Normality and Wellbeing:
There is no clear divide between normal and abnormal functioning. It considers how maladaptive (not helpful/not adaptive) the personality formation, look at underlying guilt or anxiety – anxious from unconscious. It can be interesting to know what else is going on, so it is important to note what is not being said. Normality is based on whether the functioning of the person is affecting quality of life > that is when they see a counsellor or a therapist. Some people may display abnormal habits but they make up for this by doing a majority of normal things.
v Ego is ineffective at moderating id and superego (Failure of Ego)
v Symptoms help prevent awareness of threatening drive: defence against unconscious (symptoms)
v Reduction in anxiety, can be through drug use: escape from responsibility (Primary Gain)
v Enables person to escape from responsibility, and allows them to play victim or child role (Secondary Gain)
Look at the time scale : what is the pay off and what are they getting out of this?
Secondary Gains: A enjoyable state of change: like being able to have a sleep in. Benefit of being a victim. It is common to assume that the patient wants to get better – don’t assume, it makes an ass out of you and me. There are perks of being unwell :
- special favours
- special treatment
- excuse for getting out of things
A dependency on being ill can be emotional, physical and financial dependency.
All these things can lead to a resistance to treatment.
Freud’s Ego Defence Mechanism:
Psychological processes that:
- deny or distort reality
- operate at an unconscious level
- help individual cope with anxiety, prevent the ego from being overwhelmed
- not pathological
Internal Conflict (between Id, Ego and Superego) > Anxiety > Reliance on Defence Mechanism.
- Major defence mechanism
- Threatening or painful thoughts, feelings are repressed from awareness
- This is an involuntary process
- Early childhood painful life events are repressed and later influence behaviour
- Works at the conscious level
- Denial of reality is the most simple of all self defence mechanisms
- It includes the distortion of an individual’s thoughts, feelings and perceptions in a traumatic situation
- It can be used very very short term to lessen anxiety : eg closing your eyes so you cant see the existing threat.
- Blaming your own unacceptable desires and impulses on others
- Using someone else’s behaviour as a scape goat for your own actions, thoughts and feelings. Believing that someone else has the undesirable qualities rather than yourself.
- It is about us but we make it about someone else
- Opposite of projection
- Internalisation of beliefs and ideas of values of others without checking it they are congruent with own beliefs.
- Reduces anxiety by altering the object of the impulse
- Discharging impulses by shifting from a dangerous object to a safe object
- Gets bullies by parent so the child takes it out on friends or younger siblings.
- Manufacturing a “good” reason to explain the bruised ego
- Helps justify behaviours: softens the blow associated with disappointment
- Reverting to a form of behaviour that the individual has outgrown, back when their demands were not as great.
- Occurs at a time of extreme stress or challenge
- Used to enhance ones self-worth and protect it from a feeling of failure
- Mental operation where one attributes oneself, either consciously or unconsciously, to a group or an other individual
Don’t be afraid to ask defensive people difficult questions, challenge them or call them out so that they can get that realization. Wait for them to calm down before you revisit a soft topic.
To strengthen the Ego as the main personality rather than the id or superego through the process of uncovering unconscious material and helping clients reach goals of : freedom to love, work and play, to achieve self-awareness, honesty and a better way of dealing with anxiety.
Defence mechanisms should be handled by a psychiatrist as you could cause a larger problem. It can be a long term, taking several years of twice a week sessions everyweek to help the patient eyond the blockade they made: You must be wary of it as a Practitioner, as not everyone has the financial backing or commitment : this is why not many pople do it. They should have a real person to talk to, they need more of a relationship. It fosters a dependence and will develop abandonment issues when their therapist leaves them or goes on holidays.
The Therapist Role:
- The therapist will offer insight but maintain a balck screen – with little self disclosure to allow the client to foster transference, with no idle chit chat. Client can get frustrated due to the power imbalance. The client will use the practitioner to act out a situation.
- The therapist in this situation has a passive approach and will create a theraputuc environment, which allows the client the opportunity to speak openly so that the unconscious material can be uncovered.
- The practitioner will make links of what the client has said or resistance/minimising to expressing their anger.
- After establishing rapport the therapist’s function is largely listening and interpreting. Listening for gaps and inconsistencies with clients story
- Remain sensitive to clues regarding the clients feelings towards therapist.
Client’s Experience With this Therapy:
- Intensive and long term
- Gain importance to why or how they behave a certain way
- Client may feel anxious or uncertain
- Things that keep coming up will be dealt with.
- Maintaining the analytical framework
- Refers to procedural and stylistic factors
- Therapist assumes an anonymous stance
- Regularity and consistency of meeting, twice a week at the same time, same place.
- Free association
- Word relation
- Uncovers unconscious material
- Eg first word that comes to mind
- Helps you gain insight
- Explaining and suggesting the meanings that has manifested in a dream
- Dream analysis
- Uncovering hidden latent content of dreams that are not apparent to dreamer
- Analysis of resistance
- Resistance because the client knows it will cause anxiety
- Practitioner should help the client become aware of the reasons for resistance so that they can deal with them.
- Analysis of transference
- Remind people of someone and they take it out on you: they make you into them in their mind.
- The therapist should remain detached and objective during this.
- Practitioners need to be aware of transference and countertransference.
When is psychotherapy useful in counselling?
– When problems have been occurring for a number of years in different forms or reoccurring patterns of difficulty
– Problems are not limited to one area of life or cause
– Problems are related to childhood and development difficulties.
– Brief treatments have been ineffective
– They want to understand the root of the problem.