left with their subjective experiences
In phenomenology one speaks of pure subjectivity and pure experience
Existentialists found two themes in Greek tragedy in conflict with each other Dionyasian passion and ecstasy
and Appolinian serenity and calm they contradict each other .
The task of therapy is to unite the two forces
Uniting the above two will lead to ubermensch – the noble compassionate superman
R .D laing’s theory of existentialism
A sane response to an insane situation. This is Laing's comment about what "going crazy" entailed. Applying Gregory
Bateson's concept of the double bind, in which anything a person does leads to one or another kind of punishing
consequence, he observed that some children are faced with the dilemma of having an identity defined for them that is
fundamentally different from who they experience themselves to be. Their alternatives are to either give up the
parental approval and caretaking they need to survive, in order to be truly themselves, or to give up their own sense of
their identity and comply with parental demands. Faced with this dilemma, most people choose to give up their own
identities and adopts those that are handed to them by parental figures. In some people faced with this situation, the
response is to "go crazy." This is analogous to being inside a tunnel which represents what are normally considered
"sane" thoughts, actions, and feelings, finding that moving in either direction leads to painful experiences (giving up
self, or giving up the other), and in response breaking through the ceiling of the tunnel into what is considered
insanity. (I think, although I am not certain, that this analogy is mine rather than Laing's.)
Family resistance: Laing notes that he often finds that what he thinks is going on in a family bears almost no
resemblance to what anyone in the family experiences or thinks is happening. Often "there is concerted family
resistance to discovering what is going on, and there are complicated stratagems to keep everyone in the dark."
(politics of the family, p. 77)
Metaphors for a family. "The family may be imagined as a web, a flower, a tomb, a prison, a castle," writes Laing. We
may be more aware of our image of the family than of the family itself.
Complementarity: "That feature of relatedness whereby the other is required to fulfill or complete the self.“
Confirmation: Some sign of recognition by another person that is relevant to an evocative act. This may include
disapproval. "Every relationship. . . implies a definition of self by others and other by self. . . A person's 'own' identity
can never be completely abstracted from his identity-for-others." (Self and Others)
Interest in the subjective experience of the schizophrenic. Given his own background, Laing was able to perceive how
pathetically limited and inadequate the conventional psychiatric definitions of schizophrenia are. They are largely
"looking at" from outside, and capture little of the schizophrenic's own experience. Laing tried to capture the structure
of the schizophrenic experience in "The Divided Self," written when he was only twenty-eight years old. Later he
would characterize that early work as too much in an "us-them" mode. His later work explored the nature of
relationships and the workings of schizophrenogenic families. He also included many observations on the way in
which school and other social institutions imprison both children and adults in situations that confuse them about their
own thoughts and feelings, induce them to think they have the socially approved thoughts and feelings that others
want them to, and as a consequences drive them crazy.
Treatment of the schizophrenic. Laing established a treatment facility in a London suburb which housed, I think, about
fifteen or twenty schizophrenic patients and several live-in psychiatric staff persons. (I'm not sure about that number.)
Patients were given no drugs, They were provided with support in the form of daily group therapy, individual therapy,
and ongoing interaction with staff. Staff members were careful to accept the subjective validity of the schizophrenic's
experience of the world. In addition, there was reality-testing in the form of feedback from other group members. No
drugs were administered. In Laing's view, drugs make it more difficult for a person to think and therefore interfere
with the kind of personal work that can lead to true recovery. I read one case history of a member of the psychiatric
staff who shared a room with one patient who defecated in the room and often screamed apparently uncontrollably.
Laing's approach took the existential view that each person, including the schizophrenic is ultimately responsible for
his or her own behavior, and ultimately his or her own recovery. He viewed his role as that of providing conditions
that would facilitate that recovery. For a time there were a number of treatment facilities around the world that
followed the Laingian model. To the best of my knowledge, today it has been largely abandoned, both because it is
very expensive in terms of professional time and effort and drugs are cheaper and can be administered by poorly paid
ward personnel, and because the psychiatric establishment is committed to a medical model rather than an existential
model.
Delusional structures involve a severe mismatch in mapping. In very disturbed people, one finds what may be
regarded as delusional structures, still recognizably related to family situations. The re-projection of the 'family' is not
simply a matter of projecting an 'internal' object onto an external person. It is superimposition of one set of relations
onto another: the two sets may match more or less. Only if they mismatch sufficiently in the eyes of others, is the
operation regarded as psychotic. That is, the operation is not regarded as psychotic per se.
Induction: Projection is done by one person as his own experience of the other. Induction is done by one person to the
other's experience. One does not tell him what to be, but tells him what he is. Such attributions, in context, are many
times more powerful than orders (or other forms of coercion or persuasion.)" One is told one is good, bad, evil, pretty,
sexy, etc.
What the parents tell a child "he is, is induction, far more potent than what they tell him to do. . . . These signals do
not tell him to be naughty; they define what he does as naughty. In this way, he learns that he is naughty, and how to
be naughty in his particular family."
