Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

604

Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

The patient also must be able to tolerate the stress generated by analysis without becoming overly regressed, distraught, or impulsive. As a form of psychotherapy, it uses the investigative technique, guided by Freud’s libido and instinct theories and by ego psychology, to gain insight into a person’s unconscious motivations, conflicts, and symbols and thus to effect a change in maladaptive behavior. Psychoanalytic psychotherapy Psychoanalytic psychotherapy is based on the same principles and techniques as classic psychoanalysis, but less intense. There are two types: (1) insight-oriented or expressive psychotherapy and (2) supportive or relationship psychotherapy. Expressive psychotherapy In expressive psychotherapy, patients are seen one to two times a week and sit up facing the therapist. The goal of resolution of unconscious psychological conflict is similar to that of psychoanalysis, but a greater emphasis is placed on day-to-day reality issues and a lesser emphasis on the development of transference issues. Pa tients suitable for psychoanalysis are suitable for this therapy, as are patients with a wider range of symptomatic and characterologic problems. Patients with per sonality disorders are also suitable for this therapy. A comparison of psychoanal ysis and psychoanalytically oriented psychotherapy is presented in Table 29-1 . TABLE 29-1. Scope of Psychoanalytic Practice: A Clinical Continuum Psychoanalytic Psychotherapy Feature Psychoanalysis Expressive Mode Supportive Mode Frequency

Regular, 4-5 times a week, 30- to 50-min sessions Long term, usually 3-5 + y Patient primarily on couch with analyst out of view Systematic analysis of all (positive and negative) transference and resis tance; primary focus on analyst and intrasession events; transference neurosis facilitated; re gression encouraged

Regular, 1-3 times a week, 30- to 60-min sessions Short term or long term, several sessions from months to years Patient and therapist face to face; occasional use of couch Partial analysis of dy namics and defenses; focus on current inter personal events and transference to others outside sessions; analysis of negative transference; positive transference left unexplored unless it im pedes progress; limited regression encouraged Modified neutrality; implicit gratification of patient and great activity

Flexible, once a week or less or as needed, 30- to 60-min sessions Short term or intermit tent long term, single session to lifetime Patient and therapist face to face; couch contraindicated Formation of therapeu tic alliance and real object relationship; analysis of transference contraindicated with rare exceptions; focus on conscious external events; regression discouraged

Duration

Setting

Modus operandi

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

Analyst-therapist role

Absolute neutrality; frustration of patient; reflector-minor role

Neutrality suspended; limited explicit gratifi cation, direction, and disclosure