Sigmund

Freud
and
Psychoanalysis

From hypnosis to
psychoanalysis
During 1885-1886 Freud went to
France and witnessed the famous
neurologists Charcot and Bernheim
Charcot had been studying hypnosis
for some years in order to distinguish
between organic and hysteric
paralyses
In hysteria, it is not the nerves that are
damaged but the thoughts/ideas about
the legs

From hypnosis to
psychoanalysis
Charcot had placed patients in hypnotic
trances and through hypnotic suggestion
induced hysterical symptoms
He also used hypnosis to remove symptoms
Ideas could be causal agents in the production
and (temporary) cure of hysteric symptoms
Since the subjects who had been hynotized
could not recall what had happened during
hypnotic trance these ideas must be
unconscious

From hypnosis to
psychoanalysis
Joseph Breuer discovered that if his
patient Anna O. could recall in
hypnotic trance the exact moment at
which a particular symptom started
and could also express the emotion
which she felt at the time the symptom
disappeared
Breuer named this treatment catharsis
Breuer and Freud stated that hysterics
suffer mainly from reminiscences

From hypnosis to
psychoanalysis
The content of the pathogenic memories
and feelings were disturbing and in
conflict with the rest of the persons
thoughts and feelings
They were actively kept out of
consciousness via repression
Memories and emotions are seeking to be
discharged while another part of the mind
was refusing this to happen (defense)

The topographic model

Unconscious: containing repressed ideas
and feelings
Primary process
Plesure principle
Preconscious: an intermediate zone
Conscious: containing acceptable ideas
and feelings that are in awareness at any
time,
Secondary process
Reality principle

Primary process of the

unconscious
o Absence of contradiction, logical
thinking, negation, absence of sense
of time and space
o Condensation of thoughts and ideas
o Mobility of affective investments
o Parts are equivalent to the whole

Unconscious
Freud suggests that what we
experience as our mind is a merely
small proportion of it
The rest is unconscious
The real meaning of much we think,
feel and do is determined
unconsciously

Free association
Freud struggled to find a method to
remove the defenses:
Free association: the patient says
whatever comes into her mind without
any censorship
The patient lies comfortably on a couch,
the analyst is behind, out of vision
The sessions last 45-50 minutes, 3-5
sessions per week

Free association
Unlike hypnosis, the patient is fully awake
and can be shown that her unintended flow
of thoughts contains disguised ideas and
feelings (unconscious wishes) that she has
been keeping out of awareness
Free association is impossible to do very
long
The defenses block the emergence of
unconscious wishes
The patient refuses to speak (resistance to
free association)

Tranference and resistance

Conflictual thoughts and feelings
regarding past relationships with
parents/early caregivers are soon
transfered to the analyst
The analyst becomes an object of
intense love and/or hate
Chilhood patterns are constantly
repeated during analysis

Tranference and resistance

The resistance accompanies treatment
step by step
It may take on many forms including
stay silent, forgetting appointments or
not taking medications
The patients characteristic defense
mechanisms are often transformed into
resistances in the treatment situation
Transference and resistance need to be
identified and analyzed

Dreams
Signs of the unconscious: slips of the
tongue and dreams (also symptoms of
the neurotic patients)
Dreams: royal road to the
unconscious
Dreams are disguised fulfillments of
unconscious wishes
Latent dream thoughts, manifest
content, dream work (condensation,
displacement, symbolization)

Dreams
The dream is a disguised composite
of deepest childhood wishes or fears
and defenses against these wishes or
fears woven together into a story
(secondary elaboration)
The tecnique for interpreting dreams:
each element of the manifest content
is assocated to.

Infantile sexuality
Freud found that conficts and
symptoms were invariably tied to
events in early childhood (before the
age of 6)
First he developed a theory of
infantile seduction of the child by the
parent but then he abandoned it and
began to believe in infantile sexuality

Drives
There are two kinds of stimuli affecting
the mind
External stimuli can be avoided; internal
stimuli cannot
Sexual drive (libido) belongs to the
internal stimuli
The mind tries to contain, control and if
possible discharge internal stimuli
Tension (excitation) arising from
different erogenous zones seek
discharge: oral, anal, phallic zones

Drives
Oral libido arises in the oral cavity
(source of the drive), creates a need
for sucking in order to get pleasure
(aim of the drive) and is attached to
the breast (object of the drive)
The infant discovers that the breast
is an object of libidinal pleasure while
feeding for self-preservation

