PSYCHOANALYTIC TREATMENT
INTRODUCE TOPIC
I illustrate free association by lying down on the desk in the front of the room and freely associating myself for about 5 minutes. I then ask them to act as my analyst and tell me what they think I was communicating below the level of consciousness. Some students are amazingly intuitive. They enjoy seeing a full professor so vulnerable and openly honest about private matters. And, they get excited about turning the tables and role-playing the professor's therapist.
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I come up with examples students can understand: parental transference toward teachers/professors is familiar to them and they easily generalize that to therapy, and the notion of resistance not as some kind of misbehavior or hostile withholding but as an attempt at self-protection or avoidance of uncomfortable feelings is also usually easy for them to grasp.
Rhonda Reinholtz, Ph.D.
Clinical Psychologist, Lecturer
University of Wisconsin-Madison
rreinholtz@wisc.edu
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I give case examples, using my book (101 Defenses), and published cases in 'Stepparenting' (Cath and Shopper), and in other books. I often describe defense interpretations and resistance interpretations. One phrase is 'Nobody wants to see us.' And then we look for the ways they don't.
Many (non-analytic) trainees and students do not realize that therapists, and especially analysts, are usually a last resort for (most adult) patients. Most people will try dozens of different things before they conclude their problems are unresolvable on their own. Then, when they do consult someone, they want to feel better quickly and get away from the therapist, so infrequent supportive sessions and medication are popular.
The desire to develop insight into conflicts is often a last consideration. Insight is difficult, expensive, and sometimes emotionally painful. That is not to say that the goal of analytic approaches is to cause pain; it is to say that it is difficult, using analytic approaches, to avoid painful feelings. A patient of mine told me today, "I hate coming here. It's upsetting. But I am much better, and this has helped." Some years ago, a patient was referred by a psychiatrist colleague; the patient told me my friend had said while referring him: "You're in trouble: you've got character problems; that means you need analysis, it's going to cost a fortune, take forever, and there's no guarantee you'll get better." When the patient related this to me, we both had a laugh. I had to tell him that the description was brutal, but more or less honest. The patient went on to have a very successful 7-year analysis with me.
Many people eventually sort of enjoy learning about themselves, but initial resistances, which the quote refers to, are often tenacious. In teaching, I have found it to useful to use the kind of phraseology you quote me as saying, which overstates the case a little, but gets the point home to people who have not had experience with treatment. I do not say such things in a vacuum. I am beginning to open up the subject of handling resistances as an important aspect of treatment, not as something to be ignored or detested. I hope to help the student have more empathy for resistances, as well.
Respect for the patient (cf. Salman Akhtar) involves a recognition that initial resistances have to do with wanting to avoid any treatment because of shame (over having problems and "needing" the analyst), because of financial outlay (deprivation), and because of a series of transferences. So, as much as people may want to see us because they need to, they simultaneously don't want to see us.
Jerome S. Blackman, M.D.
Adjunct Professor of Psychology
Virginia Wesleyan College
Jsbmd1@cox.net
jblackmanmd@aol.com
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My general format is as follows:
GOALS: 1. Bring everything from unconscious to consciousness. 2. Strengthen the Ego 3. Restructure the Personality
METHODS: * Free Association * Dream Analysis * Defense Mechanism Analysis * Fixation Analysis * Transference Analysis
VIEW OF ANXIETY: Anxiety represents the threat of Unconscious material about to surface. We put this stuff into the unconscious, where it needs to be held because we experience it as a threat to our self and our sanity.
COURSE of THERAPY: Long term and intensive. Often 3 to 5 sessions per week for 3 to 5 years. Now, try Interpretations: (be ready to discuss possible interpretations in class.)
Dream 1: You are on a train ride through the countryside. There are hills, valleys, lush greenery. As you speed along, you can feel an overall sense of excitement and anticipation. The train enters a tunnel.
Dream 2: In this dream, you see a snake crawling through a window into a house.
