Lesson 29

THE BEGINNING OF THE BEGINNING OF PSYCHOANALYSISPSYCHOANALYSIS

Lecture 29Lecture 29

PSYCHOANALYSIS:PSYCHOANALYSIS: The psychodynamic approach to therapy The psychodynamic approach to therapy

focuses on unconscious motives and conflicts focuses on unconscious motives and conflicts in the search for the roots of behavior.in the search for the roots of behavior.

The epitome of this perspective resides in the The epitome of this perspective resides in the original psychoanalytic theory and therapy of original psychoanalytic theory and therapy of Sigmund Freud.Sigmund Freud.

Without question, psychoanalytic theory Without question, psychoanalytic theory represents one of the most sweeping represents one of the most sweeping contributions to the field of personality.contributions to the field of personality.

PSYCHOANALYSIS: THE BEGINNINGPSYCHOANALYSIS: THE BEGINNING

In 1885, Freud was awarded a grant to study in In 1885, Freud was awarded a grant to study in Paris with the famous Jean Charcot. Charcot Paris with the famous Jean Charcot. Charcot was noted for his work with hysterics.was noted for his work with hysterics.

Charcot had discovered that some hysterical Charcot had discovered that some hysterical patients would, while under, hypnosis, patients would, while under, hypnosis, relinquish their symptoms and sometimes relinquish their symptoms and sometimes recall the traumatic experiences that had recall the traumatic experiences that had caused them.caused them.

It is likely that such recall under hypnosis It is likely that such recall under hypnosis helped stimulate Freud's thinking about the helped stimulate Freud's thinking about the nature of the unconscious.nature of the unconscious.

ANNA OANNA O

A few years earlier, Freud had been fascinated by A few years earlier, Freud had been fascinated by Josef Breuer's work with a young "hysterical" Josef Breuer's work with a young "hysterical" patient called Anna O.patient called Anna O.

She presented many classic hysterical symptoms, She presented many classic hysterical symptoms, apparently precipitated by the death of her father.apparently precipitated by the death of her father.

Breuer had been treating her using hypnosis, and Breuer had been treating her using hypnosis, and during one trance she told him about the first during one trance she told him about the first appearance of one of her symptoms.appearance of one of her symptoms.

Anna began to develop a strong emotional Anna began to develop a strong emotional attachment to Breuer and as a result, Breuer attachment to Breuer and as a result, Breuer abandoned the case. abandoned the case.

These events, with which Freud was familiar These events, with which Freud was familiar undoubtedly helped prompt his initial theories undoubtedly helped prompt his initial theories about the unconscious, the "talking cure," about the unconscious, the "talking cure," catharsis, transference, and moral anxiety.catharsis, transference, and moral anxiety.

He treated many of his patients with hypnosis.He treated many of his patients with hypnosis. An example was Elisabeth, a patient Freud saw An example was Elisabeth, a patient Freud saw

in 1892.in 1892.

He soon gave up placing his hand on patients' He soon gave up placing his hand on patients' foreheads and simply asked them to talk about foreheads and simply asked them to talk about whatever came to their minds. This was the whatever came to their minds. This was the beginning of what came to be known as the beginning of what came to be known as the method of free association.method of free association.

THE FREUDIAN VIEW: A BRIEF REVIEWTHE FREUDIAN VIEW: A BRIEF REVIEW

A major assumption of Freudian theory, A major assumption of Freudian theory, psychic psychic determinism,determinism, holds that everything we do has holds that everything we do has meaning and purpose and is goal directed.meaning and purpose and is goal directed.

The mundane behavior, the bizarre behav ior, the The mundane behavior, the bizarre behav ior, the dream, and the slip of the tongue all have significance dream, and the slip of the tongue all have significance and meaning.and meaning.

Freud also assumed the existence of Freud also assumed the existence of ununconscious conscious motivationmotivation..

The important causes of dThe important causes of diisturbed behavior are sturbed behavior are unconscious. Therefore it follows that, the goal of unconscious. Therefore it follows that, the goal of therapy is to make is unconscious conscioustherapy is to make is unconscious conscious

THE INSTINCTSTHE INSTINCTS::The energy that makes the human machine function is The energy that makes the human machine function is

provided by two sets of instincts: provided by two sets of instincts:

Life Life instincts (Eros) instincts (Eros) are the basis for all the positive are the basis for all the positive and-constructive aspects of behavior.and-constructive aspects of behavior.

