Psychotherapy Theories

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Neo-Freudians AKA Ego Psychologists: Erikson
Horney
Adler
Karen Horney: *Disagreed with Freud's view of women
*Countered penis envy with womb envy
*Saw gender differences as social & cultural instead of purely biological
*Left NY Psychoanalytic Institute to form Amer Institute for Psychoanalysis
*First feminist
Horney's view of Neurosis: Definition: problems w/interpersonal relationships
3 ways of dealing with relationships (How neurotics act):
*move toward people - people pleaser
*move away from people - "loner" style
*move against people - force power over others; bossy
Erik Erikson: Added to Freud's theory w/
Ego Psychology
* ego is positive driving force in personality & human development
*ego's main task is to establish and maintain a sense of identity
*emphasis on psychosocial aspects of personality development
Erikson's View of Human Development: Accepted Freud's psychosexual framework but expanded picture of development

Emphasized positive aspect of the ego in human development

Described psychological conflicts at each stage of development that needed to be resolved successfully

Normal devleopment must be understood in relation to each culture's life situation
Freud vs Erikson Age 12 to old age: Freud = genital
Erikson =
Adolescence Identity v Role Confusion
Young adult -Intimacy vIsolation
Middle age - Generativity v self-absorption
mature adult - integrity vs despair
Erikson's Trust v Mistrust: On continnuum from age 0 to 1
*oral stage of development
*based on primary caretaker's responsiveness to the child's basic needs, child develops a sense of when to trust (consistency responsible for child's level of trust)

no consistency = mistrust

Bowlby & Ainesworth studied attachment styles re: Mother's consistency and child's feeling of security
Erikson's Autonomy vs. Shame Doubt: Age 1 to 3
*Anal stage of dev (Freud)
*Child learns they are autonomous person with a sense of willfullness and confidence
*develops awareness of social constraints (social boundaries)
Erikson's Initiative v Guilt: Age 3 to 6
Phallic stage (Freud)
* Child learns to develop initiative or goals
*Child learns a sense of guilt, repression of fantasies

Stresses social aspect; child can take leadership role; guilt if feelings of inadequacy
Erikson's Industry v Inferiority: Age 6 to 11
Latency period (Freud)
*child learns to have sense of competence
*Awareness of inferiority if fails

Teacher role important -pride in accomplishments
Erikson's Ego Identity v Ego Diffusion: Genital State - puberty - adolesence
*Development of a sense of identity as a person as well as part of society

Adolescents form identity, explore opposite sex relationships
Erikson's Intimacy v. Isolation: Young adulthood
*Establishes relationships with significant others
*May form a family and/or become a parent; how to give and take; be mutual in relationships
Generativity v Self-absorption: Age 30-50 - middle adulthood
*Develops sense of creativity & usefulness (career, spirituality, midlife crisis, delay marriage)
*may begin to take care of ageing parents
Erikson's Integrity v Despair: Older adulthood
*faces death
*life review - accomplishments & past relationships
*Finds ways to give to the next generation
*Develops a feeling of acceptance of life and self

sense of integrity and self-respect
Alfred Adler: *contemporary of Freud & Jung
*helped estab Psychoanalytic Society in Vienna
*left Freud & founded Society for Individual Psychology

Didn't like emphasis on sexuality
Didn't like deterministic view
Greater emphasis on ego than Freud
Alfred Adler's Individual Psychology View of Human Nature: *relationship oriented
*first family systems person

People are social beings
*social variables shape personality
*motivated by search for significance & superiority
*thought conscious is center of personality
ego has its own energy - independent of the id and instinct
Adler rejected the concept of the unconscious
Adler's Inferiority: we want to be significant
* maladjusted child is discouraged about how they can be significant

We are born helpless
* Organ inferiority later called social inferiority feeling

anxiety is based in inferiority
belief system of how one should be
life tasks
love and sex
work and school
friends and community
self (later added spiritual self)

Drykers followed Adler
Program STEP: based on Adlerian concept
Alfred Adler quote:: The inner life of the child, on the strength of his feeling of inferiority, grows in the direction and toward the goal that promises tranquility, satisfaction, standing, and superiority, in short "expansion". Every manifestation of the child points in that direction.

