Psychiatry

1. PSYCHOANALYT
I
C THEORY
SIGMUN
D FREUD
by Leila Zaim & Najah Choucair
2015

2. SIGMUNDFREUD:
•May 6, 1856 –Sigmund Freud wasborn in
Freyberg town, Czech republic.
•1881 –he graduated from medical
faculty, university of Vienna.
•1896 –Sigmund Freud wasofficially
recognized.
1900 –he released ‘interpretation of
dreams’.
•September23, 1939 –Freud passed away
in Hampstead.

3. Sigmund Freud
‘s
contributions
Sigmund Freud explored the human
mind more thoroughly than any other
who came before him.
Freud wasone of the most influential
people of the twentieth century and
hasinfluenced not only psychology,
but art, literature and even the way
people bring up theirchildren.

4. Father of Psychoanalysis
Freud was the founding father of psychoanalysis a
theory which explains human behavior and a method
for treating mental illness .
Psychoanalysis is often known as the talking cure.
Typically Freud would encourage his patients to talk
freely (on his famous couch) regarding their
symptoms, and to describe exactly what was on their
mind.

5. Aim of
Psychoanalysis
Therapy
• The aim of psychoanalysis therapy is to release repressed
emotions and experiences, i.e. make the unconscious
conscious. “Gaining insight”
• Psychoanalysis is commonly used to treat depression and
anxiety disorders.
• Treatment focuses on bringing the repressed conflicts to
conscious, where the client can deal with it realistically and
maturely

6. features of the mind’s structure and
function.
Freud’s topographical
model of the mind

7. Levels of the mind
1. CONSCIOUS
•Immediate Awareness
•communicates to the outside world and the inner self through speech,
pictures, writing, physical movement, and thought
• Only level of mental life that are directly available to us
• This is seen as the tip of the iceberg. For example, you may be
feeling thirsty at this moment and decide to get a drink.

8. 2.Preconscious
Accessible memories
I
texists just below conscious. The preconscious contains
thoughts and feelings that a person is not currently aware
of, but which can easily be brought to conscious
I
fyou were asked what you watched last night or what
you had for breakfast this morning, you would be pulling
that information out of your preconscious.
Gatekeeperbetween the conscious and unconscious parts
of the mind. It allows only certain pieces of information to
pass through and enter conscious awareness.

9. 3.UNCONSCIOUS
Unconscious mind is the primary source of human
behavior. Like an iceberg, the most important part of the
mind is the part you cannot see.
Storehouse of all significant and disturbing memories
and experiences which we need to keep out of awareness
because they are too threatening to acknowledge fully.
This is called Repression
It’s these memories and experiences that our beliefs,
habits, and behaviors are formed. Freudian theory is that
the unconscious mind governs behavior to a greater degree
than people suspect.

10. PsychoanalysisAssumptions
Psychoanalytic psychologists see
psychological problems as rooted in the
unconscious mind.
Manifest symptoms are caused by
hidden disturbances.
They are a result of unresolved issues
during development or repressed
trauma.

11. Principal concepts
of F
reudian
T
heory
1. Structural concept :Id, Ego ,Super Ego.
2. Dynamic concept :Instincts , Energy, Restrain and
Anxiety .
3. Developmental concepts:Defense Mechanisms
Psychosexual stages

12. 1.Structural Concept
Thehuman personality
Freud believed human
behavior resulted from the
interaction of three
important parts of the
personality: the id, ego
and superego.
Ego, Superego have all the
mind levels
Id has only the
unconscious level

13. 13
“ThePsychicApparatus”
Freud (1923) later developed a more structural model of
the mind id, ego and superego These are not physical
areas within the brain, but rather hypothetical
conceptualizations of important mental functions

