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Mattson and Canter Life Care Conusltants, LLC | 203-838-6071 | Mattson and Canter Life Care Conusltants, LLC | 203-838-6071 | www.mattsoncanter.com Life Care Planning – Psychological Aspects A strong foundation in counseling types affords the physician Life Care Planner an opportunity to correlate the individuals’ mental health needs and synthesize a proper set of recommendations. As would follow, the Life Care Planner’s solid foundation in counseling theories is important. This document, produced by Mattson and Canter Life Care Planners, is one tool to learn more. Sigmund Freud Sigmund Freud (1856-1939) graduated from medical school at the University of Vienna in 1881. Although he has been influential in many aspects of neurology, he is most famous for his work in pioneering the field of psychoanalysis. Freud devoted significant time to developing a model of the human mind, which he split into the conscious, subconscious, and unconscious minds. Freud thought that the unconscious mind was particularly important, with it playing a large role in the client’s behavior. As a result of this, Freud shaped psychoanalysis to heavily focus on bringing aspects of the unconscious mind, ideally those that were causing the psychopathology, to the conscious mind so that the client could examine them and better understand themselves. Freud also developed a structural model of the human psyche with three parts once again: the id, ego, and super ego. In this model, the id was closely related with the unconscious mind, driving instinctual behavior that was not consciously considered. The superego was on the opposite end of the spectrum ensuring that moral norms and standards were followed. The ego was in the middle and as acted a mediator between the goals of the id and the superego, helping the psyche compromise. Freud argued that many maladaptive behaviors and psychopathologies his clients experienced were caused by the defense mechanisms of the ego. These defense mechanisms included repression, denial and projection. Freud also focused significant attention on his theory of psychosexual development, dividing it into 5 stages, each of which had an object of fixation. These stages are the oral, anal, phallic, latent, and genital stages. Freud argued that in order to become a healthy adult, a person must successfully complete each stage, otherwise they will become “fixated” in the stage and have a disorder that is related to that stage’s object of fixation. For example, should a person never complete the oral fixation stage, they are likely to develop a fixation relating to the mouth and undertake mouth-related maladaptive behaviors such as smoking or verbal aggression. Psychoanalysis/Historical: The psychoanalytic approach to therapy was developed by Sigmund Freud in the late 19th century and is still used today. It primarily examines how the unconscious mind influences thoughts and behaviors and seeks to bring the unconscious thoughts, fears, and feelings to the conscious mind. Practitioners of psychoanalysis would argue that this allows the client and therapist to gain insight into the root of a problem. It can be used with a wide variety of psychopathologies, most notably depression, anxiety, and specific phobias. Freud’s influences are still the backbone of this approach today, with much of a typical therapy session focused on examining how childhood and past events have shaped the unconscious mind. Psychoanalysis most often takes the form of talk therapy and often employs the techniques free association and interpretation. In free association, the therapist allows the client to speak freely Mattson and Canter Life Care Conusltants, LLC | 203-838-6071 | www.mattsoncanter.com without interruption about whatever is on their mind, with the therapist making connections between events, feelings, or thoughts after the client is finished. In interpretation, the client speaks freely, with the therapist interjecting into the client’s narrative with their own thoughts or interpretations. Although influential, psychoanalysis has generally fallen out of favor, with many critics arguing that its lack of empirical evidence and reliance on vague analysis such as dream interpretation make it inconsistent and non-scientific. Object Relations Object relations is a theory within psychoanalytic psychology that disagrees with Freud’s idea that sexual drives and aggression drives human behavior. Instead, it argues that human behavior is driven by a need for contact with others and a desire to form relationships. The term object relations refers to the relationship between the self and another person The goal of object relations theory is to help a client identify shortcomings in their relationships with others by examining three key components: the other as perceived by self, the perception of self in relation to the other, and the relationship between self and the other. This requires dipping into the unconscious mind to examine the dynamics of how the relationship forms and functions. Neo Freudians There are three men who are considered to be the “Neo-Freudians”: Alfred Adler, Erik Erikson, and Carl Jung. As the name