Psychoanalytic Therapy Over Time
In Psychoanalytic Therapy Over Time, Dr. Jeremy D. Safran demonstrates the relational psychoanalytic approach. Like other forms of psychoanalysis, the relational approach emphasizes the importance of exploring unconscious processes, transference and defense, but is also distinguished by a number of key features. These include emphasizing the mutuality of the therapeutic relationship, exploring the way in which both client and therapist unconsciously contribute to playing out important relational patterns in the treatment, and valuing the therapist's feelings as important clues about both the nature of these relational patterns and the client's unconscious experience.
Over the course of the six sessions on this DVD, Dr. Safran works with a young woman with a history of serious depression, substance abuse, and a pattern of romantic involvement with abusive men. Through a process of exploring tensions and relational patterns emerging in the therapeutic relationship, Dr. Safran helps the client begin to recognize her own needs and strengths and to feel more optimistic about the future. Over the course of therapy, the client progresses from a stance of wary and resentful compliance to one of growing trust and healthy self-assertion.
The origins of psychoanalysis and psychodynamic therapies date back to the beginning of the twentieth century with the writings of Sigmund Freud and colleagues such as Sandor Ferenczi, Karl Abraham, Alfred Adler, Carl Jung, Otto Rank, Ernest Jones, Wilhelm Stekel, Max Eitingon, and Hans Sachs. Psychoanalysis was the first form of modern psychotherapy, and as such has had much longer to develop than other therapeutic approaches. There has thus been an opportunity for many different psychoanalytic theories and traditions to evolve.
While Freud is considered the founder of psychoanalysis, over the years, there have been many significant theorists in different countries around the world who have made important contributions to the development of psychoanalysis and a range of different approaches have emerged. These include ego psychology, object relations theory, self psychology, interpersonal psychoanalysis, relational analysis and Lacanian analysis. While there are important differences in both theory and practice among these different approaches, there are also certain shared principles. These include an emphasis on
- the importance of unconscious processes
- the exploration of resistance (ambivalence about change) and defenses (the tendency to avoid certain feelings and wishes because they are experienced as threatening)
- the exploration of the transference (i.e., the way in which the client's past experiences shape their response to the therapy and the therapist)
- the value of self-exploration
- the value of going beyond the relief of immediate symptoms to examine fundamental assumptions and ways of being in the world
In many countries throughout Europe and Latin America the dominant forms of psychoanalysis have been strongly influenced by theoretical traditions originated by Melanie Klein in Britain or Jacques Lacan in France. Until the mid-1970s, the dominant form of psychoanalysis in North America was what is referred to as ego psychology (which evolved out of some of Freud's later thinking), and there was considerable consensus about both theoretical and technical concerns. This was a time of orthodoxy within the tradition, when departures from prescribed canons of psychoanalytic practice were looked at as technical errors.
Certain features of the ego psychology of this era have become engraved in the public mind as the stereotype of psychoanalysis (e.g., the analyst adopting a formal and distant stance and attempting to maintain a certain degree of anonymity, the analyst assuming the role of the authority whose perspective on reality is privileged over the client's, the analyst refraining from playing an active and directive role, or providing advice and guidance).
Since the 1970s there has been a breakdown in this consensus, and psychoanalysis has entered into an era of theoretical and technical pluralism. There are many competing schools of psychoanalysis, and the psychoanalytic or dynamic therapist in training is likely to be influenced by a variety of different perspectives. A postmodern ethos has suffused the field and traditional assumptions are being challenged. An important emphasis is placed on the importance of therapists' authenticity, and on their willingness and ability to bring their unique personhood into the therapeutic relationship.
In the end, psychodynamically oriented therapists must synthesize the range of different theories, research findings, supervisors and experiences in their own personal therapies and life experiences with elements of their own personalities to develop their own unique voices as therapists. There is an emphasis on the importance of being able to improvise in therapy—to intervene creatively in a way that is mediated by theory and consensually recognized guidelines, but at the same time is responsive the client's emergent feelings and needs as well as one's own intuitions about what feels "right."
In the same way that a talented jazz musician cannot perform without having mastered the fundamentals of musical theory and the discipline of practice, the skilled psychoanalyst or psychodynamic therapist requires extensive training. In the end, however, theory and technical guidelines must be internalized and made personal rather than continuing to function as external sources of authority. Practicing psychoanalysis involves learning to live with ambiguity and an openness to ongoing learning and personal growth.
