Counseling and Psychotherapy - Группа авторов

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narrative, which biases the counselor and influences the counselor’s unbiased approach to the therapeutic relationship and process. Although transference will impede successful therapy, the momentary recognition of this reaction by the therapist illuminates the emotions elicited by others in the client’s life (Thomas, 2008).

      Overview

      The psychodynamic approach still relies on the basic foundational tenet from psychoanalysis—that understanding the ways in which early experiences of the client have shaped their current motivations helps the client find interpersonal resolutions to their problems (Fulmer, 2018). Compared with traditional psychoanalytic practices, modern psychodynamic thought is comprehensive, versatile, and conceptualized as a system in its attempts to explain irrationality (Fulmer, 2018). Although this approach is still evolving, it is a more inclusive and cross-cultural approach, adopting cognitive and behavioral focal points to treat clients (Fulmer, 2018). The modern presuppositions and objectives provide a framework for modern psychodynamic theory and support its viability in today’s world.

      Although there is no precise shift from analysis to dynamic in historical practice, counseling itself experienced a person-centered shift following the work of Carl Rogers, and shortly thereafter, psychodynamic practice infused components of object relations, transference-focused attachment, self-psychology, and family systems approaches and became the foundation of cognitive behavior therapy and, later, dialectical behavioral therapy. This evolving change in the application of classical techniques is seen as dynamic, and the centralized focus on analysis has moved dramatically from the therapist to the working alliance between therapist and client.

      Goals of Counseling and Psychotherapy

      The primary goal of modern approaches is to bring the drives of the id into consciousness, allowing them to be understood and addressed directly, thus reducing the client’s reliance on defense mechanisms to function in social contexts (Levenson, 2007). When symptoms are elucidated to bring the unconscious into consciousness or awareness, the ego is strengthened and clients learn to express their needs and wants within a realistic paradigm, resulting in a greater balance between the id and the superego. The ultimate goal is to resolve interpersonal conflicts by identifying and resolving the ways in which the client is demonstrating resistances, defenses, and misplaced drives based on prior traumatic experiences.

       Modern Presuppositions and Objectives

      Presuppositions. As theorists evolved the commonly held views and ideas of the traditional psychoanalytic approach, modern psychodynamic thought focuses on four major presuppositions: (a) Unseen forces behind the sciences are influential, (b) personality shapes experiences, (c) the past is powerful, and (d) psychic determinism is real (Fulmer, 2018). Unseen forces, including biological drives and impulses, psychological motivations, and cultural pressures expressed by clients, suggest a neural basis for the unconscious responsible for self-defeating thoughts. The client’s personality influences and shapes their development, defense processes, and manifestation of mental disorders, all of which are influenced by early attachment experiences. Repeating behaviors indicate that ruminating on past experiences impedes current coping skills. And psychic determinism is the concept that a client is unable to be present and have autonomy because of influences of past experiences, which leave the client with little self-determination (Fulmer, 2018).

      Objectives. Just as the presuppositions help to provide a theoretical and conceptual underpinning of the modern psychodynamic approach, the objectives focus on the actual goals and accomplishments in session. The objectives of current psychodynamic approaches rest on the client’s development of insight, and counselors engage clients in recognizing and embracing choices to think and behave differently. Counselors also help clients holistically understand their past experiences and realize that the past has shaped their coping skills, and that they may develop healthier skills after achieving insight. And while clients develop an improved interpersonal relational style throughout this process, counselors provide an emotional corrective experience by distinguishing cognitive and emotional understanding of the interpretations of their drives and motivations.

      The five objectives of modern psychodynamic theory are (a) the development of insight, (b) the expansion of choice, (c) liberation from the past, (d) improvement of interpersonal relationships, and (e) the corrective emotional experience (Fulmer, 2018). The focus of modern psychodynamic approaches remains insight-oriented, developing both cognitive and affectual insight (Fulmer, 2018; Rutan et al., 2014). In line with developing insight, counselors attempt to expand on the notion of client choice, consistent with the idea of psychic determinism. Counselors will work with clients in session to focus on making decisions from a more mature and rational mind-set (Cabaniss et al., 2011; Fulmer, 2018).

      The past is still recognized as an important aspect of the work; many modern psychodynamic counselors understand how past experiences may shape current situations. However, counselors attempt to move beyond the past and break clients of the emotional bonds that the past may have on their lives, bringing the issues to the here and now. By doing so, counselors seek to emphasize holism in their work, recognizing that clients do not live in a vacuum. Counselors believe that the interaction with others lend itself to creating issues; therefore, seeking to improve interpersonal relationships will greatly improve one’s life. Finally, modern psychodynamic counselors focus on developing a corrective emotional experience in session, when clients can openly discuss their problems and develop solutions to these problems. However, modern psychodynamic counselors understand the importance of working through addressing the emotion that may drive the client’s problems (Fulmer, 2018).

      The Process of Change

      The process of change emerges from the use of traditional and modified techniques to bring awareness to the client and frame current maladaptive behaviors in the context of prior experiences contributing to present circumstances in the client’s life. Currently, the use of psychoanalytic techniques has expanded to include an emphasis on the treatment of serious mental health issues, cross-cultural considerations, and brief applications across contexts. The primary method of psychoanalysis is the identification, analysis, and interpretation of the unconscious conflicts that interfere with the client’s daily functioning. This is done using a variety of traditional strategies and techniques, such as the analysis of dream content, transference, resistance, and defenses, which encourage clients to increase their awareness of the etiology and manifestation of symptoms and how to cope with new experiences in a more healthful, productive manner based on this new awareness. In its brief form, a psychodynamic approach uses direct dialogue and interpretation to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in maladaptive symptoms and behaviors (Johnson, 2016).

      Techniques and Interventions

       Therapeutic Immediacy

      Transference and resistance are two fundamental aspects of traditional psychoanalytic theory. Once the source of transference is identified,

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