Psychoanalysis from mental health nursing

3. Psychoanalytic
Therapy
PRESENTED BY:-
ARCHANA TRIPATHY

4. INTRODUCTION
Sigmund Freud, who is considered one of the forefathers of
psychology and the founder of psychoanalysis. Psychoanalysis
was 1st developed by Sigmund Freud at the end of the 19th
century. Psychoanalytic therapy is a type of treatment based
upon the theories of Sigmund Freud. The most important
indication for psychoanalytical therapy is the presence of
long-standing mental conflicts, which may be unconscious but
produce symptoms. This therapy explores how the
unconscious mind influences thoughts and behaviors, with the
aim of offering insight to the person seeking therapy. In this
therapy the therapist tries to take the patient into the past in an
effort to determine where the problem began. The aim of this
therapy is to bring all repressed material to conscious
awareness.

5. Definition:-
“A therapeutic method, originated by
Sigmund Freud, for treating mental
disorders by investigating the interaction of
conscious and unconscious elements in the
patient's mind and bringing repressed fears
and conflicts into the conscious mind, using
techniques such as dream interpretation and
free association.”
(Oxford English Dictionary)

6. Therapeutic goals:-
There are two basic goals when
applying psychoanalytic therapy:
1. To make unconscious motives
conscious.
2. To strengthen the IGO to be more
aligned with reality and less
dependence on instinctual cravings
of the ID or the irrational guilt
provided by the SUPER IGO.

7. INDICATIONS

8. Indication of psychoanalytic
therapy:-
The procedure is not applicable at all below a certain
level of intelligence. The complete consent and
complete attention of the patients are needed.
 Chronic cases of psycho-neuroses without any
very violent or dangerous symptoms:-
 depression,
 anxiety,
 obsessive behaviour,
 hypochondria.
 Abulias:- abnormal lack of ability to act or to
make decisions.
 cases of hysteria(uncontrollable emotion or
excitement) in which phobias and abulias play the
most important part.

9. Contraindications
Antisocial patients.
Actively suicidal or severely depressed patients.
Low intelligence.
Unwillingness.

10. Basic concepts of psychoanalytic
theory
A. Human Nature
B. Instincts
C. Theory of Personality
– Functional or Dynamic theory
– Structural or Topographical theory
D. Anxiety
E. Ego Defense Mechanisms
F. Psycho Sexual Stages

11. A. Human Nature :–
 Determinism:- Our behaviour is determined by
irrational forces, unconscious motivations, and biological
and instinctual drives as these develops gradually through
psychosexual stages in the first six yrs of life.
B. Instincts:-
 Life Instincts ( Eros):-
- Identified with libido ( Sexual desire)
- All pleasurable acts.
 Death Instincts (Thanatos):-
-Aggressive Drives
-Manifest themselves in one’s unconscious wish to
die or to hurt oneself or others.
These two – Powerful determinants of our behaviour.

12. C. Theory of Personality:-
 Structural or Topographical
Theory :-
According to Freud, there are three levels of
Consciousness.
consciousness(small):- This is the part of the
mind that holds what you’re aware of. You
can verbalize about your conscious
experience and you can think about it in a
logical fashion.
EX:- Thoughts, perceptions
Preconscious (small-medium):- This is
ordinary memory. So although things stored
here aren’t in the conscious, they can be
readily brought into conscious.
EX:- memories, stored knowledge.

13. Cont…
Unconscious (enormous):-
 Freud felt that this part of the mind was not
directly accessible to awareness.
 In this he saw it as a dump box for urges,
feelings and ideas that are tied to anxiety,
conflict and pain.
 These feelings and thoughts have not
disappeared and according to Freud, they are
there, exerting influence on our actions and our
conscious awareness.
Ex:- Violent motives, fears, selfish need,
irrational wishes, shameful experiences etc.

15. CONT…
 Material passes easily back and forth
between the conscious and the
preconscious.
 Material from these two areas can slip
into the unconscious.
 Truly unconscious material cant’ be
made available voluntarily, according
to Freud. You need a psychoanalyst to
do this.

16. Cont…
Iceberg metaphor for the
mind’s layout: –
We can use the metaphor of an
iceberg to help us in
understanding Freud’s
topographical theory. – Only 10%
of an iceberg is visible
(conscious) whereas the other
90% is beneath the water
(preconscious and unconscious).
The Preconscious is allotted
approximately 10%-15% whereas
the Unconscious is allotted 75%-
80%.

17.  Functional or Dynamic Theory:-
Freud argued that the human mind and personality are
made up of three parts:-
 The id ( Biological component ):- The id is the
disorganized part of the personality structure that contains a
human's basic, instinctual drives. Id is the only component
of personality that is present from birth. It is the source of
our bodily needs, wants, desires, and impulses, particularly
our sexual and aggressive drives. The id contains the libido,
acts according to the "pleasure principle."