Meaning: every child wants to be important
Adler's Lifestyle: Lifestyle is a map of our beliefs regarding ourselves, our world etc.
*an individual core beliefs & assumptions
*interpretation of events were more important than event itself
*family constellation is the environment that forms the lifestyle
*change is obtained by consciously reframing a childhood event
4 areas of Adler's lifestyle:: 1- self-concept - who we are
2- self-ideal - who we should be
3- picture of the world
4- morals/ethical convictions; psychological position in family affects temperament
Cognitive map: shows where I want to go in l ife; where happiness lies
Adler's Lifestyle & Basic Mistakes: Basic mistakes:
myths we confuse with the truth are basic mistakes (growth challenges these beliefs)
overgeneralizations (all men are bad)
false/impossible goals of security (follow rules or world crashes)
misperception of life & life's demands (I get no breaks)
minimization or denial of one's worth
faulty values (win at all costs)
Adler's theory based on...: helping clients get insight so they can change
Adler's Birth position stereotypes: Importance of family relationships forms a style of relating to others

relationship between siblings
Psychological birth position in family
oldest child - higher expectation to achieve
2nd child - competitive with older child
middle child - difficulty finding significance; flexible & easy going
youngest child - spoiled child, selfish; can be confident
only child - doesn't get along well with other kids but does with adults
Adler's Phenomenological Approach (every person has their own view): Adlerian's attempt to view the world from the client's frame of reference

how life is in reality is less important than how the individual believes life to be
It is not the childhood experiences that are crucial - it is our present interpretation of these events
Unconscious instincts and our past do not determine our behavior
Adler's Process of Therapy: Phenomenological view of client is stressed
Therapeutic relationship is a collaborative partnership (2 chairs)
therapy is teaching, informing (goals of beh) and encouraging (support, helping identify positive traits)
Adler's 4 Goals of Therapy: Establishing & maintaining a good relationship
Uncovering the dynamics (lifestyle) of the patient
Interpretation culminating in insight
Reorientation - redefine beh and goals to new direction
Adler - Goal 1: Establish & maintain good relationship

friendly relationship between equals
patient has active role as a student responsible for contributing his or her own education
therapy requires cooperation, alignment of goals
Adler - Goal 2: Uncovering the individual's dynamics

understanding the lifestyle (cognitive map)
understanding how the lifestyle affect current functioning & life tasks
explore family constellation
early recollections
identifying basic mistakes and faulty assumptions
dreams --> problem solving with future orientation
preception of assets (strengths)
Alder's Goal 3: Encouraging Self Understanding & Insight

Understanding translated into constructive action
understanding purpose of behavior
understanding mistakes beliefs/assumptions
understanding how these affect life movement and growth
Adler's Encouragement: encouragement is the most powerful method available for changing a person't beliefs
the process of helping clients accept their strengths, internal resources, discover a sense of belonging and connectedness to others, and develop hope for themselves
clients are encouraged to recognize that they have the power to choose and act differently
Adler's Goal 4: Helping with Reorientation

an action phase where insights are put into practice
acting "as if"
make new decisions and modify goals
problem solving and decision making examined
therapist offers support and encouragement

therapist always sees the best in their client
Adlerian Techniques Spitting in the client's soup --: taking fun out of bad behavior by interpreting the behavior
Adlerian Techniques Catching oneself: catch themselves when doing something that is based on faulty belief
Adlerian Techniques Push Button: helping understand they create their own feelings by choosing thoughts
Adlerian Techniques Avoiding the tar baby: Avoid relational traps in therapy
Adlerian Techniques Acting as if: do it
Adlerian Techniques Paradoxical intention: do it more; exaggerating Sx contrary to behavior
Adlerian Techniques Analysis and assessment: analyzing life map
Adlerian Techniques Insight: Change in behavior
Adlerian Techniques Challenge and confrontation -: let me know what the behavior means
Adlerian Techniques tentative interpretations: hunch; sets client up as the expert
Adler's Social Interest (sign of mental health): Adler's most significant and distinctive concept

