Stages of Psychoanalysis. The classical analytic course subdivided into three major stages as follows:
STAGE ONE.
- During the initial phase, or beginning of treatment, the patient becomes familiar with the methods, routines, and requirements of
analysis and a realistic therapeutic alliance is formed between patient and analyst. - Basic rules are established, and the patient describes his or her problems, gives some review of history, and gains initial relief through catharsis and a sense of security before delving more deeply into the source of the illness.
The patient is primarily motivated by the wish to get well.
STAGE TWO
Freud compared psychoanalysis to a chess game in which the initial and end stages are subject to uniform technical rules that are virtually identical for all players but whose long middle phase represents a spontaneous unfolding in which each protagonist’s part is played out differently; it is thus often thought to be the most creative stage.
The analogy still broadly holds, in so far as each analysis is highly individual, its course can never be precisely predicted, and the participants must carefully receive their cues from each other at any particular moment.
During the long middle phase, a transference neurosis may develop.
This may substitute for the actual neurosis of the patient and in which the wish for health comes into direct conflict with the simultaneous wish to
receive emotional gratification from the analyst.
There is a gradual surfacing of unconscious conflicts; an increased irrational attachment to the analyst, with regressive and dependent concomitants of that bond; a developmental return to earlier forms of relating (sometimes compared to that of mother and infant); and a repetition of childhood patterns and recall of traumatic memories through transfer to the analyst of unresolved libidinal and aggressive wishes.
In essence the middle stage is characterized by a continual battle within the psyche of the patient and between patient and analyst wherein infantile
problems of childhood are played out with the analyst as the object of the patient’s repressed strivings.
It is also the most protracted and painstaking phase, in which recall, repetition, and synthesis of early interpersonal patterns are relived and reconstructed over and over until the patient develops new modes of reacting and interacting that are more mature and realistic.
Through the process of working through, the patient is confronted with the same material, or variations of it, many times over until the warded-off material can be sufficiently neutralized and permanently integrated into the psyche.
The length of the middle phase (sometimes interminable) is a function of the resilience of infantile behavior patterns and a manifestation of the fact that it takes numerous, repeated confrontations, clarifications, and interpretations to alter the psychic structure to effect permanent change.
Sometimes, however, there may develop what is called a “negative therapeutic reaction.” Here, paradoxically, the patient seems to get worse
in the course of treatment, often seen after the understanding of an important insight or some sense of progress. This negative reaction may
have multiple determinants. For example, patients may be masochistic and have strong feelings of guilt or wishes for punishment and suffering.
Sometimes, this reaction occurs in patients who are competitive with and envious of their analyst, with strong wishes to defeat the analyst and are
determined unconsciously to have treatment fail. Treatment may, in fact, end in a stalemate if these unconscious wishes are not interpreted.
Sometimes, an analyst overzealous and over-eager to cure a patient—the so-called “rescuers”—may arouse this clinical situation in patients who are psychologically predisposed to it.
STAGE THREE
The termination phase is marked by the dissolution of the analytic bond as the patient prepares for leave taking. The irrational attachment to the analyst in the transference neurosis has subsided because it has been worked through, and more rational aspects of the psyche preside, providing greater mastery and more mature adaptation to the patient’s problems.
However, it is not an unambivalent experience because it often revives separation anxiety and old issues of dependence on versus independence from significant persons of the past (as well as transient recurrences of original symptoms).
It has been likened to a mourning process in which the patient grieves over the impending loss of the analyst and the loss of his or her former self.
However, by incorporating the insights received the patient can better use his or her self-knowledge to
separate the reality of the analyst from the fantasy and the past from the present.
Termination is not a hard-and-fast event, and the patient invariably has to continue to work through any problems outside of the therapy situation without the analyst or may need intermittent assistance after analysis has technically terminated.
The patient is expected to continue “self-analysis” after treatment ends.