Death Death instincts (Thanatos)instincts (Thanatos). all positive activities can . all positive activities can serve destructive ends as well. When this happens, serve destructive ends as well. When this happens, the death instincts are responsible.the death instincts are responsible.

In any event, for Freud the ultimate explanation for all In any event, for Freud the ultimate explanation for all behavior was an instinctual one even though the behavior was an instinctual one even though the instincts he posited are unobservable cannot be instincts he posited are unobservable cannot be measured, and often seem better able to explain measured, and often seem better able to explain events after they occur than before.events after they occur than before.

THE STRUCTURE OF PERSONALITY:THE STRUCTURE OF PERSONALITY:

Psychoanalysis views personality as composed of three Psychoanalysis views personality as composed of three basic structures: the basic structures: the id, the ego, and the superegoid, the ego, and the superego. .

TheThe idid represents the deep, inaccessible portion of the represents the deep, inaccessible portion of the personality. The id is said to obey the personality. The id is said to obey the pleasure pleasure principle. principle. it uses it uses a a primary processprimary process kind of thinking.kind of thinking.

The The egoego is the executive of the personality, It operates is the executive of the personality, It operates according to, the according to, the reality Incomereality Income, , it employs the it employs the secondary procesecondary processss. The role. The role of the ego is to mediate of the ego is to mediate the demands of the superego, and the real world .the demands of the superego, and the real world .

The third component of the personality is the The third component of the personality is the superegosuperego..

It develops from the ego during childhood, It develops from the ego during childhood, rising specifically out of the resolutionrising specifically out of the resolution of the of the Oedipus complexOedipus complex..

In general, the role of the superego is to block In general, the role of the superego is to block unacceptable id impulses, to pressure the ego unacceptable id impulses, to pressure the ego to serve the ends of morality rather than to serve the ends of morality rather than expediency, and to generate strivings toward expediency, and to generate strivings toward perfectionperfection

THE PSYCHOSEXUAL STAGESTHE PSYCHOSEXUAL STAGES: :

FreudFreud believed that each person goes through a believed that each person goes through a series of developmental stages.series of developmental stages.

The The oral oral stage,stage, which lasts about a year, is a which lasts about a year, is a period in which the mouth is the chief means of period in which the mouth is the chief means of reaching satisfaction.reaching satisfaction.

Anal stage,Anal stage, in which attention be comes in which attention be comes centered on defecation and urination; this stage centered on defecation and urination; this stage may span the period from 6 months to 3 years may span the period from 6 months to 3 years of age.of age.

Phallic Phallic stagestage (from 3 to7 years of age), during (from 3 to7 years of age), during which the sexual organs become the prime which the sexual organs become the prime source of gratification.source of gratification.

The The latency latency stagestage, , which is characterized by a lack of which is characterized by a lack of overt sexual activity and, indeed, by an almost overt sexual activity and, indeed, by an almost negative orientation toward anything sexual. This negative orientation toward anything sexual. This stage may extend from about the age of 5 until 12 or stage may extend from about the age of 5 until 12 or so.so.

The The genital genital stagestage begins, Ideally, this stage will begins, Ideally, this stage will culminate in a mature expression of-sexuality, culminate in a mature expression of-sexuality, assuming that the sexual impulses have been handled assuming that the sexual impulses have been handled successfully by the ego.successfully by the ego.

When the child experiences difficulties at any stage, When the child experiences difficulties at any stage, these difficulties may be expressed in symptoms of these difficulties may be expressed in symptoms of maladjustment, especially when the troubles are maladjustment, especially when the troubles are severe. Either excessive frustration or overindulgence severe. Either excessive frustration or overindulgence at any psychosexual stage will lead to problems.at any psychosexual stage will lead to problems.

ANXIETY:ANXIETY: According to Freud, the circumstances that give rise to According to Freud, the circumstances that give rise to

the formations of the ego, and later the superego, the formations of the ego, and later the superego, produce a painful affective experience called anxiety.produce a painful affective experience called anxiety.

Exaggerated responses of the heart, the lungs, and Exaggerated responses of the heart, the lungs, and other internal organs are perceived and experienced other internal organs are perceived and experienced as anxiety. There are three general classes of as anxiety. There are three general classes of anxiety. anxiety.

