Traditional Intervention Strategies
One of the most important tools of change for the counselor is the concept of transference. The counselor maintains the position of a blank screen (Frank, 1998) and maintains a neutral position in the therapeutic relationship, and the client transfers, or projects, his or her unconscious feelings onto the counselor.
From a psychoanalytic framework, the client experiencing the transference is unconsciously searching for a transformational meeting with another person, and in the case of a counseling relationship, the counselor becomes that person (Binder, 2004). The counselor, as the object of transference, assumes the position of an anonymous tool for the client to expose the unconscious issues driving the maladaptive behaviors, and the counselor maintains an obscure presence during the process of transference with the goal of analyzing the transferred material later.
In addition to analyzing transference, the counselor also analyzes the observed resistances from the client during sessions with the intent to expose, or bring into consciousness, the underlying causes for those resistances. Clinically, resistance can be seen in myriad forms. One of the most important tasks of the counselor is to overcome resistance.
Within psychoanalysis, resistance is based on personal, instinctual ways of reacting to uncomfortable situations in which the client attempts to keep hidden aspects of themselves from 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. Psychoanalysis classifies client resistance into five categories, all emanating from the ego, the id, and the superego. Freud viewed all five categories of resistance as requiring more than just intellectual insight or understanding to overcome (Schuller, Crits-Christoph, & Connolly, 1991). All of the categories serve the explicit purpose of defending the ego against feelings of discomfort and require an immersion in analysis using various psychoanalytic techniques. Freud (1914/1959) suggested that the three primary processes for overcoming resistances are "recollection, repetition, and working through" (p. 366).
The first category, repression resistance, stems from the ego and includes various defenses and symptoms such as reaction formation, obsession, anxiety, and phobias. This is the result of the unconscious struggle of the psyche to maintain the repression of painful material and keep it from reaching exposure during sessions. The second category is transference resistance. It presents as projection and also stems from the ego. This succeeds in establishing a relation to the counselor and reanimates a repression. The third resistance, and the last to originate with the ego, is ego resistance, and it is framed as a secondary gain or a gain from illness. This is an unwillingness to renounce any satisfaction or relief that has been obtained. The fourth category, acting out or working through, arises from the id and presents as a compulsion to repeat maladaptive behaviors. Even after the ego releases its resistances, it still has difficulty undoing existing repressions. Working through addresses this concept and aims to reinforce the ego's successful transcendence (Miller, 1998). The last resistance, self-sabotage, stems from the superego and appears as a sense of guilt or need for punishment. It opposes every move toward success, including the client's own recovery through analysis (Schuller et al., 1991).
Hypnosis is a mental state or set of attitudes usually induced by a procedure known as a hypnotic induction, which is commonly composed of a series of preliminary instructions and suggestions. Hypnotic suggestions may be delivered by a hypnotist or may be self- administered through self-suggestion or autosuggestion (Weitzenhoffer, 2000). The use of hypnotism for therapeutic purposes is referred to as hypnotherapy, and it features one or more suggestions made to a hypnotized client that specifies an action to be performed after awakening, often in response to a cue, with the aim of unconsciously redirecting the behavior.
Initially, Freud was an enthusiastic proponent of hypnotherapy and emphasized the use of hypnotic regression and catharsis as effective therapeutic methods. He wrote a favorable encyclopedia article on hypnotism and later published Studies on Hysteria with Josef Breuer (see Breuer & Freud, 1957), which became the founding text of the subsequent tradition known as hypnoanalysis or regression hypnotherapy. However, Freud gradually abandoned the use of hypnotism in favor of his developing methods of psychoanalysis, such as free association and the interpretation of the unconscious. Struggling with the great expense of time required for psychoanalysis to be successful, Freud later suggested that his psychoanalytic approach may be combined with hypnotic suggestion once more in an attempt to hasten the outcome of treatment.
In free association, psychoanalytic clients are invited to relate whatever comes into their minds during the session without self-censorship. Analyzing unconscious and latent dramatization in dream, fantasy, and enactment with free association is enhanced by using clarification and confrontation (Lothane, 2009). This technique is intended to help the client learn more about what he or she thinks and feels in a nonjudgmental, accepting atmosphere. Psychoanalysis assumes that people are often conflicted between their need to learn about themselves and their conscious or unconscious fears of and defenses against change and self-exposure.
The method of free association has no linear or preplanned agenda but works by intuitive leaps and linkages that may lead to new personal insights and meanings. When used in this manner, neither the counselor nor the client knows in advance exactly where the conversation will lead, but it is expected to reveal valuable material to be used for treatment. The goal of this technique is not to unearth specific answers or memories but to instigate a journey of codiscovery that can enhance the client's integration of thought, feeling, agency, and selfhood.
Freud was one of the first to emphasize dreams as keys to the unconscious and interpreted dreams as symbolic wish fulfillments. He distinguished the manifest content of dreams, or the dream as it is recalled by the individual, from the latent content, or the actual meaning, of the dream. In practice, this consists of analyzing four aspects of the dreams: In condensation, one dream object stands for several associations and ideas; in displacement, a dream object's emotional significance is separated from its real object or content and attached to an entirely different one; representation is a thought that is translated to visual images; and symbolism is when a symbol replaces an action, person, or idea (Freud, 1920). These associations point to the inner conflicts and repressed drives of the client and are analyzed throughout the course of treatment.