clinical psychology

1. THE BEGINNING OFTHE BEGINNING OF
PSYCHOANALYSISPSYCHOANALYSIS
Lecture 29Lecture 29

2. PSYCHOANALYSIS:PSYCHOANALYSIS:
 The psychodynamic approach to therapyThe psychodynamic approach to therapy
focuses on unconscious motives and conflictsfocuses on unconscious motives and conflicts
in the search for the roots of behavior.in the search for the roots of behavior.
 The epitome of this perspective resides in theThe epitome of this perspective resides in the
original psychoanalytic theory and therapy oforiginal psychoanalytic theory and therapy of
Sigmund Freud.Sigmund Freud.
 Without question, psychoanalytic theoryWithout question, psychoanalytic theory
represents one of the most sweepingrepresents one of the most sweeping
contributions to the field of personality.contributions to the field of personality.

3. PSYCHOANALYSIS: THE BEGINNINGPSYCHOANALYSIS: THE BEGINNING
 In 1885, Freud was awarded a grant to study inIn 1885, Freud was awarded a grant to study in
Paris with the famous Jean Charcot. CharcotParis with the famous Jean Charcot. Charcot
was noted for his work with hysterics.was noted for his work with hysterics.
 Charcot had discovered that some hystericalCharcot had discovered that some hysterical
patients would, while under, hypnosis,patients would, while under, hypnosis,
relinquish their symptoms and sometimesrelinquish their symptoms and sometimes
recall the traumatic experiences that hadrecall the traumatic experiences that had
caused them.caused them.
 It is likely that such recall under hypnosisIt is likely that such recall under hypnosis
helped stimulate Freud's thinking about thehelped stimulate Freud's thinking about the
nature of the unconscious.nature of the unconscious.

4. ANNA OANNA O
 A few years earlier, Freud had been fascinated byA few years earlier, Freud had been fascinated by
Josef Breuer's work with a young "hysterical"Josef Breuer's work with a young "hysterical"
patient called Anna O.patient called Anna O.
 She presented many classic hysterical symptoms,She presented many classic hysterical symptoms,
apparently precipitated by the death of her father.apparently precipitated by the death of her father.
 Breuer had been treating her using hypnosis, andBreuer had been treating her using hypnosis, and
during one trance she told him about the firstduring one trance she told him about the first
appearance of one of her symptoms.appearance of one of her symptoms.
 Anna began to develop a strong emotionalAnna began to develop a strong emotional
attachment to Breuer and as a result, Breuerattachment to Breuer and as a result, Breuer
abandoned the case.abandoned the case.

5.  These events, with which Freud was familiarThese events, with which Freud was familiar
undoubtedly helped prompt his initial theoriesundoubtedly helped prompt his initial theories
about the unconscious, the "talking cure,"about the unconscious, the "talking cure,"
catharsis, transference, and moral anxiety.catharsis, transference, and moral anxiety.
 He treated many of his patients with hypnosis.He treated many of his patients with hypnosis.
 An example was Elisabeth, a patient Freud sawAn example was Elisabeth, a patient Freud saw
in 1892.in 1892.
 He soon gave up placing his hand on patients'He soon gave up placing his hand on patients'
foreheads and simply asked them to talk aboutforeheads and simply asked them to talk about
whatever came to their minds. This was thewhatever came to their minds. This was the
beginning of what came to be known as thebeginning of what came to be known as the
method of free association.method of free association.

