Psychology for Dummies (77 page)
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Authors: Adam Cash
Tags: #Psychology, #General, #Body; Mind & Spirit, #Spirituality
It’s impossible to do justice to the process of interpretation without a thorough discussion of the overall process of psychoanalytic therapy and a more detailed discussion of such issues as resistance and the therapeutic relationship.
The pragmatics have been negotiated (e.g., working out fees and scheduling), and the therapist is ready with a bag of tricks. Therapy begins. In an ideal world, psychoanalytic therapy is supposed to progress through a series of stages. Patients and therapists alike aren’t always so accommodating, however. If things go well, the analysis progresses through these stages:
Resistance
Developing transference
Working through
Termination
The therapist gathers information regarding the patient’s history, emphasizing relationships and family interactions during childhood. The patient goes through the process of discussing his problems with the analyst, a task that may seem easier than it actually is.
A patient, I’ll call him Bernie may show up to his therapy sessions and discuss how his boss is forcing him to attend therapy, constantly threatening to fire him, and just generally giving him a hard time. He may discuss his boss’s bad attitude and the raise that he thinks he deserves. He may talk about anything but the “real” reason he’s in analysis — his career is in jeopardy — to say nothing of the deeper conflicts that lie at the heart of Bernie’s career difficulties.
As a patient continues to talk and free-associate, conflicts begin to emerge. The analyst listens for the presence of deeper conflicts. The more the patient’s conflicts begin to bubble to the surface, the more the patient will work to keep them out of awareness and defend him or herself from their disturbing content. This psychological defense is accomplished, in part, by a process known as
resistance
— a form of noncompliance with the psychoanalytic process of increasing awareness and of making the unconscious conscious. All patients resist at least a little, some more than others, depending on how defensive they are. The more threatening the unconscious material, the stronger the resistance.
Resistance behavior can be as simple as missing appointments in order to avoid discussing one’s problems or as complicated as developing new symptoms to keep the analyst away from the deeper material. Resistance is usually the first obstacle to the analytic cure. An analyst can count on a patient’s resistance. This is because the whole theory of psychoanalysis hinges upon the idea that people’s resistance of being aware of their issues lies at the heart of their problems. The analyst typically deals with resistance through the process of interpretation or commenting on the resistance. For example:
Analyst:
Mr. Smith, you have spent a considerable amount of today’s session looking at your watch and being concerned with the time. Do you have somewhere to be or another engagement?
Patient:
I’m sorry Doc, but I told my financial advisor that I’d call her this afternoon, and I’m worried I’ll miss her. Do you think we could end today’s session a little early?
Analyst:
Well, whatever works best for you, but I am wondering why you told her such a thing when we’ve held our sessions every day at the same time for several months now. Couldn’t you have made another arrangement?
Patient (acting perturbed):
I didn’t think it was a big deal!
Analyst:
It may in fact not be a big deal, but I am wondering if you are somehow looking for a reason to avoid your session today or looking for a way out of it? Last session we began to discuss. . . .
This is how a resistance interpretation might be made. The analyst gently attempts to draw the patient’s attention to the idea that he conveniently scheduled a phone call during his regular therapy time and the possibility of a deeper, unconscious reason for his action. Was he avoiding something in therapy? This could be a turning point in the analysis, depending on how the patient responds to the question. He could get defensive and insist that the analyst is fishing or jumping to conclusions. He could admit to the attempt at avoidance. Or, he may get angry with the therapist and accuse her of being too nit-picky. Either way, the analyst’s comments are an attempt to get at something deeper than just a phone call to a financial advisor.
As the analysis progresses and resistance is gradually overcome, the patient begins to settle into the process, more easily free-associating, and
regressing
into earlier levels of psychological development. The patient begins to act in ways and speak about things from his or her earlier life, letting childhood conflicts and impulses emerge more fully in response to the interpretations of the analyst and the setting of the analysis itself (such as the couch). More and more is revealed as the analyst and patient get deeper into their archeological dig of the patient’s mind.
Sometimes patients get angry when their analyst points certain things out. They may stop talking or accuse the analyst of being overly critical or nit-picky. Why might the patient do this? After all, isn’t it the analyst’s job to point things out if she thinks that they may be related to unconscious material? If the patient reacts by accusing the analyst of being overly critical, the reaction may be something slightly more complex than just a simple act of resistance. The patient may be engaging in
transference.
Transference occurs when a patient begins to relate to the analyst in a way that is reflective of another, typically earlier relationship of the patient. It’s a distortion of the real relationship and interaction between the patient and analyst.
