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Individual psychotherapy is a partnership between an individual and a a
psychotherapist, often one who is analytically trained, licensed to help
people understand their inner conflicts (both conscious and unconscious),
feelings, and assist them with growth and development that ultimately
leads to changing their behaviors.
Psychoanalytic Psychotherapy is most effective in helping people
resolve, work through and cope with:
- Personality Disorders as described in the DSM IV
- Anxiety and depression
- Addiction/ eating disorders/phobias
- Personal Growth/self esteem
- Relationships
- Work
- Grieving and loss
- Trauma and abuse
- Dependency issues/separation/individuation
- Anger management
- Obsessions
- Boundary Issues
- Conflict Resolution
- Transference/Countertransference (working trough issues as therapist
as new “self object)”
- Communication
Individual Psychotherapy
There are many different styles and clinical approaches to individual
psychotherapy and often this is confusing to people in search of
treatment. For many years, psychoanalysts were treating patients on the
couch three to five times per week. Our ever-changing world and
environment has made the old classical style unavailable to the general
sector of the population. Self help books, talk radio, internet has made
psychotherapy more accessible reaching out to the mainstream of
individuals who hitherto never dreamed they would ever seek counseling or
psychotherapy. Although the psychodynamics (envy, jealousy, issues around
betrayal, entitlement, oedipal and sibling rivalry) remain the same
pathologies have changed. We see new forms of psychological emotional
viruses that demand new forms of treatment, expanding beyond the rigid
boundaries of traditional psychoanalysis. Perhaps the reason many
clinicians are encountering new pathologies is because of an increasing
percentage of single-parent families, prevalence of divorce rates, surge
of working mothers, parental unavailability to children, the near
extinction of extended families, and, in general, greater social isolation
in a society increasingly dominated by drugs, gangs, and violence. This
contributes greatly to the need for new treatment approaches.
Freud’s theory was an intrapsychic, understanding the patients
unconscious motivations and movements between id, ego and superego.
Freud’s theory was a psychology of instincts focusing more on the need for
the father; the ability to master over the father or “oedipal conflicts.”
Contemporary theorists, mainly the British School for object relations
began to see that the patient does not just struggle with internal
conflicts but lives in an interpersonal world and is vulnerable to the
responsiveness of others as well as to the environment. The recognition
that the mother is the first object the baby bonds with as a major
influence in acknowledging women and the importance of her role as a
maternal object.
Some of the criticisms are that the behaviorists are too directive,
have unrealistic expectations of the patients, and ask too many questions.
The object relationists are too confrontive and focus too much on the
internal world (patient’s distortions/projections). The self-psychologists
are "too empathic,” focus too heavily on the external environment as the
cause of all the woe (faulty self objects). The difference between the
psychoanalytic/psychodynamic model and the behavioral/cognitive approach
is that the latter approach holds what the patient accomplishes or “does”
is of number one priority while the psychodynamic/psychoanalytic approach
holds the patient’s resistance to getting things done as the number one
priority. My approach blends various theoretical methods incorporating the
works of Wilfred Bion, helping the patient “think” and understanding the
defense mechanisms that impede or destroy the ego’s capacity to function
(reality testing, perception, judgment, thinking.) ”I defend therefore I
cannot think.”
Systems theory or other "directive" approaches" are simply not enough
especially when we are dealing with more complex pathologies and
symptomatologies (individuals dominated by primitive defense mechanisms).
The problem is they all offer "quick fix" focusing primarily on the
symptom, which does not lead to lasting results, nor to any understanding
of the unconscious messages. Ironically it is the "quick fix" that got
them into mess in the first place. Many family, group and other
practitioners today are beginning to see the need for a more in-depth
approaches to marital treatment.
Object relations is a psychodynamic theory based on how one relates and
interacts with others in the external world. It is a theory of unconscious
internal objects which compels a person to form a specific dynamic
interaction or attachment. Object relations differs from Freudian theory
in that it is an interpersonal theory which helps explain why people
cannot adapt even when the environment good and nurturing. Klein taught us
how we relate to others through the lenses reflecting the child's world
through fantasy as she developed the notion of projective identification.
Klein believed the first form of anxiety is persecutory, that the
environment that although the environment can it does not originate the
baby's primary anxieties and inner conflicts. Klein developed the idea of
pathological splitting of "good and "bad" objects through the defensive
process of projection and introjection in relation to primitive anxiety
and the death instinct (based on biology). Object relations in one of the
most powerful theories that examines unconscious fantasies/motivations and
reflecting how a person can distort reality projecting and identifying
with bad objects.
Self Psychology
This a theory developed by Heinz Kohut, the forerunner of self
psychology, a term used to refer to an interpersonal process whereby the
analyst provides basic functions for the patient. These functions are used
to make up for failures in the past by caretakers who were lacking in
mirroring, empathic attunement, and had faulty responses with their
children. Kohut reminds us that psychological disturbances are caused by
failures from early parental caretakers and the narcissistic injuries
created in early childhood leaves that persona always seeking for approval
from others. They may spend the rest of their lives living in narcissistic
nostalgia longing to be the favorite child and when they feel their sense
of “specialness” is under attack will respond with withdrawal or emotional
isolation. Therapeutic reparation according to Kohut occurs when the
therapist proves appropriate object functions and good mirroring
responses.
THERAPEUTIC FUNCTIONS
- Empathy
- Listening
- Understanding
- Introspection
- Therapist as the Mirroring Object
- Therapist as Self Object
- Therapist as Container (Hard Object)
- Therapist as the Bonding/Weaning/Mommy
- Therapist as the Transitional Object, the Bonding/Weaning
- Therapist as the Holding and Environmental/ Mommy
- Therapist as the "Being" vs. "Doing" Mommy (remembering the
patient's experiences and affects)
- Therapist as Interpreter
- Thinking
- Containment
Different Theoretical Perspectives to
Treatment
- Classical Psychoanalysis (intrapsychic)
- Self Psychology (external; need for mirroring, empathy, and self
objects
- Object Relations (focus on the internal, distortions, projections,
introjections
- Behavioral/Cognitive (focus is on the partnership, directive
approach)
- Self Psychology vs. Object Relations
- Conjoint/Marital Treatment
- Group Psychotherapy
- Psychohistory
- Cross Culture/Transculture Perspectives
Theorists
- Sigmund Freud (Oedipus, drive/defense, aggression/instincts
- Heinz Kohut (self psychology, mirroring, empathy, self objects
- Melanie Klein (object relations, splitting, projection, projective
identification
- Otto Kernberg (adds aggression to drive/defense and describes four
different kinds of relationships).
- W. R. D. Fairbairn (attachments to bad internal objects)
- D, Winnicott (transitional objects, different kinds of mothering
experiences, environmental/background/holding mother)
- Wilfred Bion (therapist as the thinker, container, detoxifying
mother).
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