1 Module 6 Therapeutic Approaches in Social Case Work Intervention Psychoanalytic Approach Quadrant 1 Introduction Sigmund Freud is the founder of psychoanalytic theory. As per this theory, events that happen to persons during childhood can contribute to the way they function later as adults. Freud believed that the mind is made of the conscious mind, preconscious mind and the unconscious mind. Freud also suggested that the unconscious mind often prompts people to make certain decisions even if they do not recognize it at conscious level. The principle of id, ego and superego and their functioning was a very important contribution to the field of counselling/clinical psychology. In addition, defence mechanisms occupy a major portion of Freud s discussion of his theory. This module will help students to understand the basic assumptions of the psychoanalytic approach to know the different aspects of Freudian therapy to gain an insight into the relevance of psychoanalytical therapy in casework 1. The Perspective of Freud Psychoanalytical theory focuses on the factors at the unconscious state which influence behaviour. It is believed that the experiences or events of the first six years of life determine the development of a person s personality which becomes manifest in adult life. Hence much attention is paid to such experiences. The original so-called talking therapy involves analyzing the root causes of behaviour and feelings by exploring the unconscious mind and the conscious mind s relation to it. 1.1 View of Human Nature Freud considers human nature as basically deterministic. Our behaviour is determined by irrational forces, unconscious motivations, biological and instinctual drives as these evolve through key psychosexual stages in the first six years of life. Freud added that human nature is dynamic as he believed in the transformation and exchange of energy within the personality. Of course a person can liberate
2 himself/herself from the determinants, once the unconscious becomes conscious and blind habits are replaced by choice. For Freud, human nature could be explained in terms of a conscious mind, a preconscious mind and an unconscious mind. - Conscious: According to Freudian understanding, thoughts or motives that a person is currently aware of or is remembering. - Preconscious: Thoughts or motives that one can become aware of easily. - Unconscious: Thoughts or motives that lie beyond a person's normal awareness but that can be made available through psychoanalysis. It stores up all experiences, memories, and repressed materials. Psychoanalytic therapy aims at making the unconscious motives conscious in order to exercise choice. Freud uses the metaphor of an iceberg as an analogy to the unconscious. According to him, 10 percent of an iceberg is visible (conscious), 90 percent is beneath the water (preconscious and unconscious), wherein the unconscious is allotted an overwhelming 75-80 percent. 1.2 The Structure of Personality According to Freud, the personality consists of three parts: - Id - Ego - Superego 1.2.1 The Id It is the original system of personality with which a person is born and is the primary source of psychic energy and the seat of the instincts known as Eros. The id and the superego are confined to the unconscious; the ego operates primarily in the conscious, but also in the preconscious and unconscious. The personality of the newborn child is all id and only later does it develop an ego and super-ego. The id does not think but wishes or acts. It demands immediate satisfaction, and when this happens, a person experiences pleasure, and when it is denied he/she experiences displeasure or pain. It is illogical, amoral, and driven to satisfy instinctual drives. The id operates through drives, instincts, and images (such as dreaming, hallucinating, and fantasizing) a thought process known as primary process ( D. John Antony, Psychotherapies in Counselling, Dindigul, Anugraha Publications, 2003, p. 46-47). If the id is empowered and left on its own, it would probably destroy a person or cause trouble by acting on the primitive, aggressive, and sexual drives it harbours. The id contains basic life energy, collectively known as eros and basic death instincts, known as thanatos. At first Freud associated eros with sexuality, but
3 later he modified this idea, describing all life-preserving instincts as eros and the psychic energy that accompanies them as libido. Any acts of aggression, as well as foolishly dangerous behaviours such as taking unnecessary risks, were displays of thanatos. 1.2.2 The Ego The Ego is considered as the police or executive. It has contact with external world of reality. The executive who controls and regulates the personality: - Mediates between instincts and the environment - Controls consciousness and exercises censorship - Ruled by the reality principle 1.2.3 The Superego The superego is the judge of human personality. - Ruled by moral principle - Judicial branch of personality The main concern of superego is whether something is good or bad, right or wrong. It represents the ideal. It functions to inhibit the Id and to persuade the ego and strive for perfectionism. It acts as a parent and society in relation to rewards and punishments: Rewards create feelings of pride/self-love Punishments create feelings of guilt/inferiority 2. Anxiety and Ego-Defence Mechanisms Anxiety is a state of mind characterized by strong feelings of tension, disturbing thoughts and physical changes such as fluctuating blood pressure, sleeplessness, headache, loss of appetite, etc. This state of mind affects the individual s thoughts and feelings, and behavior. 2.1 Anxiety Anxiety is a state of tension that motivates an individual to do something. (D. John Antony, Psychotherapies in Counselling, Dindigul, Anugraha Publications, 2003, p. 48). It emerges due to a conflict among the three id, ego, and superego over the control of the psychic energy. It is said that there are three types of anxiety: Reality anxiety is the fear of danger from the external world and is proportionate to the degree of real threat.
