Empathic Understanding Concept Article Reflection Paper Reflection: Each paper, pick 1 concept or point of consideration from the assigned reading to refle

Empathic Understanding Concept Article Reflection Paper Reflection: Each paper, pick 1 concept or point of consideration from the assigned reading to reflect on. There are four readings for this week. You must pick one topic from each article and write 1 page per article.

Formatting Requirements: Single space, 12 pt. font, 1 in margins, Justified (or sometimes called block) formatting, total of 4 concepts and 4 pages, Word document. If you are uncertain as to what any of this means, I suggest you refer to the example posted in the Syllabus section and visually compare to your own.

Concept: Blah, blah, blah.

Personal Reaction: Blah, blah, blah.

Professional Use: Blah, blah, blah.

(Repeat for the 2nd concept, and 3rd concept)

Briefly provided your understanding of the concept, comment on your personal reaction to the concept, and your professional opinion of how it would be useful with examples (or how you might struggle with it). Students will receive full credits for all completed reflections that are turned in on time that meet the criteria above. You will post them to Blackboard prior to the class meeting. Please make the reflection an attached document – not in the body of the post. It must also be in Word. -r{6rH- :^*’ ?1.l^.”r-
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INSIGHT IN PSYCHODYNAMIC
THERAPY THEORY AND ASSESSMENT
STANLEY B, VIESSER AND NANCY MT:WILLIAMS
Thc pursuit of insight is generally rcg.rcled as a defining feature of
psychoanalytic psychotherapy, which is ofren referrecl to as insighr-c,riented
rhcrapy (Frank, 1993). By rhe l95Os, most psychoanalytic aurhlrs writing
ab.ut thc thcrapy process irssumed that insight is critical in effecting theral
pcutic changc (e.g., Eisslcr, l95l ). rn nddition, they viewcd the irttalnment
of insighr as a sugrerordinatc goal .f psychoanalytic ther,rpy, an iclear that
goes bcy.nd syrnprorn rclicf (c.g., Kris, 1956). M.re reccnt
works in this
field have notetl that increascd insight is an cffect of psychodynamic
rreertment,’n indication that s,rrne kind ofchange has taken place. A te.tlency
t. frrme therapeutic issues in tcrms of rhc c.nccpt of insight is so closeli
_
ass.ciarred with_dynamic apprcuches thar alternafive thernpies r,,.h,,s.*.
periential, firrni[y sysrems, and behavioral arose at least in part
frorn their
tir.ntlers’ skepticisrn about rvhethcr insight into sources .rf ,rne’s ment.l,
em.ti.nirl, and bch^vi.rul pr.lrlc.rs is nccessurily therapeutic in itsclf or
i nrl icirtivc, rf ir sr rcccssfrrl thcrirl.’c1111c
prtrgL,rr.
In this context, it is intcresting to n()re that Frcucr (1900/1953) used
the Germ.n te rm f.r insight .nly .nce, in ln informal rvay. In a preface
to an
editi.n of his b.ok on rlrci..s, he wr.te , “lnsighr srrch as this falls r..nc,s lor
bur once in a lifetime” (p. xxxvi). In his psychoanalytic writings, even references to interpremtion-the analyst’s effort to promote the patient’s insight
into feelings, thoughts, and behaviors-are surprisingly scant, limited mostly
,o or,..rriy on technique (Freud, 1913/1958). lt remains a mystery how
the psychoanalytic love afthir with the concept of insight began’ The best
gu.ri 1″.g,, Sandler, Holder, & Dare, 1971) is that the term was borrowed
iro- pry.hi”try, whose conventional mental status assessment included
insighi into illness (i.e’, awareness that one has a problem)’ Despite the ab’
,err.. of the term in Freud’s writings, however, the reverence for the pro’
cess of learning and the atrainment of knowledge that infuses Freudian
theory probably laid the groundwork for the assumption that achieving
insight into one’s psychic processes correlares with mental health. Later in
this chapter we presenr oui”tt”*pt to assess this construct in a way that will
capture its central features.
The chapter begins with an overview of the roots of insight in Freud’s
early writings. It then chronicles the meanings of insight in ego psychology
discovers
as both p.l..r, of looking inward and the content of what one
”
value
rh”re. The acknowledgme.ri th”t orr. has a problem and its prognostic
within
for rrrc.”r.ful psychoanalytic therapy is another use of the term iruight
in which iruight isego psychology. We next describe ihe relational paradigm,
of a safe therapeutic relationship and a consequence of
,!g”ra”J
make sense of the playing out of the patient’s difficulties in that
