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Click Sandler Analysis



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The patient expresses his or her thoughts, including free associations , fantasies , and dreams, from which the analyst infers the unconscious conflicts causing the patient's symptoms and character problems. Through the analysis of these conflicts, which includes interpreting the transference and countertransference [7] the analyst's feelings for the patient , the analyst confronts the patient's pathological defenses to help the patient gain insight.

Sigmund Freud first used the term 'psychoanalysis' French : psychanalyse in , ultimately retaining the term for his own school of thought. Psychologist in Frank Sulloway in his book Freud, Biologist of the Mind: Beyond the Psychoanalytic Legend argues that Freud's biological theories like libido were rooted in the biological hypothesis that accompanied the work of Charles Darwin , citing theories of Krafft-Ebing , Molland, Havelock Ellis , Haeckel , Wilhelm Fliess as influencing Freud. The idea of psychoanalysis German : psychoanalyse first began to receive serious attention under Sigmund Freud , who formulated his own theory of psychoanalysis in Vienna in the s.

Freud was a neurologist trying to find an effective treatment for patients with neurotic or hysterical symptoms. Freud realised that there were mental processes that were not conscious, whilst he was employed as a neurological consultant at the Children's Hospital, where he noticed that many aphasic children had no apparent organic cause for their symptoms. He then wrote a monograph about this subject. Charcot had introduced hypnotism as an experimental research tool and developed the photographic representation of clinical symptoms. Breuer wrote that many factors could result in such symptoms, including various types of emotional trauma, and he also credited work by others such as Pierre Janet ; while Freud contended that at the root of hysterical symptoms were repressed memories of distressing occurrences, almost always having direct or indirect sexual associations.

Around the same time, Freud attempted to develop a neuro-physiological theory of unconscious mental mechanisms, which he soon gave up. It remained unpublished in his lifetime. In , Freud also published his seduction theory , claiming to have uncovered repressed memories of incidents of sexual abuse for all his current patients, from which he proposed that the preconditions for hysterical symptoms are sexual excitations in infancy. This became the received historical account until challenged by several Freud scholars in the latter part of the 20th century who argued that he had imposed his preconceived notions on his patients.

By , Freud had theorised that dreams had symbolic significance, and generally were specific to the dreamer. Freud formulated his second psychological theory— which hypotheses that the unconscious has or is a "primary process" consisting of symbolic and condensed thoughts, and a "secondary process" of logical, conscious thoughts. This theory was published in his book, The Interpretation of Dreams. In this theory, which was mostly later supplanted by the Structural Theory, unacceptable sexual wishes were repressed into the "System Unconscious," unconscious due to society's condemnation of premarital sexual activity, and this repression created anxiety. This " topographic theory" is still popular in much of Europe, although it has fallen out of favour in much of North America.

In , Freud published Three Essays on the Theory of Sexuality in which he laid out his discovery of the psychosexual phases : [23]. His early formulation included the idea that because of societal restrictions, sexual wishes were repressed into an unconscious state, and that the energy of these unconscious wishes could be turned into anxiety or physical symptoms. Therefore, the early treatment techniques, including hypnotism and abreaction, were designed to make the unconscious conscious in order to relieve the pressure and the apparently resulting symptoms. This method would later on be left aside by Freud, giving free association a bigger role.

In On Narcissism , Freud turned his attention to the titular subject of narcissism. By , in " Mourning and Melancholia ," he suggested that certain depressions were caused by turning guilt-ridden anger on the self. By , Freud addressed the power of identification with the leader and with other members in groups as a motivation for behavior in " Group Psychology and the Analysis of the Ego ". Also, it was the first appearance of his "structural theory" consisting of three new concepts id, ego, and superego.

Three years later, in , he summarised the ideas of id, ego, and superego in " The Ego and the Id. Hence, Freud characterised repression as both a cause and a result of anxiety. In , in "Inhibitions, Symptoms and Anxiety," Freud characterised how intrapsychic conflict among drive and superego wishes and guilt caused anxiety , and how that anxiety could lead to an inhibition of mental functions, such as intellect and speech.

