Chapter 4: Psychoanalytic Therapy

Repression

Threatening or painful thoughts and feelings are excluded from awareness.

One of the most important Freudian processes, it is the basis of many other ego defenses and of neurotic disorders. Freud explained repression as an involuntary removal of something from consciousness. It is assumed that most of the painful events of the first five or six years of life are buried, yet these events do influence later behavior.

Denial

“Closing one’s eyes” to the existence of a threatening aspect of reality.

Denial of reality is perhaps the simplest of all selfdefense mechanisms. It is a way of distorting what the individual thinks, feels, or perceives in a traumatic situation. This mechanism is similar to repression, yet it generally operates at preconscious and conscious levels.

Reaction Formation

Actively expressing the opposite impulse when confronted with a threatening impulse.

By developing conscious attitudes and behaviors that are diametrically opposed to disturbing desires, people do not have to face the anxiety that would result if they were to recognize these dimensions of themselves. Individuals may conceal hate with a facade of love, be extremely nice when they harbor negative reactions, or mask cruelty with excessive kindness.

Projection

Attributing to others one’s own unacceptable desires and impulses.

This is a mechanism of self-deception. Lustful, aggressive, or other impulses are seen as being possessed by “those people out there, but not by me.”

Displacement

Directing energy toward another object or person when the original object or person is inaccessible.

Displacement is a way of coping with anxiety that involves discharging impulses by shifting from a threatening object to a “safer target.” For example, the meek man who feels intimidated by his boss comes home and unloads inappropriate hostility onto his children.

Rationalization

Manufacturing “good” reasons to explain away a bruised ego.

Rationalization helps justify specific behaviors, and it aids in softening the blow connected with disappointments. When people do not get positions they have applied for in their work, they think of logical reasons they did not succeed, and they sometimes attempt to convince themselves that they really did not want the position anyway.

Sublimation

Diverting sexual or aggressive energy into other channels.

Energy is usually diverted into socially acceptable and sometimes even admirable channels. For example, aggressive impulses can be channeled into athletic activities, so that the person finds a way of expressing aggressive feelings and, as an added bonus, is often praised.

Regression

Going back to an earlier phase of development when there were fewer demands.

In the face of severe stress or extreme challenge, individuals may attempt to cope with their anxiety by clinging to immature and inappropriate behaviors. For example, children who are frightened in school may indulge in infantile behavior such as weeping, excessive dependence, thumb-sucking, hiding, or clinging to the teacher.

Introjection

Taking in and “swallowing” the values and standards of others.

Positive forms of introjection include incorporation of parental values or the attributes and values of the therapist (assuming that these are not merely uncritically accepted). One negative example is that in concentration camps some of the prisoners dealt with overwhelming anxiety by accepting the values of the enemy through identification with the aggressor.

Identification

Identifying with successful causes, organizations, or people in the hope that you will be perceived as worthwhile.

Identification can enhance self-worth and protect one from a sense of being a failure. This is part of the developmental process by which children learn gender-role behaviors, but it can also be a defensive reaction when used by people who feel basically inferior.

Compensation

Masking perceived weaknesses or developing certain positive traits to make up for limitations.

This mechanism can have direct adjustive value, and it can also be an attempt by the person to say “Don’t see the ways in which I am inferior, but see me in my accomplishments.”

The Freudian view of human nature is basically

deterministic

According to Freud, our behavior is determined by irrational forces, unconscious motivations, and biological and instinctual drives as these evolve through

key psychosexual stages in the first six years of life

What is the goal of life according to Freud?

gaining pleasure and avoiding pain

____ are central to the Freudian approach

instincts

libido

the energy of all the life instincts

life instincts

serve the purpose of the survival of the individual and the human race; they are oriented toward growth, development, and creativity

death instincts

account for the aggressive drive

The id

roughly all the untamed drives or impulses that might be likened to the biological component

The ego

attempts to organize and mediate between the id and the reality of dangers posed by the id’s impulses

superego

the internalized social component, largely rooted in what the person imagines to be the expectations of parental figures

From the orthodox Freudian perspective, humans are viewed as

energy systems

The dynamics of personality consist of the ways in which

psychic energy is distributed to the id, ego, and superego

Because the amount of energy is limited, one system….

gains control over the available energy at the expense of the other two systems

The id

the original system of personality

at birth a person is all ___

id

pleasure principle

aimed at reducing tension, avoiding pain, and gaining pleasure

The id never matures, remaining the _____ ______ of personality

spoiled brat

The id is largely _____

unconscious, or out of awareness

The ego has contact with the….

external world of reality

The Ego

It is the “executive” that governs, controls, and regulates the personality

the reality principle

what the ego is ruled by

the ego

the seat of intelligence and rationality

The superego is the ___ _____ of personality

judicial branch

The Superego

It includes a person’s moral code, the main concern being whether an action is good or bad, right or wrong.