suggests, they were heavily influenced by Freudian ideas about the conscious and unconscious minds. Despite this influence however, the Neo-Freudians rejected many of Freud’s ideas, arguing that he focused too heavily on childhood experiences and sex. Instead, they focused more on how culture and social aspects of childhood can shape personality and thinking. Similar to Freud and his psychoanalytic approach, they are often criticized for a lack of empirical evidence on the effectiveness of their treatment and for a heavy focus on philosophy. Alfred Adler Alfred Adler (1870-1937) is best known for his creation of the field of individual psychology. He was a colleague of Sigmund Freud and worked to help established the field of psychoanalysis, but eventually disagreed with the direction Freud took the field. Instead, Alder focused on how individuals respond to feelings of inadequacy, arguing that Freud’s assertion that sexual conflicts in childhood cause mental illness was incorrect. Adler instead argued that people individually strive for their own unique version of perfection, and that they display positive behavior when they feel adequate and respected. He felt that psychopathology arises when one feels inadequate and inferior when comparing themselves to the ones around them. Thus, individual psychology involves significant examinations of both the individual and the communities in which they live. Adlerian therapy is based on these concepts. It centers around how a client fits in with their community and examines how a client can over-compensate or engage in destructive behavior should they feel inadequate compared to their peers. It uses some aspects of psychoanalysis, notably the use of free association about the client’s family history, early memories, and feelings. In using this technique, a therapist works to allow the client to develop new ways of thinking about how they view their perfect self and their situation. Carl Jung Mattson and Canter Life Care Conusltants, LLC | 203-838-6071 | www.mattsoncanter.com Carl Jung was a Swiss psychoanalyst who worked extensively with Sigmund Freud. He is considered by many to be the founder of analytical psychology, which was a response to the criticism that Freud’s psychoanalysis was not empirical science. Analytical psychology focuses on the goal of achieving individualization, a state in which a person is more aware of their collective unconscious (unconscious traits and thoughts shared by all of a species) and personal unconscious. With individualization, a person could better understand their thoughts, feelings, and choices. Similar to Freud, Jung thought that childhood experiences were key in shaping the unconscious and that clients could benefit from bringing such unconscious trauma to the conscious mind. He expanded on this, arguing that people are also influenced by archetypes which were unconscious factors that are not from their own personal life. He thought archetypes made up the collective unconscious, which spanned across the all of humanity to create many of the similarities between people from different parts of the world. Existential-Humanistic Therapies Existential and humanistic therapies focus less on the symptoms a client is experiencing and more on the client themselves. These two share a belief that people have the ability to be self-aware and make autonomous choices but differ in their underlying theories about why this is the case. The humanistic perspective is based on the idea that human nature is inherently good, and that people can make choices that are in their own best interest. As a result, humanistic therapy encourages growth and self-actualization, with the therapist providing unconditional positive regard and helping the client examine how straying away from their natural self can be the source of problems. Existential therapy is built around on the idea that all problems that clients face are based one of the four given values of existence: freedom/responsibility, existential isolation, meaninglessness, and death. Although it does consider past events, it does not take the same level of importance as in psychoanalytic therapy. Instead, it only uses past events to help give the client insight into how their future is not determine by their past. Similar to humanist therapy, the therapist will avoid any judgement of the client and encourages the client to take responsibility for successes. This therapy is designed to help clients take ownership of their lives and take responsibility for the choices they make. It has been found to be particularly useful in clients with a terminal illness or with clients who are going through a major life transition. Carl Rogers Carl Rogers (1902-1987) was a psychologist who added a great deal the humanistic perspective, adding to the work of Abraham Maslow. Rogers rejected psychoanalysis as too deterministic and instead argued that humans are driven to self-actualize, which he defined as fulfilling one’s potential and appreciating life. He argued that self-actualization occurs when someone’s ideal self is the same as their actual self, a match that he called congruency.
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