Psychoanalytic Theory Case Study Examples

The study analysed George a 35year old high school teacher who has recently been hospitalised due to the presentation of certain psychological symptoms. Approaches that have been considered for George’s treatment include both Freud’s psychoanalytical approach as well as behaviourism. Psychoanalytical approach hypothesised 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 defence mechanisms have been discussed that seem to influence George’s anxiety. Behaviourism states that George’s symptoms are the result of past behaviours that have been reinforced. As a result, this reinforcement has caused a linking effect that when those particular behaviours are repeated, the symptoms have been produced. Both approaches have been evaluated in relevance to George’s case stating both the strengths and weakness of each, as well as any similarities present. To gather further information for George’s treatment, assessment methods have also been evaluated in order to establish which methods are most appropriate.

The purpose of the current paper is to analyse a vignette character using two of the many perspectives commonly studied in psychology. Comparisons were undertaken regarding the information presented, firstly utilising Freud’s psychoanalytical theory then followed by strict behaviourism.

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Overview of Selected Approaches

Archer and McCarthy (2007) state, under Freud’s psychoanalytical theory human behaviour is explained by conflicts that develop due to an individual’s unconscious sexual and aggression drives. To meet 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).

Archer and McCarthy (2007) state behaviourism theory approaches development as a consequence of personal learning and conditioning. Two approaches commonly studied in behaviourism include classical conditioning and operant conditioning. Classical conditioning proposes that you can pair up a neutral stimulus with and unconditioned stimulus in order to elicit the same response that is commonly elicited by the unconditioned stimulus (Dawson & Grings, 1966). Under operant conditioning a response to a particular behaviour determines the reproduction or termination of future behaviours. It entails reinforcements or punishments that influence the future behaviours (Ninomiya, Mitsumasu, Aoyama, & Kusunose, 2007).

Client Information

George a 35 year old male is a high school teacher who taught physical education and coached 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 hospitalised. During university, he attended counselling and was prescribed anti-depressants because George presented signs incongruent to his normal personality.

Prior to his hospitalisation 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 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 on current relationships and development. Freud’s psychosexual stage hypothesises that during the phallic phase when George should have been forming attachment to his father, he was experiencing trauma by seeing his parent regularly arguing. In addition, the father’s drinking habits also hindered an attachment formation between father and son. According to Freud this has led to the issues in his adult life (Archer & McCarthy, 2007; Peterson, 2004).

Relevance to client. From Freud’s perspective, George’s problems manifests in a conflict that he’s having within himself, stating that when conflicts arise between the id and superego the ego initiates certain defence mechanisms in order to reduce that anxiety (Archer & McCarthy, 2007; Kluft, 2005). Few defence mechanisms that strongly fit George’s behaviour displayed in the past and present are described. Firstly using a defence of sublimation, Freud argues George has mentally shuts out what seems to trouble him by converting that anxiety onto something else (Punamaki, Kanninen, Qouta, & El-Sarraj, 2002). Observation of sleeping longer could be interpreted that, to minimise thinking about issues, he’s transferred that anxiety to a new medium of sleeping more. George might see sleeping as a 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 defence 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, defence mechanism of dissociation could be in progress. This is when a patient mentally shuts out awful events in an attempt to avoid it (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 realise one’s 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 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 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 answer judgement, rather discovery of 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. According to Watkins, Campbell, Nieberding, and Hallmark (1995) a study assessing the use of assessment procedures by 412 clinical psychologists, the Rorschach test was highly regarded as being one of the most commonly used tests, with 82% (N = 410) of respondents agreeing sufficient success for what they investigated.

Behaviourism Approach

Symptom formation. This approach argues that George developed the current issues based on past behavioural reinforcement. Under behaviourism it could be argued that the university breakdown period has conditioned his responses to be replicated in all future encounters to the initial stimulus. Based on observations that his initial depressive state was during university; and the current issues originate at the high school, it could be a sign that George’s symptoms are reinforced within the educational environment.

Relevance to client. From a classical conditioning approach it could be argued that George initially had a concern (unconditioned stimulus) that lead to his depressive state (unconditioned response). However being at university at the time he experienced these issues, the educational environment could have linked to his unconditioned stimulus (original issue) and as a result elicits the same depressive emotions (Archer & McCarthy, 2007; Dawson & Grings, 1966). Therefore whatever the reason for his breakdown in university, it has somehow paired up with the educational environment. This has now transpired to his position in high school where he’s currently dealing with some anxiety, but just because it’s present in the educational environment; his body is experiencing the same depressive symptoms.

