Freudian Treatment Schedules
Freud (1856-1939) was the founder of the modern psychotherapeutic interview.Â After abandoning hypnosis, he adopted a technique called ‘free association’. ThisÂ was a technique in which he encouraged his clients to ‘talk’ with the minimumÂ interruptions to their outpourings. Initially, they were helped to familiariseÂ themselves with the technique and then encouraged to communicate thoughts,Â memories and feelings without censorship. This became known as theÂ ‘Fundamental Rule’.
He listened to their verbalisations keenly and intuitively and as a result claimed toÂ gain insights into the workings of the unconscious minds of his clients. HeÂ unearthed fragments of unconscious memories, heard his clients struggle toÂ ‘repress’ and ‘resist’.Â With such a method of interviewing and its supposed concomitant insights into theÂ mind of the human being, Freud made an inestimable impact on theÂ psychological, anthropological and literary ideas of his time. His influence wasÂ profound and far reaching and is still very much with us today.Â Freud’s objective, then, was to employ a psychotherapeutic technique that wouldÂ enable the client, with the analyst’s help, explore his/her conscious andÂ unconscious personality to a degree that would eventually result in a
reconstruction of the personality. Such reconstruction, it was claimed, would bringÂ personal growth.Â The world of medicine and psychiatry was slow to show any interest in Freud’sÂ innovations but eventually a few psychiatrists began to integrate Freudian insightsÂ into the framework of the standard psychiatric interview.
THE INTERPERSONAL EMPHASIS OF SULLIVAN
Any discussion of the psychotherapeutic interview must recognise the contributionÂ of Harry Stack Sullivan (1892-1949).Â Sullivan saw the interviewer as a ‘participant-observer’. He was not over impressedÂ by data collected about the client from other sources. Unlike Freud he was aÂ ‘face to face’ man. He was not in sympathy with Freud’s suggestion that theÂ analyst should sit behind the client. He recommended that the therapist should sitÂ at a 45 or 90 degree angle to the client. Such an arrangement, he argued, freedÂ the client from the discomfort of being stared at.Â For Sullivan, the therapist is an active participant in the therapeutic process. TheÂ therapist observes the client but while observing is affecting the relationship inÂ which he/she is an active participant.Â The interview is a communication between two people. Sullivan is not justÂ concerned with what is said but also how it is said. The client’s expressiveÂ behaviour is a rich source of information for the therapist but Sullivan points outÂ that the therapist’s behaviour in the relationship will also have an effect on theÂ data received from the client.
The therapist must be alert at all times to register subtle behavioural changes in theÂ client’s communications. Sullivan believed that the therapist is the expert inÂ interpersonal relations and should be the instrument whereby the client makesÂ his/her interpersonal relations more effective. The therapist is another humanÂ experience for the client although it is true the setting is a professional one.
In order for the therapist to be an alert, effective observer, he/she must be an alertÂ self-observer. Since the therapist is a human being too, he/she is subject to theÂ normal range of human emotions such as boredom, frustration, anger, love, etc.Â The therapist must be aware of these reactions and ensure they do not interfereÂ with effective observation of the client.Â Sullivan, then, saw himself as an active participant in the interpersonal encounterÂ with the client. This participation was far greater than Freud’s although it should beÂ acknowledged that Freud had already taken decisive steps in this direction. HeÂ had always considered himself an important diagnostic instrument (as witness theÂ phenomena of transference, countertransference, resistance, abreaction).Â Sullivan divided the interview into four stages or parts; the inception, theÂ reconnaissance, the detailed enquiry, and the termination.
The client describes his/her problem(s). The therapist listens and assumes the rÃ´leÂ of observer. The therapist’s task is to discover the reasons for the client’s entry intoÂ therapy and to gain some understanding of the nature of the problem.
In the reconnaissance stage of the interview, the therapist gathers facts. TheÂ gathering of facts develops into a case history. It is from this case history that theÂ therapist makes his/her tentative hypotheses.Â The therapist, having gained a background to the problem, presents the clientÂ with a summary of his/her conclusions. Much of this information will have beenÂ gathered by the therapist questioning the client. In the event of the client havingÂ difficulties responding directly to the question, Sullivan would encourage freeÂ association. “You seem to be a little stuck with that question? Just let your mindÂ roam freely when I repeat it.”Â Sullivan, however, was never an advocate of free association as the mainÂ therapeutic technique. He thought it should be used judiciously and its products
examined in the setting of dialogue.
The Detailed Enquiry
In the detailed enquiry, the therapist focuses sharply on the client’s interpersonalÂ difficulties. Symptomatic behaviours are scrutinized and explored such as anxiety,Â depression, distorted thinking, etc. The therapist seeks to test his/her initial,Â tentative hypotheses.
It is at this stage that the therapist sums up. He/she discusses findings andÂ proposes a plan of action which also explains the possible consequences of anyÂ action undertaken. Sullivan strongly believed that every therapeutic sessionÂ should conclude in a structured way and not be left with loose ends. The therapistÂ should leave the client with some insight, or a clarification of an issue, at the endÂ of every session throughout the course of therapy.Â The Sullivanian approach is more open than the Freudian. The Sullivanian client isÂ more involved in his/her therapy from the outset. The client is made aware of theÂ therapist’s discoveries and both long and short term goals. It is generally a moreÂ carefully planned process than psychoanalysis and not as instructional.