Principles of Psychodynamic Psychology PDF

Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins PART 1 – FOUNDATIONS CH1: MODELLING THE LIIFE OF THE MIND INTRODUCTION AND OVERVIEW Y Founda*onal premises...

Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins PART 1 – FOUNDATIONS CH1: MODELLING THE LIIFE OF THE MIND INTRODUCTION AND OVERVIEW Y Founda*onal premises: 1. Each of us behaves and has experiences, makes plans and choices, and lives life in a way that reflect the opera*ons of the mind. à FoundaConal AssumpCons 1. The experience of having a mind is a special aspect of human existence and the mental events are important determinants of who we are and how we behave in everyday life and in clinical situa*ons. 2. That mental events cannot be reduced to the terms of any other discipline from which psychiatry and psychology draw but must be describe in their own terms. Mind – the complex elements in an individual that feels, perceives, thinks, wills and especially reasons à Merriam-webster defini0on. - The mind includes – the organized conscious and unconscious adap*ve mental ac*vity of an organisms. à Y The concept has been extensively studies and explored in many different direc*ons. - Philosophers such as Plato and Descartes debated the existence of the mind and its proper*es. - Intellectual historians’ debate on the how and to what extent the mind enters the discourse about human behaviour. - Psychologists of all fields offer theories about what kind of mind humans have. - Mental health professional however tend to pay less aOen*on to this debate. § While acknowledging that the concept of the mind is essen*al to understand pa*ents. § Most clinicians view the mind as an emergent property of the brain, meaning that it is depended on the rain but cannot be described in teams or concepts appropriate to the brain. § Clinicians tend to func*on as property dualists – meaning we treat the pa*ent’s mind and the pa*ent’s brain as though they have separate proper*es, each of which demands a unique kind of thinking and a sperate kind of interven*on. CC. 1  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins What is Psychoanalysis? - It is the branch of psychology that deals with understanding human behaviour as the result of the mind. - Psychoanalysis refers specifically to Sigmund Freud’s original theories and concepts, which he developed in the late 19th and early 20th centuries. § Freud’s work laid the founda*on for many subsequent psychological theories and therapeu*c prac*ces. - Y Tradi*onally, psychoanalysis has been variously defined as a theory of the mind, as a theory of some aspects of psychopathology, as a treatment, and as a method of inves*ga*ng the mind. What is psychodynamic psychology? - The word psychodynamic, which means «mental forces» (or mo*va*ons), is used interchangeably with psychoanaly*c, because there are few psychodynamic approaches that are dis*nct from the psychoanaly*c approach. - Today the term psychodynamic is rou*nely used to designate those theories of the mind and interpersonal rela*onships that derive from psychoanalysis... - Contemporary psychoanalysis (or psychodynamic) is best described as “pluralis0c, consis0ng of not one but several models of the mind, overlapping but dis0nct, each taking a somewhat different perspec0ve on human mental func0oning and each emphasizing a different set of phenomena”. - Auchincloss aims to combine the major psychoanaly*c models of the mind into a single usable contemporary psychoanaly*c model of the mind. MODEL à What is a model? What is the psychoanaly*c model of the mind? - It is an imaginary construc*on designed to represent a complex system. § Represents the mind of all human beings in general and the unique characteris*cs of any specific individual. - The model describes… § What psychological phenomena such as feelings, thoughts, wishes, fears, fantasies, memories, a`tudes, and values interact in the system and influence each other. § The mo*va*ons that animate the pa*ent, the structures that organize the pa*ent’s mind, and the func*ons and processes by which the pa*ent’s mind works. CC. 2  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins § How the mind works. § How mental life is expressed in pathological as well as normal behaviour and how treatment is used to influence the mind. - While this is not the first model of the mind presented, it is the most commonly used strategy. Y Contemporary Models - Contemporary models borrowed a lot from Freud’s ini*al ideas; however, they have undergrown profound changes becomes more and more complex to represent the new data that has come to light. - The contemporary psychoanaly*c models are described as pluralis*c, as they consist of several models of the mind, overlapping but dis*nct, each taking a somewhat different perspec*ve on human mental func*oning and each emphasizing a different set of phenomena. - Each contemporary psychoanaly*c model of the mind corresponds to a different psychoanaly*c school of thought. - These models vary with how they represent the mind, how they understand the pa*ent’s suffering and how they explain the therapeu*c ac*on of psychotherapy. Y Why do we need a model of the mind? Theory of Mind - Introduced in the late 1970s and used to describe a specific capacity cogni*ve psychologists observed in all humans – that is humans has the ability to develop a theory of how our minds and the minds of others works. - This capacity enables us to: 1. Understand that others have beliefs, desires, and inten*ons. 2. Realize that others’ beliefs, desires, and inten*ons might be different from our own. 3. Form opera*onal hypothesis, theories, or mental models of what other’s beliefs desires and inten*ons might be. - Essen*ally, ToM proposes that most humans are born with the poten*al to know and make sense of what goes on in the minds of others. § Helps us get by in the world and cope with complex interac*ons. à ToM Development - If development occurs normally ToM can be observed at around age 4. - Developed in a facilita*ng matrix