"It is not sufficient to say that my wife introjects my mother, if by projection, and induction, I have maneuvered her
into such a position that she actually begins to act, and even to feel, like her, [perhaps] without ever having met her."
(Politics of the family, 78-9, 119-20))
Paradoxical orders: If correctly executed, they are disobeyed. If they are disobeyed, they are obeyed. "Be
spontaneous." "Don't do what I tell you to."
We have rules against knowing certain rules. "Rule A: Don't. Rule A1: Rule A does not exist. Rule A2: Rule A1 does
not exist."
Psychiatrists as mind-police: "If a and B are incongruent, the mind police (psychiatrists) are called in. A crime
(illness) is diagnosed. An arrest is made and the patient taken into custody (hospitalization). Interviews and
investigations follow. A confession may be obtained (patient admits he is ill, displays insight). . . . The sentence is
passed (therapy is recommended). He serves his time, comes out, and obeys the law in the future." This is how the
"official story of psychiatric consultation, examination, diagnosis, prognosis, treatment. . . is often experienced."
(politics of the family, p. 74)
The situation has to be discovered: "We can never assume that the people in the situation know what the situation is.
There is no a priori reason to believe or disbelieve a story anyone tells us. Different people usually have different
stories about a situation. A psychiatric "history" of the situation is a sample of the situation. It is a story, one person's
way of defining the situation. "Few psychiatrists are experts in sorting out these stories. They are experts in construing
situations of a few standard psychiatric myths." (politics of the family, p. 33-4)
Mapping: A person "maps" some accepted social definition of reality onto his or her experience and then acts as if that
map reflects his or her experience. Or else feels terribly oppressed and unseen, if the personal experience is very
different from the "mapped" pseudo-experience.
Rollo May and his work
May determined that human beings fear death because we cannot comprehend our own lack of existence. However,
May believed that facing these feelings of anxiety and fear was a necessary experience if personal growth and
meaning were to be achieved in life.
What are the four givens of existence?
It was Irvin Yalom who defined the four “givens” of the human condition—death, meaning, isolation, and freedom,
that have formed the cornerstone of modern-day existential therapy, and a method of psychotherapy that enables
clients to face these givens head-on and so move towards living a more “authentic” and free existence.
Existential therapy is good for treating those facing issues of existence, for example, those with a terminal illness,
those contemplating suicide, or even those going through a transition in their life.
existential therapy would suggest that people with addiction disorder are dealing with anxiety and fear because of one
of the essential givens. But, they didn't find a resolution that left them reassured. They then turned to substance use
and misuse.
In Client-Centered Therapy especially values the work in the here-and-now of the therapeutic situation, and the
relationship as most effective therapeutic means; whereas an existential perspective highlights people's orientation
towards the future, their being directed towards and influenced by what is to come.
Existentialism is a philosophical theory that people are free agents who have control over their choices and actions.
Existentialists believe that society should not restrict an individual's life or actions and that these restrictions inhibit
free will and the development of that person's potential.
According to existentialism
Existence is always particular and individual -my existence, your existence, his existence, her existence.
Existence is primarily the problem of existence (i.e., of its mode of being); it is, therefore, also the investigation of the
meaning of Being.
Existentialism is a philosophy that emphasizes individual existence, freedom and choice. ... It holds that, as there is no
God or any other transcendent force, the only way to counter this nothingness (and hence to find meaning in life) is by
embracing existence.
Existentialism can be thought of as the twentieth-century analogue of nineteenth-century romanticism. The two
movements have in common the demand that the whole fabric of life be recognized and taken into account in our
thinking and acting. As such they express a form of resistance to reductionist analyses of life and its meaning for
human beings. But there are also significant differences.
Existentialism is typically focused on individual human lives and the poignant inevitability of suffering and choice for
each individual whereas romanticism tended to be more oriented to the whole of nature and saw human beings as a
part of that wider picture. Furthermore, romanticism flourished before the wars and genocides of the twentieth century
whereas existentialism is born amid those horrors.
From one point of view, the existentialists divide roughly between writers (most famously, perhaps, Albert Camus)
and philosophers. The philosophical existentialists divide roughly between the atheistic and the religious. Søren
Kierkegaard (1813-1855) ["the ultimate anti-Christianity Christian"] is often considered to be the father of them all,
but Friedrich Nietzsche ["the ultimate anti-Christ philosopher"] is a crucial figure at the origins of the developing line
of atheistic existentialism. Religious existentialists included both Jews such as Martin Buber (1878-1965) ["the
Protestant Jew"] and Christians such as Paul Tillich (1886-1965) ["the Christian crypto-atheist infatuated with Being
and God"]. Other religious existentialists include Karl Jaspers, Gabriel Marcel, and Karl Rahner. The atheistic
existentialists include Martin Heidegger (1889-1976) ["the non-Christian atheist infatuated with Being and time"],
though he denied that he was an existentialist, and Jean-Paul Sartre (1905-1980) [the ultimate atheist infatuated with
Being and nothingness]. It is quite a cast of characters. And the classifications make less sense the better you know
them, not least because it is hard to disentangle theism and atheism in the context of existential reflection on human
life. The plan here is to examine a few themes commonly treated by existentialists and then to examine the thought of
Kierkegaard more closely.

