Therapy · Uncategorized

Psychoanalysis vs Psychodynamic Psychotherapy

new doc 2017-12-11 07.53.46_1Or something about Freud and his followers…

Most people remember Freud from his teachings on childhood “psychosexual stages,” unconscious conflict based on sexual and aggressive urges, and his infamous terms “penis envy” and “Oedipal Complex.”  Most of it’s controversial, right?  Maybe, but it turns out there’s more to Freud than penis envy and the Oedipal Complex.  Not convinced?  Keep reading.

The first talk-therapy: Freud’s psychoanalysis

Freud was a neurologist who lived in the late 1800’s, and until that time, talking to mentally ill patients wasn’t considered helpful.  Treatment was limited to crowded hospitals, tight routine, brain surgery, hypnotism, spinning chairs, dunking people in water, and opium & cocaine. Freud was the first to try talk-therapy, to actually use words, something he called “psychoanalysis.”  He spent an hour each day listening to his patients, letting them talk about whatever was going on inside, and – as people got their inner world out into the open – their symptoms diminished and the quality of their lives improved. Somehow, Freud discovered, bringing repressed material to the surface was cathartic.  Psychoanalysis worked well, and that’s how talk-therapy was born.

The three parts of the psyche

So Freud talked to his patients, hoping to figure out how the mind worked.  Eventually he decided that psychiatric symptoms were caused by conflict between different parts of the mind, the id and superego.  He asserted that we humans have an unconscious aspect to our personalities, the land where the id and superego reside, and here within lie the battles that trigger all psychiatric symptoms.  A third part of the psyche, the ego, has the ungainly job of refereeing the superego and id.

new doc 2017-12-25 15.39.04_1
The ego has the ungainly job of refereeing the super-ego and id, all that while dealing with the rest of life!

The SUPEREGO knows the rules. We all have a part of our psyche that keeps a list of our personal rules. This list includes guidelines we learned during childhood, cultural taboos about what is right and wrong, and other personal laws we’ve unwittingly signed ourselves up for over the years.   For example, the superego tells us it’s not right to eat an entire pizza at once.  The superego also plays with moral standards and tries to keep us within the constraints of reality.  Some of these standards and constraints are helpful, others not so much.  Most of us aren’t aware of the particulars of our personal commandments, but we feel ill when we go against them.

The ID doesn’t care about the rules. The id is the childlike, passionate part of our personality that wants things and feels things without paying much attention to the rules.  It doesn’t care about morality and reality.  Here’s where we find our innate drives.  The id holds our libido and all hidden desires, the kinds of stuff we’d be pursuing if there weren’t mores and laws against them.  It’s the id that wants to eat that whole darn, super-sized pizza at once.

The EGO acts as go-between. The superego and the id rarely agree, and this new doc 2017-12-11 07.53.46_2creates enormous tension. Emotions fly about like wildfire, threatening to overwhelm the mind if not kept in check. That’s where the ego comes into play.  The ego’s job is to solve the quarrel between the id and superego — and deal with the emotional baggage that accompanies the conflict.  The ego is the conscious part of the brain that does all the thinking.  It decides how much of the pizza will be eaten and, after eating the entire thing, soothes itself by promising it won’t happen again.  It also takes anti-acids for the heartburn

So Freud thought that the cause of psychiatric illness was conflict between our internalized rules and desires.  What we want to do and should be doing don’t always match.  Often we stuff these conflicts so deep down inside us we hardly realize they’re there, but none-the-less, we feel the angst.  We’re suffering and don’t know why.

The goal of psychoanalysis is to bring these conflicts to the surface and, in doing so, help us gain insight into why we feel so miserable or anxious or angry.  In Freud’s eyes, insight was a beautiful thing.  It gives us a chance to understand why we do what we do, plus a chance to find healthier ways to cope.

The ego’s defense mechanisms

Conflict between the superego and id causes a lot of angst, and the ego needs ways to deal with conflict and its aftershock — it uses defense mechanisms to protect itself from harmful emotion and situations. Defense mechanisms are unconscious coping skills.  We use them to deal with stress.

Freud believed most patients used the defense mechanism “repression” to deal with their problems.  As described beforehand, when a conflict is too overwhelming or a desire too inappropriate, we stuff the stressor deep down inside so we don’t have to deal with it.  It’s so deep we aren’t aware it’s there.  This is called repression.