14. The Structure
of
Personality
The Id – Reservoir of Psychic Energy-Meeting Basic Needs
➢ Most primitive part of the mind; what we are born with.
➢ Operates on PLEASURE PRINCIPAL – to gain pleasure, avoid pain
Driven by sexual and aggressive urge
➢ The id is the most basic part of the personality, and wants instant
gratification for our wants and needs. If these needs or wants are not
met, a person becomes tense or anxious.
➢ Sally was thirsty. Rather than waiting for the server to refill her
glass of water, she reached across the table and drank from Mr.
Smith’s water glass, much to his surprise

15. TheStructure of
Personality
The Ego- Executive of Personality-Dealing with
Reality
➢ The balance between Id and Superego –Reality principal
➢ The ego develops from the id during infancy. (2_3)
➢ trying to meet the desires of the id in a way that is socially acceptable
➢ it operates in both the conscious and preconscious mind.
➢ The ego recognizes that other people have needs and wants too, and
that being selfish is not always good for us in the long run.
➢ Sally was thirsty. However, she knew that her server would be back
soon to refill her water glass, so she waited until then to get a drink,
even though she really just wanted to drink from Mr. Smith’s glass.

16. The Structure
of
Personality
The Superego- Upholder of Values and Ideals
The superego develops last during early childhood and is responsible for ensuring moral standards are
followed. The superego operates on the MORALITY PRINCIPLE and motivates us to behave in a
socially responsible and acceptable manner.
Sarah knew that she could steal the supplies from work and no one would know about
it. However, she knew that stealing was wrong, so she decided not to take anything
even though she would probably never get caught

17. The id, ego and superego work
together in creating a behavior.
The id creates the demands, the
ego adds the needs of reality
with the superego adds morality
to the action which is taken.

18. 3. Dynamics concept
Instincts : motivates human behavior
Libido : energy created by survival and
sexual instincts work
Cathexis : directing the energy to satisfy
needs
Anticathexis: the force ego exerts to
block impulses from id
Anxiety : conscious state where a painful
emotion is produces by internal or
external
interaction of drives and forces within
the person, particularly unconscious,
and between the different structures of
the personality.
Id vs. superego; Individual vs.
society
Restrain expression of all drives
Surplus energy results in anxiety

19. 3.Developmental
Concepts
• The ego, driven by the id, confined by the superego, struggles in
bringing about harmony among the forces
• The ego protects its self from overload of pressure , anxiety and
depression with a defense mechanism.
• The defense mechanism provides a short term relief but distort
reality creating more long term problems
• The Ego employs a range of defense mechanisms. Defense
mechanisms operate at an unconscious level and help get rid of
unpleasant feelings .

20. Why do we need defenses?
Defense mechanisms are invented by the Ego in an attempt to
resolve the conflict between Id and Superego – so that personality
can operate in a healthy manner.
•unwanted Memories banished to the unconscious, do not
disappear. They continue to exert a powerful influence on
behavior.
•Defense mechanisms help keep urges, thoughts, and memories that
cause anxiety in the unconscious.
•If it is used once in a while, the purpose of using it is to
reduce stress.
•But if it is used frequently, it means the individual are trying to

22. 22
EGO’S DEFENSEMECHANI
S
MS
The forces, which try to keep painful or socially undesirable
thoughts and memories out of the conscious mind
•DENIAL:refusal to acknowledge its existence.
•R
EPRESSION: pushing it out of awareness.
•PR
OJECT
ION: attributing it to someone else.
•REACTION FORMATION: overemphasizing its
opposite.
•REGRESSION: retreating to an earlier (immature)
stage of development.
•IDENTI
F
ICAT
ION: identifying oneself with a feared
person.
•RATIONALIZATION:giving excuses for it.
•INTELLECTUALIZATION:distancing oneself from it

23. Howcan we understand
the unconscious mind?
In psychoanalysis (therapy) Freud would have a patient lie
on a couch to relax, and he would sit behind them taking
noteswhile they tell him about theirdreamsand childhood
memories. Psychoanalysiswould be a lengthy process,
involving many sessions with the psychoanalyst.
Due to the nature of defense mechanismsand the
inaccessibility of the deterministic forces operating in the
unconscious, psychoanalysis in its classic form isa lengthy
process often involving 2 to 5 sessions per week for several
years.

