Chapter 15: Introduction

Some therapies focus on experiencing feelings, others stress identifying cognitive

patterns, and still others concentrate on actual behavior.

The field of psychotherapy is characterized by a diverse range of specialized models.

Practitioners have been battling over the “best” way to bring about personality change.
Chapter 15: Psychotherapy
Integration
Syncretism—practitioner
lacking in knowledge and
skill in selecting
interventions, making little
attempt to determine
therapeutic procedures are
effective
Pulling techniques from many sources without a sound
rationale results in syncretistic confusion
Chapter 15: Pathways
Toward Psychotherapy
Integration
Majority of psychotherapists prefer some form of
integration, which is expected to increase in
popularity during the next decade.

The ultimate goal of integration is to enhance the

efficiency and applicability of psychotherapy.
Pathways Toward
Psychotherapy Integration
Technical Integration:
It aims at selecting the best treatment techniques for the
person and the problem without necessarily subscribing to
the theoretical positions that spawned them.
One of the best-known forms of technical integration is
technical eclecticism, the basis of Lazarus’ multimodal
therapy.
e.g. BASIC I.D.
Pathways Toward
Psychotherapy Integration
Theoretical Integration:
It refers to a conceptual or theoretical creation beyond a
mere blending of techniques.
This approach emphasizes integrating the underlying
theories of therapy along with techniques from each.
Examples of this form of integration are dialectical behavior
therapy (DBT), acceptance and commitment therapy (ACT),
and emotion-focused therapy (EFT).
Pathways Toward
Psychotherapy Integration
Assimilative Integration:
An approach is grounded in a particular school of
psychotherapy, yet selectively incorporates practices from
other therapeutic approaches.
An example of this form of integration is mindfulness-based
cognitive therapy (MBCT), comprehensive integration of the
principles and skills of mindfulness that has been applied to
the treatment of depression.
Chapter 15: Pathways Toward
Psychotherapy Integration
Common Factors Approach:
It emphasizes common elements across
different theoretical systems.
Common factors are more important in
accounting for therapeutic outcomes than the
unique factors that differentiate one theory from
another.
Among the approaches to psychotherapy
integration, the common factors approach has
the strongest empirical support.
Chapter 15: Pathways Toward
Psychotherapy Integration
Common Factors Approach:
Some common factors identified:
1.Working alliance
2.Opportunity for catharsis
3.Practicing new behaviours
4.Client (pre-existing) factors
5.Self-reflective about one’s work
6.Therapist effects
Common Factors &
Psychotherapy Outcome
Psychotherapy outcome research examined from a common
factors perspective for the following 4 categories revealed
(Wampold, 2011; 2015):

1.Client factors (largest contributor to outcome!)

2.Therapeutic relationship
accounts for at least 12% of psychotherapy outcome effect (Horvath &
Bedi, 2012)
3.Expectancy/placebo
4.Therapeutic techniques
accounts for less than 1% outcome variance!
Psychoanalysis Chapter 4
Introduction
• Most of the theories of counseling and psychotherapy
influenced by psychoanalytic principles and techniques
• Attention to psychodynamic factors that motivate behavior
• Freudian theory gives a brief attention to Carl Jung’s
approach
 Psychoanalysis: View
of Human Nature
• Libido—sexual energy, later extended to life affirming force
• Life instincts serve the purpose of the survival of the individual
and the human race
• Freud also postulates death instincts (Thanatos)
• People manifest through their behaviour an unconscious wish
to die or to hurt themselves
Consciousness and Unconscious

• Consciousness is a thin slice of the total mind

• Like the iceberg that lies below the surface of the water, the
larger part of the mind exists below the surface of awareness
• Unconscious stores all experiences, memories, and
repressed material
• Root of all forms of neurotic symptoms and behaviors.
Structure of Personality