The first is The first is reality reality anxiety anxiety : anxiety based on a real : anxiety based on a real danger from the outside world. danger from the outside world.

The anxiety that students have when a final exam is The anxiety that students have when a final exam is coming soon may be a good example for this type of coming soon may be a good example for this type of anxiety.anxiety.

Neurotic anxietyNeurotic anxiety stems from a fear that one's stems from a fear that one's id impulses will be expressed unchecked and id impulses will be expressed unchecked and thus lead to trouble from the environment. thus lead to trouble from the environment.

Moral Moral anxietyanxiety arises from a fear that one will arises from a fear that one will not conform to the standards of the conscience.not conform to the standards of the conscience.

The essential function of anxiety is to serve as The essential function of anxiety is to serve as a warning signal to the ego that certain steps a warning signal to the ego that certain steps must be initiated to quell the danger and thus must be initiated to quell the danger and thus protect the organism.protect the organism.

THE EGO DEFENSESTHE EGO DEFENSES::

When one fears the wrath of the superego or the When one fears the wrath of the superego or the unleashed lusts of the id, where does one turn? The unleashed lusts of the id, where does one turn? The answer lies in the answer lies in the ego defensesego defenses, , or as they are or as they are sometimes called, sometimes called, defense mechanisms.defense mechanisms.

These mechanisms are generally regarded as These mechanisms are generally regarded as pathological because they divert psychic energy from pathological because they divert psychic energy from more constructive activities and at the same time more constructive activities and at the same time distort reality.distort reality.

The basic ego defense is The basic ego defense is repressionrepression. . This can be This can be described as the banishment from consciousness of described as the banishment from consciousness of highly threatening sexual or aggressive material. highly threatening sexual or aggressive material.

FixationFixation occurs when the frustration and anxiety of occurs when the frustration and anxiety of the next psychosexual stage are so great that the the next psychosexual stage are so great that the individual remains at his or her present level individual remains at his or her present level of of psychosexual development.psychosexual development.

RegressionRegression involves involves a a return to a stage that earlier return to a stage that earlier provided a great deal of gratification; this may occur provided a great deal of gratification; this may occur following extensive frustration. following extensive frustration.

Reaction Reaction formationformation is said to occur when an is said to occur when an unconscious impulse is consciously expressed, by its unconscious impulse is consciously expressed, by its behavioral opposite. Thus, “I hate you" is expressed behavioral opposite. Thus, “I hate you" is expressed as "I love you.”as "I love you.”

Projection isProjection is revealed when one's unconscious revealed when one's unconscious feelings are attributed not to oneself but to another. feelings are attributed not to oneself but to another. Thus, the feeling "I hate you" is transformed into "You Thus, the feeling "I hate you" is transformed into "You hate me."hate me."

PSYCHOANALYSIS: PSYCHOANALYSIS: FROM THEORY TO FROM THEORY TO

PRACTICEPRACTICE

THE ROLE OF INSIGHTTHE ROLE OF INSIGHT TheThe ultimate goal of psychoanalytic intervention is the ultimate goal of psychoanalytic intervention is the

removal of debilitating neurotic problems.removal of debilitating neurotic problems.

the only final and effective way of doing this is to help the only final and effective way of doing this is to help the patient achieve the patient achieve insightinsight..

It means total understanding of the unconscious It means total understanding of the unconscious determinants of those irrational feelings thoughts, or determinants of those irrational feelings thoughts, or behaviors that are producing ones personal misery.behaviors that are producing ones personal misery.

An analysis culminating in insight is slow, tedious, and An analysis culminating in insight is slow, tedious, and often very lengthy.often very lengthy.

As the therapist comes to stand for someone else As the therapist comes to stand for someone else (e.g., the father), old emotions are reexperienced and (e.g., the father), old emotions are reexperienced and then reevaluated. From this comes a deeper insight.then reevaluated. From this comes a deeper insight.

The true meaning of this insight is then brought into The true meaning of this insight is then brought into the patient's consciousness by the the patient's consciousness by the working-through working-through processprocess..

This refers to a careful and repeated examination of This refers to a careful and repeated examination of how one's conflicts and defenses have operated in how one's conflicts and defenses have operated in many different areas of life.many different areas of life.

