Pathology in Classic Psychoanalysis Flashcards
Around age ____ the ____ becomes complete
5; superego
The superego is divided into 2 parts:
- the conscience – the internalization of the punishments and the warnings
- the ego ideal – based on the rewards and positive models that person has encountered
The superego communicates its own requirements to the ____ through feelings of _____, ____, and ____
ego; shame; guilt; pride
On top of the demands of the ___, a person develops their own set of needs and wishes based on the ____
id; superego
The conflict between the ____ and the ____ must be resolved by the ____, which can lead it feeling _____
id; superego; ego; overwhelmed and threatened
The overwhelmed and threatened feeling of the ____ is where ____ comes from
ego; anxiety
To deal with threats, the ___ sometimes blocks these impulses or distorts them into more acceptable forms. These are ______
ego; defense mechanisms
Sometimes one turns to ___, ___, or ___ against themselves. This is how _____ occurs.
anger, hatred, aggression
hatred
Waelder’s (1960) theory of pathological anxiety
- Due to an inner conflict between impulse and ego
- Conflict has not been solved by suitable compromise (compromise formation), but has become unconscious through repression
- Repression has been unsuccessful and the repressed impulse has found its way back into conscious manifestations in disguised form
- Feelings, thoughts, actions, and impulses feel ego-alien
Adults affected by neurosis suffered from an _____ in childhood
(Auld, Hyman, & Rudzinski, 2005)
infantile neurosis
Infantile wish (Auld, Hyman, & Rudzinski, 2005)
pre-gential sexual wish
Childhood neurosis
Auld, Hyman, & Rudzinski, 2005
- Infantile wish is stimulated
- Child cant complete gratification of the wish because circumstances do not permit gratification of the wish and complete gratification is too frightening
- Child frustrated as a result
- Child’s develops defensive mental system to protect self against unbearable and intense stimulation
- Defense system and its repression reduces efficiency of child’s adaptation to the world
Defensive system serves to:
Auld, Hyman, & Rudzinski, 2005
(a) Express the infantile wish.
(b) Minimize the anxiety stirred by the wish.
(c) Maintain repression, which is necessary if anxiety is to be held in check.
Repression entails
Auld, Hyman, & Rudzinski, 2005
blocking of verbal systems (secondary process systems) of thought, less efficient modes of thinking are dominated by primary process systems
After repression, child is then left with
Auld, Hyman, & Rudzinski, 2005
less efficient way of thinking about problems, handicapped by repression, while struggling to solve personal problems, the child makes the same kinds of mistakes over and over (repetition compulsion)
Experience of childhood infantile neurosis can make one more susceptible to
(Auld, Hyman, & Rudzinski, 2005)
- the experience of neurosis during adulthood, because this defensive system is inefficient in giving adequate gratification
- While strength of repression is weakened, or the strength of drives is increased, result will be an adult neurosis
Neurosis is the result of
Auld, Hyman, & Rudzinski, 2005
weakened repression, and the return of the repressed
Symptoms are a compromise between
Auld, Hyman, & Rudzinski, 2005
-repressed strivings, now returning after being repressed in an unstable fashion, and the defensive forces that hold these strivings back
Although symptoms are not a complete failure of adaptation,
Auld, Hyman, & Rudzinski, 2005
- it’s the best one can do with the mental resources limited by repression. Symptoms are not very efficient compromises, offering too little drive gratification, with too much suffering and too great an expenditure of energy in the conflict between the drives and inhibiting forces
- Symptoms are unwanted and cause considerable suffering and thus are ego alien (ego-dystonic)
Depressive personality
Freud, 1950
- Over or under-indulgence at the oral phase of development (depressed, dependent, addictions)
- also Freud’s theory of real or perceived object loss with introjected object and anger/aggression turned inward with loss of self-esteem.
Obsessional personality
Freud, 1950
Over or under-indulgence at the anal phase of development (see issues of orderliness, neatness, perfectionism, control)
Hysterical personality
Freud, 1950
Rejection or over-stimulating seductiveness at the phallic/Oedipal phase of development.
