Transcript of Audio Lecture
From the psychoanalytic perspective, psychological
problems such as distressing feelings, inaccurate impressions, and
immature or inappropriate behaviors, suggest the presence of unresolved,
unconscious dynamics and associated mechanisms of defense. In this
section we will examine the psychoanalytic approach to assessing and
treating psychological problems and, as we do so, we will see how
assessment and treatment are inextricably intertwined.
Slide two. Consider the following types of
psychological problems and how a psychoanalyst might conceptualize them.
You don’t need to know these in particular, I just want you to get a
flavor for the psychoanalytic approach. If someone has amnesia, cannot
remember certain events or perhaps entire periods from their life, you
(as a psychoanalyst) may wonder if this is an extreme instance of a
defense mechanism such as repression and isolation, and so may explore
whether there are some very traumatic or anxiety producing memories that
the ego is trying to keep out awareness. If someone is complaining of
excessive anxiety, you may wonder if perhaps some change in the person’s
life is causing their defense mechanisms to become less effective, thus
causing the ego to feel neurotic anxiety. If instead a person has been
acting unusually helpless, dependent, or immature lately, you may wonder
it the person is exhibiting regression to the oral stage, and wonder if
current stresses are causing them to retreat to ways of acting from a
time when they felt more protected and secure. Finally, if the person
shows paranoid symptoms, you may wonder if internal feelings that the
ego is defending against are being projected onto others.
Slide three.
Regardless of what the particular problem is, what would be the process
of psychoanalysis. Psychoanalysis is both a method of therapy and a
method of assessment, and indeed the process of revealing the cause and
the process of fixing the problem are inseparable. Freud was enamored of
archeological metaphors. He conceptualized the psychoanalyst as an
archeologist who digs down into the past—which is buried deep down in
the unconscious—to unearth the source of the problem and then carefully
bring these unconscious experiences back up into consciousness, into
present awareness.
Slide four. The process of psychoanalysis involves
both intellectual insight and emotion catharsis. Catharsis involving not
only releasing the repressed knowledge, but also all the associated
feelings, and all the energy that’s been bound up in repressing that
knowledge. So, what cures is not intellectualization; rather, it is
fully experiencing the previously repressed knowledge and impulses and
emotions. If that happens, theoretically the surface symptoms (for
example, the amnesia, or anxiety, or immature behaviors, the overused
defenses) should decline because the root cause—the repressed
unconscious but unresolved experience—has now been resolved. But how do
we actually do this? How does one reveal the unconscious? Certainly not
by means of self-reports. While we have seen that self-reports are the
most popular method of assessment, self-reports by definition are not
useful in psychoanalysis because what is unconscious cannot be reported
by the self!
Slide five. So instead, psychoanalysts have pioneered
projective assessment techniques. Projective assessment techniques allow
people to project unconscious dynamics onto ambiguous stimuli. For
example, you may be given incomplete sentence stems and asked to
complete the sentences. Or you may be asked to make drawings of people,
or houses, or various objects. Or you may be asked to tell stories about
ambiguous pictures, as in the Thematic Apperception Test. Or you may
play dramatic characters in a psychodrama. Because you are not directly
speaking about yourself, it relaxes your defenses a little, and allows
unconscious thoughts, feelings, and motives to sneak into what you
write, or draw, or say in ways that can be interpreted.
Slide six. But of course the most famous and most
widely used projective technique is the Rorshach ink blot test, which
consists of 10 ink blots of the type that you saw in your homework
assignment. Initially responses to the ink blots were scored in a
clinical way, meaning each clinician would, based on their understanding
of psychodynamics and of the particular patient, interpret what was
being conveyed in the persons' response to the ink blot. But the problem
was that different clinicians would come up with very different
interpretations. Because the clinical approach to was lacking in
reliability and validity, a more objective scoring system (called the
Exner system) was developed. This system is extremely detailed (I had to
take an entire course on it during my clinical training) and is
consequently extremely reliable; that is, any person using the scoring
system should reach similar conclusions. The objection to this new
system, however, is that it transformed the test from a projective test
into a more objective test of perceptual, cognitive, emotional style.