6. THE FREUDIAN VIEW: A BRIEF REVIEWTHE FREUDIAN VIEW: A BRIEF REVIEW
 A major assumption of Freudian theory,A major assumption of Freudian theory, psychicpsychic
determinism,determinism, holds that everything we do hasholds that everything we do has
meaning and purpose and is goal directed.meaning and purpose and is goal directed.
 The mundane behavior, the bizarre behav­ior, theThe mundane behavior, the bizarre behav­ior, the
dream, and the slip of the tongue all have significancedream, and the slip of the tongue all have significance
and meaning.and meaning.
 Freud also assumed the existence ofFreud also assumed the existence of ununconsciousconscious
motivationmotivation..
 The important causes of dThe important causes of diisturbed behavior aresturbed behavior are
unconscious. Therefore it follows that, the goal ofunconscious. Therefore it follows that, the goal of
therapy is to make is unconscious conscioustherapy is to make is unconscious conscious

7. THE INSTINCTSTHE INSTINCTS::
The energy that makes the human machine function isThe energy that makes the human machine function is
provided by two sets of instincts:provided by two sets of instincts:
LifeLife instincts (Eros)instincts (Eros) are the basis for all the positiveare the basis for all the positive
and­constructive aspects of behavior.and­constructive aspects of behavior.
DeathDeath instincts (Thanatos)instincts (Thanatos). all positive activities can. all positive activities can
serve destructive ends as well. When this happens,serve destructive ends as well. When this happens,
the death instincts are responsible.the death instincts are responsible.
In any event, for Freud the ultimate explanation for allIn any event, for Freud the ultimate explanation for all
behavior was an instinctual one even though thebehavior was an instinctual one even though the
instincts he posited are unobservable cannot beinstincts he posited are unobservable cannot be
measured, and often seem better able to explainmeasured, and often seem better able to explain
events after they occur than before.events after they occur than before.

8. THE STRUCTURE OF PERSONALITY:THE STRUCTURE OF PERSONALITY:
Psychoanalysis views personality as composed of threePsychoanalysis views personality as composed of three
basic structures: thebasic structures: the id, the ego, and the superegoid, the ego, and the superego..
 TheThe idid represents the deep, inaccessible portion of therepresents the deep, inaccessible portion of the
personality. The id is said to obey thepersonality. The id is said to obey the pleasurepleasure
principle.principle. it usesit uses aa primary processprimary process kind of thinking.kind of thinking.
 TheThe egoego is the executive of the personality, It operatesis the executive of the personality, It operates
according to, theaccording to, the reality Incomereality Income,, it employs theit employs the
secondary procesecondary processss. The role. The role of the ego is to mediateof the ego is to mediate
the demands of the superego, and the real world .the demands of the superego, and the real world .

9.  The third component of the personality is theThe third component of the personality is the
superegosuperego..
 It develops from the ego during childhood,It develops from the ego during childhood,
rising specifically out of the resolutionrising specifically out of the resolution of theof the
Oedipus complexOedipus complex..
 In general, the role of the superego is to blockIn general, the role of the superego is to block
unacceptable id impulses, to pressure the egounacceptable id impulses, to pressure the ego
to serve the ends of morality rather thanto serve the ends of morality rather than
expediency, and to generate strivings towardexpediency, and to generate strivings toward
perfectionperfection

10. THE PSYCHOSEXUAL STAGESTHE PSYCHOSEXUAL STAGES::
FreudFreud believed that each person goes through abelieved that each person goes through a
series of developmental stages.series of developmental stages.
 TheThe oraloral stage,stage, which lasts about a year, is awhich lasts about a year, is a
period in which the mouth is the chief means ofperiod in which the mouth is the chief means of
reaching satisfaction.reaching satisfaction.
 Anal stage,Anal stage, in which attention be­comesin which attention be­comes
centered on defecation and urination; this stagecentered on defecation and urination; this stage
may span the period from 6 months to 3 yearsmay span the period from 6 months to 3 years
of age.of age.
 PhallicPhallic stagestage (from 3 to7 years of age), during(from 3 to7 years of age), during
which the sexual organs become the primewhich the sexual organs become the prime
source of gratification.source of gratification.

