Psychoanalysis

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Psychoanalysis

 Autobiographical therapeutic approach cuz based on freud's


observation of self (thought of himself as a patient)
 In terms of quantity, the work isn't extensive/ a lot.
 His history overlap with psychiatry + world history in general
HISTORY:
 Mother: father's 3rd wife
 Unsuccessful worker. Felt superior to his father even when
he was 2 cuz of his doting mother who thought he's grow up
to be successful > childhood experiences shape you >
received privileged treatment at home in terms of his
studies
 Age 26: hired and given tenure as professor in uni of vienna
while being a Jew (due to anti-semanticist)
 Was a physician/ psychiatrist
 Freud wanted to become a researcher, which was a very
common choice cuz wasn’t valued back then; worked on
eels, animals and published papers, however still involved
mainly in teaching.
 Mentor, Joseph Broer, (pioneer of talk/psycho therapy;
conflicted in the credit for this therapy: whether Broer or
Freud (experimented with Bertha Pappenheim/ Anna O);
worked on hypnosis
 Anna O called Therapy called chimney sweeping > later
became known as psychotherapy
 Freud didn’t like hypnosis and replaced it with free-
association. Broer had his own psychological issues coupled
with aging on which Freud worked.
 Broer suggests Freud to open private practice to then be
abble to marry his fiance (Martha someone). This when his
actual career/work starts as it is known today.
 Freud was the most nominated person for nobel prize.
 Eisten + frued collaborated pre-WWI (1915)
 Travelled to France, Paris during his practice:
o Someone Sharko: french neurologist
o The root cause of all neurosis/ hysteria (symptoms of

conversion disorder) is sexual drive/conflict.


o Neurosis/neurotic disorders used ot indicate

conversion disorder or anxiety related disorders (which


mostly remains the same today).
o Sexual conflicts can be accessible thru hypnosis (it was

very popular at that time)


o Hypnosis introduced by Anton Mesmer in Europe. He

practiced Mesmerism (hypnosis) in a theatrical


manner.
o After interpretations pf dreams > writes an article on

childhood sexual abuse. After his patients reported


cases of CSA and incest especially in vienese society >
backlash cuz a proudly prudish society.
o Clarified that these abuse were imaginings of patients/

hadn't really happened in real life ('unconscious


fantasies') just to avoid criticism. Explained by hysteria
(cuz repressed sexual conflict; ne manifestation of
that is CSA)
o u-turns like this on homosexuality as well
o The case of Dora: girl with hysterical symptoms who's

attached to father, has hostile towards mother.


Father's has a couple which is a close friend of his. Her
father has an affair with the friend's wife, and the
wife's husband pursues Dora. Starts unraveling her
unconscious too quickly > loses her voice.
 Freud is called to the US, after giving a series of lecs > gains
fame there (in areas of parenting, marriage, hysteria)
 Open psychology club with his bright students talked ab the
psychology of cigar making (carl jung, albert adler)
 1920s: struggles with personal conflicts : neurosthemia (a
particular somatic symptom disorder:
o exhaustion, stomach-related issues, phobia of dying an

d aging, headaches (same symptoms as broer)


o disdainful ab sex in older life (sexual conflicts of his

own)
 Holocaust: burned his books, raided his homes, 4 sis die in
concentration camps, killed daughter.
 Thru napolean's great, great, greta granddaughter was able
to escape to London. Had jaw cancer > euthinized
 His theories are based on his life experiences

INSERT NOTES

Anxiety Ego Defense Mechanism:


 Ego is the manager, regulator of psyche (intrapsychic:

within the psyche) which helps strike equilibrium. When ego


is unable to do that due to being overwhelmed > anxiety >
DM (defend/ protect ego against anxiety)
 Anxiety for Freud: state of tension that demands some sort

of action due to being ill at ease. Called it objectless fear.


