Psychoanalysis: The Begippipgs

  • Focus is on unconscious motives and conflicts in the search for roots of behavior.
  • Freud was influenced by Jean Charcot (famous work on hysterics), and his use of hypnosis.

The Case of Anna O.

  • Josef Bruer's work with Anna O's, patient with severe hysteria led Freud to develop his initial theories on catharsis, transference and moral anxiety.
  • Freud over time asked patients to simply talk about whatever came to their minds; this method led to the development of a concept known as free association.

The Freudian View: A Brief Review

  • Psychic Determinism: Everything we do has meaning and purpose and is goal-directed.
  • To account for different aspects of behavior Freud also assumed the existence of unconscious motivation.

o A person understands motivation for healthy behavior; the causes of disturbed behavior are unconscious; so to treat these they need to be made conscious.

The Instincts

  • Life energy is provided by the life instincts/Eros and the death instinct/
  • Life instincts: All positive aspects of behavior—thirst, sex, hunger, creative aspects (ex: music)
  • Death instincts: Self-destructive behavior; Freud believed all behavior was

Personality Structures—The Id, Ego and Superego (Iceberg)

  • Id: Deep inaccessible part of the personality. Instinctual gratification urges that need to be immediately met (access is gained via dreams & neurotic behavior; has no value, logic or ethics).

o Pleasure Principle: One seeks to obtain pleasure and avoid pain. Discharge tension. Uses the primary process (ex: dreaming)

  • Ego: Organized, rational system that uses perception, learning and memory to gain satisfaction.

o Reality Principle: Attempts to delay gratification of the Id until a suitable mode & object are identified. Uses secondary process (ex: learning, memory, planning).

o The Ego balances the demands of the Id and the Superego (provide satisfaction/prevent from being killed).

  • Superego: Develops during childhood from the Ego. Ideas and values of society as conveyed by parents as well as rewards and punishments. Its goal is to block extreme impulses of the Id

o Oedipus Complex—Child's sexual attraction to the parent of the opposite sex. o Ego Ideal—Reward (pride + worth)/Conscience—Punishment (guilt +worthlessness)

The Psychosexual Stages

  • Oral Stage—the mouth is the means of satisfaction (ex: breastfeeding). Lasts for about 1 yr.
  • Anal Stage—Attention to defecation and urination (6 months-3 years)
  • Phallic Stage—Sexual organs are the sources of satisfaction (3-7 years)
  • Latency Stage—Lack of sexual activity; negative attitude towards anything sexual (5-12 years)
  • Genital Stage—Mature expression of sexuality
  • Disruptions to any staged maladjustment

Anxiety

  • Circumstances that give rise to the Ego and the Superego. There are 3 types
  • Reality Anxiety: Real danger from the outside world.
  • Neurotic Anxiety:_Fear that Id's impulses with remain unchecked^ trouble from external environment.
  • Moral Anxiety: Fear that one will not conform to the standards of the conscience.
  • Warning sign to the Ego that certain steps must be taken to reduce danger for protection.

The Ego Defenses or Defense Mechanisms

  • Regarded as pathological because they divert energy from the more constructive activities whilst also distorting reality.
  • Ego defense mechanism is repression—banishment from consciousness of threatening sexual/aggressive material.
  • Fixation: Frustration and aggression at the next psychosexual stage is so great that an individual remains at their current psychosexual level of development.
  • Regression: Return to a previous psychosexual stage
  • Reaction Formation: An unconscious principle is consciously expressed by its behavioral opposite. (Ex: “I hate you” is expressed as “I love you”).
  • Projection: One's unconscious feelings is attributed to another and not oneself (Ex: “I hate you” is changed to “You hate me”).

From Theory to Practice

  • Free Association: Patient is supposed to say everything that comes to mind, regardless of what it is.
  • Transference: Patient reacts to therapist as if they represent an important figure in the patient's past/life (ex: transference of feelings onto therapist).
  • Catharsis: Release of energy that could have benefits (ex: related to trauma experienced).
  • Resistance: Reluctance to discuss, remember or think about events that are troubling/threatening.
  • Repression: Banishment of a thought/impulse to the unconscious (area of the mind inaccessible to conscious thought).

The Role of Insight

  • Insight refers to total understanding of the unconscious determinants of irrational feelings, thoughts, behaviors that are producing personal misery.
  • Analysis leading to insight is slow and very time consuming (years).
  • Working Thought Process: True insight brought into patient's consciousness. Careful and repeated examination of how one's conflicts and defenses have operated in different areas of life.

Techniques of Psychodynamic Psychotherapy

  • Neurosis symptoms are signs of conflict between the Id, Ego and Superego & demands of reality.
  • Psychoanalysis aims to dissolve defenses and confront the unconscious.

Free Association

  • Patient must say anything and everything that comes to mind. Requires that the patient stop screening their thoughts.
  • Helps discover the basis of the patient's problem
  • The patient lies on a couch and the psychoanalyst sits on a chair (not in line of vision)
  • Psychoanalyst assumes that associations are linked and one will lead to another bringing the patient closer to unconscious thoughts and urges.