11.  TheThe latencylatency stagestage,, which is characterized by a lack ofwhich is characterized by a lack of
overt sexual activity and, indeed, by an almostovert sexual activity and, indeed, by an almost
negative orientation toward anything sexual. Thisnegative orientation toward anything sexual. This
stage may extend from about the age of 5 until 12 orstage may extend from about the age of 5 until 12 or
so.so.
 TheThe genitalgenital stagestage begins, Ideally, this stage willbegins, Ideally, this stage will
culminate in a mature expression of­sexuality,culminate in a mature expression of­sexuality,
assuming that the sexual impulses have been handledassuming that the sexual impulses have been handled
successfully by the ego.successfully by the ego.
 When the child experiences difficulties at any stage,When the child experiences difficulties at any stage,
these difficulties may be expressed in symptoms ofthese difficulties may be expressed in symptoms of
maladjustment, especially when the troubles aremaladjustment, especially when the troubles are
severe. Either excessive frustration or overindulgencesevere. Either excessive frustration or overindulgence
at any psychosexual stage will lead to problems.at any psychosexual stage will lead to problems.

12. ANXIETY:ANXIETY:
 According to Freud, the circumstances that give rise toAccording to Freud, the circumstances that give rise to
the formations of the ego, and later the superego,the formations of the ego, and later the superego,
produce a painful affective experience called anxiety.produce a painful affective experience called anxiety.
 Exaggerated responses of the heart, the lungs, andExaggerated responses of the heart, the lungs, and
other internal organs are perceived and experiencedother internal organs are perceived and experienced
as anxiety. There are three general classes ofas anxiety. There are three general classes of
anxiety.anxiety.
 The first isThe first is realityreality anxietyanxiety : anxiety based on a real: anxiety based on a real
danger from the outside world.danger from the outside world.
 The anxiety that students have when a final exam isThe anxiety that students have when a final exam is
coming soon may be a good example for this type ofcoming soon may be a good example for this type of
anxiety.anxiety.

13.  Neurotic anxietyNeurotic anxiety stems from a fear that one'sstems from a fear that one's
id impulses will be expressed unchecked andid impulses will be expressed unchecked and
thus lead to trouble from the environment.thus lead to trouble from the environment.
 MoralMoral anxietyanxiety arises from a fear that one willarises from a fear that one will
not conform to the standards of the conscience.not conform to the standards of the conscience.
 The essential function of anxiety is to serve asThe essential function of anxiety is to serve as
a warning signal to the ego that certain stepsa warning signal to the ego that certain steps
must be initiated to quell the danger and thusmust be initiated to quell the danger and thus
protect the organism.protect the organism.

14. THE EGO DEFENSESTHE EGO DEFENSES::
 When one fears the wrath of the superego or theWhen one fears the wrath of the superego or the
unleashed lusts of the id, where does one turn? Theunleashed lusts of the id, where does one turn? The
answer lies in theanswer lies in the ego defensesego defenses,, or as they areor as they are
sometimes called,sometimes called, defense mechanisms.defense mechanisms.
 These mechanisms are generally regarded asThese mechanisms are generally regarded as
pathological because they divert psychic energy frompathological because they divert psychic energy from
more constructive activities and at the same timemore constructive activities and at the same time
distort reality.distort reality.
 The basic ego defense isThe basic ego defense is repressionrepression.. This can beThis can be
described as the banishment from consciousness ofdescribed as the banishment from consciousness of
highly threatening sexual or aggressive material.highly threatening sexual or aggressive material.

15.  FixationFixation occurs when the frustration and anxiety ofoccurs when the frustration and anxiety of
the next psychosexual stage are so great that thethe next psychosexual stage are so great that the
individual remains at his or her present levelindividual remains at his or her present level ofof
psychosexual development.psychosexual development.
 RegressionRegression involvesinvolves aa return to a stage that earlierreturn to a stage that earlier
provided a great deal of gratification; this may occurprovided a great deal of gratification; this may occur
following extensive frustration.following extensive frustration.
 ReactionReaction formationformation is said to occur when anis said to occur when an
unconscious impulse is consciously expressed, by itsunconscious impulse is consciously expressed, by its
behavioral opposite. Thus, “I hate you" is expressedbehavioral opposite. Thus, “I hate you" is expressed
as "I love you.”as "I love you.”
 Projection isProjection is revealed when one's unconsciousrevealed when one's unconscious
feelings are attributed not to oneself but to another.feelings are attributed not to oneself but to another.
Thus, the feeling "I hate you" is transformed into "YouThus, the feeling "I hate you" is transformed into "You
hate me."hate me."

