Psychodynamic Principles

Question 1

describe unconscious motivation

Answer 1

• most human behavior is determined by forces that lie outside our awareness
• our true motivations are irrational, biologically-based drives, such as sex and aggression which are unacceptable to our society
• these drives push for satisfaction but are actively excluded from consciousness
• such unconscious conflict determines our behavior

Question 2

describe Freud’s topographic model

Answer 2

the unconscious is inaccessible to us

Question 3

_____ are critical as most conflict occurs during this period

Answer 3

early childhood experiences are critical as most conflict occurs during this period

• according to Freud, those drives and basic needs not satisfied in childhood continue to influence our adult behavior

Question 4

describe the goal of psychoanalysis

Answer 4

• psychoanalysis aims to help patient become conscious of such unconscious material
  
  • such insight leads to healing

Question 5

describe the id

Answer 5

• the deepest part of the unconscious mind
  
  • primitive, instinctual, animalistic
• source of all energy needed to run the mind
• comprised of biological drives, such as sex and aggression and repressed personal memories
• also includes biological urges for food, water, sex, warmth and elimination
  
  • Freud referred to such drives as the libido (life energy)

Question 6

the id is ____ and doesn’t differentiate well between ____ and ____

Answer 6

the id is illogical and doesn’t differentiate well between fantasy and reality

Question 7

the id operates according to the ____; it seeks pleasure and _______ and avoids _____, regardless of reality

Answer 7

the id operates according to the pleasure principle; it seeks pleasure and immediate gratification and avoids pain, regardless of reality

the drives of the id continually press for satisfaction and it is the job of the ego to somehow satisfy them in accordance with reality and societal dictates

Question 8

describe the ego

Answer 8

• forms in first year of life
• tasked with satisfying the id’s desires but doing so in a realistic and morally acceptable manner
• the ego operates according to the “reality principle”–engaging with the world using logic, reason, language and problem solving

Question 9

describe the superego

Answer 9

• one’s “conscience”
• consists of the internalized beliefs, values and morals of one’s culture, family and religion
• these values are commonly in conflict with the primal biological urges of the id
• again, it is the job of the ego to mediate this conflict–to satisfy the id in a morally acceptable manner

Question 10

describe repression (defense mechanism)

Answer 10

• blocking or eliminating painful or threatening impulses or memories from consciousness
  
  • such disturbing material is somehow unacceptable to our view of who we are
  • one of the most primitive defenses in terms of distorting reality–often seen in other defenses
    
    • a child sexually assaulted by a parent later has no memory of the incident, but has trouble forming intimate relationships
  • psychoanalysis seeks to recover such content from the unconscious

Question 11

describe denial (defense mechanism)

Answer 11

• refusing to acknowledge some clear feature of reality because it is too painful or upsetting
  
  • bad news: after receiving terminal diagnosis or undergoing triple bypass, patient continues life as though nothing has happened
  • child abuse: abused child insists to social worker she is being treated well by parents
  • substance abuse: denial by patient of extent of problem and inability to control it
  • grieving: a way of coping with devastating loss of a loved one

Question 12

describe projection (defense mechanism)

Answer 12

• attributing one’s own unacceptable thoughts or feelings to others
  
  • an MD sexually attracted to a patient is convinced without evidence that it is actually the patient who is attracted to him
  • a man has unacknowledged feelings of hatred toward those of another ethnicity but is convinced it is them who hate him

Question 13

describe splitting (defense mechanism)

Answer 13

• tending to perceive people and the world as either all good or all bad
  
  • “this doctor is simply fabulous, that one totally incompetent”
  • “this spiritual tradition is the only true path”
  • seen in borderline personality disorder–patient may idealize someone one minute and hate them the next

Question 14

describe regression (defense mechanism)

Answer 14

• returning to a more infantile pattern of behavior when confronted with stessful situations or unacceptable thoughts/feelings
  
  • common when people are ill, afraid, stressed or simply socially uncomfortable
  • a hospitalized adult becomes tearful and demanding
  • a 4-yr old child returns to crawling following birth of sibling

Question 15

describe raltionalization (defense mechanism)

Answer 15

• self-serving “rational” explanations are used to justify behavior, attitudes or beliefs that are not otherwise acceptable
  
  • used to alleviate guilt and shame–helps us feel OK about doing something harmful or self-serving
  • “yes, killing is wrong, but he deserved it”
  • “I cheated on my income taxes, but everyone does”

