Origin and development
The perspectives in social work that we can call psychodynamic, all have an origin that leads back to Sigmund Freud (1856–1939). Freud was an educated physician and worked for many years as a researcher within the area of neurology before he developed a theory about:
- The personality’s construction
- Children’s development
- Mental illness and treatment
These three parts of the theory make up a whole. In the following, we want to present the fundamental classical psychodynamic theory. Freud wrote a lot, and it is self-explanatory that this presentation will be brief and more like an outline, but we have made an attempt at presenting the core of the theory.
Freud worked for many years trying to describe the personality of a model. He ended up with a model where the personality is described as consisting of three main structures which are in a dynamic relationship to each other;
- The id
- The ego
- The superego
In a reasonably balanced person, these three structures will harmonize and be part of a unit, operating together and in a continual exchange. The “purpose’ of the personality is to control the link between the drives and the needs on one side, and the individual as a member of society on the other. The id is the fundamental and only hereditary part of the personality and it consists of needs, drives, and impulses. The Ego and Superego are not hereditary, they develop. The id is driven by the pleasure principle, seeking immediate gratification of unsatisfied needs. The Id’s job is to avoid displeasure and suffering. The newborn is therefore completely controlled by the id, Freud argued. In addition to the fundamental needs for food and warmth regulation, he meant that aggression and sexual drives were the most important drives for the development of the personality (Freud 1972).
Freud describes the ego as created through stages of development. Ego represents a person’s reason and will which governs the behavior in a beneficial way. The purpose of the ego is primarily the fulfillment of the id’s drives, but in a way that is acceptable in the child’s social environment. The child is adapting to the environment, and ‘the pleasure principle’ is slowly being replaced by what Freud calls the “reality principle”. The reality principle is the strategy the ego learns to hold back impulses from the id until they can be satisfied in a socially accepted manner.
According to Freud, the superego consists of some ideal norms and values that the ego tries to live by, and which has its model based on societies and parents’ norms and values. Many of the conflicts that the child is experiencing between their instinctive drives and the demands of their surroundings take place as a sort of inner dialogue between the ego and the superego.
Psychoanalytic theory has as its starting point that the personality develops and is shaped by a process where the reality principle takes control of the instinctive drives. The governing of the pleasure principle must take place in acceptable ways, that is, a restraint, possible to live with, and acceptable to the surroundings. If this process is not developing in a successful manner, libido could be ‘fixated’ on activities linked to this stage, and this may lead to difficulties later in life. Freud was of the opinion that the human being has a closed energy system and that each individual has a constant amount of energy given at birth. He argues that there are two fundamental drives (translated from Freud 1972: 77–78): After hesitating for a long time we have decided to assume that there are only two existing fundamental drives, Eros and the death drive … The goal of Eros is to continually procure and hold on to more and more, while the death drive has as its goal to dissolve the surroundings and thereby destroy everything.
He divides the child’s psychosexual development into stages. Each stage in the development is characterized by the dominance of one erogenous zone. First, it is the mouth, “the oral stage”, from birth to approximately two years of age. The child experiences satisfaction by sucking and putting everything into their mouth. The child is exploring through the mouth during these first years. The period from approximately one to three years old is what Freud calls “the anal stage”. He argues that the child finds pleasure from holding back and releasing feces, testing the parents' focus on toilet training. In this way, the parents represent the outer world with their demands.
Freud calls the period from three to six years old ‘the phallic stage’. The libido is then specifically linked to the genitals. The child is becoming aware of the difference between men and women, and their sexual instincts are being directed towards the parent of the opposite gender. It is in this stage the Oedipus conflict has to be resolved. The child sees the parent of the same gender as a competitor whom he/she has to render harmless.
It is these first stages, towards the age of six, that Freud sees as especially important for further development. After this age, according to Freud, a more latent period follows until puberty. The psychosexual development is now stationary while the main focus is directed toward the world around them. The children are not as occupied with the body as they have been previously. The gaze is outwards and they use their energy to deal with the world and their surroundings. This stage is to be replaced by the genital stage in puberty which is characterized by adult sexuality and functioning.
Psychological Disorders and Treatment
Psychoanalysis is the form of treatment within the psychodynamic theory and is used in therapies. A characteristic of the ‘pure’ psychoanalysis is that the treatment takes a long time and that the focus is on the past, the childhood, in order to capture the situations that created anxiety. It is especially in the treatment of neuroses, Freud argues, that psychoanalysis can be of help. He is of the opinion that it is less accessible for people with more serious psychological illnesses because of the need for the ego to have retained a certain amount of inner coherence and insight into the demands of reality (Freud 192).