4 Neurotic anxiety is the fear that the instincts of a person will get out of hand and make the person do things for which he/she will be punished. Moral anxiety is the fear of one s own conscience. 2.2 Defence Mechanisms When the ego is not in a position to control anxiety by rational and direct methods, it takes to unrealistic methods, and these methods are known as defence mechanisms. A person makes use of defence mechanisms to cope with anxiety. It is to be noted that defence mechanisms are not exactly pathological but they have an adaptive value if they do not become a way of life, and do not prevent a person to face the reality. Ego-defences operate on an unconscious level and tend to deny or distort reality. The following two characteristics are common to all the defence mechanisms: - Denying, falsifying and distorting reality - Operating unconsciously Some of the common defence mechanisms are: Repression: This is one of the earliest concepts of psychoanalysis, and the basis of many other ego-defences and neurotic disorders. Repression is an involuntary removal of anxiety-provoking memories from our consciousness. However, these memories don't just disappear and they continue to influence one s behavior. For example, a person who has repressed memories of sexual abuse as an adolescent may later find it difficult to enter into intimate relationships. Denial: This mechanism also operates like repression but at preconscious and conscious levels. It is the simplest form of self-defence. Denial is very evident in the dynamics of death and grief. For example, when a person is diagnosed as having terminal cancer, he/she, after the initial shock, tends to deny the reality of cancer by saying The doctor may have wrongly diagnosed. Reaction Formation: It is the replacement in consciousness of an anxiety-producing feeling by its opposite. Usually extreme forms of behaviour of any kind signify a reaction formation. For example, a person who hates another person cannot accept the painful fact of hating, and so expresses extraordinary affection towards that person. Projection: This is the mechanism that helps to convert neurotic or moral anxiety into an objective fear is called projection. It is used especially when a person feels uneasy with his/her own thoughts, because he/she considers those thoughts unacceptable to express, and misattribute those thoughts to another person who actually does not have those thoughts. For example, a spouse may get angry with the partner for not listening, when actually it is the angry spouse who does not listen. Projection is often the outcome of one s inability to own up one s motivations and feelings. And it reduces anxiety by substituting a greater danger with a lesser one.
5 Displacement: When a person cannot express his/her feelings directly to an intended person or object because of the inherent danger, he/she resorts to the displacement mechanism by redirecting the feelings to another person. Human beings often make use of this mechanism when they cannot give vent to their feelings in a safe manner to the person whom they have in their mind. For example, a woman who cannot express her anger to her spouse for fear of being beaten by him, may take out her anger at her child. Fixation and Regression: Every person goes through different stages of development before reaching maturity. The passage from one stage to another entails certain amount of frustration and anxiety. When this passing becomes too difficult, the process of normal growth may halt and the person may, therefore, gets fixated at one stage. Thus, when a person gets fixated at an earlier stage in the face of unacceptable thoughts and impulses, this reversion is known as regression. For example, an adolescent who is weighed down by feelings of fear, anger and guilt through growing sexual impulses may feel safe by reverting to an earlier childhood stage and start exhibiting childhood behavior such as bedwetting. An adult who is under a great deal of stress, may not like to get up from bed and carry on normal life but feel comfortable by staying in bed for longer duration as he/she did as a child. Introjection: This mechanism refers to the internalization of the values and standards of others uncritically. For example, a child that is constantly labelled as stupid thinks that it is really stupid and cannot achieve anything in life. This type of taking in and accepting others values and norms blindly may reduce the anxiety that arises out of one s critical thinking that is contrary to others but inhibit the growth of the person. However, introjection could be beneficial to the growth of the person if he/she imbibes good values from others that are acceptable. Identification: Individuals take to this mechanism when they feel inferior to others. They, therefore, feel great and worthwhile by identifying themselves with great persons, successful causes, and organisations because of the status attached. Sublimation: Refocusing or channelizing one s thoughts, emotions and impulses that are considered unacceptable is known as sublimation. For example, when a person cannot act upon a strong sexual urge for some reasons, he/she may instead focus on some outdoor activity or intense physical exercise that could diffuse the urge. Refocusing any unacceptable or harmful impulse onto creative and productive activity helps a person to channelize his/her energy which otherwise would be used in a way that could cause great harm and anxiety to the person concerned.