The most influential development in North American psychoanalysis in the last 20 years has been the emergence of relational psychoanalysis, and this is the approach Dr. Safran is most closely identified with. While there have been many contributors to the development of the relational tradition, the American analyst, Stephen Mitchell is generally viewed as its founding father. Other significant contributors include Neil Altman, Lewis Aron, Philip Bromberg, Jessica Benjamin, Muriel Dimen, Emmanuel Ghent, Jay Greenberg, Irwin Hoffman, Adrienne Harris, Stuart Pizer, and Donnel Stern.
Relational psychoanalysis reflects a number of different influences including:
- interpersonal psychoanalysis
- object relations theory
- self psychology
- feminist and postmodern thinking
- infant–mother developmental research (including research on attachment theory)
- developments in emotion theory and research
- both theory and research on therapeutic impasses
Relational approaches to psychotherapy start with the assumption that therapists inevitably influence the phenomenon they are observing through their own participation in the relational field. Client and therapist are always influencing one another in both conscious and unconscious ways. This ongoing process of mutual influence results in repetitive relational patterns (also referred to as enactments) that reflect the unique personal histories, conflicts, and ways of relating to the world of both client and therapist.
While these enactments are likely to have some similarities to repetitive relational patterns that are problematic for clients in their everyday lives, one cannot assume that there will be an exact parallel. These enactments can vary in kind from more subtle patterns that are difficult to become aware of, to more intense enactments that can be associated with therapeutic impasses or stalemates. While enactments and therapeutic impasses can be destructive if they are not addressed, they also afford tremendous opportunities for change, if they are worked through in a constructive fashion.
Working with clients to help them become aware of their contributions (both intrapsychic and interpersonal) to these inevitable enactments helps them to develop the kind of self-reflective skills that will be useful for purposes of becoming aware of and deautomating their unconscious, self-defeating relational patterns. Moreover, to the extent that therapists are able to collaborate with their clients in a process of observing and disembedding from these enactments, clients are able to participate in a new type of relational experience with their therapists that can, over time, modify the type of presymbolic, implicit relational knowing that shapes their everyday interactions.
In treatment there is often an ongoing process of rupture and repair in the relationship between client and therapist, that is similar in some respects to the ongoing process of disruption and repair that developmental researchers observe in mother–infant interactions. The process of acknowledging and working through these ruptures plays a critical role in helping clients to develop an internal representation of self as capable of negotiating the inevitable tensions that emerge in relationships with others, and of others as available and open to working things through. This therapeutic process typically (but not always) has a conceptual or reflective dimension to it, but it is important to emphasize that much of the learning takes place at a bodily felt, affective level.
Although the therapeutic relationship is often an explicit focus of exploration in contemporary psychoanalysis, it does not have to be. In fact, a wide range of interventions can be compatible with a psychoanalytic approach. Such interventions may include various types of interpretations, exploring and deepening emotional experience, empathic responding, exploring resistance and defenses, cognitive and affective restructuring, exploring the past, constructing new narratives, suggesting activities between sessions, or simply providing guidance or reassurance. It is important to bear in mind, however, that every intervention has a relational meaning for both client and therapist.
For example, a genetic transference interpretation (e.g., drawing a link between the therapeutic relationship and the client's relationship with his or her father) can be experienced by a client as a disconfirmation of his fears that the therapist is the same as his father, or as an attempt on the therapist's part to blame the client for problems in the therapeutic relationship. A therapist's reluctance to give advice can be experienced by the clients as respectful of their autonomy or as withholding. A therapist's attempt to challenge a client's perception can be experienced as either comforting or invalidating.
By the same token, the therapist's intervention will be experienced differently by the client if it is motivated by the therapist's unconscious anger than if it is motivated by compassionate feelings. The relational meaning of the intervention can thus provide clients with a new, constructive interpersonal experience that modifies their maladaptive views of self and other, or contribute to an enactment that needs to be disembedded from. It is thus critical for therapists to attend to and reflect on what is transpiring in the therapeutic relationship in an ongoing fashion, in an effort to understand what is playing out at the relational level and to be able to disembed from enactments as they emerge.
