Psychiatric Mental Health Nursing by Videbeck

(Nancy Kaufman) #1

not currently in the person’s awareness, but he or she
can recall them with some effort—for example, an
adult remembering what he or she did, thought, or
felt as a child. The unconsciousis the realm of thoughts
and feelings that motivate a person, even though he
or she is totally unaware of them. This realm includes
most defense mechanisms (see discussion below) and
some instinctual drives or motivations. According to
Freud’s theories, the person represses into the un-
conscious the memory of traumatic events that are
too painful to remember.
Freud believed that much of what we do and say
is motivated by our subconsciousthoughts or feel-
ings (those in the preconscious or unconscious level
of awareness). A “Freudian slip” is a term we com-
monly use to describe slips of the tongue—for exam-
ple, saying, “You look portly today” to an overweight
friend instead of, “You look pretty today.” Freud be-
lieved these “slips” were not accidents or coincidences;
rather, they were indications of subconscious feelings
or thoughts that accidentally emerged in casual day-
to-day conversation.


Freud’s Dream Analysis.Freud believed that a per-
son’s dreams reflected his or her subconscious and
had significant meaning, although sometimes the
meaning was hidden or symbolic (Gabbard, 2000).


Dream analysis,a primary method used in psycho-
analysis, involves discussing a client’s dreams to dis-
cover their true meaning and significance. For exam-
ple, a client might report having recurrent, frightening
dreams about snakes chasing her. Freud’s interpre-
tation might be that the woman fears intimacy with
men; he would view the snake as a phallic symbol,
representing the penis.
Another method used to gain access to sub-
conscious thoughts and feelings is free association
in which the therapist tries to uncover the client’s
true thoughts and feelings by saying a word and ask-
ing the client to respond quickly with the first thing
that comes to mind. Freud believed that such quick
responses would be likely to uncover subconscious
or repressed thoughts or feelings.

Ego Defense Mechanisms.Freud believed the self
or ego used ego defense mechanisms,which are
methods of attempting to protect the self and cope
with basic drives or emotionally painful thoughts,
feelings, or events. Defense mechanisms are explained
in Table 3-1. For example, a person who has been di-
agnosed with cancer and told he has 6 months to live
but refuses to talk about his illness is using the de-
fense mechanism of denial, or refusal to accept the
reality of the situation. If a person dying of cancer ex-
hibits continuously cheerful behavior, he could be
using the defense mechanism of reaction formation
to protect his emotions. Most defense mechanisms
operate at the unconscious level of awareness, so peo-
ple are not aware of what they are doing and often
need help to see the reality.

Five Stages of Psychosexual Development.Freud’s
based his theory of childhood development on the be-
lief that sexual energy, termed libido,was the driving
force of human behavior. He proposed that children
progress through five stages of psychosexual develop-
ment: oral (birth to 18 months), anal (18 to 36 months),
phallic /oedipal (3 to 5 years), latency (5 to 11 or
13 years), and genital (11 to 13 years). Table 3-2 de-
scribes these stages and the accompanying develop-
mental tasks. Psychopathology results when a person
has difficulty making the transition from one stage to
the next, or when a person remains stalled at a partic-
ular stage or regresses to an earlier stage. Freud’s open
discussion of sexual impulses, particularly in children,
was considered shocking for his time (Gabbard, 2000).

Transference and Countertransference.Freud de-
veloped the concept of transference and counter-
transference. Transferenceoccurs when the client
displaces onto the therapist attitudes and feelings
that the client originally experienced in other rela-
tionships (Gabbard, 2000). Transference patterns

50 Unit 1 CURRENTTHEORIES ANDPRACTICE


Freud’s components of personality
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