According to Freud, the Oedipus complex, was at the centre of neurosis, and was the foundational source of all art, myth, religion, philosophy, therapy—indeed of all human culture and civilization. It was the first time that anyone in the inner circle had characterised something other than the Oedipus complex as contributing to intrapsychic development, a notion that was rejected by Freud and his followers at the time. Also in , Anna Freud , Sigmund's daughter, published her seminal book, The Ego and the Mechanisms of Defense , outlining numerous ways the mind could shut upsetting things out of consciousness.

When Hitler 's power grew, the Freud family and many of their colleagues fled to London. Within a year, Sigmund Freud died. Led by Heinz Hartmann , the group built upon understandings of the synthetic function of the ego as a mediator in psychic functioning, distinguishing such from autonomous ego functions e. These "Ego Psychologists" of the s paved a way to focus analytic work by attending to the defenses mediated by the ego before exploring the deeper roots to the unconscious conflicts. In addition, there was burgeoning interest in child psychoanalysis. Although criticized since its inception, psychoanalysis has been used as a research tool into childhood development, [vi] and is still used to treat certain mental disturbances.

Several researchers followed Karen Horney 's studies of societal pressures that influence the development of women. In the first decade of the 21st century, there were approximately 35 training institutes for psychoanalysis in the United States accredited by the American Psychoanalytic Association APsaA , which is a component organization of the International Psychoanalytical Association IPA , and there are over graduated psychoanalysts practicing in the United States. The IPA accredits psychoanalytic training centers through such "component organisations" throughout the rest of the world, including countries such as Serbia, France, Germany, Austria, Italy, Switzerland, [39] and many others, as well as about six institutes directly in the United States.

In the s, psychoanalysis was the main modality of psychotherapy. Behavioural models of psychotherapy started to assume a more central role in psychotherapy in the s. Beck a psychiatrist trained in a psychoanalytic tradition set out to test the psychoanalytic models of depression and found that conscious ruminations of loss and personal failing were correlated with depression. He suggested that distorted and biased beliefs were a causal factor of depression, publishing an influential paper in after a decade of research using the construct of schemas to explain the process. The predominant psychoanalytic theories can be organised into several theoretical schools.

Although these perspectives differ, most of them emphasize the influence of unconscious elements on the conscious. There has also been considerable work done on consolidating elements of conflicting theories. As in the field of medicine , there are some persistent conflicts regarding specific causes of certain syndromes, and disputes regarding the ideal treatment techniques. In the 21st century, psychoanalytic ideas are embedded in Western culture , [ vague ] especially in fields such as childcare , education , literary criticism , cultural studies , mental health , and particularly psychotherapy. Though there is a mainstream of evolved analytic ideas , there are groups who follow the precepts of one or more of the later theoreticians.

Psychoanalytic ideas also play roles in some types of literary analysis such as Archetypal literary criticism. Topographic theory was named and first described by Sigmund Freud in The Interpretation of Dreams These systems are not anatomical structures of the brain but, rather, mental processes. Although Freud retained this theory throughout his life he largely replaced it with the structural theory. Structural theory divides the psyche into the id , the ego , and the super-ego. The id is present at birth as the repository of basic instincts, which Freud called " Triebe " "drives" : unorganized and unconscious, it operates merely on the 'pleasure principle', without realism or foresight.

The ego develops slowly and gradually, being concerned with mediating between the urging of the id and the realities of the external world; it thus operates on the 'reality principle'. The super-ego is held to be the part of the ego in which self-observation, self-criticism and other reflective and judgmental faculties develop. The ego and the super-ego are both partly conscious and partly unconscious. During the twentieth century, many different clinical and theoretical models of psychoanalysis emerged. Ego psychology was initially suggested by Freud in "Inhibitions, Symptoms and Anxiety" , [31] while major steps forward would be made through Anna Freud 's work on defense mechanisms , first published in her book The Ego and the Mechanisms of Defence The theory was refined by Hartmann , Loewenstein, and Kris in a series of papers and books from through the late s.

Leo Bellak was a later contributor. This series of constructs, paralleling some of the later developments of cognitive theory, includes the notions of autonomous ego functions: mental functions not dependent, at least in origin, on intrapsychic conflict. Such functions include: sensory perception, motor control, symbolic thought, logical thought, speech, abstraction, integration synthesis , orientation, concentration, judgment about danger, reality testing, adaptive ability, executive decision-making, hygiene, and self-preservation.

