Psychotherapy Theory and Applications
PSY443
By Nadine Alhamzawi
Psychoanalytic Treatment
Transference:
The unconscious redirection of feelings from one person to another, often from a patient to their
therapist.
In essence, transference plays a crucial role in psychoanalysis, where childhood emotions are
projected onto the analyst. Understanding this dynamic, along with the therapeutic alliance and
real relationship, is essential for effective treatment.
It involves the reactivation of feelings from childhood, often directed toward significant figures
(like parents), onto the analyst.
Patients may irrationally perceive the analyst based on past relationships, leading to strong
feelings of attachment, affection, hostility, or anger.
The analyst often becomes the focus of the patient's unresolved sexual and aggressive desires,
leading to intense erotic feelings. As a result, patients may genuinely believe they are in love with
their analyst, a phenomenon known as erotic transference.
The analyst encourages transference through specific techniques, fostering a regression that can
lead to transference neurosis.
● Inappropriateness: The irrational nature of feelings.
● Intensity: The strong reactions from the patient.
● Ambivalence: Mixed feelings toward the analyst.
● Tenacity: Persistence of feelings regardless of the analyst's actions.
● Capriciousness: Erratic triggers for these feelings.
1-Positive Transference: Positive feelings (love, admiration) toward the analyst, mirroring
childhood feelings for parents, which can facilitate trust and rapport.
2-Negative Transference: Negative feelings (anger, hate) toward the analyst, resulting in
devaluation.
3-Non-Transference Relationships:
● Therapeutic Alliance: A collaborative, task-oriented partnership focused on the patient’s
conscious self, promoting engagement in problem exploration.
● Real Relationship: An authentic and realistic aspect of the therapeutic relationship,
contrasting with the genuine but unrealistic transference and the realistic but artificial
working alliance.
,Resistance:
The patient’s unconscious defence mechanism prevents confronting painful or repressed
thoughts during therapy.
Refers to the internal forces within a patient that hinders the progress of psychoanalysis and
oppose the analyst's efforts to facilitate insight.
Resistance reflects the patient’s defence mechanisms, helping them protect themselves from
discomfort.
1-Resistance to Transference: The patient resists developing transference neurosis, which
prevents the analyst from addressing the root of the patient's inner conflicts.
2-Transference Resistance: The patient uses transference to resist analysis by clinging to
irrational feelings rather than exploring past experiences.
Resistance can be conscious (deliberately withholding information) or unconscious (a defence
against uncovering repressed material). Conscious resistance is usually temporary and can be
addressed directly, while unconscious resistance is a persistent force that emerges whenever
significant issues arise.
● Initial phase: patients may avoid forming a bond with the analyst.
● Middle phase: they may experience intense, irrational feelings toward the analyst.
● Termination phase: there may be a resurgence of earlier symptoms.
Countertransference:
The therapist’s unconscious emotional reactions to the patient, are influenced by the therapist’s
own experiences.
Refers to the unconscious emotional responses and conflicts of the analyst that are triggered by
the patient, which can negatively affect the analyst’s objective judgment. Common signs of
countertransference include:
● Feeling uneasy during or after sessions with certain patients.
● Becoming drowsy or falling asleep during sessions.
● Carelessly altering session schedules or appointments.
● Treating patients inconsistently in financial arrangements.
● Wanting to assist the patient outside of sessions.
● Dreaming about or preoccupying oneself with patients in free time.
● Using patients as examples in discussions or lectures.
● Reacting strongly to how the patient perceives the analyst.
● Having strong feelings about the patient’s termination.
● Difficulty exploring certain topics or understanding the patient.
● Experiencing sudden, excessive emotions like anxiety or boredom during sessions.
While countertransference is a natural part of therapy, it becomes problematic when these
feelings are influenced by past events or relationships in the analyst's life. This can lead to
inappropriate or non-therapeutic behaviours.
Projective Identification in Countertransference involves three steps:
, 1. A patient projects an unconscious part of themselves onto the analyst.
2. The analyst unconsciously identifies with this projection.
3. The analyst processes this projection and sends a modified version back to the patient,
influencing their interaction.
