The Freudian Approach To Psychotherapy

The Freudian Approach

Of course, Sigmund Freud was the founder of psychoanalytical therapy, but his ideas have also been adapted to form a branch of psychodynamic therapy. In this context there is more intervention, less concentration on free association and more reliance on the relationship between therapist and client than in psychoanalysis.

If you are particularly interested in the history of Freud or his writings, these are easily available, but I feel it more important to concentrate on the theories espoused and how these are utilised in psychotherapy especially hypno-psychotherapy.

Here are some of the Freudian theories that underpin Freudian psychodynamic psychotherapy:

Physical determinism

The mind is a function of the human brain and therefore a part of the natural world and therefore subject to the laws of nature. This means that while we have free choice, this is part of the natural world and so the human mind can be studied scientifically just as any other part of it. It also means that it is reasonable to suggest that we would not necessarily be aware of the inner workings of the mind. We do not “know” how our minds work, only of the results of the workings.

Unconscious, preconscious, conscious

Unconscious mental states are totally inaccessible to conscious awareness. In order for something from within the unconscious become conscious it first becomes preconscious. This means that it is accessible and can be retrieved by some mental process. For example, if you think now of what you had for dinner last night this will be moving something from within the preconscious into the conscious. If however you were to think of what you had for dinner this time last year it is unlikely to be accessible, but if someone were to remind you that that was the day you went to a particular restaurant with a particular friend, then it may become accessible again.

How much of our experience is ever available to be re-accessed once “forgotten” is still very much a matter of opinion. Some believe that everything a person ever sees or does is lodged in the memory somewhere, while others believe that unless there is some reason to keep it, an experience may not be stored. Certainly memories retrieved having been forgotten or repressed are unreliable so care must be taken when working with memory. See Unit  7.

Freud believed that some things are kept permanently in the unconscious because to have them in conscious awareness would cause huge negative emotion but even so they have an influence. For example a man who unconsciously feels hatred for his father and wishes him harm may take this out in an aggressively anti-authority attitude as men in authority unconsciously take the place of the man’s father.

Repressed thoughts can include any which we feel inappropriate but chiefly these are either aggressive or sexual impulses (or both) that may contravene social mores. Perhaps then we all possess a store of highly charged sexual and aggressive fantasies: one of the problems with this theory is that you cannot prove you don’t!

Id, ego, superego

Freud grew dissatisfied with the previous model of the mind, and in 1923 proposed a new structural model. The id is the biological bedrock of motivation (where those sexual and aggressive impulses lie). It doesn’t care about external reality and looks for its own gratification regardless.

The ego is the part that coordinates internal and external realities. Sometimes it has to suppress the needs of the id for the safety of the person as a whole, but otherwise it works to gratify the needs of the id. The superego is sometimes likened to the conscience: it will “tell us” when we have been good or bad and help determine future behaviour through “shoulds”.

There is, by the very nature or them, a continual battle between id and superego with the ego stuck in the middle trying to keep everyone happy. If the conflict is too severe and intense the ego may have to defend against this by rendering the conflict unconscious.

Just as an aside, one text states that if we only had an id, survival would be difficult which makes one wonder whether Freud believed that animals had an ego and superego?

Psychological disturbance

Freudian theory states that this derives from the inner conflicts described above. Freud was keen to stress that there is no clear demarcation between health and illness; we are all on a continuum, and the position on that continuum will vary from situation to situation while each person will have underlying tendencies determined by their experiences and skills in handling inner states.

In order for there to be disturbance however, a conflict is not all that is required. There also has to be a defence set up to protect the conscious mind from the conflict.

Oedipus/Electra complex

(Note: please forgive the fact that I have written this section with a slight flippancy: this is reflective of my view that these ideas MAY have SOME merit for SOME clients, but that generally the ideas are too simplistic and contrived to be generalisable. Maybe you disagree, if so I am happy to have a friendly discussion with you sometime!).