16. PSYCHOANALYSIS:PSYCHOANALYSIS:
FROM THEORY TOFROM THEORY TO
PRACTICEPRACTICE

17. THE ROLE OF INSIGHTTHE ROLE OF INSIGHT
 TheThe ultimate goal of psychoanalytic intervention is theultimate goal of psychoanalytic intervention is the
removal of debilitating neurotic problems.removal of debilitating neurotic problems.
 the only final and effective way of doing this is to helpthe only final and effective way of doing this is to help
the patient achievethe patient achieve insightinsight..
 It means total understanding of the unconsciousIt means total understanding of the unconscious
determinants of those irrational feelings thoughts, ordeterminants of those irrational feelings thoughts, or
behaviors that are producing ones personal misery.behaviors that are producing ones personal misery.
 An analysis culminating in insight is slow, tedious, andAn analysis culminating in insight is slow, tedious, and
often very lengthy.often very lengthy.
 As the therapist comes to stand for someone elseAs the therapist comes to stand for someone else
(e.g., the father), old emotions are reexperienced and(e.g., the father), old emotions are reexperienced and
then reevaluated. From this comes a deeper insight.then reevaluated. From this comes a deeper insight.

18.  The true meaning of this insight is then brought intoThe true meaning of this insight is then brought into
the patient's consciousness by thethe patient's consciousness by the working-throughworking-through
processprocess..
 This refers to a careful and repeated examination ofThis refers to a careful and repeated examination of
how one's conflicts and defenses have operated inhow one's conflicts and defenses have operated in
many different areas of life.many different areas of life.
 The patient must be confronted with the insight as itThe patient must be confronted with the insight as it
applies to relations with a spouse, a friend, or aapplies to relations with a spouse, a friend, or a
supervisor, and, yes, even as it affects reactions to thesupervisor, and, yes, even as it affects reactions to the
therapist.therapist.
 It is due in part to this extensive working­throughIt is due in part to this extensive working­through
period that traditional psychoanalysis takes so long ­period that traditional psychoanalysis takes so long ­
three to five therapy sessions per week for three tothree to five therapy sessions per week for three to
five years and sometimes much longer.five years and sometimes much longer.

19. Techniques Of PsychodynamicTechniques Of Psychodynamic
PsychotherapyPsychotherapy
 The analysts regard the symptoms of neurosis asThe analysts regard the symptoms of neurosis as
signs of conflict among the id, ego, superego, and thesigns of conflict among the id, ego, superego, and the
demands of reality.demands of reality.
 The symptom, then, indicates an unconscious problemThe symptom, then, indicates an unconscious problem
that needs resolution.that needs resolution.
 To dissolve defenses and confront the unconscious inTo dissolve defenses and confront the unconscious in
a therapeutic relationship is the whole purpose ofa therapeutic relationship is the whole purpose of
psychoanalysis. Over the years, many variations inpsychoanalysis. Over the years, many variations in
techniques have been developed.techniques have been developed.

20. FREE ASSOCIATIONFREE ASSOCIATION
 A cardinal rule in psychoanalysis is that the patientA cardinal rule in psychoanalysis is that the patient
must say anything and everything that comes to mind.must say anything and everything that comes to mind.
 It requires the patient to stop censoring or screeningIt requires the patient to stop censoring or screening
thoughts that are ridiculous, aggressive,thoughts that are ridiculous, aggressive,
embarrassing, or sexual.embarrassing, or sexual.
 From it, the patient and the therapist can begin toFrom it, the patient and the therapist can begin to
discover the long hidden bases of the patient'sdiscover the long hidden bases of the patient's
problems.problems.
 Traditionally, the psychoanalyst sits behind theTraditionally, the psychoanalyst sits behind the
patient, who reclines on a couch. The purpose of thepatient, who reclines on a couch. The purpose of the
couch is to help the patient relax and make it easier tocouch is to help the patient relax and make it easier to
free associate.free associate.