Operant conditioning hypothesises that with the initial issues starting in university, George may have removed himself from the anxiety causing situation by isolating himself. It was also noted that George kept himself distracted by keeping the TV on. By doing this and also isolating himself, George has negatively reinforced the feeling of reducing the aversive consequences. When his anxiety causing issues redeveloped recently, George has reverted to handling the current problem by isolating himself from his family just like he did in university. Leaving his job and sleeping more can be seen as a distracter from the current problem and therefore linked to his university strategy of leaving the TV on to distract himself (Aeschleman, Rosen & Williams, 2003)

Assessment. The goal of therapy is to challenge and change those behaviours that are causing the anxiety (Archer & McCarthy, 2007). George needs to discover what behaviours are being acted out and the effects it has on him. In turn the therapist will teach him how to handle them better.

A method to implement is behavioural interview which entails talking with George and gathering concrete evidence of what behavioural actions are taking place to cause these symptoms. Cohen and Swerdlik (2005) state interviews can entail some of the following tests. Mental status examination which identify George’s mood in showing anger, guilt and even if he’s depressed. A psychological history test which can identify any traumatic experiences George may have endured. Most importantly a mental status test investigating whether George is suffering any hallucinations which could be endangering him.

Similarly according to Middleton and Butler (1998) a dissociation disorder interview schedule would be beneficial. The test battery would help identify personality disorder issues and major depression. His study showed the test battery aided diagnosing 62 patients with dissociative identity disorder.

Also recommended for George is to keep a diary. When George experiences similar symptoms, George is to write specifically what he was doing just prior and after the symptoms happened. Diary keeping will help gain understanding of what seems to trigger the symptoms and also helps identify if there’s any actions that George does that reinforces them (Archer & McCarthy, 2007). These reinforcements may happen unconsciously without George even realising that he performs them. Further support for diary keeping is given by Brand (1979) who states by keeping a diary, client disclosure is expressed in a more honest and less confronting manner.

Similarly to free association, Kluft (2005) states both these techniques also have the benefit of seeing when George changes from normal self to his other alter ego of being the Olympic coach. If interviewing, you see the point at which George changes his answering perspective from his normal self to that of the Olympic coach. Similarly the diary entries might shed light on what he specifically does that makes him switch personalities.

Comparisons of the two approaches

Similar. Both approaches are similar in that both look at the current symptoms being a direct product of George’s past. Freud’s approach links George’s experiences from childhood and connects them to the unresolved conflict that George maybe unconsciously having. While behaviourism looks at George’s past behaviours and connects those experiences as being the main cause of the current issues.

In essence this is where the difference between the two approaches also rest. While Freud looked at the cause being due to conflicts between George’s unconscious immediate needs and the suppression of those needs by societal norms, behavioural identified concrete behaviours by George that occurred as being the main causal factor.

Strengths and weaknesses of Freud’s approach. Freud strength lay in the fact that his approach looked at the different aspects of human conditioning and summarised it into a practical framework. In George’s case his framework explored childhood memories as well as his unconscious experiences and thoughts (Archer & McCarthy, 2007). However his weakness is that it relies too heavily on the psychosexual stages. Can it be proven that everything that happens to George now is a result of his psychosexual stages as a child? In George’s case it can be queried; is his current problem really linked to his phallic stage of not forming an attachment to his father?

Strengths and weaknesses of behaviourism approach. The strength of behaviourism is that it tries to change behaviours that cause the anxiety and relies on changing something that can be concretely seen transpiring in a client (Archer & McCarthy, 2007). The weakness of this approach is that although therapy may control behaviours, other skills must also be learnt so that George does not relapse (Linden, Christof & Rentzsch, 2008).

Therefore in summary, we have seen George’s issues have transpired into a state causing him to become very isolated and depressed; and ultimately causing him to be hospitalised with false perspective of his own personality. Freud stated that the problem has arisen due to his childhood experience; specifically his relationship to his father, whilst behaviourism has taken the stance that his past behaviours were the main causal factor. Freud has argued that by repressing his thoughts and feelings and not directly confronting them, George has perpetuated the problem to its current state. However behaviourism disagrees saying it’s George’s past behaviours being reinforced through their consequences that has developed the current problems. While Freud’s downside of the fact those current behaviours, attitudes, feelings and thoughts are not clearly visible in how they are linked back to the psychosexual stages, behaviourism draws its strength in this area by concretely pinpointing certain behaviours that could potentially lead to the current issues.

In conclusion in order to analyse George’s situation, a psychoanalytical approach is recommended as being the best option given the facts. While behaviourism will find the behaviours that cause the feelings experienced by George, Freud addresses the thoughts that initially preceded these reinforced behaviours and emotions.

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