Freud noted that inhibition is one method that the mind may utilize to interfere with any of these functions in order to avoid painful emotions. Hartmann s pointed out that there may be delays or deficits in such functions. Frosch described differences in those people who demonstrated damage to their relationship to reality, but who seemed able to test it. According to ego psychology, ego strengths, later described by Otto F. Kernberg , include the capacities to control oral, sexual, and destructive impulses; to tolerate painful affects without falling apart; and to prevent the eruption into consciousness of bizarre symbolic fantasy.

Defenses are synthetic functions that protect the conscious mind from awareness of forbidden impulses and thoughts. One purpose of ego psychology has been to emphasize that some mental functions can be considered to be basic, rather than derivatives of wishes, affects, or defenses. However, autonomous ego functions can be secondarily affected because of unconscious conflict.

Taken together, the above theories present a group of metapsychological assumptions. Therefore, the inclusive group of the different classical theories provides a cross-sectional view of human mental processes. There are six "points of view", five described by Freud and a sixth added by Hartmann. Unconscious processes can therefore be evaluated from each of these six points of view: [48]. Modern conflict theory , a variation of ego psychology , is a revised version of structural theory, most notably different by altering concepts related to where repressed thoughts were stored. Moreover, healthy functioning adaptive is also determined, to a great extent, by resolutions of conflict. A major objective of modern conflict-theory psychoanalysis is to change the balance of conflict in a patient by making aspects of the less adaptive solutions also called "compromise formations" conscious so that they can be rethought, and more adaptive solutions found.

Object relations theory attempts to explain the ups and downs of human relationships through a study of how internal representations of the self and others are organized. Concepts regarding internal representation aka 'introspect,' 'self and object representation,' or 'internalization of self and other' , although often attributed to Melanie Klein , were actually first mentioned by Sigmund Freud in his early concepts of drive theory Three Essays on the Theory of Sexuality , Freud's paper " Mourning and Melancholia ," for example, hypothesized that unresolved grief was caused by the survivor's internalized image of the deceased becoming fused with that of the survivor, and then the survivor shifting unacceptable anger toward the deceased onto the now complex self-image.

Vamik Volkan , in "Linking Objects and Linking Phenomena," expanded on Freud's thoughts on this, describing the syndromes of "established pathological mourning" vs. Mahler , Fine, and Bergman describe distinct phases and subphases of child development leading to "separation-individuation" during the first three years of life, stressing the importance of constancy of parental figures in the face of the child's destructive aggression, internalizations, stability of affect management, and ability to develop healthy autonomy.

John Frosch, Otto Kernberg , Salman Akhtar , and Sheldon Bach have developed the theory of self and object constancy as it affects adult psychiatric problems such as psychosis and borderline states. During adolescence, Erik Erikson —s described the 'identity crisis,' that involves identity-diffusion anxiety. In order for an adult to be able to experience "Warm-ETHICS: warmth, Empathy, Trust, Holding environment , Identity, Closeness, and Stability in relationships, the teenager must resolve the problems with identity and redevelop self and object constancy.

Self psychology emphasizes the development of a stable and integrated sense of self through empathic contacts with other humans, primary significant others conceived of as ' selfobjects. The process of treatment proceeds through "transmuting internalizations" in which the patient gradually internalizes the selfobject functions provided by the therapist. Lacanian psychoanalysis , which integrates psychoanalysis with structural linguistics and Hegelian philosophy, is especially popular in France and parts of Latin America. Lacanian psychoanalysis is a departure from the traditional British and American psychoanalysis. Lacan's concepts concern the " mirror stage ", the "Real" , the "Imaginary" , and the "Symbolic" , and the claim that "the unconscious is structured as a language.

Though a major influence on psychoanalysis in France and parts of Latin America, Lacan and his ideas have taken longer to be translated into English and he has thus had a lesser impact on psychoanalysis and psychotherapy in the English-speaking world. In the United Kingdom and the United States, his ideas are most widely used to analyze texts in literary theory.