* refers to an individual's attitude toward & awareness of being part of the human community
* mental health is measured by the degree to which we successfully share with others & are concerned with their welfare
* happiness & success are largely related to social connectedness
Adler's Mental Health is the Development of Social Interest: The educational process between self-interest and social interest has 6 goals:
1- fostering of social interest
2- Decrease of inferiority feelings
3- Changes in the person't lifestyle
4- Changing faulty motivation
5- Encouraging the individual to recognize equality among people
6- Helping the person to become a contributing human being
Theories on this Test:: Psychoanalytic (Freud)
Adlerian (Adler)
Jungian (Jung)
Existential (Frankl)
Gestalt
Personality is:: a pattern of interpersonal behavior (Sullivan, 1953)
Theory of personality is:: a framework that seeks to interpret the interaction of dynamic forces operating in every person't life, describing what goes on it each person's internal world.
Counseling theory...: builds on personality and focus on the attitude, skills, and techniques used in a counseling relationship to help clients grow and develop
Counseling Theory includes:: * a view of human nature
* description of the role of counselor
* description of the goals of therapy
* specific techniques
* research that demonstrates its effectiveness with client populations
Major stage sof the counseling process: 1- building a counseling relationship
2- working
3- termination
Freud's view of Human Development: *people move through stages of development
* humans experience conflicts between biological dries and social expectations
* the way these conflicts are resolved determines the individuals ability to learn, get along with others, and to cope with anxiety
Freud's 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
Freud - Clinical evidence for postulating the unconscious: dreams
posthypnotic suggestions
material derived from free-association
material derived from projective techniques
symbolic content of psychotic Sx

NOTE: The consciousness is only a thin slice of the total mind
Freud - Anxiety is:: State ofr tension that motivates us to do something
reality anxiety - the fear of danger from the external world
neurotic anxiety - the fear that the drives and instincts will get out of control
moral anxiety - fear of one's own conscious
Freud's Ego-Defense Mechanisms: are normal behaviors which operate on an unconscious level and tend to distort reality
help the ind cope with anxiety and prevent the ego from being overwhelmed
have adaptive value if they do not become a style of life to avoid facing reality
Freud's Ego Defense Mechanisms: repression
denial
reactgion formation
projection
displacement
sublimation
regression
introjectgion
identification
compensation
Anal Stage: Develops a sense of control over holding an relesing uring/feces

toilet training major issue
Phallic Stage: 3-6 years

Id impulses transfer to genitals - genital sexual desire for the opposite sex parent

Most resolve loss of mother/father and establish an identity with the same sex parent
Latency Stage: Age 6-11 years

Sexual instince die down
Superego develops further
Same sex peer relationships important
Genital Stage: 11=20 years (adolescemce)

Sexual impulses reappear - if earlier stages are resolved successful social maturity results
Psychoanalytic Techniques: Free Association - client reports immediately without censoring any feelings or thoughts

Interpretation - therapist points out, explains, and teaches the meanings of whatever is revealed

Dream analysis - Therpaist uses the "royal road to the unconscious" to bring unconscious material to light
Freud's Transference: The client reacts to the therapist as he did to an earlier significant other

This allowing the client to experience feelings that would otherwise be inaccessible

ANALYSIS OF TRANSFERENCE - the reaction of the therapist toward the client may interfere with objectivity
Freud's Countertransference: The reaction of the therapist toward the client that may interfere with objectivity
Freud's Resistance: anything that works against the progress of therapy and prevents the production of unconscious material
Freud's Analysis of Resistance: Helps the client to see that canceling appointments, fleeing from therapy prematurely, etc., are ways of defending against anxiety --

