Psychoanalysis

1. Psychoanalysis By: Elaine Wheat, Cameron Hopkin, Martha Orozco, Guadalupe Molina, Robert Burns, David Alvarado, Julian Nasserian, Christian Charles, Jose Torres, Randi Lampert, Jeanette Lambert, Brandon Tong and Christine Montagna

2. History of Psychoanalysis Medical beginnings of Psychoanalysis Sigmund Freud gave birth to psychoanalysis in the late 19th century. Psychoanalysis began as a medical specialty. Freud was a physician and student of neurology. 1873 he entered University of Vienna 1891 he earned his medical degree His science background and inclination toward natural scientific explanations influenced his attitudes and assumptions about how to treat patients and eventually the formation of psychoanalytic theory.

3. History of Psychoanalysis Hypnosis and Hysteria Influences� In the 1880s and 1890s, Freud and his co-worker Josef Breuer focused on finding a cure for a condition called hysteria. They used hypnosis to treat the hysteric patient known as Anna O. The patient would be put in an hypnotic trance and symptoms would be removed by posthypnotic suggestions. Freud turned out to not be a very good hypnotist and gave it up.�

4. History of Psychoanalysis Free Association Technique Develops� Freud found that he was able to lead patients through associations in their memory to a cure. He would listen while the patient talked freely. The patient was encouraged to put aside all inhibitions and follow their associations. The recovery of forgotten events also known as unconscious events led to the cure.�

5. History of Psychoanalysis Defining the Topographic Model of the Psyche� From about 1895 to 1905 Freud developed and defined his theory of psychoanalysis He categorized subsections of the psyche as unconscious, preconscious and conscious He discovered that resistance to the association process was the patient�s use of defense mechanisms. He found unconscious events could also show up in dreams, slip of the tongue and jokes He came to believe that neurosis is based in sexual conflict During this time Freud�s insights were not respected in the professional arena and he experienced professional isolation.

6. History of Psychoanalysis Theory of Personality & Psychosexual Development� Freud proposed that personality is divided into six different areas: topographic, dynamic, genetic, economic, adaptive, and the structural which embodied the id, ego and superego Instinctual drive was the foundation of the psychosexual theory this included sexual and aggressive drive Stages of life were determined and defined oral, anal, phallic, latency, genital Freud�s theory of the Oedipal complex was formulated and energy called the libido was explored

7. History of Psychoanalysis Vienna Psychoanalytic Society is formed� Acceptance of Freud�s theories take hold in the early 1900s. Scholars such as William James, Alfred Adler and Carl Jung contributed to the growth and development of psychoanalysis Freud is determined to stay in control of the development of his theories He enters into conflicts with colleagues who offer alternative perspectives Adler, Jung, Rank and Ferenczi leave to develop their own systems of psychoanalysis

8. History of Psychoanalysis Carl Jung (1875-1965) Collaborated with Freud for more than 6 years. Had very different ideas of the unconscious. Jung disagreed with the biological and sexual theories Freud proposed. These disagreement lead to Jung�s split from Freudian Theory �

9. History of Psychoanalysis � Jung�s Contributions to Psychoanalytic theory Word Association Central importance of psychological changes that is associated with midlife. Divided the unconscious into two parts The personal unconscious The collective unconscious Archetypes Four Personality types Like Freud thought dreams were a pathway to the unconscious Prospective Compensatory

10. History of Psychoanalysis � Alfred Adler (1870-1937) Adler believed Freud stressed too much on biological and instinctual determination We create ourselves, rather than merely being shaped by childhood experiences Humans are motivated primarily by social relatedness rather than sexual urges More conscious than unconscious focus in therapy

11. History of Psychoanalysis � Adler cont.. Stressed unity of personality, people can only be understood as integrated and complete beings First systemic therapist; essential to understand people within the systems they are a part of Stressed choice and responsibility, feelings of inferiority as source of creativity and motivation

12. History of Psychoanalysis � Adler�s contributions -Social interest and community feeling (Gemeinschaftsgefuhl)��� -Individual's awareness of being part of the human community and to individual's attitudes in dealing with the social world. -Short-term format��� -Time limited therapy, such as certain amount of sessions, and goals to be fulfilled by then -Influence on other systems:��� -Many of Adler's ideas have found their way into other theories and therapy approaches.