In class I describe and discuss each of these things. On the Dream Interpretation, I give the scenarios presented above, then ask students to interpret. They ALWAYS offer some sexual interpretation as the 'Freudian' but I argue that there are several ways each could be interpreted, both sexual and non-sexual and that the context of the dreamer's life is vital to understanding the dream. On the train ride dream, I agree that it has all the elements of a sexual dream, symbols for lovers' bodies, the excitement, the train and tunnel, and that the dream sets them up for this interpretation. Then we talk about how the context matters. If the dreamer is going on vacation, travelling by train, then manifest content may be the whole of the dream. If the dreamer is a student about to graduate, who has already accepted a job in another state, the green hills and valleys may represent college life, looked back upon fondly. The tunnel represents plunging into the unknown, as they don't know the terrain on the other side of the transition, and they are riding a train rather than driving because they have already accepted the job, their future is determined and laid out ahead of them, the decisions already made, much like being a passenger on the train - the track is laid out.
In defense mechanisms, I give examples. To address the issue of transference, I use the example of being suspicious about the new boy/girlfriend because of being cheated on by the previous. This helps students understand.
Matthew Westra
Psychology Coordinator
MCC-Longview
Matthew.westra@mcckc.edu
http://www.mcckc.edu/~westra/WESTRA.HTML
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I have them read Wild Analysis.
- During discussion of my free associations, I point out what an analyst might do ---for example, keep an open mind--asking for further associatins, etc--before jumping to the theoretical conclusion students seek right off.
Freud, S. (2002). Wild Analysis (New Edition). New York: Penguin.
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As a one time visitor to high school class rooms I work at presenting myself and psychoanalysis as being relevant to everyones' everyday experience. It is about the ordinary, not the extrordinary!
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RECOMMENDED RESOURCESBlackman, J. (2003).
101 Defenses: How the Mind Shields Itself. New York: Brunner-Routledge.
Cath, S. H. & Shopper, M. (2001).
Stepparenting: Creating and Recreating Families in America Today. Mahwah, NJ: The Analytic Press.
One year, I used the old movie, 'Marnie', but have gotten away from that. Someone wanted to look at 'Ordinary People,' but the psychiatrist is such an unprofessional clutz that I can't stand it anymore. I sometimes point out that the therapists in The Sopranos and in Prince of Tides are phony, and describe why I hate them. This gets an affective response in a smaller class, and can be effective in stimulating discussion.
Jerome S. Blackman, M.D.
Adjunct Professor of Psychology
Virginia Wesleyan College
Jsbmd1@cox.net
jblackmanmd@aol.com
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Anderson, S. M., & Berk, M. S. (1998). The social-cognitive model of transference: Experiencing past relationships in the present. Current Directions in Psychological Science, 7, 109-115.
Basch, M. F. (1980). Doing Psychotherapy. New York: Basic Books.
Freud, S. (1914). Remembering, repeating, working-through: technique of psychoanalysis. S.E., 12:147-156.
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Case notes on how to teach the basic ideas of psychoanalytic therapy using the book "I never promised you a rose garden" by Joanne Greenberg.
Teaching Notes
Student Version
Robert W. Grossman
Professor of Psychology
Kalamazoo College
Robert.Grossman@kzoo.edu
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My article
"Finding an Ear: Reflections on an Analytic Journey" (#58) has been used at clinical practicums for the psychology interns at Stony Brook University, N.Y. (The instructor has conveyed that the students have found it, over the years, very useful).
In: M. Stanton & D. Reason, eds. (1996). Teaching Transference. London: Rebus Press. 79-89.My students have to turn in a written response to all of the readings in which they share their reactions, including questions, examples they can think of, points of disagreement, etc. -- so the question I ask is, 'what did you think of this reading and these ideas? easy to understand? hard to wrap your head around? easy or hard to believe it works this way?' etc. Because I begin the semester by always obtaining a response from at least a couple of students before moving on, the class quickly becomes one in which people share their thoughts.
Rhonda Reinholtz, Ph.D.
Clinical Psychologist, Lecturer
University of Wisconsin-Madison
rreinholtz@wisc.edu