Contemporary Psychoanalytic Theory & Practice

1. Contemporary Psychoanalytic Theory & Practice A Brief Synopsis of a more Ambitious Psychotherapy. Timothy D. Kruse, M.S.Ed.

2. Contemporary Psychoanalytic Theory & Practice • For the confidential use of Counseling Theory students. • Permission to quote, distribute, or reproduce in any form any of these materials is expressly denied. Timothy D. Kruse, M.S.Ed.

3. PsychologyHeraclitus / Bathun psyche • Psyche (Greek) for Soul (vs. Behavior) -You can never grasp it by itself apart from other things, perhaps b/c it is like a reflection in a flowing mirror, or like the moon which mediates only borrowed light. (J. Hillman) • Logos (Greek) for meaning / way of / reason / logic of / word Timothy D. Kruse, M.S.Ed.

4. Friedrich NietzscheThe “true” founder of modern psychology (L. Klages) • The content of our conscience consists of all that which, in childhood, was demanded from us, without explanation and regularly, from persons we respected or feared…Faith in authority is the source of conscience; it is not the voice of God in man’s breast, but the voice of men in man. Timothy D. Kruse, M.S.Ed.

5. Friedrich Nietzsche • Everyone is the farthest to himself. • A quantum of dammed up (psychic) energy exists in all. • Man is something that must be overcome. • Good actions are sublimated evil ones. • In the last analysis, [man] gives nothing but his own biography. Timothy D. Kruse, M.S.Ed.

6. Sigismund SchlomoA.K.A Sigmund Freud • [I have] completed an undertaking which a number of people, still unborn but fated to misfortune, will feel severely. • An intimate friend and a hated enemy have always been necessary requirements of my emotional life…I always knew how to provide myself with both over and over. Timothy D. Kruse, M.S.Ed.

7. Sigmund Freud • Ignorance is ignorance; no right to believe anything can be derived from it. In other matters no sensible person will behave so irresponsibly or rest contentment with such feeble grounds for his opinions and for the line he takes. It is only in the highest and most sacred things that he allows himself to do so. Timothy D. Kruse, M.S.Ed.

8. James HillmanPsychology vs. ??? • Where there is a connection to the soul, there is psychology; where not, what is taking place is better called statistics, physical anthropology, cultural journalism, or animal breeding. [or cognitive behaviorism?] Timothy D. Kruse, M.S.Ed.

9. David Bowe Life is the consistent persistence of Rage. Timothy D. Kruse, M.S.Ed.

10. Contemporary vs. Classical Psychoanalysis • Psychoanalysis • Psychoanalytically Informed Psychotherapy • Insight Oriented Psychotherapy • Exploratory / Uncovering Psychotherapy Timothy D. Kruse, M.S.Ed.

11. Contemporary Psychoanalytic Theory • The synergistic effect of four analytic theories… • Drive Theory (classical Freudian) • Ego Psychology (Tripartite Psychic System) • Self Psychology (H. Kohut) • Object Relations (British school of PA) Timothy D. Kruse, M.S.Ed.

12. Drive TheoryClassical Freudian Psychoanalysis / Biological Determinism • Biologically based instincts prominent (libido /aggression) • Modern perspective = “unconscious wishes and desires” • Sexual (bodily) development important determinant of conflict areas Timothy D. Kruse, M.S.Ed.

13. Ego Analytic PsychologyContemporary Freudian Psychology / Erikson (1950) & Rapaport (1958) • Adaptation and regulation of unconscious drives (Ego Strength) prominent (Tripartite System). • Primary and secondary ego defense mechanisms. • Non-conflicted areas of mental function are resources (intelligence, perception, memory, etc.) . • Bio / psycho / social perspective on the human condition (emotions, cognitions, behavior). Timothy D. Kruse, M.S.Ed.

14. Ego Psychology (cont.) • The Freudian Tripartite System…review • The Id (“It”) contains primitive drives, impulses, prerational/prelogical strivings, wish-fear combinations, primary process thought and fantasies. • The Ego (“Me”) adapts Id energies to life’s exigencies, finding acceptable outlets for strivings. (Observing and Experiencing Ego). • The Superego (“Above me”) is the judicial branch. Provides a moral perspective that impinges upon Id energies and Ego adaptations. Timothy D. Kruse, M.S.Ed.

15. Self PsychologyHeinz Kohut • Development and regulation of self-esteem and self-worth defines characterological, temperamental traits and dispositions • Early parent-child relationships important in self-esteem development and learned aspects of regulation • Separation/individualization important developmental task Timothy D. Kruse, M.S.Ed.

