Principles of Psychodynamics PDF

Principles of psychodynamics What is psychoanalysis? It is a branch of psychology that deals with behavior as a result of the mind, it focus on the understanding of the unconscious, childhood experiences and psychosexual stages in shaping personality and behaviour. Psychoanalysis refers specifically to Sigmund Freud’s original theories and concepts, which he developed in the late 19th and 20th centuries. Freud lead the foundation for many psychological theories and processes. The psychoanalytic model of the mind attempts to organize our understanding of how mental phenomena such as feelings, thoughts, memories, wishes and fantasies affect what we experience and do. Psychoanalysis has been defined as: theory of the mind, theory of some aspects of psychopathology, as treatment and as a method of investigating the mind. What is psychodynamic psychology? The word psychodynamic, which means “mental forces” (or motivations), is used interchangeably with psychoanalytic, because there are a few psychodynamic approaches that are distinct from the psychoanalytic approach. Today the term is used to describe those theories of the mind and interpersonal relationships that derive from psychoanalysis. ➔ Psychodynamic psychology is based on the thought that each of us behave in which we reflect operations of the mind, so mental events are crucial and shape us. A few psychodynamic approaches are different from some psychoanalytic, psychodynamic is a broader term that includes Freud’s idea but also later approaches from other psychoanalysts influenced by Freud, so it is a field that has evolved and incorporated new ideas. Why using the word psychodynamic instead of psychoanalysis? the reason is the inclusion of all theories, both pre and post Freud. Contemporary psychoanalysis (or psychodynamics): is best described as pluralistic, consisting of not one but several models of the mind, overlapping but distinct, each taking a somewhat different perspective on human mental functioning and each emphasizing a different set of phenomena. Each contemporary psychoanalytic model of the mind corresponds to different school of thought about the mind. The major model are: drive psychology, ego psychology, object-relation psychology, attachment theory etc.. Auchincloss aims to combine the major psychoanalytic models of the mind into a single usable contemporary psychoanalytic model of the mind. What is the psychoanalytic model of the mind? Model of the mind: imaginary construction designed to represent a complex system(in this case the human mind) that cannot be observed directly in its entirety. The purpose of any model is to represent a system in such a way that it is easier to talk about and easier to study. It describes how psychological phenomena such as feelings, thoughts, fears, fantasies, values and attitudes interact in the system to influence each other. It describes the motivations, the structures and the functions and processes of people’s mind. It also describes how the mind develops. It attempts to organize the data of the clinical situation (patient’s life story, report, inner experience and the patient’s interactions in the treatment setting) into a representation of the human mind as a coherent psychological system. →It represents the mind of all human beings in general, as well as the mind of any specific individual, with its unique characteristics. It can be used to express how mental life is expressed in a pathological as well as a normal behavior and how treatment is used to influence the mind. →The earliest psychoanalytic model of the mind was constructed by Sigmund Freud in his attempt to make sense of his experience with his own patients. In “The interpretation of dreams” he introduced his first fully developed model of the mind or what he called psychic apparatus. →Some aspects of Freud’s model, often referred to as the Topographic Model of the Mind, survive in contemporary psychoanalytic model of the mind, while others have been abandoned. Indeed, an important part of his legacy is the reminder that successful model making should always be flexible and open ended, no scientific model is ever complete. →Today, no single psychoanalytic model of the mind is able to account for all data from within and outside the clinical situation. The contemporary psychoanalytic model of the mind is best described as pluralistic, consisting of not one but several models of the mind, overlapping but distinct. →These models of the mind (or schools of thought) vary with respect to how they represent the mind, how they understand the patient’s suffering and how they explain the therapeutic action of psychotherapy. ➔ Freud unpacked the definition of psychoanalysis in 3 ways: - Theory of the mind - Treatment - Method for investigating the mind Theory of mind According to this theory, all humans are hardwired with the capacity to develop a theory about how minds work (both our own minds and the minds of other people). 1. Unconscious mental phenomena have a major role for understanding both normal and pathological mental life. 2. Early (childhood) experience is central on the development of the mind, strongly influencing adult mental states. 3. Mental distress can be understood as a compromise solution (mental conflict) and/or as a result of developmental deficit. ➔ This theory indicates the capacity to understand our and other’s mental states, we understand mental states different from our own by developing theories and assumption. Mentalisation: capacity to understand one’s and other’s mental experiences and one’s and other’s mental states. →This capacity enables us: - To understand that others have beliefs, desires and intentions; - To realize that others’ beliefs, desires and intentions might be different from our own; - To form operational hypothesis, theories or mental models of what others’ beliefs, desires and intentions might be. →ToM is essential to survival in our evolutionary niche. In the psychoanalytic model of the mind is referred to as mentalisation. →It begins as an innate potential in infancy and develops in a facilitating matrix of normal maturation, social interactions and other experiences. →ToM can be shown in children by about the age of 4 years. →The ability of each of us to accurately represent what others are feeling and trying to do predicts how well we perform in a variety of interpersonal tasks: at one end of the spectrum, individuals with autism, who have specific defects on this module, have a very hard time functioning on the social world, while, at the other end of the spectrum, people with high capacity for ToM can negotiate a range of social and interpersonal transactions, ranging from parenting, friendship and romantic intimacy to business, teaching, politics and working in the field of mental health. →Scientists believe that mirror neurons might be a crucial part of the neural substrate for our capacity to envision what others are thinking, feeling and planning to do. The three assumption of this theory in detail: 1. Major role of unconscious, centrality of early childhood and mental distress as a compromise solution or as a result of developmental deficit. 1) Unconscious: “the ego is not master in its own house” meaning that unconscious mental phenomena have an important impact even if we don’t see it. Ex. an individual could have unconscious hostility toward a colleague because he reminds them of a bad memory that they are not aware. Nonconscious is different: more broad than unconscious. 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 is to account for consciousness. 2) Centrality of early childhood: Our temperament shapes the experiences we have with our primary caregivers and genetic makeup as well as the caregivers- response. Freud believed caregivers were important for a child’s development and their response shapes the child’s understanding of themselves and the world around them, and also defines their attachment styles. Our struggle as young children to understand and come up with complicated feelings about our earliest love objects and our place in the family lays the foundations of enduring psychic structures that will determine the characteristics of our future attachment relationships. Developmental nature of mental health problems is emphasized. 3) Mental distress as a compromise solution or developmental deficit: the concept of conflict derives from the idea that there are unconscious forces in the mind that battle against each other. Mantal conflicts come from: an intense affect (desire or fear) and a defence against that affect; different intrapsychic structures with different purposes and priorities and an impulse in contrast to an internalized awareness of the demands of external reality. And/or they can be a result of a developmental deficit. To cope with the conflict the individual might engage in different mechanisms: repression, defence mechanisms, denial mechanism (refusing to acknowledge the desire), rationalisation mechanism. Basically, mental distress is a result of conflicting forces in the mind resulting in mechanism to try and maintain equilibrium and control. →We are used to thinking about psychoanalysis in a tripartite way (Freud, 1923): 1. As a theory of the mind; 2. As a treatment; 3. As a method for investigating the mind. As a treatment It is the first contemporary kind of psychotherapy that we know of. Psychoanalysis comprehends a variety of techniques: free association, analysis of transference and countertransference and interpretation (or defences, resistance etc.). To get insight about their underlying processes. Psychoanalytic therapists tend to place a stronger emphasis on: 1. Affect and emotional expression; 2. The explanation of patients’ tendency to avoid topics (defences); 3. The identification of recurring patterns in behavior, feelings, experiences and relationships; 4. The past and its influence on the present; 5. Interpersonal experiences; 6. The therapeutic relationship; 7. The exploration of wishes, dreams and fantasies. As a method for investigating the mind Methods: data were exclusively collected by observing patients’ mental processes during psychoanalytic sessions. Some exceptions (before the 90s): clinical observation of children behavior (A. Freud, M. Klein), Squiggle game (D. Winnicott), observations of children behavior in a laboratory setting. Case studies (or case reports): “Dora” (Freud, 1905), “Rat Man” (Freud, 1908), “Wolf man” (Freud, 1908), “Richard” (Klein, 1960), “Piggle” (Winnicott, 1977), “Mr. Z” (Kohut, 1979). Is psychoanalysis a science? Evidence-based medicine: aims to identify the most effective treatments for psychological conditions (mental disorders) by applying empirical methodologies (standardized measures, statistical methods), this approach shortens the gap between research evidence All the research types that can be performed to respond to a clinical question, the quality of assessment if evaluated based on study designs, methodology. Study with strong designs and methods carry more weight in the analysis. Individual case records Observational research, related to an individual case record, a single case conditions: symptoms, clinical course, response. Case series or studies Also observational studies, related to a sample of case studies, it describes a group of patients not a single one. The group has the same condition or is undergoing the same treatment and the emphasis is typically on the commonalities and outcomes among patients. ➔ Scientific evidence is not only found with large scale experiments and statistical analysis, it can also be found with case studies which will then shape further research. There are limitations to it but also strengths: lack of replicability because you cannot replicate a unique individual (we would have to replicate exact