tie effort”,to”i'”ff”.t
to
relationship. The chapter then includes a brief review of early attempts
a”iin. irrriit t operationally. This is presented as a backdrop to our effort and
ti”t of oui r,ui”rrn to devise ” *.”.rlr. of insight as part of .a scaleofthat
inhow degree
assesses patient progress in psychotherapy’- We describe
scale ,r,i giu” examples from therapv.sessions of each
;igh,
;;?i;g;;;;.. we conclude the ihapter bv recommending directions for fir’
ture ,.r.”r.h on insight in psychodynamic therapy’
;;;i;n’thii
INSIGHT IN EARLY FREUDIAN THEORY
Freud’s bedrock idenrity was rhar of a scientist. Like many intellectuals
by the ideals of ih. Enlightenment, he consistently framed his
over body’
ideas in terms of the victory of ratio,,.lity outt irrationality’ mind
,,civilized” faculties over experiential, “primitive” human pro’
and objective,
.”rr”r. Fr.,rd liked to see himself as a kindof conquistador overthrowing the
in which
superstitions of the dark past and leading-the way.to a bright future
influ*.J
scientific explanation wluld replace seductive illusions. Attaining insight
into the workings of the mind and conveying his discoveries to others was his
he often spoke didactically, trying to get them
life’s work. With his patients
-hud
made of their problems. Over time, Freud increas’
to see what sense he
ingly valued their coming trp with their own discoveries about their motiva’
rions. Thus, ctrnvcying his ou’u insights and cnctlttrltging th()sc of his p;rricnts we rc contr:rl to his ctlirtt, cven if he (lid n()t say so cxplicitly.
Anothcr procursor ttt the ltrter psychothcragtetrtic cmphasis cln insight
rv:rs Frcud’s tenclcncy t() c(ltrirte thcrapy rvith thc sclrch for truth. Fretrd descrilted thc therirpcutic re lationship irs “bitsetl on a love t>f truth” (1937 I 1964a,
p. 248) and eurbracecl thc Delphic, Platonic, and biblical cquation of trtrth
rvitlr fiecdorn (or agency in crtrrent psychoanulytic parlance). He frcqucntly
stated thitt to be frcc ofnettrosis, one h:rs to cttnfront ttnplcasant truths. Freud
( lgli/1955) viewctl hirnself as the rnessenger of a highly unpalatable but
l5 tlnmotivi,rtion ls
htlman motlvtltton
nirlncly that most human
trtlth, n:rrncly
unassaihble tnlth,
scicntifically tunassaihble
conscious. He boastctl that psychoanalysis had dt-livcrecl ir third devrstilting
insult to humnn vanity: “thc ttnivcrsal nitrcissism of nten, their sclf-love, has
tup tti thc prescnt suffcred three scvcre blows tiorn the rcscrrches of science”
(p. I i9), the first bcing Copernicus’s discovcry that the earth is not the cen’
ter of thc universe rnd the sccond being l)lrwin’s rcvelation that hurnan
beings nrc sin’rply anirnnls :rtnong animtrls and not a sttpcrior, clualitativcly
.liiierent kind of being. In thcse postrnodern times’ pcople are reluctirnt to
talk blithcly irbout “the truth,” and the horrors perpetrated by the Nazis have
laicl to rest any confidence that science is always w.rrking for the good of
lrumanity. However, the intcllecttrirl ctrrrcncy of Freutl’s era glittcred with
optinrism thlt trccumulating sc ientific knowledge would libcrate htrmanity
fiom the shackles of unrers.,n.
Like most scminal thcorists of pcrs,rnarlity antl psychotherapy, Freud
was highly intluenccd by his initial expericnccs with urentally troublecl pcople.
Thus, rrnothcr scrurce of the psychoanalytic focus on insight wils the fact that
Freutl’s earliest psychiatric plticnts rvere “hysterics” (irn interesting contrast’
e.g., to Jung’s early experie nccs with psychotic patients or Carl Rogers’s etrrly
rvork with chil,Jren and aclolesccnts, the inrpirct of which cirn be sccn in their
respcctive theorics). lndivitltrals diagnosed trs hysterical in the lirte l9th century cxperienccd sevcre, cotnplex dissociative antl stlmirtic syndromes that
ivould tocltry be secn irs posttrlrumatic Strch problcms irre cattsed by events
thit irre too ovcrwheltning when cxpcricnccd to assimilate emotionally or
proccss verbally. Fretrcl cottltl not havc fotrnd a better grotlp to stlpport his
into the
l,reexisting conviction that knowlcdge liber:rres. N,,tt only is insight
rr:lurnatic origins of their strffering thcrapetrtic to paticnts with hysterical
clist,rtlcrs (e.g., L{orowitz’ 199 [; van cler Kolk, McFarlrrne , & Weisacth, 1996)
but their rccovcry fiorn specific syrnpt()r1s (albeit not fr6rn their 6verirll ten.lency tr’, dissociate or devel,rp ncw symptolns) also can be stunning. Frer-rd’s
