The psychodynamic model is the oldest and most famous of the modern psychological models. Psychodynamic theorists believe that a person’s behavior, whether normal or abnormal, is determined largely by underlying psychological forces of which he or she is not consciously aware. These internal forces are described as dynamic—that is, they interact with one another—and their interaction gives rise to behavior, thoughts, and emotions. Abnormal symptoms are viewed as the result of conflicts between these forces.

Psychodynamic theorists would view Philip Berman as a person in conflict. They would want to explore his past experiences because, in their view, psychological conflicts are tied to early relationships and to traumatic experiences that occurred during childhood. Psychodynamic theories rest on the deterministic assumption that no symptom or behavior is “accidental”: All behavior is determined by past experiences. Thus Philip’s hatred for his mother, his memories of her as cruel and overbearing, the weakness of his father, and the birth of a younger brother when Philip was 10 may all be important to the understanding of his current problems.

The psychodynamic model was first formulated by Viennese neurologist Sigmund Freud (1856–1939) at the turn of the twentieth century. First, Freud worked with physician Josef Breuer (1842–1925), conducting experiments on hypnosis and hysterical illnesses—mysterious physical ailments with no apparent medical cause. In a famous case, Breuer had treated a woman he called “Anna O.,” whose hysterical symptoms included paralysis of the legs and right arm, deafness, and disorganized speech. Breuer placed the woman under hypnosis, expecting that suggestions made to her in that state would help rid her of her hysterical symptoms. While she was under hypnosis, however, she began to talk about traumatic past events and to express deeply felt emotions. This expression of repressed memories seemed to enhance the effectiveness of the treatment. Anna referred to it as her “talking cure.”

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Building on this early work, Freud developed the theory of psychoanalysis to explain both normal and abnormal psychological functioning as well as a corresponding method of treatment, a conversational approach also called psychoanalysis. During the early 1900s, Freud and several of his colleagues in the Vienna Psychoanalytic Society—including Carl Gustav Jung (1875–1961) and Alfred Adler (1870–1937)—became the most influential clinical theorists in the Western world.

Freud believed that three central forces shape the personality—instinctual needs, rational thinking, and moral standards. All of these forces, he believed, operate at the unconscious level, unavailable to immediate awareness; he further believed these forces to be dynamic, or interactive. Freud called the forces the id, the ego, and the superego.

The IdFreud used the term id to denote instinctual needs, drives, and impulses. The id operates in accordance with the pleasure principle; that is, it always seeks gratification. Freud also believed that all id instincts tend to be sexual, noting that from the very earliest stages of life a child’s pleasure is obtained from nursing, defecating, masturbating, or engaging in other activities that he considered to have sexual ties. He further suggested that a person’s libido, or sexual energy, fuels the id.

The EgoDuring our early years we come to recognize that our environment will not meet every instinctual need. Our mother, for example, is not always available to do our bidding. A part of the id separates off and becomes the ego. Like the id, the ego unconsciously seeks gratification, but it does so in accordance with the reality principle, the knowledge we acquire through experience that it can be unacceptable to express our id impulses outright. The ego, employing reason, guides us to know when we can and cannot express those impulses.

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The ego develops basic strategies, called ego defense mechanisms, to control unacceptable id impulses and avoid or reduce the anxiety they arouse. The most basic defense mechanism, repression, prevents unacceptable impulses from ever reaching consciousness. There are many other ego defense mechanisms, and each of us tends to favor some over others (see Table 3-1).

The SuperegoThe superego grows from the ego, just as the ego grows out of the id. This personality force operates by the morality principle, a sense of what is right and what is wrong. As we learn from our parents that many of our id impulses are unacceptable, we unconsciously adopt our parents’ values. Judging ourselves by their standards, we feel good when we uphold their values; conversely, when we go against them, we feel guilty. In short, we develop a conscience.