conditions), lack of reliability because it depends also on the single interpretation of the clinician, casual inference: we cannot have a control group to compare the conditions. Cohort studies Observational studies made on a cohort of individuals over time used to study how a treatment or conditions develops. Ex. used in epidemiology. Randomized control trials (RCTs) Research design used in medical and psychological research to determine the relationship between any intervention and its specific outcome. It is a gold standard for the evaluation of a treatment of intervention because participants in the various groups are randomly assigned (control and experiment groups/conditions). It allows researchers to control confounding variables. Some authors in psychodynamics do not approve of it, for example it is difficult to analyse free association with this method. Other research designs are explored to better understand psychodynamics in real world settings: naturalistic studies,… Collaborative interaction scales: allows to measure ruptures and resolutions between therapist and patient (from the therapist point of view), so there is something that can be measured in psychoanalysis. Meta analysis A combination of systematic reviews, because every single study based on your research has to be reviewed. It allows us to understand the efficacy of a treatment. Helps provide a more robust and precise estimate of treatment effectiveness. The strong debate within the psychoanalytic community regarding the application of evidence- based and empirical research methods: Clinicians: Are afraid that these changes may challenge their well-practiced interpretative ways of working and their years of training in interpretative approaches. →Reducing human experiences to variables reduces uniqueness. Attempting to reduce psychoanalysis to purely a scientific framework excludes subjective experiences, so instead of seeking rigid mechanisms they interpret. They claim that the search for a scientific basis for psychoanalysis is inherently misguided, arguing that it is a philosophical and linguistic discipline concerned with meaning and interpretation rather than mechanism and explanation. Researchers: Want to stick to “hard” methods and theories in order to maintain scientific respectability and academic recognition. They want a more scientific basis for psychoanalysis, cause and effect are as relevant in psychoanalysis as in any other science. Although perhaps more difficult to study than in the physical sciences, cause/effect principle apply just as strongly in psychoanalysis as in physics. →This 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 argue that what we call a is itself a construction and therefore subject to coherence criteria). ➔ We don’t see coherence and correspondence in psychoanalysis ➔ Psychoanalysis is no longer the undisputed queen of the psychotherapies: decline of psychoanalysis. It is seen more as an ideological belief. The welcome and respect it used to find in the larger intellectual world can no longer be taken for granted, even in the world of medicine and psychiatry. Positivist critique: which saw psychoanalysis as an “ideological”, closed belief system, lacking falsifiable postulates or a sound empirical basis. The post analytic account has been considered no more or less true than a homoeopathic or astrological account of a patient’s difficulties. Outcomes: Psychodynamic psychotherapies were no longer reimbursed by health insurance companies, and it has began to almost no longer being taught in the training of psychiatrists and clinical psychologists. →Pyles acknowledges that psychoanalysis is no more in a dominant position and to save it he suggests for psychoanalysts to be active participants, they should engage in scholarly exploration and contribute to the ongoing development if the field. Today: - Empirical studies demonstrate not only that psychoanalytic concepts can be tested empirically, but also that solid evidence supports many psychoanalytic assumptions; - Parts of psychoanalysis (unconscious, awareness, repression, internalisation and identification) are scientifically established phenomena. Others represent meta physiological structures, which may eventually be dismantled, amalgamated, or modified. →Today researchers are finding ways to investigate using scientific method. →Psychodynamic research is increasingly published in major, high-ranking, mainstream psychology and psychiatry journals. →There is also now considerable evidence documenting both the efficacy and effectiveness of various kinds of psychodynamic psychotherapy. Today there are a bunch of psychotherapies derived from psychoanalysis: - Brief psychodynamic psychotherapy; - Mentalization based therapy (MBT) - Transference focused psychotherapy (TFP). →Pragmatic demarcation line between psychoanalysis and psychodynamic psychotherapy concerns the frequency, intensity and duration of therapy. But simply: More than three sessions a week→psychoanalysis; three sessions or less→Everything else. All the new psychotherapies derived from psychoanalyses have all a unique approach but they share something in exploration of people’s mind. Brief psychodynamic: shorter, draws on principles of classic psychoanalysis focusing on unconscious processes and the manifesting of behavior, therapist and patient work together to bring unconscious processes to the patient’s awareness. Hysteria and Hypnosis Although mental experience has been a subject of fascination since the dawn of consciousness, the history of scientific study of the mind is only about 150 years old. When Freud introduced his psychoanalytic model of the mind, the term psychologist did not even exist. The word psychology was introduced around 1520, however, psychological reflection did not become organized into a distinct academic or university-based discipline until the end of the 19th century, with the birth of two major branches of scientific psychology: experimental psychology and psychoanalysis. →Modern scientific psychology is the result of the convergence of two major trends in the history of ideas: enlightenment and the romantic movement. - Enlightenment was characterized by a belief in the power of human reason to triumph over ignorance and superstition. Enlightenment philosophers held to the doctrine of physical determinism: asserts that all events in the natural world obey laws: “If we know the laws, we control the world”. - The romantic movement: In contrast to enlightenment, it idealized man’s capacity for imagination and feeling. For the romantics, irrationality was not to overcome but to be explored as a vital source of creativity. →As a result of their combined influence, enthusiasm for successes in the natural sciences had begun to spread to the study of human behaviour, so that by the beginning of the 19th century in Europe we see the development of social sciences including anthropology, sociology, economics, political science and psychology. →Much of psychology is based on the principle of psychic determinism: Psychological life, like physics, biology, physiology and all other systems of the natural world, is lawfully determined. In other words, psychological events are determined by antecedent psychological events, transformed according to natural laws. Psychological phenomena are not simply and not only brain processes but they obey laws of their own. This does not mean that brain processes are not taken into account anymore but it simply establishes the field of mental activity itself as an appropriate subject. →We can trace the origins of scientific psychotherapy to the end of the 18th century, when there is a shift from the healing arts from the domain of religion to the domain of science, as doctors and men of science began to dominate the study of treatment of mental sufferings. The treatment of mental suffering in the 19th century Franz Anton Mesmer (1734-1815) Franz Anton Mesmer, a Viennese physician working more than 100 years before Freud, believed that he had discovered the existence of a universal, magnetic and physical fluid and health and disease according to him are explained by the distribution or equilibrium of the fluid (magnetic diseases). Mesmer’s theory of cure proposed that the therapist, or “magnetizer”, induces in the patient a trance-like state, transmitting his own strengths and better fluid to the patient through the channel of the rapport or relationship (→mesmerism). →Although he initially became famous throughout Europe, he was ultimately discredited by the French Academy of science. However, his name was preserved in the English vocabulary through the word “mesmerized” which means “to fascinate or enthral”. →By the middle of 19th century, mesmerism had disappeared, however, by the second half of the century, we find a new wave of medicalization fuelled by three developments: the widespread of hysteria, a fascination with hypnosis and the development of the field of neuroscience. →Patients with hysteria were most often young to middle-aged women who suffered from an odd assortment of sensory and motor symptoms, as well as disorders of thought, emotion and consciousness frequently neurological in appearance, that did not fit the pattern of any known neurological condition. →Hysteria was not a new illness, however, by the middle of 19th century it had become the focus of healers previously interested in the “magnetic diseases”. →The illness also drew attention of the earliest practitioners of our modern field of neurology who began to offer ideas about disordered functioning within the mind/brain system. →Mesmerism was replaced by hypnosis, a phenomenon that can be traced back to ancient Egypt and which was brought back to Europe by James Braid and the term was adopted by the official and newly medicalized name for the practice of inducing a trance for the purpose of treatment. Important discoveries in the century: - Camillo Golgi and Ramon y Cajal (who made advances in the microscopic study of brain tissue that led to the development of neurone doctrine, which posits as its basic structure the specialized cell called neuron); - Emil du Bois-Reymond (important in the field of electrophysiology); - Hermann von Helmholtz (principle of energy conservation); - Paul Pierre Broca; - Carl Wernicke; - John Hughlings Jackson (important for research on epilepsy and together with Broca and Wernicke began to map correlations between specific areas of the brain and functions such as speech and language and motor functions). →In this period there is also the rise of university-based psychiatry. Jean-Martin Charcot (1825-1893): Charcot was one of the most luminous characters in the 19th century medicine. He had transformed a warehouse for the forgotten into a modern academic medical centre with new consulting rooms for treatment, laboratories for research and a large auditorium. - Founder of modern neurology; - L’Hôpital Salpêtrière; - He played a crucial role to the understanding of various neurological and psychological disorders, including hysteria. Hysteria, according to him, was not simply a result of moral or psychological weakness, as it was often perceived at the time, but he believed that it had genuine neurological underpinnings and should be treated as a legitimate brain condition, more specifically, it was a brain illness that left constitutionally predisposed individuals susceptible to disturbance of the psyche. His work on hysteria began with his efforts to distinguish patients with epileptic seizures from those who were having hysterical paralyses and traumatic paralyses for which there was no evident organic cause. →Charcot and his colleagues developed an elaborate classification system for hysteria, including what he called traumatic hysteria. His research on hysteria also led him to investigate the use of hypnosis as a therapeutic tool and began to treat women with hysteria with it. Using hypnosis, he demonstrated that he could reproduce the same symptoms in patients suffering from hysteria as could be found in those suffering from traumatic paralyses. He also demonstrated that with hypnosis, he was able to remove the same symptoms of paralysis from both groups of patients. →On the basis of his work, Charcot concluded that hypnotic, hysterical and traumatic paralyses were identical to one another, all the result of suggestion and all consisting of lawful, ordered phenomena. Moreover, he argued that in susceptible individuals with a hereditary predisposition who were exposed to suggestion a small, sequestered fragments of the mind could follow a course of development separate from the rest of personality, manifesting themselves through bodily symptoms. These sequestered bits of psychic life became known as “subconscious fixed ideas”. Charcot’s concept marked the first time that ideas were seen as having causal properties in physical world; his revolutionary concept that ideas outside of awareness can be pathogenic, or have the power to cause hysterical and other kinds of neurotic symptoms, would soon be seized upon and modified by another of Charcot’s students, the young Sigmund Freud. The concept of “hysteria” in the current nosology of DSM-5-TR: The term “hysteria” is no longer used as a diagnostic category, the concept has evolved overtime and contemporary psychiatric classifications focus on more specific and well-defined diagnoses related to emotional and psychological disorders. Why was hysteria so prevalent in the 19th century? 