Psychodynamic Approach

Dr. Manasi Kumar

Lecturer
Department of Psychiatry
 Freud’s Theories, in Context

• Freud was originally trained as a

Neurologist- biological approach to illness
• Treated mostly Hysteria (conversion
disorders)
• Applied findings from abnormal patients to
“normal” development
 Freud: A Sign of the Times?

• Time period: late 1800’s

• Victorian times: conservative, repressed
society
• Prohibitions against sex
 Key Contributions of Freud

• Psychic Determinism/ Dynamic Model

• Topographical Model of the Mind
– Unconscious, Preconscious, Conscious
• Stages of Psychosexual Development
• Structural Model of the Mind
• Defense Mechanisms
• Transference and Countertransference
 Basic Principles of
Psychodynamics

• Freud sees people as passive; behaviors

determined by interaction of external reality
and internal drives
• Psychic Determinism: all behaviors driven
by antecedent events, experiences. There
are no accidents; nothing happens by
chance
 Basic Principles

• Pleasure Principle: constant drive to reduce

tension thru expression of instinctual urges
• Mind is a dynamic (changing/active)
process based on the Pleasure Principle
 Basic Principles

• Libidinal (sexual, aggressive) instincts drive

people
– In children “libido” isn’t purely sexual, it’s
pleasure thru sensations (oral, anal gratification,
etc.)
• Behaviors result from conflicts:
– Between instinctual libidinal drives
(aggression, sex) and efforts to repress them
from consciousness)
 More Basic Principles

• The Cathartic Method

• Primary vs. Secondary Gain
• Transference and Countertransference
• Ego-Syntonic vs. Ego-Dystonic
 Cathartic Method

• Therapy benefits thru release of pent-up

tensions, “catharsis”
• Some inherent value in the “talking cure”-
being able to “unload”, or “get stuff off
your mind”
 Primary vs. Secondary Gain

• Primary Gain: symptoms serve a purpose:

they function to decrease intra-psychic
conflict and distress by keeping such
unpleasantries from conscious awareness
 Primary Gain: Examples:

• Comfort of being taken care of thru

assumption of the sick role
• Conversion Disorder- psychological conflict
is converted into physical symptom that
allows for more acceptable expression of an
unacceptable wish
 Secondary Gain

• Actual or external advantages that patients

gain from their symptoms, or from being ill:
– Relief from duties, responsibilities (work)
– Prescription drugs (ex. Opiates)
– Manipulation in relationships
– Deferring of legal proceedings, exams
– Food, shelter, money (financial gain)
 Transference

• Displacement (false attribution) of feelings,

attitudes, behavioral expectations and
attributes from important childhood
relationships to current ones
 Transference

• Traditionally refers to what the patient

projects onto the therapist, but applies to
other situations as well- ex. relationships in
general
• Aka “emotional baggage”
• Occurs unconsciously (person’s unaware
they’re doing it)
 Countertransference

• Feelings toward another are based on your

own past relationships/ experiences.
• Traditionally refers to the therapist
projecting their own feelings (“issues”,
“emotional baggage”) onto their patient
 Ego-syntonic vs. dystonic

• Neurotic symptoms are distressing to the

person, or ego-dystonic
– Vs.
• Character pathology, which is ego-syntonic;
patient doesn’t perceive as a problem; only
problematic in dealings with others/
external world
 Topographical Model

• Freud’s first model of psychopathology

• Division of the mind into three different
layers of consciousness:
– Unconscious
– Preconscious
– Conscious
 Unconscious

• Contains repressed thoughts and feelings

• Unconscious shows itself in:
– Dreams
– Parapraxes (Freudian slips)
• Driven by Primary Process Thinking
 Primary Process Thinking

• Not cause-effect; illogical; fantasy

• Only concern is immediate gratification
(drive satisfaction)
• Does not take reality into account
• Seen in dreams, during hypnosis, some
forms of psychosis, young children,
psychoanalytic psychotherapy
 Freudian Slips (Parapraxes)

• A “slip of the tongue”

• Errors of speech or hearing that reveal one’s
true but unconscious feelings
 Preconscious

