Theories of the Ego

1. Theories of the Ego The Unconscious, Ego Psychology & coping with crises SSS 571

2. Psychodynamic theory • Freud's biopsychosocial approach • Two Freudian models of the mind • Ego Psychology and autonomous ego functions • Coping and Adaptation • Change Concepts

3. “Psychodynamic Theory” is NOT just one theory… • It is a set of theories • Drive or structural theory • Ego Psychology • Object Relations Theory • Self Psychology • Relational Theory • Our focus today: • Classical theory (drive theory & ego psychology) • Focus of advanced psychodynamic theory (SSS 723): • Contemporary theories (object relations, self psychology, & relational theory)

4. What is psychodynamic theory? • It is a set of theories that describe... • the changing inner energies that motivate, dominate, & control people’s behavior • It provides a framework that examines... • past experiences & present reality, as well as the internal & external forces that impact emotional development • It looks from “the inside out & the outside in”

5. Freud's Path • How did a medically trained neurologist come to describe this particular theory of the mind? • Charcot & the state of art of psychological care in the 19th century • Freudian problems in Victorian context

11. The Couch

12. Psychodynamic Commonalities • Personal history (particularly early childhood experiences) influence development. • The psyche is formed at the intersection of internal and external forces. • A dynamic unconscious (UCS) influences thoughts, feelings and behaviors. • The “Talking cure” is influenced by transference.

13. Basic Premises of all Psychodynamic Theories • Internal & external forces—both conscious & unconscious, based on past experience & present reality—interact to motivate, dominate, & control human behavior, personality development, & social functioning • The internal mind affects how we relate to the external environment & the external environment affects the internal mind in a dynamic interaction throughout the life span

14. Assumptions about human behavior • All biological, psychological, & social factors interact in a complex way to impact development & adaptation throughout life • Humans learn to adapt to the external environment through relationships shaped by in-born genetic capacities , culture, & socio-historical context • Early childhood experiences & relationships shape personality development & interact with present reality to shape adaptation in current life

15. Two Freudian Schemata • The importance of theories of the mind-a framework in which to understand presenting problems. • Topographic theory • Structural theory • Freud's theory developed and changed, but built on what had come before

16. Topographic Model • Conscious (cs)‏-the part of the mind that interacts with the external world, and which can reflect on itself. • Pre-conscious (pcs)-the part of the mind in which thoughts, feelings and ideas are being prepared for outward expression. Can be brought to attention.‏ --------------------------------------------------------------- • Unconscious (ucs)-governed by the pleasure principle. The cauldron of wishes, desires and fears that make up the bulk of our mind.

18. “These wishes of our Unconscious, ever stirring, never dying—immortal, one might say—remind us of the legendary Titans whose shoulders from time immemorial bore the great mountain-masses laden upon them by the victorious gods, which even now still quake from time to time from the convulsions of their limbs…” (Int. of Dreams, 363, J. Crick, trans.)‏

19. Aspects of a Freudian Theory of the Mind: • The unconscious • Disavowed wishes and dreams • Controlled chaos and a mechanism of control • Persistent (but moderately mutable) mental representations • A personal history

20. Freudian Psychosexual Stages • Oral stage (First year of life)‏ • Focus on primary gratification through oral means • Anal stage (2-3 yrs)‏ • Focus on primary gratification through holding on & letting go, corresponds with toilet training • Phallic (Oedipal) stage (3-5 yrs)‏ • Focus on primary gratification through genitals; awareness of erotic feelings for parents; emergence of triangular relationships • Latency stage (5 or 6 through puberty)‏ • Focus on repression of erotic feelings • Genital stage (puberty through adulthood)‏ • Focus on primary gratification though meeting adult sexual needs

21. The move to Structural Theory • Guilt, anxiety & self-loathing • Drive theory's mechanism of change • Observation informs theory

22. Structural Theory • Id • Superego • Ego • (Where did the ucs go?)‏ • (A note on translation.)‏

25. The It (Id)‏ • The home of our sexual and aggressive urges. • Fully unconscious, although the unconscious is not fully id. • “the dark inaccessible part of our personality...We approach the id with analogies: we call it chaos, a cauldron full of seething excitation.”

26. The Over-me (Superego)‏ • Both conscience and punisher. • The seat of moral expectations and regulation of self-esteem associated with meeting those expectations. • Identification & moral development

27. The I • Conscious and unconscious • has an integrative function & provides psychological cohesion • mediates between the Id and the Superego • The (non-unitary) Executive.

28. Post-Freudian Ego Psychology • Anna Freud elaborated the mechanisms that the ego uses to maintain homeostatis, and mediate the impingements from inside (the id, the ucs ego, the superego) and outside (unacceptable reality). • Heinz Hartmann developed a theory of the mechanisms of the ego that are independent of psychodynamics, and inherent in the mental structure from birth.

29. How does the ego develop? • Ego development occurs as result of: • meeting basic needs • identification with others • learning • mastery of developmental tasks • effective problem-solving • successful coping • The ego develops capacities to function in the world, known as “ego functions” • Enable people to function in coherent, organized manner

30. Hartmann's ego functions • Some ego functions are inborn & hereditary & function autonomously, i.e., “conflict-free” • At birth, we are “preadapted” to an “average expectable environment” • Some functions (perception, memory, intelligence, thought processes, motor activity, reality testing) are separate from the drives

31. Bellack's list of ego functions: • Reality testing • Judgment • Sense of reality of the world & the self • Modulating & controlling drives, affects, & impulses • Object or interpersonal relations • Thought processes • Adaptive regression in the service of the ego • Defensive functioning • Stimulus barrier • Autonomous functioning • Mastery-competence • Synthetic-integrative function