According to Freud, these three parts of the personality—the id, the ego, and the superego—are often in some degree of conflict. A healthy personality is one in which an effective working relationship, an acceptable compromise, has formed among the three forces. If the id, ego, and superego are in excessive conflict, the person’s behavior may show signs of dysfunction.

Freudians would therefore view Philip Berman as someone whose personality forces have a poor working relationship. His ego and superego are unable to control his id impulses, which lead him repeatedly to act in impulsive and often dangerous ways—suicide gestures, jealous rages, job resignations, outbursts of temper, frequent arguments.

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Developmental StagesFreud proposed that at each stage of development, from infancy to maturity, new events challenge individuals and require adjustments in their id, ego, and superego. If the adjustments are successful, they lead to personal growth. If not, the person may become fixated, or stuck, at an early stage of development. Then all subsequent development suffers, and the individual may well be headed for abnormal functioning in the future. Because parents are the key figures during the early years of life, they are often seen as the cause of improper development.

Freud named each stage of development after the body area that he considered most important to the child at that time. For example, he referred to the first 18 months of life as the oral stage. During this stage, children fear that the mother who feeds and comforts them will disappear. Children whose mothers consistently fail to gratify their oral needs may become fixated at the oral stage and display an “oral character” throughout their lives, one marked by extreme dependence or extreme mistrust. Such persons are particularly prone to develop depression. As you will see in later chapters, Freud linked fixations at the other stages of development—anal (18 months to 3 years of age), phallic (3 to 5 years), latency (5 to 12 years), and genital (12 years to adulthood)—to yet other kinds of psychological dysfunction.

Personal and professional differences between Freud and his colleagues led to a split in the Vienna Psychoanalytic Society early in the twentieth century. Carl Jung, Alfred Adler, and others developed new theories. Although the new theories departed from Freud’s ideas in important ways, each held on to Freud’s belief that human functioning is shaped by dynamic (interacting) psychological forces. Thus all such theories, including Freud’s, are referred to as psychodynamic.

Three of today’s most influential psychodynamic theories are ego theory, self theory, and object relations theory. Ego theorists emphasize the role of the ego and consider it a more independent and powerful force than Freud did (Sharf, 2012). Self theorists, in contrast, give the greatest attention to the role of the self—the unified personality. They believe that the basic human motive is to strengthen the wholeness of the self (Dunn, 2013; Kohut, 2001, 1977). Object relations theorists propose that people are motivated mainly by a need to have relationships with others and that severe problems in the relationships between children and their caregivers may lead to abnormal development (Yun et al., 2013; Kernberg, 2005, 2001, 1997).

Psychodynamic therapies range from Freudian psychoanalysis to modern therapies based on self theory or object relations theory. Psychodynamic therapists seek to uncover past traumas and the inner conflicts that have resulted from them. They try to help clients resolve, or settle, those conflicts and to resume personal development.

According to most psychodynamic therapists, therapists must subtly guide therapy discussions so that the patients discover their underlying problems for themselves. To aid in the process, the therapists rely on such techniques as free association, therapist interpretation, catharsis, and working through.

Free AssociationIn psychodynamic therapies, the patient is responsible for starting and leading each discussion. The therapist tells the patient to describe any thought, feeling, or image that comes to mind, even if it seems unimportant. This practice is known as free association. The therapist expects that the patient’s associations will eventually uncover unconscious events. In the following excerpts from a famous psychodynamic case, notice how free association helps a woman to discover threatening impulses and conflicts within herself:

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Therapist InterpretationPsychodynamic therapists listen carefully as patients talk, looking for clues, drawing tentative conclusions, and sharing interpretations when they think the patient is ready to hear them. Interpretations of three phenomena are particularly important—resistance, transference, and dreams.

