Definition Of Psychoanalytic Concepts

Psychoanalysis is a theory of human psychology and a treatment method based on several basic principles, including: The dynamic unconscious, that is, the existence of mental contents that we are not aware of due to the process of repression, or the keeping of certain mental contents out of awareness. Freud emphasized the conflict between id (instinctual wishes pressing for gratification) and superego (the result of the oedipal conflict in which the young child accepts the superior strength and power of the same-sex parent and begins to identify with parental prohibitions) as the pathway to development of ego, the reasonable, adaptable, reality-oriented part of the self. Later theorists (Hartmann, Anna Freud, and others) felt that humans are endowed with ego functions from birth and that some of these functions are primary and autonomous (locomotion, ability to manipulate tools, capacity for language, capacity for relatedness to other humans, appreciation of humor, curiosity, reflectiveness, and others) rather than developed out of the id-superego struggle.

The process of repression of prohibited mental material is accompanied by the development of the ego mechanisms of defense (Freud, 1966), various observable behaviors that serve to keep objectionable ideas out of awareness. The defense mechanisms are linked to developmental levels from immature to mature, and range in their demand for distorting versus acknowledging reality (from psychotic to healthy). The analytic process is based on the concept of transference, or the development of intense feelings appropriate to important people from the individual's past that are experienced toward people in the present, in this case, the analyst. Transference feelings develop in all human interactions; for example, feelings about one's supervisor may have more to do with how one experienced one's father than the specific characteristics of the supervisor. These feelings become observable in the analytic situation in which patient and analyst meet several times per week, and through the use of free association, the requirement that the patient say whatever comes to mind during the session, also known as the fundamental rule of psychoanalysis. By analyzing transference feelings, unconscious mental contents become recognizable and the patient gains conviction about their existence.

Repetition compulsion refers to the predictability with which humans repeat certain painful situations without recognizing their part in bringing these situations about: For example, a woman with an alcoholic father marries a man who is an alcoholic. The phenomenon of repetition compulsion reflects the impact of the past on current behavior through the unconscious. If unconscious wishes become conscious through the analytic process, individuals may be able to make healthier choices in life.

Resistance is another important concept: Inevitably, despite the best intentions of the individual to cooperate with the analyst by saying whatever comes to mind, he/she comes to resist the process. This represents the individual's defensive efforts to avoid painful awareness of unacceptable wishes and fantasies. Analysis of resistance is a key part of analytic technique; the therapeutic alliance between analyst and patient enables the analyst to help the patient see how "perfectly reasonable" behavior may serve resistance. As an example, a woman in her third year of analysis, coming into greater awareness of the full impact of her competitive and hateful feelings toward the analyst, reflecting similar feelings toward her mother, interviews for a job in another city since she sees a number of reasons why her present job may become undesirable. She was unaware of the implicit meaning, specifically, that she is planning to undermine and leave the analyst, until the analyst brings it to her attention for further investigation.

Determining which psychotherapeutic technique will benefit which patient is unfortunately neither an art nor a science; the decision is most often based on the therapist's theoretical persuasion and preference for a particular form of treatment. Analyzable

(see below) patients are also suitable for psychoanalytic psychotherapy, which is typically conducted up to three times weekly with the patient sitting up and face to face with the therapist. Psychoanalytic psychotherapy may utilize similar techniques such as analysis of transference and resistance but may also focus more on current life events and utilize greater amounts of support and advice. In modern practice, many patients seen in psychotherapy are treated with medications for anxiety and depression, and when medication is effective, many benefit from less intensive treatment processes. Since psychoanalysis is typically conducted four to five times per week, money and time factor into the decision about the intensity of treatment.

Analyzability, though difficult to define objectively, refers to the set of characteristics of individuals thought likely to benefit from psychoanalysis. [It is important to note that analyzability is impossible to predict, and that outcome studies over the past 50 years have shown that benefit from analytic treatment is always greater than is analyzability; i.e., even "unanalyzable" patients make considerable gains with analysis and psychoanalytic psychotherapy. These gains are largely achieved through the more supportive aspects of treatment (Wallerstein, 1996).] This list typically includes: average or high intelligence, capacity for self-observation, ability to verbalize one's feelings and thoughts, capacity for ongoing human relationships, motivation to engage in a lengthy therapeutic process, a sense of hopefulness about the future, capacity to defer gratification, adequate employment or adequate means to pay for treatment (as money and payment have many important meanings), and the lack of any serious psychiatric illness. This last is an obvious source of controversy since there is complete overlap between the symptoms of depression in patients with psychological conflicts that are amenable to analysis and in patients with depression who are not analyzable: "in patients who are analyzable, such things as sleep disturbances, loss of appetite, despondency, and so on, come and go and are part and parcel of what I am analyzing rather than being a function of physiological imbalances that I have to attend to with different means" (Nersessian, 1992). While depressed patients who are either not ana-lyzable or not in analytic treatment are typically treated with antidepressants, patients in analytic treatment with symptoms of depression that do not respond to analytic investigation may also require medication.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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