6 Compensation: This is a kind of making up for perceived weakness or limitation by strengthening the positive traits in oneself. For example, when a student is not performing well in academics, he/she can focus on any artistic or mechanical talent such as drawing cartoons, painting, writing poetry, cooking, motor or electrical mechanism and so on and grow in self worth. As a defense mechanism, compensation helps to alleviate any anxiety that comes out of an individual s sense of inadequacy in a particular area but reinforces the person s self esteem and self confidence, if his/her area of strength is emphasized and focused upon. Assertiveness: This is one of the mature defence mechanisms that help a person to strike a balance between being aggressive and submissive in his/her interactions with others. Assertiveness reflects a person s thoughts and feelings in a respectful and acceptable manner. People who are aggressive tend to get things done in the way they want but in the process they may not be empathetic and understanding. People who are submissive remain passive and rarely speak up for themselves. Hence their needs may not be fulfilled, and they may feel low and anxious in their relationships. By becoming assertive a person is able to communicate his/her thoughts directly and firmly and while doing so, the person can be empathetically listen to others. This mechanism is what many people want to learn in order to cope with their stressful situations effectively. Defence mechanisms are most often learned behaviours, particularly during one s childhood. As an adult, a person can choose to learn some new behavior and new defence mechanism that may be helpful. By being aware of the type of mechanism one resorts to, a person can choose to modify his behavior and reduce his/her level of anxiety also. 3. Psychosexual Stages of Development: Each is marked by the involvement of a particular erogenous zone of the body. 3.1 Oral stage: Freud describes five developmental periods during which particular kind of pleasures must be gratified if personality development is to proceed normally. This period is the first one year and a half during which sucking at the breast of the mother satisfies the need for food and pleasure for the child. And this stage is marked by two main activities. 1. Oralincorporative behaviour which is the pleasurable stimulation of the mouth. If this is not happening, later in adult life the person takes to excessive eating, chewing, talking, smoking and drinking, and this behaviour is known as oral fixation. 2. Oral-aggressive behaviour which starts when the child teethes.
7 0-18 months: The infant receives satisfaction through sucking, eating, biting, etc. The erogenous zone is the mouth. When this sucking and biting need is not adequately met, then the individual will have feelings of greediness and acquisitiveness, and suffer from personality problems of mistrust of others, rejecting the love of others, and fear of entering into intimate relationship. Adults exhibiting behaviour of sarcasm, hostility, aggression, gossip and making bitter comments are related to this period of inadequate fulfilment of oral pleasure. Overindulgent: gullible, dependent, and passive person. Under indulgent: aggressive, sadistic person. Oral fixated adults orient their life around their mouth by overeating, alcoholism, smoking, talking too much. 3.2 Anal stage: 18 months-3 years: The child receives satisfaction by having and retaining bowel movements. The erogenous zone is the anus. Fixation results in retentive or explosive personality. Anal-retentive--highly controlled, compulsively neat Anal-explosive--messy, disorderly, rebellious, and destructive 3.3 Phallic Stage: 3-6 years: The centre of pleasure is the genitals, typically a time of exploration of pleasure through masturbation. The child resolves the Oedipus Complex (the period of conflict during the phallic stage when children are sexually attracted to the opposite-sex parent and hostile toward the same-sex parent). This period is also marked by the castration anxiety in males and penis envy in girls, though this concept was later discredited by Karen Horney. The attitude of parents towards the emerging sexuality of their children at this stage has some bearing on the formation of sexual attitudes and feelings of the children. Threatening or punishing the child has an adverse effect on the adult sex life later. 3.4 Latency Stage: 6-12 years: This is a dormant period during which the child begins to socialize and turns its attention outward in order to form relationships. At this time there is little manifest interest in sexuality. The sexual interests that just emerged previously will be replaced by interests in a wide variety of activities in school and neighbourhood such as games and sports. His/her energy is focused on peer activities and personal mastery of cognitive learning and physical skills.
