Psychoanalysis: Does one size fit all?
Prof Mark Solms on the psychoanalytic model of the mind, its relation to psychoanalytic diagnostic categories and their implications for psychotherapy
Should psychotherapists apply the same technique to all of their patients?
Prof Mark Solms asks whether psychotherapists should approach all cases in the same way. In so doing, he delivers a lucid integration of the psychoanalytic model, its relation to diagnostic categories, and the implications that this has for treatment and technique.
Although all patients seek help because they are suffering, not all psychological suffering is of the same kind and not all people are the same.
We are immensely grateful to Professor Mark Solms for allowing us to share this important work and to the South African Psychoanalytical Society for producing it. Watching this series will make you a better therapist.
A summary of some of the key points is offered below.
The essence of psychodynamic work lies in the recognition that psychological symptoms are the consequence of failed attempts to push something unbearable out of mind and out of awareness.
There are different ways in which this 'pushing out' occurs (repression, projection, disavowal) and each requires a different approach to treatment.
An appreciation of the psychoanalytic model of the mind and its development clarifies these differences and their implications.
Psychoanalytic Model of Human Development
When we think of a person, what we tend to have in mind is the part that psychoanalysis calls the Ego. This is the part of the mind that includes our personal story, our personality, our beliefs and values, our memories, our dreams, and our wishes. It is that part that is uniquely you, and it’s the part that we also tend to think of as ourselves. It’s also the part that includes all that we know about the world including how to successfully meet our needs and wishes in it.
In the beginning
Most people would probably agree that it isn’t meaningful to think in these terms right from the moment of conception. At conception, we are surely more body than person. Psychoanalysis calls this body part, the Id (starts at toes and ends at head). Once we develop to the point that our consciousness begins (probably before birth), then we add something to this Id called the experiencing self, i.e. your awareness. The term Ego only becomes meaningful from the moment we start laying down memories.
Birth: (Id / It)
The most important point to note is that at birth, we are much more body (Id) than person (Ego). This means we have a lot of feelings, impulses, and needs but very little know how.
In psychoanalysis, we call the feelings and needs Drives. Contemporary affective neurosciences tell us that there are at least 7 of them, i.e. RAGE, FEAR, GRIEF/PANIC, LUST, CARE, PLAY, & SEEKING. But psychoanalysts have historically focused on only two (love and hate).
To survive, your Ego needs to take note of the drives and then find a way to satisfy them by engaging with reality (out there). To do this, you need to understand the principles behind how reality (and social reality) works. But in the beginning, you don’t know very much (Ego has few resources). In fact, you operate at a level called ‘primary process’. This is a fancy way to say that you ignore logic and contradiction, and don’t distinguish past from present or thoughts from actions. It is consciousness without the rules or reality applied.
When you are in this mode of functioning, you are dependent on others for your survival. The best you can do to satisfy your drives is to have wishful filling fantasies, i.e. You pretend things are the way you want them to be. Psychoanalysts call this phase of development ‘primary narcissism’. It is a mode of being in which you declare yourself to be whatever you would like to be.
If you still function in this way as an adult, we say that you are PSYCHOTIC.
A bit later: (Ego / I)
As we grow older, so the Ego will start to mature and begin to appreciate out how the world works. The development process happens gradually. During the earlier phase, we believe that we are all the good things and attribute any discomfort and badness to the other. When things go well, we take the credit, and when they don’t, we blame someone. When we feel good, we think the whole world is lovely, when we have a nappy rash the world seems a terrible place. Notice that this requires you to be able to classify things into good and bad. This is called splitting, and it is an incredibly valuable ability that helps us to distinguish between things that we need to avoid and the things we need to keep. Note that in the beginning, we categorise the world according to how it makes us fee.
The critical point here is that the distinction between us and other is not yet clear to us because our reality ego is still developing. Consequently, our perception of the outside world is heavily influenced by our feelings. When someone makes us happy (Mom says yes), we like them and long to be like them (in the very beginning we say that we are them. We take images of them to our minds (introjection) and identify with them. These identifications form our aspirational self (pleasure ego / ego-ideal).
Note: Every described till this point is to be found in the work of Sigmund Freud.
Melanie Klein tells us that when someone makes us feel bad (Mom says no), we think that they are bad, and we want to get rid of them (projection) or wipe them out. These bad objects (another word for impression left by a person) are also internalised and so come to form the primitive superego (part of yourself that is experienced as not you, i.e. your self-critical voice).
If this remains your primary mode of functioning as an adult, then we say you are NARCISSISTIC.
Acting as though we create (rather than adapt to) reality doesn’t work very well. Fantasies are fun by they can’t satisfy our needs. To do that, we need to apply the rules of reality. Luckily, most of us learn how to do this. We first develop the capacity to tolerate ambivalence. This helps us to appreciate reality more clearly. We see that our frustrating bad mother is also our satisfying ideal mother (integration). We learn that we can’t just be the things we want to be and slowly we face the growling process of accepting who we indeed are. Melanie Klein called this the ‘depressive position’.
If you function at this level as an adult, we say you are NEUROTIC, and that’s a good thing.
How does this help us appreciate psychopathology?
Every level of development brings its own set of challenges. It doesn’t feel pleasant to see that faults exist alongside your strengths. It also doesn’t feel comfortable to know that the mother you hated yesterday is also the mother you love right now; Conflict! Holding this complexity requires strength and when overwhelmed we respond by attempting to exclude the overwhelming item from consciousness.
Remember, symptoms point to the existence of something that we can’t cope with and so try to exclude.
There are three main ways that we do this.
1. If our capacity to tolerate ambivalence and emotion remains intact, we just ignore it. This is called primary repression. “I want my mom, but she is at work, let me go play Lego.” Notice that this doesn’t stop the need. You still want your mom, and so you apply what Freud called ‘after pressure’, i.e. a defence mechanism. Maybe you use rationalisation and tell yourself “I’m a loner anyway”. This is normal, and although it disconnects us from aspects of ourselves, we all do this much of the time. It is only called a symptom when it fails. For example, your longing for Mom pops up as a panic attack. This is called transference neurosis (underdiagnosed).
2. If you can’t just ignore it, your next best approach is to attribute it to something or someone other than you, i.e. you regress to projection and introjection. If you do this all the time, we say that you suffer from narcissistic neurosis or worse, character pathology.
3. The third and most devastating approach is to regress right back to the beginning of development. You disavow reality and patch over it with a delusion, i.e. Psychosis.
Why is this important?
Holding this model in mind help the clinician to understand the nature of the suffering that they are presented with and guides on how to intervene.
The task is thus clarified as follows…
1st Find out, with the patient, what they have not been able to cope with in their lives. Analysing
2nd Discover how they have tried to get rid of this difficulty. Interpreting
3rd The difficult part. Persuade the patient to try something different. Analysing Resistance / Working through
This summary is offered by TherapyRoute.com as an introductory guide to the advanced video seminars of Prof Mark Solms.
Click for CPD approved video lecturers by Mark Solms
MORE POSTS
What Makes the Human Brain Human?
The Scientific Standing of Psychoanalysis
Mark is a qualified Psychoanalyst, based in Rondebosch, Cape Town, South Africa.
With a commitment to mental health, Prof Solms provides services in , including Psychoanalysis and Psychology (Clinical).
Prof Solms has expertise in Relationship Problems and Identity Issues.
Click here to schedule a session with Prof Solms.
Important:
TherapyRoute does not provide medical advice. All content is for informational purposes and cannot replace consulting a healthcare professional. If you face an emergency, please contact a local emergency service. For immediate emotional support, consider contacting a local helpline.
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