Psychoanalysis and Psychodynamic Psychotherapy

 
Psychodynamic Theory Learning Objectives

History and Background

     Sigmund Freud, a Viennese neurologist, could perhaps be considered the first psychiatrist.  He became very interested in mental anguish or conflict expressed as physical illness, such as paralysis or an unwanted tic.  He attempted to develop a unifying theory of human behavior and emotion and modeled his theory on the work being done on thermodynamics in his day.
     Freud theorized that unresolved, unconscious conflicts, possibly arising from early childhood trauma, become manifest in the adult patient through maladaptive, "fixated" defenses against painful memory of the trauma.
     Anna Freud made one of the more enduring contributions through her elucidation of mechanisms of ego defense, an area her father frequently alluded to but did not as clearly and categorically define.   Unfortunately, much of the subsequent history of psychoanalysis was marred by bitter fighting between the master and his former pupils, such as Jung and Adler, who both broke away from Freud with his emphasis on infantile sexuality, so no coherent single body of psychoanalytic literature emerged.  Rather, warring camps of neo-Freudians, such as Karen Horney, battled with the orthodox defenders of psychoanalyst's founder.  It is unclear if Freud intended his theories to be viewed as a foundation to be built upon or a fortress to be defended, but he had been criticized for turning any counterarguments ad hominum (he wrote Jung before their split that his first inclination was to treat anyone who resisted his ideas as patients, that is displaying unconscious resistance).  The circularity of this line of  thinking (i.e., that any legitimate scientific skepticism must represent some unresolved unconscious conflict on the part of the critic (Johnson, 1992)) has been one of the main obstacles to universal acceptance of psychoanlytic principles or to its critical acceptance.

 Freud's Topographic Theory

     The Topographic Theory was Freud's first attempt to divide the mind into structural regions, separated by function:

     The Unconscious

     The Unconscious is the repository of repressed ideas and affects (emotions).  Usually these ideas are unaccessible to consciousness.  In fact, consciousness may make an effort to exclude them via repression.   Three states in which these ideas bubble up to consciousness is when asleep (through dreams), in jokes, and when overwhelmed (neurotic symptom formation).
 In the land of the unconscious, the primary process rules.  The primary process is a type of mental activity that knows no logical constriants or boundaries, concepts of time, and permits contradictions.  Immediate gratification is its motto.  To see the primary process at work, observe children in a candy store and their complete inability to delay gratification.
     The unconscious is also where instincts and unfulfilled wishes are stored.

 The Preconscious

     The Preconscious can be viewed as the link between conscious and unconscious processes.  It acts as a screen, filter, or censor.
     Secondary process is the rule here.  Secondary process thinking recognizes the reality principle, that there are constraints, that logic must be followed, that contradictory truths cannot coexist.   The secondary process attempts to regulate or delay discharge of instinctive energy, and to prevent unpleasantness.
 

 The Conscious

     Freud viewed the conscious as the instrument of attention.  Only a minority of mental energy occurs here (most is unconscious).  We are only immediately aware of our conscious and preconscious; the rest of the mind is beyond awareness, but can percolate up to consciousness for example through dreams or jokes.

[Kaplan, 135-139]