Neuroses, in this theoretical perspective, are seen as a sign that the defense mechanisms, which try to govern the anxiety, are having such an impact on the person that normal self-realization is inhibited. Through an analysis based on associations, dreams, and a free-floating of thoughts, the therapist will – together with the patient – analyze the dreams and thoughts. In this way, the unconscious is made conscious.
“The defense mechanisms” play an important role in Freud’s illness and treatment theory. He defines defense mechanisms as unconscious strategies used to deal with negative emotions, where repression is especially emphasized.
Elaboration of the Psychodynamic Theory
Psychosocial Stages throughout the Life
Erikson extends the theory of developmental stages further. He identifies eight developmental stages which he argues the human being goes through from birth to old age and then death (Erikson 1974). He is of the opinion that the development within the various stages comes about through crises which determine the formation of normal or deviant personality. While Freud divides the development in childhood into “psychosexual stages”, Erikson divides the lifespan into “psychosocial stages”.
Erikson’s Psychosocial Stages
Stage / Psychosocial conflict / Desirable conflicts
- First-year of life / Trust vs. Mistrust / Trust and optimism
- Second-year of life / Autonomy vs. Doubt / Sense of personal control
- Third, the fourth and fifth years of life / Initiative vs. Guilt / Ability to take initiative to own activities
- From the sixth year of life and up to puberty / Industry vs. Inferiority / Competency in intellectual, social, and physical skills
- Adolescence / Identity vs. Role confusion / An integrated perception of oneself as a unique person.
- Early adulthood (20-40 years) / Intimacy vs. Isolation / Ability to form intimate and long-lasting relations, establish a professional life
- Middle age/ adulthood (40-65 years old) / Generativity vs. Stagnation / Care of family, society and future generations
- Old age / Ego integrity vs. Bitterness and despair / A feeling of satisfaction when looking back and a ‘willingness” to face death.
Early Object Relations Important in Life
Object relation theory is another continuation of Freud’s classical theory. Mahler (1879–1985) together with Klein (1948) are leading representatives for this continuation. “Object” is understood as a love object; people who are emotionally important. The first important object is the mother or a mother figure. Then other objects enter the stage; that is, other people that whom the child makes an emotional relationship. Based on the early interactions, with emphasis on the mother/child relationship, they argue that the child is creating an inner picture of the object and the situation around the interaction. This picture, or object presentation, of the mother, becomes a psychological structure in the ego. It is the child’s subjective picture of the mother which is created. These inner structures are carried on in life and are important for the individual’s way of reacting toward others later in life. With a basis on the early experiences of interactions, the child is developing a view of himself, her/his career, and what he/she can expect from others.
Bowlby (1969, 1988) developed a theoretical framework for the study of the attachment between children and parents by integrating three theories; ethology (the study of animals’ development and survival), psychodynamic theory, and system theory. According to Bowlby’s attachment theory, all children are attached to their parents no matter how they are treated, but they attach themselves in different ways depending on the emotional interaction. The function of attachment behavior is to hold the child close enough to the mother so as to increase the possibilities of survival. In this way, the child is born with a range of specific characteristics. Based on the experiences from early interaction with the carers the child develops an opinion of itself, their carers, and what is expected from others. The experiences contribute to how the child is making attachment patterns. These become working models when they later become parents themselves.
Anna Freud (1994) together with others developed the theory about the function of defense mechanisms. Freud was especially focused on how the ego can use ‘repression’ as a defense mechanism to deal with unacceptable needs and thoughts. Successors have described a range of other defense mechanisms. “Intellectualization” is one of these and is about when a person is only relating intellectually to something which awakes anxiety. A defense mechanism where reactions are transferred to something other than what was originally the starting point is called ‘transference’. With ‘projection’, one’s own feelings that one does not want to admit to, are transferred to other people.
A Stronger Focus on the Ego’s Role in Personality Development
One of the characteristics of the shift in psychodynamic theory is that there is a greater focus on the ego and its relationship to the surroundings. Important characteristics are the ability to create meaning of the experiences and the down toning of the importance of the drives’ influence on ego’s development.
