Psych 3501 Exam 2: Psychoanalysis and Psychodynamic Therapy

Freud's psychoanalytic theory

Emphasized the role of unconscious psychological conflicts and led to development of therapy to resolve those conflicts

Freud's theory of psychosexual development

Oral

Anal

Phallic

Latency

Genital

Levels of consciousness

Conscious level

Full awareness

Preconscious level

Can become aware by directing attention

E.g.: can turn my attention to my stomach and realize that I’m hungry

Unconscious level

Unaware without psychoanalysis

Hidden, unspoken desires and thoughts

Day to day awareness only at conscious and preconscious level

Freud's structural model of personality

Id

Unconscious

Operates on the pleasure principle: what feels good for me, what is best for me

Source of basic biological drives: sex and violence

Superego

Morals, perfection

Conscience: guilt we feel in response to an immoral act

Ego ideal: moral striving, pride we feel when we do something good

Ego

Mainly conscious

Operate on reality principle

Balances the impulses of the id and the superego

Responsive to external realities

E.g., I need to do certain things, I can’t do certain things

Topological map of the structural model

Ego: conscious & preconscious

Id: entirely unconscious

Superego: across all three levels

Neurosis

An umbrella term for all odd, unusual presentations of emotions and behaviors

Due to psychic conflicts between the id and superego

Usually occur in the unconscious

Anxiety occurs when unacceptable drives begin to enter the conscious mind

Ego responds by engaging a defense mechanism

Defense mechanisms

Unconscious strategies used to keep anxiety-provoking unconscious urges/desires from becoming conscious

Types of defense mechanism

denial

projection

repression

displacement

intellectualization

reaction formation

sublimation

Denial

Dismissing external reality

E.g., continue to shop for luxury good despite in debt

Projection

Attributing one’s own impulse or urge to someone else

E.g., Someone cheating on their spouse accuse spouse of cheating

Repression

Blocking undesirable ideas, impulses, or memories

E.g., No recollection of a traumatic event

Displacement

Transferring emotions from one source to another

E.g., Get into a fight with roommate after a stressful day

Intellectualization

Create distance from emotions by overanalyzing

E.g., People diagnosed of a terminal illness started searching for papers but not engaging with the emotions

Reaction formation

Replacing initial unacceptable urge with its opposite

E.g., If you really dislike someone, you are excessively nice to this person

Sublimation

Channeling urge into a socially acceptable output

E.g., Playing sports to offset violent urges

Psychoanalysis goals

Goals: to help clients gain insight into and work through the unconscious thoughts and emotions underlying their neuroses and strengthen the ego’s control over the id and superego

Psychoanalysis 4 fundamental processes

Identifying relationships between psychosexual development and current issues

- What stages of psychosexual development did they get stuck in, how does early childhood experience influence their experience today

Lack of or limits in self-awareness causes neuroses

Talking about thoughts and emotions can be curative

The importance of the therapeutic relationship

Psychoanalytic techniques

free association

dream interpretation

transference

countertransference

psychic determinism

resistance

interpretation

insight

working through

Free association

The essential piece of psychoanalysis (Considered the sine qua non of psychoanalysis)

Expressing thoughts without censorship in order to reveal unconscious processes

Freud’s alternative to hypnosis

Dream interpretation

Probing content and imagery of dreams to reveal unconscious processes

Dreams generated by 2 processes

- Unconscious impulses that generate a desire or wish expressed in the dream

- A censorship process that distorts the expression of the wish

Dreams consist of 2 types of content

- Manifest content: narrative content that often reflects details of the prior day

- Latent content: unconscious urges in a disguised form

Disentangle the latent content from the manifest content and the censorship process that is distorting the latent content

Transference

Client's typical relationship patterns and defense mechanisms appear in therapy

Clients will repeat patterns of behavior in therapy

Freud believes these patterns reflect important early relationships (e.g., child-parent)

Creates an opportunity to bring awareness to the pattern and facilitate resolution

Countertransference

Therapist's reactions towards the client are impacted by their personal history

Can adversely affect therapy

Impetus for requiring therapy in trainees

Psychic determinism

Associations between memories, ideas, experiences are not random but reflect important underlying unconscious processes