• Accessible, but not immediately available

• Always running in the background/ behind
the scenes
 Conscious

• Fully and readily accessible

• Conscious mind does not have access to the
unconscious
• Utilizes Secondary Process Thinking:
– Reality-based (takes external reality into
consideration), logical, mature, time-oriented
 Psychosexual Development

• Children pass thru a series of age-dependent

stages during development
• Each stage has a designated “pleasure zone”
and “primary activity”
• Each stage requires resolution of a
particular conflict/task
 Psychosexual Stages

• Failure to successfully navigate a stage’s

particular conflict/ task is known as
Fixation
– Leaving some energy in a stage
• Specific problems result from Fixation,
depending on which stage is involved
– Fixation may result from environmental
disruption
 Psychosexual Stages

• Freud's stages are based on clinical

observations of his patients
• The Stages are:
– Oral
– Anal
– Phallic
– Latency
– Genital
 Oral Stage

• Birth to 18 months
– Pleasure Zone: Mouth
– Primary Activity: Nursing
– Fixation results in difficulties with trust,
attachment, commitment
– Fixation may also manifest as eating disorders,
smoking, drinking problems
 Anal Phase

• 18months- 2yrs
– Pleasure Zone: Anus
– Primary Activity: Toilet training
– Failure to produce on schedule arouses parental
disappointment
 Anal Phase

• 18months- 2yrs
– Parental disappointment, in turn, arouses
feelings in child of anger and aggression
towards caregivers, which are defended against
– Fixation may result in either:
• Anal retentiveness: perfectionism, obsessive-
compulsive tendencies
• Anal expulsive: sloppy, messy, disorganized
 Phallic (Oedipal) Phase

• Ages 3-6
– Pleasure Zone: Genitals
– Primary Activity: Genital fondling
– Must successfully navigate the Oedipal Conflict
 Oedipal Conflict

• Boys want to marry mom and kill father,

aka Oedipal Complex, but fear retaliation
from father (castration anxiety); ultimately
resolved thru identification with father
• Girls have penis envy, want to marry dad,
aka “Electra Complex”; identify with mom
to try to win dad’s love
 Phallic (Oedipal) Phase:

• Ages 3-6
– Resolution of the Oedipal Conflict results in
formation of the Superego
– Fixation results in attraction to unattainable
partners
 Latency Phase

• Ages 6-11
– Pleasure Zone: Sex drive is rerouted into
socialization and skills development
– Primary Activity: Same sex play; identification
of sex role
– Don’t like opposite sex (has “cooties”)
– Fixation results in lack of initiative, low self
esteem; environmental incompetence
 Genital Phase

• Ages 13- young adulthood

– Pleasure Zone: Genitals
– Primary Activity: Adult sexual relationships
– Fixation results in regression to an earlier stage,
lack of sense of self
 Structural (Tripartite) Theory

• Freud’s second model of the mind to

explain psychopathology
• Developed in the early 1900’s
 The ID

• Home of instinctual Drives

• “I want it and I want it NOW”
• Completely unconscious
• Present at birth
• Operates on the Pleasure Principle and
employs Primary Process Thinking
 To Review:

• Pleasure Principle: constant drive to reduce

tension thru expression of instinctual urges
• Primary Process Thinking: Not cause-
effect; illogical; fantasy; only concern is
immediate gratification (drive satisfaction)
 The Superego

• Internalized morals/values- sense of right

and wrong
• Suppresses instinctual drives of ID (thru
guilt and shame) and serves as the moral
conscience
 The Superego

• Largely unconscious, but has conscious

component
• Develops with socialization, and thru
identification with same-sex parent (via
introjection) at the resolution of the Oedipal
Conflict
• Introjection: absorbing rules for behavior
from role models
 The Superego- 2 Parts:

• Conscience: Dictates what is proscribed

(should not be done); results in guilt
• Ego-Ideal: Dictates what is prescribed
(should be done); results in shame
 The Ego

• Created by the ID to help it interface with

external reality
• Mediates between the ID, Superego, and
reality
• Partly conscious
• Uses Secondary Process Thinking:
– Logical, rational
 “Ego” Defense Mechanisms