Question 16

describe displacement (defense mechanism)

Answer 16

• re-directing an emotion or impulse from its original target to a more acceptable one
  
  • a resident gets yelled at by her attending but is not comfortable yelling back, so she shouts at the 3rd year medical student she is supervising

Question 17

describe passive-aggression (defense mechanism)

Answer 17

• the indirect expression of hostility, such as through procrastination, sullenness, obstructionist resistance or purposeful inefficiency
  
  • common in work and interpersonal situations as a reaction to demands by authority figures
  • a physician doesn’t answer direct questions from a patient whom she finds annoying
  • a patient is kept waiting is sullen and uncommunicative during the medical interview
  • often used by borderline personality patients and young children

Question 18

describe reaction formation (defense mechanism)

Answer 18

• an unacceptable impulse is transformed into its opposite
  
  • a teenage boy from a strict religious background is aroused by sexually explicit images but not able to acknowledge this to himself. He responds by organizing an “anti-pornography” group at school
  • two adolescents fight and insult each other constantly but are actually quite attracted to each other

Question 19

desccribe intellecutalization (defense mechanism)

Answer 19

• dealing with uncomfortable emotions by focusing on facts and logic while ignoring the emotional aspects
  
  • medical jargon: using complex terminology to focus on words and definitions rather than emotions
  • a newly diagnosed patient uses terms like “survival curves” rather than dealing with her emotions
  • doctor joins in, using terms such as “carcinoma” rather than “cancer” and “terminal” rather than “fatal”

Question 20

describe acting out (defense mechanism)

Answer 20

• a behavioral or emotional outburst to cover up feelings of fear or inadequacy
  
  • a child neglected at home begins to set fires
  • the adolescent who gets into fights and abuses drugs in order to mask feelings of inadequacy
  • a teenage girl beings pattern of binge eating in resposne to feelings of low self-worth
  • also seen in borderline and antisocial personality disorders

Question 21

describe isolation of effect (defense mechanism)

Answer 21

• separating an idea or event from its emotional component
  
  • a patient who has been raped describes the event to her physician without any display of emotion

Question 22

describe undoing (defense mechanism)

Answer 22

• performing the “reverse” of a previously performed unacceptable behavior in order to “undo” or atone for that behavior
  
  • man who feels guilty because he has cheated on his wife buys her a nice bottle of perfume
  • may have a superstitious quality (in some religions)

Question 23

describe somatization (defense mechanism)

Answer 23

• the re-channeling of repressed emotions into somatic symptoms
  
  • feelings are expressed as bodily symptoms as opposed to psychological anxiety/distress
  • may be diagnosed as a disorder such as a psychophysiological or somatic symptom disorder

Question 24

describe dissociation (defense mechanism)

Answer 24

• separates the self from the full impact of one’s experience–removes one from unpleasant reality
  
  • “it’s like I wasn’t even there–just watching a movie of it all”
  • a man in a motorcycle accident says it “seemed unreal–like it was all happening in slow motion”
• in more extreme cases, may be diagnosed as one of the DSM disorders

Question 25

describe sublimation (defense mechanism)

Answer 25

• channeling an unacceptable impulse into a socially-acceptable undertaking
• referred to as one of the “mature” defenses–socially acceptable–distorts reality to lesser extent
  
  • a man becomes very angry with his boss but instead of lashing out he goes to the gym and vigorously works out
  • a med student with a strong aggression drive becomes a surgeon

Question 26

describe suppression (defense mechanism)

Answer 26

• conscious decision to postpone attention to an upsetting or otherwise unpleasant life situation
  
  • a conscious coping strategy
  • a terminally ill patient decides simply not to think of her prognosis during the holiday season

Question 27

describe identification (defense mechanism)

Answer 27

• feelings of low self-worth are dealt with by identifying with someone of higher status or power
  
  • a person changing social circles or relocating to a new country, adopts the behaviors, values or attitudes of those in the new setting in order to fit in
  • without being aware of it, a medical student begins to dress and act like his attending when interacting with patients on the ward
  • identification with the aggressor: if you are afraid of someone you can deal with the fear by identifying with that person

Question 28

describe humor (defense mechanism)

Answer 28

• allows for the expression of thoughts and feelings without discomfort (which might otherwise be uncomfortable or inappropriate)
  
  • focusing on funny aspects of a disturbing situation
  • joking about death in a situation where death may be imminent
  • a patient undergoing chemo loses his hair and jokes about being bald