13. History of Psychoanalysis � Adler contributions cont.. Stressed unity of personality, people can only be understood as integrated and complete beings First systemic therapist; essential to understand people within the systems they are a part of Stressed choice and responsibility, feelings of inferiority as source of creativity and motivation

14. History of Psychoanalysis Erick Erickson Psychosocial Perspective (1963) Extended Freud�s theory by stressing the psychosocial aspects of development beyond early childhood Described development in terms of entire lifespan Crisis is equivalent to a turning point in life We have potential to move forward or regress Our life is the result of choices we make at each of these stages

15. History of Psychoanalysis Erick Erickson cont� Credited with bringing an emphasis on social factors to contemporary psychoanalysis Ego psychology vs. Classical Id psychology Id psychology holds that instincts and intrapsychic conflicts are the basic factors shaping personality development Ego Psychology does not deny the role of intrapsychic conflicts but emphasizes the striving of the ego for mastery and competence throughout the human life span

16. History of Psychoanalysis Erick Erickson cont� Believed Freud did not go far enough in explaining the ego�s place in development Did not give enough attention to social influences through the lifespan. Develops own Psychosocial stages First year of life: Infancy 1-3. Early childhood: Autonomy versus shame and doubt 3-6. Preschool age: initiative versus guilt 6-12 School age: Industry vs Inferiority 12-18. Adolescence: Identity vs role confusion 18-35. Young adulthood: Intimacy vs Isolation 35-60. Middle age: Generativityvs stagnation 60 +. Later life: Integrity vs Despair

17. History of Psychoanalysis Development of Object relations perspective James Masterson, and Heinz Kohut developed object relations theory in the U.S. Felt internal emotional world of children focuses on interpersonal relationships rather than on the control of impulses and drives Theorists view infants as being relationship or object seeking rather than pleasure seeking Object relations theorists have been influential in further developing and fine-tuning current psychodynamic theory, research and practice.

18. Origins of Psychopathology as Described by Psychoanalysis Purpose: To outline the systematic structure of theories concerning the relation of the conscious and unconscious processes of the mind in order to describe the origins of the conditions of a mental disorder.

19. Definition Psychoanalysis: A method of analyzing psychic phenomena and treating emotional disorders that involves treatment sessions during which the patient is encouraged to talk freely about personal experiences and especially about early childhood and dreams (merriam-webster.com)

20. Psychoanalysis Several Uses for Psychoanalysis: 1. Investigating the mind 2. Training Purposes 2. Attain theories about human behavior 3. Method of treatment of psychological or emotional illness

21. Psychoanalysis in Adults Adults that have an impairment of self-development due to an integrative defect in the autonomous ego function. Example: Depression with Psychotic Features Warmth Trust Instability in Relationships Integrative Defects loose associations, blocking, flight of ideas, and thought withdrawal Integrative Defects loose associations, blocking, flight of ideas, and thought withdrawal

22. Psychoanalysis in Adults Adults that show problems with object relations but whose autonomous ego functions are more intact. Example: Borderline Controlling Impulses Affects Fantasies This adults still have the ability to test reality.This adults still have the ability to test reality.

23. Psychoanalysis in Adults Adults that have intrapsychic conflicts such as sexual and hostile-aggressive wishes, guilt and shame that create anxiety and depression. Examples: Obsessions Compulsions Phobias

24. Psychoanalysis in Adults Adults that shut off brain mechanisms in order to remove themselves from a situation. Example: Repression

25. Psychoanalysis in Children In children it is said that their distress is caused by a mental imbalance that goes back to their first memories and involve unresolved conflicts from different phases in their lives. At one time it was claimed that those first memories involved sexual abuse, but eventually that theory disproved

26. Sigmund Freud

27. The Journey of Freud Goal= to understand the unconscious factors that lead to certain feelings and ways of thinking Working-Through Process: Examination of the role of unconscious wishes, drives, impulses, and conflicts in everyday life

28. Freud�s Perspective �The basis of Neurosis was sexual conflicts or more specifically, the conflict between the id�s instinctive desires and the society�s retribution for the direct expression of those desires� (Prochaska, 2007) Aggression and Sexual impulses

29. Freud�s Psychoanalytic Perspective The Id Develops at birth Representation of wants, desires, and wishes The Ego Develops at one

30. Freud�s Psychoanalytic Perspective (cont.) Operates on Reality The Superego Develops at age 5 Represents the internalization of cultural, familial, and societal norms Conflict between the structures= defense mechanisms

31. Freud�s Theories Perspective on Personality: Topographic Dynamic Genetic Economic Structural

32. Freud�s Theories (cont.) Adaptive Stages of Life Oral Stage Anal Phallic Latency Genital

33. Results If one doesn�t fully develop during each stage, they will not reach the ideal personality Fixations at either on of these stages = development of conflicts and problems