rncntor Charcot rvas knowtr firr tlcrnttnstrat itlns in which hystcrical sympt()rns wcre “curcct” with hypnosis. Paralyzed wctrncn wirlkcd again’ the blind
rve re irtrle to sce, ancl the mtrtc spt ke. Strch drirtnatic changes, lirter echoed
rvfien psych,iitnalyt ic thcrupists treutcd trlulnatizc(l ss[liers in both wgrld
ivurs, hrtd ir lrrt to do rvith the lttstcr.tf psychoanalysis in the early to mid20rh ccntury.
I\,(;llllNl’\'(lll()l)”!ll(lflll-.R.l’l’
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I
The nature of hysterical problems contributed in another way to the
good press insight has enjoyed. From a structural psychoanalytic perspective,
hysterical symptoms (e.g., numbness in an arm) are created by a compromise
between the sexual or aggressive drive (e.g., a desire to strike someone) and
the defense mechanisms of repression and dissociation. These defenses, which
keep knowledge out of awareness, differ from defenses such as projection,
which is implieated in paranola, or idealization and devaluation, which are
associated witfr narcissistic problems. Clinical experience suggests that repression apd dissociation can be slowly reduced by integrating cognition and
strong affect in tfre context of a safe relationship. The association of symptom reduction with the facing of painful truths (whether it be the “truth” of
Freud’s early conclusion that hysterical symptoms result from childhood
molesration or of his later belief that they express traumatically disturbing
fantasies) paved the way for analysts to cast insight in a staring rote in their
formulations.
Ig is intriguing that in his last years Freud (191?/1964b) did not consider ghe veridical recollection of traumatizing events or fantasies necessary
for psychological healing. Increasingly, he wrote about corutructi oi ot recon
sttrlction of the childhood scenarios he assumed gave rise to neurotic symptoms. Like many contemporary analytic therapisrs treating individuals with
probable trauma histories (e.g., Davies & Frawley, 1994), Freud ( l917/1964b)
felt that the analyst and patient can reconstnrct enough to make sense ofthe
patient’s suffering and to reduce it significantly:
The path that starts from the analyst’s construction ought ro end in the
patient’s recollection; but it does not always lead so far. Quire often we
do not succeed in bringing the patient to recollect what has been re.
pressed. Instead of that, if the analysis is canied out conectly, we produce in him an assured conviction ofthe truth of the constnrction which
achieves the same therapeutic results as a recaptured memory. (p,265)
Such construction is not the same kind of insight as a memory that
emerges in treatment, but surely ir consrirutes a kind of insight or insightful
therapeutic activity (see Bouchard & Guerette, 1991, on Freud’s use of both
empiricist-realist and hermeneuric approaches), Because Freud did not discuss iruight per se in his rheoretical wrirings, he never defined the word. If he
had, we believe he would have construed it in terms of the replacement of
unconscious, conflictual wishes, motives, and fantasies bv conscious, ratio.
nal understanding.
INSIGHT ACCORDING TO EGO PSYCHOLOGY
Freud’s ( 1923/1961) theoretica[ change from a topographical (conscious,
preconscious, unconscious) to a structural (id, ego, superego) model ushered
I
)
l,trsFp
AN,n
tl.ry/rr r rar,{s
in thc cnr of cgo psychokrgy, dourinirtcd by such lurninrrries as Hcinz
Flart.nann, Ernst Kris, a.tl R.d.lph Lrervc.srcin. fhe metaph.r.f thc itl,
cgo, and supercgo cnptured thc psychoirnalytic imirginati(rn, mainly becausc
its clinical applicability: Frcud lnd his foll.wers had lelrnccl rhar it was
morc l-rclpful frrr paticnts t. w.rk with thcir dcfenses against irnxiety th^n to
work r.lirectly with the nurterial about whtch they werc presumably anxious.
In the language of the ncw paradigrn, they addressed the cgo rather than
the id.
.f
Along with Frcuc.l’s shift from excavirring the conrenrs of rhe id to exploring the defensive operarions of the ego, he hatl become increasingly npprcciative of the phcnornenon of rransfercncc by the l92Os. In addition to
noting more frequent insrances in which his paticnts transferrcd to him fcelings and expectations that belongcd to their elrly experienccs with caregivers,
he was slorvly seeing rlre therapeutic implicarions of their investing him with
this transferred authority. Although he initially fcrund transf’erenrial reactions a tlistraction fi
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