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Flashcards in Psychodynamics I and II Deck (30):
1

Psychosexual stages:

1. Oral: Libido: Oral: Birth – 1 ½ years

--Sucking
--Dependent (p a r a d i s e!)
Adult “oral” traits: enjoy food, chew gum, smoke, drink: passive, dependent

2. Anal
Libido->Anal: 1 ½ - 3 years
Crawling, exploring
“No!”
Potty training (holding on, letting go)
terrible twos (paradise lost!)
Adult anal traits: neat, on time, correct, organized, careful with money, controlled

Fixation: Extra investment of libido in one phase
Regression: reversion to earlier phase under stress

3. (Oedipal complex in boys; Electra complex in girls)

Libido--> Phallic 3- 5/6 yrs
-->curious about sex differences
-->close to parent of opposite sex

4. Latency: Libido--> Latency: 6 yrs- adolescent
-->girl scouts/ boy scouts

5. Genital: Libido-->Genital: Adolescent/ Adult on…
-->capacity for true intimacy






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Structural hypothesis:

1. ID
ID “Child”

from birth
fun, gratification

How do you hear it?
- “I want now!”

2. Superego
Superego “Parent”
from age 5 on
Conscience; rules, morals, values
Develops based on input from:
-parents, teachers, religious authorities
-Political authorities, societal norms, legal system
How do we hear it?
“Thou shalt not!” (Guilt+; dissolves in alcohol!)

3. Ego “Adult”
growing, evolving “I”
Purpose: deals with internal and external reality

Superego feeds on

Reality feeds on EGO --> “I will do…” -->personality
Id feeds on EGO

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Ego under stress:


Reality, Id, superego feed on EGO -->“ can’t deal with this” -->anxiety --> ego defense mechanisms
Purpose: decrease distress; make reality better

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Glossary of Defenses: Level I Psychotic Mechs

--common in “healthy” individuals before age five
--common in adult dreams and fantasy.

--For the user, these mechanisms alter reality.
--To the beholder, they appear “crazy”.

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1. Delusional projection:

Frank delusions about external reality, usually of a persecutory type.

perception of one’s feelings in another person and then acting on it (e.g., florid paranoid delusions)

perception of other people or their feelings literally inside oneself (e.g., agitated patient’s claim that “the devil is devouring my heart”).

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2. Psychotic denial:

Denial of external reality.

Eg., when a patient with psychosis says “I am Jesus Christ”, he is entirely denying the fact that he is John Williams.

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3. Distortion:

Grossly reshaping external reality to suit inner needs.

unrealistic megalomaniacal beliefs

hallucinations, wish-fulfilling delusions of delusional superiority or entitlement.

denial of personal responsibility for one’s own behavior.

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Level II: Immature mechs;

common in “healthy” individuals ages 3 to 15
Seen in personality disorders

For the user, alter distress due to the threat of interpersonal intimacy or its loss.
- To the beholder they appear socially undesirable.

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4. Projection:

Attributing one’s own unacknowledged feelings to others.

- includes severe prejudice, rejections of intimacy through unwarranted suspicion, marked hypervigilance to external danger, and injustice-collecting.
Behavior may be eccentric and abrasive but within the “letter of the law.”
-->paranoid personality

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5. Somatization:

Turning an unacceptable impulse or feeling eg from bereavement, loneliness, fear or anger
-->into complaints of pain, or somatic illness.

Permits the individual to belabor others with his own pain or discomfort in lieu of making direct demands upon them or in lieu of complaining that others have ignored his wishes (often unexpressed) to be dependent.
Eg: ‘My chest hurts” rather than “Please pay attention to me” or “Please care about me”
-->Hypochondriac; psychosomatic disorders

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6. Acting Out:

Direct expression of an unconscious wish or impulse in order to avoid being conscious of the affect that accompanies it.

Delinquent or impulsive act to avoid being aware of one’s feelings eg anger, sadness.

Includes chronic use of drugs, failure, perversion, or self-inflicted injury to relieve tension.

*Doing [eg punching] instead of thinking or feeling [eg I hate you]
-->Antisocial personality disorder

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7. Splitting

Seeing people and events as ALL good or ALL bad

Will quickly switch between these extreme positions
-->Borderline Personality Disorder

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Level III: Neurotic defenses:

common in “healthy” individuals ages 3- 90

in neurotic disorder, and in acute stress.

