As I continue my training in psychoanalysis, I am beginning to see that this modality can offer clients the ability to work at a deeper level than the traditional psychotherapy we are taught in graduate school. Graduate school, as a generalist model, provides the basic tools to engage clients in the therapeutic process and after becoming licensed as an LCSW, the ability to open one’s own private psychotherapy practice. However, I am finding that additional training after graduate school and even for seasoned therapists is imperative to understand the psyche more clearly and provide treatment more effectively to our clients. I believe graduate school provided me with a foundation on which to layer more specialized training and to utilize the two areas of studies as one.
The basic tenant of psychoanalysis is that our psyche is composed of our conscious selves and our unconscious selves and that it is structured like an iceberg with consciousness above the water and the unconscious below the water. If you were to see an illustration of an iceberg, you would find that the part below the water is many times larger than the part above the water. Therefore, there is significantly more information about who we are, our life’s experiences, memories, pains, desires, fears, and wishes tucked away in our unconscious. The goal of psychoanalysis is to make repressed unconscious feelings conscious.
The concept above is only the beginning of developing an understanding of psychoanalysis as a modality for working directly with clients to get to know what lies deep inside themselves and to help mediate their psychic suffering. Some of the courses available to students in a master's in social work program are Human Behavior in the Social Environment, Social Welfare Policies, Organizations and Communities, Psychopathology, and Statistics. These courses are very important in understanding some of the different settings where social work can help various populations of people. And the social workers who work in these environments should be commended for the great work they do. However, it does not include how to understand why our clients think the way they do, feel the way they feel, dream their dreams, and behave in ways that often prove dysfunctional in one way or another. It is essential that future analysts have this foundation on which to build. However, I have found that this basic understanding of social work is not comprehensive enough, even with masters-level training, to do the deep work that is necessary for analysis. Like any additional post-graduate training, it can only bolster the skills of the clinician to do the necessary work to help their clients.
Two areas of great importance that an analyst will use to help understand clients in treatment are transference and countertransference. Transference is when a client unconsciously associates a person in the present with a past relationship. The transference can be associated with feelings of affection, frustration, disappointment, envy, or anger projected onto the analyst who is seen as a representative of an important person from ones past. For example, Kohut (1971) outlined two forms of transference he called mirror transference and idealizing transference. Mirror transference refers to the client’s efforts to capture the admiration or validation of the mother, which is displaced in the present onto the analyst. In idealizing transference, the client attributes exaggerated, near-perfect qualities to the analyst. However, the client can also feel envious or angry at the analyst for having the ability to be helpful and insightful in which the client can’t do for themselves. A client can feel so envious of the analyst’s work that he/she may try to undo or sabotage the progress that had been gained. The analyst can also use the transference to look at the clients feelings and explore who may be the actual person the client is having a reaction to.
Countertransference is the thoughts and feelings the analyst has about the client in the session. In one form, a client can be unconsciously viewed as someone from the analyst’s past that triggers an internal response to the client or, in a second form, the client can induce thoughts and feelings in the analyst by what they are saying or doing in the session. Generally, if an analyst is feeling a certain way when working with the client and can be aware that the feelings have not arisen before, the analyst can tell that his or her feelings must have been induced by the client. It can be safe to say that other people may have the same feelings when interacting within the client orbit.
Another aspect in the countertransference process is called projective identification Klein (1946). Projective identification involves the fusion of projective (casting out) and introjections (the taking in) of mechanisms from client to analyst. The client projects internal objects (other people) and gets the person on whom they are projected (analyst) to behave like those objects (other people), as if the target person had those same introjects (characteristics).
One more concept in psychoanalysis I’ll outline in this article is of resistance in the therapy session. Resistance, a defense mechanism, speaks to the unconscious departure of difficult memories or emotions or an avoidance to make changes within a person’s life. Some of the ways a client can put up a resistance to treatment in the session are as follows:
- Irrelevant small talk
- Silence or minimal discussion with the therapist
- Wordiness or “pressured” speech
- Discounting or correcting the therapist
- Not keeping appointments
- Failing to pay for therapy sessions
- Preoccupation with the past or future
One way I notice resistance in session is when I become aware of a client suddenly shift topic away from a difficult subject to one that is less important or more benign. For example, if a client is talking about the neglect they felt from their mother when they were growing up and then shifts and starts talking about a birthday party of a friend they recently attended, that’s resistance. Another example is a woman, who was just told that her husband wants a divorce, may exclusively hypothesize about her husband reasons for leaving her and fail to talk about her own thoughts and feelings. A third example is when a client continually corrects the therapist or uses “big” words to try to impress the therapist and not talk freely and easily about their issues. It is important for an analyst to look for resistance in the therapy as it will always be there in one form or another.
Transference, countertransference, projective identification, and resistance are just a few of the theoretical concepts found in psychoanalysis. It would be important to look at a persons character development, the three basic parts of character and how they interact, defense mechanisms, dreams, the conscious verses the unconscious, suppression and repression and many other concepts in psychoanalysis.