Wk 3 - Psychoanalysis Flashcards
In the 1800s, neurology and pscychiatry were… (x1)
Making it the…(x2)
Same medical discipline
First period of biological psychiatry
o Post-mortem exams were common way to look at people with psych problems – brain/ventricle differences etc
What are the major tenets of Freudian psych? (x5)
Lack of empirical evidence – ideas not falsifiable/don’t lend to scientific method
Theories developed most when he was in therapy
Lots of introspection, dream analysis
Medical background/modelling
Linking childhood to current psych problems
Freud was trained in… (x2)
Influenced by his visit to…(b 1856) (x2) and
Dabbled in cocaine… (x3)
Trained in medicine and also experimental science –
Visited Charcot in Paris (1886) influenced by his work on hysteria and the use of hypnosis -
Patients into clinic, induced hypnosis, bring up psych material
Wrote landmark paper ‘on cocaine’ about usefulness for anaesthesia
Did a lot of experimental research in is vein – figured out later that it was holy addictive –
Used it himself too
Who was Anna O?
Treated by Breuer for severe cough, paralysis of the extremities on the right side of her body, disturbances of vision, hearing and speech, hallucinations and loss of consciousness.
• Diagnosed with hysteria
The beginning of psychoanalysis/free association - her conversations with Freud
Who was Burnt Pudding, and what was she ‘evidence’ for?
Woman molested by father, With smell of burnt pudding in background;
Later exposure to same smell brought on hysteria
Free association – unguided ramblings that revealed underlying conflicts over time –
Invariably, they all went back to adolescence and childhood
What was the context of Freud’s view of human nature? (x5)
Leading him to what two conclusions?
WWI atrocities - at its worst
o Pessimistic
o Deterministic
o Humans have instinctual urges that are innate; resulting from our evolutionary heritage
o Unconscious motivations
Your biological and environmental history determine your psych
Our behaviours can be understood as representations of repressed drives
What are the key concepts in psychoanalytic theory? (x6)
Instinct theory - Eros, Libido, Pleasure Principle, Death Drive
Topographic model - the Iceberg of conscious, preconscious, unconscious
Structural model of personality - Id, Ego, Superego and Inner conflict
Defense mechanisms
Theory of Psychosexual Development
Therapy - symptom formation and removal
What are the themes within the psychoanalytic concept of Instinct Theory? (x6)
Life instinct is Eros
Life energy in Libido
All instincts are innate and biological
Pleasure principle: humans driven by the desire to obtain pleasure and avoid pain
Death drive/’Thanatos’: opposite of Eros, why people d that which is painful
Repetition compulsion: the reenactment of trauma
What are the themes within the psychoanalytic concept of ‘the iceberg’? (x4)
Conscious mind is the tiny bit we’re aware of
Preconscious material can be accessed eg through questioning and exploring
Unconscious material can be inferred from behaviour,
How can we infer the unconscious, according to psychoanalysis? (x5)
Dreams – symbolic representations of our needs, wishes or conflicts
Slips of the tongue and forgetting something familiar
Post-hypnotic suggestion
Free-association techniques
Material derived from projective techniques
What three systems make up the psychoanalytic model of personality?
Which are all guided by…
Id - biological component
Ego - psychological
Superego - Social
Inner conflict
Describe the Id (biological component of our unconscious) (x5)
Primary process - the most basic primitive form, just survival and nurturance
At birth, we are all id - only need survival – fed, bathed
Need gratification - Wanting to feel comfortable, warm, soothed, not left in discomfort
Inability to tolerate tension or frustration
Driven by pleasure principle
Describe the Ego (psychological component of our unconscious) (x5)
Secondary process - attempts to satisfy Id impulses while preserving the person/moral goodness
(thinks about the consequences)
Has contact with the external world of reality
Regulates personality - mediates between instincts and surrounding environment
Reality principle: realistic thinking and planning
Describe the Superego (social componenet of our unconscious) (x5)
Our “conscience” Moral/judicial branch of personality Idealistic and moralistic Internalisation of societal standards Main concern is whether action is a good or bad/right or wrong
What do we mean by Inner conflict in psychoanalytic terms? (x3)
Anxiety/tension develops -conflict between the id, ego and superego
Expression = Symptoms (vomiting, phobias, hysteria, mourning and melancholia)
Freud identified 3 kinds of anxiety: neurotic, moral, and realistic.