These acts interfere with the ability to accept changes which could lead to a more satisfying life
Contemporary Psychoanalytic Theory Erk Erikson's Psychosocial Perspective: Built on Freud's theory emphasizing the psychosocial aspects of personality development

Ego psychology - emphasizing the role of the ego for mastery and competence throughout the lifespan

Psychosocial Stages of Development emphasize developmental crises that must be addressed successfully for healthy development
Erikson's Psychosocial Stage: 0-1 yr - trust v. mistrust
1-2 yr - autonomy v. shame and doubt
3-5 yr - initiative v. guilt
6-11 yr - industry v. inferiority
12-14 yr - identity v. role conclusion
20s-30s - intimacy v. isolation
40s-50s - generativity v. stagnation
60 yr + -integrity v. despair
Comparison Freud v. Erikson Development: Oral - trust v. mistrust
Anal - autonomy v. doubt
phallic - initiative v. guilt
latency - industry v. inferiority
genital - identity v. role confusion
itimacy v. isolation
generativity v. self-absorptn
integrity v. despair
Erikson's Psychosocial Stages: Basic trust v mistrust (oral)
Autonomy v. shame & doubt (anal)
Initiative v. guilt (phallic)
Industry v. inferiority (latency)
Identity v. Identity confusion (genital)
Intimacy v. isolation (young adulthood)
Generativity v. stagnation
(middle adulthood)
Ego integrity v. despair (old age)
Erikson's Trust v. Mistrust: oral stage development -
based on primary caretaker's responsiveness to the child's basic needs the child develops a sense of when to trust and when not to trust
Autonomy v. Shame and Doubt: Anal stage of development
Child learns he/she is separate autonomouse person w/sense of willfullness
Develops and awareness of social constraints
Erikson's Initiative v. Guilt: Phallis stage 3-6 years
Child lears to develop initiative/goals
Also learns sense of guilt, repression of fantasies
Erikson's Industry v. Inferiority: Latency period ages 6-11
Learns sense of competence
Awarenesss of inferiority
Ego Identity v. Ego Diffusion: Genital stage - puberty (adolescence)
Development of a sense of identity as a person as well as part of society
Intimacy v. Isolation: Young adulthood
Establishes relationships w/significant others
May forma a family and/or become a parent
Learns how to give and take, be mutual in relationships
Generativity v. Self-absorption: Middle adulthood
Develops a sense of creativity and usefulness
May begin to take care of ageing parents
Erikson's Integrity v. Despair: Older adulthood
Faces death
Life review accomplishments & past relationships
Finds ways to give to the next generation
Develops a feeling of accepptance of the life and self
Contributions of Psycholanalytic Theory: Emphasis on a person's life history
Emphasizes the clinical method of understanding a person't development
Inspired research
Erikson's broad outline of lifespan development captures the essence of personality development at each stage of life
Limitations of Psychoanalytic Theory: No longer in the mainstream of human development research
Some concepts and stages are so vague they cannot be tested empirically
Contemporary Psychoanalytic Thereapy: Object Relations: Relational Theories that have evolved from Classical Psychoanalytic theory

Rational Theories take into account self-organization, attachments to others, interpersonal transactions, and the role of the client in the continual recreation of his/her subjective world
Existential Psychotherapy - Major Figures: Viktor Frankl
Rollo May
Irving Yalom
James Bugental
Existentialism is....: a philosophical approach that influences a counselor's therapeutic practice
Nietzsche Quote:: "He who has a why to live for can bear with almost any how."