Drives
Oral, anal, phallic drives are component
drives
These drives of infantile sexuality survive in
adulthood in disguised and undisguised
forms
They may find gratification via sublimation
or defenses are built against them to keep
them repressed
Freud regarded sexual drive as the source
of conflict and psychopathology

Drives
Later he also introduced agression as a
source of basic instinctual energy that
drives mental processes
Dual drive theory: libido and aggression
Drives represent for human what
instincts represent for animals
They are the ultimate biological
motivational system

Psychosexual stages of the

libido
Oral: the first year; breast feeding,

dependency
Anal: 1-3 years; toilet trainig; domination,
control, autonomy
Phallic: 3-6 years; Oedipus complex; desire
for the opposite sex parent
Latency: early school years; dominace of the
superego
Genital: puberte and adolescence;
reactivation of all childhood conflicts

Oedipus Complex
The Oedipus complex been the concept most
widely associated with Freudian classical
psychoanalysis, it is the core concept of the
neuroses
In the phallic stage (3-6 years), component
drives are organized under a infantile genital
hegemony, libido focuses on the genitals
The parent of the opposite sex becomes the
focus of the libidinal desire (all types of
pleasure), the parent of the same sex becomes
a feared rival

Stages and anxieties

The fear of loss of the object and the
the loss of the objects fear
The fear of being destructively
controled and losing autonomy
Castration anxiety
Superego anxiety and unconscious
guilt

Oedipus Complex
The Oedipus complex is resolved through
the threat of castration anxiety
It is only by the threat of castration that the
childs Oedipal ambitions are nenounced
Superego is the heir of the Oedipus
complex
Parental rules and values are internalized
as superego (and ego-ideal) after the
resolution of the Oedipus complex

Psychic Conflict
Psychopathology (symptoms, inhibitions,
character pathology,) reflects
unconscious intrapsychic conflicts
Psychic conflict: a struggle between a
forbidden unacceptable wish and defensive
operations against it (and superego
rules/values)
Inhibitions of normal ego functioning and
compromise formations between impulses
and defenses are expressions of conflicts

Psychic Conflict
Id, ego and superego battle among
themselves as sexual or agressive drives
strive for discharge
Conflict between these agencies produces
signal anxiety; signal anxiety alerts the
ego that a defense mechanism is required
Conflict produces anxiety which results in
defense which leads to a compromise
formation between id, ego and superego

Compromise Formation
Neurotic symptoms and character
traits are compromise formations
Symptoms and character traits are
compromise formations that both
defend against the expression of the
wish and gratify the wish in a
disguised form

Structural Model
Freud discovered that not just the
forbidden wishes and impuses but
also the defenses were unconscious
Freud discovered something else in
the unconscious: probibitions, self
accusations and guilt

Id, Ego, Superego

Id is the mental structure that
contains mental representatives of
the drives
Under the dominance of the drives
and guided by the primary process
the id exerts an ongoing pressure
towards gratification operating in
accordance with the pleasure
principle

Ego
Ego functions according to the logical and
reality based principles of secondary
process and is guided by the reality
principle
Unconscios defense mechanisms, primarily
repression
The ego is also the seat of anxiety as an
alarm signal against the danger of
emergence of unconscious, repressed
impulses (signal anxiety)

Ego
Represents reality
Contols drive pressures through the
defenses in the face of reality

Defense Mechanisms
Neurotic
Defense
Mechanisms
Repression
Displacement
Reaction
Formation
Isolation
Undoing
Conversion

Immature
Defense
Mechanisms
Splitting
Projective
Identification
Denial
Devaluation
Primitive
Idealization
Projection

Mature
Defense
Mechanisms

Suppression
Altruism
Sublimation
Humor

Neurotic Defenses

Immature
Defenses

Mature
Defenses

Neurotic Patients

Psychotic and
Personality Disorder
(i.e. Borderline
Patients) Patients
Splitting
Projective
Identification
Denial
Devaluation
Primitive Idealization
Projection

Healthy People

Hysterics
Repression
Conversion

O-Cs
Reaction
Formation
Isolation
Undoing
Repressio
n

Phobics
Displaceme
nt
Repression

Suppression
Altruism
Sublimation
Humor

Superego
The superego is a mental structure
constituted by the internalized demands
and prohibitions of parents
It is built after the resolution of the Oedipus
complex with identifications of the same
sex parent
Ego ideal is cosidered as a part of the
superego
It is built with the internalization of the
expectations of the idealized parents