Borderline personality
Not Freud: but separation-individuation (Mahler)
Transference
The Dynamics of Transference (Freud, 1912)
Observation on Transference Love (Freud, 1915)
- Positive Transference – attachment to the therapist, representing libidinal strivings of the client. Freud recommended that these kinds of transferences go untouched, unless they comprised “intense, infantile erotic strivings
- Negative Transference – the client’s inappropriate, angry feelings towards the therapist
- Love/Erotic Transference
5 Stages of Technique
(WICCA)
(Auld, Hyman, & Rudzinski, 2005)
Association
- Confrontation
- Clarification
- Interpretation
4. Construction - Working Through
5 Stages of Technique: Confrontation
(WICCA)
(Auld, Hyman, & Rudzinski, 2005)
presenting to the client what has become preconscious; it is simply calling attention to an action or utterance
5 Stages of Technique:
Clarification
(WICCA)
(Auld, Hyman, & Rudzinski, 2005)
a description of the basis on which the therapist perceives the operation of an unconscious process
5 Stages of Technique:
Interpretation
(WICCA)
(Auld, Hyman, & Rudzinski, 2005)
an intervention that makes what was unconscious, conscious. It is the labeling of a wish-defense complex in any of its aspects or layers.
–(4) Construction – a pattern of interpretations that extend over time and meetings, having to do with a segment of infantile neurosis. One interpretation builds on another. A coherent set of explanations about a realm of the clients’ behavior
5 Stages of Technique: Working Through
(WICCA)
(Auld, Hyman, & Rudzinski, 2005)
the interpretation of each aspect of a segment of the infantile neurosis. The client comes to recognize the impact of the neurotic conflict in many areas of life and in relationships with other people
Specific analytic techniques
dream interpretation, free association, analysis of parapraxes, interpretation of resistance/transference
Curative factors of psychoanalytic therapy
- Resolution of conflict
- understand unconscious conflicts
- Neutral stance
- Offering insight and interpretations
- understanding pleasure principle
- helping institute compromise formations
- allowing transference neuroses
- working through
Resolution of conflict
Freud believed the curative aspect of therapy was to undo the repression and make the unconscious conscious. This required examining and bringing to light core conflicts and resolving them.
Understanding unconscious conflicts
through free association, parapraxes (slips of tongue), dream interpretation, and interpretation of transference/countertransference (working alliance).
Neutral stance
equally hovering attention and was not to give in to gratification of the id strivings. It was believed that id urges would eventually emerge when not gratified.
Offer insight and interpretations
and use confrontation, clarification, and working through
-All these taken together help the patient understand their unconscious conflict, and pursuit of infantile strivings which cannot realistically be achieved.
Understanding pleasure principle
gives way to the reality principle and the patient learns to adopt more adaptive ways to meet demands of ego and superego.
Helping institute compromise formations
conflicts are not completely eliminated. Requires breaking down resistances
Allowing transference neurosis
(i.e. set of attitudes, affects, fantasies, and assumptions about the analyst that express central organizing themes and conflicts dating from their experiences as children) to develop and to resolve it
Auld, Hyman, & Rudzinski’s (2005) example of stages/ techniques of psychoanalytic psychotherapy
- Therapist makes interpretation, patient is driven by personal suffering to cooperate with therapist, verbalizing all thoughts freely leads to the undoing of repression, interpretations when the patient is resistant, warm relationship necessary to make the pain of self discovery bearable for the patient, interpretations often involve narcissistic injury
- Suffering caused by neurosis motivates the patient to cooperate with treatment in achieving the goals of therapy.
- As this is being done, the patient often shows resistance, mostly unconsciously, the patient acts in a way that is intended to prevent further self-discovery.
- The therapist calls attention to the resistance and informs the patient to the purpose that this resistance serves. By demonstrating this, the therapist enables the patient to consider whether this defense is still necessary (INTERPRETATION).
- As the patient tries to cooperate, becoming more involved in the treatment, TRANSFERENCE occurs. Reactions inappropriate to what the therapist has done and said, where the patient’s actions and feelings earlier in his life toward parents and others are determining the patient’s current actions.
- Transference forms the focus for the most important resistances, and reveals all of the important unconscious attitudes of the patient.
- When the vital unconscious conflicts become focused on the therapist, a result that’s achieved gradually through the course of treatment is called the TRANSFERENCE NEUROSIS
Transference neurosis does not exist until all of the unconscious conflicts are expressing themselves through the transference. Explain the 7 steps Auld, Hyman, & Rudzinski, 2005) propose
(1) Repressions are undone by helping the patient make what has previously been unconscious, now conscious.