Patients are showing resistance, an unconscious refusal to participate fully in therapy, when they suddenly cannot free associate or when they change a subject to avoid a painful discussion. They demonstrate transference when they act and feel toward the therapist as they did or do toward important persons in their lives, especially their parents, siblings, and spouses. Consider again the woman who walked in Central Park. As she continues talking, the therapist helps her to explore her transference:

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Finally, many psychodynamic therapists try to help patients interpret their dreams (Russo, 2014) (see Table 3-2). Freud (1924) called dreams the “royal road to the unconscious.”He believed that repression and other defense mechanisms operate less completely during sleep and that dreams, if correctly interpreted, can reveal unconscious instincts, needs, and wishes. Freud identified two kinds of dream content—manifest and latent. Manifest content is the consciously remembered dream; latent content is its symbolic meaning. To interpret a dream, therapists must translate its manifest content into its latent content.

CatharsisInsight must be an emotional as well as an intellectual process. Psychodynamic therapists believe that patients must experience catharsis, a reliving of past repressed feelings, if they are to settle internal conflicts and overcome their problems.

Working ThroughA single episode of interpretation and catharsis will not change the way a person functions. The patient and therapist must examine the same issues over and over in the course of many sessions, each time with greater clarity. This process, called working through, usually takes a long time, often years.

Current Trends in Psychodynamic TherapyThe past 40 years have witnessed significant changes in the way many psychodynamic therapists conduct sessions. An increased demand for focused, time-limited psychotherapies has resulted in efforts to make psychodynamic therapy more efficient and affordable. Two current psychodynamic approaches that illustrate this trend are short-term psychodynamic therapies and relational psychoanalytic therapy.

SHORT-TERM PSYCHODYNAMIC THERAPIESIn several short versions of psychodynamic therapy, patients choose a single problem—a dynamic focus—to work on, such as difficulty getting along with other people (Frederickson, 2013; Wolitzky, 2011). The therapist and patient focus on this problem throughout the treatment and work only on the psychodynamic issues that relate to it (such as unresolved oral needs). Only a limited number of studies have tested the effectiveness of these short-term psychodynamic therapies, but their findings do suggest that the approaches are sometimes quite helpful to patients (Levy, Ablon, & Kächele, 2012; Wolitzky, 2011).

RELATIONAL PSYCHOANALYTIC THERAPYWhereas Freud believed that psychodynamic therapists should take on the role of a neutral, distant expert during a treatment session, a contemporary school of psychodynamic therapy referred to as relational psychoanalytic therapy argues that therapists are key figures in the lives of patients—figures whose reactions and beliefs should be included in the therapy process (Ringstrom, 2014; Luborsky et al., 2011). Thus, a key principle of relational therapy is that therapists should also disclose things about themselves, particularly their own reactions to patients, and try to establish more equal relationships with patients.

Freud and his followers have helped change the way abnormal functioning is understood. Largely because of their work, a wide range of theorists today look for answers outside of biological processes. Psychodynamic theorists have also helped us to understand that abnormal functioning may be rooted in the same processes as normal functioning (see PsychWatch below). Psychological conflict is a common experience; it leads to abnormal functioning only if the conflict becomes excessive.

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Freud and his many followers have also had a monumental impact on treatment. They were the first to apply theory systematically to treatment. They were also the first to demonstrate the potential of psychological, as opposed to biological, treatment, and their ideas have served as starting points for many other psychological treatments.

At the same time, the psychodynamic model has its shortcomings. Its concepts are hard to research (Prochaska & Norcross, 2013; Levy et al., 2012). Because processes such as id drives, ego defenses, and fixation are abstract and supposedly operate at an unconscious level, there is no way of knowing for certain if they are occurring. Not surprisingly, then, psychodynamic explanations and treatments have received limited research support over the years, and psychodynamic theorists rely largely on evidence provided by individual case studies. Nevertheless, recent research evidence suggests that long-term psychodynamic therapy may be helpful for many persons with long-term complex disorders (Kunst, 2014; Safran, 2013; Levy et al., 2012), and 18 percent of today’s clinical psychologists identify themselves as psychodynamic therapists (Prochaska & Norcross, 2013, 2010).

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