 All neurotic disorders/ prolonged psychopathalogy is due to

anxiety. (but we know today that anxiety will not result in


psychopathology.
 Stated we feel anxiety for the very first time at borth,
called it 'birth trauma'. Most work done by Otto Rank after
Freud. When born, we exerience aa sensory overload. In the
fetus was fed, warm, had physical needs met naturally, but
its absence of being born and having to do that all at the
same time (e.g. regulate breathing, adjust to hearing, visual
perception, etc) > birth trauma (stress/anxiety). Results in
increased heart rate automatically as a result of sensory
overload (autonomic NS arousal). When grow up,
experience the same kind of anxiety symptoms as when
you were born.
 Moral of the story:
o Believed anxiety is inevitable. Present since birth
o will re-enact the symptoms of how it was experienced

at first, when experience it later in life.


 Criticism: Subjectivity (doesn’t take into acc diff in individual
experience) + doesn’t take into acc nature vs. nurture.
 Types of anxiety:
o Reality anxiety (aka fear): grounded in reality/ is real

(duh). Reason to be afraid of a particular fear e.g. fear


of lions, snakes, thunder.
o When takes on an extreme form > specific phobia
o Not always causes or is as a result of psychopathology
o Neurotic anxiety: afraid of having for their Id impulses

(pleasure seeking impulses) to be discovered and


punished by society for having these impulses.
 e.g. a person who has multiple partners > calls them by

endearment so as not to be confuse one, or call one


person by another's name and be discovered.
 Checking to make sure hadnt texted the person u were

bishing ab
 Pedophilic impulses > got a job in elementary school >

turns downt he job cuz of being discovered when I do


smthng
 External punishment
o Moral anxiety:

 afraid of internal punishment (inner punishing

dialogue)
 Every time an individual has an impulse or a thought,

they are afraid of their super ego punishment


 e.g. while fasting, dream of eating or drinking

something which breaks ur fast


 Experienced by ppl whose superego is very stringent/
strong (e.g. homosexuality is wrong). Evident in
religious ppl
 In extreme for resembles OCD (obsessive thoughts of
praying multiple times cuz didn’t pray it properly)
 Manifests in guilt and shame

EDM
 Helpful in short-term (have adaptive value). Become
problematic when become a lifestyle.
 Almost always distort/ deny reality
 Mostly operate at an unconscious level (sometimes also
operate on subconscious level aka somewhat voluntary
when you become able in examining your psyche
(psychological mindedness), will be able to identify which
ones you have used; on an unconscious level, u wont)
 Some EEDM are more adaptive than other so are considered
on a continuum.

Types
 Projection: when have certain feelings ab others, you go

thru dual process:


o disown them (splitting: this feeling is not mine)
o and project it on others (Project)

 e.g. a person you don’t like but publicly claim that that

person doesn’t like me.


 e.g. repressed promiscuously > tell her teenage girl that she

dresses up provocatively to gain male attention.


 Least adaptive

Side note: Incorporate psychoanalysis + REBT when client has


psychological mindedness (the ability to introspect and the
admission that there might be processes that the individual might
not be aware of.
 Projective identification: like self-fulfiling prophecy but for
the person u are projecting ur feelings on. When u project ur
feelings on others > eventually act in that way because of
you repeating ur belief ab them. Create circumstances
where the other person is left with no choice but to engage
that same behavior which was projected onto them.
 e.g. employee + boss: my boss doesn't like me > e.g. when
are late to work, calls you out for you.
 A level beyond projection. Not commonly witnessed cuz a
very high level of manipulation
 Repression: is being implicated in most of ego defense
mechanisms. One of the most adaptable. More adaptive
with, and least with sublimation.
 Operates on memories, experience, emotion, feeling,
pushed out of awareness. Have specifiers of sorts: Some
ppl may repression both, thoughts and emotions:
e.g. a cliet who's lost mother recently but are going on
with their life. Haven't had any thoughts ab it.
 Case of repressed thought only:
e.g. client being crippling/ intolerable sadness. Did lose
their mother but havent been thinking ab it.
 Repressed emotions, thought is present:
e.g. parent dies, keep thinking ab it but never feel an
emotion/ sadness.
 Have to identify what type of repression it is

More adaptive (moderate)


 Reaction Formation (unconsciously hypocrite; fake):
 When you behave in a way diff to your feelings ab ppl,
places
 e.g. mom feeling resentment towards child, tries to be
overly loving
 e.g. ppl against homosexuality talk profusely ab
homosexulaity (in its support) publicly