34. Psychopathology Alfred Adler Student of Freud Psychoanalysis System: Individual Psychology

35. Theories �Pathological personalities are those that have become discouraged from being able to attain superiority in a socially constructive style� (Prochaska, 2007) Emerge from family atmospheres Striving for superiority Inferiority complex

36. Basics Pathological personalities tend to emerge from family atmospheres of: -Competition -Mistrust -Neglect -Domination -Abuse -Pampering Four selfish goals for attaining superiority: -Attention Seeking -Power Seeking -Revenge Taking -Declare Deficiency

37. Results Parental domination--> Compulsive lifestyle and inferiority complex Raised with neglect--> Apt to declare defeat Pampered lifestyle--> Feelings of inadequacy or inferiority complex Abuse as child--> Need for revenge

38. Psychopathology �People construct their lifestyles partly on the basis of early childhood experiences� (Prochaska, 2007) Feelings of inferiority in early childhood lead to pathological personalities Family atmospheres encourage positive or negative goals later in life

39. Erik Erickson 1902-1994

40. Erickson A German developmental psychologist and psychoanalyst who moved to the states shortly prior to WWII� Most well known for his eight psychosocial stages of development. � Theorized that the psychosocial stages of development are the stages in which a typically developing human would pass from birth until death. Each stage is to build in success off of the previous

41. Erickson Infancy (Birth until 18 months)� Trust vs. mistrust� The goal of this stage is to develop trust with a parental figure� A failure to meet this goal may explain reactive attachment disorder� In addition to other factors, it is the result of persistent disregard of a child�s basic physical needs (APA, 2000)

42. Erickson Toddler (until 3 years)� Autonomy vs. shame and doubt� The goal of this stage is to develop a sense of self and independence� A failure to meet this goal may explain selective mutism

43. Erickson Preschool (until 5 years)� Initiative vs. guilt� The goal of this stage is to develop responsibility � A failure to meet this goal may explain dysthymia

44. Erickson Adolescents (until 20 years)� Identity vs. role confusion� The goal of this stage is to develop a full sense self and life aspirations.� Previous four stages largely contribute to this stage (Erikson, 1959)� A failure to meet this goal may explain gender identity disorder and depression

45. Erickson Young adulthood (until 40years)� Intimacy vs. isolation� The goal of this stage is to develop a life long partner� A failure to meet this goal may explain depression and numerous personality disorders

46. Erickson � Middle adulthood (until 60 years)� Generativity vs. Stagnation� The goal of this stage is to help shape younger generations and society

47. Erickson ? Late adulthood (until death)? Ego Integrity vs. Despair ? The goal of this stage is to develop a sense of satisfaction with the life one has lead? A failure to meet this goal may explain depression

48. Goals of Treatment Take full, rational control of self through therapy Bring unconscious conflicts to light Process emotion produced by realized conflict Strengthen ego; it rationally resolves conflict Form therapeutic alliance Uncovering unconscious = short-term stress Emotional bond between patient and analyst helps with handling this pain

49. Treatment Approaches Blank Screen Approach: Analyst has very little self-disclosure, and the client may project repressed situations or memories Free Association: Clients verbalize whatever comes to their mind without worrying how it sounds or how much it makes sense. This can open the door to unconscious thoughts, motivations, etc. The analyst then identifies these repressed materials (Corey, 2005). Dream Analysis: Dreams may be signs of the unconscious because defenses are lowered during sleep. Wishes, needs, and fears can take symbolic forms: Latent Content: Unconscious sexual and aggressive impulses that are hidden Manifest Content: The dream as it appears to the dreamer.

50. Treatment Approaches Continued Play Therapy: Playing allows a child to put their conflict into a symbolic arena. The therapist empathetically listens and responds to the child�s play. Very effective for children who deal with anxiety, depression, and more. Group Therapy: Analysis in the group is carried out, as well as analysis of the group. Focus can be on one individual, however the group processes are the main interest.