24. Psychoanalytic Counseling Methods
Lengthy T
herapeutic T
echniques
T
he primary goal ofcounseling
within a psychoanalytic frame of
reference isto make the
unconscious conscious.

25. Psychoanalytic Theory
Basic principals
T
o become a practitioner of psychoanalysis,
one must complete a long training process of
many years, which is open only to M.D.’s and
PhD's.
Id, Ego, Superego and intrapsychic conflicts:
Psychological symptoms are self-defeating
patterns brought on by internal struggles.
The past: Current problems stem from
unresolved issues that occurred in early
childhood.

26. General Principles
Help the person to tell his or her story.
Establish a solid working alliance.
Deal with resistance.
Gather background information and history.
Select the problem or issue to be worked on.
Explore the precipitating events.
Detachment: The therapist is detached, objective and neutral so
that the client can project onto the therapist things from the client’s
unconscious.

27. Psychoanalytic Therapy
Basic Techniques:
Catharsis: The release of pent-up emotion. A Corrective
Emotional experience. The therapist helps clients alter their self-
perceptions and behavior.
Freud , along with Breuer, first discovered the benefits of catharsis
through hypnosis where hysterical patients were able to verbalize
an early precipitating causal event.Unfotunately,many of his
patients could not remember the origin of their symptoms even on
command. So, he developed free association and interpretation to
bring everyone to the emotional state of catharsis that was
necessary for their cure.

28. Free Association: The client lies on a couch and the analyst sits at
the head of the couch beyond the client’s line of vision. The analyst
then orders the client to say whatever comes to mind. Through this
method the unconscious thoughts and conflicts are given freedom to
reach the conscious mind.
The fundamental rule of psychoanalysis counseling requires clients to
tell the counselor whatever thoughts and feelings into their minds,
regardless of how personal, painful or seemingly irrelevant.
The counselor must remain patient and nonjudgmental and insists the
client to continue.
The counselor must look for continuity of thoughts and feelings,
rational patterns of speech.
The counselor must pay attention to the affect or feelings behind the
client’s verbalization, noting the client’s gestures, tone of voice and
general body language during free association.
At this point the counselor offers some interpretations of the client’s
statements to try open another door for free association.

29. Interpretation: Three major areas of interpretations are dreams,
Parapraxia, and Humor.
In Dreams, Freud( 1901/1952,1965a) believed dreams expressed wish
fulfillment. for Freud dreams are the royal road to the unconscious. As
the individual matures, the wish, as exposed the dream becomes
distorted and disguised. The ego fights the initial conscious wish, which
thus is pushed back to the unconscious mind. When sleeping repressive
are weaker, and forbidden desires and feelings can find an outlet in
dreams. The counselors role is to listen to the client’s dream and help
the client interpret the dream’s symbolism in free association technique.
Certain objects in dreams were universal symbols for Freud: e.g. car
symbolizes analysis or direction of life/ jewel cases and
purses=vaginas/ peaches and twin sisters=female breasts/ nb3=male
genitals….
The key for understanding one’s dream is identifying the basic theme by
stripping away details as names ,places, and things; leaving only the
action.
Freud believed every dream to be a confession and a by-product of
repressed anxiety producing thoughts or unfulfilled sexual desires
which expressed the superego’s guilt and self-punishment. Nightmares
result from the desire for self punishment.