Schools of Psychoanalysis

Drive Theory
Ego Psychology
Object Relations Theory
Self Psychology
Postmodern Views

Ego Psychology
Anna Freud, Heinz Hartmann
Freud gave most of his attention to
repression
Anna Freud described 9 other defense
mechanisms: regression, reaction formation,
undoing, introjection, identification,
projection, turning against the self, reversal
and sublimation
She shifted the emphasis of psychoanalysis
from the drives of the id to the ego defenses

Ego Psychology
Hartmann focused on the nondefensive
aspects of the ego
A conflict free sphere of the ego that
develops independently from id and conflicts
Given an average exceptable environment
certain autonomous ego functions present at
birth will develop without being impeded by
conflict; thinking, learning, perception,
language,

Functions of the Ego

Reality testing
Impuls control
Thought processes
Judgement
Synthesis-integration
Primary and secondary autonomous
functions
Defense mechanisms

Object Relations Theory

Object means person
According to the classical theory drives are
primary while object relations are secondary
Object relation theory holds that drives
emerge in the context of a relationship
The drives are not viewed as seeking tension
reduction but as directed towards specific
objects for specific reasons
Drives are not pleasure seeking but rather
object seeking (Fairbairn)

Object Relations Theory

Interpersonal relationships are
transformed into internalized
represantations of relationships
As children develop, they do not
internalize an object rather they
internalize an entire relationship

Object Relations Theory

The nursing infant-the caretaking
mother-a positive affective experience
(satiation,pleasure)
The demanding infant-the unavailable
mother-a negative affective experience
(hunger, anger, terror)
These two experiences are internalized
as two opposing sets of object
relationships

Object Relations Theory

Accoeding to the object relations
theory unconscious conflict is not
seen as a struggle between an
impulse and a defense; it is a clash
between opposing pairs of object
relations units

Object Relations Theory

Melanie Klein
Unconscious fantasy
Inherent aggression and annihilation
anxiety, projection, splitting of the
objects into good and bad,
reintrojection, bringing together the
split objects-the whole object, loss and
depressive anxiety, guilt and remorse,
reparation

Object Relations Theory

Paranoid-schizoid position,
depressive position
Projective identification
Oedipus Complex in the first year of
life

Object Relations Theory

The Independents (the British School of
object relations)
Winnicott: good enough mother, false self,
transitional object, transitional zone
(interactive play)
Fairbairn, Balint, Heimann, Little, Guntrip,
They stressed the importance of the
infants early environment (infant-mother
relationship)

Psychodynamic Psychiatry

Psychodynamic Psychiatry
Psychodynamic psychiatry (dynamic
psychiatry) has developed from
psychoanalytic theory and practice
Psychodynamic is equal to
psychoanalytic in contemporary usage
Psychodynamic psychiatry is a branch
of psychiatry that explains mental
phenomena or symptoms as the
outgrowth of conflict.

Basic principles of
psychodynamic psychiatry
Unconscious
Psychic determinism
Developmental orientation (past is
prologue)
Transference
Countertransference
Resistance

Interventions in
psychodynamic
psychotherapy

Inrepretation
Confrontation
Clarification
Encouragement to elaborate
Empathic validation
Advice
Praise
Affirmation

Interpretation
Making something conscious that was
previously unconscious
Interpretation links a feeling, thought,
behavior or symptom to its
unconscious meaning or origin.
May focus on the transference or extra
transference issues, on the patients
past or present, on the intinctual
demands (wishes) or defenses

Interpretation
Perhaps the reason you are late is
that you were afraid I would react to
the success you are now having in
the business the way your father
reacted.

Confrontation
Addresses something the patient
does not want to accept or identifies
the patients avoidance or
minimization.
A patient talked about car problems
at great lengths he encountered on
the way to the session:
I think you would rather talk about
cars than face the sadness about
your...

Clarification
Reformulation or pulling together of
the patients statements.
Helps the patient articulate
something that is difficult to put into
words.

Interventions
Interpretation, confrontation and
clarification (expressive
interventions) are the major
interventions of psychoanalytic or
psychodynamic therapies.
There other interventions used in
psychotherapy, which may not be
defined as expressive and called
supportive interventions.
These are empathic validation,
advice, praise, suggestion and