of normal matura*on, social interac*ons and other experiences. - In adults → the theory of mind exists on a con*nuum. CC. 3  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins → The Neurobiology of ToM - Func*onal neuroimaging allows scien*sts to illuminate the regions of the brain and systems responsible for ToM. § Findings → Mirror neurons – these are neurons that fire when we perfume an ac*on and when we see others perform the same ac*on. These neurons are thought to be crucial to our capacity to envision what others are thinking, feeling and planning to do. Are thought to allow us to understand the inten*ons behind other’s ac*ons by crea*ng a template for those ac*ons inside our own mind. Y Modeling the Mind in the Era of the Brain → Freud’s goal was to create a science of the mind that would be based on an understanding of the brain. - Although mind science is s*ll far from realizing the brain of a brain-based psychology, we have reached a point where intelligible conversa*on across the mind-brain barrier is at least possible. - Important aspects of our model of the mind that had long been thought to be beyond the scope of systema*c inquiry as suddenly of renewed interest. The Unconscious - While revolu*onary at the *me, the ideas that what goes on in our mind occurs outside of awareness is not taken for granted as a basic feature of the mind. - The current challenge is to account for consciousness and to explain the purpose it serves. Mind and Body - Contemporary mind science is interested in the concept of embodiment. - Embodiment – that is the idea that the mind is intrinsically shaped by its connec*on to the body. § In other words, it is the understanding that cogni*on cannot be studies independently from affects → the complex emo*onal/physical states produced by and in the body as part of its system of evalua*ng the self in rela*onships to the environment for the purpose of survival. CC. 4  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins Self and Other - Freud launched the first modern explora*on of the psychoac*ve, behaviour modifying and un*mely brain-altering power of human rela*onships. - Contemporary cogni*ve scien*sts and neuroscien*st have demonstrated that mother-baby interac*ons in earliest infancy help shape the cogni*ve and neuronal structures underlying the infant’s capacity to tolerate human distress. The NarraCve Self - The psychoanaly*c model of the mind and cogni*ve neuroscience is a shared interest in the mind’s innate capacity for narra*ve expression. - Contemporary cogni*ve scien*st have started to take an interest in the way, individuals are con*nuously inven*ng and reinven*ng a life story as part of an ongoing effort to situate ourselves in the world and to maintain a coherent sense of self. Y The Psychoanaly*c Model of the Mind in the Clinical Se`ng - In a clinical se`ng the psychoanaly*cal model of the mind provides the clinician with a way of making sense of his or her interac*on with the pa*ent. - It allows the clinician to organize the clinical details, so as to construct a picture of the pa*ent’s inner workings, that can be used to understand the current situa*on, predict responses and plan interven*ons. PSYCHOANALTYSIS à We are used to thinking about psychoanalysis in a tripar0te way (Freud, 1923): As a theory of the mind (and a theory of some aspects of psychopathology) 1. Major role of unconscious mental phenomena for understanding both normal and pathological mental life. § Freud (1896/1962) presented his revolu*onary “new psychology”: most of what goes on in the mind occurs outside of awareness. The ego is not master in its own house. (S. Freud, 1917) Rather than living our lives ourselves, we are «lived» by unknown and uncontrollable forces. (S. Freud, 1923) § In the exploding world of mind science, nonconscious mental processes are now taken for granted as a basic feature of the mind. § The new challenge: account for consciousness. CC. 5  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins 2. Centrality of early (childhood) experience on the development of the mind, strongly influencing adult mental states. § Our temperament shapes the experiences we have with our primary caregivers and gene*c makeup (i.e., Freud’s “cons*tu*on”) as well as by our caregivers’ responses. § This intense interpersonal biobehavioural matrix of infancy and early childhood forms templates – which are more or less modifiable – for future rela*onships and being in the world. § Our struggle as young children to understand and come up with our complicated feelings about our earliest love objects and our place in the family lays the founda*ons of enduring psychic structures that will determine the characteris*cs of our future aOachment rela*onships. § Developmental nature of mental health problems. 3. Mental distress can be understood as a compromise solu*on (mental conflict) and/or as a result of a developmental deficit. § «Mental distress can be understood as a compromise solu*on (mental conflict)» Mental conflicts arise from unconscious forces seeking to express themselves and require constant control by opposing forces that prevent their expression. Mental conflicts: à An intense affect (e.g. a desire or a fear) and a defence against that affect; à different intrapsychic structures, or «parts», with different purposes and priori*es; à an impulse in contrast to an internalized awareness of the demands of external reality. § «...and/or as a result of a developmental deficit» Early childhood experiences are crucial for future adult rela*onships. As a treatment - It is the first contemporary kind of psychotherapy that we know of! - Psychoanalysis comprises a set of specific psychotherapeu*c techniques: § Free associa*on. § Analysis of transference and countertransference. § Interpreta*on (of defences, resistance etc.). - Psychanaly*c therapists tend to place a stronger emphasis on: 1. affect and emo*onal expression; CC. 6  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins 2. the explora*on of pa*ents’ tendency to avoid topics (i.e., defenses); 3. the iden*fica*on of recurring paOerns in behavior, feelings, experiences, and rela*onships; 4. the past and its influence on the present; 5. interpersonal experiences; 6. the therapeu*c rela*onship; 7. the explora*on of wishes, dreams, and fantasies. - A common feature of all the psychoanaly*c psychotherapies: - A therapists’ non judging and deeply respecnul a`tudes regarding pa*ents’ mental life and the avoiding assuming that there is something «wrong» in pa*ents’ minds! As a method for invesCgaCng the mind - Methods: Data were exclusively collected by observing pa*ents’ mental processes during psychoanaly*c sessions - Some excep*ons (before ‘90s): § Clinical observa*ons of children behaviour (A. Freud, M. Klein) § Squiggle Game (D. WinnicoO) § Observa*ons of children behaviour in a laboratory se`ng (M. Ainsworth) Case studies (or case reports) § Dora – Freud, 1905 § Rat man – Freud, 1908 § Wolf man – Freud, 1918 § Richard – Klein, 1960), § Piggle – WinnicoO, 1977 § Mr. Z – Kohut, 1979 Drew Westen, 2002: «Narra0ves [case reports]... are invariably compromise forma0ons. Hopefully, they include a strong dose of rela0vely accurate percep0on and memory. But as compromise forma0ons, they... are likely to reflect a variety of desires and fears: to make a par0cular point...convincingly, to appear intelligent and clinically talented to one's colleagues, to establish one's iden0ty as a member of the analy0c community (or a subset thereof), to express iden0fica0on with others one admires and those whose admira0on one desires, to express compe00ve or hos0le impulses toward those with whom one disagrees or dislikes, and so on... Among the most important limita0ons are lack of replicability, lack of reliability of inference, lack of control over the variables that would allow causal inference, and unknown generalizability. » (p. 883) CC. 7  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins Is Psychoanalysis a Science? ObjecCve: Establishing which clinical treatment is most effec*ve for a specific clinical condi*on (mental disorder) by applying empirical methodologies (e.g., standardized measures, sta*s*cal methods etc.) Case Studies / Case Reports “As the history of science a]ests (and, as recently emphasized by the American Psychological Associa0on in their guidelines defining “evidence”), scien0fic evidence includes and oaen begins with sound descrip0ons, such as case studies.” – Psychodynamic Diagnos*c Manual, 2006, p. 3 Individual Case Reports – Looks at a single pa*ent’s condi*on and treatment. Typically looks at rare and unique presenta*ons/condi*ons of illnesses. Case studies – they look a group of pa*ents with a shared condi*on or treatment. - Places emphasis is on the outcome and commonali*es among the pa*ents. - Limita*ons: § Lack of reliability of inference à means that inference here typically relies on the clinicians’ subjec*ve interpreta*ons. This can lead to issues in the drawn conclusion from the evidence. § Lack the experimental control to validate their treatment and analyse the efficacy of the treatment. § They are descrip*ve in nature. —> not causal. Cohort Studies - A type of observa*onal research - Follows a group of individuals over a period in order to study how certain factors affect a certain outcome. - Sector: Public health, Genealogy, Medical research - Aim: inves*gate the development of a disease…or other outcomes within a defined popula*on. Controlled Trials Non-Randomised Controlled Trials – par*cipants are assigned to different treatment groups without randomisa*on. occurs in a clinical se`ng. CC. 8  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins Randomised Controlled Trials – a type of experimental research design that is widely used in medical and psychological research. - It aims to determine the rela*onship between an interven*on/treatment, and an outcome. - Considered the gold standard for the evalua*on of a treatment, due to its random assignment of a control and experimental group. - Allows you to make causal inference. - Limita*ons: authors argue that it is complex, and that it’s not fully suitable for psychodynamics because it doesn’t not account for individual differences and quali*es. § In other words, you can’t analyse the effec*veness of “free associa*on”, with this method. à Alterna*ve research methods used in psychodynamics. 1. Process Outcome Research – focuses on understanding the rela*onship between the therapeu*c process and outcome? § ruptures and resolu*on? 2. CollaboraAve InteracAon Scale – an instrument to measure the rapture and resolu*ons during a therapeu*c resolu*on. § The scale is administered to the therapist via a ques*oner, that is completed by the therapist. The score is then calculated by the researcher and can provide insight on the things. § Seeks to examine how specific aspects of the therapeu*c process contributed to the effec*veness of the therapeu*c process. 3. NaturalisAc Studies – Research conducted in real world therapeu*c se`ngs, offer ecological validity as there is no experimental interven*on. CriCcally Appraised Literature and Evidence-Based PracCce Guidelines à very complicated but it will not be asked in the exam. SystemaCc Reviews - Combines all published studies on the research ques*on à data bases are searched. - Lit review - There is no sta*s*cal analysis involved. - A common approach in psychodynamic psych. CC. 9  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins Meta-Analyses - A combina*on of systema*c reviews and sta*s*cal analysis. - Conducts sta*s*cal analysis of the various results to come up with an overall conclusion. - Helps provide a more robust and precise es*mate of treatment efficacy. Science vs. Psychoanalysis in Research The strong debate within the psychoanaly*c community regarding the applica*on of evidence-based and empirical research methods. - Clinician’s perspec0ve à Worry changes may challenge their well-prac*ced interpre*ve ways of working and their years of training in interpre*ve approaches. - Researchers’ perspec0ve à Want to s*ck