30. ”
Parapraxia: or Freudian slips of a tongue are consciously excused as
harmless mistakes but through them the ID pushes the unconscious
material through to the conscious .
According to psychoanalytic thinking everything we do for ex: forgetting
a person’s name, cutting a finger while peeling potatoes- has
unconscious motivation. The analyst must take all these unconscious
mistakes and arrange them into a conscious pattern.
Humor: Jokes, puns, and satire are all acceptable means for
unconscious urges to gain access to the conscious; they simultaneously
disguise and reveal repressed thoughts which are generally generated
from the ID and Superego e.g.: sexual thoughts are usually repressed
forming aggressive thoughts expressed in humor, satire ,and
witticisms.

31. Analysis of Transference:
Transference generally is a product of unfinished business with
a significant person from the client’s childhood. Clients
commonly transfer their feelings, thought, and expectations
about the significant other to the counselor. Counseling
provides a stage for re-enacting unresolved conflicts with the
counselor, who can help client’s deal with them in more
effective and functional ways.
Transference relationships can become a real battle ground
when love feelings directed toward the counselor are rejected
and the client in turn rejects the counselor by resisting his
every effort to be helpful.
Counter transference occurs when the counselor begins to view
a client as someone other than a client. In such case referral
to another professional is recommended.

32. AnalysisofIncomplete Sentences:
This procedure maybe especially useful in acquainting
counselors with children and in establishing better rapport
with those who are anxious, fearful or reluctant to talk: ex:
-The things I like to do the most is
-The person in my family who helps me the most is
-My friends are
-I feel saddest (or happiest) when
-When I grow up, I want
-My teacher is

33. Biblio counseling: That is reading and discussing books
about children similar to themselves; it can help clients in
several ways. Those who are unable to verbalize their
thoughts and feelings, may find themselves in books.
Directed reading can lead to expressions of feelings, attitudes,
behavior, or environment:
1. Teaches constructive and positive thinking.
2. Encourages free expressions concerning problems.
3. Helping clients analyze their attitudes and behaviors.
4. Looking at alternative solutions.
5. Encouraging the client to find a way that is not in conflict with
society.
6. Allows clients to see the similarity of their problems with those
of others.
Biblio counseling is also a means of educating children about
certain areas of concern such as physical disabilities, divorce,
and deaths.

34. Storytelling:
-
-
-
- Richard Gardner developed the mutual storytelling
techniques as a therapeutic means for working with
children to help them understand or cope with their own
thoughts and feelings and to communicate meaningful
insights, values, and standards of behavior.
The counselor sets the stage for the child and it is
recorded. (The story should have :beginning, middle,
end)
The counselor clarifies same points of the story finished.
The counselor then prepares a similar story using a
similar theme, setting, and significant figures from the
child’s story. However, he provides the child with better
alternatives or responses to the situation.

35. Play Therapy: It is used to make the child feel at ease and the
analyst discovers clues about his inner life(fantasies,
dramatization, make-believe world ; it is a natural mode of
communication for children who have limited verbal ability.
Play is first: the emergence and integration of the dissociated self
states, symbols, and recognition.
Second: renegotiation of relationships with self and others.
Goals: resolve fixations , regression, developmental deficiencies,
and other impediments to the child’s normal developement.
From a Freudian view, play provides the medium for moving through
the five psychosexual stages and the corresponding development of
the ego and super ego superstructures from the ID structure.
Exercise of the pleasure principle, such as hitting, biting, pushing
others, and doing what the child pleases gradually comes up against
the reality principle, which tells the child that games have rules and
that sometimes it is necessary and even best to postpone
pleasurable act.

36. Psychoanalytic Therapy Process
General Principles
Help the client behave more effectively.
Provide feedback and confront discrepancies.
Negotiate with the client regarding homework assignments.
Remind the client of the termination date.
End therapy as agreed upon with the client.
Schedule follow-up as needed.

37. Psychoanalytic Therapy Process
Limitations
Doesn’t take all the client’s needs into consideration. (e.g.
sometimes clients have a need to be alone or regress.)
Psychoanalysis isn’t for everyone and it is still long in duration
compared to more brief theories.
The writings of some psychoanalytic theorists (Freud and Jung In
particular) are technical and hard to read.