Basic Psychological Treatments: Psychodynamic therapy Dr Simon Reid Milligan Forensic Psychologist Roseberry Park Hospital Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust theory Psyche – focus on psychological experience, primarily emotional pain. Mind is constructed in struggle to manage (conflicting) difficult and demanding processes Dynamic – our mental life is in flux. Responding to constant conflict within ourselves based on changing world around us theory No single articulated paradigm Pre-theoretical: focus is on perception of human condition, not a concept Includes all theories in psychology which regard human functioning as result of interaction of drives and forces within person, especially unconscious Encompasses many theoretical approaches which remain connected to psychoanalytic roots Object Relations Theory – internalised relation of self to self within world theory Psychic determinism – unconscious motives. All behaviour has a cause Developmental – role of childhood experiences and relationships as template for later life Tripartite structure of personality History Freud – psychoanalysis was the original psychodynamic theory Adler (1927) Anna Freud (1930s) Erikson (1950) Jung (1964) History Late 19th century – Dr Joseph Breuer; Anna O 1895 – Studies on Hysteria (Breuer & Freud). Emotional distress is product of trauma which cannot be integrated into one’s understanding of the world 1896 – psychoanalysis and ‘free association’ 1900 – Interpretation of Dreams. Within two years, founded Vienna Psychoanalytic Society International Psychoanalytic Association was founded – Freud named Jung as successor Jung collaborated with Freud re dementia praecox History 1913 – Jung and Freud broke collaboration regarding disagreement about focus on sexual definition of libido and incest Jung developed own theories of Analytical Psychology. Concepts included collective unconscious and archetypes 1930s – Anna Freud (daughter) became significant influential figure in British psychology and application of psychoanalysis to children 1950 – Erikson, ran with concept of stages of (psychosexual-) development Melanie Klein (1882-1960), Wilfrid Bion (1897-1979) 1995 – Malan, Triangles of Conflict and Person, contemporary impact on practice and formulation Freud Active between 1890s and 1930s developed collection of theories which have formed basis of psychodynamic approach Theories are clinically derived – based on small number of case studies of therapy (primarily depression or anxiety disorders) Psychoanalysis is both a theory and therapy Affect-Trauma model: Childhood trauma leads to painful affect. This leads to a physiological reaction Topographical model: Unconscious, preconscious and conscious ‘layers’. Primary and secondary processes of mental functioning Freud Case studies Anna O Dora Little Hans Rat Man Wolf Man Anna O Bertha Pappenheim – 21yrs Healthy and intelligent, no signs of neurosis but feelings always exaggerated, moody, daydreamed Developed illness: - incubation. Had to nurse unwell father until she was too unwell - manifest illness: paralysis of right arm, leg, squint and disturbed vision, hallucinated, abusive (threw things), false accusations against others, exclusively spoke in English - After father’s death – sleepwalking, could not understand german, refused food Anna O Symptoms result of events buried in unconscious looking for expression Lasted approx. 12 months ‘talking cure’ Discussed each symptom to identify cause. Each disappeared after describing its first episode Although still spent time in sanatorium, addicted to morphine and lost German, became social worker and feminist figure Dora Ida Bauer - 1900 (18yrs) Contact from work with father. Attached to father (rich and intelligent), despised mother Hysteria – depressed, suicidal, frequently lost consciousness, bouts of amnesia and migraines 11 weeks analysis. Predominantly dream analysis Attributed to sexual abuse perpetrated by family friend. Guilt about masturbation and subsequent abstinence Symptoms reduced. Attributed to conscious awareness of problems Little Hans 1909 (5yrs) Presentation relayed by father Phobia of horses; refused to go into street. Fear horse would enter house and bite him in revenge for wishing them dead Attributed to ego defence mechanism of displaced fear of father onto horses. Wished father dead as competitor for mother’s love Oedipus Complex – “foreshadowing of budding sexual wishes” Rat Man Ernst Lanzer - 1907 (late 20s) Compulsive irrational behaviours (opening apartment door at midnight to allow father’s ghost to enter); stared at penis: feared something bad would happen to young woman he was attracted to; feared his father would die (already dead); preoccupied