Counseling and Psychotherapy

Displacement is the redirecting of thoughts, feelings, and impulses from an object that gives rise to anxiety to a safer, more acceptable one.

Intellectualization is the use of a cognitive approach without the attendant emotions to suppress and attempt to gain mastery over the perceived disorderly and potentially overwhelming impulses.

Projection is the attribution of one’s undesired impulses to another.

Rationalization is the cognitive reframing of one’s perceptions to protect the ego in the face of changing realities.

Reaction formation is the converting of wishes or impulses that are perceived to be dangerous into their opposites.

Regression is the reversion to an earlier stage of development in the face of unacceptable impulses.

Repression is the blocking of unacceptable impulses from consciousness.

Sublimation is the channeling of unacceptable impulses into more acceptable outlets.

Transference , or the process of the client projecting their feelings onto another person or object, is one of the most important psychoanalytic concepts still utilized today. Once the transference is identified, the counselor assumes a blank screen position, engaging the client in exposing the unconscious motivation behind the individual’s defense mechanisms by welcoming all transferred attitudes, feelings, impulses, and desires that were generated in early life by adults whom the client considers important. It is assumed that the motivations will appear on their own during this process, and they may then be examined and redirected by the conscious.

Countertransference describes an intense personal emotional reaction to the client’s 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).

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.

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.

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).

With these four presuppositions, modern psychodynamic theorists further substantiate the importance of the unconscious on biological impulses and psychological motives (Berlin, 2011). Additionally, a reexamination of personality illuminates the biopsychosocial philosophy that guides the exploration of the systemic nature of one’s personality (Fulmer, 2018; Lingiardi et al., 2015). Although the past is still powerful according to the modern psychodynamic approach, clinicians attempt to have clients live freely in the present. However, living in the present, the here and now, is difficult because of the immense force the past has on the present and the future. The past may be observed in the present through transference and countertransference (Fulmer, 2018). Last, modern psychodynamic theory understands the weight of the past and its often tremendous hold over the conscious mind. Therefore, there is a need for both cognitive and emotional awareness so that one has autonomy over one’s life (Fulmer, 2018; Rutan et al., 2014).

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).