Psychoanalytic Theory and Defense Mechanisms PDF

Psych oan alytic c ha pte r 6 Th eory an d De en se Mech an ism s Typical Board Question A 28-year-old em ale p atien t is hospitalized a ter m akin g a suicide attem pt bec...

Psych oan alytic c ha pte r 6 Th eory an d De en se Mech an ism s Typical Board Question A 28-year-old em ale p atien t is hospitalized a ter m akin g a suicide attem pt because her doctor did n ot resp on d to h er o er to rien d h im on Facebook. Wh en sh e is in terviewed, the patien t states that all em ale doctors are good but all m ale doctors are in com peten t. The best exp lan a- tion or th is statem en t by th e p atien t is (A) p reju dice (B) lack o basic tru st (C) ch au vin ism (D) sp littin g (E) bias (See “An sw ers an d Explan ation s” at th e en d of th e ch apter.) I. OVERVIEW Psych oan alytic th eory is b ased on Freu d’s con cep t th at beh avior is determ in ed by orces derived rom u n con sciou s m en tal p rocesses. Psych oan alysis an d related th erap ies are p sych oth erap eu - tic treatm en ts based on th is con cep t (see Ch ap ter 17). II. FREUD’S THEORIES OF THE MIND To exp lain h is id eas, Freu d d evelop ed, early in h is career, th e top ograp h ic th eory o th e m in d an d , later in h is career, th e stru ctu ral th eory. A. Topographic theory of the mind. In th e top ograp h ic th eory, th e m in d con tain s th ree levels: Th e u n con sciou s, p recon sciou s, an d con sciou s. 1. Th e unconscious mind con tain s rep ressed th ou gh ts an d eelin gs th at are n ot available to th e con sciou s m in d, an d u ses p rim ary p rocess th in kin g. a. Primary process is a typ e o th in kin g associated with p rim itive drives, wish u l illm en t, an d p leasu re seekin g an d h as n o logic or con cep t o tim e. Prim ary p rocess th in kin g is seen in you n g ch ildren an d p sych otic adu lts. b. Dreams rep resen t grati ication o u n con sciou s in stin ctive im p u lses an d wish u l illm en t. 57 Www.Medicalstudyzone.com  58 BRS Behavioral Science t a b l e 6.1 Freud’s Structural Theory of the Mind Structural Topographic Level Age at Which It Component of Operation Develops Characteristics Id Unconscious Present at birth Contains instinctive sexual and aggressive drives Controlled by primary process thinking Not influenced by external reality Ego Unconscious, Begins to develop Controls the expression of the id to adapt to the preconscious, immediately after requirements of the external world primarily by the and conscious birth use of defense mechanisms Enables one to sustain satisfying interpersonal relationships Through reality testing (i.e., constantly evaluating what is valid and then adapting to that reality), enables one to maintain a sense of reality about the body and the external world Superego Unconscious, Begins to develop at Associated with moral values and conscience preconscious, about 6 y of age Controls the expression of the id and conscious 2. Th e preconscious mind con tain s m em ories th at, wh ile n ot im m ediately available, can be accessed easily. 3. Th e conscious mind con tain s th ou gh ts th at a p erson is cu rren tly aware o. It op erates in close con ju n ction with th e p recon sciou s m in d b u t does n ot h ave access to th e u n con - sciou s m in d. Th e con sciou s m in d u ses secon d ary p rocess th in kin g (logical, m atu re, tim e orien ted) an d can delay grati ication. B. Structural theory of the mind. In th e stru ctu ral th eory, th e m in d con tain s th ree p arts: th e id , th e ego, an d th e su p erego (Tab le 6.1). III. DEFENSE MECHANISMS A. Definition. De en se m ech an ism s are u n con sciou s m en tal tech n iqu es u sed by th e ego to keep con licts ou t o th e con sciou s m in d, th u s decreasin g an xiety an d m ain tain in g a p erson’s sen se o sa ety, equ ilibriu m , an d sel -esteem. Th ey can be u se u l in h elp in g p eop le deal with d i icu lt li e situ ation s su ch as m ed ical illn ess, b u t, wh en u sed in excess, can becom e a bar- rier to seekin g care or adh erin g to treatm en t recom m en d ation s. B. Specific defense mechanisms (Table 6.2) 1. Som e de en se m ech an ism s are immature (i.e., th ey are m an i estation s o ch ild-like or dis- tu rb ed beh avior). 2. Mature defense mechanisms (e.g., altru ism , h u m or, su blim ation , an d su p p ression ), wh en u sed in m od eration , d irectly h elp th e p atien t or oth ers. 3. Repression, p u sh in g u n accep table em otion s in to th e u n con sciou s, is th e basic defense mechanism on wh ich all oth ers are based. IV. TRANSFERENCE REACTIONS A. Definition. Tran s eren ce an d cou n tertran s eren ce are unconscious mental attitudes b ased on im p ortan t p ast p erson al relation sh ip s (e.g., with p aren ts). Th ese p h en om en a in crease em otion ality an d m ay th u s alter ju dgm en t an d b eh avior in p atien ts’ relation sh ip s with th eir doctors (tran s eren ce) an d doctors’ relation sh ip s with th eir p atien ts (cou n tertran s eren ce). Www.Medicalstudyzone.com  Chapter 6 Psychoanalytic Theory and Defense Mechanisms 59 t a b l e 6.2 Commonly Used Defense Mechanisms (Listed Alphabetically) Defense Mechanism