psychoanalysis

Psychoanalytic Theory and Defense Mechanisms د.وليد العميدي
Psychoanalytic theory is based on Freud s concept that behavior is determined by forces derived from unconscious mental processes. Psychoanalysis and related
therapies are psychotherapeutic treatments based on this concept.
FREUD S THEORIES OF THE MIND
To explain his ideas, Freud developed, early in his career, the topographic theory of the mind and, later in his career, the structural theory
A. Topographic theory of the mind.
In the topographic theory, the mind contains three levels: the unconscious, preconscious, and conscious.
1-The unconscious mind contains repressed thoughts and feelings that are not available to the conscious mind, and uses primary process thinking.
a. Primary process is a type of thinking associated with primitive drives, wish fulfillment, and pleasure seeking, and has no logic or concept of time.
Primary process thinking is seen in young children and psychotic adults.
b. Dreams represent gratification of unconscious instinctive impulses and wish fulfillment.
2-The preconscious mind contains memories that, while not immediately available, can be accessed easily.
3-The conscious mind contains thoughts that a person is currently aware of. It operates in close conjunction with the preconscious mind but does not have
access to the unconscious mind. The conscious mind uses secondary process thinking (logical, mature, time-oriented) and can del ay gratification.
B. Structural theory of the mind.
In the structural theory, the mind contains three parts: the id, the ego, and the superego






Freud s Structural Theory of the Mind
Structural
Component Topographic Level
of Operation Age at Which
It Develops Characteristics
Id Unconscious Present at birth Contains instinctive sexual and aggressive drives
Controlled by primary process thinking
Not influenced by external reality
Ego Unconscious,
preconscious,
and conscious Begins to develop
immediately
after birth Controls the expression of the id to adapt to the requirements of the external world primarily by the use of defense mechanisms
Enables one to sustain satisfying interpersonal relationships
Through reality testing (i.e., constantly evaluating what is
valid and then adapting that to reality), enables one to
maintain a sense of reality about the body and the external world
Superego Unconscious,
preconscious,
and conscious Begins to develop
by about 6 years
of age Associated with moral values and conscience
Controls the expression of the id

DEFENSE MECHANISMS
A. Definition.
Defense mechanisms are unconscious mental techniques used by the ego to keep conflicts out of the conscious mind, thus decreasing anxiety and maintaining a person s sense of safety, equilibrium, and self-esteem.
B. Specific defense mechanisms
Acting out : Avoiding personally unacceptable emotions by behaving in an attention-getting, often socially inappropriate manner
Example : A depressed 14-year-old girl with no history of conduct disorder has sexual encounters with multiple partners after her parents divorce
Altruism : Assisting others to avoid negative personal feelings
Example: A man with a poor self-image, who is a social worker during the week, donates every other weekend to charity work
Denial : Not accepting aspects of reality that the person finds unbearable
Example: An alcoholic insists that he is only a social drinker
Displacement : Moving emotions from a personally intolerable situation to one that is personally tolerable
e.g. : A surgeon with unacknowledged anger toward his mother is abrasive to the female residents on his service
Dissociation : Mentally separating part of one s consciousness from real life events or mentally distancing oneself from others
e.g. : Although he was not injured, a teenager has no memory of a car accident in which he was driving and his girlfriend was killed
Humor : Expressing personally uncomfortable feelings without causing emotional discomfort
e.g. : A man who is concerned about his erectile problems makes jokes about Viagra (sildenafil citrate)
Identification (introjection) : Unconsciously patterning one s behavior after that of someone more powerful (can be either positive or negative)
e.g. : A man who was terrorized by his gym teacher as a child becomes a punitive, critical gym teacher (identification with the aggressor)
Intellectualization : Using the mind s higher functions to avoid experiencing emotion
e.g. A sailor whose boat is about to sink calmly explains the
technical aspects of the hull damage in great detail to other crew members
Isolation of affect : Failing to experience the feelings associated with a stressful life event, although logically understanding the significance of the event
e.g. : Without showing any emotion, a woman tells her family
the results of tests that indicate her lung cancer has metastasized
Projection : Attributing one s own personally unacceptable feelings to others
Associated with paranoid symptoms and prejudice
e.g. : A man with unconscious homosexual impulses begins to believe that his boss is homosexual
Rationalization : Distorting one s perception of an event so that its negative outcome seems reasonable
e.g. : A man who loses an arm in an accident says the loss of his arm was good because it kept him from getting in trouble with the law
Reaction formation : Adopting opposite attitudes to avoid personally unacceptable emotions, i.e., unconscious hypocrisy
e.g. : A woman who unconsciously is resentful of the responsibilities of child rearing overspends on expensive gifts and clothing for her children
Regression: Reverting to behavior patterns like those seen in someone of a younger age
e.g. : A 5-year-old child who was previously toilet trained begins to wet the bed when his mother has a new baby
Splitting : Categorizing people or situations into categories of either "fabulous" or "dreadful" because of intolerance of ambiguity Seen in patients with borderline personality disorder
e.g. : A patient tells the doctor that while all of the doctors in the group practice are wonderful, all of the nurses and office help are unfriendly and curt
Sublimation : Expressing a personally unacceptable feeling )e.g., rage) in a socially useful way
e.g. : A man who got into fights as a teenager becomes a professional prize fighter
Suppression : Deliberately pushing personally unacceptable emotions out of conscious awareness (the only defense mechanism that includes some aspect of consciousness(
e.g. : A medical student taking a review course for the UnitedStates Medical Licensing Examination, mentally changes the subject when her mind wanders to the
exam during a lecture
Undoing : Believing that one can magically reverse past events caused by "incorrect" behavior by now adopting "correct" behavior
e.g. : A woman who is terminally ill with AIDS caused by drug abuse stops using drugs and alcohol and starts an exercise and healthful diet program.

1-Some defense mechanisms are immature (i.e., they are manifestations of childlike or disturbed behavior.
2-. Mature defense mechanisms (e.g., altruism, humor, sublimation, and suppression), when used in moderation, directly help the patient or others.
3. Repression, pushing unacceptable emotions into the unconscious, is the basic defense mechanism on which all others are based.

TRANSFERENCE REACTIONS
A. Definition.
Transference and countertransference are unconscious mental attitudes based on important past personal relationships (e.g., with parents). These phenomena
increase emotionality and may thus alter judgment and behavior in patients relationships with their doctors (transference) and doctors relationships with their
patients (countertransference).
B. Transference
1. In positive transference, the patient has confidence in the doctor. If intense, the patient may over-idealize the doctor or develop sexual feelings toward the
doctor.
2. In negative transference, the patient may become resentful or angry toward the doctor if the patient s desires and expectations are not realized. This may
lead to noncompliance with medical advice.
C. countertranference
In countertransference, feelings about a patient who reminds the doctor of a close friend or relative can interfere with the doctor s medical judgment.