What did Freud mean by ‘realistic anxiety’? (x1 plus eg x3)
Fear of things that could really harm the organism,
eg falling from a height; snakes and spiders etc
What did Freud mean by ‘neurotic anxiety’? (x2)
The fear of libido;
It’s a realistic anxiety because if the libidinal drives are expressed (eg seduce your married colleague and punch your boss) could result in harm to the organism
What did Freud mean by ‘moral anxiety’? (x2)
Fear of the punitive superego –
Ruminating on things you know you shouldn’t have done
What did Freud mean by ‘defense mechanisms’? (x4)
Automatic forms of response
Help cope with anxiety
Prevent feelings overwhelming
But distort reality so that actual wish does not enter consciousness
What is involved in the defense mechanism Repression? (x2)
Key one - shoving it back down under the water
“Forgetting” early childhood in which traumatic experiences occurred
What is involved in the defense mechanism Denial? (x2 thru eg)
eg in A&D treatment, stating that s/he has no problem with drinking, no more than the average person –
Can’t account for extent of use, or consequences for self and others
What is involved in the defense mechanism Reaction Formation? (x 1eg)
eg a mother who doesn’t experience loving feelings towards her child becomes overprotective and smothering
What is involved in the defense mechanism Projection? (x2 plus eg)
eg seeing traits in someone else that we don’t like to admit in ourselves –
Which then really irritate you,
eg they’re such a control freak
What is involved in the defense mechanism Displacement? (x3 thru eg)
eg man is angry towards his critical demanding boss and takes it out on his computer – Unable to let emotions out onto actual object that might bring adverse consequences,
Take it out on some other lesser object/person
What is involved in the defense mechanism Intellectualisation? (x1 thru eg)
eg justification of not getting a job you want and emphasising negative aspects of that job
What is involved in the defense mechanism Sublimation? (x1 thru eg)
eg taking aggressive drive out in sport or sexual energy into a creative pursuit
What is involved in the defense mechanism Regression? (X1 plus eg x2)
Retreating to an earlier stage of development that is less demanding –
eg a school child who is frightened may hide or suck her thumb;
When an adult is triggered by something that reminds of trauma
What is involved in the defense mechanism Identification? (x2 thru eg)
eg homophobic aggression in young man who rejects his own homosexual desires –
Identify with the aggressor to protect self from knowledge of own sexuality
What are the stages in psychoanalytic theory of psychosexual development?
Oral stage - first yr Anal stage - 1-3yo Phallic stage - 3-6yo Latency - 7-12yo Gentital phase - adolescence/maturity
What are the characteristics of the psychoanalytic Oral Stage? (x4)
Corresponds to sucking milk –
Nourishment and attachment, pleasure:
Responding when something is wrong,
Explore the world by shoving everything in their mouth
What are the characteristics of the psychoanalytic Anal Stage? (x3)
Corresponds to toilet training – lots of mistakes, success depends on child’s and parents reaction
Anal retentive – wouldn’t go when parents wanted them to: overly strict toilet training may result in characteristics like obsessively tidy
Anal expulsive - excessive reward/attention for toileting may = being overgenerous, messy and vague
What are the characteristics of the psychoanalytic Phallic Stage? (x4)
Focus of sexual gratification is genital =>
Very curious about bodies, differences, where babies come from, lots of jokes about body parts/functions.