1. It had very broad diagnostic boundaries and described very different conditions; 2. The society of the time was even more sexist and patriarchal than it is today; 3. Childhood trauma (particularly sexual abuse) was probably more frequent. Hypnosis Hypnosis can be defined as a “procedure during which health professionals or researchers suggest that a patient or subject experience changes in sensations, perceptions, thoughts or behavior” (American Psychological Association). Hypnosis is seen as a state of focused attention involving focal concentration, and inner absorption with relative suspension of peripheral awareness. Hypnosis has three components: 1. Absorption: tendency to become fully involved in a perceptual, imaginative or ideational experience; 2. Dissociation: mental separation of components of experience that would ordinarily be processed together; 3. Suggestibility: responsiveness to social cues, leading to an enhanced tendency to comply with hypnotic instructions, representing a suspension of critical judgement. →Hypnotic susceptibility is a relatively stable and measurable trait over the human lifetime, somewhat normally distributed: - Stanford Hypnotic susceptibility scale; - Harvard Group Scale of hypnotic susceptibility; - Elkins Hypnotisability Scale. Hippolyte Bernheim (1840-1919)-Nancy School Hippolyte Bernheim was also using hypnosis to treat hysteria and, like Charcot, he understood hysteria to be a pathogenic effect of subconscious fixed ideas. Suggestion or suggestibility: “the aptitude to transform an idea into an act”. →Jean-Martin Charcot (1825-1893) and Hippolyte Barnheim (1840-1919): Consolidated 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 susceptible individuals functioned autonomously. Subconscious fixed ideas, a term given by a Charcot’s student. It made the way for new approaches to treatment based on the goal of reintegrating split-off ideas into ordinary conscious mental life. In contrast to Charcot, Bernheim and the Nancy School argued that hypnosis was not a pathological brain state that can be induced only in people predisposed through heredity but was itself the result of suggestion, reproducible in everyone to varying degrees. Bernheim was interested in developing hypnosis as a therapeutic intervention. He treats patients suffering from hysteria, but also rheumatism, gastrointestinal diseases and menstrual disorders etc. →Overtime, Bernheim began to dispense with hypnosis altogether, using suggestion alone to influence the expression of the patient’s pathogenic ideas. This use of suggestion in the waking state was a treatment that the Nancy School named psychotherapy, the first use of what is now a common word. →Despite the differences between these two men (Charcot and Bernheim), their shared insights led to the consolidation of a new theory of hysteria based on a disordered brain/mind system. This new theory explained the bizarre symptoms of hysteria as the result of separate systems of awareness, or consciousness, and/or split fragments of mental life, which in susceptible individuals functioned autonomously. Freud’s studies on hysteria Sigmund Freud (1856-1939) was born in Freiberg (Moravia) in a Jewish family. He was plagued with neurotic symptoms including palpitations, shortness of breath, indigestion and extreme moodiness. His boyhood heroes were not famous philosophers and intellectuals, but “conquistadors” and rebellious heroes of antiquity. He enrols at the faculty of Medicine of Vienna, devoting himself to the study of medicine “with hesitation and a certain carelessness”, but allowing himself “the intellectual luxury of casting a fleeting glance at philosophy”→Attends lectures by Brentano. 1938: escapes in London with his family. 1939: dies in London. 1896: he begins is clinical practice. As one of the few specialists in nervous diseases in Vienna the time, his practice quickly grew, made up largely of women suffering from hysteria whom few wanted to treat. Freud was mostly influenced in his technique by Bernheim. Freud’s early technique for the treatment of hysteria: the induction of a hypnotic trance (as described by Bernheim) followed by the use of the imperative suggestion for the removal of symptoms→Change it in order to investigate the illness. Nevertheless, despite his enthusiastic endorsement for Bernheim’s method, Freud quickly became frustrated with the use of suggestion to remove symptoms and modified the technique to include the use of hypnosis not only for therapy but also for the “investigation” of the illness. Freud and Josef Breuer (1842-1925) “Studies on hysteria” (1895) Joseph Breuer was a well-known Viennese family physician, known today for his description of the Hering- Breuer reflexes governing respiration. He became Freud’s mentor and started sending him patients and sharing his ideas about hysteria. It was Breuer with whom Freud co-authored his first full-length treatise on psychology, Studies on Hysteria, published in 1895. This work laid the foundation for the development of psychoanalysis and contributed significantly to the understanding of hysteria. Made of 5 case studies, one treated by Breuer and the other four treated by Freud, and two theoretical chapters: one was on the pathogenesis of hysteria (written by Breuer) and one on psychotherapy (written by Freud). The book describes how Brewer and Freud understood the psychotherapy of hysteria and how they used what they both referred to as “the cathartic method” to treat patients suffering from this disorder. →They introduced the cathartic method as a therapeutic technique, this method involved helping patients recall and express their emotions and traumatic experiences associated with their hysterical symptoms. The release of these repressed emotions was believed to alleviate symptoms. →They also emphasized the concept of repression which is the unconscious process of pushing distressing memories and emotions out of conscious awareness and they argued that hysterical symptoms were the result of repressed psychological conflicts. →They also emphasized the significance of the unconscious mind in the development of a treatment of hysteria. The case of Anna O. Anna O. (Bertha Pappenheim) was a “young girl of unusual education and gifts who had fallen ill while nursing her father of whom she was devotedly fond”. Symptoms included: paralyses of her limbs, paraesthesia, disturbances of vision and speech and states of mental confusion. She had two alternating personalities, one that was normal and the other one that she called “naughty”. The transition from one to another was marked by a phase of autohypnosis. →Breuer observed that Anna O. could be relieved of her symptoms if, during these self-induced trance states, she allowed to “express in words the affective phantasy by which she was at the moment dominated”. Treatment method-“the cathartic method” Breuer developed a treatment method in which Anna O. was encouraged to tell stories about her symptoms under the influence of hypnosis. She is generally accepted as the co-inventor with Breuer of a new treatment characterized by introspective investigation, shared narrative and the expression of feelings. Invariably led to recounting of her state of mind and her feelings at the same time when her symptoms first developed. Careful attention to the details of her stories demonstrated that her symptoms represented symbolic expressions of experiences and memories of which she was not aware in her “normal” state. →Anna O. found herself unable to drink liquids and Breuer placed her in a trance and prodded her to talk about her disgust. She felt disinclined to talk about it and he pushed her: overcoming a strong resistance, she remembered recently walking into her room to discover the dog of her “English lady companion, whom she did not care for” lapping water from a glass. She talked about the scene with great anger that, wanting to be polite, she had held back at the time. She then emerged from the trance and asked for a glass of water. Her symptoms represented symbolic expressions of experiences and memories of which she was not aware in her “normal” state. “The Cathartic Method” It was an early therapeutic technique used in the treatment of hysteria and other psychological disorders and it aimed to help patients express and release repressed emotions and memories that were believed to be at the root of the symptoms. Freud hypnotized his patients using the cathartic method with the aim of uncovering dissociated pathogenic ideas and tracing them back through a chain of associations to the point of origin, which was inevitably a traumatic event. In this early phase of his work, traumatic memories (and later, forbidden wishes) were effaced through suggestion (in the manner of Bernheim) or were discharged through words, affective expression, and/or corrective association with the rest of conscious mental life (in the manner of Breuer). Abandonment of hypnosis and discovery of dynamic unconscious →At first, Freud was enthusiastic about the new treatment, which he referred to as “Breuer’s method”, applying it to his own patients, but after, he gradually became frustrated with this technique, discouraged by the fact that many of his patients were not hypnotizable or by the fact that the cures seemed short-lived. Freud recalled a remark made by Bernheim: events experienced by patients under hypnosis are only apparently forgotten and can be brought to consciousness if the therapist insists that the patient can remember. Freud concluded that this fact might also be true of forgotten ideas in hysteria, and he began to conduct his therapeutic investigations in the waking state, in a technique he later called free association: Freud invited his patients to let thoughts flow freely, with as little conscious control as possible and he also insisted that his patients report to him everything that passed through the mind with as little censorship as possible. →Freud’s insistence that the patient report to the analyst everything is on his/her mind with little censorship as possible would later become the fundamental rule of psychoanalysis. Free association: one of the fundamental rules of psychoanalysis →Freud was