Behaviour Therapies
Behaviour therapy is grounded in learning theories, particularly operant (instrumental) and
classical (respondent) conditioning.
Classical Conditioning: involves the process of extinction, where the conditioned response
diminishes when the conditioned stimulus is presented without the unconditioned stimulus.
Operant Conditioning: as defined by Skinner, focuses on how behavior is shaped by its
consequences, allowing for the learning of new behaviors.
● Parent-child interaction training
● Exposure and response prevention
● Systematic desensitization
● Stress management
● Token economies
● Problem-solving skills training
This approach views clinical symptoms as learned behaviours, aiming to create treatment
programs that teach patients new behaviours and thoughts to alleviate symptoms and enhance
their quality of life.
Behaviour therapy has roots in various historical practices aimed at modifying behaviour. Notably,
Pliny the Elder employed a form of aversion therapy by placing spiders in drinkers' glasses to
discourage excessive drinking. In the 19th century, Alexander Maconochie introduced a token
economy in Norfolk Island’s penal colony, rewarding prisoners for positive behaviours.
Behaviour Modification: first appeared in 1911 in Edward Thorndike's book Provisional Laws of
Acquired Behavior or Learning, where he studied learning through his experiments with cats.
The field of behaviour therapy advanced significantly in the mid-1950s, influenced by figures like
B.F. Skinner in the United States, Joseph Wolpe in South Africa, and Hans Eysenck and Stanley
Rachman in the UK, focusing on classical conditioning and operant learning.
Theoretical Principles of Behavior Therapy
Acquisition of Maladaptive Behaviors: Maladaptive behaviours are learned just like adaptive
behaviours.
No Need for Underlying Causes: It's unnecessary to find a root cause for maladaptive behaviours;
the focus is on observable symptoms and behaviours.
Modification Through Learning Principles: Behavioral techniques can be applied to change
maladaptive behaviours.
Focus on Current Behavior Maintenance: Treatment emphasizes understanding current
environmental factors maintaining the behaviour rather than historical causes.
PSY443
By Nadine Alhamzawi
Psychoanalytic Treatment
Transference:
The unconscious redirection of feelings from one person to another, often from a patient to their
therapist.
In essence, transference plays a crucial role in psychoanalysis, where childhood emotions are
projected onto the analyst. Understanding this dynamic, along with the therapeutic alliance and
real relationship, is essential for effective treatment.
It involves the reactivation of feelings from childhood, often directed toward significant figures
(like parents), onto the analyst.
Patients may irrationally perceive the analyst based on past relationships, leading to strong
feelings of attachment, affection, hostility, or anger.
The analyst often becomes the focus of the patient's unresolved sexual and aggressive desires,
leading to intense erotic feelings. As a result, patients may genuinely believe they are in love with
their analyst, a phenomenon known as erotic transference.
The analyst encourages transference through specific techniques, fostering a regression that can
lead to transference neurosis.
● Inappropriateness: The irrational nature of feelings.
● Intensity: The strong reactions from the patient.
● Ambivalence: Mixed feelings toward the analyst.
● Tenacity: Persistence of feelings regardless of the analyst's actions.
● Capriciousness: Erratic triggers for these feelings.
1-Positive Transference: Positive feelings (love, admiration) toward the analyst, mirroring
childhood feelings for parents, which can facilitate trust and rapport.
2-Negative Transference: Negative feelings (anger, hate) toward the analyst, resulting in
devaluation.
3-Non-Transference Relationships:
● Therapeutic Alliance: A collaborative, task-oriented partnership focused on the patient’s
conscious self, promoting engagement in problem exploration.
● Real Relationship: An authentic and realistic aspect of the therapeutic relationship,
contrasting with the genuine but unrealistic transference and the realistic but artificial
working alliance.
,Resistance:
The patient’s unconscious defence mechanism prevents confronting painful or repressed
thoughts during therapy.
Refers to the internal forces within a patient that hinders the progress of psychoanalysis and
oppose the analyst's efforts to facilitate insight.