Oedipal complex – boy wants attention, doesn’t want to compete with dad, fantasy of cutting dad out/getting mum to meet all needs
Electra is gender reversal
What are the characteristics of the psychoanalytic Latency Stage? (x2)
Engaged in what they can do, learn;
Joining peer groups, clubs etc
What are the characteristics of the psychoanalytic Genital Stage? (x2)
Finding out who you are,
orming new relationships
What are Erikson’s 8 stages of development?
moving on from sexual obsession of Freud’s…
Trust vs mistrust (oral) - being left to cry, go hungry, start to mistrust caregiver
Autonomy vs shame (anal) - trying to be independent, not gaining autonomy brings shame
Initiative vs guilt (phallic)
Industry vs inferiority (latency) - knowing whether you can do things as well as your peers
Identity vs role confusion (adolescence)
Intimacy vs isolation (young adulthood) – relationships, groups
Generativity vs stagnation (adulthood) – work and life goals
Ego integrity vs despair (older adulthood) – was my life meaningful
What did Freud say about Symptom formation? (x3)
Traumatic childhood experiences (neglect, overly/missing parents) =
Defense mechanisms and forgetting/supression =
Symptoms (hysteria, vomiting, depression)
What was critical about Freud’s view of childhood experiences? (x5)
Departure from biological psychiatry approach (cross sectional)
Longitudinal approach - events of childhood (attachment, trauma, loss) can influence:
• Personality development
• Current relationships
• Emotional vulnerabilities
What did Freud say about symptom removal? (x4)
Free association and dreams =
Recovery of forgotten material =
Awareness and interpretation of forgotten material (insight) =
Symptom removal
What are the therapeutic goals of psychoanalysis? (x3)
Increase awareness of unconscious material and foster…
Insight into behaviour and symptoms - originally thought to be everything, later not sufficient in itself
Strengthen ego – the reality based subsystem
What is the therapist’s roles in psychoanalysis? (x2)
Neutrality – therapist is a blank slate – no homework etc
Listening and interpretation - understand meaning of symptoms in order to resolve them
What characterises the client experience in psychoanalysis? (x2)
Intensive, long-term commitment – several times a week, possibly for years
Verbalising – patient responsibility to say what’s on their mind
What characterises the therapeutic relationship in psychoanalysis? (x2)
Working-through transference – re-creation of important outside relationships
Analyst and ego band together to form a stronger unit against the id and superego
What is free association? (x3)
Fundamental rule is for client to reveal everything that comes into his head, even if seems unimportant or nonsensical
Free association aims to uncover unconscious material that is typically blocked
• Nothing can be censored
What are Rorschach tests? (x3)
Lots of ambiguity that patient then interprets
Presumed to be coloured by unconscious…
New uses with validated coding for ink blots
What is the role of Interpretation in psychoanalysis? (x5)
Pointing out, explaining, teaching meanings of behaviour
Sharing understanding of central themes
Allow ego to assimilate new material
Accelerate process of uncovering unconscious material
Timing is important
What is the role of dream analysis in psychoanalysis? (x4)
Is it still used? (x1)
Uncover unconscious material
Insight into areas of unresolved conflict
Manifest vs latent content
Quite amusing because almost everything in the dream is interpreted as sexual
No - validity, testing issues
What is meant by resistance in psychoanalysis? (x2)
How might it manifest? (x4)
Anything that works against progress in therapy
Unconscious dynamic protecting against anxiety
o Missing sessions
o Lateness
o Not paying
o Anger or withdrawal on counsellor’s absence
What is transference in the context of psychoanalysis?
The core of the psychoanalytic process
Client will unconsciously transfer onto therapist qualities of significant others, esp parental figures
Cautiously, analyst interprets client’s behaviour/feelings -
Increase insight of influence of past on present functioning
What is the psychoanlaytic process of ‘working through’? (x1)
Repeated interpretation of transference
What is psychoanalystic countertransference? (x5)
Therapist reactions to client
Eg feelings of dislike toward controlling client; reminds him of his own mother.