convinced that every thought or feeling that came to the patient’s mind would be a link in a determined chain of associations, leading back ultimately to the original pathogenic idea or memory. Patients were now fully “awake” and as a result were more actively engaged in the treatment process. Therapist role, by contrast, became less intrusive and controlling. →With these changes, Freud had discovered a treatment method that afforded him a view of the patient-s mind at work that had not been apparent before. →His first observation was that despite his patient’s best attempt to adhere to demands of the new treatment, they were not always able to bring themselves to be fully aware of their own mental activity, the patients’ efforts at free association inevitably produced gaps and discontinuities in the train of thought and incoherence in the story. Resistance: to describe discontinuity in the flow of association. →Freud concluded that his patients’ conscious motivation to adhere to the technique of free association was opposed by another, less conscious motivation to conceal aspects of mental life, not only from the doctor but also from the patient himself. →Freud observed that all of the bits of mental life that his patients were reluctant to reveal turned out to be of a “distressing nature, calculated to arouse the effects of shame and self-reproach…they were all of a kind that one would prefer not to have experienced, that one would rather forget”. →Freud concluded that his patients 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. →Freud used the word “Repression” to describe the defensive process of removing unacceptable thoughts and feelings from consciousness. Freud was able, for the first time, to see a psychological battle going on in his patient’s mind that had previously been obscured by hypnosis. After the observation of resistance he organized a new theory of hysteria. A new theory of hysteria: defence hysteria →Freud introduced the revolutionary idea that, in hysteria, thoughts and feelings are separated from consciousness not because of diseased brain processes but rather because of the emotional needs of the patient or from the “motive of defence”. Freud described what he called “defence hysteria”, asserting that individuals with hysteria are essentially normal people struggling with thoughts and feelings that they find unacceptable. In his view, hysteria is the result of a battle over unacceptable thoughts, memories and wishes that are barred from consciousness but that continue to seek expression in the form of symptoms. →Initially, Freud saw what he called “resistance” as a barrier to exploration of inner life. However, over time, he learned to be as curious about the patient’s reasons for keeping secretes as he was about the secrets of themselves. In other words, he became curious in observing resistance as the most important clue to areas of conflict in the patient’s emotional life. When patients were able to overcome their resistance and to accept these warded-off aspects of psychological lives, their symptoms disappeared. “A New psychology” By 1896 psychical analysis became psychoanalysis. Made to explore how the process of defence and repression operate not just in psychopathology but also in psychological health→”a new psychology”. Freud’s new psychology, known as psychoanalysis, was founded on his ideas about parts of the mind that in everyone are unconscious. To sum up 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 favour of a new treatment strategy based on the use of the free association method. Resistance: He observed his patients struggled with conflict between revealing what was on their minds and concealing it from themselves and from the doctor. Defence hysteria: individuals with hysteria are normal people struggling with thoughts and feelings that they find unacceptable. All minds are divided by a struggle between conscious acceptable thoughts/feelings and unconscious unacceptable thoughts/feelings. →When his patients 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 degeneration but because of motivations, or dynamic forces. Evolution of the dynamic unconscious →The unconscious is a core feature of every psychoanalytic model of the mind. Although psychoanalytic models of the mind may vary, the idea that thoughts, feelings, memories, wishes, fears, fantasies and patterns of personal meaning outside of our awareness influence experience and behavior is a core feature of all of them. →The observation that shared investigation into unconscious mental life can lead to relief from suffering is one of the cornerstones of psychodynamic psychotherapy. →The basic idea that unconscious factors influence mental life remains the most important shared feature of the psychoanalytic model of the mind. →Psychoanalytic approaches focus on the importance of unconscious motivation and intentionality and shared investigation into unconscious mental life can lead to relied from suffering. →Freud invented the psychoanalytic model of the mind when he applied the principle of psychic determinism to data derived from waking therapy, arriving to the concept of dynamic unconscious. →In the psychoanalytic model of the mind, we often refer to the unconscious as the dynamic unconscious to distinguish it from other kinds of nonconscious aspects of mind. Dynamic is a state of continuous interplay of multiple forces. →Repression: Unconscious process in which thoughts or feelings judged to be irrational, immoral, distressing or otherwise unacceptable are excluded from awareness. In other words, thoughts and feelings become part of the dynamic unconscious when they are kept out of awareness by other dynamic mental forces, which oppose our efforts to know our mind. →Freud’s exploration of the conflict in the patient’s mind led to its exploration: all minds are divided by a struggle between conscious acceptable thoughts and unconscious unacceptable thoughts. He saw the mind as split not because of brain disease or degeneration but because of motivations or dynamic forces. For this reason, we often refer to the unconscious as the dynamic unconscious, to distinguish it from other kinds of non-conscious aspects of the mind. →The word dynamic describes a state of continuous interplay of multiple forces. In psychoanalysis, because we are talking about the mind, dynamic refers to psychological forces or, more precisely, motivational forces; including wishes, needs, hopes and fears that influence all aspects of behaviour. →In the psychoanalytic model of the mind, unconscious mental life is dynamic in two senses: - It makes its influence felt in everything we do not just in some states of mind; - Its contents are actively denied access to consciousness by a psychological force called repression. Repression: purposeful or motivated unconscious process in which thoughts or feelings are judged to be irrational, immoral distressing or otherwise unacceptable are excluded from awareness. In other words, thoughts and feelings become part of the dynamic unconscious when they are kept out of awareness by other dynamic mental forces, which oppose our efforts to know our minds. →The psychoanalytic model of the mind, with its particular concept of the unconscious, includes the idea that the mind can store information, work on intellectual problems and register stimuli outside of conscious awareness. It also includes the idea that lots of information processing happens outside of awareness. →The main idea is that thoughts and feelings are not just stored in some unseen compartment in the mind waiting to be noticed or called upon but are alive, powerful, ever present influencing all of our experiences and life choices, both large and small. →The contents of dynamic unconscious are kept from awareness because we do not want to know about them. Was it Freud who discovered the unconscious? Freud was not the first to argue for the possibility of mental life outside awareness, even if one could give it for granted. →Wundt, in 1879, took possession of an abandoned storage closet at the university of Leipzig to set up his first laboratory at what he called “Institute of psychology”. Wundt’s research program was based on an investigative technique called “Introspection”, which involved controlled attention to minute bits of conscious experience such as sound, light and colour came to be called “Introspectionism”. →Wundt’s mission was to elucidate the basic elements of conscious psychic life (which he identified as sensation and feeling) and discover how these basic elements interact to form conscious experience. →Titchener developed a branch of psychology called structuralism, which carried on Wundt’s project of delineating the structures of the conscious mind. →William James was the chief proponent of a school of psychology known as functionalism. James functionalism argued that the goal of psychology was to elucidate the function, or purpose, of mental life. →Wundt and Titchener structuralism and James’s functionalism would dominate the field of psychology until the rise of behaviourism. →Wundt, Titchener, James and many others in the early years of academic psychology took for granted the idea that the mind and consciousness can be equated. In one way or another, they were all intellectual descendants of René Descartes, he is considered an important ancestor of the field cognitive psychology even though there are some ideas not quite admired today (mind-body dualism, mind=soul and it belongs to the domain of religion, ideas and thoughts are distinct from emotions, mind and consciousness are the same thing and thinking cannot happen out of awareness). →Outside of university-based academy psychology, however, there were many who felt that important mental events occur outside of awareness: - Leibniz asserted that there are many small perceptions below the threshold of what he called “apperception” that have a profound impact on conscious experience. In contrast to Descartes, he asserted that “clear concepts are like islands which arise above the ocean of obscure ones”. - Johan Friedrich Herbart, building on Leibniz idea of threshold of perception, added a dynamic component conceiving of ideas and forces. He borrowed the term dynamic from Leibniz and he argued that all mental phenomena result from an interaction of multiple perceptions, representations and ideas that compete with each other at the threshold of consciousness. According to him, the stronger ideas push the weaker one below this threshold in a process called verdrangt (the same word Freud used for repression), repressed ideas strive to reemerge, reinforcing themselves through association with other ideas. - Gustav Theodor Fechner introduced an experimental approach to the study of unconscious. He is probably best known for his metaphor of the iceberg floating on the sea (borrowed by Freud). Fechner began a series of experiments testing the relationship between the intensities of stimulation and perception that are considered by many to be the starting point of experimental psychology and were influenced by Wundt. →In contrast to the philosophers of the Enlightenment, German romantic movement were fascinated by the irrational of the individual. German romantic philosophers took a special interest in the phenomena such as creativity, genius, dreams and mental illness, all of which were seen having sources in the unconscious. In contrast to the Leibnizians or “cognitivists”, romantic philosophers were interested in unconscious motivation, they were all influenced by Jean-Jacques Rousseau. →A particular brand of German romanticism that had a profound influence on all aspects of German culture, including the development of psychology, was the Philosophy of nature (Naturphilosophie). According to Schelling (who founded it) the unconscious was rooted in