16. Object Relations TheoryKlein / Faribairn / Winnicott / Jacabson / Kernberg • Relational / Structural Model. • Humans have an innate drive to form and maintain relationships. • Memories (organized cognitive and emotional schemata) of important objects from the past organize wishes, behavior, perception, and meaning of current interpersonal and intrapsychic functioning. • Internal and external Object Representations. • Object Constancy. Timothy D. Kruse, M.S.Ed.

17. Philosophical Support System • Friedrich Nietzsche (Enlightenment Philosophy) • Man is a self-deceiving creature • Primary & Secondary Ego-defenses • Therapist should draw inference based on what we mean vs. what we say (Process vs. Content) • Conscious – unconscious continuum • Consciousness is “ciphered formula of the unconscious” / (das Es) “id” • To understand present character structure (behavior), unconscious patterns and motives must be decoded Timothy D. Kruse, M.S.Ed.

18. Philosophical Support System • Darwinism (Social Darwinism) • Instinct • Replaced with the notion that “drives” are present and equally influenced via developmental experiences • Survival of the Fittest!? • Now includes environmental influences Timothy D. Kruse, M.S.Ed.

19. O God, I could be bounded in a nutshell and count myself a king of infinite space, were it not that I have bad dreams (Shakespeare's Hamlet). Timothy D. Kruse, M.S.Ed.

20. Contemporary Psychoanalytic TheoryThe Fun Stuff Psychotherapeutic Stance Human Condition & Characterological Issues Timothy D. Kruse, M.S.Ed.

21. First…A Review! Ego Defenses Timothy D. Kruse, M.S.Ed.

22. Ego Defenses • Two levels of ego defenses • 1) Primary, Infantile, immature, lower-order, primitive, pre-rational, archaic defenses. • 2) Secondary, mature, higher-order defenses. Timothy D. Kruse, M.S.Ed.

23. Primary Ego Defenses • Involve the boundary between the Self and the external world or reality. • They are preverbal / prerational (oral) and governed by primary process thought (i.e., deficit of the/in the reality principle). • They lack an appreciation for separateness and constancy of objects. Timothy D. Kruse, M.S.Ed.

24. Primitive withdrawal or Autistic/Schizoid fantasy Denial Omnipotent Control Primitive Idealization & Devaluation Projective Identification Splitting Dissociation Projection Introjection Primary Ego Defenses (cont.)Boundary between Self and World Timothy D. Kruse, M.S.Ed.

25. Secondary Ego Defenses • Deal with the internal / intrapsychic boundaries between the Tripartite System and between the Observing and Experiencing Ego. • They are considered higher order and at times more adaptive. (Ego-strength) Timothy D. Kruse, M.S.Ed.

26. Repression Regression Isolation Intellectualization Rationalization Moralization Compartmentalization Undoing Displacement Reaction Formation Reversal Identification Acting Out Sexualization Turning Against the Self Sublimation Secondary Ego Defenses (Cont.)Internal Boundaries Timothy D. Kruse, M.S.Ed.

27. Psychotherapeutic Stance • Hermeneutic vs. Scientific / Empirical Tradition • Isolation of variables (parsimony) so that a particular cause-and-effect process can be exposed, uncontaminated by other possible explanations is a woefully inadequate representation of reality… • …thus, the clients subjective experience can be devalued, minimized, and impoverished. Timothy D. Kruse, M.S.Ed.

28. Psychotherapeutic Stance (cont.) • It is more important for the clinician to understand people than it is to master specific treatment techniques--Therapy taught backward. • EVT’s do not take into account the vicissitudes of the Human Condition--What helps one can damage another! i.e., Shame vs. Guilt / Depression vs. grief (Freud, 1917) • Unless the clinician understands someone’s unique, personal subjectivity, one cannot infer / orient competent tx. Timothy D. Kruse, M.S.Ed.

29. Psychotherapeutic Stance (cont.) • By understanding the idiosyncratic way an individual organizes knowledge, emotion, sensation, and behavior, a therapist has more choice about how to influence him or her and contribute improvements sought. • Unravel the different strands (not single event) of causation… • Eight Attending Areas (McWilliams, 1999) • Temperament and fixed attributes, maturational themes, defensive patterns, central affects, identifications, relational schemas, self-esteem regulation, and pathogenic beliefs. Timothy D. Kruse, M.S.Ed.

30. The Human ConditionA brief synopsis • The essential character structure cannot be understood without an appreciation of two distinct and interacting dimensions: developmental level of personality organization and defensive style within that level (McWilliams, 1994). • 2 Dimensions of the Human Condition = Developmental 1) Level & 2) Type of Character Organization Timothy D. Kruse, M.S.Ed.