• Interferes with therapist objectivity
Therapist may be meeting own needs through therapy relationship eg fostering dependency
Very important that therapist pays attention to own process
What are 5 major theoretical developments that stemmed from psychoanalysis?
Ego psychology (Anna Freud) Jungian Object relations (Melanie Klein) Self-psychology (Kohut) Relational psychology (Franzecki and Sullivan)
What is involved in Ego psychology? (offshoot of psychoanalysis) (x4)
Most closely associated with classical psychoanalysis
More emphasis on adaptive functions of the ego
i.e. ego function more central and less dependent on id/superego
Working with defence mechanisms to deal with ego
What is involved in Jungian psychology? (offshoot of psychoanalysis) (x4)
Personality typology – introversion, extroversion, sensing, feeling etc, as in Myers Briggs
Concept of balance e.g. animus & anima (male & female)
Collective unconscious e.g., archetypes such as hero
Similarities to person centred approaches (e.g. self-actualisation, unconditional positive regard)
What is involved in Object Relations psychology? (offshoot of psychoanalysis) (x3)
Rejection of sexual drive theory,
Emphasis on seeking objects – relations with objects (people)
External vs internal objects
What is involved in Self-psychology? (offshoot of psychoanalysis) (x3)
Self-object
Optimal frustrations & mirroring and idealizing important for development
Awareness, self-esteem, the object as the self
What is involved in Relational psychology? (offshoot of psychoanalysis) (x2)
Rejection of drive theory
Problems arise from lack of consistent experience of self and others
What is common to all psychoanalytic methods? (x5)
Unconscious processes – affect thinking and behaviour
Past experience – can help understand current difficulties
Themes and patterns in life – that we are often unaware of
Life as a series of stages
Relationships with significant others may be recreated with therapist
Why did short-term psychodynamic therapy develop? (x1)
What does it involve? (x7)
To compete with behavioural/cognitive
Still 16-30 sessions
Participatory ongoing dialogue
Date for termination is set
Therapists active: foster therapeutic alliance and positive transference
Focus on specific conflicts/themes
Recognition of patterns of interactions with others
Adherence to focus, achievable goals, termination issues
What client features relate to the success of short-term psychoanalysis? (x7)
Severity of disturbance
Motivation
Capacity to relate
Ego strength (ability to cope with stress – the unconscious material, the work being done)
Psychological mindedness
Focality of problem
Response to trial therapy – if responding after a couple of weeks, it’s encouraging to continue on
What are 5 key diffs between long- and short-term psychoanalysis?
Change in basic character vs symptom relief
Problems reflect basic pathology vs being focus of treatment
Timeless vs finite
Therapy is most important part of life vs being in world as more important
What features are more frequently observed in dynamic therapy over CBT? (x7)
Affect Resistance Identification of consistent patterns (relationships, feelings, behaviour) Past experiences Interpersonal experiences Therapeutic relationship Wishes, dreams, fantasies
What is the evidence base for long-term psychotherapy? (x5)
Not much for efficacy
Only uncontrolled case-studies, but these won’t turn up in Cochrane reviews -
Absence of manualised treatments
Personality disorders?
What is the evidence base for long-term psychotherapy? (x4)
STPP better than Wait-List and Treatment-as-usual, and comparable to other psychotherapy
Limitations: self-report only, definitions of psychotherapy, file drawer problem (1970-2004?)
• Same old issues of self-report, insight and honesty
• File drawer – not finding good results means you don’t publish
What disorders is psychoanalysis categorised as possibly/efficacious for? (x4)
Major depressive disorder
Panic disorder
BPD
Substance abuse
What are the major theoretical contributions of psychodynamic approches? (3)
Importance of person’s past experience to understanding current symptoms
Understanding of resistance
Understanding transference in therapeutic relationship
What are the major limitations of psychodynamic approaches? (x3, x2, x1)
Limited practical application
o Time commitment
o Financial commitment
Failure to address external factors
o All focus on subconscious, insight – misses things actually going on in life that may contribute to anxieties
Resistance to empirical validation