to «hard» methods and theories to maintain scien*fic respectability and academic recogni*on. à Note: the human mind is complex and may not always fit into quan*fiable categories. Therefore, a significant shiw towards the “hard sciences” comes with a risk of oversimplifica*on of the psychoanaly*c process possibly excluding some crucial although complex components. - The debate exemplifies the philosophical struggle between the coherence and correspondence theories of truth (Cavell, 1994): § Coherence → depends on how robust and internally consistent a theory is. § Correspondence → depends on how much it appears to correspond with the «facts» of external reality (but note that coherence theorists CC. 10  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins argue that what we call a «fact» is itself a construc*on and therefore subject to coherence criteria). The CreaCon and Social Transmission of PsychoanalyCc Knowledge – Arnold D. Richards “Psychoanalysis is no longer the undisputed queen of the psychotherapies. The welcome and respect it used to find in the larger intellectual world can no longer be taken for granted, even—in the final irony of all, perhaps especially—in the world of medicine and psychiatry.” - “Psychoanalysis is no longer the undisputed queen of the psychotherapies” – suggests that the undominant, and unques*oned posi*on has shiwed. § In the past it was weirdly regarded as the primary and most respected approach to trea*ng and understanding psychological issues. - “Even—in the final irony of all, perhaps especially—in the world of medicine and psychiatry.” – this emphasises a paradoxical situa*on. The Decline of Psychoanalysis à The Cri0cism: - PosiCvist criCque, which saw psychoanalysis as an «ideological», closed belief system, lacking falsifiable postulates or a sound empirical basis. § Why this cri0que? Well psychoanalysis (not empirical). - The psychoanaly*c account has been considered no more or less true than a homoeopathic or astrological account of a pa*ent’s difficul*es. à The Outcome: - Psychodynamic psychotherapies were no longer reimbursed by health insurance companies. - Psychoanalysis began to be almost no longer taught in the training of psychiatrists and clinical psychologists. § Training priori*ses empirical and evidence based clinical treatments. § This shiw reflects a boarder trend, where academics, research and training in favour of empiric-ability. Popula0on no likieà Psychodynamics is phased out à Not thought à If applied no money à Bye, bye jobs. à RIP Psychodynamics. à Cogni0ve vs Psychoanalysis Psychotherapy - With cogni*ve psychotherapy, over*me the symptoms might present differently à not cure just new manifesta*on. Thus, there is s*ll the need for psychoanalysis. - Cogni*ve Psychotherapists try to modify the paOern of behaviour. CC. 11  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins - While Psychoanalysis tries to increase pa*ents’ awareness of the behaviour and the cause of it. § Allowing you to accept it and accept your limits, which can then help you regulate and modulate your behaviour and emo*ons. § This it is also slow and requires a lot of session, and we now prefer more rapid treatment. - Solu*on: An integrated approach which combines the two. Why do we currently use a different term? – Psychodynamic vs Psychoanalysis à Rebranding à Psychodynamics takes place in the scien*fic field. Robert Pyles, 2003 – Warned that «Psychoanalysis is under siege and figh*ng for its survival. We must become not quite ci*zen-soldiers, but analy*c scholar-ac*vists. Our ‘splendid isola*on’ must end» (p. 34). - Pyles issued a call to ac*on for the psychoanaly*c community. - He suggested psychoanalysts should be more than just passive observers and be more ac*ve in order to insure the fields survival. Contemporary SituaCon - Empirical studies demonstrate not only that psychoanaly*c concepts can be tested empirically, but also that solid evidence supports many psychoanaly*c assump*ons. - Parts of psychoanalysis – unconscious, awareness, repression, internalisa*on, and iden*fica*on – are scien*fically established phenomena. Others represent metapsychological superstructures, which may eventually be dismantled, amalgamated, or modified. § Metapsychological superstructures – concepts that are not observable or measurable. ie ego and super-ego. unconscious processes/instances. - Psychodynamic research is increasingly published in major, high-ranking, mainstream psychology and psychiatry journals. - There is now also considerable evidence documen*ng both the efficacy and effec*veness of various kinds of psychodynamic psychotherapy. Psychodynamic Psychotherapy - Today, there are a bunch of psychotherapies derived from psychoanalysis: § Brief Psychodynamic Psychotherapy § MentalizaCon Based Therapy – MBT CC. 12  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins Typically used for BPD as pa*ents typically lack mentalisa*on and the ability to understand the mental state of theirs and others. MBT teaches them that, helping BPD individuals recognise and understand mental state in emo*onally charged situa*ons. MBT can be applied in many se`ngs, ie in public services, in group dynamics/therapy. MBT is typically a group therapy, therapy can help pa*ents explore discrepancies. improve reflec*ve capacity. § Transference focused psychotherapy – TFP Also, for BPD pa*ents, owen view life and situa*ons in black and white, missing several nuances. Pa*ents might rapidly switch from the idealisa0on to the devalua0on of an individual. TFP can reveal distor*ons through the rela*onship with the therapist and can be explored. TFP is a long-term therapy, 2 weekly sessions. à approaches share a common founda0on on the unconscious thoughts and processes and emo0ons, that occur in the mind. - Pragma*c demarca*on line between psychoanalysis and psychodynamic psychotherapy concerns the frequency, intensity, and dura*on of therapy. - Put simply: more than three sessions a week – psychoanalysis; three sessions or less – everything else. § the difference