the invisible life of the universe, forming the link between man and nature. Arthur Schopenhauer Although his philosophy is impossible to classify, his ideas are important to psychodynamics story because of his emphasis on the concept “will to live”, a blind, unconscious force driving the entire universe, including the mind of man. In Schopenhauer view, man is a self-deceiving, irrational creature motivated by internal instincts serving the larger universal will. The work of Schopenhauer profoundly influenced Friedrich Nietzsche. Friedrich Nietzsche Preoccupied with man’s capacity for self-deception, he tried to demonstrate that every emotion, attitude, opinion, behavior and apparent virtue is rooted in an unconscious lie. In his view the unconscious is the essential part of every individual and consists of a turbulent cauldron of thoughts, emotions and instincts, including needs for pleasure and struggle, sexual and herd instincts, instincts for knowledge and truth and ultimately the one basic instinct, the “will to power”. He viewed self-deception as a complex and pervasive aspect of human existence which takes different forms: moral self-deception, denial of the will to power and the creation of false values. →Nietzsche was critical of self-deception because he believed it hindered individuals from embracing their true nature and potential and contributed to the development of moral and existential problems in society. →The most shocking of Nietzsche ideas, was his view that professions of Christian morality are nothing more than a disguised form of inhibited, unconscious “resentment”, he argued that every religion and every philosophy is no more than a disguised confession. Karl Robert Eduard von Hartmann Late 19th century speculation about unconscious mental life culminated with his work “The philosophy of the unconscious”: Discussed the unconscious in relation to 26 topics, including neural physiology, movements, reflexes, will, instinct, idea, curative processes, energy, sexual love, feeling, morality, language, history and ultimate principles etc. Did Freud ever acknowledged these influences? He denied having been influenced by either of them, claiming that he avoided the works of both Schopenhauer and Nietzsche until later life “with the deliberate object of not being hampered in working out the impressions received in psychoanalysis by anticipatory ideas”. The Topographic Model of the mind What is a model? It is an imaginary construction designed to represent a complex system (in our case the human mind) that cannot be observed directly in its entirety. Scientific models are judged by how well they: - Explain the available evidence; - Predict new findings; - Are consistent with other knowledge. 1900: the first fully developed model, introduced in Chapter 7 of “the interpretation of dreams”, formally designated 15 years later. Topographic model ➔ Freud’s topographic model is one of the foundational concepts in his theory of psychoanalysis. It is a way of conceptualizing the structure and organization of the human mind, in particular the unconscious aspects of the mind and it consists of three main components or regions: the conscious mind, the preconscious mind and the unconscious mind. →Places do not refer to any existing brain anatomy, just a metaphor for an imaginary mapping of the mental terrain in which the unconscious is conceived as lying “beneath” the domain of consciousness as a kind of psychic underworld. Conception of the mind as consisting of structures, each of which occupies a particular psychical locality and functions in a particular spatial relation to the others. Topography: emphasizing which mental contents are allowed to access consciousness. - Description of the ongoing motivational interactions among the three regions, which both work together and are in conflict, each influencing the others. - Description of the structural properties of each part of the mind, including the characteristics and modes of functioning of each. - Developmental point of view that accounts for how psychological life of the child lives on in the adult; - Clinical concept of neurosis (psychopathology) and treatment strategies (therapeutic action): free association, analysis of resistance, analysis of transference, interpretation, insight. 1. Conscious-→ Mental experience that is within awareness at any given moment. Lies on the surface of the mind. 2. Preconscious→Mental contents that are in the descriptive unconscious, although they are not within awareness at any given moment, they can easily be brought to awareness if attention is applied to them. 3. Unconscious→Is dynamically unconscious, its contents cannot be brought to awareness by a simple act of attention but are actively denied access to consciousness (repression). 1. Topography It is the notion that the mind, whether normal or pathological, is always divided into conscious and unconscious parts and it is often called the topographic point of view. Descriptions of the mind topography (or what it is conscious and what is unconscious) are part of every psychoanalytic model of the mind. The earliest psychoanalytic model of the mind was itself called The Topographic Model (by Freud). This early model relied heavily on the topographic point of view of mental functioning but included the other four points of view as well (motivation, structure, development, treatment). 2. Motivation →Motivation is the second feature and most significant feature of every psychoanalytic model of the mind and is, therefore, part of the topographic model. It is the dynamic interaction between the topographic components. Motivation is another word for the impetus for mental and/or physical activity. It may take the form of needs, fears, wishes, purposes and intentions. It’s the wish or act of desire. Behind every action there is a thought, feeling or inner desire driving it, it is not just random or solely result of external factors, there is always a mental reason or trigger. →Experience and action are understood as being motivated from within the mind. In the psychoanalytic model of the mind, the search to understand motivation is called dynamic or motivational point of view. There are several aspects of the theory of motivation about which most psychoanalysts agree: - Motivation and action come from within the mind, behaviour is not simply a collection of responses to stimuli from the external world, the mind is capable of spontaneous activity and it is not merely reactive to the environment. - Motivation is guided by the pleasure/unpleasure principle: This principle asserts that behaviour and mental activity always seek to maximize pleasure and escape from pain, in general psychology known as hedonic principle; - Motivation develops in interaction between the mind and external environment: Motivations have a mental origins but are refined and challenged by our surroundings; in other words, it operates according to the reality principle in addition to the pleasure principle, so, the psychoanalytic model of the mind takes into account both internal and external factors; Ex. an internal desire for success (from the mind) might be amplified when someone sees their peers succeeding (external environment). - Conflict and tension: the mind always works to balance and reconcile the conflicting motivations between desires and feelings. The mind seeks compromise formation, every conscious experience represents a compromise between competing demands. →The unconscious is dynamic in two senses: first, unconscious wishes seek to express themselves all of the time, affecting all that we experience and do. Second, unconscious wishes are repressed, or held outside awareness, because we do not want to know about them, having judged them to be unacceptable. However, these repressed wishes are not destroyed; instead they are preserved in the unconscious and continue to exert an active effect on all of mental life and behaviour. →In the Topographic model there is little interaction between consciousness and preconscious. →The most important interaction in the mind is the ongoing struggle between preconscious and unconscious, which are separated by a censor with the authority to decide which wishes are socially or morally acceptable. →Wishes of sexual nature are the most important wishes in the mind and also the most unacceptable. 3. Structure/process →A mental structure is a relatively stable mental configuration with a slow rate of change. The structural point of view arises from the observation that the motivational forces controlling mental life, along with the processes by which they are modulated, are not fleeting or erratic, but instead represent enduring patterns that are stable over time. →The term structure has been used to refer to mental events and processes at varying levels of abstraction, ranging from fantasies, memories, ideals, moral standards, character traits and representations of self and other to more abstract and/or complex concepts such as mental agency or modes of function such as defence. Freud’s well-known tripartite model of mind, which divides mental life into id, ego and superego, it is only one broad example of how the broad example of mental structure has been used to create a model of mind. →Unconscious, preconscious and conscious regions of the mind each have a characteristic structure and each operates in different ways. →Another important aspect of the concept of structure is that every structure has certain capacities, or processes. →The unconscious consists exclusively of unacceptable wishes that have been separated from the rest of the mind by repression and it operates according to the primary process. Unconscious-Primary process The unconscious operates according to the primary process: mode of mental functioning, associated with the unconscious mind, especially dreams, fantasies and symptoms. →Primary process operates based on the pleasure principle, in which wishes strive for immediate expression or satisfaction without regard for consequences. →Unconscious is uncapable of social judgement or moral concern since it is driven by the pleasure principle. According to Freud, the unconscious is perturbed by logical contradictions and operates without sense of time. →It is characterized by symbolization: much of the content of unconscious mind is expressed in symbolic form (like dreams) rather than straightforward, literal representation. It represents the dominance of the pleasure principle. These symbols might not be hold the same meaning for everyone but are personally significant to the individual in question. →The specific organizing mechanisms of primary process include: 1. Condensation: a single idea is capable of representing many related ideas, linked by private, idiosyncratic associations (symbols with specific meaning for the individual); 2. Displacement: an idea is capable of representing another idea, again linked by personal associations. →The concepts of condensation and displacement are fundamental to understanding primary process, in relation to dream interpretation. Both mechanisms serve to transform latent dream content (hidden meaning) into manifest dream content (what we remember when awake), while they seem similar they operate differently: Condensation →Is the fusion of several ideas or elements into a single image or representation. This process is more about the merging of multiple distinct ideas or entities into one representation. Ex. In a dream a single character might have the features of several people and the character is a condensed representation of the individuals and of the feelings associated with them. Displacement →It involves the redirection of emotion or desire from its original object to another substitute object. It transfers the emotional intensity from a significant idea to a less significant