• The Ego employs “ego defense

mechanisms”
• They serve to protect an individual from
unpleasant thoughts or emotions
– Keep unconscious conflicts unconscious
• Defense Mechanisms are primarily
unconscious
 “Ego” Defense Mechanisms

• Result from interactions between the ID,

Ego, and Superego
• Thus, they’re compromises:
– Attempts to express an impulse (to satisfy the
ID) in a socially acceptable or disguised way
(so that the Superego can deal with it)
 “Ego” Defense Mechanisms

• Less mature defenses protect the person

from anxiety and negative feelings, but at
price
• Some defense mechanisms explain aspects
of psychopathology:
– Ex. Identification with aggressor: can explain
tendency of some abused kids to grow into
abusers
 Primary Repression

• Conflict arises when the ID’s drives

threaten to overwhelm the controls of the
Ego and Superego
• Ego pushes ID impulses deeper into the
unconscious via repression
• Material pushed into unconscious does not
sit quietly- causes symptoms
 Classification of Defenses

• Mature
• Immature
• Narcissistic
• Neurotic
 Mature Defenses

Altruism
Anticipation
Humor
Sublimation
Suppression
 Altruism

• Unselfishly assisting others to avoid

negative personal feelings
 Anticipation
• Thinking ahead and planning appropriately
 Sublimation

• Rerouting an unacceptable drive in a

socially acceptable way; redirecting the
energy from a forbidden drive into a
constructive act
– A healthy, conscious defense
– Ex. Martial Arts
 Suppression

• Deliberately (consciously) pushing anxiety-

provoking or personally unacceptable
material out of conscious awareness
 Immature Defenses
• Acting Out • Dissociation
• Somatization • Reaction Formation
• Regression • Repression
• Denial • Magical Thinking
• Projection • Isolation of Affect
• Splitting • Intellectualization
• Displacement • Rationalization
 Acting out

• Behaving in an attention-getting, often

socially inappropriate manner to avoid
dealing with unacceptable emotions or
material
 Somatization

• Unconscious transformation of
unacceptable impulses or feelings into
physical symptoms
 Regression

• Return to earlier level of functioning

(childlike behaviors) during stressful
situations
– Ex. Kids regress after trauma
 Denial

• Unconsciously discounting external reality

 Projection

• Falsely attributing one’s own unacceptable

impulses or feelings onto others
– Can manifest as paranoia
 Splitting

• Selectively focusing on only part of a

person to meet a current need state; seeing
people as either all-good or all-bad
• Serves to relieve the uncertainty engendered
by the fact that people have both bad and
good qualities
• Considered normal in childhood
 Displacement

• Redirection of unacceptable feelings,

impulses from their source onto a less
threatening person or object
– Ex. Mad at your boss, so you go home and kick
the dog
 Dissociation

• Mentally separating part of consciousness

from reality; can result in forgetting certain
events
– Ex. Dissociative amnesia
 Reaction Formation

• Transforming an unacceptable impulse into

a diametrically opposed thought, feeling,
attitude, or behavior; denying unacceptable
feelings and adopting opposite attitudes
– Ex. Person who loves pornography leads a
movement to outlaw its sale in the
neighborhood
 Repression

• Keeping an idea or feeling out of conscious

awareness
• The primary ego defense
• Freud postulated that other defenses are
employed only when repression fails
 Magical Thinking

• A thought is given great power, deemed to

have more of a connection to events than is
realistic
– Ex. Thinking about a disaster can bring it about
– Can manifest as obsessions
 Isolation of Affect

• Stripping an idea from its accompanying

feeling or affect
• Idea is made conscious but the feelings are
kept unconscious
 Intellectualization

• Using higher cortical functions to avoid

experiencing uncomfortable emotions;
thinking without accompanying emotion
 Rationalization

• Unconscious distortion of reality so that it’s

negative outcome seems reasonable or “not
so bad, after all” (making lemonade out of
lemons)
• Giving seemingly reasonable explanations
for unacceptable or irrational feelings