MODULE 5

Psychoanalysis

Psychoanalysis is based on Freud's psychoanalytic theory of personality. It is used primarily for treating neurotic conditions that have their roots in internal conflict. These conflicts are between the impulses of the id and the defenses of the ego.

As you read the text, try to answer the following questions.

According to Freud, all neuroses are based en conflict. Id impulses seeking release are opposed by ego defenses. The ego defenses prevent the release of the drives and also make the conflict unconscious. This process is called repression. However, repression is only partly successful. The repressed id drive manifests itself in a symptom. This expression of the repressed drive in a different form is called the return of the repressed. For example, a young man with unconscious homosexual impulses may behave in a very aggressive way toward men. In this case, homosexual impulses are aroused when the young man begins to feel friendly toward another man. These impulses are opposed and repressed by the ego. The repressed impulses return, however, in a somewhat more acceptable form -- aggression.

THE AIM OF PSYCHOANALYSIS Analysis tries to bring the patient to understand and resolve his own cony lets

The aim of psychoanalysis is to resolve neurotic conflicts. One could conceive of a number of ways to do this. One might attempt to diminish the strength of the impulse. Conflict could be resolved by making the repressed conflict conscious. The return of the repressed (expression of the repressed impulse in symptom form) could be eliminated. The second of these possibilities, making the unconscious elements of the conflict conscious, is the technique used in psychoanalysis. In the following passage Karl Menninger (1958) gives a clear and humane picture of psychoanalysts' goals.

For what is it that we. . . want of the patient? We want him to see himself. We want him to see that as a resul t of his being a human being who came into contact (long ago) with other human beings who were not perfect, and as a result of misunderstanding certain things and being misunderstood by certain people, he experienced pain and fright from which he tried to protect himself by devices which he still continues to use, not from present necessity, but from a kind of habit. We want him to see that he persists in the same unprof table formulae of adaptation. We want him to see that he expects the wrong things from the right people and the right thingsfrom the wrong people. And, f nally, we want him to see that he doesn't want to see it, that he wants to get wellÄin a wayÄbut is afraid to; that he wants to change, but fights against it.

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PSYCHOANALYTIC TECHNIQUE

How does psychoanalysis accomplish its aim, which is the emergence of unconscious conflicts into conscious awareness? Unconscious material can be revealed by hypnotic suggestion, dreams, verbal slips, and free association. The chief method used is free association. Menninger describes the process as follows:

Whoever undergoes psychoanalysis soon realizes that he has become involved in a most extraordinary and unique process. For many of us it is so familiar and "routine" that we forget how remarkable this situation is. A patient who has come to a doctor for relief from his pain is invited to lie down and to talk about it, or about anything else he choosses! may talk about himself, he may talk about his neighbors, he may talk about his wife. He may talk about the past, about the present, or about the future. He does not have to be fair; he does not have to be considerate, he does not have to be objective. Everything is to be considered "tentative" an opinion as of this moment only. The main object of the procedure, as it has been explained to him, is that he present his thoughts and feelings to the joint observation of himself and his unseen listener. Thus he mayÄindeed mustÄsay anything that comes into his mind, which is something he cannot do in any other existing human circumstances or in any other social situation.

Gradually the patient verbalizes repressed feelings and memories

The patient is instructed early in the treatment to follow a basic rule. He is to say whatever comes into his mind no matter how silly, trivial, or embarrassing it might be. Easy as this is to state, the basic rule is hard to follow. In everyday life we select what we want to say and try to eliminate distractions. The basic rule of psychoanalysis tells the patient that everything, even the distractions, must be expressed. This is very painful because of a vague fear of losing control of what might be said and of being surprised by unacknowledged impulses.

Any violation of the basic rule and any attempt on the part of the patient to prevent the repressed from coming to consciousness, is called resistance. The chief task of the psychoanalyst is to overcome resistances. For a description of resistances, we will again turn to Menninger.