18. Functional or Dynamic Theory:-
 The ego (Psychological
Component):- that part of the
personality that is aware of
reality and is in contact with the
outside world. It is the part that
considers the consequences of an
action and deals with the
demands of the id and superego.
 The superego (Social
Component):- This contains our
social conscience and through
the experience of guilt and
anxiety when we do something
wrong, it guides us towards
socially acceptable behaviour. its
related on morality.

19. D. Anxiety
It is a state of tension that motivates an
individual to do something. It arises out of a conflict
among the id, the ego and super igo. There are 3 types
of anxiety.
 Reality Anxiety – Fear of danger from the external
world , real, objective sources of danger in the
environment .
 Neurotic Anxiety – Fear that the Id impulses will
overwhelm the ego and cause the person to do
something that will be punished.
 Moral Anxiety – Fear of one’s own conscience,
Fear the person will do something opposite to the
desires of the Superego.
 Moral anxiety is based on a feeling that one's
internalized values are about to be compromised.

20. E. Defense Mechanisms:-
unconscious mental processes used to protect
oneself from shame, anxiety, loss of self-esteem,
conflict, or other unacceptable feelings or thoughts,
and including behaviors such as repression,
projection, denial, and rationalization.

22. Cont…
 Projection — In this mechanism, an individual
puts the blame of his own failure upon others.
Blaming others for his mistake .
e.g. a student comes late to the class excuses by
saying that the bus or train was late.
 Sublimation — It is a defense mechanism in
which unacceptable desire are redirected into
socially accepted channels.
e.g. Anger –Kick boxing
 Rationalization — An individual tries to
justify his failure by giving some excuses
e.g. A student makes use of rationalization, when
he tries to blame teachers for hard question paper

23. Cont…
 Displacement — An individual does something
as a substitute for something else.
e.g. If a wife gets angry with Husband and cannot
say anything to him, she beats her child.
 Denial – Denying thre reality.
eg. If a person is diagnosed as having cancer, they
will first get shock, then start denying reality
saying perhaps that the diagnosis was not proper.

24. F. Psychosexual stages
1. Oral Stage(Birth to 18 months) :-
Pleasure centers on the mouth – sucking, biting.
 Pleasurable stimulation of the mouth –absence –
excessive eating, chewing talking, smoking, drinking
will develop in later life.
2. Anal Stage(18 months until 3 years):- Pleasure focuses on
bowel movement.
 Strict toilet training Personality – Cruelty, inappropriate
displays of anger, extreme disorderliness etc..
 Too much importance to the anal activity “Anal retentive
personality – extreme orderliness, stubbornness(not to
change one's attitude or position ).

25. F. Psychosexual stages
3. Phallic Stage(3 years to 6 years):- Pleasure
zone is the sex organ/genital.
 Oedipus complex – boy desiring mother as
love object
 Electra Complex - girl desiring father and
his love and approval.
 Attitudes of the parents at this stage
towards the emerging sexuality of the child
are going to affect the sexual attitudes and
feelings of the child.

26. F. Psychosexual stages
4. Latency Stage( 6 years to 11 years, until
puberty):-
 the child’s energy are focused on peer
activities.
 Child socializes and turns its attention outward and
forms relationship with others
5. Genital Stage (12 years onwards):-
 Sexual interest in opposite sex increase.
 Adolescent develops interest in the opposite sex,
does sexual experimentation.

27. THERAPEUTIC
TECHNIQUES

28. TECHNIQUES OF PSYCHOANALYTIC
THERAPY
The six basic techniques of psychoanalytic
therapy are :-
I. Maintaining the Analytic Framework
II. Free Association
III. Interpretation
IV. Dream Analysis
V. Analysis of Resistance
VI. Analysis of Transference

29. I. Maintaining the Analytic
Framework
 Like a systematic process on how students follow their
class schedules, Analysts must keep in mind in
maintaining the framework as it will provide proper
guidance and a planned course for achieving the goals of
the therapy.
 The framework includes a wide variety of procedures
and impacts on clients, ranging from the amount of
disclosure and anonymity of the therapist to the
consistency of meetings, etc.
This includes:-
 The regularity and consistency of meetings.
 Starting and ending the sessions on time.
 Explain the basic boundary issues.

30. II. Free Association:-
 A central technique used in
psychoanalysis. In which Clients must say
whatever that comes to there mind regardless
of how painful, silly or irrelevant it may seem.
The therapist will sit by and listen well on
what the client says, listening for significant
resistances which may mean that there are
anxiety-arousing material or surfaced
unconscious material which will lead to
discovering the root‘ problem’.
Free association is one of the basic tools used
to open the doors to unconscious wishes,
fantasies, conflicts, and motivations.

