jewel-case. …So you are ready to give Mr. K. what his wife withholds from him.
That is the thought which has had to be repressed with so much energy, and
which has made it necessary for every one of its elements to be turned into itsopposite. The dream confirms once more what I had already told you before youdreamt it— that you are summoning up your old love for your father in order to
protect yourself against your love for Mr. K. (p. 69)
Freud interpreted several important psychoanalytic concepts for Dora. He
identified her use of symbols and her repression of her true desires. He ex-
plained how she used reaction formation —dreaming the opposite of what
she really wanted —and how her repressed desires for her father affected her
behavior. Not surprisingly, Dora had difficulty accepting this interpretationat first. As this example illustrates, clients must obtain a reasonable under-
standing of psychoanalytic theory before they can appreciate the therapist ’s
interpretation of their dreams, thoughts, and behaviors.
Ironically, one of the first signs that therapy is progressing is the develop-
ment of resistance. For example, clients might declare that the sessions aren ’t
helping and that they want to discontinue therapy. Or they might lapse into
long silences, return to material already discussed, miss appointments, or in-
sist that certain topics aren ’t worth exploring. These attempts at resistance
could indicate that the therapist and client are getting close to the crucial ma-
terial. The threatened ego is desperately attempting to defend against the ap-
proaching demise of its defenses as crucial unconscious material is almost
ready to burst into consciousness.
Another necessary step in traditional psychoanalysis is the development
oftransference. Here emotions associated with people from past situations
are displaced onto the therapist. For example, a client might talk to and acttoward the therapist as if the therapist were a deceased parent. Unconscious
emotions and previously undelivered speeches buried deep and long ago are
unleashed, feelings that often lie at the heart of the client ’s disorder. Freud
warned that handling transference was a delicate and crucial part of the ther-
apy process. He also cautioned therapists against countertransference, in
which therapists displace their own feelings toward other individuals onto the
client.
From the outset, psychoanalysis has been controversial, and the debate
about its effectiveness has never ended (Gabbard, Gunderson, & Fonagy,2002). Nonetheless, although many therapy options are available today, a
large number of psychotherapists continue to identify their approach as “psy-
choanalytic ”(Mayne, Norcross, & Sayette, 1994). Recent reviews of carefully
designed studies find evidence that psychoanalytic therapies are often effectivewhen treating a wide variety of psychological disorders (Leichsenring, 2007;
Leichsenring & Rabung, 2008). Predictably, these claims of effectivenesshave been met with skepticism (Beck & Bhar, 2009; Roepke & Renneberg,
2009). Critics also argue that psychoanalysis, if it works, can often take years
and therefore is not as cost effective as many short-term therapies. As withmost things associated with Freud, it is safe to say this controversy is likely to
continue.58 CHAPTER 3 The Psychoanalyt ic Approach