Module IV (Gestalt Therapy): Viewpoint, goals, techniques and limitations

Gestalt therapy
Gestalt therapy emphasizes what it calls "organismic holism," the importance of being aware of the here and now and
accepting responsibility for yourself. Existential therapy focuses on free will, self-determination and the search for
meaning.Originated in Frankfurt ,Germany
Postulates of gestalt
The whole is primary and has properties different from sum of its parts
The whole dominates the part and is the primary reality.
The whole is not the sum , product or even a simple function of its parts but whose character depends upon itself
Personality – P=T+F+B
Detailed organization and inter-relationship of things
Centralistic ,importance of organization in memory
Accepted introspection but canged its character .
features of gestalt therapy
Laws of science were laws of systems .
The whole in psychology like physics or chemistry required laws of its own . Psychology needs to do the same
Phenomenological - phenomenology is the study of “phenomena”: appearances of things, or things as they appear in
our experience, or the ways we experience things, thus the meanings things have in our experience. Phenomenology
studies conscious experience as experienced from the subjective or first person point of view .
Overuse of past experience as a explanatory concept or therapeutic change of a person
Learning and problem solving as restructuring of the perceptual field
Gestalt theory emphasizes that the whole of anything is greater than the sum of its parts. That is, the attributes of the
whole are not deducible from analysis of the parts in isolation. The word Gestalt is used in modern German to mean
the way a thing has been “placed,” or “put together.” There is no exact equivalent in English.
The key concepts of gestalt therapy
figure and ground –person and behavior are separate . Position and behavior
balance and polarities – splits within , with others or between wants
Awareness – partial vs total .what is happening now ? What do you experience as I say this
present‐centeredness -
unfinished business – with significant others , with yourself
personal responsibility -
Internal processing occurs through focusing inwards .
Gestalt therapy seeks to resolve the conflicts and ambiguities that result from the failure to integrate features of the
personality. The goal of Gestalt therapy is to teach people to become aware of significant sensations within themselves
and their environment so that they respond fully and reasonably to situations.
Gestalt Therapy rejects the dualities of mind and body, body and soul, thinking and feeling, and feeling and action.
According to Perls, people are not made up of separate components, this is, mind, body and soul, rather human beings
function as a whole.
Essentials concepts of a gestalt session
Therapeutic contract
Owning an aspect of the self you haven’t accepted /owned /are not aware of
Top dog /underdog are trying to compete within and see the contradiction within
Take personal responsibility –from it to I
role of imagination - role reversal
Exaggeration makes you see the absurdity of the situation
Comfort and discomfort
Gestalt's theory of change is known as the paradoxical theory of change because it is based on the apparently
paradoxical premise that people change by becoming more fully themselves not by trying to make themselves be
something or someone they are not: 'Change occurs when one becomes what he is, not when he tries to be someone
else .
What is unfinished business in psychology?in therapy and counseling, the personal experiences that have been
blocked or tasks that have been avoided because of feared emotional or interpersonal effects.
In Gestalt psychology when any aspect of one’s life is left hanging it is called unfinished business. Some common
experiences that are attached to unfinished business are abuse suffered at the hands of primary caregivers, difficult
endings of romantic relationships, and deaths of important people.

