The origins of The Psychodynamic Perspective can be traced to the early work of Sigmund Freud. Using sub headings this essay will identify the main tenets of Freud’s approach to the understanding of human behaviour: his views on determinism; his use of hypnosis as therapy; his belief that human behaviour is controlled by separate yet interlinked layers of the mind (conscious and unconscious); his views on sex and aggression; and the importance he placed on unresolved and unseen conflict involving the ‘ego’, the ‘id’, and the ‘superego’ (Cave: 1999, p.31/2). The work will then explore how the perspective might be used in a healthcare setting, and will assess inherent strengths and weaknesses.
Determinism, the belief that ‘every state of affairs, including every human event, act, and decision is the inevitable consequence of antecedent states of affairs’ (GuruNet: for details see References) greatly influenced Freud who sought to identify hidden causes for human behaviours. His theory is a dynamic process – from the early years of a human’s life – where the first interactions with others affect the development of the personality, through to the adult years where the person learns and adopts social values.
During his time in France, Freud observed the work of Jean Charcot whose use of hypnosis led to his ‘inducing and curing hysterical paralyses by means of direct hypnotic suggestion.’ (Gay: 1998, p.49). Later work with Josef Breuer involved hypnosis where patients recalled traumatic experiences and expressed their emotions as a way to release the conflict within; this was the cathartic method. Freud began to develop his idea that emotionally disturbed patients had problems that were sexually orientated, and, as a development on his work in hypnosis he worked on the idea of ‘free association.’ (Nye: 1975, p.11). Instead of sending patients into a trance using his voice, Freud altered the technique of hypnosis so that the patient independently drew forth words and feelings which might be analysed or explained by the analyst.
Unconscious and Conscious activity
‘Freud himself regarded the concept of the unconscious as fundamental to psychoanalysis. It is what makes the psychoanalytic approach distinctive; it is the defining characteristic of the Freudian perspective towards human action.’ (Bocock: 2002, P.32)
One of the fundamental beliefs behind Freud’s work was indeed his distinction between the unconscious, preconscious, and conscious areas of the human mind. He stipulated that the unconscious was the governing force where dreams, habits, thoughts and feelings originate from. In order to investigate these phenomenon he used psychoanalysis; as Nye phrases it in The Three Psychologies – ‘it is the role of psychoanalysis to unravel the mystery by seeking the sources of thoughts, feelings, and actions in hidden drives and conflicts.’ (1975, p.10). Through using this technique Freud aimed to identify the nature of crucial communications occurring in early childhood which would affect adult behaviour.
Dream interpretation is another of Freud’s infamous techniques; occurring when a person is asleep and unguarded he claimed that this was an opportunity for unconscious drives and desires to manifest themselves through symbolic images. The waking human mind however is conscious, meaning that it is aware of what is immediate to it, and the preconscious is the level between. As Nye summarises it:
‘the unconscious consists of all aspects of our personalities of which we are unaware. The preconscious consists of that which is not immediately at the level of awareness but is fairly accessible.’ (1975, p.13).
As part of his understanding of human behaviour Freud identified the human personality as constituting three different structures: the id, the ego, and the superego. The id is what the human child is born with – instinct which contains base biological drives; the id seeks immediate satisfaction of primitive impulses, and operates on the ‘pleasure principle’ (Freud: 1927, p.30), seeking to avoid pain and maximise gratification. The instincts that a person is born with remain with them for life: life energy and death energy, which exist side by side, respectively concern the drive to survive (eat, drink, reproduce), and the primitive tendency to return to the ‘inanimate state’ (Nye: 1975, p.14) which has its origins in the prehistory of the world where life forms were unstable.
Sex and Aggression
‘In proposing two psychological entities: our animal selves, in the form of the id, and our social selves, the ego and super-ego, (Freud) directly addressed the relationship between biology and socialisation, and the dynamic between them. For Freud, being human was individual people’s endless negotiation between the two.’ (Bland: 2003). It is precisely such negotiation that causes the varieties and extremes of behaviour seen in human beings. As well as the life and death instincts, humans are driven by their sexual drive and their aggressive drive; these being underlying causes of human
behaviour. Freud made no distinction between what people might class as ‘everyday’ feelings and sexual feelings. Because humans are animals they are driven to experience primal urges and desires but simultaneously live in a society where standards contain and condition human behaviour. Thus, this is where the conflict arises – between the drives of the id and the learnt morality of the superego so that anxiety, fear, and neuroses can all be traced to a basic incompatibility of the human instinct with the socialised world which has evolved around it.
The nature of Freud’s concept of aggression is that it is innate and thus a natural state. As one of the most powerful energies within the human mind aggression can cause serious damage – mental and physical – if it is not released in some way. Freud’s claims that some of the innate destructive energy is never released and so a person harbours the death instinct which eventually overcomes the other drives resulting in death. (Nye: 1975).
Ultimately, the emotional life of a human being is destined to be a turbulent one: powerful energies conflict and override each other, and it is the role of psychodynamic therapy to uncover and understand the layers and symbolism within the psyche. A further understanding of these complex processes may be achieved through examining Freud’s concept of the ego and the nature of its functions.
Freud suggested that the ego is a form of mediation between the urges of the id and the learnt morality in the super-ego, evolving as a person grows older in order to help them cope with the world. As the ego develops so does the person’s perception of reality, and a wider view is attained than simply the pleasures of subjective gratification. Freud’s pleasure principle thus becomes replaced by the ’reality principle’ (Stoodley: 1959, p.169). The desires of the id cannot always be realised, so the ego causes humans to convert them into other modes of behaviour; not only in cathartic sport activities but also in people’s careers. Understanding the work environment in the context of the Psychodynamic Perspective will be discussed later.