one. Displacement is about redirection not fusion (like condensation). Ex. In a dream, a crucial emotion or desire that might be considered unacceptable or distressing gets attached to a more innocuous element in the dream. This process disguises the true emotional significance of the dream content. →To sum up: condensation is about the combination of multiple ideas and feelings into one representation and displacement is about redirection of emotional significance transferred into another less threatening object. Preconscious and conscious-Secondary process The preconscious is the seat of reason and operates according to secondary process: capacity to judge mental contents and censor those judged to be unacceptable according to conventional norms. This process obeys to the reality principle, which indicates the capacity to judge mental contents and censor those judged to be unacceptable according to conventional norms. →This process is logical, sequential and operates in accordance with the rules of cause and effect, it is associated with conscious thought, rational decision-making and problem solving. →Preconscious thoughts are logical, goal directed and language based (they rely on stable, conventional or culturally shared meaning of words). →It has capacity for assessment of external reality, delayed gratification and planned action for the purpose of solving problems. →This process develops only after the child learns through experience that wishing alone does not bring satisfaction and that more advanced forms of thought and action are necessary for gratification. →The conscious mind is the same as the preconscious in terms of structure, it also functions according to the secondary process which uses logic. Being conscious refers to our awareness of our surroundings, our thoughts, feelings, sensations and perceptions at any given moment. Consciousness comprehends experiences, emotions and thoughts that we are actively aware of. →Cognitive processes: comprehend the mental functions and procedures involved in acquiring, processing, storing and using information. These processes are not always in conscious awareness, and they allow us to think, learn, remember, perceive and solve problems. Ex. Recognizing a face in a crowd, remembering a phone number, making a decision based on past experiences or deducing the answer to a math problem. →Censorship: In Freudian psychoanalytic theory, censorship is a metaphorical “gatekeeper” between the unconscious and conscious mind. It prevents unwanted, unacceptable or disturbing thoughts and desires from the conscious (those governed by the primary process) from entering conscious awareness. Relaxed censorship: There are times when the censorship is not as strict or effective as usual. When the censorship is “relaxed”, it allows for the contents of the unconscious to seep into the conscious mind. →Under conditions in which censorship is relaxed, or when mental life is especially dominated by unconscious wishes, feelings and thoughts it becomes possible to observe the penetration of primary process into conscious mental life. There are a number of situations in which this might happen: - Dreams: when we sleep the conscious is less strict and dreams can be influenced by desires; - Daydreams: Even when awake, our mind could go into deeper, unconscious desires; - Slips of the tongue: Accidental mistakes in speech that might reveal underlying unconscious thoughts or desires; - Children play: Children, having less rigid censor mechanisms, often express unconscious desires and fears through play; - Art and poetry: Creative expressions can be avenues through which artists and poets channel and explore their unconscious feelings, desires and conflicts; - Neurotic symptoms: certain behaviours or symptoms might be manifestations of unresolved unconscious conflicts; - Highly emotional states: Intense emotion can weaken the censorship mechanism, allowing contents to surface. →Penetration of primary process: when censorship is relaxed, this mode of thinking (illogical, timeless and wish-fulfilling) penetrates and becomes observable in our conscious mental life. →Freud theorized that the primary process was the original, or earliest mode of mental functioning, with secondary process developing only after the child learns through experience that wishing alone does not bring satisfaction and that more advanced forms of thought and action are necessary for gratification. The word primary refers to what comes first in the development of the mind. However, contemporary psychodynamic theorists no longer adhere to this view, arguing that both kinds of mental organization develop simultaneously and that primary process should not be confused with immature cognition. 4. Development The development point of view seeks to understand behaviour and mental life as part of meaningful progression from infancy to adulthood. It assumes that an adult can be understood as a psychological being only by exploring his or her story. The developmental point of view seeks to understand the origins of the patient’s wishes, fears, ideals, values, attitudes and adaptive strategies and it also explores how these change over time. The developmental dimension seeks to understand the history of psychological life from the point of view of an objective observer, often through the use of empirical methodology. Initially Freud’s developmental theory focused on describing wishes, which are organized into drives and which emerge according to stages (oral, anal, phallic, oedipal/genital phases), however, most contemporary psychodynamic psychiatrists prefer the notion of developmental lines along which they can trace the history of a number of aspects of mental life. →The developmental point of view adds depth to the adaptational perspective by asserting that what may have been adaptive for a child at one phase of development may be maladaptive in the same person as an older child or an older adult. →Finally, it allow us to understand how the mind of a child may be preserved in the mind of an adult, so that we are forever influenced by our childhood wishes, fears and ways of thinking. →We have said that the unconscious consists of unacceptable thoughts and Freud came to believe that the most important of these wishes were sexual. Development of infantile sexuality: As the child grows older, his or her childhood wishes become increasingly unacceptable in terms of conventional morality and the surrounding society and these wishes are repressed. →At the same time ad censorship capacities of the child develop, other mental processes develop as well, and they develop to avoid discomfort of conflict they might cause. →Childhood wishes refer to the natural desires, impulses and fantasies that children have. For example, being jealous of a sibling or fantasizing of marrying a parent. As the child matures, they start to understand social norms and rules and moral standards of the society and many desires don’t feet with them, so they start to repress them. However, despite the repression, the childhood wishes do not go away but continue to survive in the mind. 5. Theory of therapeutic action: →The theory of psychopathology attempts to account for how and why the mind of the patient causes suffering. The theory of treatment attempts to explain how psychodynamic psychotherapy might help the patient to find relief. Theory of therapeutic action in the topographic model of the mind →The Topographic model of the mind is central to our understanding not only of how people develop symptoms or fixed ways of feeling/acting that lead to suffering but also to how psychodynamic psychotherapy can bring relief. Many of the clinical techniques used in psychodynamic psychotherapy were developed with the aim of bringing unconscious mental contents into conscious awareness: - Free associations: “say whatever comes to mind”, were developed by Freud so that the patient can abandon conscious control of their thought processes and can observe the unconscious. The patient and therapist work together to infer the nature of unconscious determinants following the patient’s flow of ideas and feelings, the nature of their avoidance in engaging in exploration and the transference experiences enact during this process, to maximize the effects the therapist might sit behind the patient; - Resistance: is related to the clinical phenomenon of a patient’s active or unconsciously avoidance of knowing their mind. The exploration of this resistance allow patient and therapist to go to the heart of the patient’s most intense struggles and seeking expression. At the heart of the resistance are defence mechanisms, strategies employed by the ego to protect the individual from anxiety-provoking thoughts or feelings and when defences are at play they manifest in resistance. Resistance shields individuals from painful or traumatic feelings and memories, and the patient can: avoid, rationalize (offering logical explanation instead of exploring feelings) or engage in transference issues (strong emotional reactions toward the therapist, whether positive (idealization) or negative (hostility). Exploration of resistance leads patient’s most intense struggles between the unconscious wishes and feelings seeking expression and the effort to avoid awareness of these unconscious wishes and feelings. - Transference: refers to the unconscious redirection of feelings, desires and expectations that a patient originally associated with significant figures in their early life (like parents) onto the therapist. It can be characterized by: reenactment of the past, emotional intensity. →It has therapeutic utility since it provides a “live” experience of how a patient relates to others, making behavior patterns more accessible. Countertransference: is the therapist’s emotional and unconscious reactions and responses to the patient, often a response to transference. It is essential for therapists to be continually self- reflective and to seek supervision or personal therapy to understand and manage their reactions. →Interpretation: refers to the process of helping a patient understand and make meaning of their thoughts, feelings, behaviours and dreams and it is primarily aimed at bringing unconscious thoughts on conscious ones. Successful interpretation depends largely on timing and it is crucial for the therapist to offer insights when the patient is most ready to assimilate them, while, providing an interpretation too early or without proper groundwork can lead to resistance or misunderstanding. It can: facilitate change (as patients become more aware of their motivations and patterns) and resolve conflicts (by shedding light on them the patient can have symptoms of relief). →Reconstruction: refers to when an interpretation makes inferences about forgotten or repressed past. It refers to the process of piecing together and making sense of the patient’s early life experiences and their influence on current behaviours, thoughts and feelings. It is done with the aim of understanding the origins of unconscious conflicts, maladaptive patterns and symptoms. The goal is to draw connections between past and present. TO SUM UP: The topographic model enables us to understand not only the content but also the peculiar form in which symptoms often appear. The goal of making unconscious conscious is part of most psychodynamic therapy. The topographic model provides framework to understand how and why symptoms manifest in different ways: content of symptoms (what the symptom is communicating and expressing, ex. phobia of elevators could be a deeper fear of being trapped), form of symptoms. The topographic model describes a mind that is divided into two domains, the upper layer is reality oriented and the lower is pleasure-seeking. The upper layer obscures often the lower one but it is not able