Defense Mechanisms and Ego Psychology

new doc 2017-11-17 11.55.39_3Freud invented psychoanalysis… then things got complicated.  The neurologist had lots of students, and each created a new branch of talk-therapy.  Psychoanalysis was divided into multiple new schools, a group of therapies called psychodynamic psychotherapy.

Some therapists, including Freud’s daughter, Anna Freud, started a branch of therapy called “Ego Psychology.”  The focus of ego psychology was still on defense mechanisms and the ego-superego-id triad.  But this group took things a step further.  Freud’s daughter expanded on the number of defense mechanisms, describing other ways people deal with conflict apart from repression.  Some are healthy.  Others are not-so-good.  Examples of Anna Freud’s mechanisms includes:

  • Projection involves taking one’s unwanted thoughts and attributing them to another person. An example is when you hate someone but instead convince yourself that person hates you.
  • Denial is about rejecting awareness of a situation.  A good example is a smoker who refuses to admit smoking is bad for their health.
  • Sublimation is a healthy defense mechanism that involves changing a socially “objectionable” desire into something society values.  An example would be using a tendency towards aggression to work in demolition.
  • Reaction formation involves managing stress by doing the opposite to what you want to do.  It can be a good skill.  An extreme example would be a serial killer who, discharged from prison, studies to be a doctor to truly help others.

Ego psychologists also focused on relationships rather than conflict.  The source of angst in our lives is related to our connection with others, or lack thereof.  They also described the ego as more adaptive and cognitively oriented than Freud’s concept of ego.  That is, the ego is more awake and capable than before.  The goal of therapy, then, was to identify unhealthy defense mechanisms related to past relationships and the ego – and replace these mechanisms with mature ones.  In super brief terms, ego psychology is about identifying the ego’s unhealthy coping skills and replacing them with good ones.

Object Relations

Object relation therapists insisted that symptoms were a result of problems in early relationships. That is, if childhood caregivers didn’t meet our needs, we got “stuck” in the past.  As adults, we’re doomed to repeat the same bad relationship pattern over and over with different people.  An example is a man who, when growing up, had a troubled connection with his mother – so much so that as a grown man he can’t relate to women and repeatedly fails at marriage.  The goal of therapy is to recognize the bad relationship patterns we carry along with us from childhood and change them. These early relationships are seen as internalized objects we keep with us over the years, playing them out over and over until we see what we’re doing.

Self Psychology

Next came self-psychology.  This group of therapists took it a step further.  Like object relations, this school of thought believed that mental illness was a result of poor parenting.  However, the approach to treatment was different.  Instead of exploring the past, the therapist works at “re-parenting” the patient themselves.  They offer an empathetic, affirming perspective. Treatment emphasizes strengths, self-esteem, and cohesion of the self.  Instead of dissecting past relationships, self-psychology focuses on instilling a healthy self-concept.

Conclusion: psychoanalysis vs psychodynamic therapy

new doc 2017-12-11 07.53.46_3These schools (Ego-psychology, Object Relations, and Self-psychology, and others not mentioned above) are branches of psychodynamic psychotherapy.  They are different to psychoanalysis in several ways, but the biggest difference is the philosophy behind the treatment and therapist’s role and timeline.

Psychoanalysis is a term used to describe Freud’s theoretical ideas and perspectives.  His therapy is based on the conflict between the superego’s pursuit of rules & morality and the id’s need for pleasure (regardless of what’s right or wrong), also called the conflict model.  The ego moderates the superego and id, trying to find a balance that brings peace to all.  Often this is done pathologically, leaving behind a mess that needs to be repressed.  In the office, Freud’s treatment is marked by a silent psychoanalyst who sits out of view behind the patient.  The analyst says very little.  The patient talks randomly, associating freely whatever comes to mind.  This type of talk-therapy usually takes place 3-5 sessions/week and lasts several years.  Health insurance rarely covers it because of its long duration.

Psychodynamic therapy was started by Freud’s followers.  There are many types.  In general, it broadens the understanding of the human psyche and how it deals with stress.  The ego is considered more adaptive and vibrant.  Defense mechanisms are expanded.  Malignant early relationships have replaced Freud’s conflict model as the cause of mental illness.  In therapy, psychodynamic counselors are pro-active, offering ready interpretations during sessions.  The treatment frequently uses the provider-patient relationship as a tool to promote patient health.  Sessions are typically  once/week and can last months to years.

That’s a quick overview of psychoanalysis and psychodynamic therapy.  It ain’t easy stuff!  For more info, look into the “Difference Between” website’s article, Difference between Psychoanalysis and Psychodynamic Therapies.  (Opens in a new window)

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