Freud said the purpose of therapy was “to be able to love and to work”.

Freud focused on the understanding of psycho-sexual development. Erick Erickson took it further with his focus on psychosocial development…Freud was not a happy camper about that.

The focus is on the historical antecedents of current behavior….our history is what subconsciously guides us.

Ego Defense Mechanisms

• Repression – push the bad stuff into our unconscious
• Denial – suppress bad stuff…but we are still fully or semi-conscious of  it
• Regression – revert back to an old pattern or coping mechanism that used to work
• Projection – accuse someone else of  being how  we guiltily feel we actually are
• Displacement – Misplaced anger, take out your anger on a safer target…Mad at your spouse? Go kick the dog.
• Reaction Formation – A  man fearfully still  in the closet and ashamed may vehemently lash out at openly gay people.
• Rationalization – We can justify about anything if it suits our needs.

Psychoanalytic Approach to Groups

Psychoanalytic Approach

• Major influence in other models
• Freudian approach
• Alexander Wolf first credited with using psychoanalytic principles for groups (1938)

How does the psychoanalytic approach work?

• By restructuring the client’s character and personality

How?

• By making unconscious conflicts conscious and examining them

How do you do that?

• Repeating the historical past in the present by reenacting the family of origin in a symbolic way

Use of the Past in Psychoanalytic Approach

• first six years of life
  • inability to freely give and accept love; difficulty recognizing and dealing with emotions; resentment and aggression; independence and dependence conflicts; difficulty in separating from one’s parents; avoidance of intimacy; difficulty accepting one’s sexual identity; and guilt over sexual problems
• modern analytical approaches include the incorporation of past, present, and future events

The Unconscious

• The thoughts, feelings, motives, impulses, events that out kept out of our awareness to protect against anxiety
• Freudian concept
• Human behavior is motivated by the unconscious
• The events in the unconscious never go away with time, so the client will still feel dealing with the anxiety provoking situation as intolerable
• Choices are not freely made but influenced by the unconscious
• Goal of psychoanalytic therapy is to bring unconscious to the conscious mind, as one can become aware of what are the motivations behind their behavior
• Done through dreams, free-association, transference, and interpretations
• Anxiety is the result of unconscious material breaking through.

Ego-Defence Mechanisms

• Way to explain behavior
• Protects the ego from threatening thoughts and feelings
• Learned behavior
• Often start in childhood and continues throughout adulthood
• Repression, Denial, Regression, Projection, Displacement, Reaction, and Rationalization

Repression

• pushing distressing thoughts/ feelings into the unconscious
• blocking memories
• some have no recollections of traumatic events

Denial

• Coping with anxiety by pretending the source does not exist
• Can be the refusal to accept that there is a problem
• Deception is a common trait in denial, to one’s self and to others

Regression

• Returning to a less mature developmental level
• Reverting to old patterns of behavior that may have worked at a previous point in time

Projection

• Attributing one’s own unacceptable thoughts, feelings, behaviors and motives to others
• Pointing out flaws in others that you see in yourself

Displacement

• Redirection of an emotions from the real source to a substitute object or person
• Common for one to choose a non-threatening target to direct their anger

Reaction Formation

• Behaving in a way that is opposite to what one is really feeling
• A common way to avoid anxiety provoking feelings
• Examples
  • “This won’t hurt that bad”
  • “It doesn’t really bother me if I’m rejected”

Rationalization

• Justification of behavior through logic
• Coming up with reasons to justify negative feelings or emotions

Resistance

• Apprehension to bring threatening material into the conscious mind
• OR anything that gets in the way of dealing with unconscious material
• Defence against feeling emotion pain/anxiety
• Can materialize in the form of
  • apprehension about joining a group
  • participation in the group
  • desire to leave the group
• Other ways resistance can manifest
  • Arriving late
  • Attitude of Indifference
  • Intellectualizing
  • Trying to help other group members in an exaggerated way
  • Distrust
  • Uncooperative
  • Inappropriate behavior
  • Using the group for socialization
• To work through this the therapist must start with the client’s immediate problems, working through them together and recognizing them as blocks against anxiety
• Criticism will only increase behavior

Transference

Unconsciously shifting feelings about significant people in the past to people in the present

• Therapy setting should be a comfortable place to express these feelings
• Tend to compete for attention from the leader (therapist) just as a child one would compete for the attention of their parents
• Group setting allows for multiple transferences to the therapist as well as other members of the group

Countertransference

The therapist’s unconscious feelings toward the client, resulting in distorted perceptions of the client’s behavior.

Common Examples:

• Taking advantage of having the position of power, using seductive behavior to get the attention of the group members
• Seeing traits that you dislike in yourself in members of the group, thinking that member may be difficult to work with
• Overidentifying with the clients

Countertransference Continued

• Recommended that therapist undergoes their own analytical therapy session to become conscious of how they may obstruct therapeutic tasks
• Countertransference common for group therapists
  • Five most common countertransference patterns of a therapist
    • emotionally withdrawn and unavailable
    • passive
    • overly controlling
    • regression
    • paternalistic

Role of the Group Leader

• Reacts rather than initiate
• Waits for the group process to occur and then comments on it
• Emphasizes the therapeutic alliance between the therapist and the client
• Gives support when the group is not providing it
• Aids with resistances from the clients
• Aids in the process of awareness of the clients behavior

Client Benefits of Psychoanalytical Therapy

• Build relationships in a safe environment
• Learn how their defenses and resistances are manifested
• More dependence on other group members instead of just the therapist
• Learn to express intense feelings
• Centrally focuses on controlling and limiting anxiety, allows the client to realize that anxiety and its defences are normal

Psychoanalytic Therapeutic Techniques

• Free Association
• Interpretation
• Dream Analysis
• Insight and Working Through

Free Association

• Communicating whatever comes to mind regardless of what it is
• Reporting feelings fully and without censorship
• Talking about whatever is brought up instead of a specific theme
• In group setting members are encouraged to make comments and free associate with each other member

Interpretation

Used in the analysis of free association, dreams, transference, and resistances.