Core assumption of psychoanalysis

“Freudian slips”, unexpected associations, memory failures, etc. are meaningful

Probing these will reveal an important unconscious meaning behind the connection

Resistance

Clients behave in ways that interfere with treatment

Not unique with psychoanalysis

As therapy progresses, unconscious conflicts become revealed, which provokes anxiety

Resistance behaviors to protect the conscious mind from unconscious impulses

E.g., forgetting appointments, emotionally detaching, disagreeing with the therapist, distracting from important conflicts

Interpretation

Insight

Working through

Interpretation

Therapist remarks on how thoughts, experiences, etc. might be related to an unconscious conflict; presented as hypotheses

Insight

Client gains conscious awareness of the underlying conflict

Occurs if an interpretation is accurate and client is ready to hear it

Working through

Insight is not sufficient

Exploring the implications of insights

Therapist encourages exploration of how the conflict drives problems in daily life

Criticisms of psychoanalytic theory and therapy

Vague and elusive concepts make theory difficult to test scientifically

Most of theory is based on case studies

Minimal evidence for efficacy of psychoanalysis

Excessive focus on sexuality

Intensive, long, and expensive

Psychodynamic therapies

“Neo-Freudians”

3 differences from original psychoanalytic theory

De-emphasized sexual/aggressive id, emphasized positive role of ego in promoting adaptive functions

de-emphasized sexuality in early experiences, emphasized attachment/bonding with caregivers

Emphasized the therapeutic relationship as healing itself

Alfred Adler's individual psychology

Striving for superiority: personality development driven by desire to overcome feelings of helplessness and gain control over environment

“Individual” refers to emphasis on the whole person

Emphasized personal fulfillment

Overprotection or neglect -> intense inferiority -> excessive striving, desperate and unhealthy efforts to enhance self-esteem

Emphasized the social context: vital for striving for the fulfillness

All behavior is goal-directed: not biological urge, but pursuing a specific goal

Fulfillment in the context of 3 basic life tasks

Work: realized when work is meaningful and satisfying

Friendship: realized by creating satisfying relationships with others

love/intimacy: realized when one can love oneself and partner

Adlerian psychodynamic techniques

Goal: explore and alter maladaptive lifestyles using strategies to promote growth and resilience

Interpretations focus on current problems and lifestyle patterns

- Still offer interpretation, but focus on current instead of early experiences

- Examine the purpose of a behavior

Create expectations for the client

- Ask clients to imagine how they would act if they were their ideal self

- Identify discrepancies between current self vs. the ideal self

Provide encouragement and empathy

- Help clients recognize their own strengths and increase their confidence

- Precursor to humanistic therapy

Object relations theory

Melanie Klein: one of first to adapt psychoanalysis to young children

Adult relationships are shaped by experiences of caregivers (objects) during infancy

Object: caregivers

Relations to objects are internalized early in life and unconsciously repeated in adult life

Emphasis on the relationship in contrast to discharging sexual and violent impulses

Object relations therapy

Therapist are more directive

Highlight patterns, conflicts rather than letting them be revealed naturally (e.g., through free association)

Focus on creating a nurturing relationship with the client

Criticisms of object relations theory

Relies on infant abstraction ability that exceeds cognitive capacity

- Can infants think abstractly at the stage of development?

Untestable

Short-term psychodynamic psychotherapy

1930-1940s: psychoanalysts begin questioning the necessity of year-long analysis

Argued daily sessions could create dependence (on the therapist) and monotony (bored)

Distinguished between clients who needed long-term traditional psychoanalysis and those who could be helped with shorter care

Intensive short-term dynamic psychotherapy

Developed by Habib Davanloo

Emphasizes concrete goals achievable in limited sessions

Insight and working through based on current problems

- Instead of exploration on past experiences & early experiences, focus on the present; no attention to past conflicts

Relatively fast-paced

Therapist is more active and directive

Identify problem, challenge to abandon defense mechanisms, highlight resistance as needed

~ 20 sessions

State of the science on psychodynamic approaches

Traditional psychoanalysis rarely practiced

Psychodynamic therapies are 2nd most common practiced

Less ideological than in past: many practitioners integrate elements of other approaches

Continues to be limited by insufficient evidence, though research is becoming more common

Efficacy of short-term psychodynamic psychotherapy in depressive disorders

Large effect compared to no treatment

Negligible effect compared to supportive therapy

Less effective than CBT but the effect size is small

Summary