8 3.5 Genital stage: This stage of development begins around the age of twelve years. The adolescent develops interest in the opposite sex, desires for sexual experimentations and assumes adult role and responsibilities. This is the last of the psychosexual phases that occurs around puberty and lasts till old age. If all has gone well previously, each gender takes more interest in the other and normal heterosexual patterns of interaction appear. Frustration or overindulgence: Freud believed that two difficulties could arise in the pre genital stages; excessive frustration or overindulgence. In such cases, the person becomes fixated (or arrested) at the level of development and overly dependent on the use of defence mechanisms. 4. Inner Forces Drive Human Behaviour. The basic components of Psychoanalytic Theory of Freud portray the principle idea that behaviour of an adult person is influenced by things that happened during his/her childhood. As Freud believed, the unconscious mind often prompts an individual to make certain decisions and he/she may not recognize it at the conscious level. The following are some examples to understand how an individual s behaviour could be influenced by his/her unconscious mind. Leena broke up with Anand, and three months later went on a date with Raju. While at the restaurant, Leena accidentally called Raju by Anand s name. While this could have just been a simple slip of tongue, psychoanalytic theory says that there is a deeper reason for Leena s slip she still has feelings for Anand and her mind is on him, and therefore she called her new date by her old boyfriend s name. Every time the vehicle she is riding in stops suddenly, Swathi panics. She thinks this is because she was in a car accident when she was a child and in each new situation the fear of another accident sweeps over her like a wave. Laxmi is 57 years old and is an accomplished professional, but she never feels that her work is good enough and is always afraid that people will be unhappy with her performance. She realizes that she might have this outlook because when she was growing up, her mother criticized everything she did. If she brought home a test with an A+ on it, her mother would comment that Laxmi must have cheated because she certainly wasn t smart enough to do that well on her own. Leela is adamant that she does not want to get married. Her parents divorced when she was young, and deep down, she does not really think that any marriage can work.
9 5. The Four Stages of Psychoanalytic Therapy The psycho analytic approach in helping a person to solve his/her problem involves the following steps. 5.1 The Initial stage The therapist should learn about the problems that the clients need to solve. - He/she determines the suitability of psychoanalytic therapy. - He/she makes agreement on the counselling principles, stages and mutual obligations. - Then the therapist gradually learns about the cause and symptoms of the client. 5.2 The Transference stage As the therapeutic process develops, the client would transfer his or her feelings for a significant person in the childhood to the therapist. According to the transference, the therapist could experience and better understand the client s feelings. 5.3 The Consolidation stage After learning about the transference and other information of the client, the therapist would make explanations and reveal the relationship between the inner unconscious conflicts or desires and the problem. In this way, the therapist leads the person to realize and comprehend. During this process, there are continuous resistances, which are useful to the process of intervention and have good effects. 5.4 The Resolution stage After consolidating the client's unconscious conflicts or desires, the therapist can set the time for the end of intervention. However, in this period, the transference may repeat many times. So the therapist should reveal some unresolved problems through explanations to make the client face the reality. When the client can solve the transference by himself or herself, the intervention can be terminated. 6. Contribution of Erik H. Erikson Erikson, a German born American developmental psychologist and psychoanalyst was born in 1902 and died in 1994. While Freud s theory had highlighted the psychosexual aspects of human development,