The unconscious

stores all experiences, memories, and repressed material

The aim of psychoanalytic therapy is

to make the unconscious motives conscious

anxiety

a feeling of dread that results from repressed feelings, memories, desires, and experiences that emerge to the surface of awareness

reality anxiety

the fear of danger from the external world, and the level of such anxiety is proportionate to the degree of real threat.

neurotic anxiety

the fear that the instincts will get out of hand and cause the person to do something for which she or he will be punished

Moral anxiety

the fear of one’s own conscience. People with a well-developed conscience tend to feel guilty when they do something contrary to their moral code.

ego-defense mechanisms

help the individual cope with anxiety and prevent the ego from being overwhelmed

psychosexual stages

the Freudian chronological phases of development, beginning in infancy

the oral stage

First stage; deals with the inability to trust oneself and others, resulting in the fear of loving and forming close relationships and low self-esteem.

the anal stage

second stage; deals with the inability to recognize and express anger, leading to the denial of one’s own power as a person and the lack of a sense of autonomy.

the phallic stage

third stage; deals with the inability to fully accept one’s sexuality and sexual feelings, and also to difficulty in accepting oneself as a man or woman.

The psychosocial stages

Erikson’s basic psychological and social tasks, which individuals need to master at intervals from infancy through old age.

a crisis

equivalent to a turning point in life when we have the potential to move forward or to regress

classical psychoanalysis

grounded on id psychology; holds that instincts and intrapsychic conflicts are the basic factors shaping personality development (both normal and abnormal)

contemporary psychoanalysis

tends to be based on ego psychology

ego psychology

does not deny the role of intrapsychic conflicts but emphasizes the striving of the ego for mastery and competence throughout the human life span

Infancy: Trust versus mistrust

If significant others provide for basic physical and emotional needs, infant develops a sense of trust. If basic needs are not met, an attitude of mistrust toward the world, especially toward interpersonal relationships, is the result.

Early childhood: Autonomy versus shame and doubt

A time for developing autonomy. Basic struggle is between a sense of self-reliance and a sense of self-doubt. Child needs to explore and experiment, to make mistakes, and to test limits. If parents promote dependency, child’s autonomy is inhibited and capacity to deal with world successfully is hampered.

Preschool age: Initiative versus guilt

Basic task is to achieve a sense of competence and initiative. If children are given freedom to select personally meaningful activities, they tend to develop a positive view of self and follow through with their projects. If they are not allowed to make their own decisions, they tend to develop guilt over taking initiative. They then refrain from taking an active stance and allow others to choose for them.

School age: Industry versus inferiority

Child needs to expand understanding of world, continue to develop appropriate gender-role identity, and learn the basic skills required for school success. Basic task is to achieve a sense of industry, which refers to setting and attaining personal goals. Failure to do so results in a sense of inadequacy.

Adolescence: Identity versus role confusion

A time of transition between childhood and adulthood. A time for testing limits, for breaking dependent ties, and for establishing a new identity. Major conflicts center on clarification of self-identity, life goals, and life’s meaning. Failure to achieve a sense of identity results in role confusion

Young adulthood: Intimacy versus isolation

Developmental task at this time is to form intimate relationships. Failure to achieve intimacy can lead to alienation and isolation.

Middle age: Generativity versus stagnation.

There is a need to go beyond self and family and be involved in helping the next generation. This is a time of adjusting to the discrepancy between one’s dream and one’s actual accomplishments. Failure to achieve a sense of productivity often leads to psychological stagnation.

Later life Integrity versus despair

If one looks back on life with few regrets and feels personally worthwhile, ego integrity results. Failure to achieve ego integrity can lead to feelings of despair, hopelessness, guilt, resentment, and self-rejection.

The ultimate goal of psychoanalytic treatment is to

increase adaptive functioning, which involves the reduction of symptoms and the resolution of conflicts

Two goals of Freudian psychoanalytic therapy are to:

(1) make the unconscious conscious

(2) to strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt

the “blank-screen” approach

They avoid self-disclosure and maintain a sense of neutrality

transference relationship

their clients will make projections onto them.

How do Freudian therapists foster a transference relationship?