to control it completely, and this model helps us understand the lower one. →The Topographic model describes a mind that is divided, from the earliest days of life, forever and permanently into two domains of psychological life (one layered on top of the other) that are separated by a censor. The upper layer of the mind constitutes a reality oriented, rational and morally constrained domain of reason, responsive to the constraints of society. The lower layer is in part a pleasure-seeking, illogical and amoral domain of childhood wishes, subject to highly idiosyncratic forms of symbolic representations. The upper layer obscures the lower layer but it is not able to control it completely. Indeed, the two domains of the psyche coexist in dynamic relationship with one another, each making its own unique contribution to psychological life. →The Topographic model of the mind helps us to understand the idiosyncratic, personal and often not-so- rational private world of personal meaning that constitutes each individual’s ongoing subjective experience. →In the formation of subjective experience, unconscious wishes, hopes and fears evade the censor by assuming many forms of disguise so that every aspect of mental life represents a mixture of unconscious wish and disguise. In describing how this mixture of unconscious wish and disguise comes about, Freud proposed the concept of transference: in any mental state, an unconscious wish may transfer, or displace, some of its intensity to an unobjectionable preconscious thought with which it might have some symbolic or associative connection. →Transference is the mechanism by which a patient transfers strong feelings from a person of emotional importance to the therapist. →In any situation in which censorship is relatively relaxed, we can see the influence of the unconscious on aspects of mental life through: slips of tongue, jokes and dreams. →The Topographic Model of the mind has made a lasting contribution to the study of psychopathology. The model posits that all experience is the result of a mixture of unconscious and preconscious elements, as inner unconscious experience combines with the experience of external and social reality to form subjectivity. This formula applies to pathological as well as normal mental phenomena. →Pathological phenomena best accounted for by the psychoanalytic model of the mind are described with the concept of neurosis: any inflexible, maladaptive behaviour that represents a solution to unconscious conflict. Therefore, in neurosis also, wishes are always both partially expressed and partially hidden, however, this comes at a cost with suffering and bodily symptoms. →The term neurosis was dropped from the official psychiatric nomenclature in favour of the word disorder. →In Freud’s view, in neurosis we find unacceptable wishes “returning” disguised as symptoms, whereas in non-pathological experience, the mixture causes less distress. →Unconscious conflict ,ay be expressed not only in the form of neurotic symptoms but also in the form of troubling neurotic personality traits, such as difficulties in work, troubles in love relationship, crippling life patterns or disturbances in mood and/or self-esteem. →The Topographic model of the mind enables us to understand not only the content but also the peculiar form in which symptoms often appear. All symptoms are symbolic communication that, like drams, make use of primary process mechanisms such as condensation, displacement and symbolization to represent personal and idiosyncratic hidden thoughts and feelings. Indeed, the similarity between the organization of symptoms and the organization of dreams was one of Freud’s brilliant observations. →Another important contribution made by the concept of the dynamic unconscious to the understanding of neurotic psychopathology is that it allows us to understand not only the inner content and complex form of symptoms, character traits and problematic patterns but also their striking inflexibility since neurosis is characterized by the failure to respond to the demands of common sense or current reality. →The wishes and forbidden desires are not worn away by exposure to reality but they continue to be active in mental life: they contribute to the repetition compulsion of neurotic patients, who repeatedly enact specific scenarios during the course of their lives without ever recognizing the relationship of these scenarios to unconscious memories or wishes. →Freud subjected both his early model and all subsequent models to continuous revision and, in doing so, he established a tradition in which models of the mind are questioned and changed in response to new data. Evolving clinical experience demands modification of each existing model, leading to the development of new ones. The result is that the contemporary psychoanalytic model of the mind is a composite of several models, each of which attempts to address the insufficiencies of the others: 1. Topographic model: It was Freud’s first model of the mind, introduced in 1900. It posited a basic structure of conscious, preconscious and unconscious, domains separated by a barrier of defense or repression. Its main focus was the topography of the mind. 2. Structural model: Freud introduced his new model in 1923. In this model the mind is divided into three parts: ego, id and superego, each differing in structure and motivational aims and each having unconscious features. As Freud and his followers became increasingly interested in the functioning of the ego, the structural model came to be known as ego psychology. 3. Object relations theory: In contrast to previous models, it views the mind as organized by internal object relations (self and object representations linked by an interaction between self and object). Object relations theory seeks to understand basic motivations such as attachment and separation, positing that infants are object seeking from the beginning of life. It explores how object relations develop overtime under the influence of various pressures and how different configurations in these object relations can lead to psychopathology and can suggest associated treatment strategies. 4. Self-psychology: Introduced by Heinz Kohut in the 1960, Self-psychology looks at mental functioning as representing the functioning of a basic structure called the self. Kohut explores basic inborn narcissistic needs in all of us, positing that we all seek recognition and encouragement from caregivers, whom he described as self-objects. Self-psychology proposed that, during childhood, in interactions with empathic caregivers, each of us developed a self that was more or less robust in terms of agency, energy and ability to form ideals. It also describes a treatment strategy based on understanding the self-object function of the therapist. Working on dreams Freud’s model of dream formation and their meanings Dream: mental experiences that occurs when the dreamer is asleep. →Psychodynamic psychotherapists work with patients to explore their dreams as part of shared search for better understanding of the patient’s psychological life. There are many approaches to understanding dreams, including approaches from anthropology, sociology and other branches of psychology. →Dream states are produced by the brain, primarily during rapid eye movement (REM) sleep but also during other stages of sleep. →In “The interpretation of dreams”, Freud related how he became interested in dreams after observing that his patients invariably inserted dreams into their free associations and, as he became increasingly immersed in dream interpretation, he found support for his concept of the dynamic unconscious. →Dreams also serve as a form of defence mechanism and they are a window into the unconscious mind. →Freud’s theory of dreams addresses two issues: 1. The purpose of dreams 2. The meaning of dreams →”A dream is the fulfilment of a wish”. →Freud argued that the purpose of dreams is to protect sleep in the face of disturbing sensations. Freud also argued that both mental preoccupations and unconscious wishes are represented as being fulfilled in the dream, however, in a disguised form. →He went on to say that if unconscious wishes are not sufficiently disguised, they will arouse anxiety, so that the dream fails to protect sleep and the dreamer awakens. →Nowadays, psychodynamic psychiatrists do not attempt to account for the purpose of dreams, understanding that the data from the clinical situation does not lend itself to the exploration of this important question. Interpreting dreams →In contrast to his ideas about the purpose of dreams, Freud’s efforts to understand the meaning of dreams have persisted and are still in use today. →Freud used the term manifest dream to describe the dream as recalled and narrated by the dreamer awakening. He understood that the manifest content of dreams often changes, because we remember different versions of the dream at different times. →Freud distinguished the manifest dream from what he called “Latent dream thoughts” or underlying thoughts expressed by the dream. →Finally, he used the term “Dream work” to describe the process (within the dreamer) of transforming the latent dream thoughts into the manifest of the dream. Process of forming a dream: according to Freud, in the process of making a dream, the latent dream thoughts attach themselves to through associations to unconscious wishes from childhood. The latent thoughts and the childhood wishes, both of which are unacceptable by the censor, then attach themselves (again by association) to a bit of day residue, or an innocuous image and/or event from current experience, which then appears in the manifest dream. →When the patient is asleep, the censor relaxes a bit, and there is a penetration of latent thoughts into consciousness, disguised in the form of dream. →In other words, the power of forbidden unconscious wishes is transferred to unobjectionable day residues, or bits of conscious experiences from everyday life that serve as symbols for the formation of the dream. In this way, latent dream thoughts are altered or disguised for the purpose of evading the censor, which is charged with the task of keeping unacceptable thoughts out of awareness. →Freud argued that the structure of dreams resembles the structure of neurotic symptoms, which he understood as resulting from a struggle between the unacceptable thoughts seeking expression in consciousness and the forces of repression. →Dreams can be interpreted by the therapist by breaking them down into component parts, images or phrases and asking the patient to associate to each component. In this process, therapist and patient uncover unacceptable thoughts from present life as well as thoughts from many stages of childhood and, if they work long enough on any dream, they will discover very early childhood wishes. →Logical processes of mental life are relatively inactive during dream sleeps and primary processes can be more easily observed in the unusual thought processes that characterize dreams. Primary processes include: condensation, displacement and symbolism. →Freud identified a number of ways in which the original dream thoughts are modified on their journey from the unconscious to the manifest narratable dream: Condensation Different elements are combined or fused into a single image, so that the explication or unpacking of such image is invariably longer and more complex than the dream itself. Ex. a man named Ernest, whose dream consistent in the single word Frank. This dreamer had been involved in financial deceit, and needed to remind himself the importance of being honest. Displacement What is important in the dream may appear in the manifest content to be insignificant, and vice versa. To unravel displacements, therapists need to be alert to the multiple meanings, or polysemy, of