Psychodynamics I and II

Question 1

Psychosexual stages:

Answer 1

1. Oral: Libido: Oral: Birth – 1 ½ years

–Sucking
–Dependent (p a r a d i s e!)
Adult “oral” traits: enjoy food, chew gum, smoke, drink: passive, dependent

2. Anal
   Libido->Anal: 1 ½ - 3 years
   Crawling, exploring
   “No!”
   Potty training (holding on, letting go)
   terrible twos (paradise lost!)
   Adult anal traits: neat, on time, correct, organized, careful with money, controlledFixation: Extra investment of libido in one phase
   Regression: reversion to earlier phase under stress
3. (Oedipal complex in boys; Electra complex in girls)Libido–> Phallic 3- 5/6 yrs

• ->curious about sex differences
• ->close to parent of opposite sex

4. Latency: Libido–> Latency: 6 yrs- adolescent
   - ->girl scouts/ boy scouts
5. Genital: Libido–>Genital: Adolescent/ Adult on…
   - ->capacity for true intimacy

Question 2

Structural hypothesis:

Answer 2

1. ID
   ID “Child”

from birth
fun, gratification

How do you hear it?
- “I want now!”

2. Superego
   Superego “Parent”
   from age 5 on
   Conscience; rules, morals, values
   Develops based on input from:
   -parents, teachers, religious authorities
   -Political authorities, societal norms, legal system
   How do we hear it?
   “Thou shalt not!” (Guilt+; dissolves in alcohol!)
3. Ego “Adult”
   growing, evolving “I”
   Purpose: deals with internal and external reality

Superego feeds on

Reality feeds on EGO –> “I will do…” –>personality
Id feeds on EGO

Question 3

Ego under stress:

Answer 3

Reality, Id, superego feed on EGO –>“ can’t deal with this” –>anxiety –> ego defense mechanisms
Purpose: decrease distress; make reality better

Question 4

Glossary of Defenses: Level I Psychotic Mechs

Answer 4

• -common in “healthy” individuals before age five
• -common in adult dreams and fantasy.
• -For the user, these mechanisms alter reality.
• -To the beholder, they appear “crazy”.

Question 5

1. Delusional projection:

Answer 5

Frank delusions about external reality, usually of a persecutory type.

perception of one’s feelings in another person and then acting on it (e.g., florid paranoid delusions)

perception of other people or their feelings literally inside oneself (e.g., agitated patient’s claim that “the devil is devouring my heart”).

Question 6

2. Psychotic denial:

Answer 6

Denial of external reality.

Eg., when a patient with psychosis says “I am Jesus Christ”, he is entirely denying the fact that he is John Williams.

Question 7

3. Distortion:

Answer 7

Grossly reshaping external reality to suit inner needs.

unrealistic megalomaniacal beliefs

hallucinations, wish-fulfilling delusions of delusional superiority or entitlement.

denial of personal responsibility for one’s own behavior.

Question 8

Level II: Immature mechs;

Answer 8

common in “healthy” individuals ages 3 to 15
Seen in personality disorders

For the user, alter distress due to the threat of interpersonal intimacy or its loss.
- To the beholder they appear socially undesirable.

Question 9

4. Projection:

Answer 9

Attributing one’s own unacknowledged feelings to others.

• includes severe prejudice, rejections of intimacy through unwarranted suspicion, marked hypervigilance to external danger, and injustice-collecting.
  Behavior may be eccentric and abrasive but within the “letter of the law.”
  –>paranoid personality

Question 10

5. Somatization:

Answer 10

Turning an unacceptable impulse or feeling eg from bereavement, loneliness, fear or anger
–>into complaints of pain, or somatic illness.

Permits the individual to belabor others with his own pain or discomfort in lieu of making direct demands upon them or in lieu of complaining that others have ignored his wishes (often unexpressed) to be dependent.
Eg: ‘My chest hurts” rather than “Please pay attention to me” or “Please care about me”
–>Hypochondriac; psychosomatic disorders

Question 11

6. Acting Out:

Answer 11

Direct expression of an unconscious wish or impulse in order to avoid being conscious of the affect that accompanies it.

Delinquent or impulsive act to avoid being aware of one’s feelings eg anger, sadness.

Includes chronic use of drugs, failure, perversion, or self-inflicted injury to relieve tension.

• Doing [eg punching] instead of thinking or feeling [eg I hate you]
  - ->Antisocial personality disorder

Question 12

7. Splitting

Answer 12

Seeing people and events as ALL good or ALL bad

Will quickly switch between these extreme positions
–>Borderline Personality Disorder

Question 13

Level III: Neurotic defenses:

Answer 13

common in “healthy” individuals ages 3- 90

in neurotic disorder, and in acute stress.