Jeremy D. Safran, PhD, is professor of psychology and director of clinical training at the New School for Social Research in New York. He is also senior research scientist at Beth Israel Medical Center. In addition, he is a faculty member at the New York University postdoctoral program in Psychotherapy and Psychoanalysis, and a faculty member at the Stephen A. Mitchell Center for Relational Studies. He is also incoming president of the International Association for Relational Psychoanalysis and Psychotherapy.
Dr. Safran is on the editorial boards of Psychotherapy Research and Psychoanalytic Psychology, and an associate editor for the journal Psychoanalytic Dialogues. He has published more than 100 articles and chapters, and several books including Negotiating the Therapeutic Alliance: A Relational Treatment Guide; Emotion in Psychotherapy; The Therapeutic Alliance in Brief Psychotherapy; Interpersonal Process in Cognitive Therapy; and Psychoanalysis and Buddhism: An Unfolding Dialogue.
Dr. Safran and his colleagues have conducted research on the topic of therapeutic impasses for the past 2 decades. He is also known for his work on the topic of emotion in psychotherapy and for his integration of principles from Buddhist psychology into Western psychotherapy.
- Greenberg, L. S., & Safran, J. D. (1987). Emotion in psychotherapy. New York: Guilford Press.
- Safran, J. D. (1993). Breaches in the therapeutic alliance: An arena for negotiating authentic relatedness. Psychotherapy, 30, 11–24.
- Safran, J. D. (1999). Faith, will and despair in psychoanalysis. Contemporary Psychoanalysis, 35, 5–23.
- Safran, J. D. (2002). Brief relational psychoanalytic treatment. Psychoanalytic Dialogues, 12, 171–196.
- Safran, J. D. (Ed.). (2003). Psychoanalysis and Buddhism: An unfolding dialogue. Boston: Wisdom Publications.
- Safran, J. D. (2003). The relational turn, the therapeutic alliance and psychotherapy research: Strange bedfellows or postmodern marriage? Contemporary Psychoanalysis, 39, 449–475.
- Safran, J. D. (2006). Before the ass has gone the horse has already arrived. Contemporary Psychoanalysis, 42, 197–212.
- Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press.
- Safran, J. D., Muran, J. C., Wallner Samstag, L., & Stevens, C. (2002). Repairing therapeutic alliance ruptures. In J. C. Norcross (Ed.), A guide to psychotherapy relationships that work: Effective elements of the therapy relationship (pp. 235–244). New York: Oxford University Press.
- Safran, J. D., & Segal, Z. V. (1990/1996). Interpersonal process in cognitive therapy. New York: Basic Books. (2nd. ed., Northvale, NJ: Jason Aronson).
Other Relevant References
- Altman, N. (1995). The analyst in the inner city: Race, class and culture through a psychoanalytic lens. Hillsdale, NJ: Analytic Press.
- Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. Hillsdale, NJ: Analytic Press.
- Benjamin, J. (1988). The bonds of love. New York: Pantheon Books.
- Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: Analytic Press.
- Davies, J. M., & Frawley, M. G. (1994). Treating the adult survivor of sexual abuse. New York: Basic Books.
- Dimen, M. (2003). Sexuality, intimacy and power. Hillsdale, NJ: Analytic Press.
- Ehrenberg, D. (1992). The intimate edge. New York: Norton.
- Ghent, E. (1989). Credo: The dialectics of one-person and two-person psychologies. Contemporary Psychoanalysis, 25, 169–211.
- Greenberg, J., & Mitchell, S. A. (1983). Object relations in psychoanalytic theory. Cambridge, MA: Harvard University Press.
- Harris, A. (2005). Gender as soft assembly. Hillsdale, NJ: Analytic Press.
- Hoffman, I. Z. (1998). Ritual and spontaneity in the psychoanalytic process: A dialectical-constructivist view. Hillsdale, NJ: Analytic Press.
- Levenson, E. (1983). The ambiguity of change. New York: Basic Books.
- Mitchell, S. A. (1988). Relational concepts in psychoanalysis. Cambridge, MA: Harvard University Press.
- Mitchell, S. A. (1993). Hope and dread in psychoanalysis. New York: Basic Books.
- Pizer, S. A. (1998). Building bridges: The negotiation of paradox in psychoanalysis. Hillsdale, NJ: Analytic Press.
- Stern, D. B. (1997). Unformulated experience. Hillsdale, NJ: Analytic Press.
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