21.  AsAs the process continues, one gets closer and closerthe process continues, one gets closer and closer
to unconscious thoughts and urges.to unconscious thoughts and urges.
 Any single set of associa­tions may not be terriblyAny single set of associa­tions may not be terribly
clear. But over many sessions, patterns ofclear. But over many sessions, patterns of
associations start to emerge, and the analyst canassociations start to emerge, and the analyst can
begin to make sense out of them through theirbegin to make sense out of them through their
repetitive themes.repetitive themes.
 They are outgrowths of unconscious forces thatThey are outgrowths of unconscious forces that
determine the direction of one's associations.determine the direction of one's associations.
 Memories of long­forgotten experiences give theMemories of long­forgotten experiences give the
analyst clues to the structure of personality and itsanalyst clues to the structure of personality and its
development.development.

22. ANALYSIS OF DREAMSANALYSIS OF DREAMS
 A related technique is theA related technique is the analysis of dreamsanalysis of dreams..
 Dreams are thought to reveal the nature of theDreams are thought to reveal the nature of the
unconscious because they are regarded asunconscious because they are regarded as
heavily laden with unconscious wishes, albeit inheavily laden with unconscious wishes, albeit in
symbolic form.symbolic form.
 The material of the dream is important enoughThe material of the dream is important enough
to provide some gratification to the id but notto provide some gratification to the id but not
usually so threatening as to terrorize the ego.usually so threatening as to terrorize the ego.
 Dreams content can be of two types:Dreams content can be of two types:

23.  TheThe manifest contentmanifest content of a dream is whatof a dream is what
actually happens during the dream.actually happens during the dream.
 For example, the manifest content of a dreamFor example, the manifest content of a dream
may be that one is confronted with two large,may be that one is confronted with two large,
delicious­looking ice cream cones.delicious­looking ice cream cones.
 TheThe latent contentlatent content of a dream is its symbolicof a dream is its symbolic
meaning. In the preceding example, perhapsmeaning. In the preceding example, perhaps
there is a message about the need for oralthere is a message about the need for oral
gratification or a longing to return to thegratification or a longing to return to the
mother's breast.mother's breast.

24.  In order to get at the latent content the patientIn order to get at the latent content the patient
is often encouraged to free­associate to ais often encouraged to free­associate to a
dream with the hope of gaining insight into itsdream with the hope of gaining insight into its
meaning, normally, the manifest content is anmeaning, normally, the manifest content is an
amalgam of displacement, condensation,amalgam of displacement, condensation,
substitution, symbolization, or lack of logic.substitution, symbolization, or lack of logic.
 The real meaning of a dream in the life of anThe real meaning of a dream in the life of an
individual may only become apparent from theindividual may only become apparent from the
analysis of a whole series of dreams.analysis of a whole series of dreams.
 For many analysts, dreams do not provideFor many analysts, dreams do not provide
inevitable, final clues to validate with furtherinevitable, final clues to validate with further
information.information.

25. RESISTANCERESISTANCE
 During the course of psychotherapy, the patientDuring the course of psychotherapy, the patient
will attempt to ward off efforts to dissolvewill attempt to ward off efforts to dissolve
neurotic methods of resolving problems calledneurotic methods of resolving problems called
resistance.resistance.
 Patients find painful subjects difficult toPatients find painful subjects difficult to
contemplate or discuss.contemplate or discuss.
 Although a certain amount of resistance is to­Although a certain amount of resistance is to­
be expected from most patients, when thebe expected from most patients, when the
resistance becomes sufficient to retard theresistance becomes sufficient to retard the
progress of therapy, it must be recognized andprogress of therapy, it must be recognized and
dealt with by the therapist.dealt with by the therapist.

