Dr. Shafranske's therapeutic approach emphasizes the development of insight and aims for greater integration of cognitive and emotional experiences, assisting clients to better attain their personal desires by resolving intrapsychic and interpersonal conflicts and modifying defenses. Drawing substantively upon a unified composite theory of psychoanalysis, he pays close attention to unconscious mental processes and defenses, inferred in the client's free associations, reflected in the "here and now" of the therapy interaction, and through an analysis of the "in vivo" experience of transference.
As the client achieves greater psychological freedom and authenticity in the context of an empathic therapeutic relationship, awareness of the self and relationship with others deepens. Past experiences, which have limited the client's ability to be fully genuine, are worked through by means of insight and catharsis, and gradually the client comes to see relationships and desires in new ways, leading to changes in basic schemas, defensive operations, unconscious compromises, and improvement in daily living.
Clinical techniques include the use of free association, dream interpretation, analysis of defenses, and transference interpretation; attention is focused on the therapeutic alliance and on the ways in which implicit organizing principles shape unconscious meaning, conscious attributions, and behavior. Change is initiated within the immediacy of a trusting, empathic therapeutic relationship and under the influence of transference.
Dr. Shafranske views religion and spirituality as contributing significantly to many clients' schemas and the implicit beliefs they actively construct about themselves and the world in which they live. In addition, religious and spiritual involvement often serves as a potential resource in coping, and for some, a source of conflict. In psychoanalytic treatment, spiritual experience (broadly defined) is seen to reflect fundamental ways of viewing the self in relationship to "transcendent realities" as well as to others, and provides a means of articulating personal experiences associated to religious motifs.
Rather than conducting religious counseling, actively modifying religious attributions, or bringing religious and spiritual practices into the consulting room, the psychodynamic approach addresses religious and spiritual material in a manner similar to considering other client associations—as manifestations of conscious and unconscious mental processes. This approach recognizes that the understanding that is constructed concerning a clients' religious and spiritual experiences, is at best "interpreted" experiences, which have particular meaning when coming to mind in the unique setting of treatment. Such understanding is limited and does not allow the ability to assess the "truth claims" inherent in such beliefs and experiences—in this respect, psychoanalyses remains silent.
In the clinical session shown here, Dr. Shafranske initially places emphasis on understanding how the client's experience of the idea of a God of Grace conflicts with his implicit experience of God. His apparent inability to reconcile this theological belief with his personal experience is hypothesized to reflect both psychological and spiritual conflicts, shaped in part by past and present experiences of others in his life.
Dr. Shafranske views the client's explicit "religious conflict" as concerning conflicts related to basic issues of trust, relationships, control, experiences of loss and anomie, and vulnerability to narcissistic injury. Beyond the content of the client's religious associations, Dr. Shafranske became aware in the session of what appeared to be the client's use of "thinking" as a defense against experiences of true emotional feeling and engagement, which also limited his awareness of events and relationships involved with unresolved losses and conflicts. With this clinical hypothesis in mind, Dr. Shafranske shifted emphasis from inquiry concerning the contents of the client's religious beliefs to the exploration and later interpretation of the immediate process and his use of religious thinking at times as a means or an outcome of moving away from painful emotional experiences.
Psychotherapy rests on the establishment of a strong and effective therapeutic alliance. In Dr. Shafranske's view, clinicians must rely upon multiple theories and approaches in an effort to facilitate clinical collaboration. Psychodynamic psychotherapy provides but one approach to addressing human suffering; its principles can be applied singularly or can be meaningfully integrated with other clinical perspectives.
A relatively wide range of adult and adolescent individuals can benefit from psychodynamic psychotherapy. Psychodynamic treatment is not well suited to address the needs of clients with antisocial personality disorder, those who are significantly impaired and have not demonstrated positive use of insight-oriented, transference-based treatment, or are in states of significant and destabilizing crisis. Following stabilization and with a careful review of history and ego functions and psychological capabilities and motivation, insight-oriented approaches may be considered.
The decision to address religious and spiritual issues within psychological treatment first requires a systematic assessment of the salience of spirituality in a client's orienting system and, in Dr. Shafranske's view, informed consent to actively explore such issues, particularly, if explicit integration is an aim. In psychodynamic psychotherapy, the exploration of spiritual issues occurs implicitly. Typically, when religion and spirituality play important roles in individuals' lives, these individuals bring such issues into the therapeutic discourse.
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