32. Ego Defenses • “The defensive methods so far discovered by analysis all serve a single purpose—that of assisting the ego in its struggle with its instinctual life. They are motivated by the three principle types of anxiety to which the ego is exposed—instinctual anxiety, objective anxiety and anxiety of conscience. In addition, the mere struggle of conflicting impulses suffices to set the defence-mechanisms in motion.”--Anna Freud, The Ego and the Mechanisms of Defence

33. How defenses operate: • Defense mechanisms operate out of conscious awareness, while coping mechanisms are conscious • Defenses protect individuals from intolerable or unacceptable impulses • Effective defenses enable optimal functioning without undue anxiety, while maladaptive defenses distort reality & impair overall ego functioning

35. Anna Freudian Ego Defenses • Repression • Reaction formation • Projection • Isolation • Undoing • Regression • Introjection (internalization)‏ • Turning against the self • Reversal • Sublimation • Displacement

36. Other Defenses • Denial • Intellectualization • Humor • Splitting • Altruism • Asceticism • Dissociation

37. Eriksonian Ego Psychology • The work of Erikson not only grew out of a critique of Freud's psychsexual stages, it also integrated observations from post-Freudian ego psychology.

38. Erickson’s Eight Stages of Man Epigenetic Stages Ages Virtues • Basic trust vs. mistrust (0-18 mo) • Autonomy vs. shame & doubt (18-3 yr) • Initiative vs. guilty (3-6 yr) • Industry vs. inferiority (6-11 yr) • Identity vs. confusion (11-18 yr) • Intimacy vs. isolation (young adulthood) • Generativity vs. stagnation (middle adulthood) • Integrity vs. despair (old age) • Hope • Will • Sense of purpose • Competence • Personal identity • Love • Care • Wisdom

39. What is a crisis? • An upset in psychological equilibrium triggered by: • outside harm or threat from the environment • internal developmental or biological changes • interpersonal challenges, conflicts, or losses • Symptoms may include anxiety, guilt, shame, sadness, envy, disgust, fear • “Traumatic stress”—actual or threatened severe injury or death of oneself or significant others

40. Diathesis/stress model of mental illness • “Diathesis”—a predisposition to develop disease or morbid condition • “Diathesis/stress model”—an interaction of life experiences with biological variables (genetics, neurochemistry, neuroanatomy) • Each person has a unique vulnerability to stress

41. Coping and Adaptation • Our efforts to manage stress & meet new challenges • Biological coping (demands on nervous & hormonal systems)‏ • “fight-or-flight” • “tend-and-befriend” • Psychological coping • Defense mechanisms (internal, unconscious traits)‏ • Coping styles or capacities (fluid states, changeable)‏ • Problem-focused—change environment • Emotion-focused—change internal self

42. Individual's ability to cope with stress is influenced by: • Capacity to adapt & restore equilibrium • Interpersonal relationships • Current environmental supports & resources • “social supports”—resources that provide material, emotional, & instrumental support • personal supports perhaps salient—affirm identity, compensate for deficits

43. Core Change Concepts ACCORDING TO CLASSICAL THEORY & EGO PSYCHOLOGY

44. Psychopathology, according to classical theory • Unresolved “conflicts of the mind” between id, ego, & superego or between ego & external environment: • May cause “fixation” at developmental stages • May cause weak ego functioning , leading to difficulties with adaptation • May cause inadequate defensive functioning leading to symptoms • Symptoms of unresolved conflict (e.g., anxiety, depression, compulsions, or sociopathy) are: • Efforts to overcome or work through conflicts • Efforts to compensate for conflicts

45. Transference—a key to all dynamic treatments • Transference defined as: • The feelings & wishes from past experiences placed onto another in the present • The central component of the “talking cure” • A means for viewing client’s unresolved conflicts by the interaction with the clinician • Countertransference defined as: • The clinician’s feelings about the client in treatment • Through understanding transference, clients may develop insight & self-understanding, leading to change

46. Treatment based on ego psychology EGO-MODIFYING TREATMENT EGO-SUPPORTIVE TREATMENT Focus:past & present; conscious, unconscious, & preconscious Nature of change: insight & conflict resolution Curative process: make unconscious conscious through interpretation Use of relationship: use & understand positive & negative transference Focus:current behavior, conscious thoughts/feelings; limit past focus Nature of change: ego mastery, increased understanding, better person-in-environment fit Curative process: strengthen ego, shore up defenses, promote adaptation Use of relationship: real relationship, positive transference, corrective relationship

47. Interventions & treatment populations EGO-MODIFYING TREATMENT EGO-SUPPORTIVE TREATMENT • Types of interventions: Nondirective, reflective, interpretive; “free association;” work with environment not emphasized but may be used; usually long-term tx. • Appropriate clients: Persons with good ego strengths, but maladaptive functioning • Types of interventions: Direction, support, education, structure, some reflection; environmental modification; provision & mobilization of resources; short- or long-term tx. • Appropriate clients: Persons encountering crises, life transitions, extreme stress; with low tolerance & impulse control

48. “…a knowledge of psychodynamic forces can illuminate what is going on in any human interaction or communication, no matter how brief it is.”--Berzoff, J., Flanagan, L., & Hertz, P. (Eds.). (2008). Inside out and outside in (2nd ed.). NY: Jason Aaronson, p. 2. 48

49. Ego Psychology’s use in social work practice SOCIAL WORK THEORISTS & EGO PSYCHOLOGY TODAY

50. Social Work’s long history with ego psychology • Ego psychology was very influential in early social work • Mary Richmond (1867-1928), wrote Social Diagnosis (1917) • Backlash emerged in 1960-1970s due to civil rights movements, war on poverty • Founding of Clinical Social Work Journal (1972) & Federation of Societies for Clinical Social Work (1971) re-emphasized social work’s psychodynamic roots