26.  Resistance takes many forms : Patients may begin toResistance takes many forms : Patients may begin to
talk less, to pause longertalk less, to pause longer or to report their minds areor to report their minds are
blank, lengthy silences are also frequent.blank, lengthy silences are also frequent.
 Therapy may become an arena for discussing suchTherapy may become an arena for discussing such
problems as unemployment or taxes­weighty issues,problems as unemployment or taxes­weighty issues,
but hardly the ones that brought the patient to therapy.but hardly the ones that brought the patient to therapy.
 Some patients may intellectualize about the relativeSome patients may intellectualize about the relative
meritsmerits of primal screaming versus nude marathons orof primal screaming versus nude marathons or
even the effect of Freud's boyhood on the subsequenteven the effect of Freud's boyhood on the subsequent
development of psychoanalysis.development of psychoanalysis.
 In some instances, the patient's feelings or ideasIn some instances, the patient's feelings or ideas
about the therapist may begin to dominate theabout the therapist may begin to dominate the
sessions.sessions.

27.  The therapist may also begin to notice that a variety ofThe therapist may also begin to notice that a variety of
"real" events in the patient's life seem to be conspiring"real" events in the patient's life seem to be conspiring
against the sessions.against the sessions.
 Nearly anything can become a form of resistanceNearly anything can become a form of resistance
 As the patient's defenses are addressed, there isAs the patient's defenses are addressed, there is
sometimes an intensification of symp­toms. But thesometimes an intensification of symp­toms. But the
opposite can also occur, so that an actual "flight intoopposite can also occur, so that an actual "flight into
health" occurs the patient gets better.health" occurs the patient gets better.
 Another method is "acting out." Here the patientAnother method is "acting out." Here the patient
attempts to escape the anxiety generated in therapyattempts to escape the anxiety generated in therapy
by indulging in irrational acts or engaging in potentiallyby indulging in irrational acts or engaging in potentially
dangerous behavior.dangerous behavior.

28.  Still other patients flee into "intellectualization."Still other patients flee into "intellectualization."
Experiences or memories become stripped of theirExperiences or memories become stripped of their
emotional content and are dissected calmly andemotional content and are dissected calmly and
rationally.rationally.
 In one form or another, resistance goes on throughoutIn one form or another, resistance goes on throughout
the course of therapy.the course of therapy.
 The resistance that goes on in therapy probablyThe resistance that goes on in therapy probably
mirrors what has happened in real life.mirrors what has happened in real life.
 If resistance during therapy can be analyzed and theIf resistance during therapy can be analyzed and the
patient made to understand its true function, then suchpatient made to understand its true function, then such
defenses will not be as likely t0 operate outside thedefenses will not be as likely t0 operate outside the
therapist's officetherapist's office

29. TRANSFERENCETRANSFERENCE
 A key phenomenon in psychoanalytic therapy isA key phenomenon in psychoanalytic therapy is
transference.transference.
 It occurs when the patient reacts to the therapist as ifIt occurs when the patient reacts to the therapist as if
the latter represented some important figure out ofthe latter represented some important figure out of
childhood. Both positive and negative feelings can bechildhood. Both positive and negative feelings can be
transferred.transferred.
 This provides not only important clues as to the natureThis provides not only important clues as to the nature
of the patient's problems but also an opportunity forof the patient's problems but also an opportunity for
the therapist to interpret the transference in anthe therapist to interpret the transference in an
immediate and vital situation.immediate and vital situation.
 ManyMany characteristics of the psychoanalyticcharacteristics of the psychoanalytic
sessionsession : the patient is seated on a couch facing: the patient is seated on a couch facing
away from the analyst, who does not interrupt.away from the analyst, who does not interrupt.