For the user, these alter private feelings or instinctual expression.

To the beholder, they are quirks or “hang-ups.”

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8. Denial

Unable to accept (and therefore seems to ignore/be unaware of/denies) intolerable facts about reality

The commonest defense seen in medical practice.

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9. Displacement

The redirection of feelings toward a relatively less cared for (less cathected) object than the person or situation arousing the feelings.

Eg., If angry at your boss but unable to say anything, you replace her by a thing (kick a chair) or a stranger (road rage)
-->Most phobias, many hysterical conversion reactions, and some prejudice involve displacement.

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10. Dissociation:

Temporary but drastic modification of one’s character or of one’s sense of personal identity to avoid emotional distress.

-->Acute reaction to trauma
-->Multiple Personality Disorder

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11. ID:

Unconscious patterning of one’s behavior after a powerful, influential person
Eg.,
Adopting the habits of a parent or coach
Behaviors/parenting style “runs in families”
Stockholm syndrome [‘identification with the aggressor’]

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12. Intellectualization:

Thinking about instinctual wishes in formal, affectively bland terms, and not acting on them. The idea is in consciousness, but the feeling is missing.

isolation, rationalization, ritual, un-doing, restitution, magical thinking, and “busywork”.

usually occur as a cluster.
-->Obsessive Compulsive disorder

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13. Isolation of Affect:

Intellectual knowledge and understanding of a negative event without experiencing the feelings

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14. Rationalization

Providing superficially reasonable accounts to explain away negative events, feelings, actions.

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15. Reaction Formation:

Behavior in a fashion diametrically opposed to an unacceptable instinctual impulse.

overtly caring for someone else when one wishes to be cared for oneself

“hating” someone or something one really likes

“loving” a hated rival or unpleasant duty.

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16. Regression:

Appearance of child-like behavior during periods of stress.

Seen in medical crises

When a sibling is born

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17. Undoing:

Protecting against a negative past event by acceptable “corrective” behavior eg superstitious rituals or formal atonement or confession.

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Level IV: Mature Mechs:

common in “healthy” individuals ages 12-90

For the user, they integrate reality, interpersonal relationships, and private feelings.

To the beholder they appear as convenient virtues.

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18. Altruism

Vicarious but constructive and instinctually gratifying service to others.

It includes benign and constructive reaction formation, philanthropy, and well-repaid service to others. Altruism differs from projection and acting out in that it provides real, not imaginary, benefit to others and from reaction formation in that it leaves the person using the defense at least partly gratified.

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Sublimation; it includes:

Indirect or attenuated expression of instincts without either adverse consequences or marked loss of pleasure.

expressing aggression through pleasurable games, sports, and hobbies

romantic attenuation of instinctual expression during a real courtship.

instincts are channeled rather than dammed or diverted. Successful artistic expression remains the classic example.

feelings are acknowledged, modified, and directed toward a relatively significant person or goal so that modest instinctual satisfaction results.

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20. Anticipation:

Realistic anticipation of or planning for future inner discomfort.

Includes goal-directed but overly careful planning or worrying

- premature but realistic affective anticipation of death or surgery or separation

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21. Suppression:

The conscious or semiconscious decision to postpone paying attention to a conscious impulse or conflict.

Includes looking for silver linings, minimizing acknowledged discomfort, employing a stiff upper lip

- deliberately postponing but not avoiding. One says, “I will think about it tomorrow”; and the next day one remembers to think about it.

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22. Humor:

Overt expression of ideas and feelings without individual discomfort or immobilization and without unpleasant effect on others.

Some games and playful regression come under this heading.

-humor lets you call a spade a spade
-Like hope, humor permits one to bear and yet to focus upon what is too terrible to be borne

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Transference and Countertransference

Transference: Patient’s unconscious “transfer” and replay of relationship with influential figures from the past. More likely with physicians.
-Positive: eg.,Unrealistic expectations
-Negative: Mistrust, missed appointments, non-adherence, poor outcomes

Countertransference: The MD’s transference to the pt- Positive or Negative. Yes, behind our coats, we are just as human, prone to distorting!