(2) Therapist helps through making interpretations, as the patient is driven by personal suffering to cooperate with the therapist.
(3) Patient is instructed to verbalize all thoughts freely, a process which, if carried out fully, is bound to bring about the undoing of repressions.
(4) As the patient tries to speak freely, resistances arise, but because of the established relationships and the warn atmosphere of therapy, the therapist can begin to make interpretations of the resistance.
(5) The warm relationship is needed to make the pain of self-discovery bearable for the patient, as it is the necessary context for the interpretive actions of the therapist.
(6) The warmth is necessary because the interpretations involve some narcissistic injury to the patient.
(7) In sum, the therapist listens to the patient with friendly interest, acceptance, lack of condemnation, and with an active attempt to understanding the meaning of the patient’s communications. Therapist is alert to communications that express the patient’s unconscious wishes and fears. Such communications are indirect because of the anxiety attached to the unconscious motives. Therapist responds appropriately in a timely fashion to make patient aware of the patient’s communications and the feelings that underlie them.
Goals of psychoanalytic therapy
Auld, Hyman, & Rudzinski (2005)
- Aim to enable patient to behave more adaptively through undoing repression
- Ego modified, enlarged, and made capable of dealing with conflicts it formerly repressed
- Greater ego capacity is reflected in increased mastery of live actions, emotions, greater employment of rational thinking and increased self-understanding
- These changes lead to greater happiness, more efficient adaptation, and abolishment of symptoms
Goals of psychoanalytic therapy
Freud, 1926
- Restore adaptive functioning by undoing repression in order to allow the patient to attempt a new resolution of the conflict
- Once the repression has been undone, the patient can decide whether to renounce gratification, allow it, or try some combination of the two, and to modify the kind of gratification one will attempt
8 Goals for psychoanalytic therapy
“EACH DICE”
(Freud, 1923)
-Ego Strength: Look at a person’s repressions and defensive functioning and bring about a strengthening of the ego; client is better able to perceive and adapt to reality without distorting it no matter how painful
-Adaptation: Give up old costly ways of functioning for more adaptive ways of coping and more highly functioning defenses, relate to circumstances more constructively. Deal with reality unconscious to conscious
-Common: obtain a common understanding about what problems and treatment goals are
Hopefulness: Achieve a sense of hopefulness that individual can make changes and things will be better
-Defenses: Help them use more mature defense functioning, or use old defenses less rigidly
-Identification: Goal is to identify with therapist to facilitate the mechanism of treatment and to reach goal, to develop these new ego functions and internalize them so patient can do it themselves
-Consciousness: make the unconscious, conscious.
-Energy: Help person save/conserve mental energy that they are expending on psychological conflict
Goals of psychoanalytic psychotherapy - Contemporary
McWilliams (1994)
- First five sessions: explore and come to psychodynamic formulation of the nature of the problem, come to agreement about the problem, illicit curiosity and hopefulness.
- Examine and explore resistances – Interpretation of transference: Through confrontation, clarification, interpretation, and working through, pt. can begin to develop a more enhanced level of functioning.
- Encourage pt. to use free association as well as dream analysis to uncover unconscious material
- Therapy with neurotic patients - Weaken defenses and get access to id to release those energies for more constructive activity.
- Therapy with psychotic and borderline patients – more supportive
- Strengthen defenses
- Encourage reality testing
- Push id into unconscious
- Lessen stress
Results of Psychoanalytic Therapy
Auld, Hyman, & Rudzinski (2005)
- When the ego has been restored and extended, the person can get more satisfaction
- More adequate satisfaction, including more adequate sexual satisfaction
- Structural change in ego brings lasting relief in person via capacity to deal with new increases in tension and to find ways of either gratifying drives or renouncing gratification
- Increased ability to pursue work and play
Working with the Analysand
Freud, 1923
- How to explain the therapeutic process to the patient
- First few sessions to assess and do formulations, discuss goals and treatment
- Process of becoming curious about the self, exploring the past as to better understand the present
- Use of free association and therapy to allow the expression of things not fully aware of yet intimately connected to issues
- Place of experience issues with therapist and work these through in a caring, supportive environment