Erik Erikson and Anna Freud (Sigmund Freud’s daughter) place less importance on the conflict between the id and the superego and ascribe ego to a more independent role in personality development. Erikson describes three processes that govern human beings' behavior: ego processes, physical processes, and social processes (1974). The human being is seen as a part biological organism, part person with an ego, and part social member of society. He states that the human being can be understood by observing these three parts as interrelated even though they can be described separately. In developmental crises, great emphasis is placed on the positive possibilities the individual possesses throughout their life. This more active view of human life can be said to be integrated into psychodynamic models in social work today.
Psychodynamic Theory and Social Work
Social work existed as a discipline when the psychodynamic theory was made accessible. The discipline was however new and with little theoretical ballast. Social work had its origin in practice. With this as its starting point, casework (work with individuals and families) was developed as a method. Mary Richmond was especially central in this work. She explains the background for why she started developing the work with casework as follows (Richmond, 1917)
With other practitioners – with physicians and lawyers, for example – there was always a basis of knowledge held in common. If a neurologist had occasion to confer with a surgeon, each could assume in the other mastery of the elements of a whole group of basic sciences and of the formulated and transmitted experience of this own guild besides. But what common knowledge could social workers assume in like case? This was my query of fifteen years ago. It seemed to me then, and it is still my opinion, that the elements of social diagnosis, if formulated, should constitute a part of the ground that all social case workers could occupy in common and that it should become possible in time to take for granted, in every social practitioner, knowledge and mastery of those elements, and of the modifications in them which each decade of practice would surely bring.
In this way, she wanted to contribute to developing a knowledge bank that should be common for social workers. In the method Richmond developed, she focused on a good relationship between the social worker and the client. In this relationship, information and advice are imparted, and discussions are held, the client is to gain greater insight into his/her own situation and solution alternatives so that he/she can act in alternative ways. With her strong connections to natural science, Richmond tried to give social work a scientific foundation. . Through a systematic gathering of data the social diagnosis is set and treatment procedures to correct the reasons for the problems are made and implemented. Richmond points out that both the economical and social situations influence the individual’s problems, so in the work of mapping out the causality, these reasons are included. She also emphasizes that each individual should be perceived and treated uniquely, also when these outer conditions are described. Richmond wanted to develop social work to become a profession. Her methods are thorough and systematic, concerned both with deciding diagnoses as well as forms of treatment.
One central representative of the development of psychosocial work from the1960s is Florence Hollis. She developed her models with a foundation in casework and with a strong influence from psychodynamic therapy. Hollis and Woods (1981) use psychodynamic theory to understand stress. In their model, stress is seen as more important than pressure in order to understand the cause of the problems and how the social worker can proceed in the work. Hollis and Wood are of the opinion that the reasons for the problematic living situation can be found in the following:
- A weak ego or superego influences how independently a person acts, how strong their character is, and if one can delay needs
- Fixation in earlier stages – needs not being dealt with acceptably, so that the person is impaired in further development.
- Pressure from the environment, bad economy, bad living conditions.
Characteristics in Psychodynamic Theories in Social Work
Main characteristics of psychodynamic theory in social work:
- The unconscious is assumed to be playing a vital role in behavior, thoughts, and feelings.
- The personality is seen as consisting of three parts: the id, the ego, and the superego which are all in a dynamic relationship.
- Experiences in childhood are seen as especially important in the development of the personality.
- Unsolved conflict-filled experiences and traumatic incidents will be consigned to the unconscious.
- Defense mechanisms are a way of dealing with difficulties
- The developmental crises, which are ongoing throughout life, have in them the possibility of both growth and stagnation.
- Good psychological health is characterized by being able to free oneself from unconscious conflicts and tensions.
- Ego strength is evaluated by how independently human beings can act, how energetic and how many characters they have, and if they can delay the gratification of needs and impulses and understand others' needs.
- Essential in good interaction with others is to see other people as separate from oneself, see them as complex persons and not judge them in a black and white way of thinking.
The social worker-client relationship:
- A great emphasis is placed on the gathering of information to obtain a holistic picture.