The adaptive paradigm of psychotherapy develops out of the work of Robert Langs. The adaptive paradigm interprets psychic conflict primarily in terms of conscious and unconscious adaptation to reality. Relational psychoanalysis combines interpersonal psychoanalysis with object-relations theory and with inter-subjective theory as critical for mental health. It was introduced by Stephen Mitchell. Fonagy and Target, in London, have propounded their view of the necessity of helping certain detached, isolated patients, develop the capacity for "mentalization" associated with thinking about relationships and themselves. Arietta Slade, Susan Coates , and Daniel Schechter in New York have additionally contributed to the application of relational psychoanalysis to treatment of the adult patient-as-parent, the clinical study of mentalization in parent-infant relationships, and the intergenerational transmission of attachment and trauma.

The term interpersonal-relational psychoanalysis is often used as a professional identification. Psychoanalysts under this broader umbrella debate about what precisely are the differences between the two schools, without any current clear consensus. The various psychoses involve deficits in the autonomous ego functions see above of integration organization of thought, in abstraction ability, in relationship to reality and in reality testing. In depressions with psychotic features, the self-preservation function may also be damaged sometimes by overwhelming depressive affect.

Because of the integrative deficits often causing what general psychiatrists call "loose associations," "blocking," " flight of ideas ," "verbigeration," and "thought withdrawal" , the development of self and object representations is also impaired. In patients whose autonomous ego functions are more intact, but who still show problems with object relations, the diagnosis often falls into the category known as "borderline". Borderline patients also show deficits, often in controlling impulses, affects, or fantasies — but their ability to test reality remains more or less intact. Adults who do not experience guilt and shame, and who indulge in criminal behavior, are usually diagnosed with psychopathy or antisocial personality disorder.

Neurotic symptoms —including panic, phobias, conversions, obsessions, compulsions and depressions—are not usually caused by deficits in functions. Instead, they are caused by intrapsychic conflicts. The conflicts are generally among sexual and hostile-aggressive wishes, guilt and shame, and reality factors. The conflicts may be conscious or unconscious, but create anxiety, depressive affect, and anger. Finally, the various elements are managed by defensive operations—essentially shut-off brain mechanisms that make people unaware of that element of conflict.

Repression is the term given to the mechanism that shuts thoughts out of consciousness. Isolation of affect is the term used for the mechanism that shuts sensations out of consciousness. Neurotic symptoms may occur with or without deficits in ego functions, object relations, and ego strengths. Therefore, it is not uncommon to encounter obsessive-compulsive schizophrenics, panic patients who also suffer with borderline personality disorder , etc. Freudian theories hold that adult problems can be traced to unresolved conflicts from certain phases of childhood and adolescence , caused by fantasy, stemming from their own drives. Freud, based on the data gathered from his patients early in his career, suspected that neurotic disturbances occurred when children were sexually abused in childhood i.

Later, Freud came to believe that, although child abuse occurs, neurotic symptoms were not associated with this. He believed that neurotic people often had unconscious conflicts that involved incestuous fantasies deriving from different stages of development. He found the stage from about three to six years of age preschool years, today called the "first genital stage" to be filled with fantasies of having romantic relationships with both parents. Arguments were quickly generated in early 20th-century Vienna about whether adult seduction of children, i. There still is no complete agreement, although nowadays professionals recognize the negative effects of child sexual abuse on mental health.

Many psychoanalysts who work with children have studied the actual effects of child abuse, which include ego and object relations deficits and severe neurotic conflicts. Much research has been done on these types of trauma in childhood, and the adult sequelae of those. In studying the childhood factors that start neurotic symptom development, Freud found a constellation of factors that, for literary reasons, he termed the Oedipus complex , based on the play by Sophocles , Oedipus Rex , in which the protagonist unwittingly kills his father and marries his mother. The validity of the Oedipus complex is now widely disputed and rejected. The shorthand term, oedipal —later explicated by Joseph J.

Sandler in "On the Concept Superego" [64] and modified by Charles Brenner in The Mind in Conflict —refers to the powerful attachments that children make to their parents in the preschool years. These attachments involve fantasies of sexual relationships with either or both parent, and, therefore, competitive fantasies toward either or both parents. Humberto Nagera has been particularly helpful in clarifying many of the complexities of the child through these years. Both seem to occur in development of most children. Eventually, the developing child's concessions to reality that they will neither marry one parent nor eliminate the other lead to identifications with parental values. These identifications generally create a new set of mental operations regarding values and guilt, subsumed under the term superego.

