Midterm

◤

THEORIES OF PERSONALITY AND

COUNSELING – PART II

Professor Treniece Lewis Harris, PhD APSY7445

Spring 2022

Week 3

On Beginning Treatment ● These were Freud’s recommendations for psychoanalysis not rules ● Treatment is Not recommended when

○ you have a previous social connection ○ the client wants to delay beginning

● Suggest a preliminary period of two weeks ● Be up front that this treatment is long-term and without a predefined ending ● Set a specific day and time to meet and hold the client accountable for it ● Charge a fee. Be clear about your fee and collect it on a regular basis ● Maintain the established frequency of appointments ● Maintain the treatment “position” and boundaries

On Beginning Treatment ● Allow the client to end treatment at any time

○ be clear about the risk of continued illness if ended prematurely ● Encourage the client to say whatever comes to mind. Say especially those

things that come to mind that you are reluctant to say for whatever reason. ● Allow the client to do most of the talking ● Say only enough to support them in talking further ● Do not grant requests to tell them what to talk about ● Reassure and question resistance if they “don’t have anything on their mind” ● Discourage client from preparing something to say or creating a narrative ● Discourage talking to others about the therapy, the therapist etc.

Guiding Principles & Values ● Capacity for survival or the continuation of a meaningful or purposeful state ● Acknowledgment of life’s complexity, depth, nuance ● Essential stance of humility, curiosity and patience ● Essential honesty about self and motives ● Exploration of motivational forces outside of our awareness (i.e. the

unconscious)

● Understanding the role of fantasy life

○ fulfillment of libidinal or aggressive wishes through one’s imagination

○ regulating self esteem, affect etc.

○ managing trauma or creating an experience of safety

● Balancing universal concepts with the client’s subjectivity and phenomenology

Guiding Principles & Values ● The Therapist’s Stance

Maintaining a Degree of Anonymity & Neutrality ■ keeping the focus on the patient’s desires, needs, conflicts etc. ■ respecting the client’s autonomy and decision-making ■ goal to facilitate the working alliance ■ understanding the impact on intimacy and power in the therapeutic

relationship

Use of Reflection-in-action ■ ongoing assessment ■ evolving situation with new information ■ modification of understanding

The Therapeutic Alliance ● Ongoing process of negotiating a collaborative relationship between the

therapist and the client to achieve a benefit from therapy ● The Three Parts of the Working Alliance

○ The Bond ■ Trust and attachment between therapist & client; degree of feeling

understood by the therapist ○ The Goals

■ Alignment on the aims or objectives the client and therapist are working toward

○ The Tasks ■ Agreement on methods used to reach therapeutic goals

● Involves a psychic partnerships between the client’s observing ego and the observing role of the therapist

Bordin, 1979

Defensive Functioning ● Defense - an intrapsychic process that functions to avoid psychic pain by moving

thoughts, wishes, feelings or fantasies out of awareness ● Most often an adaptive part of mental health functioning e.g. a way of coping ● Sometimes operating at a cost to overall mental health functioning

○ thus “breaking down defenses” was originally thought to lead to better functioning ● “Defensive behavior” can be viewed as an unconscious effort to:

○ avoid threatening feelings like anxiety, grief or disorganizing emotions ○ maintain self-esteem

● People tend to have “preferred defenses” as part of their coping style influenced by ○ temperament ○ nature of early childhood stressors ○ defenses modeled by caregivers ○ consequences and rewards of using particular defenses

McWilliams,1994

McWilliams,1994

I Really Want to Change… ● Resistance - ways that the client’s defensive processes undermine their goal to

change ● Despite the negative connotation, resistance is seen as a core aspect of the

therapeutic process that provide the first clues to the self-protective parts of the client’s personality.

● Reflect the complexity of the self manifested through ambivalence ● Examples: cancelling, missing or forgetting sessions, arriving late, having nothing to

say, the “sudden cure” ● A primary goal of therapy is to explore the purpose of the resistance ● Abstaining from wish fulfillment that interferes with therapeutic goals and defaulting to

understanding the wish and ● Therapists can influence the presentation of and/or maintenance of resistance

○ empathic failure ○ countertransferential collusion

Two-Person Psychology ● From “blank screen”, anonymity & neutrality authenticity and mutual

subjectivity ● Mutuality of the therapeutic relationship

○ shared meaning-making ○ mutual influence at unconscious & conscious levels

● Full understanding of the client involves ○ Reflection on the client’s intrapsychic processes ○ Reflection on the interpersonal relationship processes enacted in the

therapeutic relationship (e.g. emotions and reactions evoked in the therapist)

○ understanding the client’s AND the therapist’s own subjectivity ● Deemphasizing the role of the therapist as a psychological authority or expert

Transference ● Transference - tendency to view the therapist in terms that are shaped by early

experiences with caregivers and other significant people in early life ● These early experiences often represent the inception of

○ identity templates ○ relational schemas or internal working models ○ unresolved conflicts

● Transference reactions help identify early life factors that impact various aps[ects of one’s self-concept and expectations in current relationships

● These schemas evoke and interact with real aspects of the therapist ● Exploring transference reactions with the client as they occur facilitates an in vivo

intellectual and emotional understanding of their personality & interpersonal functioning

● The experiential nature of this part of the therapeutic process facilitates change

Countertransference ● Countertransference - the therapist’s reactions to the client including thoughts,

feelings, fantasies, images etc. ● Countertransference reactions can provide information to the therapist about

themselves: ○ identity templates ○ relational schemas ○ unresolved, unconscious conflicts

● Countertransference reactions can provide information about the client ○ sometimes information about the client’s intrapsychic experience ○ sometimes information about the experience of others interacting with the client

● To share or not to share the therapist’s experience of subjectivity…that is the question ○ Selective disclosure to facilitate the client’s insight ○ Private reflection to inform ongoing case formulation

Playing it Out in Session… ● Enactments

○ reflective of personal histories, conflicts, relational schemas ○ therapist and client contribute at conscious and unconscious levels ○ repeat in the therapeutic relationship ○ unavoidable

● Help the client see how early relationship patterns are repeated in present relationships

● The therapist’s subjective experience in enactments can often provide information about ○ the experience of others in the client’s life ○ the internal experience of the client that they are unable to express

● Reflection-in-action is an important clinical tool in recognizing enactments ● Improving the client’s reflective functioning increases their capacity to mentalize the

thoughts and feelings of others

What’s Love Got to Do with it?

● Freud’s Observation On Transference Love (1915)- examine the challenge of examining the transference reaction rather than colluding with the client in resisting this essential part of the therapeutic process by acting as if this is a real part of the relationship

● Describes early expressions of “affectionate transference” ● Transference love as treatment interference = resistance ● Unconscious motives of transference love ● Acting out as a form of resistance ● Supression, compromise and gratification as treatment sabotage ● The therapeutic role of honesty