Resistance reflects the patient’s defence mechanisms, helping them protect themselves from
discomfort.
1-Resistance to Transference: The patient resists developing transference neurosis, which
prevents the analyst from addressing the root of the patient's inner conflicts.
2-Transference Resistance: The patient uses transference to resist analysis by clinging to
irrational feelings rather than exploring past experiences.
Resistance can be conscious (deliberately withholding information) or unconscious (a defence
against uncovering repressed material). Conscious resistance is usually temporary and can be
addressed directly, while unconscious resistance is a persistent force that emerges whenever
significant issues arise.
● Initial phase: patients may avoid forming a bond with the analyst.
● Middle phase: they may experience intense, irrational feelings toward the analyst.
● Termination phase: there may be a resurgence of earlier symptoms.
Countertransference:
The therapist’s unconscious emotional reactions to the patient, are influenced by the therapist’s
own experiences.
Refers to the unconscious emotional responses and conflicts of the analyst that are triggered by
the patient, which can negatively affect the analyst’s objective judgment. Common signs of
countertransference include:
● Feeling uneasy during or after sessions with certain patients.
● Becoming drowsy or falling asleep during sessions.
● Carelessly altering session schedules or appointments.
● Treating patients inconsistently in financial arrangements.
● Wanting to assist the patient outside of sessions.
● Dreaming about or preoccupying oneself with patients in free time.
● Using patients as examples in discussions or lectures.
● Reacting strongly to how the patient perceives the analyst.
● Having strong feelings about the patient’s termination.
● Difficulty exploring certain topics or understanding the patient.
● Experiencing sudden, excessive emotions like anxiety or boredom during sessions.
While countertransference is a natural part of therapy, it becomes problematic when these
feelings are influenced by past events or relationships in the analyst's life. This can lead to
inappropriate or non-therapeutic behaviours.
Projective Identification in Countertransference involves three steps:
, 1. A patient projects an unconscious part of themselves onto the analyst.
2. The analyst unconsciously identifies with this projection.
3. The analyst processes this projection and sends a modified version back to the patient,
influencing their interaction.
Behaviour Therapies
Behaviour therapy is grounded in learning theories, particularly operant (instrumental) and
classical (respondent) conditioning.
Classical Conditioning: involves the process of extinction, where the conditioned response
diminishes when the conditioned stimulus is presented without the unconditioned stimulus.
Operant Conditioning: as defined by Skinner, focuses on how behavior is shaped by its
consequences, allowing for the learning of new behaviors.
● Parent-child interaction training
● Exposure and response prevention
● Systematic desensitization
● Stress management
● Token economies
● Problem-solving skills training
This approach views clinical symptoms as learned behaviours, aiming to create treatment
programs that teach patients new behaviours and thoughts to alleviate symptoms and enhance
their quality of life.
Behaviour therapy has roots in various historical practices aimed at modifying behaviour. Notably,
Pliny the Elder employed a form of aversion therapy by placing spiders in drinkers' glasses to
discourage excessive drinking. In the 19th century, Alexander Maconochie introduced a token
economy in Norfolk Island’s penal colony, rewarding prisoners for positive behaviours.
Behaviour Modification: first appeared in 1911 in Edward Thorndike's book Provisional Laws of
Acquired Behavior or Learning, where he studied learning through his experiments with cats.
The field of behaviour therapy advanced significantly in the mid-1950s, influenced by figures like
B.F. Skinner in the United States, Joseph Wolpe in South Africa, and Hans Eysenck and Stanley
Rachman in the UK, focusing on classical conditioning and operant learning.
Theoretical Principles of Behavior Therapy
Acquisition of Maladaptive Behaviors: Maladaptive behaviours are learned just like adaptive
behaviours.
No Need for Underlying Causes: It's unnecessary to find a root cause for maladaptive behaviours;
the focus is on observable symptoms and behaviours.
Modification Through Learning Principles: Behavioral techniques can be applied to change
maladaptive behaviours.
Focus on Current Behavior Maintenance: Treatment emphasizes understanding current
environmental factors maintaining the behaviour rather than historical causes.
