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A therapist asks the client to reveal all his/her thoughts including early childhood experiences. Describe the technique and type of therapy being used.

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Psychoanalysis is a method of treatment of neurotic patients which emphasized the thoughts and experiences of childhood. It was developed by Dr. Sigmund Freud. The whole modality of treatment occurs in three phases: 

1. Initial Phase: The client becomes making client familial with the routines. 

• Establishment of a therapeutic relationship with the analyst, 

• Relief with the process of recollecting the superficial materials from the unconscious about the past and present troublesome events. 

2. Middle Phase: Transference and interpretation are the means of treating the patient. 

• Transference: The client starts identifying positively or negatively to the therapist with other significant people often with father and mother, in his childhood. 

• Parent-child relationships are often replayed in this way. 

• The therapist may be seen as the punitive father or as negligent mother or vice-versa. 

• The therapist maintains a non-judgmental yet permissive attitude towards the client and overcomes the resistance showed by the client. 

• This whole process is known as transference and when the therapist becomes a substitute for the client in the present is known as transference neurosis. 

Stage of Transference  Neurosis: 

In the process of transference the client acts out his/her frustrations, anger, fear and depression that he/she carried toward that person in the past, but could not express at that time. 

• The therapist becomes a substitute for that person in the present. 

This substitution which is known as transference neurosis is helpful in making the therapist aware of the nature of intrapsychic conflicts suffered by the client. The transference neurosis may develop in two forms: 

(i) Positive Transference: Here the client may fall in love with the therapist and seeks the therapist’s approval. 

(ii)  Negative Transference: When the client develops feeling of hostility, anger and resentment towards the therapist. 

• Stage of Resistance: During the process of transference an individual may develop resistance. Since process of transference exposes the unconscious wishes and conflicts, client’s distress level increases and so the client resists transference. 

(i) Conscious Resistance: It is present when the client intentionally hides some information. 

(ii) Unconscious Resistance: It is present when the client becomes silent during the therapy session or starts coming late for the sessions, flight into sickness or show unwillingness-to talk about certain things, sudden blocks forgetting and so on. 

• According to Freud, resistance is patient’s unconscious struggle to prevent painful material from being brought to the surface and faced directly. 

• Interpretation: Interpretation is the fundamental mechanism to bring change in the client. 

Interpretation is done through two analytical techniques: 

(i) Confrontation: The therapist points out to the client an aspect of his psyche that must be faced by the client. It is a subtle process and considered to be the pinnacle of psychoanalysis.  

(ii) Clarification: It is the process by which the therapist brings a vague or confusing event into clarity. Both the process are done by sharpening and pruning of the material which is brought from unconscious to conscious level. 

• The therapist highlights certain important aspects and deletes the unimportant ones. 

Working Through: The repeated process of using confrontation, clarification and interpretation is known as working through.

• This process helps the patient to understand himself and the source of the problem. 

• It integrates the uncovered material into his ego.

• Insight: The end product of working through is insight. It is a gradual process wherein the unconscious memories are again and again integrated into conscious awareness. As this process continues, the client starts to understand himself better at an intellectual and emotional level and gains insight into his/her conflicts and problems.  The insight is of two types: 

(i) Intellectual Insight: It is intellectual understanding of the event. 

(ii) Emotional Insight: The emotional understanding, acceptance of one’s irritations due to unpleasant events of the past and the willingness to change emotionally is known as emotional insight. 

3. Third Phase: 

• Termination: Insight is the end part of therapy. Now the client is supposed to gain new understanding of himself. Conflicts of the past, excessive usage of defence mechanism and physical symptoms are no longer present and he/she becomes a healthy person.

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