Besides superego development, children "resolve" their preschool oedipal conflicts through channeling wishes into something their parents approve of "sublimation" and the development, during the school-age years "latency" of age-appropriate obsessive-compulsive defensive maneuvers rules, repetitive games. Using the various analytic and psychological techniques to assess mental problems, some believe [ by whom?

To be treated with psychoanalysis, whatever the presenting problem, the person requesting help must demonstrate a desire to start an analysis. The person wishing to start an analysis must have some capacity for speech and communication. As well, they need to be able to have or develop trust and insight within the psychoanalytic session. Potential patients must undergo a preliminary stage of treatment to assess their amenability to psychoanalysis at that time, and also to enable the analyst to form a working psychological model, which the analyst will use to direct the treatment. Psychoanalysts mainly work with neurosis and hysteria in particular; however, adapted forms of psychoanalysis are used in working with schizophrenia and other forms of psychosis or mental disorder.

Finally, if a prospective patient is severely suicidal a longer preliminary stage may be employed, sometimes with sessions which have a twenty-minute break in the middle. There are numerous modifications in technique under the heading of psychoanalysis due to the individualistic nature of personality in both analyst and patient. The most common problems treatable with psychoanalysis include: phobias , conversions , compulsions , obsessions , anxiety attacks , depressions , sexual dysfunctions , a wide variety of relationship problems such as dating and marital strife , and a wide variety of character problems for example, painful shyness, meanness, obnoxiousness, workaholism, hyperseductiveness, hyperemotionality, hyperfastidiousness.

The fact that many of such patients also demonstrate deficits above makes diagnosis and treatment selection difficult. Analytical organizations such as the IPA, APsaA and the European Federation for Psychoanalytic Psychotherapy have established procedures and models for the indication and practice of psychoanalytical therapy for trainees in analysis. The match between the analyst and the patient can be viewed as another contributing factor for the indication and contraindication for psychoanalytic treatment.

The analyst decides whether the patient is suitable for psychoanalysis. This decision made by the analyst, besides made on the usual indications and pathology, is also based to a certain degree by the "fit" between analyst and patient. A person's suitability for analysis at any particular time is based on their desire to know something about where their illness has come from. Someone who is not suitable for analysis expresses no desire to know more about the root causes of their illness. An evaluation may include one or more other analysts' independent opinions and will include discussion of the patient's financial situation and insurances.

The basic method of psychoanalysis is interpretation of the patient's unconscious conflicts that are interfering with current-day functioning — conflicts that are causing painful symptoms such as phobias, anxiety, depression, and compulsions. Strachey stressed that figuring out ways the patient distorted perceptions about the analyst led to understanding what may have been forgotten. In patients who made mistakes, forgot, or showed other peculiarities regarding time, fees, and talking, the analyst can usually find various unconscious "resistances" to the flow of thoughts aka free association. When the patient reclines on a couch with the analyst out of view, the patient tends to remember more experiences, more resistance and transference, and is able to reorganize thoughts after the development of insight — through the interpretive work of the analyst.

Although fantasy life can be understood through the examination of dreams , masturbation fantasies [viii] are also important. The analyst is interested in how the patient reacts to and avoids such fantasies. There is what is known among psychoanalysts as classical technique , although Freud throughout his writings deviated from this considerably, depending on the problems of any given patient. Classical technique was summarized by Allan Compton as comprising: [ citation needed ]. As well, the analyst can also use confrontation to bringing an aspect of functioning, usually a defense, to the patient's attention. The analyst then uses a variety of interpretation methods, such as: [ citation needed ].

Analysts can also use reconstruction to estimate what may have happened in the past that created some current issue. These techniques are primarily based on conflict theory see above. As object relations theory evolved, supplemented by the work of John Bowlby and Mary Ainsworth , techniques with patients who had more severe problems with basic trust Erikson , and a history of maternal deprivation see the works of Augusta Alpert led to new techniques with adults. These have sometimes been called interpersonal, intersubjective cf. Stolorow , relational, or corrective object relations techniques.