By the “blank-screen” approach

free association

saying whatever comes to mind without self-censorship

Psychodynamic therapy

emerged as a way of shortening and simplifying the lengthy process of classical psychoanalysis

transference

the client’s unconscious shifting to the analyst of feelings, attitudes, and fantasies (both positive and negative) that are reactions to significant others in the client’s past

the working-through process

consists of repetitive and elaborate explorations of unconscious material and defenses, most of which originated in early childhood.

countertransference

viewed as a phenomenon that occurs when there is inappropriate affect, when therapists respond in irrational ways, or when they lose their objectivity in a relationship because their own conflicts are triggered

The six basic techniques of psychoanalytic therapy

(1) maintaining the analytic framework

(2) free association

(3) interpretation

(4) dream analysis

(5) analysis of resistance

(6) analysis of transference

Maintaining the analytic framework

A whole range of procedural and stylistic factors, such as the analyst’s relative anonymity, maintaining neutrality and objectivity, the regularity and consistency of meetings, starting and ending the sessions on time, clarity on fees, and basic boundary issues such as the avoidance of advice giving or imposition of the therapist’s values

free association

clients are encouraged to say whatever comes to mind, regardless of how painful, silly, trivial, illogical, or irrelevant it may seem

interpretation

consists of the analyst’s pointing out, explaining, and even teaching the client the meanings of behavior that is manifested in dreams, free association, resistances, defenses, and the therapeutic relationship itself.

Dream analysis

an important procedure for uncovering unconscious material and giving the client insight into some areas of unresolved problems

Latent content

consists of hidden, symbolic, and unconscious motives, wishes, and fears

manifest content

the dream as it appears to the dreamer

dream work

The process by which the latent content of a dream is transformed into the less threatening manifest content

resistance

anything that works against the progress of therapy and prevents the client from producing previously unconscious material

Jung’s analytical psychology

an elaborate explanation of human nature that combines ideas from history, mythology, anthropology, and religion

individuation

the harmonious integration of the conscious and unconscious aspects of personality

shadow

our dark side; primitive impulses such as selfishness and greed

collective unconscious

“the deepest and least accessible level of the psyche,” which contains the accumulation of inherited experiences of human and prehuman species

archetypes

The images of universal experiences contained in the collective unconscious

The persona

a mask, or public face, that we wear to protect ourselves

The animus and the anima

represent both the biological and psychological aspects of masculinity and femininity, which are thought to coexist in both sexes

The ____ has the deepest roots and is the most dangerous and powerful of the archetypes

shadow

ego psychology

part of classical psychoanalysis with the emphasis placed on the vocabulary of id, ego, and superego, and on Anna Freud’s identification of defense mechanisms

Object-relations theory

encompasses the work of a number of rather different psychoanalytic theorists who are especially concerned with investigating attachment and separation. Their emphasize is how our relationships with other people are affected by the way we have internalized our experiences of others and set up representations of others within ourselves.

self psychology

emphasizes how we use interpersonal relationships (self objects) to develop our own sense of self.

The relational model

based on the assumption that therapy is an interactive process between client and therapist

normal infantile autism

what Mahler calls the first three or four weeks of life

symbiosis

recognizable by the 3rd month and extends roughly through the 8th month. At this age the infant has a pronounced dependency on the mother. She (or the primary caregiver) is clearly a partner and not just an interchangeable part. The infant seems to expect a very high degree of emotional attunement with its mother.

The separation–individuation process

begins in the 4th or 5th month. During this time the child moves away from symbiotic forms of relating. The child experiences separation from significant others yet still turns to them for a sense of confirmation and comfort. The child may demonstrate ambivalence, torn between enjoying separate states of independence and dependence.

The narcissistic personality

characterized by a grandiose and exaggerated sense of self-importance and an exploitive attitude toward others, which serve the func- tion of masking a frail self-concept

borderline personality disorder

People with this have moved into the separation process but have been thwarted by parental rejection of their individuation. In other words, a crisis ensues when the child does develop beyond the stage of symbiosis, but the parents are unable to tolerate this beginning individuation and withdraw emotional support. Characterized by instability, irritability, self-destructive acts, impulsive anger, and extreme mood shifts. They typically experience extended periods of disillusionment, punctuated by occasional euphoria.

brief psychodynamic therapy (bPt)

Messer and Warren (2001)

This adaptation applies the principles of psychodynamic theory and therapy to treating selective disorders within a preestablished time limit of, generally, 10 to 25 sessions.