Take total responsibility for yourself. It's ultimately up to you to take the necessary actions to help move you forward.
Grieve the loss. Take plenty of time to do this.
Gather your strengths.
Make a plan for the immediate future. Determine what's most important for you moving forward.
Create a ritual.

Module V (Applications) : Humanistic, existential, and gestalt therapy in current scenario

Humanistic, Existential, Gestalt in current scenario

Prevent violence ,war and migration .
Combine science with arts and spirituality.
Prevent extremism , terrorism and fascism
Stop labeling people between crazy and non crazy
End discrimination of all kinds - caste , race and color
Make psychology less of a elitist discipline
Address climate change
Undo the historical injustices of the past
Humanistic psychology and social issues
RD Laing –normal and everyday experience
Erich From -disintegration of capacity to love in modern society
Technical dominance over human life - Medard Boss
Question of evil , tragic dimension of existence of human choice –Rollo may
Rollo may - Carl Rogers Debate
The humanist manifesto-lll 2003
Knowledge of the world is derived from observation, experimentation and rational analysis
Human are an integral part of nature ,the result of unguided evolutionary change
Ethical values are derived from human need and interest as tested by experience
Life’s fulfillment emerges from individual participation in the service of human ideals
Humans are social by nature and find meaning in relationships
Working to benefit society maximizes human happiness
Theories of Rollo may
May determined that human beings fear death because we cannot comprehend our own lack of existence. However,
May believed that facing these feelings of anxiety and fear was a necessary experience if personal growth and
meaning were to be achieved in life.
May (1953) defined love as a “delight in the presence of the other person and an affirming of [that person's] value and
development as much as one's own” (p. 206). Without care there can be no love—only empty sentimentality or
transient sexual arousal.
Theories of R .D LAING
Ronald D. Laing's work was centered on understanding and treating schizophrenic patients. He could perhaps best be
termed an "existential psychiatrist." Indeed, one of his early books was on Jean-Paul Sartre, and he used concepts from
Sartre, Hegel and others in endeavoring to conceptualize the life and world of the schizophrenic. Laing himself grew
up in a bizarre family setting. His parents forbid him to go out of the house alone or play with other children until
middle childhood, they repeatedly conveyed the message to him that he was "evil," and when he went out with them
he was kept on a leash with a harness. His childhood environment was such as to cause him severe confusion about
which thoughts and feelings were his own, and which were "mapped onto" him by his environment. As an adult, he
was himself schizophrenic for periods of time, spending some time as a patient in psychiatric wards. As such, he
gained a perspective on schizophrenia which was unusual and perhaps even unique for a psychiatrist. That is, he truly
understood what the schizophrenic's world looked like from the inside, as well as from the outside. He also had
gained, from his own experience, a sense of the kind of situations in family, school, etc., that could drive a person
crazy.
Laing theorized that insanity could be understood as a reaction to the divided self. Instead of arising as a purely
medical disease, schizophrenia was thus the result of wrestling with two identities: the identity defined for us by our
families and our authentic identity, as we experience ourselves to be. When the two are fundamentally different, it
triggers an internal fracturing of the self.
His theories overturned the prevailing orthodoxy of the day that mental illness was, as the German psychiatrist Karl
Jaspers had put it, 'un-understandable'. He became a countercultural guru in the Sixties and Seventies, attracting a
large anti-establishment following who admired his anarchic and individualist philosophies. Laing believed that
mental illness was a sane response to an insane world and that a psychiatrist had a duty to communicate
empathetically with patients. Once, when faced with a naked schizophrenic woman rocking silently to and fro in a
padded cell, Laing took off his own clothes and sat next to her, rocking to the same rhythm until she spoke for the first
time in months.
As a psychiatrist, both brilliant and unconventional, RD Laing pioneered the humane treatment of the mentally ill.
According to Humanists , science is not just about to bring progress
Spinoza those who are governed by reason desire nothing more for themselves which they also desire for the rest
of the mankind .
The goal of maximizing human flourishing –life health ,happiness ,freedom ,knowledge ,love, richness of
experience may be called humanism
Humanistic psychology
Is undergoing a revitalization
Has quietly influence American psychology and culture
Has an image issue
Has influenced the civil rights debate and women rights movement
interest in the field is skyrocketing
Sought to restore the importance of consciousness and holistic view of human life

Criticism of humanistic psychology

It contributes to systemic injustice
Lacks an empirical base –rejection of quantitative research
It promotes narcissism , egotism and selfishness

R.D laings ideas

A sane response to an insane situation
Interest in the subjective experience of the schizophrenic
Treatment of the schizophrenic
The situation has to be discovered
Family resistance