The patient must be confronted with the insight as it The patient must be confronted with the insight as it applies to relations with a spouse, a friend, or a applies to relations with a spouse, a friend, or a supervisor, and, yes, even as it affects reactions to the supervisor, and, yes, even as it affects reactions to the therapist.therapist.

It is due in part to this extensive working-through It is due in part to this extensive working-through period that traditional psychoanalysis takes so long period that traditional psychoanalysis takes so long three to five therapy sessions per week for three to three to five therapy sessions per week for three to five years and sometimes much longer. five years and sometimes much longer.

Techniques Of Psychodynamic Techniques Of Psychodynamic PsychotherapyPsychotherapy

The analysts regard the symptoms of neurosis as The analysts regard the symptoms of neurosis as signs of conflict among the id, ego, superego, and the signs of conflict among the id, ego, superego, and the demands of reality.demands of reality.

The symptom, then, indicates an unconscious problem The symptom, then, indicates an unconscious problem that needs resolution.that needs resolution.

To dissolve defenses and confront the unconscious in To dissolve defenses and confront the unconscious in a therapeutic relationship is the whole purpose of a therapeutic relationship is the whole purpose of psychoanalysis. Over the years, many variations in psychoanalysis. Over the years, many variations in techniques have been developed.techniques have been developed.

FREE ASSOCIATIONFREE ASSOCIATION A cardinal rule in psychoanalysis is that the patient A cardinal rule in psychoanalysis is that the patient

must say anything and everything that comes to mind.must say anything and everything that comes to mind.

It requires the patient to stop censoring or screening It requires the patient to stop censoring or screening thoughts that are ridiculous, aggressive, thoughts that are ridiculous, aggressive, embarrassing, or sexual.embarrassing, or sexual.

From it, the patient and the therapist can begin to From it, the patient and the therapist can begin to discover the long hidden bases of the patient's discover the long hidden bases of the patient's problems.problems.

Traditionally, the psychoanalyst sits behind the Traditionally, the psychoanalyst sits behind the patient, who reclines on a couch. The purpose of the patient, who reclines on a couch. The purpose of the couch is to help the patient relax and make it easier to couch is to help the patient relax and make it easier to free associate.free associate.

As As the process continues, one gets closer and closer the process continues, one gets closer and closer to unconscious thoughts and urges.to unconscious thoughts and urges.

Any single set of associa tions may not be terribly Any single set of associa tions may not be terribly clear. But over many sessions, patterns of clear. But over many sessions, patterns of associations start to emerge, and the analyst can associations start to emerge, and the analyst can begin to make sense out of them through their begin to make sense out of them through their repetitive themes.repetitive themes.

They are outgrowths of unconscious forces that They are outgrowths of unconscious forces that determine the direction of one's associations.determine the direction of one's associations.

Memories of long-forgotten experiences give the Memories of long-forgotten experiences give the analyst clues to the structure of personality and its analyst clues to the structure of personality and its development.development.

ANALYSIS OF DREAMSANALYSIS OF DREAMS

A related technique is the A related technique is the analysis of dreamsanalysis of dreams..

Dreams are thought to reveal the nature of the Dreams are thought to reveal the nature of the unconscious because they are regarded as unconscious because they are regarded as heavily laden with unconscious wishes, albeit in heavily laden with unconscious wishes, albeit in symbolic form.symbolic form.

The material of the dream is important enough The material of the dream is important enough to provide some gratification to the id but not to provide some gratification to the id but not usually so threatening as to terrorize the ego.usually so threatening as to terrorize the ego.

Dreams content can be of two types: Dreams content can be of two types:

The The manifest contentmanifest content of a dream is what of a dream is what actually happens during the dream.actually happens during the dream.

For example, the manifest content of a dream For example, the manifest content of a dream may be that one is confronted with two large, may be that one is confronted with two large, delicious-looking ice cream cones. delicious-looking ice cream cones.

The The latent contentlatent content of a dream is its symbolic of a dream is its symbolic meaning. In the preceding example, perhaps meaning. In the preceding example, perhaps there is a message about the need for oral there is a message about the need for oral gratification or a longing to return to the gratification or a longing to return to the mother's breast.mother's breast.

In order to get at the latent content the patient is In order to get at the latent content the patient is often encouraged to free-associate to a dream often encouraged to free-associate to a dream with the hope of gaining insight into its with the hope of gaining insight into its meaning, normally, the manifest content is an meaning, normally, the manifest content is an amalgam of displacement, condensation, amalgam of displacement, condensation, substitution, symbolization, or lack of logic.substitution, symbolization, or lack of logic.