revolves around how owen the therapy session occurs, and the depth of the therapy session. § 3+ weekly sessions à Psychoanalysis. § Less than 3 weekly sessions à Psychodynamic psychotherapies, cogni*ve. “We do not even require of our pa0ents that they should bring a convic0on of the truth of psychoanalysis into the treatment or be adherents of it. Such an aitude oaen raises our suspicions. The aitude that we find the most desirable in them is a benevolent scep0cism”. – Freud, 1917a, p. 244 CC. 13  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins CH2: THE ORIGINS OF THE PSYCHOANALYTIC MODEL OF THE MIND THE ORIGINS OF PSYCHOANALYSIS The treatment of Mental Suffering in the 19th Century - During the 19th century there was a growing interest in esoteric and spiritual treatment. - Treatment focused on the spiritual and mental dimensions to address mental suffering. § Founded on the belief that spiritual and mys*cal forces could influence mental wellbeing. à E.g. Ego was explored to provide insight in the nature of mental suffering. PrimiCve Healing Disease Theory Therapy Disease-object intrusion Extrac*on of disease-object Loss of the soul To find and bring back, and restore the lost soul à using exorcisms Spirit intrusion a. Exorcism b. Mechanical extrac*on of the foreign spirit. c. Transference of the foreign spirit into another living being. Breach of taboo Confession, propi*a*on Sorcery Counter-magic. - Primi*ve healing displayed a considerable insight of the human mind. - Towards the end of the 18th century start of the 19th century however, we see a shiw towards more scien*fic healing. Franz Anton Mesmer à 1734-1815 - First man of science to study illness outside the domain of religion. § Took the first step towards psychotherapy. - Universal, physical fluid - Health and disease explained by the distribu*on of the fluid à MagneAc diseases. § Suggested that disrup*ons and imbalances in the flow of magne*c fluid could lead to mental and physical issues. CC. 14  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins § Theorized that the manipula*on of this fluid could restore balance and health to the individual. - Therapist, or «magne*zer», induce in the pa*ent a trance-like state, transmi`ng his own stronger and beOer fluid to the pa*ent through the channel of the rapport (mesmerism). § We now know Mesmer’s treatment essen*ally hypno*zed his pa*ents. Enlightenment vs. Roman*c Movement - Enlightenment was characterized by a belief in the power of human reason to triumph over ignorance and supers**on. § à physical determinism, which asserts that all events in the natural world obey laws. § «If we know the laws, we control the world» § Mesmer was part of the enlightenment period of philosophy, thus he believed in the physical determinism law. - RomanAc movement à subjec*vity, irra*onality, introspec*on became worthy of aOen*on in understanding the individual. § Related to feelings and imagina*on. § Subjec*vity became a phenomena worthy of aOen*on to beOer understand individuals. Modern Psychology Psychic determinism – analogous to physical determinism. - Asserts that psychological life— like physics, biology, physiology, and all other systems in the natural world—is lawfully determined. § In other words, psychological events are determined by antecedent psychological events, transformed according to natural laws. - The result of the influence of the two approaches à enlightenment and the roman*c movement coming together - This concept means that our life (psych life) tends to be determined by previous psychological events. § Thus, our currents thoughts and feelings/behaviours, are the result of past psychological occurrences. our current thoughts are influenced by past events. Neuron Doctrine – the concept that the nervous system is made up of discrete individual cells, the neurons, supported by astrocytes and by other glial cells. - Immerged around the same *me as the psychic determinism. - Pioneered by: CC. 15  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins § Camillo Golgi (1843–1926) § San*ago Ramon y Cajal (1852–1934) § Emil du Bois-Reymond (1818–1896) Hermann von Helmholtz (1821– 1894) - Forms the basis of modern neuroscience. - Various scien*fic advancements mapped func*on with regions of the brain. § Paul Pierre Broca (1824–1880) § Carl Wernicke (1948–1905) § John Hughlings Jackson (1835–1911) Jean-Mar*n Charcot à 1825-1893 - French neurologist, who made significant contribu*ons to neurology. § Specifically, by linking neurological disorders and psychology. § Essen*ally was the founder of modern neurology. - Worked at “L’Hôpital Salpêtrière” § Within a decade he transformed the hospital where he worked, into rooms for treatment and research. - Most well-known for his ground breaking work on hysteria. § Hysteria – a brain illness that lew cons*tu*onally predisposed individuals suscep*ble to disturbance in the psyche. § Charcot thought hysteria was a brain illness, linked to the pathogene*c effects. § Developed a classifica*on system for complex hysteria – trauma*c hysteria. - Began to treat women with hysteria through hypnosis. § Used hypnosis to induce and alleviate symptoms in his pa*ents. § At that *me, it was a groundbreaking technique. § Through hypnosis he found that pa*ents with hypnosis were more suscep*ble to sugges*on. - He discovered the so called subconscious fixed ideas, which have the power to be pathogenic or cause hysterical symptoms. «A coherent group of associated ideas se]le themselves in the mind in the fashion of parasites, remaining isolated from the rest of the mind and expressing themselves outwardly through corresponding motor phenomena» – Ellenberger, 1970, p. 149 à What is hysteria? What is hypnosis? CC. 16  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins HYSTERIA - Historically a female disorder, typically associated with the womb. § Thought to be caused by irregular blood movement, from the uterus to the brain. - Used as a term to diagnose several symptoms, for women who suffered from a various of physical and