Week 6 Psychodynamic Approach

Theoretical Perspectives: Psychodynamic Approach by Dr. Wesam Darawsheh

Overview of the Content

  • Lecture Date: 2/11/2026

  • Course Code: OT 723 Theoretical Perspectives

  • Instructor: Dr. Wesam Darawsheh, OTR/L, BScOT, MScOT, PhD

    • Qualifications: 2018-2019 Fulbright Post-doc Research Grantee; 2020 Cordelia Myers Best Article Recipient

Lecture Objectives

  • Review: Understanding the fundamental principles of psychology.

  • Psychosocial Approaches:

    • Definition and purpose of these approaches.

    • Key characteristics of psychosocial approaches.

  • Psychodynamic Approach:

    • Core concepts.

    • Psychoanalytic theory introduction.

    • Developmental stages determined by psychodynamic theory.

    • Description of psychological forces at work.

    • Explanation of defense mechanisms, including definitions, examples, and practical exercises.

    • Defense mechanisms:

      • Denial

      • Sublimation

      • Suppression

      • Displacement

      • Regression

      • Reaction Formation

      • Repression

      • Somatization

      • Projection

      • Introjection

  • Applications in Occupational Therapy (OT):

    • Methods for assessment and intervention.

    • Considerations of focus, dimensions, actions, and expected outcomes.

    • Various intervention tools and techniques described.

Review of Psychology

  • Defining Psychology: A branch of science focused on understanding the mind and behavior.

  • Call to Action: "Behave!" - Invitation for engagement and reflection on personal experiences.

Psychosocial Approaches: Understanding Principles

  • Development of Approaches: Psychologists formulated specific approaches to provide insights into human behavior and mental processes.

  • Purpose of Psychosocial Approaches:

    • To offer various perspectives for interpreting social behavior.

    • Inspired by psychoanalytic theories by Freud and followers.

  • Florence Hollis's Perspective (1977):

    • "We can attempt to mobilize the strengths of the personality & the resources of the environment at strategic points to improve the opportunities available to the individual & to develop more effective personal & interpersonal functioning."

Characteristics of Psychosocial Approaches

  • Integrated Model: A comprehensive approach that combines multiple theoretical frameworks.

  • Key Realizations:

    • No singular approach adequately explains psychopathology.

    • Mental health disorders likely have multiple contributing factors.

    • The absence of a one-size-fits-all treatment method exists.

Considerations in Psychosocial Approaches

  • Temporal aspects of mental health:

    • Consider the individual before and after intervention.

    • Explore the mechanisms and effects of change.

Overview of Psychological Approaches

  • Categories of Psychological Approaches:

    • Humanistic

    • Psychodynamic

    • Neo-Freudian

    • Behavioral

    • Cognitive

Psychodynamic Approach Concepts

  • Foundation of Psychoanalysis: Developed by Sigmund Freud, highlighting the significance of childhood experiences in forming emotional and personality traits.

  • Role of the Unconscious:

    • All psychological functioning, including both normal and abnormal states, is influenced by unconscious factors.

Developmental Stages in Psychodynamics

  • Stages of Psychosexual Development:

    1. Oral Stage (0-1.5 years): Focus on feeding; fixation can lead to issues related to dependence.

    2. Anal Stage (1.5-3 years): Focus on toilet training; fixation can lead to obsession with order and cleanliness.

    3. Phallic Stage (3-6 years): Involvement with sexual identity development, including Oedipus and Electra complexes.

    4. Latency Stage (6-12 years): Suppression of sexual development in favor of learning and social experiences.

    5. Genital Stage (>12 years): Maturing sexual relationships and increased intimacy.

  • Fixation: A state where an individual becomes stuck in a particular psychosexual stage due to unsatisfaction, leading to maladaptive behaviors and relationships.

Freud's Concepts of Treatment

  • Psychoanalytic Treatment Key Principle:

    • Making unconscious conflicts conscious as the pathway to healing.

  • Techniques in Treatment:

    • Hypnosis: Inducing a heightened state of focus to access repressed thoughts.

    • Dream Analysis: Interpreting dreams to uncover unconscious motives and desires.