 Regression:
 e.g. making a fetal position when lying down
 e.g. going back to ur parents home when stressed out
 Happens cuz so overwhelmed we need to regress to a stage
where other ppl used to take care of things for me.
 Therapeutic exchange is a position of regression. It is a re-
enactment of childhood experience where an elder person
would solve the problem. Client often feels small cuz of
voicing their need for help cuz that concept is not associated
with adulthood.
 e.g. taking advice from someone when in conflict/ stressed

 Rationalization
 Justifying/ making excuses for what happened.
 e.g. when fired: 'I never liked that job anyway'.
 e.g. rape myth: the victim were asking for it cuz wearing a
certain type of clothing.

 Displacement: (least to most adaptive more adaptive than


regression, least adaptive than sublimation). Since cant
place an emotion at the original target, so displace it on the
least threatening target.
 Two feelings that are displaced:
o Sexual impulses (e.g. rom-com)
o Anger/ aggressive impulses.

 Denial: do not accept reality/ closes eyes to reality.


 Repression: do not remember anything happening even
when it has happened; denial: it is not possible, don’t even
accept it in the first place. U are aware the event has
happened to you but refuse to accept it.
 e.g. grief wouldn’t touch anything of the deceased e.g. in
their room cuz don’t accept that the person is dead
 e.g. diagnosis for terminal illness and saying these reports
aren't right.

Most adaptive
 Sublimation: able to sublimate/ convert/ channel an

unacceptable emotion ito socially acceptable manner.


 e.g. aggeressive impulse > martial arts/ boxer/ jog
 e.g. sexual impulse > artist

 Altruism: individual amy channel behavior into generosity in


order to cope with a painful experience.
 e.g. sadqa- Jariyah: death of someone > build mosque or
give a lot of charoty e.g. by opening a hospital like shaukat
khanam

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Applications
 Free association and resistance
 free association could be used with other techniques at
any time. Thru Calls forassociation: Ask the client 'what
comes to mind/ what are you reminded of' when
considering a certain object while using any other
technique outside of free association being an individual
technique. Meaning doesn’t have to be structured.
 Try to identify gaps and inconsistencies in the client's
account of things (e.g. not mentioning mother + sister
when talking ab family:
o Client will pause more or change subject (signs that

show progress in therapy and towards UC) ab things


they are hesitant to talk ab, aka the unconscious
conflict.
 Good listening thru evenly suspended attention for free
association.
 Suspended attention: the therapist constantly oscillating
b/w:
o what's being heard (the client is saying)
o and what it may mean (the implicit meaning; and what

the thrapist thinks the client thinks ab it)


o Learned overtime thru:

 process notes (hw was I doing during the thrapy.


 Thru personal counselling/ go into therapy where

u r the client
o Try to identify resistances/unconscious conflicts and

interpret them thru:


 Client will pause more or change subject (signs

that show progress in therapy and towards UC)


ab things they are hesitant to talk ab, aka the
unconscious conflict.
 Interpret information gained from:
 Free association
 And resistance

Interpretation:
o Are layered and complex. Not as easy as REBT emotive
smthng
o Therefore important to have insight + experience w/
psych.analysis
o First, pinpoint resistance, then interpret it, but consider
before confiding in the client ab it the following:
 In interpretation, timing matters to avoid regression in

client. The effectiveness of interpretation depends on


the timing/ the client's readiness to accept it. Along w/
identifying, determine wether the client is ready.
 Determine Ego strength to gauge readiness: Readiness

of client depends on whetehr they have enough ego


strength to deal with it. Underdeveloped ego >
insufficient reasoning skills/ cognitive power > inability
to understand and cope with what the therapist is
trying to make the client understand and adapt.
 Surface to depth ratios: is the conflict we're looking to

uncover closer to the client's conscious.


e.g. a client referring to the conflict indirectly/ latent
(due to defense mechanisms that distort the reality)
through an account of a dream or childhood
experience means it is recognized by the client to
some extent.