by story of people being tortured by rats boring into their anus Compulsions and urges to cut own throat with razor Freud attributed neurosis to subject’s engagement in sexual foreplay with governess and fear his father would discover this and punish him Associated sexual pleasure with fear of punishment; manifested as fear father would be harmed Significant reduction in symptoms after 11 months Wolf Man Sergei Pankeieff – 1910 (23yrs) Depression and inability to open bowels without an enema Attributed to childhood dream about six wolves sitting in walnut tree which he had been terrified by Symbolic of fear reaction to seeing parents engaged in ‘violent’ intercourse. Long tails represented fear of castration; wolf represented father; stillness represented violent motion Structural perspective Psychodynamic theory focuses on different levels of mental organisation Conscious – verbal syntax, logic, abstract conceptualisation, delineation Unconscious – no contradiction, no ordered sequences, no delineation (concepts can be displaced, condensed), similar to dreams Structural perspective Internal world is dominant force in structuring our perception of the world All experiences are made to conform with expectations of world Unconscious model used to interpret hidden meanings which are repressed, transformed or disguised by repression in our conscious mind Tripartite structure Id Impulsive unconscious, responds directly and immediately to instincts. Personality of newborn is all id Remains infantile throughout life. Does not change because it has no contact with external world comprised of two instinctive drives – eros (sex drive and life) and thanatos (aggressive drive and death). Character of drives change with age, Stages of Development Pleasure principle – to be satisfied immediately; tension when not satisfied Primary process thinking – primitive, illogical, irrational and fantasy orientated Tripartite structure Super-ego Incorporates values and morals of society learned from environment Develops between 3-5yrs, during phallic stage of psychosexual development Internalisation of societal rules. Determined by childhood environment. To control forbidden impulses including sex and aggression; aims to achieve perfection and moralistic goals, not just realistic ones Includes two systems: conscience and ideal self Punishes self for giving in to id and drives aspiration. Also rewards self for acting in accordance with internalised norms Tripartite structure Ego Develops to mediate unrealistic id and external world Reality principle – to find ways to satisfy id’s demands, inc compromise, postponing satisfaction. Considers social realities and norms Secondary process thinking – decision-making component of personality; uses reason Horse-rider analogy If ego fails to use reality principle, and anxiety is experiences, unconscious defence mechanisms are used to ward off unpleasant feelings Tripartite structure Id (exclusively) and super-ego (predominantly) are unconscious. They are often in conflict Experience of conflict creates anxiety which can enter consciousness (ego) Defence mechanisms are used to manage anxiety of conflict Defences operate on continuum of more-less healthy, levels of primitiveness and behavioural control strength Dynamic perspective Psychic determinism – all behaviour is meaningful, purposeful, motivated and of potential significance, even maladaptive actions Dynamic process of psychic pain and wish to avoid it Conflict between parts of self – what we want and what we fear about its consequences Triangle of Conflict (Ezriel, 1952) Defence Anxiety (A) mechanism (D) about consequences of feelings Hidden feelings (F) Wishes and impulses Triangle of Conflict Defence Anxiety (A) mechanism (D) about consequences of feelings Hidden feelings (F) Wishes and impulses Triangle of Conflict Defence Anxiety (A) mechanism (D) about consequences of feelings Hidden feelings (F) “I am angry at you” Triangle of Conflict Defence Anxiety (A) mechanism (D) about consequences of feelings Hidden feelings (F) “I am angry at you” Triangle of Conflict Defence Anxiety (A) mechanism (D) “if I show my anger, I fear it will destroy our relationship” Hidden feelings (F) “I am angry at you” McCullough et al (2003) Activating emotion (F) Function Adaptive expression Maladaptive expression Inhibiting anxieties Anger Assert needs, protect Assertion boundaries Sexual desire Mate, reproduce Mutual consenting sex Attachment Nurture others Closeness, care and trust Positive feelings to self Nurture self Self-regard Joy Soothe self Self-soothe Excitement & interest Explore Exploration Grief Relieve pain, elicit Resolve loss attachment McCullough et al (2003) Activating emotion (F) Function Adaptive