Analysis of Dreams

  • Reveal the nature of the unconscious because they are steeped in unconscious wishes (symbolic).
  • Dream material provides gratification to the Id but is not threatening as to terrorize the Ego.
  • Manifest Content: What actually occurs during a dream.
  • Latent Content: The symbolic meaning behind a dream. Patient asked to free-associate.
  • Patients often distort the manifest content of a dream as they retell it.

Psychopathology of Everyday Life

  • In Freud's view everything is determined and there are no accidents (ex: a missed appointment is not a simple mistake)

o Represent conscious expression of an unconscious wish.

Resistance

  • Reluctance to open up to the therapist and discuss problems; doesn't want to give up a certain behavior even though it may cause distress.
  • Prevents insight or prevents material from the unconscious into being brought to consciousness.
  • Patients may engage in long periods of silence, discuss irrelevant topics, or omit certain information, constantly miss meetings.
  • Patient's resistance can lead to a flight into health—leads to patient getting better.
  • In one form or another resistance is always present in therapy

Transference

  • When a patient reacts to a therapist as if they were some important figure that is part of the patient's childhood.
  • The conflicts that were present during childhood are voiced in therapy and transference provides the therapist with important clues.

o Encourage transference—sitting on the couch, away from therapist, no advice given.

  • Transference can be both positive and negative—ex: direct admiration, love, anger, comments about the therapy room, attack on the therapist.
  • Both positive and negative transference are forms of resistance.

Interpretation

  • The method by which the therapist reveals patient's unconscious thoughts or feelings.
  • Allows patients to view their thoughts, feelings. This is a slow repetitive process.
  • Interpretations are limited to important life areas that relate directly to patient's problem.
  • It should be offered when it arouses enough anxiety in the patient for serious consideration but not when too much anxiety is present or else the patient may reject it.
  • Small doses of interpretation over time are best.

Psychoanalytic Alternatives

  • Psychoanalytic theory was also influenced by Alfred Adler, Carl Jung & other neo-Freudians.
  • The neurotic symptoms were now seen as being rooted not only in sexual or aggressive urges but it was now being associated with the fear of being alone/adult insecurity.
  • How interpretation occurred and by whom was different (family, spouse, friends...)

Ego Analysis

  • Origination from traditional psychoanalysis, this theory held that there was an overemphasis on unconscious and instinctual determinants that occurred at the expense of the ego process.
  • Conflict-free functions of the ego—memory, learning, perception; apart from mediating demands between the Id & the real world.
  • Focus on contemporary problems in living than examination of the past.

Contemporary Psychodynamic Psychotherapy

  • Those who no longer practice the Freudian techniques are said to practice “psychoanalytically oriented” therapy or psychodynamic psychotherapy.
  • May involve only one or two vs. five sessions in one week, short-term treatment or can be open-ended.
  • Greater flexibility has been introduced.

Interpersonal Psychotherapy: An Empirically Supported Treatment (Form of Psychodynamic)

  • Interpersonal Psychotherapy (IPT): Brief, insight oriented approach mainly used for depressive disorders.
  • Involves through assessment of depressive symptoms, targeted intervention and reducing symptoms by improving relations with others.

Does Psychodynamic Psychotherapy Work?

  • Support for psychodynamic psychotherapy work with children and adolescents is not promising. The findings for adults are slightly more supportive.
  • For those studies showing support criticisms include: poor quality meta-analysis studies, poor methods and the failure to specify the effects of psychodynamic therapy for a disorder.
  • There is slight support for psychodynamic therapy for major depressive disorder, panic disorder, bipolar disorder and substance abuse & dependence.

Interpretation and Insight

  • Psychotherapeutic treatment and psychoanalysis use of insight into solving problems is its greatest asset but can also cause problems (ex: too much examination of the past).
  • Learning specifics behind their problems may help in the short-term but a failure to emphasize alternative ways of behaving may be a shortcoming of psychoanalysis.
  • Psychoanalysis assumes that insight^ behavioral change; but others have argued that it is behavioral changed

Curative Factors

  • Positive outcomes in psychodynamic psychotherapy depend of client-therapist alliance in terms of quality & strength.
  • Therapeutic alliance: Refers to patient's affective bond to the therapist.

o Allows for self-examination by the patient and allows for interpretation.

The Lack of Emphasis on Behavior

  • Psychoanalysis engages in interpretation but fails to deal with behavior.
  • A therapist that engages in interpretation but also guides the patient in learning situations will be more effective than one who relies solely on insight.
  • This may be linked to rise of behavioral therapist; psychoanalysis does not focus on behavior.

The Economics of Psychotherapy

  • The fact that psychoanalysis (reconstruction of the personality) takes anywhere from 3-5 years means that it is expensive, and so only those in need for psychotherapy are likely to go in for it (not poor, uneducated minorities).
  • Psychoanalysis is viewed as being limited as it can only help some, but it has proved to be helpful for those who can afford it.
  • Brief psychodynamic psychotherapy treatments with manuals have shown to be more effective than those without manuals.
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