language. Ex. A young man with anxiety about to make love to his girlfriend is puzzled by a dream in which he was swimming in deep water, doing breast-stroke, until he suddenly realised in the dream an illusion to his sexual fears. Is the meaning of dreams universal and generalizable? Carl Jung, the notion of “archetypes”: an archetype is a universally understood symbol or term or pattern of behavior, a prototype upon which others are copied, patterned or emulated. Archetypes are often used in myths and storytelling across different cultures. →Freud was critical of the Jung’s dream book, specifically of “this means that” approach to dream unravelling, “dream interpretation, without reference to a dreamer-s associations, would remain a piece of unscientific virtuosity of very doubtful value” Understanding neurosis All symptoms are symbolic communications that, like dreams, make use of primary process mechanisms such as condensation, displacement and symbolization to represent personal hidden thoughts and feelings. There is a similarity between the organization of symptoms and the organization of dreams. Basic techniques of analytic dream interpretation The case of Gloria Manifest content: She dreamed that she was five years old, waiting with great excitement for her father to return home from work. When he arrived, it was discovered that he had something disgusting on his shoe, probably some dog feces he had stepped in. But there was something ominous about whatever this was he had brought in. The dream ended with a feeling of spooky uneasiness. Patient’s associations: When she was five years old a brother was born, she remembered having a vague understanding of her father’s role in impregnating her mother and eventually remembered feeling quite jealous of the father’s having given the mother, rather than her, a baby. She had many memories of baby dolls, which she valued highly, and also many horrible memories of her early relationship with her brother, whose arrival she came to regard as a virtual disaster. Latent content (interpretation): As a little girl, and even as a grown woman, Gloria was intensely attached to her father and his penis (the erotic excitement of her relationship to her father is condensed into the image of his eagerly awaited return home, and her interest in his penis is displaced onto and symbolized by his shoe). Her brother was a piece of shit, she believed, and his arrival marred her erotic relationship with her father. She was unable to blame her father directly for this event that deeply enraged her, so she tended to regard it as an accident outside of her control. More recent approaches: →See the dream in the total context of the session and the analytic relationship; →Pay attention to the form and manner the dream’s telling as well as its manner; →See the working through traumatic experience as a central issue in dreaming; →Give equal status to the manifest and the latent content. →Most psychodynamic psychiatrists since Freud continue to see dreams as an important source of information about unconscious mental life. However, the new focus of dreams is based on a new understanding of the mind, contemporary work with dreams has broadened to include exploration not only of unacceptable latent thoughts but also of the defensive modes of functioning that are adopted in dreams. Contemporary clinicians also use dreams to gather information about the state of the transference. “The interpretation of dreams” It was written between 1895 and 1899 and was published in 1900. As the title suggests, it is a treatise on the subject of dreams and their structure, function and meaning. “Flectere si nequero Superos, Acheronta movebo”, at the end of the book, Freud waves these famous lines of ancient poetry into the intellectual plot of the book to represent the fate of “repressed ideas” which, even when banished to the underworld by “the higher powers” of consciousness, are far from vanquished but instead find renewed power to influence and, by implication, even to destroy our life. By using these words, Freud offers his readers a dramatic and stirring bit of foreshadowing of the story he plans to tell. The plot of the book is divided into three subplots: in the first there is Freud’s theory of dreams (what dreams mean, what they are for and how they work); in the second part there is the presentation of Freud’s first fully developed theory of the unconscious in the workings of the normal human mind (the topographic model of the mind); the third plot is the story of Freud’s own coming of age and his struggles with insecurity, self-doubt and competition on the way to becoming a man, told through the recounting of his own dreams. Exploring the meaning of dreams Exploration of the meaning of dreams and/or motivated forgetting requires the use of the correct methods. These methods must be in the domain of psychology, not neuroscience. Data from the clinical situation is an important source of such psychological data and, other psychological appropriate methods are “data mining” techniques. Researchers have been using quantitative methods of analysis for many years to study the content of dreams. Blind analysis is a technique which exploits advances in digital technology to explore recurring patterns in dreams. The Oedipus Complex →Freud named the Oedipus complex after the myth of Oedipus, as told in the play “Oedipus Rex” by Sophocles: Oedipus has a tragic fate, according to the prophecy he will marry his mother and kill his father and, despite his best efforts, he accidentally marries his mother and kills his father. →In Freud’s view, this fate is inescapable because Oedipus is acting out what we all wish for, by virtue of having once been children. Despite the term having been named after a mythical male hero, Freud used it to refer both to men and women. →Freud borrowed the term “complex” after Jung who used the term to mean any set of unconscious associated feelings and ideas that form a network or template in the mind. What is the Oedipus complex? The Oedipus complex consists of a set of feelings and thoughts that we all have about our role in a three- way relationship between ourselves and our parents. It is a stage in a child's psychosexual development where they experience unconscious feelings of desire for their opposite-sex parent and rivalry with their same-sex parent. Between the ages of 3 and 6 years (phallic stage): wish for romantic union with one parent, along with a wish to be rid of the other, competing parent (Freud). →The result is a complex network of feelings, including love and hate, desire and jealousy, disappointment and hope, competition and fear. This network of feelings forms a template in the mind that lasts for the rest of our lives and influences everything we do. As the child grows older and repression sets in, the Oedipus complex becomes increasingly unconscious. However, it is universal and has a lasting effect on the psychological life of all of us. →Freud first formulated the Oedipus complex as he was developing his earliest theories on hysteria and the topographic model of the mind and he discovered the complex in his own self-analysis inspired by the death of his father: 1. The Oedipus complex represents Freud’s first fully developed idea about the contents of the unconscious. 2. The Oedipus complex represents a change in Freud’s theory from one that emphasized external causes of mental events to one that emphasized internal psychological motivation (it was an important event for the advancement of Freud’s theories). 3. The Oedipus complex represents Freud’s first effort to describe in detail how the psychological life of the child lives on the adult. 4. The Oedipus complex includes some of Freud’s first ideas about the importance of the body and of sexuality, leading to his later descriptions of the oral and anal phases of psychosexual development, drives and libido. 5. The Oedipus complex includes some of Freud’s first ideas about the importance of early caretakers in the development of psychological life. 6. The Oedipus complex represents Freud’s first complete account of the mind’s storytelling capacity. →Because the Oedipus complex contains many thoughts and feelings that contradict one another, such as wishes and fears, we often refer to the oedipal conflict when talking about its influence on mental life. Although the conflict is universal, some differences can be found. Oedipal conflict: the differences with the two genders have to do with how each gender negotiates the oedipal period. →Preoedipal children of both genders are most always involved with and attached to the mother. - Little boy: the bond with the mother becomes more romantic and sexual as he enters the oedipal stage, and he develops a full-blown oedipal complex. Then the Oedipal boy: in the grip of “castration anxiety”, starts to experience this anxiety when he becomes aware of the anatomical differences between him and his father and this anxiety arises from the fear that the father, who is perceived as a rival for the mother’s affection will retaliate by castrating the boy, so he relinquishes his sexual/romantic longings for his mother. →In the process, he develops a conscience that thereafter tells him how to behave. →The resolution involves the boy identifying with his father, internalizing societal norms, and adopting the values of his culture. This identification leads to the development of the superego, which represents the internalized moral and societal standards. - Little girl, in the recognition of genital differences between men and women, develops “penis envy”: the little girl blames her mother for her lack of penis and turns to her father, who has the desired and admired organ and develops a full-blown Oedipus complex. In this way, the little girl changes her love object from the mother to her father. Oedipal girl: The renunciation of Oedipal strivings is not so complete as in the boy’s case as she feels that she has already been castrated and therefore has less to fear. Her oedipal wishes are never fully repressed and her conscience never fully formed. →The resolution of penis envy involves the girl accepting her anatomical differences, identifying with her mother, and eventually directing her libidinal desires toward someone outside the family. In this way, she is thought to develop a mature feminine identity. The Oedipus complex becomes increasingly unconscious →Few adults are consciously aware of having romantic and sexual feelings toward a parent, however beloved that parent may be. →The Oedipus complex becomes increasingly unconscious as repression sets in and it happens for several reasons: - Castration anxiety; - Fear of loss of love of the parent(s) and/or abandonment by them; - Fear of feeling guilty. →The Oedipus complex leaves behind: unconscious wishes, fears, superego and modification in self-image (or identification, formed as the child begins to copy his or her parents instead of pursuing his or her wishes for romantic attachment to them). The complex is universal Psychodynamic psychiatrists say that the complex describes an important and universal set of thoughts and feelings that have lasting effects on everyone. (To correct the male-centred bias in terminology: Electra complex or Persephone, however the efforts were vain since we still use the term “Oedipus complex” to refer to both). →In every culture and every mind there are at least 3 problems: 1. Other people with whom we are emotionally involved may have a relationship with each other that excludes us (EXLUSION AND COMPETITION); 2. Certain strivings are forbidden (PROHIBITION); 3. Having once been a child and with the many lasting feelings that accompany that fact (TOLERANCE OF AMBIVALENCE). →Although the oedipal configuration may d

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