Attaching meaning to behaviors.

• A skill that if used well can allow client to gain valuable insights
• Interpretations are not truth but a hypothesis
• Interpretations asked as questions are more likely to be considered by the client
• Interpretations should start out superficial and go emotionally deeper
• Interpretations can be met with defense mechanisms and the therapist should point this out

Dream Analysis

• Dreams have both a conscious meaning and a hidden meaning
• Group members are encouraged to offer their own interpretations
• Essential aspect of the analytical process
• Dreams can reveal how the group member views the therapist and other members

Insight and Working Through

Insight is awareness into the cause of your own difficulties.

Working through is the resolution of dysfunctional patterns.

• Very complex part of psychoanalysis, requires deep commitment
• Can be a painful experience for the client that requires reexperiencing traumatic events
• Never completely frees the individual from old patterns, but is an acceptance process

Developmental Stages

This model pulls both from Erikson’s 8 stages of psychosocial development and Freud’s psychosexual stages of development.

Reflecting on each person’s experiences during these stages can reveal a lot about their behaviors and emotions about current life events.

Stage 1: Infancy- Trust vs. Mistrust

• Freud’s “oral stage,” in this stage of life infants are dependant on parents to feel safe and protected. Without proper care the child will grow up to be fearful of intimacy and have difficult relationships.
• Group leaders can work with members to express their pain and to help break down barriers that are preventing them from trusting other people.

Stage 2: Early Childhood- Autonomy vs Shame and Doubt

“anal stage” a child must learn how to cope with negative feelings like anger and must start learning independence and accepting personal power. Parent’s role of praising/punishing and having expectations of independence is important.

Group members may need to “relive” or “re-experience” situations from the past that they have intense conflicting feelings about and work through the guilt associated with them.

Stage 3: Preschool age- Initiative vs Guilt

“phallic stage” and the Oedipus Syndrome. Erikson stresses the children’s ability to make own decisions and follow through with them vs not making decisions or being criticized for decisions.

Group members may be concerned with sexual feelings, behaviors, values, or attitudes that they have. They may be concerned about their gender role and the group is a safe place to discuss concerns.

Stage 4: The School Age- Industry vs. Inferiority

“latency stage” sexual desires have tapered off.

Industry refers to setting and attaining meaningful goals. If a child fails to do this they may feel inadequate.

Group members may have to go back to relive and reexperience the pain of inadequate feelings in childhood to move on and face their fears of failure as adults.

Stage 5: Adolescents- Identity vs Identity confusion

Adolescents must struggle with breaking ties of dependence and reacting under pressures stemming from multiple social sources. If they fail to do this they may have identity confusion

Groups generally spend a good deal of time exploring and resolving problems with dependence/independence conflict and struggles of individuality and autonomy.

Stage 6: Early Adulthood- Intimacy vs. Isolation

In this period establishing intimate committed relationships and establishing a satisfying lifestyle is important. Isolation can occur if intimate relationships do not form.

Groups often dedicate a lot of time to discussing issues with intimacy. Often people struggle with maintaining independence while caring deeply for other people.

Stage 7: Middle Adulthood- Generativity vs. Stagnation

Focus on reexamining how one is living and trying to guide the new generation. Can be painful to reflect on what was intended to be accomplished in early adulthood and what was accomplished.

Group work can be used to change people’s negative views about their accomplishments and help them find new value and meaning in life.

Stage 8: Later Life- Integrity vs. Despair

adjusting to the deaths of loved ones, maintaining interests, adjusting to retirement, and reviewing the past. Looking back on the past with integrity or despair.

Groups are therapeutic for older persons because it can help diminish feelings of loneliness and can direct members to focus on the positive aspects of their age.

Object Relations Theory

• Interpersonal relationships that shape a person’s current interaction with people
• Object relations therapy is based on the premise that early in life the individual has drives that are satisfied through attachment to specific people, primarily parents.
• These early interactions lay the foundation for relationship patterns later in life

Attachment Theory

Infants emotionally bond with a caretaker who provides a sense of security.

The better an infant’s needs are taken care of, the stronger the relationships they will have later in life.

Borderline Personality Disorder

A borderline personality disorder is characterized by bouts of irritability, self-destructive acts, impulsive anger, and extreme mood shifts.

people with BPD are not easy to work with in groups, but they are even harder to work with individually. They can often use the support from the group and test the boundaries of what is reality against what their thought process is.

Narcissistic Personality Disorder

This syndrome is characterized by an exaggerated sense of self-importance and an exploitive attitude toward others, which serves the function of masking a frail self-concept.

Like people with BPD, it is difficult to make progress with narcissists in groups. Particularly when they elicit strong negative emotions from therapists, which they often do.

Future of Psychodynamic Approach

• Integrative therapy with Cognitive behavior therapy.
• Treating selective disorders in 10-25 sessions

(focuses on strengths and here-and-now)

• Psychoanalytical approaches are helpful in school settings where children are in adolescent stage.

Criticisms

• Too much emphasis on child-mother bond and blame on mother.
• Addresses ways to reconstruct long term personality problems and does not focus on short-term problem solving.
• Usually a lengthy and expensive process.