These techniques include expressing an empathic attunement to the patient or warmth; exposing a bit of the analyst's personal life or attitudes to the patient; allowing the patient autonomy in the form of disagreement with the analyst cf. Paul, Letters to Simon ; and explaining the motivations of others which the patient misperceives. Ego psychological concepts of deficit in functioning led to refinements in supportive therapy. These techniques are particularly applicable to psychotic and near-psychotic cf. These supportive therapy techniques include discussions of reality; encouragement to stay alive including hospitalization ; psychotropic medicines to relieve overwhelming depressive affect or overwhelming fantasies hallucinations and delusions ; and advice about the meanings of things to counter abstraction failures.

The notion of the "silent analyst" has been criticized. Actually, the analyst listens using Arlow's approach as set out in "The Genesis of Interpretation", using active intervention to interpret resistances, defenses creating pathology, and fantasies. Silence is not a technique of psychoanalysis see also the studies and opinion papers of Owen Renik. It refers to the analyst's position of not taking sides in the internal struggles of the patient. For example, if a patient feels guilty, the analyst might explore what the patient has been doing or thinking that causes the guilt, but not reassure the patient not to feel guilty. The analyst might also explore the identifications with parents and others that led to the guilt.

Interpersonal—relational psychoanalysts emphasize the notion that it is impossible to be neutral. Sullivan introduced the term participant-observer to indicate the analyst inevitably interacts with the analysand, and suggested the detailed inquiry as an alternative to interpretation. The detailed inquiry involves noting where the analysand is leaving out important elements of an account and noting when the story is obfuscated, and asking careful questions to open up the dialogue. Although single-client sessions remain the norm, psychoanalytic theory has been used to develop other types of psychological treatment.

Schilder , Samuel R. Slavson , Harry Stack Sullivan , and Wolfe. Child-centered counseling for parents was instituted early in analytic history by Freud, and was later further developed by Irwin Marcus , Edith Schulhofer, and Gilbert Kliman. Psychoanalytically based couples therapy has been promulgated and explicated by Fred Sander. Techniques and tools developed in the first decade of the 21st century have made psychoanalysis available to patients who were not treatable by earlier techniques. This meant that the analytic situation was modified so that it would be more suitable and more likely to be helpful for these patients. Eagle believes that psychoanalysis cannot be a self-contained discipline but instead must be open to influence from and integration with findings and theory from other disciplines.

Psychoanalytic constructs have been adapted for use with children with treatments such as play therapy , art therapy , and storytelling. Throughout her career, from the s through the s, Anna Freud adapted psychoanalysis for children through play. This is still used today for children, especially those who are preadolescent. Psychoanalytic play therapy allows the child and analyst to understand children's conflicts, particularly defenses such as disobedience and withdrawal, that have been guarding against various unpleasant feelings and hostile wishes. In art therapy, the counselor may have a child draw a portrait and then tell a story about the portrait. The counselor watches for recurring themes—regardless of whether it is with art or toys.

Psychoanalysis can be adapted to different cultures , as long as the therapist or counselor understands the client's culture. The use of certain defense mechanisms was related to cultural values. For example, Thais value calmness and collectiveness because of Buddhist beliefs , so they were low on regressive emotionality. Psychoanalysis also applies because Freud used techniques that allowed him to get the subjective perceptions of his patients. He takes an objective approach by not facing his clients during his talk therapy sessions. He met with his patients wherever they were, such as when he used free association—where clients would say whatever came to mind without self-censorship.

His treatments had little to no structure for most cultures, especially Asian cultures. Therefore, it is more likely that Freudian constructs will be used in structured therapy. The cost to the patient of psychoanalytic treatment ranges widely from place to place and between practitioners. Otherwise, the fee set by each analyst varies with the analyst's training and experience. Since, in most locations in the United States, unlike in Ontario and Germany, classical analysis which usually requires sessions three to five times per week is not covered by health insurance, many analysts may negotiate their fees with patients whom they feel they can help, but who have financial difficulties.

The modifications of analysis, which include psychodynamic therapy, brief therapies, and certain types of group therapy, [xi] are carried out on a less frequent basis — usually once, twice, or three times a week — and usually the patient sits facing the therapist. All Rights Reserved. Law Topics. Thank you for sharing! Your article was successfully shared with the contacts you provided. Lawyers On the Move.

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