The real meaning of a dream in the life of an The real meaning of a dream in the life of an individual may only become apparent from the individual may only become apparent from the analysis of a whole series of dreams.analysis of a whole series of dreams.

For many analysts, dreams do not provide For many analysts, dreams do not provide inevitable, final clues to validate with further inevitable, final clues to validate with further information.information.

RESISTANCERESISTANCE During the course of psychotherapy, the patient During the course of psychotherapy, the patient

will attempt to ward off efforts to dissolve will attempt to ward off efforts to dissolve neurotic methods of resolving problems called neurotic methods of resolving problems called resistance.resistance.

Patients find painful subjects difficult to Patients find painful subjects difficult to contemplate or discuss.contemplate or discuss.

Although a certain amount of resistance is to- Although a certain amount of resistance is to- be expected from most patients, when the be expected from most patients, when the resistance becomes sufficient to retard the resistance becomes sufficient to retard the progress of therapy, it must be recognized and progress of therapy, it must be recognized and dealt with by the therapist.dealt with by the therapist.

Resistance takes many forms : Patients may begin to Resistance takes many forms : Patients may begin to talk less, to pause longertalk less, to pause longer or to report their minds are or to report their minds are blank, lengthy silences are also frequent. blank, lengthy silences are also frequent.

Therapy may become an arena for discussing such Therapy may become an arena for discussing such problems as unemployment or taxes-weighty issues, problems as unemployment or taxes-weighty issues, but hardly the ones that brought the patient to therapy.but hardly the ones that brought the patient to therapy.

Some patients may intellectualize about the relative Some patients may intellectualize about the relative meritsmerits of primal screaming versus nude marathons or of primal screaming versus nude marathons or even the effect of Freud's boyhood on the subsequent even the effect of Freud's boyhood on the subsequent development of psychoanalysis.development of psychoanalysis.

In some instances, the patient's feelings or ideas In some instances, the patient's feelings or ideas about the therapist may begin to dominate the about the therapist may begin to dominate the sessions.sessions.

The therapist may also begin to notice that a variety of The therapist may also begin to notice that a variety of "real" events in the patient's life seem to be conspiring "real" events in the patient's life seem to be conspiring against the sessions.against the sessions.

Nearly anything can become a form of resistanceNearly anything can become a form of resistance

As the patient's defenses are addressed, there is As the patient's defenses are addressed, there is sometimes an intensification of symp toms. But the sometimes an intensification of symp toms. But the opposite can also occur, so that an actual "flight into opposite can also occur, so that an actual "flight into health" occurs the patient gets better.health" occurs the patient gets better.

Another method is "acting out." Here the patient Another method is "acting out." Here the patient attempts to escape the anxiety generated in therapy attempts to escape the anxiety generated in therapy by indulging in irrational acts or engaging in potentially by indulging in irrational acts or engaging in potentially dangerous behavior.dangerous behavior.

Still other patients flee into "intellectualization." Still other patients flee into "intellectualization." Experiences or memories become stripped of their Experiences or memories become stripped of their emotional content and are dissected calmly and emotional content and are dissected calmly and rationally.rationally.

In one form or another, resistance goes on throughout In one form or another, resistance goes on throughout the course of therapy.the course of therapy.

The resistance that goes on in therapy probably The resistance that goes on in therapy probably mirrors what has happened in real life.mirrors what has happened in real life.

If resistance during therapy can be analyzed and the If resistance during therapy can be analyzed and the patient made to understand its true function, then such patient made to understand its true function, then such defenses will not be as likely t0 operate outside the defenses will not be as likely t0 operate outside the therapist's officetherapist's office

TRANSFERENCETRANSFERENCE A key phenomenon in psychoanalytic therapy is A key phenomenon in psychoanalytic therapy is

transference.transference.

It occurs when the patient reacts to the therapist as if It occurs when the patient reacts to the therapist as if the latter represented some important figure out of the latter represented some important figure out of childhood. Both positive and negative feelings can be childhood. Both positive and negative feelings can be transferred.transferred.

This provides not only important clues as to the nature This provides not only important clues as to the nature of the patient's problems but also an opportunity for of the patient's problems but also an opportunity for the therapist to interpret the transference in an the therapist to interpret the transference in an immediate and vital situation.immediate and vital situation.

