Hello to all our wonderful therapists out there . Welcome to our Theory to Therapy series here at LicensureExamscom . I'm Linton and this is my co-host Stacy . How's it going up there in the Mitten State ?
Hi everyone . Well , I feel like I'm back in Florida . With the heat wave putting us up into the scorching 60s , I feel like I need to break out the bathing suit and flip flops what you got cooking for us down south today , Linton .
I see what you're doing there , stacy . I'm no stranger to the sarcasm , but thanks for asking . We're just fine with a heat index of 110 here at the beach . Well , stacy , I'm looking at the case about a 35-year-old man named Charlie who presents to therapy in the hopes of overcoming a long-standing phobia .
He's been overwhelmed with anxiety for as long as he can remember and he's afraid of the dark . His fear is so severe that he often stays up late at night because he can't bear the close's eyes in darkness .
To cope , charlie has tried various methods , such as drinking himself into a stupor and using sleeping pills , but none of them have effectively helped him manage his fears .
Okay , gotcha . Basically , this has been going on for way too long and the coping skills that he's been relying on have put him into really sounds like a self-destructive path that is A , not sustainable and B is going to result in him , as my mom would say , pushing up carrots sooner than he thinks .
She's from Germany , linton , so it's not pushing up daisies , it's pushing up carrots . Can you tell me more about how Charlie's fear has been affecting his daily life ?
Well , in the case study , Charlie has a long history of avoidant behavior related to his phobia , and he has a hard time discussing his fears with anyone because he feels so embarrassed about it . He has no idea where the fear comes from .
He does say that he was discharged from NAMM in his late 20s and he met with a therapist for a few months and tried exposure therapy , but he didn't find the process at all helpful . He's feeling pretty overwhelmed by the thought of confronting his fear , but he's tired of feeling like he's not living fully , so he has decided to go to therapy again .
Okay , very good , we're thinking about the best treatment interventions to use with Charlie , and we've got a couple of options to consider . The ones that you most commonly hear about for this type of thing are exposure therapy and hypnosis , but the one you don't hear as much about is psychoanalytic therapy , even though it's perfectly valid as a methodology .
Really , there was a time and not the so distant past , when I was a budding therapist that psychodynamic theory was a go-to approach for treating phobias .
I'm not going to ask what year that was , linton , you were a budding young therapist . But it's also important to note that psychoanalytic therapy has some limitations . So , for starters , it's a really long-term approach , so your client needs to be willing to commit to therapy over the long haul . Sometimes this means a few to several years .
It can also be expensive for the client , because most insurance companies don't cover this kind of treatment .
I don't know . I think you're a bit biased there , Stacey .
Am I Hmm .
But , as we reiterate time and time again , the exam is not testing your real life practicalities . It's testing you on your academic knowledge of treatment interventions .
Well said , linton , well said . So what do you say ? We break tradition here and explore how we can use psychoanalytic therapy with Charlie for his phobia . So first you need to know what psychoanalytic therapy entails . So this approach focuses on uncovering unconscious conflicts and exploring past experiences that may be contributing to current issues .
Talk about deep diving . This therapy process is all about swimming with the sharks and those elusive mermaids , uncovering the depths of the mind .
Yes , indeed , Now the exam may have questions asking you to interpret the client's behavior using a certain theoretical framework . From a psychoanalytic perspective , phobias are seen as complex psychological issues that result from childhood experiences and earlier unresolved conflicts .
Okay , so what you're saying is that Charlie's fear of the dark is connected to something that happened when he was in Nong , or even when he was a kid ?
Exactly . He may have repressed memories of witnessing something frightening in a dark room , or perhaps he was in a situation where he felt helpless and vulnerable and darkness represented those feelings . As a therapist , you'll be exploring Charlie's past and working to expose those repressed memories .
Okay , well , it sounds relatively simple when you put it that way , but , as with most things , I know there's a lot more to it .
Yes , dear yes , the process of psychoanalytic therapy goes well beyond just uncovering repressed memories . It's also about helping the client make sense of those experiences and come to terms with them , and helping them find some kind of resolution .
It can be a long and winding road , but eventually you want to help Charlie develop insight into his fears so that he can move on through it and forward in life with more confidence and peace of mind .
I see . What techniques could we use to increase Charlie's awareness of repressed material and promote insight ? I'm guessing you don't just go up to him and say so , charlie . Where do you think the sphere of the dark comes from , buddy ?
Remember there are unconscious forces at play here , so he's not going to have a clue On the exam . For example , the case study might even tell you that Charlie doesn't know where the fears come from and might ask what psychoanalytic technique you should use . One technique you could employ is free association , free association .
Is that the one where you ask the client to say some random word that pops into their mind like a corn dog , thick crust pizza , cherry pie .
Sounds like you're a bit hungry for a typical Michigander lunch Stacy . Well , in our work with Charlie , we'd ask him to share any thoughts , feelings or memory that randomly come to mind , without worrying about whether or not they make any sense . Nothing is taken at face value . There's always a latent meaning .
Any time there's a disruption in the associations that he's coming up with , you'll see some anxiety-provoking content , and that's where the deeper exploration needs to happen .
Free association is used a lot with DreamWork I know I've used it myself where the client describes their dream and then speaks freely about whatever thoughts come to mind in relation to the dream's content . Freud believed that this process could help reveal the latent content of the dream , based on the manifest content that the client discloses .
Yeah , that reminds me . Didn't Freud say dreams were the royal road to the unconscious ? Very interesting , okay . Now , as I understand it , psychoanalytic therapy is different from a lot of other counseling theories , like the famous cognitive behavioral therapy and solution focus therapy , in that it's really heavy on therapist interpretations . Is that right ?