That which does snot kill me makes me stronger.
Yalom Quote:: Death and life are independent, and though physical death destroys us, the idea of death saves us.
Frankl quote:: What is it that I and no one else has to offer life, not what does life have to offer me.
Existentialist Basic Assumptions: Humans are free and responsible
Humans strugge with internal conflicts related to existence
Death
Isolation
Meaninglessness
Freedom

Therapy is a process of searching for value and meaning
Inner conflict arises as the individual confronts the ultimate concerns of being human
Anxiety is a condition for living
As humans we have the opportunity to continually recreate ourselves
Existential Therapy -: A philosophical/Intellectual Approach to Therapy

Basic dimensions - of the human condition
Existential Capacity for Self-Awareness: The greater our awareness, the greater our possibilities for freedom
Existential - Identity and Relationship: Identity is the "courage to be" - we must trust ourselves to search within and find our own answers

Relatedness - At their best our relationships are based on our desire for fulfillment, not our deprivation.
Existential - The Search for Meaning: Meaning - like pleasure, meaning must be pursued obliquely
Finding meaning in life is a by-product of a commitment to creating, loving, and working.

The "will to meaning" is our primary striving
Life is not meaningful in itself; the individual must create and discover meaning
Existentialist - Anxiety - A condition of Living: Existential anxiety is normal - life cannot be lived, nor can death be faced without anxiety.
Existential -Relationship Between Therapist and Client: Therapy is a journey taken by therapist and client

The core of the therapeutic relationship
The existential counselor...: is a facilitator of the individual's process
is concerned with understanding the world of the client
focuses on current life situations
assists clients in accepting their own power and resources
assists clients in examining choices and grieving losses of options
Existential Group Discussions:: When did you feel most "alive" in your life? how does this related to your search for meaning in your life expereience.

When have you been most aware of these existential themes in your life:
Death
Isolation
Meaninglessness
Freedom
Gestalt Therapy: Existential and Pehnomenological

People are endlessly remaking or discovering themselves. There is no "once and for all"

Initial goal is for clients to gain awareness of what they are experiencing and doing now
Promotes direct experiencing rather than the abstractness of talking about situations
Gestalt --The now: Our "power is in the present"

For many people the power of the present is lost
Gestalt Field Theory Perspective: The field is a whole in which the parts are in immediate relationship and responsive to each other

Field theory is a method of exploring the whole field of which the event is currently a part rather than analyzing the event in terms of a class to which it belongs
Descriptive rather than speculative, interpretive or classificatory

Emphasizes observing, describing and explicating the exacft structure of whatever is being studied
Gestalt Field Theory -: Data u7nabilable to direct observation by the therapist are explored and studied by phenomenological
Focusing
Experimenting
Reporting of participants
Dialogue
Gestalt Dialogue: The relationship between the therapist and client is most importact aspect of psychotherapy

Existential dialogue is an essential part of Gestalt Therapy's methodology

Relationship grows out of contact

Contact is the experience of boundary between "me" and "not me"

The I has bemaning only in relation to others, in the I-Thou dialogue or the I-It manipulative contact (Buber)
Gestalt - 4 characteristics of Diagogue: Inclusion - putting oneself as fully into the experience of the other without judging, analyzing or interpeting while retaining a sense of one's separate autonomous presence

Presence - expressing onself fully to the client

Committment to Dialogue-Contact is something that arises from interaction, the therapist allows this to happen and does not control the outcome

Dialogue is lived - Lived emphasizes the excitement and immediacy of doing; Dialogue can be dancing, song, words or any modality that expresses and moves the energy between persons
Contact: Interacting with nature and with other people without losing one's individuality
Resistance to Contact: The defneses we devlope to prevent us from experiencing the present fully

5 major channels of resistance:
introjection
projection
retroflection
deflection
confluence
Gestalt - Unfinished business: Feelings about the past are unexpressed
These feelings are associated with distinct membories and fantasies
Feelings not fully experienced linger in the background and interfere with effective contact

Result
Preoccupation, compulsive behavior, wariness oppressive energy and self-defeating behavior
Therapeutic Techniques: The experiment in Gestalt Therapy
Preparing clients for experiments
Internal dialogue exercise
Rehearsal exerecise
Reversal technique
Exaggeration exercise

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