Many Many characteristics of the psychoanalytic characteristics of the psychoanalytic sessionsession : the patient is seated on a couch facing : the patient is seated on a couch facing away from the analyst, who does not interrupt. away from the analyst, who does not interrupt.

Positive transference is often responsible for what appears Positive transference is often responsible for what appears to be, rapid improvement at the beginning stages of to be, rapid improvement at the beginning stages of therapy.therapy.

Transference can take many forms. It may be reflected in Transference can take many forms. It may be reflected in comments about the therapist's clothing or office comments about the therapist's clothing or office furnishings.furnishings.

However, the truly sensitive therapist is one who can However, the truly sensitive therapist is one who can separate reactions that have some support in reality from separate reactions that have some support in reality from reactions that are neurotic in character. reactions that are neurotic in character.

Basically, both positive and negative transferences are Basically, both positive and negative transferences are forms of resistance.forms of resistance.

Through interpretation, the patient is helped to recognize Through interpretation, the patient is helped to recognize the irrational nature and origins of transference feelings.the irrational nature and origins of transference feelings.

INTERPRETATIONINTERPRETATION Interpretation is the cornerstone of nearly every form Interpretation is the cornerstone of nearly every form

of dynamic psychotherapy.of dynamic psychotherapy.

Interpretation Interpretation is the method by which the unconscious is the method by which the unconscious meaning of thoughts and behavior is revealed.meaning of thoughts and behavior is revealed.

Interpretation is a process by which the patient can be Interpretation is a process by which the patient can be induced to view thoughts, behavior, feelings, or wishes induced to view thoughts, behavior, feelings, or wishes in a different manner.in a different manner.

It is a prime method for bringing about insight.It is a prime method for bringing about insight. it is a slow, repetitive process in which the essential it is a slow, repetitive process in which the essential

meaning behind certain behaviors, thoughts, and meaning behind certain behaviors, thoughts, and feelings is repeatedly pointed out to the patient in one feelings is repeatedly pointed out to the patient in one context after anothercontext after another

Interpretation is limited to important life areas Interpretation is limited to important life areas those that relate directly to the problems that those that relate directly to the problems that the therapist is trying to resolve.the therapist is trying to resolve.

An interpretation should be offered when it will An interpretation should be offered when it will arouse enough anxiety to engage the patient's arouse enough anxiety to engage the patient's serious contemplation but not so much anxiety serious contemplation but not so much anxiety that the patient will reject it.that the patient will reject it.

As a general rule, small dosages are best.As a general rule, small dosages are best. In making interpretations, it is important to build In making interpretations, it is important to build

on what the patient has said previously, using on what the patient has said previously, using the patient's own comments and descriptions to the patient's own comments and descriptions to build the interpretive casebuild the interpretive case

It can be difficult to determine whether a specific It can be difficult to determine whether a specific interpretation has been effective.interpretation has been effective.

Sometimes the patient's response will suggest that the Sometimes the patient's response will suggest that the target has been hit. But at other times patients may be target has been hit. But at other times patients may be entirely noncommittal.entirely noncommittal.

In any event, the real test of the utility of an In any event, the real test of the utility of an interpretation is more likely to come from the interpretation is more likely to come from the subsequent course of the sessions.subsequent course of the sessions.

A classic psychoanalytic interpretation is designed to A classic psychoanalytic interpretation is designed to open up the patient to new ways of viewing things open up the patient to new ways of viewing things and, ultimately, to neutralize unconscious conflicts and and, ultimately, to neutralize unconscious conflicts and defenses.defenses.

Interpretations can vary a great deal in terms of Interpretations can vary a great deal in terms of their complexity and their incisiveness.their complexity and their incisiveness.

Sometimes they are designed to cut right to the Sometimes they are designed to cut right to the heart of a patient's unconscious conflicts. But in heart of a patient's unconscious conflicts. But in other cases, they may be little more than other cases, they may be little more than comments or questions designed to move the comments or questions designed to move the patient ever so slightly in the direction of insight.patient ever so slightly in the direction of insight.

These verbal interventions might be considered These verbal interventions might be considered as a dimension in terms of how directly they as a dimension in terms of how directly they seek to lead the patient to a fresh way of seek to lead the patient to a fresh way of viewing things.viewing things.