    • Transference: Redirecting feelings and desires from one person (often a caregiver) onto another (typically the therapist).

Psychological Forces in Psychodynamics

  • Three Forces Influencing Behavior:

    1. Id: Represents instinctual desires and drives, seeking immediate gratification without regard for consequences.

    2. Ego: Acts as the mediator, organizing thoughts, and making rational decisions to satisfy the id in a socially acceptable manner.

    3. Superego: Embodies moral standards and ideals, often creating feelings of guilt or inadequacy.

Examination of the Id, Ego, and Superego

  • Id Characteristics:

    • Seeks immediate pleasure and is not bound by reality.

    • Associated with primal instincts, especially sexual urges.

  • Ego's Role:

    • Balances between the id's desires and the superego's morality.

  • Superego's Function:

    • Develops through interactions with parents and society, nurturing conscience and ideals.

Defense Mechanisms in Psychodynamics

  • Definition: Unconscious strategies utilized by the ego to protect itself from anxiety arising from unacceptable id impulses.

Lists of Defense Mechanisms and Their Examples

  1. Denial: Refusal to accept reality.

    • Example: A person unable to acknowledge a diagnosis after an accident.

  2. Suppression: Diverting uncomfortable feelings into socially acceptable activities.

    • Example: Discussing positive topics during therapy following a traumatic event.

  3. Sublimation: Channeling negative emotions into acceptable forms.

    • Example: An angry individual participates in competitive sports.

  4. Regression: Reverting to earlier developmental behaviors under stress.

    • Example: An adult responding childishly when faced with challenges.

  5. Displacement: Transferring emotions from a threatening person to a less threatening target.

    • Example: A child yells at their sibling after an argument with a parent.

  6. Somatization: Conversion of psychological distress into physical symptoms.

    • Example: Chronic pain developing in an unhappy marriage.

  7. Repression: Unconscious blocking of painful memories.

    • Example: An adult with no recollection of child abuse.

  8. Reaction Formation: Opposition behavior to one’s true feelings.

    • Example: Showing kindness to someone resentful.

  9. Projection: Misattributing unacceptable feelings to others.

    • Example: A spouse accusing their partner of not listening.

  10. Introjection: Absorbing external sentiments as one’s own.

    • Example: A child adopting a parent's beliefs without scrutiny.

Transference Mechanisms

  • Transference: Unconscious transfer of feelings toward a person (e.g., therapist) based on past experiences with significant others (e.g., parents).

    • Negative Transference: Transfer of hostility or anger, as seen with clients who project unresolved issues on their therapists.

    • Positive Transference: The idealization of the therapist as a nurturing figure, based on past positive relationships.

Therapeutic Implications

  • Focus in Transference-focused Psychotherapy (TFP):

    • Changing patient perceptions of themselves in relational contexts, especially in cases of borderline personality disorder.

  • Countertransference: The therapist's emotional responses reflecting their own past experiences in response to the client’s relational dynamics.

Practical Applications in Occupational Therapy (OT)

  • Understanding Dysfunction: Viewed as deficiencies in ego functions primarily stemming from early psychosocial development issues.

  • Focus Areas in OT Intervention:

    • Enhancing self-identity and adaptive skills through therapeutic activities.

    • Recognizing and exploring interpersonal and intra-personal dynamics.

  • Outcome Goals:

    • Creating self-awareness, insight, and understanding behaviors within past experiences.

    • Implementing expressive activities to manage emotions and enhance relationships.

Intervention Tools and Techniques in OT

  • Creative Media Utilization: Inclusion of art therapies to facilitate emotional expression.

  • Pet Therapy: Using animal interactions for therapeutic benefits.

  • Trauma-Informed Care: Framing care around understanding the impact of trauma on individual clients.

  • Task-Oriented Groups: Group activities aimed at improving social skills and self-efficacy.

  • Mindfulness Practices: Incorporating awareness strategies that promote mental presence and emotional regulation.

Trauma-Informed Framework

  • Central Question in Trauma Context: "What happened to you?" versus "What is wrong with you?"

  • ACEs (Adverse Childhood Experiences): Understanding past traumas in guiding the therapeutic approach.