While coding whether you use the whole blot versus details might tell us
about your perceptual dynamics—that is, whether you see the big picture
or focus on details—it does not reveal your unconscious psychodynamics.
Another projective assessment technique is how a patient reacts to their
therapist, because if the therapist is relatively non-reactive, is
essentially being a blank screen, then the reactions of the client to
the therapist can be interpreted as projections. Projections onto a
therapist are called transference. The word transference implies that
the patient’s reaction to the therapist involves transferring thoughts
and feelings and impulses from other earlier relationships onto the
current therapeutic relationship.
Slide seven. A projective assessment technique Freud
was particularly enamored with, at least initially, was the analysis of
dreams. He called it the royal road to the unconscious. We can
distinguish between the latent dream and the manifest dream. The latent
dream is the unconscious dream, the dream that’s not even available to
your sleeping consciousness. The latent dream consists of three
components. One is sensory stimulation. Even when you’re dreaming, some
sensory information from the outside world is getting through; for
example, you might find that if a dog is barking outside while you are
dreaming, a dog becomes incorporated into your dream. Or if a siren goes
off you may begin dreaming about an accident or a fire. So although
sensory input is muted, you’re not completely cut off from the outside
world in your dream state. So one type of activation that’s occurring in
the brain is the activation that’s occurring as a result of sensory
stimulation. A second type of activation in the brain are concerns from
your waking life. So, if prior to falling asleep you were ruminating
about a meeting you were going to have with your boss the next morning,
the image of your boss and the topic of the meeting may remain activated
during REM sleep and therefore also might become incorporated into your
dreams. And finally activated 24/7, including during dream states, are
the memories and desires that are always activate in your unconscious.
The unconscious never sleeps. In summary, the latent dream is the sum of
the activation in your brain as you are experiencing REM sleep,
including sensory stimulation, current concerns from you waking life,
and unconscious repressed memories and desires.
The manifest dream is
the dream you actually experience and can report if you’re awakened
during REM sleep. According to Freud, during dreams your defenses are
weakened, so unconscious activity (that is the latent dream) is more
present in awareness (that is the manifest dream) that during ordinary
waking states. The latent dream is still disguised—for example, by being
encoded in symbols or opposites—but nonetheless some material that
usually is completely inaccessible is leaking out.
So the task is to
work back from this manifest dream that you can report to the latent
dream. Often this is done as follows. The patient is asked to free
associate to some of the images and events and feelings that came up in
the manifest dream. Perhaps you have seen in movies the image of the
patient laying on a couch while the analyst sits behind them. The
purpose is to put the patient into a relaxed state; they’re laying down
and not actually looking at somebody in the eye, making it easier for
them to say whatever comes into their mind. Meanwhile the analyst
attends to both what the patient says and what they do not say. Indeed,
what they do not say is often most revealing, because when they
hesitate, switch subjects, or lose their train of thought, that all can
indicate that they were touching on a threatening topic, and so that’s
probably a good place to explore further.
Slide eight. Freud used the
phrase the psychopathology of everyday life because actually in a sense
every moment could be a projective test. All your behaviors are
potentially revealing and thus can be interpreted but some behaviors do
tend to be more revealing than others. Some of the everyday behaviors
that might be of interest to a psychoanalyst include jokes; as we
already talked about in the last lesson, humor is often a defense
mechanism, so the things that find funniest may be things that evoke
tension in you. Also potentially revealing are artistic expressions.
When painting, or writing poetry, and so on, people’s resistance or
defenses are relaxed a little bit and so the sorts of images they create
or words they use can be revealing of unconscious material. Finally,
there are the parapraxes, which are all the little mistakes, slips of
the tongue, moments of forgetting we make. Psychoanalysts suggest that
any orgasm, whoops, I mean organism… well, there’s an example. One could
then ask: Why is it that the word orgasm slipped out when I tried to say
the word organism. Was there some unconscious activation, some sexual
thoughts, that happened to leak out in that moment when my ego was
distracted and my defenses diminished? From the psychoanalytic
perspective, oftentimes such accidents aren’t really accidents; instead,
they are brief glimpses into the unconscious.
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