51. Treatment Approaches Continued Object-Relations Therapy: More contemporary approach, also known as �self psychology� and �relational psychoanalysis� Relies less on reducing internal conflict from unconscious forces, and more on reducing internal conflict due to unconsciousness internalizations of external objects The term �object� was used by Freud to refer to that which satisfies a need; the person or thing that is the object of one�s feelings or drives (Example: an important person to whom the child, and later the adult, becomes attached)

52. Object-Relations Continued Based on Margaret Mahler�s phases of development versus Freud�s psychosexual stages Normal infantile autism (first 3 or 4 weeks) Symbiosis (3rd to 8th month) Separation-individuation (begins during 4th or 5th month)

53. Intrapersonal Conflicts Psychoanalysis focuses on intrapersonal conflicts in therapy, with the individual�s inner conflicts among impulses, anxiety, and defenses being of central concern Primal anxiety: due to the assumed birth trauma of being overwhelmed with stimulation, it�s the bodily basis for panic Defenses or resistance: The analytic goal is not to remove defenses, but rather to replace immature and distorting defenses with more mature, realistic, and gratifying defenses. Self-esteem: Lack of genuine self-esteem is the result of personality problems, not the cause. The best that can be done is to help patients consciously restructure their personalities into a more genital level of functioning; only then can individuals experience a stable sense of self-esteem Responsibility: How can we hold a person responsible for any action, if all pathological behavior is determined by unconscious conflicts and pregenital fixations?

54. Interpersonal Conflicts Intimacy and sexuality: the problem of intimacy is basically a transference problem. The patient cannot relate to another person as the other person really is. Communication: They do not respond to what the other says, but rather to their own desires that they want satisfied by the other. Hostility: the violence in our urban era is seen by Freudians as a reflection of the hostility inherent in humans. Control: struggles over interpersonal control are frequently struggles over whose defenses will dominate the relationship. The analyst will recognize when controlling behavior is serving defensive purposes of resistance or gratifying purposes of transference.

55. Differences Between Contemporary & Classical Approach Based on a relational model, in which therapy is an interactive process between client and therapist. Instead of avoiding counter-transference, it is believed to provide a source of information about the client�s character We�re all deeply embedded within our culture, so our unconscious structures are relational and relative. This is a huge contrast to classical psychoanalysis, which is based on universal biological drives Assumes a more equal power relationship between client and therapist (mutual exploration) rather than the therapist being the truth seeker

56. Differences Between Contemporary & Classical Approach Analyst is no longer detached and anonymous, and is able to be responsive and emotionally present

57. Interpretation To identify, clarify, and translate material The analyst points out and explains the meaning of behavior that�s manifested in dreams, free association, and resistances It enables the client�s ego to assimilate new concepts and identify more unconscious material Three Rules: Must be appropriately timed (during conscious awareness) Start at surface and go as deep as the client can stand Point out a resistance before interpreting the conflict that causes it

58. Interpretation Continued Interpretation of Resistance: Resistance is the client�s reluctance to bring repressed unconscious material to the surface It gets in the way of change, and can often be a defense against anxiety Analyst needs to help client become aware of the reasons behind the resistance so they can be dealt with appropriately Interpretation of Transference: Transference is the client�s unconscious shifting of feelings and fantasies to the analyst The client�s past relationships distort their current relationship with the analyst, reacting to their analyst as they did to a significant person. Allows clients to change some of their long-standing behavior

59. Treatment Risks The primary risk to the patient is related to the emotional pain resulting from new insights and changes in long-standing behavior patterns In some patients, it produces so much anxiety that they cannot continue with treatment A therapist�s lack of skill and failure to form a solid therapeutic alliance

60. Length & Cost of Treatment Classic psychoanalysis Average of 5 years, 3x a week or more Cost dependent on analyst�s exp./training Not usually covered by insurance Abbreviated treatment methods Brief Psychodynamic Therapy, Brief Relations Therapy, Time-Limited Dynamic Therapy, etc. Recommended for less complex psychodynamic problems

61. References Corey, G. (2005). Theory and Practice of Counseling and Psychotherapy, 7th ed. California: Thomas Learning, Inc. Stein, A. (1966). A Textbook in Analytic Group Psychotherapy: By S. R. Slavson. New York: International Universities Press, Inc. Carver, C. S., & Scheier, M. F. (2004). Perspectives on Personality. 5th ed. Boston, MA. Pearson Education, Inc. Prochaska, J. O., & Norcross, J.C. (2007). Systems of Psychotherapy: A Transtheoretical Analysis, 6th Edition. Pacific Grove, CA: Brooks/Cole. Karrel, A., & Gill, J. (2002, June). A comparison of Alfred Adler's and Heinz Kohut's conceptions of psychopathology. Journal of Individual Psychology, 58(2), 160-168. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author. Butcher, J. N., Mineka, S., Hooley, J. M. (2004). Abnormal Psychology (483). USA: Prentice Hall. Erikson, E. H. (1959). Identity and the Life Cycle. New York: International Universities.