Freud used the term Oedipus complex to describe a group of psychological disturbances created by childhood sexuality. He divided childhood into stages:

• Oral: this is the period of babyhood where Freud believed sexuality is concentrated in the mouth.
• Anal: the next stage where Freud believed a child’s sexual development is focused on anal sensation and on impulses to sadistically control others
• Phallic: this is the stage where the child (note the start of a presumption that a child is a boy!) is preoccupied with the phallus (age 3-7)
• Latency: sexuality is somewhat suppressed and undergoes no new developments
• Genital: starts at puberty

The Oedipus complex reaches its height in the phallic stage. It is more complicated than simply saying that the boy fancies his mother and wants his father out of the way, although this is the crux of the complex. The “attraction” to the mother is not just sexual, but is intense and all encompassing and the boy may be jealous of all rivals, of which the father is typically seen as the greatest.

This then leads to the next part of the complex: castration anxiety. The boy fears that because the strong feelings he has for his mother coincide with feelings in his genitals, his father may damage them. Because of this fear, he renounces his incestuous claims and enters the latency period.

So what about girls? The term Electra complex was formed as an equivalent term but Freud himself felt that girls too were focused on their mother and also wants rid of the father. But then she realises she doesn’t have a penis (which is obviously a problem) and develops “penis envy”. She blames her mother for not giving her one and rejects her because she doesn’t have one either! The girl transforms her wish for a penis into a wish for a baby and hence into an incestuous wish for her father.

Having given the above outline, please note that Freud did NOT think that everyone went through this in exactly the same way with the same outcomes. He did believe though that this process collapsed at the time of the establishment of the superego which suppresses these incestuous and aggressive impulses. Oedipal conflicts are sometimes stated as a necessary (but not sufficient) condition for psychological disturbance, but we feel that this is too restrictive. (Sorry: I keep my personal opinions out of most theorising but sometimes it is just not possible!).

Because psychological symptoms represent the fact that the conflict is too great for the mind to bear, they are usually symbolic or associated with the real cause, not directly related. These links can be extremely convoluted and demonstrate the creative nature of the unconscious mind (which of course can be utilised to find appropriate means of dealing with any conflicts).

Perpetuation of disturbance

Freud believed that overt symptoms were an expression of an underlying conflict, but that they are not the same thing. It is possible to remove the symptom without dealing with the disturbance. Symptoms are perpetuated because of the advantages they give; primary and secondary gain.

Primary gain is the fact that the symptom prevents the person from facing the repressed conflict. Secondary gains are the other advantages that one can get from the symptom but are not necessarily causally linked to the inner disturbance.

Mechanisms of defence

These are the ways that emotional reality is kept at bay and thereby perpetuate psychological disturbance. There are many ways but some of the key ones are listed below. I will also give an example of how a man (Bert) who has aggressive impulses towards his violent father might utilise each defence.

• Repression: putting something unconsciously out of mind. Bert forgets that his father beat him every Saturday night and says he had a great childhood
• Projection: attributing an unwanted characteristic of the self onto someone or something else. Bert says “young people of today are so violent!”
• Reversal: directing an emotion towards the self rather than another. Bert self harms.
• Disavowal: rejecting the existence of upsetting aspects of the world. Bert says that the NSPCC full stop campaign is a load of nonsense, no one hurts their children.
• Displacement: substituting one person for another. Bert regularly gets into fights at pub closing time.
• Introjection: internalising beliefs or attitudes of another. Bert takes on his father’s attitude that children need to be disciplined
• Isolation: detaching from feeling. Bert says he knows it was tough but he is fine with it.
• Negation: forming of a false belief that one does NOT have whatever the distressing emotion is. Bert says he is a pacifist and there is not an aggressive bone in his body.
• Reaction formation: creating an opposing emotional reaction. Bert finds violence sexually exciting rather than causing him to feel aggressive in response.
• Acting out: taking impulsive action to pre-empt the upsetting inner conflict. Bert goes for a run whenever he feels the least bit of the emotion stirring.
• Conversion: converting a distressing state into a physical problem. Bert’s feeling of being weak in relation to his father manifests as a bad back which means he can do little.

Rationalisation: finding false but logical reasons for the attitude. Bert says that the aggression he feels is simply because he has high testosterone levels.

Shaun Brookhouse