Clinically, resistance can be seen in a myriad of forms Sometimes it is a mere concealing of acts and facts, sometimes an increased forgetting instead of an increased remembering, sometimes a tardiness or an absence, sometimes a prolonged silence. Enacting the events of a memory which does not come to mind as such is a form of resistance called "acting-out"; indeed, some analysts feel that one criterion of the end of an analysis is when acting-out is entirely replaced by remembering in the ordinary sense. There are also the forms of intellectualization, of cataloging, of dawdling, of "emoting" instead of thinking and talking.

The analyst's task is to overcome resistance

Many aspects of the psychoanalytic situation are designed to promote the production of unconscious material. Typically the patient lies on a couch with the analyst behind him out of view, although some analytic schools advocate face-to-face treatment. The analyst ordinarily remains rather unknown to the patient in that the patient knows little about the analyst's personal life. But the situation still becomes a highly intimate one for the patient. He reveals details of his own life and thoughts never before revealed to anyone. Moreover, he is neither explicitly rewarded or punished for his communications. It is out of this emotionally charged situation that transference develops. The patient experiences feelings toward the analyst that he has previously experienced toward significant figures in his own life. For instance, at times he may be angry with the analyst in just the way he used to be angry with his father. At other times he may feel that the analyst disapproves of him just as his mother did.

In transference, the analyst becomes the object of repressed feelings directed at others

Transference is a special case of stimulus generalization. However, this statement fails to convey the depth of feeling experienced by the patient. Feelings a patient had toward his father or mother or sibling must be reexperienced and transferring them to the analyst is a critical part of psychoanalysis. For example, a male patient asserted that he had not felt sad when his father died. Suddenly he burst into tears when his analyst said something quite ordinary but in an intonation the patient heard as his father's. The usefulness of the transference lies in the analyst's being able to detect behavior of the patient that reveals attitudes of which the patient may not be aware. l

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Psychoanalysis, then, provides a situation in which unconscious elements of neurotic conflict can be made conscious. It does this through the interpretation of transferences and resistances. The conflicting impulses then make contact with many parts of the patient's ego. This process enlarges the sphere of the patient's consciousness.

The goal of psychoanalysis is not necessarily to make the patient happier. Freud said that what analysis does is change "neurotic suffering into everyday misery." More optimistically, the patient experiences greater freedom from unconscious conflict and is better able to cope with reality.

LIMITATIONS Of PSYCHOANALYSIS

Most psychoanalysts feel that psychoanalysis is most suitable for treating neuroses, less effective for character or personality disorders, and not suitable for treating psychoses.

Only a small number of people have undergone psychoanalytic treatment. There are a number of reasons for this. There are very few psychoanalysts (graduates of a psychoanalytic institute) in the United States. Also, the treat- ment is prolonged and expensive. An analysis may take five years or more with four or five sessions per week. At a cost of $25 to $50 per session, the sum is prohibitive to many, and only the well-to-do can even consider the possibility of psychoanalysis.

Because of the small number of patients it affects, psychoanalysis has little ? direct importance to the mental health of the community. The chief value of psychoanalysis lies in what it can contribute to other therapeutic methods. Freud himself was well aware of how few patients could be reached. He considered that the major importance of psychoanalysis would be its contribu- tion to personality research.

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MODULE 5
PROGRESS CHECK 1

Now test yourself without looking back.

1. According to the psychoanalytic theory of neurosis, what are the effects of ego defense in conflict?________________________________________________________________

2. The process that keeps a conflict from becoming conscious is called____________________________________________________________.

3. Psychoanalysis strives to resolve neurotic conflicts by:
a. diminishing the strength of the drive.
b. making the conflict conscious.
c. eliminating the return of the repressed.
d. changing reinforcement contingencies.

4. What is a patient instructed to do in free association?____________________________________________________________

5. In psychoanalysis a patient may have feelings toward his analyst that he once had toward significant people in his life. This is called______________________________________________.