30.  Positive transference is often responsible for what appearsPositive transference is often responsible for what appears
to be, rapid improvement at the beginning stages ofto be, rapid improvement at the beginning stages of
therapy.therapy.
 Transference can take many forms. It may be reflected inTransference can take many forms. It may be reflected in
comments about the therapist's clothing or officecomments about the therapist's clothing or office
furnishings.furnishings.
 However, the truly sensitive therapist is one who canHowever, the truly sensitive therapist is one who can
separate reactions that have some support in reality fromseparate reactions that have some support in reality from
reactions that are neurotic in character.reactions that are neurotic in character.
 Basically, both positive and negative transferences areBasically, both positive and negative transferences are
forms of resistance.forms of resistance.
 Through interpretation, the patient is helped to recognizeThrough interpretation, the patient is helped to recognize
the irrational nature and origins of transference feelings.the irrational nature and origins of transference feelings.

31. INTERPRETATIONINTERPRETATION
 Interpretation is the cornerstone of nearly every formInterpretation is the cornerstone of nearly every form
of dynamic psychotherapy.of dynamic psychotherapy.
 InterpretationInterpretation is the method by which the unconsciousis the method by which the unconscious
meaning of thoughts and behavior is revealed.meaning of thoughts and behavior is revealed.
 Interpretation is a process by which the patient can beInterpretation is a process by which the patient can be
induced to view thoughts, behavior, feelings, or wishesinduced to view thoughts, behavior, feelings, or wishes
in a different manner.in a different manner.
 It is a prime method for bringing about insight.It is a prime method for bringing about insight.
 it is a slow, repetitive process in which the essentialit is a slow, repetitive process in which the essential
meaning behind certain behaviors, thoughts, andmeaning behind certain behaviors, thoughts, and
feelings is repeatedly pointed out to the patient in onefeelings is repeatedly pointed out to the patient in one
context after anothercontext after another

32.  Interpretation is limited to important life areasInterpretation is limited to important life areas
those that relate directly to the problems thatthose that relate directly to the problems that
the therapist is trying to resolve.the therapist is trying to resolve.
 An interpretation should be offered when it willAn interpretation should be offered when it will
arouse enough anxiety to engage the patient'sarouse enough anxiety to engage the patient's
serious contemplation but not so much anxietyserious contemplation but not so much anxiety
that the patient will reject it.that the patient will reject it.
 As a general rule, small dosages are best.As a general rule, small dosages are best.
 In making interpretations, it is important to buildIn making interpretations, it is important to build
on what the patient has said previously, usingon what the patient has said previously, using
the patient's own comments and descriptions tothe patient's own comments and descriptions to
build the interpretive casebuild the interpretive case

33.  It can be difficult to determine whether a specificIt can be difficult to determine whether a specific
interpretation has been effective.interpretation has been effective.
 Sometimes the patient's response will suggest that theSometimes the patient's response will suggest that the
target has been hit. But at other times patients may betarget has been hit. But at other times patients may be
entirely noncommittal.entirely noncommittal.
 In any event, the real test of the utility of anIn any event, the real test of the utility of an
interpretation is more likely to come from theinterpretation is more likely to come from the
subsequent course of the sessions.subsequent course of the sessions.
 A classic psychoanalytic interpretation is designed toA classic psychoanalytic interpretation is designed to
open up the patient to new ways of viewing thingsopen up the patient to new ways of viewing things
and, ultimately, to neutralize unconscious conflicts andand, ultimately, to neutralize unconscious conflicts and
defenses.defenses.

34.  Interpretations can vary a great deal in terms ofInterpretations can vary a great deal in terms of
their complexity and their incisiveness.their complexity and their incisiveness.
 Sometimes they are designed to cut right to theSometimes they are designed to cut right to the
heart of a patient's unconscious conflicts. But inheart of a patient's unconscious conflicts. But in
other cases, they may be little more thanother cases, they may be little more than
comments or questions designed to move thecomments or questions designed to move the
patient ever so slightly in the direction ofpatient ever so slightly in the direction of
insight.insight.
 These verbal interventions might be consideredThese verbal interventions might be considered
as a dimension in terms of how directly theyas a dimension in terms of how directly they
seek to lead the patient to a fresh way ofseek to lead the patient to a fresh way of