THE ID—The Demanding Child

• Ruled by the pleasure principle
THE EGO—The Traffic Cop
• Ruled by the reality principle
THE SUPEREGO —The Judge
• Ruled by the moral principle
Conscious and Unconscious
The following are clinical evidence for postulating the
unconscious:
• Dreams
• Slips of the tongue
• Posthypnotic suggestions
• Material derived from free-association techniques
• Material derived from projective techniques
• Symbolic content of psychotic symptoms
 More on Freud’s
Unconscious
 majority of needs & motivations are (directly) inaccessible
 includes both cognitive and emotional processes, and memories
that affect the person’s reactions and behaviour
 “unconscious mind” predates Freud
 Freud’s contribution: HOW the “unconscious mind” could be
used to understand & inform treatment of psychological problems
Theory of Psychopathology
No one is immune!
Fixations: everyone is vulnerable to regress into psychopathology
(unconsciousness)

Conflicts & fixations earlier: less psychic energy, more problems

Stressful events can stimulate unconscious conflict:
React unconsciously to current event AS IF it were a repetition
of a childhood experience e.g., rejection by a parent
Overreaction to life events : symptoms = defending against unacceptable
impulses and childish anxieties
Primary-process thinking: unconscious, alogical , atemporal
Displacement; manifest & latent content
Importance of Anxiety

Feeling of dread resulting from repressed feelings, memories, and desires

• Develops out of conflict among the id, ego, and superego to control psychic
energy
The following are the three types of anxiety:
• Reality Anxiety: fear of danger from the external world
• Neurotic Anxiety: fear that instincts cause person to do something for which
they will be punished
• Moral Anxiety: fear of one’s conscience
Ego-Defense Mechanisms
Help the individual cope with anxiety and prevent the
ego from being overwhelmed

Are normal behaviors that have adaptive value if they do

not become a style of life to avoid facing reality

The following are the two characteristics in common:

They either deny or distort reality.
They operate on an unconscious level.
Ego-Defense Mechanisms continued
 automatic forms of response to situations that arouse
unconscious fears or the anticipation of “psychic danger”

 shorthand or rigid ways to avoid bringing up thoughts or

emotions the person cannot tolerate

 can be employed in healthy functioning or problematic

functioning
Ego-Defense Mechanisms continued
Anna Freud fully developed this concept

Defensive styles shape people’s experience/personality

Borderline personality = projection & splitting (Kernberg, 1975)

Typical defenses used later mental and physical health
a) sublimation & humour – less problems
b) projection & denial – more problems (Vaillant, 1977, 2002)
Ego-Defense Mechanisms
• Repression • Sublimation
• Denial • Regression
• Reaction Formation • Introjection
• Projection • Identification
• Displacement • Compensation
• Rationalization
Development of Personality
Freud’s Psychosexual Stages

• First year: Oral stage (adult: mistrust of others, reject others; fear of
loving, forming close relationships
• Ages 1–3: Anal stage (adult: denial of one’s power & autonomy

• Ages 3–6: Phallic stage (adult: difficulty with sexuality & sexual
feelings, accepting self as a man or woman)
• Ages 6–12: Latency stage
• Ages 12–18: Genital stage (transform sexual energy to
friendships/relationships & activities like art, sports, career efforts
• Ages 18–35: Genital stage continues
• Ages 35–60: Genital Stage continues
• Ages 60+: Genital stage continues
Development of Personality
Erikson’s Psychosocial Stages
• First year: Infancy (trust vs. mistrust)
• Ages 1–3: Early Childhood (autonomy vs. shame & doubt)
• Ages 3–6: Preschool Age (initiative vs. guilt)
• Ages 6–12: School Age (industry vs. inferiority)
• Ages 12–18: Adolescence (identity vs. role confusion)
• Ages 18–35: Young adulthood (intimacy vs. isolation)
• Ages 35–60: Middle age (generativity vs. stagnation)
• Ages 60+: Later life (integrity vs. despair)
Erikson’s Psychosocial
Perspective
Psychosocial stages: Erikson’s basic psychological and
social tasks to be mastered from infancy through old age