Explanation Example Acting out Avoiding personally unacceptable A depressed 14-year-old girl with no history emotions by behaving in an of conduct disorder has sexual encounters attention-getting, often socially with multiple partners after her parents’ inappropriate manner divorce Altruisma Assisting others to avoid negative A man with a poor self-image, who is a social personal feelings worker during the week, donates every other weekend to charity work Denial Not accepting aspects of reality that A man who has a problem with alcohol insists the person finds unbearable that he is only a social drinker Displacement Moving emotions from a personally A surgeon with unacknowledged anger intolerable situation to one that is toward his sister is abrasive to the female personally tolerable residents on his service Dissociation Mentally separating part of one’s Although he was not injured, a teenager has consciousness from real-life no memory of a car accident in which he events or mentally distancing was driving and his girlfriend was killed oneself from others Humora Expressing personally uncomfortable A man who is concerned about his erectile feelings without causing problems makes jokes about Viagra emotional discomfort (sildenafil citrate) Idealization Seeing others as more competent or A patient tells the doctor that he is not worried powerful than they are because he is sure that the doctor will always know what to do Identification Unconsciously patterning one’s A man who was terrorized by his gym teacher (introjection) behavior after that of someone as a child becomes a punitive, critical gym more powerful (can be either teacher (identification with the aggressor) positive or negative) Intellectualization Using the mind’s higher functions to A sailor whose boat is about to sink calmly avoid experiencing emotion explains the technical aspects of the hull damage in great detail to the other crew members Isolation of affect Failing to experience the feelings Without showing any emotion, a woman tells associated with a stressful her family the results of tests that indicate life event, although logically her lung cancer has metastasized understanding the significance of the event Projection Attributing one’s own personally A man with unconscious homosexual impulses unacceptable feelings to others begins to believe that a male colleague is Associated with paranoid symptoms attracted to him and prejudice Rationalization Distorting one’s perception of an A man who loses an arm in an accident says event so that its negative outcome the loss of his arm was good because it seems reasonable kept him from getting in trouble with the law Reaction formation Adopting opposite attitudes to A woman who unconsciously is resentful avoid personally unacceptable of the responsibilities of child rearing emotions, i.e., unconscious overspends on expensive gifts and clothing hypocrisy for her children Regression Reverting to behavior patterns like A woman insists that her husband stay those seen in someone of a overnight in the hospital with her before younger age surgery Splitting Categorizing people or situations into A patient tells the doctor that while all of categories of either “fabulous” or the doctors in the group practice are “dreadful” because of intolerance wonderful, all of the nurses and office help of ambiguity are unfriendly and curt Seen in patients with borderline personality disorder (continued) Www.Medicalstudyzone.com  60 BRS Behavioral Science t a b l e 6.2 Commonly Used Defense Mechanisms (Listed Alphabetically) (continued) Sublimationa Expressing a personally A man who got into fights as a teenager unacceptable feeling (e.g., rage) becomes a professional prize fighter in a socially useful way Suppressiona Deliberately pushing personally A medical student taking a review course unacceptable emotions out of for the United States Medical Licensing conscious awareness (the only Examination mentally changes the subject defense mechanism that includes when her mind wanders to the exam during some aspect of consciousness) a lecture Undoing Believing that one can magically A woman who stole money from a friend, reverse past events caused by confesses to the theft, returns the money, “incorrect” behavior by now and then feels compelled to offer to drive adopting “correct” behavior, the friend to and from work for a year e.g., atonement, confession, or penance. Seen in obsessive– compulsive disorder “Mature” defense mechanisms. a Adapted from Fadem B. Behavioral Science in Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:83. B. Transference 1. In positive transference , th e p atien t h as con id en ce in th e d octor. I in ten se, th e p atien t m ay overid ealize th e d octor or develop sexu al eelin gs toward th e doctor. 2. In negative transference , th e p atien t m ay b ecom e resen t u l or an gry toward th e d octor i th e p atien t’s desires an d exp ectation s are n ot realized. Th is m ay lead to p oor adh eren ce to m edical advice. C. In countertransference, eelin gs abou t a p atien t wh o rem in d s th e d octor o a close rien d or relative can in ter ere with th e doctor’s m edical ju dgm en t. Www.Medicalstudyzone.com