- Concerned about bringing conflicts to the surface and working through them
- It is crucial to create a climate that is accepting of the client
- The goal of the work is to process previous conflicts (also unconscious ones), increase ego- strength, and find new and more appropriate adjustments to the surroundings and own life
- Resistance and defense mechanisms are cause for interpretations
- The client is to be seen as a unique person with a unique history
Overview of Selected Approach
Archer and McCarthy (2007) state, that under Freud’s psychoanalytical theory human behavior is explained by conflicts that develop due to an individual’s unconscious sexual and aggression drives. To meet the norms of society, individuals attempt to control these drives which inevitably produce a conflict within us. Three structures that interact together resulting in this conflict are the id, ego, and super-ego. The unconscious id works on a pleasure principle satisfying immediate wants without reference to external consequences, whilst the conscious super-ego works to meet expectations considered the norm of society. The resulting conflict between the two structures is controlled by the ego which struggles to meet the reality principle; that is doing what is possible and yet practical (Kluft, 2005).
George a 35-year-old male is a high school teacher who taught physical education and coached the school track team. Making false statements such as being the coach of an Olympic track along with the tendency to easily become enraged by minor provocation, George is now hospitalized. During university, he attended counseling and was prescribed anti-depressants because George presented signs incongruent to his normal personality.
Prior to his hospitalization George presented similar symptoms to his first episode and stated he experienced constant worrying about his job and team. His family state George has become tense, anxious, and depressed, adding George spends long hours asleep or staring at the ceiling. George has quit his job stating personal incompetence and sees suicide as the only possible solution to the current issues.
Freud’s Psychoanalytical Approach
Symptom formation. Freud states all adult experiences originate from childhood experiences and that issues such as attachment with parents, losses encountered, and traumas experienced as a child; can all impact current relationships and development. Freud’s psychosexual stage hypothesizes that during the phallic phase when George should have been forming an attachment to his father, he was experiencing trauma by seeing his parent regularly arguing. In addition, the father’s drinking habits also hindered attachment formation between father and son. According to Freud, this has led to issues in his adult life (Archer & McCarthy, 2007; Peterson, 2004).
Relevance to the client. From Freud’s perspective, George’s problems manifest in a conflict that he’s having within himself, stating that when conflicts arise between the id and superego the ego initiates certain defense mechanisms in order to reduce that anxiety (Archer & McCarthy, 2007; Kluft, 2005). Few defense mechanisms that strongly fit George’s behavior displayed in the past and present are described. Firstly using a defense of sublimation, Freud argues George has mentally shut out what seems to trouble him by converting that anxiety into something else (Punamäki, Kanninen, Qouta, & El-Sarraj, 2002). Observation of sleeping longer could be interpreted that, to minimize thinking about issues, he’s transferred that anxiety to a new medium of sleeping more. George might see sleeping as something he can consciously control in order to help shut out the issues he is having.
Secondly, George mentioned he worries about his job, combined with his later action of quitting his job, George could have employed a defense mechanism known as repression; whereby a person consciously ignores issues by not confronting them (Archer & McCarthy, 2007; Erdelyi, 2006). This is exemplified when George decided that the best way to deal with work concerns was best dealt by leaving the situation that was eliciting those feelings.
Finally, in contribution to thinking, he is an Olympic coach; in order to deal with the anxiety, the defense mechanism of dissociation could be in progress. This is when a patient mentally shuts out awful events in an attempt to avoid them (Erdelyi, 2006). However, Freud states an important by-product of dissociation is that sometimes it leads to a feeling of living two separate lives (Archer & McCarthy, 2007).
Assessment. The aim of Freud’s assessment is to enable patients to understand what is causing their conflict and in essence realize their own wishes, talents, and capabilities; whilst still accepting the limitations (Roth, 1996).
Gilmore (2002) states helping clients discover information stored within their unconscious is the most important technique possible. According to Archer and McCarthy (2007), free association can be used in order to let George release everything that he’s thinking and feeling, allowing both the client and therapist to discover suppressed thoughts. Further support by Kluft (2005) adds that free association can also show the therapist a possible transition point when George changes from his normal self to his alter ego of being the Olympic coach; entailing further investigation of what he said and thought just prior to switching to the alter ego.
Secondly, there’s the option of projective assessment such as Rorschach inkblot tests whereby George describes what he sees to presented stimuli. Archer and McCarthy (2007) state the aim of this exercise is not to answer judgment, but rather to discover hidden content in George’s unconscious. This enables therapists to identify any patterns of thought that may be suppressed and factors that might be triggering his actions.
The psychoanalytical approach hypothesized that George’s symptoms have occurred due to inner conflicts that resulted as a consequence of his psychosexual stages not being accomplished. Under this method, certain defense mechanisms have been discussed that seem to influence George’s anxiety.
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