31. Developmental Level of Character Organization • This dimension conceptualizes a person’s extent of individuation or degree of pathology (i.e., Identity Diffusion or Symbiosis). The three levels are… • 1)Neurotic • Oedipal (Freud), Initiative vs. Guilt (Erikson), Identity Integration & Object Constancy (OR/Mahler) • 2)Borderline • Anal (Freud), Autonomy vs. Shame & Doubt (Erikson), Separation/Individuation (OR/Mahler) • 3) Psychotic • Oral (Freud), Trust vs. Mistrust (Erikson), Symbiosis (OR/Mahler). Timothy D. Kruse, M.S.Ed.

32. Developmental Level of Character Organization (cont.) • Neurotic organization presents with… • Secondary, higher order, or mature defenses • Closed & inflexible ego defenses • Reality principle • Secondary process thought • Observing Ego • Ego Strength • Ego dystonic neurosis • Intact reality testing and object relations Timothy D. Kruse, M.S.Ed.

33. Developmental Level of Character Organization (cont.) • Borderline organization presents with… • Identity diffusion – the lack of an integrated self concept and an integrated and stable concept of total objects in relation to the self (i.e., impaired object relations/auxiliary ego) • …as manifested by a subjective experience of chronic emptiness, contradictory self-perceptions, contradictory behavior, impoverished and contradictory perceptions of objects, and an inability to convey interaction in a non-global fashion. Timothy D. Kruse, M.S.Ed.

34. Developmental Level of Character Organization (cont.) • Primary, infantile, immature ego defenses (splitting) • Chronic, diffuse, free-floating anxiety • Sporadic (situational) impairment in reality testing • Prepsychotic personality structures (anticipation) • Polymorphous perverse sexual trends • Impulse neurosis and addictions • Low level character disorders • Hysterical, Narcissistic, Depressive-Masochistic, & Infantile personality • Polysymptomatic Neurosis • Multiple phobias, dissociative reactions, paranoia, etc. Timothy D. Kruse, M.S.Ed.

35. Developmental Level of Character Organization (cont.) • Psychotic organization presents with… • Weak and infantile ego defense mechanisms • So much so that they are overwhelmed by the external world (congruent - bizarre delusions, hallucinations) • Non objective evaluation and judgment of world outside of self. • Primary process thought • Governed by the pleasure principle • Gross impairment in reality testing (hallucinations, delusions, illusions, etc.) • Ego syntonic neurosis • Symbiotic (narcissistic) fusion Timothy D. Kruse, M.S.Ed.

36. Developmental Level of Character Organization (cont.) • The clinician must differentiate between • 1) Symptom Neurosis. • 2) Neurotic Character. • 3) Psychosis (Narcissism). Timothy D. Kruse, M.S.Ed.

37. Developmental Level of Character Organization

38. Developmental Type of Character Organization • The degree of individuation or psychopathological phenomena. • Predominant or Bedrock (stereotypical) dispositional defensive operation. • Formed by aligning constellations of central primary and secondary ego defenses. Timothy D. Kruse, M.S.Ed.

39. Sample Constellations • Narcissism = idealization, devaluation • Schizoid = primitive withdrawal, autistic/schizoid fantasy • Paranoid = reaction formation, projective defenses • Hysteria = repression, sexualization • Obsessional = isolation, rationalization, moralization, compartmentalization, intellectualization • Mania = denial • Phobic = displacement, symbolization

40. Developmental Level & Type of Character Organization

41. Developmental Level & Type of Character Organization • The aforementioned view of the Human Condition provides contemporary psychoanalysts to work within individual psychologies. • …and to do so during the analytic process. Timothy D. Kruse, M.S.Ed.

42. …for there is nothing either good or bad, but thinking makes it so. (Shakespeare’s Hamlet) Life is the existence of Degree The art and science of Interpretation Timothy D. Kruse, M.S.Ed.

43. The Degrees of the Human Condition • Id there such a thing as too much love? • Narcissism…only if the self love is without warrant…otherwise, it is astute and keen observation into one’s self awareness. • Id there such a thing as too little anger? • Id there such a thing as too much joy? Timothy D. Kruse, M.S.Ed.

44. Psychoanalytic Process • Today, remains loyal to the Freudian process. • Couch, duration, etc. • Present in session…formulations outside of session. • Altering of transference issues. • Provide insight into unresolved developmental stages through the following… • Transference/Counter-transference, free association, dream analysis, resistance, analysis, and interpretation. Timothy D. Kruse, M.S.Ed.