Lecture 4: Psychodynamic Perspectives Flashcards
1
Q
Myths about psychanalysis
A
- Psychoanalysis is the work of one man
- Contemporary psychoanalysis is the same as it was in Freud’s day
- Psychoanalysis has gone out of fashion
- There is NO evidence for psychoanalysis
2
Q
The American Psychological Association says…
A
- Psychodynamic theory is highly effective
- The benefits are at least as large as those of other psychotherapies and they last
- Benefits of the therapy grow after treatment has ended
- Lasting benefits through self-knowledge
3
Q
The Lancet Psychiatry 2015 (Leichsenring et al. 2015)
A
- Identified 64 randomised controlled trials that provide evidence for efficacy of PDT in common mental health disorders
- “Suggest PDT is as efficacious as treatments established in efficacy”
4
Q
And…
A
- “Still the most coherent and intellectually satisfying view of the mind” (Kandel)
- Resists being drawn into the ‘quick fix’ mentality governed by economic concerns
- Asserts a continuity between normal & ‘abnormal’ behaviour
- Goes beyond symptom removal to dev. of positive capacities + relationships
5
Q
Origins of Psychoanalysis
A
- Freud (1856-1939) a neurologist in Vienna
- Since then, there have been thousands of academic + clinical papers written in this area and dev. of many of related theories + approaches (including contemporary versions)
6
Q
The unconscious
A
- We commonly experience a ‘divided self’ e.g. “I expect more of myself”
7
Q
The topographical model
A
- The conscious = that which we know
- The preconscious = that which we can bring to mind
- The unconscious = that which we do not know
= feelings/thoughts that we are unaware of
= actively represeed into unconscious
= continue to influence us without our awareness
8
Q
The topographical model (cont.)
A
- Conscious is just the tip of the iceberg
- We ‘know’ the unconscious through…
1) Dreams = the royal road to the unconscious (manifest + latent content)
2) Slips of the tongue (Freudian slips) = parapraxes
3) Symptoms e.g. compulsive hand washing reveals an unconscious fear of being contaminated
4) Art & play
9
Q
Implications of unconscious for therapy
A
- Encourage ‘free association’ = open talking space
- Listening below the surface for unconscious meaning
- Explore possible meanings with patient through questioning
- Use interpretations to develop insight about unconscious motives
- Insight brings catharsis & relief
- Awareness allows possibility of choice & change
10
Q
The ID, Ego and Superego (the structural model)
A
- ID = contains primitive drives (sexual + aggressive)
= Operates according to the ‘Pleasure Principle’ - Ego = mediates between other parts of mind & external world
= Operates according to the ‘Reality Principle’ - Superego = develops last & helps us to negotiate the moral demands of society
= Operates according to the ‘Morality Principle’ - Results in conflict = unacceptable feelings/thoughts are held back from consciousness
11
Q
Defences
A
- Unconscious conflict causes anxiety and we respond by shoring up the ego’s defences against unconscious material emerging into consciousness
- Sometimes the anxiety comes out anyway and sometimes these defences create other problems for the person
12
Q
Types of Defences
A
1) Denial = avoids anxiety by refusing to acknowledge an aspect of external reality
2) Projection = attributes unacceptable feelings to others
3) Displacement = directs impulses towards a more appropriate target
4) Reaction formation = acts in exact opposite way of impulse he/she is afraid to acknowledge
5) Intellectualisation = overly rational response aimed at distancing
6) Sublimation = expresses unacceptable wishes in socially acceptable ways
13
Q
Implications of defences for PDT
A
- Resistance to therapy
- Set up a ‘working alliance’ with client (against stuff that is hard to get to)
- Work close to what client can tolerate
- Recognise & point out defences used in therapy
- Allow time to ‘work through’ issues
14
Q
The role of development & childhood experience
A
- Person’s past helps to create their particular sets of unconscious associations (phantasy) e.g. being an unplanned pregnancy
- Personal history gives clues about what experiences may have been seen as painful/difficult
- Events are seen & experienced through eyes of a child - at a particular developmental level
15
Q
Children’s phantasis
A
“My parents are the world”
16
Q
Repetition of relationship patterns (transference)
A
- Most powerful childhood experiences are those that occurs in our primary relationships
- These relationship experiences create ‘blueprints’ for later relationships
- Relationship patterns may be functional/dysfunctional
17
Q
Implications of development for psychdynamic therapy
A
- Find out about past history
- Determine whether there are unconscious anxieties related to particular developmental levels
- Explore relationship patterns
- Transference: the transfer & repetition of early relationships in the therapy relationship
- Therapists own early relationships also influence the way they relate to a client - ‘counter-transference’
18
Q
How does psychoanalysis explain the development of psychological problems?
A
- A ‘divided self’ creates the potential for conflict which in turn creates anxiety
- Conflicts are shaped by interaction of childhood experiences and our developmental needs
- Defence mechanisms try to push away conflicts & deal with anxiety but sometimes creates further problems
- We end up with patterns of behaviour, thought and feelings which are unconsciously motivates and we do not fully understand
19
Q
How does psychodynamic therapy work?
A
- Encourage free association to get access to unconscious material
- Use the transference to understand unconscious relationship patterns as they are expressed in therapy relationship
- Use interpretation & questioning to generate insight into the source of unconscious anxiety
- Make the unconscious conscious - create freedom + choice
20
Q
More recent therapies
A
- Target present relationships (in therapy + outside) - rather than past relationships
- Briefer and more focussed on a particular problem e.g. loss
- More active therapist (e.g. Inter-Personal Therapy)
21
Q
Critiques
A
- Early reliance of case study method (also its strength)
- Theory untestable - concepts too abstract
- Theory is unfalsifiable
- Some say limited evidence of treatment efficacy - but this is debatable
- Debate on whether psychoanalysis has a place in modern mental health care
