Flashcards in Psychoanalytic Theory and Defense Mechanisms Deck (67):
To explain his ideas, Freud developed what?
1. Early in his career --> The topographic theory of the mind.
2. Later --> The structural theory.
In the topographic theory, the mind contains 3 levels:
1. The unconscious.
2. The preconscious.
3. The conscious.
The unconscious mind contains:
Repressed thoughts and feelings that are not available to the conscious mind, and uses PRIMARY PROCESS THINKING.
Primary process thinking is:
A type of thinking associated with:
1. Primitive drives.
2. Wish fulfillment.
3. Pleasure seeking.
Has NO LOGIC or CONCEPT OF TIME.
Primary process thinking is seen in ...?
1. Young children.
2. Psychotic adults.
What do dreams represent?
Gratification of unconscious instictive impulses and wish fulfillment.
The preconscious mind contains:
Memories that, while NOT immediately available, can be accessed easily.
The conscious mind contains:
Thoughts that a person is currently aware of.
The conscious mind operates in close conjunction with ...?
The preconscious mind but DOES NOT HAVE ACCESS to the unconscious mind.
The conscious mind uses what type of thinking?
Secondary process thinking (logical, mature, time-oriented) and can delay gratification.
Structural theory of the mind - The mind contains 3 parts:
Freud's structural theory of the mind - Id - Topographic level of operation:
Freud's structural theory of the mind - Id - Age at which it develops:
Present at birth.
Freud's structural theory of the mind - Id - Characteristics:
1. Contains instinctive sexual and aggressive drives.
2. Controlled by primary process thinking.
3. Not influenced by external reality.
Freud's structural theory of the mind - Ego - Topographic level of operation:
Freud's structural theory of the mind - Ego - Age at which it develops:
Begins to develop immediately after birth.
Freud's structural theory of the mind - Ego - Characteristics:
1. Controls the expression of the id to adapt to the requirements of the external world primarily by the use of defense mechanisms.
2. Enables one to sustain satisfying interpersonal relationships.
3. Through reality testing (ie constantly evaluating what is valid and then adapting to that reality), enables one to maintain a sense of reality about the body and the external world.
Freud's structural theory of the mind - Superego - Topographic level of operation:
Freud's structural theory of the mind - Superego - Age at which it develops:
Begins to develop by about 6yrs of age.
Freud's structural theory of the mind - Superego - Characteristics:
1. Associated with moral values and conscience.
2. Controls the expression of the id.
Defense mechanisms - Definition:
Defense mechanisms are UNCONSCIOUS MENTAL TECHNIQUES used by the ego to keep conflicts out of the conscious mind, thus decreasing anxiety and maintaining a person's sense of safety, equilibrium, and self-esteem.
Defense mechanisms - Can be useful in ...?
Helping people deal with difficult life situations such as medical illness, but, when used to excess, can become a barrier to seeking care or adhering to treatment recommendations.
The 4 mature defense mechanisms:
Mature defense mechanisms, when used in moderation, ...?
Directly help the patient or others.
What is the BASIC defense mechanism on which all others are based?
REPRESSION = Pushing unacceptable emotions into the unconscious.
Commonly used defense mechanisms:
1. Acting out.
7. Identification (introjection).
9. Isolation of affect.
12. Reaction formation.
Avoiding personally unacceptable emotions by behaving in an attention-getting, often socially inappropriate manner.
Acting out - Example:
A depressed 14-yr old girl with no history of conduct disorder has sexual encounters with multiple partners after her parents; divorce.
Assisting others to avoid negative personal feelings.
Altruism - Example:
A man with a poor self-image, who is a social worker during the week, donates every other weekend to charity work.
Not accepting aspects of reality that the person finds unbearable.
Denial - Example:
An alcoholic insists that he is only a social drinker.
Moving emotions from a personally intolerable situation to one that is personally tolerable.
Displacement - Example:
A surgeon with unacknowledged anger toward his sister is abrasive to the female residents on his service.
Mentally separating part of one's consciousness from real life events or mentally distancing oneself from others.
Dissociation - Example:
Although he was not injured, a teenager has no memory of a car accident in which he was driving and his girlfriend was killed.
Expressing personally uncomfortable feelings without causing emotional discomfort.
Humor - Example:
A man who is concerned about his erectile problems makes jokes about Viagra (sildenafil citrate).
Unconsciously patterning one's behavior after that of someone more powerful (can be either positive or negative).
Identification - Example:
A man who is terrorized by his gym teacher as a child become's a punitive, critical gym teacher (identification with the aggressor).
Using the mind's higher functions to avoid experiencing emotion.
Intellectualization - Example:
A sailor whose boat is about to sink calmly explains the technical aspects of the hull damage in great detail to the other crew members.
Isolation of affect:
Failure to experience the feelings associated with a stressful life event, although logically understanding the significance of the event.
Isolation of affect - Example:
Without showing any emotion, a woman tells her family the results of tests that indicate her lung cancer has metastasized.
1. Attributing one's own personally unacceptable feelings to others.
2. Associated with paranoid symptoms and prejudice.
Projection - Example:
A man with unconscious homosexual impulses begins to believe that a male colleague is attracted to him.
Distorting one's perception of an event so that its negative outcome seems reasonable.
Rationalization - Example:
A man who loses an arm in an accident says the loss of his arm was good because it kept him from getting in trouble with the law.
Adopting opposite attitudes to avoid personally unacceptable emotions, ie unconscious hypocrisy.
Reaction formation - Example:
A woman who unconsiously is resentlful of the responsibilities of child rearing overspends on expensive gifts and clothing for her children.
Reverting to behavior patterns like those seen in someone of a younger age.
Regression - Example:
A woman insists that her husband stay overnight in the hospital with her before surgery.
Categorizing people or situations into categories of either "fabulous" or "dreadful" because of intolerance of ambiguity.
Splitting is seen in patients with ...?
Borderline personality disorder.
Splitting - Example:
A patient tells the doctor that while all of the doctors in the group practice are wonderful, all of the nurses and office help are unfriendly and curt.
Expressing a personally unacceptable feeling (Eg rage) in a socially useful way.
Sublimation - Example:
A man who got into fights as a teenager becomes a professional prize fighter.
Deliberately pushing personally unacceptable emotions out of conscious awareness (the ONLY defense mechanism that includes some aspect of consciousness).
Suppression - Example:
A medical student taking a review course for the USMLE mentally changes the subject when her mind wanders to the exam during a lecture.
Believing that one can magically reverse past events caused by "incorrect" behavior by now adopting "correct" behavior, eg atonement, confession, or penance.
Undoing - Example:
A woman who stole money from a friend, confesses to the theft, returns the money, and then feels compelled to offer to drive the friend to and from work for a year.
Transference - Definition:
Transference (and countertransference) are unconscious mental attitudes based on important past personal relationships (eg with parents).
Importance of transference and countertransference:
These phenomena increase emotionality and may thus alter judgement and behavior in patients' relationships with their doctors (transference) and doctors' relationship with their patients (countertransference).
In POSITIVE transference:
The patient has confidence in the doctor. If intense, the patient may over-idealize the doctor or develop sexual feelings toward the doctor.
In NEGATIVE transference:
The patient may become resentful or angry toward the doctor if the patient's desires and expectations are not realized.
--> This may lead to poor adherence to medical advice.
Feelings about a patient who reminds the doctor of a close friend or relative can interfere with the doctor's medical judgement.