10 Erikson included other experiences to broaden Freud s theory. He contributed to the understanding of human personality along the line of its natural course of development over the life span. He is remembered for his famous phrase identity crisis. According to him, identity crisis is the result of the failure to achieve ego identity during adolescence. His observations of children as they grow up threw much light on the developmental process at work and paved the way for further research. He believed that children have enormous creativity, and whatever is in them will rise to the surface in free play. 6.1 The Perspective of Human Life: Erikson subscribed to the theory of Freud but extended the psychoanalytic theory by highlighting the psychosocial aspects of human development beyond early childhood. According to him, psychosexual growth and psychosocial growth take place together. The task of a human person in each stage is to establish equilibrium between oneself and one s social world. Erickson stated that development takes place in stages, which are eight in one s life span. 6.1.1 The Eight Stages: 1. First year of Life Infancy: Trust versus Mistrust When physical and emotional needs of the infant are provided, it develops a sense of trust and if not, an attitude of mistrust towards the world, especially towards interpersonal relationship will result. 2. Early Childhood (Age 1-3) Autonomy versus Shame and Doubt During this stage the child develops autonomy. The child explores and experiments and makes mistakes. If it is not encouraged to explore and experiment, its capacity to deal with the world successfully is hampered. If the child does not gain mastery of self-control and ability to cope with the world, it will develop a sense of shame and doubt about its abilities. 3. Preschool Age (Age 3-6): Initiative versus Guilt The developmental task in this age is to achieve a sense of competence and initiative. When the child is allowed to select personally meaningful activities, it will develop a positive view of self. If it is not allowed to make its own decisions, it tends to develop guilt over taking initiative. In later life it will refrain from taking an active stance and allow others to choose for it. 4. School Age (Age 6 12 ) Industry versus Inferiority: During this period, the child expands its understanding of the world and learns the basic skills required for school success. The developmental task is to achieve a sense of industry and attain the set goals. If failed, the child feels a sense of inadequacy.
11 5. Adolescence (Age 12-18 ) Identity versus Role Confusion This is a time of transition during which period the individual tests hi/her limits, tries to be independent and establish a new identity. If he/she fails in this attempt, he/she goes through role confusion. Adolescents usually struggle to define who they are, where they want to go and how to get there. 6. Young Adulthood (Age 18-35) Intimacy versus Isolation After establishing one s own identity, one is in search of forming intimate relationships. If the individual meets with failure, he/she experiences alienation and isolation. 7. Middle Age (Age 35 60 ) Generativity versus Stagnation The individual makes adjustment with the discrepancies between his/her dreams and actual accomplishments. Thus he/she realizes a sense of productivity. The main quality of productivity is to love, to work, and play well. If one is not able to succeed well, he/she stagnates and dies psychologically. 8. Later Life (Age 60 +) Integrity versus Despair if one has lived a productive and meaningful life, and has coped with his/her successes and failures well and has no regrets, he/she has achieved ego integrity; otherwise one feels despair, hopelessness, guilt, resentment and selfhatred. The first four stages occur in infancy and childhood, the fifth one during adolescence, and the last three during the adulthood including old age. However, these stages are not clearly marked out uniformly in all cases, as everyone has his/her own time line. Summary A comprehensive understanding of psychoanalytical therapy is necessary in helping persons to identify their problems and to solve them. The basic assumption of psychoanalytical theory is that things that happen to persons during childhood can contribute to the way they function later as adults. For Freud, human nature could be explained in terms of a conscious mind, a preconscious mind and an unconscious mind. According to Freud, the personality consists of three parts: Id, Ego, and Superego. Freud describes five developmental periods during which particular kind of pleasures must be gratified, if personality development is to proceed normally. Anxiety emerges due to a conflict among the three id, ego, and superego over the control of the psychic energy.
12 When the ego is not in a position to control anxiety by rational and direct methods, it takes to unrealistic methods, and these methods are known as defence mechanisms. There are four stages in psychoanalytical approach in the process of intervention in working with individuals in problem solving. Erikson, faithful to the idea of Freud extended his theory by stressing the psychosocial aspects of human development beyond early childhood. The development of identity seems to have been one of his greatest concerns in Erikson s own life as well as in his theory. According to Erikson, human development proceeds by eight stages which are not clearly marked uniformly among all people.