Erikson’s theory of development holds that psychosexual and

psychosocial growth take place together

During each psychosocial stage, we face a specific crisis

that must be resolved in order to move forward
Psychoanalysis: The Therapeutic
Process
• The goal is to make the unconscious conscious and
strengthen the ego so that behavior is based on
reality

• Increase adaptive functioning, which involves the

reduction of symptoms and the resolution of conflicts

• The process is not limited to solving problems and

learning new behaviors

• Achieving insight but not just an intellectual

Therapist’s Function and Role
Blank-screen approach, also known as anonymous
nonjudgmental stance, fosters transference.

Transference relationship refers to the client’s tendency to

view the therapist in terms that are shaped by his or her
experiences with important caregivers and other significant
figures who played important roles during the developmental
process.
Psychoanalysis: Client Role &
Experience
Willing to commit to intensive, long-term therapy
Engage in free association, report feelings, experiences,
associations, memories, & fantasies
Asked not to make any radical changes in lifestyle during
period of analysis
Therapy termination when client/analyst mutually agree they
have resolved symptoms & conflicts amenable to resolution,
clarified & accepted remaining emotional problems

Answers “why” questions about client’s life

Relationship Between Therapist &
Client
Transference is the client’s unconscious shifting to the
analyst feelings originally experienced in an early
relationship to other important people in their present
environment
Working-through process consists of repetitive and
elaborate explorations of unconscious material,
originated in early childhood.
Countertransference occurs when therapists lose their
objectivity because their own conflicts are triggered
Application: Therapeutic
Techniques and Procedures
Maintaining the Analytic Framework
• Therapist uses a range of procedural and stylistic
factors (e.g., analyst’s relative anonymity,
consistency of meetings)

Free Association
• Clients are encouraged to say whatever comes to
mind

Interpretation
• Analyst’s pointing out, explaining, and even
teaching the client the meanings of behaviour
Dr. Gerald Corey with Stan - video

Free Association
Application: Therapeutic Techniques
and Procedures
• Dream Analysis
Therapist uses the “royal road to the unconscious” to bring
unconscious material to light; manifest versus latent dream
content

• Analysis and Interpretation of Resistance

Works against the progress of therapy and prevents the client
from producing previously unconscious material

• Analysis and Interpretation of Transference

Therapist points out, explains, and teaches the meanings of
whatever is revealed
Activity: Freudian Analysis of Stan’s Dream
He describes coming across a house, it is not any house he has ever
lived in but in the dream the house seems familiar. He suddenly needs to
go to the washroom, and so he enters the house. It is virtually empty, it
seems as if a family just moved out. The floors are wooden and clean. He
finds the washroom, which is oddly shaped, very long and narrow, it
seems almost like a hallway. He tries to go to the washroom but he
cannot. He notices that as he leaves the washroom, there is no roof and
he can see the tops of trees and the clouds in the sky. As he goes to
leave, he notices a small wooden box, the size of a jewelry box in one of
the rooms, sitting on the floor. It’s beautiful and it looks expensive. He is
unsure what to do, he picks it up to look at the detail and as he does so,
the box starts to change shape and colour. This startles him, he drops the
box and leaves the house. Once he is outside, he immediately regrets not
taking the box, and goes back to try to retrieve it. Now, the doors are
locked and he can’t get back into the house. He wakes up feeling anxious
and unsettled by the dream.
Theoretical Goals of Psychoanalysis
to uncover inner problems that have been disguised as
symptoms (identifying thematic & emotional links)
to become integrated
to uncover sources of past pain that may be embedded in
the present, causing ripples (or whirlpools) of the past in the
present
to discover what stands in the way of taking appropriate
actions for the self; foster client’s coping & own problem solving
Application:
From a psychoanalytic point of view, what issues do
you think are primary issues for Stan? For Gwen?

What type of transference relationship do you think

Gwen would form with her therapist? Or Stan?

What potential types of counter-transference

relationships could occur with Stan’s therapist?