3-step process of interpretation:


 Confrontation (observing): the therapist would identify and
acknowledge a response of the client
 Clarification:
 link reaction/response with something else similar you

have noticed before.


 Clarify when client is ready
 Interpretation: give the reaction a meaning. e.g. did you
'say/do this because…'
 Are 'because…' statements
 Everything said here needs to be said that leaves room

for other possibilities/ flexible language e.g. 'I am


seeing… I was wondering…' cuz you may not be correct
 Interpretation are genetic- meaning would see the
problem being linked to childhood experiences/
influences
 e.g.
Confrontation- Observation regarding a client's
behavior/response: I notice you have a hard time
talking today/ convo is minimum today
Clarification- I have noticed you were also having
a hard time talking the last time I was planning to
take a vacation
Interpretation- Do you think/ I was
wondering/could it be that you are behaving this
way bcuz…/ I am reminded of how you relayed as
a child every time ur child would leave for a
posting/ project, you would withhold and not say
goodbye.
e.g.
Client starts crying in the last 10 mins of the
session due to bringing up smthng very
emotional
Confrontation- sharing something very
distressing towards the end of the session.
Clarification- noticed how did this in the last
session as well
Interpretation- reminded of the incident where
every time ur mother would elave for work, you
would cry to make her stay.

 Dream analysis:
 Cautioned against wild analysis: analysis w/out the
understanding of the clients childhood experiences/
conflicts, history.
 Did it collaboratively
 Freud did not have rigid menaing for each symbol, which
could not mean anything else other than what he assigned it
to be.
 Interpreted client's manifest content:
e.g. no steering wheel in car
 Latent content: menaning of the manifest dream:
e.g. no steering wheel in car > experiencing loss of control
(cant control direction)
 Analysis: to convert manifest to latent:
o Dream symbols: ask the client to free associate ab the

first thing you can think of ab (e.g. in adjectives) that


symbol.
o Feelings before and after the dream

 Alderian

 Case Formulation/ conceptualization:


4 elements:
 problem: the client's presenting complaint. e.g. feeling
anxious/ problems with forming initmate relationships.
 Could be written verbatim or paraphrased
 Person (most important element):
o EGD the therapist is able to pinpoint right from the

start
e.g. have moved to parent's house.
 Note at least 1 or 2 dominant ones
 Egos Function:
 The efficiency of the client's psychological processes
 Which ego functions are present (strength) and absent
(weakness)
 Types of EF (identify 1or 2 absent and/or present):
 Reality testing: able to differentiate b/w real/unreal.

Delusions means this is not intact/ impaired.


 Cognitive ability: intelligence, memory, and attention.
Cog ability present. e.g. intellectual disability, amnesia,
ADHD > impaired, hence absent.
 Affect tolerance: ability to cope w/ strong emotions

e.g. regulate anger, anxiety, sadness. Exam anxiety >


absent affect tolerance.
 Object relations: the quality of client's social

relationships. No friends/ getting into fights with co-


workers > absent.
 Judgement: is the client aware of the consequences of

certain actions. e.g. schizophrenic client relays that


they had to wear a hat made of aluminum foil to
prevent aliens from attacking their thoughts > not
intact. Wear winter clothes in summer > no intact.
Not attending class will result in absent> absence.
Absent in alzheimer's, dimentia, psychosis,
hypochondriases, OCD.
 Accurate Self-appraisal: Is the client of their individual self-
identity, self- efficacy (what I am capable of and can do
well). e.g. clients wants to build a car w/out a degree in
engineering > absent/ impaired. Are you aware of your
strengths and weaknesses. e.g. says will travel around the
world on foot in 8 days.

 Superego Function (client's basic understanding of reality)


 When the client is very religious/ uncompromising/
fundamentalist, or comes with a lot of guilt > harsh super
ego.
 Quick to feel guilt: I'm a bad person, I don’t deserve love, etc
 When client comes with no remorse where it should be
there e.g. antisocial personality, conduct disorder,
psychopathy disorder client > underdeveloped superego
(even after using .
 Either superego harsh or underdeveloped super ego.
 Where its on neither extremes > it is called adequate

Exams: REBT interpretation will be done of ABC only

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