31. III. Interpretation:-
 Interpretation consists of the analyst’s pointing
out, explaining, and even teaching the client
the meanings of behavior that is manifested in
dreams, free association and the therapeutic
relationship itself.
 The therapist can Identify, clarify and translate
clients material to help the client to expand
their consciousness.
 Analyst must pay attention not only to the
content but also the process of conveying it to
the patient.

32. cont…
 The patients readiness to accept the material is
an important consideration.
 If the interpretation are too deep or unpleasant ,
the patient might not be able to accept it and bring
it into the conscious mind. Therefore, before
telling the interpretation to the patient, the analyst
must evaluate the unconscious material.
 The closer the material to the preconscious, the
more likely the patient will accept it.

33. IV. Dream Analysis:-
 Freud describes dreams as ―The Royal Road To
Unconsciousness. While asleep, the person‘s defenses are
lowered, and repressed feelings and emotions arise in
dreams. Material in dreams may show a person‘s
unconscious needs, wishes and fears.
Terms include in dream analysis:-
 Manifestations – unacceptable and painful – expressed in
symbolic form.
 Manifest Content :- what a person remembers and
consciously considers - only a partial representation (Real
dream).
 Latent Content :- Hidden, symbolic and unconscious
motives wishes and fears.
 Dream symbol:- represents some person, thing, or activity
involved in the unconscious process.

34. Cont…
 Clients are asked to describe‘ the Manifest
Content of their dreams, through Free
Association, the therapist then helps and finds
the client‘s associations with the manifest
content to uncover the latent content.
 Freud assumed every dream has a meaning
that can be interpreted by decoding
representations of the unconscious material.

35. V. Analysis and Interpretation
of Resistance:-
 This technique identifies the client‘s
restriction, refusal to bring surface awareness
(any unconscious material that is repressed).
 Resistance of any kind coming from Free
Association and through interpretation, the
therapist should make it clear to the client.
 Then the therapist will motivate the client that
he/she is to unbar any restrictions, as he/she
has to confront the problem in reality than
keeping it repressed.

36. Cont…
 The therapists’ interpretation is aimed at
helping clients become aware of the reasons for
the resistance so that they can deal with them.
 As a general rule, therapists point out and
interpret the easily perceived resistances to the
client. So that the client will not ’ reject the
interpretation.

37. VI. Analysis and Interpretation
of Transference:-
 Transference describes a situation where the feelings,
desires, and expectations of one person are redirected
and applied to another person.
 Most commonly, transference refers to a therapeutic
setting, where a person in therapy may apply certain
feelings or emotions toward the therapist.
 Being one of the major cornerstones in
Psychoanalytic therapy, it is important that the therapist
analyze and properly interpret the transference
relationship they hold.

38. Cont…
 Transference, Clients project their
relationship with the significant persons in
their past life to the present therapist.
Through this relationship , client
expresses feelings, beliefs and desires
which are carried in his/her unconscious.

39. Role of nurse in psychoanalytic
therapyThe goals of psychoanalytic psychotherapy to strengthen
the client’s ego, promote emotional and interpersonal
maturation, and improve the client’s ability to perform or
act appropriately. These goals are achieved by:-
 Establishing a therapeutic relationship with the client.
 A nurse manager works less directly with patients, but has
the responsibility to provide nursing leadership to ensure
that The therapy is maintained properly.
 Providing an opportunity for the client to release tension
as problems are discussed.
 Assisting the client in gaining insight about the
problem.
 Providing the opportunity to practice new skills.

40. Cont…
 Reinforcing appropriate behavior.
 Providing constant emotional support to the
patient.
 Nurses should bring their own specialized
knowledge to the treatment process.
 The nurse should have characteristics of
effective collaboration includes: trust, respect,
commitment, co-operation, co-ordination,
communication & flexibility.

43. Psychoanalytic therapy tends to look at experiences from early
childhood to see if these events have affected the individual’s
life, or potentially contributed to current concerns. This form
of therapy is considered a long-term choice and can continue
for weeks, months or even years depending on the depth of the
concern being explored.

44.  Townsend.M, (2007), “Psychiatric Mental Health
Nursing”, Jaypee brothers, New Delhi, India.
 Ahuja.N, (2006), “A Short Text Book of Psychiatry”,
Jaypee brothers, New Delhi, India.
 Sreevani.R, (2008), “A Guide to Mental Health and
Psychiatric Nursing”, Jaypee Brothers, New Delhi, India.
 www.nursingplanet.com.
 onlinelibrary.wiley.com.