6. Which of the following limit(s) psychoanalysis as a practical therapeutic method?
a. Few people can afford it.
b. There are too few qualified psychoanalysts.
c. It is not suitable for neurotics.
d. It is not suitable for psychotics.

ANSWER KEY PAGE 117

5 OR MORE CORRECT PAGE 97
FEWER THAN 5 CORRECT PAGE 94

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. MODULE 5
EXERCISES

The method of psychoanalysis depends on the idea that all neuroses are based on conflicts between the___________________ (id/ego/ superego) and the _____________________ (id/ego/superego).
____________________________________________________6

In neurotic conflict the id drives are opposed by_____________________________________________________4

The ego defenses keep a person from being aware of his conflicts. This process is called:
a. free association.
b. transference.
c. repression.
d. resistance.
____________________________________________ 7

The ego defenses have two effects in conflict situations. These effects are:
a. permitting the individual to act on his id drives.
b. preventing release of the id drives.
c. keeping the individual aware of the conflict.
d. making the conflict unconscious.
________________________________________________ 2

Repression is the process that keeps the conflict in the ___________________________________mind.
_________________________________________________1

Since a neurotic conflict is normally in the unconscious mind, psychoanalysts try to resolve the conflict by:
a. keeping the patient unaware of it.
b. strengthening the ego defenses
c. making the conflict conscious.
d. strengthening the id drives.
____________________________________________5

When a patient begins psychoanalysis, he is instructed to say whatever comes into his mind. He is not to worry about continuity, relevance, or even shame, but is to feel free to say anything. This is called:
a. resistance.
b. free association.
c. transference.
d. repression.
________________________________________________8

During the course of psychoanalysis, a patient may experience transference. He may, for example, be angry with the analyst in the same way he used to be angry with his father. Transference means:
a. having the same feelings toward the analyst that one had for someone significant in the past.
b. that the patient attributes to the analyst characteristics of someone important to him.
d. (neither)
________________________________________________________3

ANSWERS

l unconscious
2 b, d
3 a, b
4 ego defenses
5 c
6 id, ego
7 c
8 b

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Match.

Repression _______ a.

Transference_________ b.

Free Association _________c.

a. The primary method of psychoanalysis

b. The process of keeping conflict in the unconscious

c. Attributing to the analyst characteristics of someone important to the patient

d. The process of saying whatever comes into one's mind
______________________________________________4

Psychoanalysis has limitations. The process is lengthy and expensive. There are few trained psychoanalysts. Also there are limitations of the method itself. It is most suitable for treating neuroses. It is less suitable for treating character and personality disorders. It is not suitable at all for treating psychotics. For which of the following conditions might psychoanalysis be considered?
a. Neurosis
b. Schizophrenia (psychosis)
c. Character disorder
d. Phobias
________________________________________________2

NOW TAKE PROGRESS CHECK 2

ANSWERS

2 a,c,d

4 1) b
2) c
3) a,d

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MODULE
PROGRESS CHECK 2

1. Ego defenses in conflict with id drives:
a. prevent the release of the id drives.
b. permit the id drives to be expressed. c. bring the conflict into the conscious mind.
d. keep the conflict out of the conscious mind.

2. Unconscious material can be revealed in any of the ways listed below. Which is (are) used in psychoanalysis?
a. Hypnotic suggestion
b. Free association
c. Verbal slips
d. Body language

3. Psychoanalysis tries to resolve neurotic conflicts by:
a. eliminating the return of the repressed.
b. modifying basic sexual drives.
c. supporting the superego.
d. making conflicts conscious.

4. Psychoanalysis is most effective in treating:
a. character disorders.
b. neuroses.
c. psychoses.
d. borderline personalities.

5. Describe the phenomenon of transference._____________________________________________________________________

ANSWER KEY PAGE 117

4 OR MORE CORRECT PAGE 97
FEWER THAN 4 COFRECT INSTRUCTOR CONFERENCE

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