Yes , yes , in fact , interpretation is another technique that uses psychoanalytic therapy . You , as a therapist , try to make sense of the client's feelings and behaviors by drawing those kind of connections together with the past .
Once you have an understanding of the unconscious conflicts and how they're playing out in the present , then you can offer possible explanations of the meaning behind the client's behavior to help them gain insight .
All right , Linton , so I have a very important question . Sometimes clients aren't really ready to hear your feedback , especially if their behavior involves a lot of self-protection . Like those defense mechanisms are working . So , they might actually take it as criticism and it puts them right on the defensive . So how would you handle that if that comes up ?
Well , that actually does happen when you use interpretation in the psychoanalytic therapy process . It's really important to be sensitive to the client's readiness to hear your feedback and only offer it when they are ready to hear what you have to say .
Okay , well , that's smart . So you mentioned a little bit earlier . I'm serious . What about dream analysis ? This is right up your alley , linton .
It is . That's what I did . My dissertation on Dream analysis is another tool in the Freudian tool bag . Not to make me a Freudian , though , dream work is a process by which the unconscious mind transforms the latent content of the dream into the manifest content .
This process often involves the use of mechanisms like displacement , which is shifting emotional significance from one thing to another . Condensation , which is combining very elements into one , and secondary revision , we're making the dream narrative coherent . Talking about this reminds me of a dream that I had last night . Stacey , did you have ?
any dreams . I did , but I need to start keeping a dream journal because five minutes go by and I can't remember it , I know it's just gone .
Well , I was being held captive by a frigid Arctic queen and I was afraid she was going to sacrifice me to the gods . Oh yeah , she came and got me , but instead of ripping my heart out , she threw me in a pit full of snakes .
So I reached down into my pocket , pulled up my lighter and lit a cigar and waved it around hoping the smoke would distract them .
And then You're gonna keep me on pins and needles here , okay . What happened next ?
I woke up .
Of course , cliffhanger .
So what do you think Freud would say about that one Stacy ?
Well , all right , freud was here . I bet he'd have a field day with this one . He was really big on the use of symbolism and he believed that the unconscious expresses itself through , primarily through , symbols . And from what you've described , lentin , your dream is rich in those . So the snake and cigar images might represent something else .
Like Just throwing this out here , performance anxiety as an example .
Maybe , but remember Freud used to say that sometimes a cigar is just a cigar .
Sure , let's ensure All right . Well , joking aside , let's get back to our case with Charlie . Okay , all right . So let's say that during one of your clinical sessions , you're using free association or dream analysis , and Charlie is reluctant to talk about certain things . You've basically hit a block . So how would a psychoanalyst deal with that ?
Well , actually this is a good thing , you know . This is where analysis and interpretation of resistance is useful . This is another technique that you would use of psychoanalytic technique . First , you need to recognize that , from a psychoanalytic point of view , resistance is a normal part of the process of therapy .
It's not something that should be seen as negative , but rather an opportunity for deeper , deeper understanding . The way to look at this with Charlie is that his resistance is a kind of defense mechanism .
Then he's using it to protect himself from the intense anxiety and pain that he would feel if he suddenly became aware of his repressed memories , which might not be a good thing .
Okay , this makes this is starting to make some sense . So Resistance isn't something that you're trying to overcome , but instead , as a psychoanalyst , you're working with it .
You're using it ? Yeah , exactly exactly . The last technique We'll talk about right now is analysis of transference .
So it does actually . So this is a term I hear about a lot , especially in an ethical context . So you've got transference , counter transference , that kind of stuff . But how exactly does transference fit into psychoanalytic therapy ?
transference occurs when a client unconsciously projects their unresolved conflicts or feelings From the past , as you know , on to the therapist right . It's often considered to be an important aspect of the psychoanalytic relationship that can lead to insight and greater Self-awareness . So this is a good thing where a lot of times in therapy it's looked as a negative .
The key is to recognize it as it is happening and then to gently invite the client to explore it further .
Okay , so could you give a quick example of what that might look like with Charlie ?
Okay , so let's say we went through Charlie's dream not mine , but Charlie's dream , not that I'm open to going through an interpretation with it , with you , stacy .
All right , we'll have to save that for a future episode . I love it .
Okay , but if Charlie is displaying resentment or anger towards me , I'd explore it by asking him questions like when have you felt this way before or what does this remind you of ? These kind of questions would help him identify patterns and his behavior and then link them to past Experiences interesting .
I'm digging the whole psychoanalytic therapy going going deep into the past . Well , we've really just scratched the surface of what we can do with this therapy . So , in summary , here are some of the techniques that psychoanalytic therapy and . Number one , interpretation .
This is where the therapist shares insights and potential meanings about a client's thoughts , behaviors and experiences . Number two , free association , which is where the client talks freely about whatever comes to mind , without censoring or editing their thoughts .
Number three , dream analysis , which involves an interpretation of symbols and events in the dream , revealing unconscious feelings or experiences . Number four , resistance . This is seen as a normal part of the process and it's explored as an opportunity for deeper understanding .
And Last but not least , transference , which is the client's projection of feelings or attitudes toward a person or situation from their past on to the Therapist . And this is where the the therapist is going to analyze that transference work within therapy . Right , all right , linton .
I think it is now time to let our therapists free associate about how these concepts might appear on the exam agreed and Okay .
Everyone , Thanks for joining us today as you are studying for your exam . Remember it's in there .