psychological symptoms that did not fit into the paOern of other known neurological illnesses. - People with hysteria were also thought to be suffering from demonic possession. à Modern Day Hysteria: The current nosology of DSM-5-TR 1. FuncConal Neurological Symptom Disorder – previously Conversion Disorder - Falls under the category of somaAc symptoms disorders. - Characterized by neurological symptoms that cannot be explained by other neurological disorder. - Symptoms can vary: § Movement disorders à e.g., tremors or paralysis) § Sensory problems à e.g., blindness, numbness. - Symptoms are thought to arise from emo*onal conflict or psychological stressors. § Thus, FNSD is the physical manifesta*on of psychological distress. CC. 17  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins 2. DepersonalizaCon/DerealizaCon Disorder - Dissocia*ve symptoms: are a result of disrup*ons in the usually integrated func*ons of consciousness and memory/iden*ty. § These symptoms can be a natural response to a trauma*c event or stress event or can manifest as part of a dissocia*ve disorder. - Characterized by clinically significant and recurrent depersonaliza*on or detachment from one’s mind/self/body, or the derealiza*on. § Derealiza*on is experiences of our reality as fake or detachment from ones surroundings. - Symptoms are persistent or sever to the extent they interfere with daily func*oning. § Thus, DD should not be mistaken, when mild symptoms occur in our daily life - i.e. when we immerge ourselves in a book and lose sense of our surroundings. - Do not confuse with: § Dissocia*ve amnesia – the inability to recall autobiographical informa*on, in a manner that is inconsistent with normal forge`ng. Can be selec*ve. Localized to a certain period of *me or to an aspect of an event. Generalized – related to iden*ty and life history. 3. Histrionic Personality Disorder - A personality disorder characterized by aOen*on seeking behaviour, exaggerated emo*onal behaviour. - People owen seek to be the center of aOen*on and perceive rela*onships to be more in*mate than they actually are. - Also has origins in the concept of hysteria. CC. 18  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins *Do Not Confuse FNS and HPD* à there is an important dis0nc0on between FNS and HPD. - FNS and HPD differ in the nature of symptoms and the underlying mechanisms, and the diagnos*c criteria. § FNS involves physical symptoms with psychological origins. § HPD involves maladap*ve personality traits. - Although both condi*ons demonstrate/highlight the interplay between psychological and psychical aspects. - if an individual is suspected of having both, clinicians need to approach the situa*on with sensi*vity and comprehensive evalua*on to develop an accurate diagnosis and treatment. Why was hysteria so prevalent in 19th century? 1. It had very broad diagnos*c boundaries and described very different condi*ons. - There was a lack of a clear diagnos*c criterion, and sophis*cated diagnos*c methods. - There was a lack of knowledge about different condi*ons. à Therefore, it easily became a catch all term for physical and psychological symptoms. 2. The society of the *me was even more sexist and patriarchal than it is today. - Prevalent belief in the weaker sex. - Beliefs that the emo*onal nature of women making women more suscep*ble to hysteria. 3. Childhood trauma (par*cularly sexual abuse) was probably more frequent. CC. 19  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins HYPNOSIS Hypnosis – a procedure during which a health professional or researcher suggests that a pa*ent or subject experience changes in sensa*ons, percep*ons, thoughts, or behavior. - Hypnosis is seen as a state of focused aOen*on involving focal concentra*on, and inner absorp*on with a rela*ve suspension of peripheral awareness. - Hypnosis has three components: 1. AbsorpAon – tendency to become fully involved in a perceptual, imagina*ve, or idea*onal experience. 2. DissociaAon – mental separa*on of components of experience that would ordinarily be processed together. 3. SuggesAbility – responsiveness to social cues, leading to an enhanced tendency to comply with hypno*c instruc*ons, represen*ng a suspension of cri*cal judgment. § Hypno*c suscep*bility is a rela*vely stable and measurable trait over the human life*me, somewhat normally distributed. Stanford Hypno*c Suscep*bility Scale Harvard Group Scale of Hypno*c Suscep*bility Elkins Hypno*zability Scale Hippolyte Bernheim à 1840-1919 - Sugges*on or sugges*bility: «the ap*tude to transform an idea into an act» - Hypnosis was not a pathological brain state that can be induced only in people predisposed through heredity but was itself the result of sugges*on, reproducible in everyone to varying degrees. - He treats pa*ents suffering from hysteria, but also rheuma*sm, gastrointes*nal diseases, and menstrual disorders, etc. Jean-Mar*n Charcot and Hippolyte Bernheim - The consolida*on of a new theory of hysteria based on a disordered brain/ mind - system. - Bizarre symptoms of hysteria as the result of separate systems of awareness, or consciousness, and/or split fragments of mental life, which in suscep*ble individuals func*oned autonomously––subconscious fixed ideas, a term given Pierre Janet (a Charcot’s student) - Way for new approaches to treatment based on the goal of reintegra*ng split-off ideas into ordinary conscious mental life. CC. 20  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins FREUD’S STUDIES ON HYSTERIA Sigmund Freud à 1856-1939 - Born in1 856 in Freiberg (Moravia) in a Jewish family § 1938: Freud and his family escape to London § 23 September 1939 he died in London - He was plagued with neuro*c symptoms including palpita*ons, shortness of breath, indiges*on, and extreme moodiness. - His boyhood heroes were not famous philosophers and intellectuals, but “conquistadors” and rebellious heroes of an*quity. - Enrolls at the Faculty of Medicine in Vienna. § Devoted himself to the study of medicine «with hesita*on and a certain carelessness». § While allowing himself «the intellectual luxury of cas*ng a flee*ng glance at philosophy» à aOends lectures by Brentano. - 1886: began clinical prac*ce. - As one of the few specialists in nervous diseases in Vienna at the *me, his prac*ce quickly grew. § Made up largely of women suffering from hysteria whom few wanted to treat. - Freud’s early technique for the treatment of hysteria: § The induc*on of a hypno*c trance followed by the use of impera*ve sugges*on for the removal of symptoms à change it in order to inves*gate the illness. § He became frustrated with the use of this technique, so he modified the method. He also wanted to use it for the inves*ga*on of illness along with the treatment. - Used electrotherapy and deep whole-body massage and also baths for relaxa*on. Studies on Hysteria à 1895 - Book wriOen by Freud and Josef Breuer (1842-1925) - Outlined 5 case studies: § One treated by Breuer § Four treated by Freud - Also included two theore*cal chapters: § One on the pathogenesis of hysteria à wriOen by Breuer. § One on psychotherapy à wriOen by Freud. CC. 21  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins - How Breuer and Freud understood the psychopathology of hysteria and how they used what they both referred to as “the cathar*c method” to treat pa*ents suffering from this disorder. The Case of Anna O. - Anna O. (Bertha Pappenheim) was “a young girl of unusual educa*on and giws who had fallen ill while nursing her father of whom she was devotedly fond”. - Symptoms included paralyses of her limbs, paresthesias, disturbances of vision and speech, and states of mental confusion. - She had two alterna*ng personali*es— one that was normal and the other that she called “naughty”. - Breuer observed that Anna O. could be relieved of her symptoms if, during these self- induced trance states, she were allowed to «express in words the affec*ve phantasy by which she was at the moment dominated» - Treatment method – «the cathar*c method» § Anna O. was encouraged to tell stories about her symptoms under the influence of hypnosis. § Anna O. is generally accepted as the co-inventor with Breuer of a new treatment characterized by introspecCve invesCgaCon, shared narraCve, and the expression of feelings. à New treatment = the catharAc method § Invariably led to are coun*ng of her state of mind and her feelings at the *me when her symptoms first developed––inevitably some disturbing, stressful event. - Anna O. ound herself unable to drink liquids... § Breuer placed her in a trance and prodded her into talking about her disgust. She felt disinclined to talk about its onset. He pushed her. § Overcoming a strong resistance, she remembered recently walking into her room to discover the dog of her «English ladycompanion, whom she did not care for» lapping water from a glass (p. 34) § She recounted the scene with great anger that, wan*ng to be polite, she had held back at the *me. She then emerged from the trance and requested a glass of water. - Her symptoms represented symbolic expressions of experiences and memories of which she was not aware in her «normal» state. CC. 22  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins The Cathar*c Method - Freud hypno*zed his pa*ents using the cathar*c method with the aim of uncovering dissociated pathogenic ideas and tracing them back through a chain of associa*ons to the point of origin, which was inevitably a trauma*c event. - In this early phase of his work, trauma*c memories (and later, forbidden wishes) were effaced through sugges*on (in the manner of Bernheim) or were discharged through words, affec*ve expression, and/or correc*ve associa*on with the rest of conscious mental life (in the manner of Breuer). Abandonment of Hypnosis and Discovery of The Dynamic Unconscious - Freud became frustrated with hypnosis because: 1. Many of his pa*ents seemed not to be hypno*zable. 2. Hypnosis appeared to be a short-term solu*on à cures were short-lived. § Due to his frustra*ons Freud decided to shiw his focus on forgoOen ideas in the waking state, using a new technique à free associaAon. - Events experienced by pa*ents under hypnosis are only apparently forgoOen and can be brought to consciousness if the therapist insists that the pa*ent can remember. - ForgoOen ideas in the waking state. Free AssociaCon à One of the fundamental rules of psychanalysis - Every thought or feeling that came to the pa*ent’s mind would be a link in a determined chain of associa*ons, leading back ul*mately to the original pathogenic idea or memory. § Pa*ents would be instructed to share/express every thought that came to mind without censorship. § The thoughts from a chain which guide the therapist to iden*fy the ini*al pathogenic memory that represents the trauma*c event. - Pa*ents were now fully «awake», rather than in a hypno*c trance à as a result they were more ac*vely engaged in the treatment process. - Therapist role, by contrast, became less intrusive and controlling. - The pa*ents’ efforts at free associated inevitably produced gaps and discon*nui*es in the train of thought and incoherence in the story. § These incoherence’s were to be expected because patents were not asked to produce thoughts linked through a logic connec*on. § Essen*ally the string of illogical thoughts produced by free associa*on was the whole point of psychoanalysis. CC. 23  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins à Resistance – to describe discon*nuity in the flow of associa*on. - Freud argued that his pa*ents should work hard to overcome this resistance, this could be done by: § Pushing pa*ents to tell him (the therapist) everything that came to their mind. § By directly asking them and pushing them not to have filters and censors. § Overcoming the resistance was important as by following the illogical flow the pa*ent would eventually lead the therapist to the origin of the trauma. - However, pa*ents struggled with this demand, due to the difficulty of digging that deep into themselves. - Overcoming of this resistance allows the disappearance of organic symptoms. Conscious