Most of us have had some experience with the concept of transference. Ever heard of the term “baggage?” In today’s usage, it commonly refers to bringing relationship problems and issues from previous relationships into new ones. Say you’re out on a first date and you run into a coworker at a restaurant. He or she stops by the table and says hello, you introduce your date and the coworker to each other, and then say you’ll see the person tomorrow at work. Your date then proceeds to question you about who that person was and whether you have been intimate with him or her. He or she generally acts jealous and insecure about your friendly interaction with this person.
It’s pretty clear that your date is overreacting, and because it is your first date, you’re probably a little confused as to where all of this jealous behavior is coming from. Luckily for your date, you’ve just read
Psychology For Dummies
and understand that his or her behavior is probably a type of transference from a previous relationship. However, you’re on a date, not in a therapy session, so you make a mental note to lose this person’s phone number the first chance you get.
When a patient starts acting toward an analyst in a similar way, the analyst interprets the behavior as representing a kind of reenactment of some other relationship. The analyst points out the distortion, helping the patient become aware of when it happens and how it influences his or her perceptions of people. This process is intended to help patients become fully aware of their distortions, how they relate to people based not on the people themselves but on their own “baggage.”
An interesting thing can also happen on the other side of the couch. An analyst also can be guilty of transference toward the patient, relating to him or her in a distorted way based on the previous relationships of the analyst —
countertransference.
When a patient gets angry with his analyst, accusing her of being too nit-picky, the analyst may get angry in return, accusing him of being an avoidant jerk. The analyst may have had a father or husband who avoided responsibility and then called her a nag when she reminded him of things he needed to do. Or, she may have witnessed her mother doing that to her father, and her father accusing her mother of the same. Either way, the analyst is out of touch with the reality of the current analytic relationship and should seek consultation in order to get this situation under control. After all, patients are not paying their analysts good money for them to work out their own relationship problems at the patient’s expense.
Transference and the analyst’s interpretation of it comprise the core of psychoanalytic therapy. This process happens over and over again, and each time the analyst interprets it with the goal of awareness in mind. As episodes of transference occur and reoccur, the analyst and patient work them out in a stage of therapy known as
working through.
Old conflicts are brought to light and worked out by the patient, learning how to recognize these incidents and relate to the analyst in a more realistic and non-distorted way. The reality of the patient-analyst relationship is not interfered with by transference, and the patient will be well on the way toward ending his or her analysis.
As the distortions diminish, awareness increases, and symptoms subside, a date for terminating the therapy is decided on. This involves another layer of working through that focuses on addressing thoughts, feelings, and distortions related to separation in relationships. Saying goodbye is hard for some people, but even harder for others. If a patient has significant conflict with being separated from her parents or other important relationships, there may be more resistance, transference, and working through in order before the analysis can finally end.
Much of what I’ve talked about in this chapter applies to classic psychoanalysis. However, very few people practice classic psychoanalysis today. Numerous revisions and adaptations have been made to this classic form, even though the basic process and mechanisms remain at the core of conducting psychoanalytic therapy. The main difference between the newer forms of psychoanalytic therapy and the classic form is the emphasis on the relationship and the interpretation of transference.
Harry Stack-Sullivan introduced an
interpersonal
focus to psychoanalysis in the 1920s that emphasized the real relationship dynamics between patient and analyst. Freud emphasized what was going on inside the patient’s deep unconscious, but the interpersonally-oriented analysts instead began to focus on what happened in the relationship. They viewed and interpreted incidents of transference as deriving from the interaction, not solely from within the patient. The analyst may actually act in certain ways that remind the patient of earlier, conflicted relationships, thus setting the wheels of transference in motion.
The key for the newer psychoanalysts is the relationship between the therapist and the analyst and how the patient interacts with others in relationships — reenacting earlier conflicts in their styles of relating to others. Alexander introduced the concept of the
corrective emotional experience
to depict a situation in which the analyst relates to the patient in a manner that the patient did not experience growing up, helping the patient to overcome his developmental impasse. If a patient’s conflicts are assumed to be the consequence of poor parenting, the analyst’s job is to “re-parent” the patient, in a sense. Therapy, then, is a new type of relationship, one that the patient has never had and one that will help him or her relate to people in a healthier and more mature manner.
Shorter versions of psychoanalytic therapy, known as
brief dynamic therapies,
also exist. The process is much more active, and the therapist attempts to push the process along by being more targeted in his or her work. More specific goals are established that focus the therapist and patient on a specific interpersonal problem and practically change the problematic circumstances that a patient finds him or herself in. Instead of talking about relationships in general, they target a specific relationship such as spouse to spouse or parent to child.