For the user, these alter private feelings or instinctual expression.

To the beholder, they are quirks or “hang-ups.”

Question 14

8. Denial

Answer 14

Unable to accept (and therefore seems to ignore/be unaware of/denies) intolerable facts about reality

The commonest defense seen in medical practice.

Question 15

9. Displacement

Answer 15

The redirection of feelings toward a relatively less cared for (less cathected) object than the person or situation arousing the feelings.

Eg., If angry at your boss but unable to say anything, you replace her by a thing (kick a chair) or a stranger (road rage)
–>Most phobias, many hysterical conversion reactions, and some prejudice involve displacement.

Question 16

10. Dissociation:

Answer 16

Temporary but drastic modification of one’s character or of one’s sense of personal identity to avoid emotional distress.

• ->Acute reaction to trauma
• ->Multiple Personality Disorder

Question 17

11. ID:

Answer 17

Unconscious patterning of one’s behavior after a powerful, influential person
Eg.,
Adopting the habits of a parent or coach
Behaviors/parenting style “runs in families”
Stockholm syndrome [‘identification with the aggressor’]

Question 18

12. Intellectualization:

Answer 18

Thinking about instinctual wishes in formal, affectively bland terms, and not acting on them. The idea is in consciousness, but the feeling is missing.

isolation, rationalization, ritual, un-doing, restitution, magical thinking, and “busywork”.

usually occur as a cluster.
–>Obsessive Compulsive disorder

Question 19

13. Isolation of Affect:

Answer 19

Intellectual knowledge and understanding of a negative event without experiencing the feelings

Question 20

14. Rationalization

Answer 20

Providing superficially reasonable accounts to explain away negative events, feelings, actions.

Question 21

15. Reaction Formation:

Answer 21

Behavior in a fashion diametrically opposed to an unacceptable instinctual impulse.

overtly caring for someone else when one wishes to be cared for oneself

“hating” someone or something one really likes

“loving” a hated rival or unpleasant duty.

Question 22

16. Regression:

Answer 22

Appearance of child-like behavior during periods of stress.

Seen in medical crises

When a sibling is born

Question 23

17. Undoing:

Answer 23

Protecting against a negative past event by acceptable “corrective” behavior eg superstitious rituals or formal atonement or confession.

Question 24

Level IV: Mature Mechs:

Answer 24

common in “healthy” individuals ages 12-90

For the user, they integrate reality, interpersonal relationships, and private feelings.

To the beholder they appear as convenient virtues.

Question 25

18. Altruism

Answer 25

Vicarious but constructive and instinctually gratifying service to others.

It includes benign and constructive reaction formation, philanthropy, and well-repaid service to others. Altruism differs from projection and acting out in that it provides real, not imaginary, benefit to others and from reaction formation in that it leaves the person using the defense at least partly gratified.

Question 26

Sublimation; it includes:

Answer 26

Indirect or attenuated expression of instincts without either adverse consequences or marked loss of pleasure.

expressing aggression through pleasurable games, sports, and hobbies

romantic attenuation of instinctual expression during a real courtship.

instincts are channeled rather than dammed or diverted. Successful artistic expression remains the classic example.

feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results.

Question 27

20. Anticipation:

Answer 27

Realistic anticipation of or planning for future inner discomfort.

Includes goal-directed but overly careful planning or worrying

• premature but realistic affective anticipation of death or surgery or separation

Question 28

21. Suppression:

Answer 28

The conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict.

Includes looking for silver linings, minimizing acknowledged discomfort, employing a stiff upper lip

• deliberately postponing but not avoiding. One says, “I will think about it tomorrow”; and the next day one remembers to think about it.

Question 29

22. Humor:

Answer 29

Overt expression of ideas and feelings without individual discomfort or immobilization and without unpleasant effect on others.

Some games and playful regression come under this heading.

• humor lets you call a spade a spade
• Like hope, humor permits one to bear and yet to focus upon what is too terrible to be borne

Question 30

Transference and Countertransference

Answer 30

Transference: Patient’s unconscious “transfer” and replay of relationship with influential figures from the past. More likely with physicians.

• Positive: eg.,Unrealistic expectations
• Negative: Mistrust, missed appointments, non-adherence, poor outcomes

Countertransference: The MD’s transference to the pt- Positive or Negative. Yes, behind our coats, we are just as human, prone to distorting!