mo*va*on to adhere to the VS. Less conscious mo*va*on to conceal technique of free associa*on. aspects of mental life, not only from the doctor but from the pa*ent/themselves. - All the bits of mental life that his pa*ents were reluctant to reveal turned out to be of a «distressing nature, calculated to arouse the affects of shame and of self- reproach...they were all of a kind that one would prefer not to have experienced, that one would rather forget» (Breuer & Freud, 1893/1895/1962, p. 269; Makari 2008). - Freud concluded that his pa*ents wanted to keep certain ideas, feelings, memories, and wishes out of consciousness because they needed to defend themselves from associated feelings of shame and self-reproach. - Thus, they would experience internal conflicts when asked to bring to light their unconscious. § When an individual experiences inner conflicts between the conscious and the unconscious, we talk about neurosis. - Feud believed that individuals employ mechanisms to deal with these internal conflicts. § One of these defence mechanisms is à Repression. Repression à A defence mechanism that individuals unconsciously ac*vate to denied thoughts or feelings that he/she judged as irra*onal, immoral and thus they are excluded from awareness. CC. 24  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins - The point of psychoanalysis is to become self-aware and to self-regulate behaviours and emo*ons. § Thought therapy, Freud was able to see a psychological baOle going on in his pa*ent's mind that had previously been obscured by the use of hypnosis. A New Theory of Hysteria – Defense Hysteria - Freud introduced the revolu*onary idea that in hysteria, thoughts and feelings are separated from consciousness not because of diseased brain processes but rather because of the emo*onal needs of the pa*ent—or from «the mo*ve of defense». § I.e., in the case of Anna O. - Individuals with hysteria are essen*ally normal people struggling with thoughts and feelings that they find unacceptable. - Defense Hysteria therefore is the result of a baOle over unacceptable thoughts, memories, and wishes that are barred from consciousness but that con*nue to seek expression in the form of symptoms. A New Psychology à Freud, 1896a/1962, 1901/1962, 1933/1962 - By 1896 – Psychical analysis became psychoanalysis. § By this year, Freud had completely abandoned hypnosis, had coined the term “psychoanalysis” to explain his therapeu*c method. - Freud said that to understand ‘normality’ we should look at psychopathology first. - Freud argued that to explore how the processes of defense and repression operate not just in psychopathology but also in psychological health. § Thus, he invented a new psychology, that would be applied to everyone, not just people suffering from psychopathological issues. - Freud’s new psychology, known now as psychoanalysis, was founded on his ideas about parts of the mind that in everyone are unconscious. à Recap - Freud applied the principle of psychic determinism to data derived from waking therapy, arriving at the concept of a dynamic unconscious. - He abandoned the use of hypnosis in favor of a new treatment strategy based on the use of the free associaCon method. - Resistance à Freud observed that his pa*ents struggled with conflict between revealing what was on their minds and concealing it from themselves and from the doctor. CC. 25  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins - Individuals with hysteria are normal people struggling with thoughts and feelings that they find unacceptable. § Defense hysteria à All minds are divided by a struggle between conscious acceptable thoughts/feelings and unconscious unacceptable thoughts/feelings. - When his pa*ents were able to overcome their resistance and to accept these warded-off aspects of psychological lives, their symptoms disappeared. - Freud saw the mind as split not because of brain disease or degenera*on but because of mo*va*ons, or dynamic forces. CC. 26  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins CH3: EVOLUTION OF THE DYNAMIC UNCONCIOUS THE UNCONCIOUS Y The Unconscious in the Psychoanaly*c Model of the Mind - Core features of psychoanaly*c models: 1. Although psychoanaly*c models of the mind may vary, the idea that feelings, thoughts, memories, wishes, fears, fantasies, and pa4erns of personal meaning outside of our awareness influence experience and behaviour is a core feature of all of them. 2. Symptoms, troublesome personality traits, or problems in living represent efforts to solve unconscious conflict. 3. The observa*on that shared invesCgaCon into unconscious mental life can lead to relief from suffering. Dynamic – Describes a state of con*nuous interplay of mul*ple psychological and mo*va*onal forces. - Dynamic in two senses: § It makes its influence felt in everything we do (not just some*mes) § Its contents are ac*vely denied access to consciousness by a psychological force called repression. → What can we learn from introspec0on? - Ordinary experiences prepare us (somewhat) for the idea that the mind is at work outside awareness. § Ex. when we experience of suddenly remembering something we had forgoOen. - The psychoanaly*c model of the mind, with its par*cular concept of the unconscious, includes the idea that the mind can: § store informa*on, § work on intellectual problems, § register s*muli outside of consciousness. lots of informa*on processing occurs outside of awareness. - However, the idea specific to the psychoanaly*c view of the mind is that: § Thoughts and feelings outside of awareness are not just stored in some unseen compartment in the mind wai*ng to be no*ced or called upon, § Rather are alive, powerful, and ever-present, influencing all of our experiences and life choices, both large and small. CC. 27  Principles of Psychodynamic Psychology Exam Notes Introduc*on, Overview and Origins § Also, the contents of the dynamic unconscious are kept from awareness because we do not want to know about them. → Instances of self-decep0on (hiding the real mo0ves behind an ac