Counseling and Psychotherapy

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 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).

Transference and resistance are two fundamental aspects of traditional psychoanalytic theory. Once the source of transference is identified, the counselor engages 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 (Thomas, 2008). In addition to analyzing transference, the counselor also analyzes the resistances observed from the client during sessions with the intent to expose, or bring into consciousness, the underlying causes for those resistances. Resistance is interpreted as an instinctual reaction to uncomfortable situations that clients attempt to keep hidden from themselves and the counselor (Weiss, 2014).

In modern psychodynamic theory, counselors use therapeutic immediacy to address transference and resistance within the therapeutic relationship (Luyten et al., 2015). Therapeutic immediacy involves any discussion in the therapy session about the relationship between counselor and client that occurs in the here and now, and it processes what is occurring in the here-and-now client-counselor relationship. Examples of therapeutic immediacy include exploring parallels between external relationships and the therapeutic relationship; expressing in-session emotional reactions; inquiring about the client’s reactions to therapy; exploring the counselor’s comments on the client; supporting, affirming, and validating the client’s feelings in the therapeutic relationship; and expressing gratitude (Luyten et al., 2015). Ultimately, the counselor uses therapeutic immediacy to work on improving interpersonal functioning and to create a corrective emotional experience in the here and now (Luyten et al., 2015).

In his book Beyond the Pleasure Principle, Freud (1920/1955) stated that “the goal of all life is death” (p. 38). He noted that after people experience a traumatic event, they often reenact the experience, and these reenactments contradict the presentation of the life instincts. If we apply this in a contemporary context, the counselor may recognize this concept as a foundation for eye movement desensitization and reprocessing and other trauma-informed counseling techniques. Within a current psychodynamic view, self-destructive behavior is an expression of the energy created by the death instincts that a therapist may recognize as anxiety, depression, and suicidal thoughts. When this energy is directed inward, it appears as masochism and self-loathing, and the therapist may recognize symptoms of anxiety and suicidal thoughts. If directed outward onto others, it is expressed as aggression and violence. Understanding this concept helps the client illuminate the relationship between life, death, and meaning (Georgescu, 2011), which aligns with existential theoretical components.

Conscious awareness is helpful but is only effective in a strong, stable, and safe therapeutic relationship. For many clients diagnosed with a serious mental illness, symptoms and concerns need to be addressed early and proactively, and counselors need to be acutely aware of their own feelings during these interactions. Seligman and Reichenberg (2014) noted that countertransference may be useful in understanding these clients, as reactions may enhance understanding of reinforcing social interactions beyond the session. Countertransference reactions should be examined using psychodynamic techniques in a supportive, empathic manner. The counselor is responsible for modeling a healthy ego, and the relationship with the counselor is internalized by the client representing healthy relational interaction (see Sidebar 3.1).

In addition to analyzing transference, the counselor also analyzes the resistances observed from the client during sessions with the intent to expose, or bring into consciousness, the underlying causes for those resistances. One of the most important tasks of the therapeutic alliance is to overcome resistance through remembering, reenacting events, and working through negative feelings. A psychodynamic counselor interprets resistance as an instinctual reaction to uncomfortable situations that clients attempt to keep hidden from themselves and the counselor. It is a way of avoiding the expression of feelings, fantasies, and drives that the client’s subconscious has learned over time to repress and defend.

Transference-focused psychotherapy is a developing approach that researchers suggest as an evidence-based treatment for narcissistic personality disorder. This approach integrates contemporary object relations theory and attachment theory and focuses on the interpretation of devalued and idealized representations of self and others. These are key components of this approach, and the aim is to expose the underlying reasons for the profound sense of vulnerability and imperfection that results in the hallmark compensatory grandiosity associated with narcissistic personality disorder. Randomized clinical trials suggest that this is a promising innovative combination of psychoanalysis and object relations for improving symptomatic functioning in clients with identified attachment disruptions stemming from trauma (Diamond & Meehan, 2013).