Freud likens the ego to a ‘a man on horseback, who has to hold in check the superior strength of the horse; with this difference, that the rider seeks to do so with his own strength while the ego uses borrowed forces. (…) Often a rider, if he is not to be parted from his horse, is obliged to guide it where it wants to go; so in the same way the ego constantly carries into action the wishes of the id as if they were its own.’ (Freud: 1927, p.30).
Freud’s approach was radical for his time because he saw psychology very much through the same eyes as he saw evolution; as a process involving accumulative and transferable energy. Freud suggested that the energy levels in a person – originating from the id and controlled, to an extent, by the ego (depending on circumstances) – were affected by restrictions placed on that person by those around them. If these energies were not allowed to have an outlet then the person might suffer from anxiety. A strong ego will therefore develop as the person’s circumstances allow them to adjust to the real world while also going part of the way to satisfying the demands of the id.
The superego incorporates the values and morals of society which are learnt from a person’s parents and other influential figures, and develops as a result of rewards and punishments as the individual grows up. The superego provides the personality with a conscience; a form of overview concerning right and wrong actions, which can cause a person to feel guilty. Freud termed the superego’s internal standard of what a person should be as the ‘ego-ideal’. (Nye: 1975, p.20). The superego is responsible for extremes of behaviour – such as introvert behaviour, where it will concern the person with too many of society’s rules, inhibiting the id and ’immobilizing the ego’s attempts to achieve satisfaction in the real world (Nye: 1975, p.20). On the other hand it can also cause extrovert behaviour where the individual abandons the expected standards of society.
Anxiety and defence mechanisms
When anxieties develop they can often be explained through the processes which Freud termed ‘anxiety or defence mechanisms.’ The problem is to do with the desires of the id – they can be controlled by the superego and directed by the ego, but they still remain as very strong inclinations within the psyche. A desire of the id to act in a particular way may be thought of as wrong or punishable and thus creates guilt and tension anxiety within the person. The impulse might be expressed in a disguised form that society does approve of – for example becoming a racing car driver or boxer as an outlet for aggression. Other ways of coping with the presence of inner energies are:
This is the phenomenon of forcing the uncomfortable desires, painful feelings and memories into the unconscious, only for them to affect our behaviour and mental states on a subliminal level, maybe emerging as ‘Freudian slips’ or as symbolic imagery in nightmares. It is the job of the ego to try and prevent the ‘forgotten’ thoughts from returning to the conscious mind.
This occurs when someone assigns their own negative thoughts to another in order to absolve themselves of the feeling.
Negative aspects of a situation may be avoided if the ego simply does not acknowledge that they are there; this may be conscious or unconscious.
When forbidden impulses are channelled into socially acceptable behaviour or a socially beneficial situation – for example, an aggressive man might choose to become a martial arts teacher or a soldier. Alternatively, when a substitute action or transfer of energy replaces the reaction to the person or object that originally caused the upset it is called displacement.
The Psychodynamic Perspective in a healthcare setting
Freud’s work has been influential not just in the field of psychology but also in conjunction with the sphere of mental health and social care. His group dynamics – where he suggests that a group of people admit the same person – a leader – into their superego and identify with each other (Cave: 1999, p.57) – can help individuals to understand the sometimes complex relations between work colleagues. For example, when a new worker joins a team it takes time to become integrated: Freud would say that this was due to the ‘personal space’ barrier (Cave: 1999, p.58) not yet being broken. Once the person is accepted then the group directs hostility to others outside of it, the barrier changing to a ‘group space’ barrier. More importantly an awareness of group processes can help ‘inform, promote insight, change behaviour or alleviate suffering.’(Cave: 1999, p.50).
Understanding the relationships between individuals within a group is crucial for healthcare professionals who work in hospitals and care homes. For example, it could be beneficial to understand what facilitates group cohesion when working with discussion/therapy groups. Alternatively, a patient who is afraid of group work may be best understood in isolation – Freud’s psychoanalytic approach is commonly used in counselling and therapy for drug users, those who have been/are abused, and can be beneficial to those suffering from obsessions and neurotic disorders.
It is vital to have a good rapport and understanding between healthcare workers and patients to provide the best professional environment for recovery. Difficult situations often arise which require tact and discretion – such as bereavement – and can be understood in terms of Freud’s distinctions between the ego and the id and the conscious and unconscious mind. For example, an unusual pattern of behaviour (possibly anger or guilt) seen in a bereaved person might be attributed to a defence mechanism which is masking the hidden conflict or upset associated with the death.
Critical evaluation of the Psychodynamic Perspective
Like all psychological theories, Freud’s is susceptible to heavy criticism because it is one of many perspectives – all of which are formed by people trying to study other people – making it difficult to attain complete objectivity.
Skinner’s behaviourist theory criticises Freud for his belief that many guilt and anxiety complexes are sexually orientated (Nye: 1975, p.52), and there is also conflict between Freudian theorists and those psychologists who view behaviour as controlled by external factors: an example being the issue of suggestion in psychoanalysis and hypnosis. Take for instance, the case study of ‘Dora’ (Cave: 1975, p.37) whose abuse was suggested by Freud to be imagined, the consequence being that after counselling sessions with Freud she showed no signs of improvement.
There is discrepancy about the meaning of dream symbols, and the outcome of hypnosis and psychoanalysis is often ambiguous and unreliable. Further problems occur when using hypnosis as therapy because the patient might not be properly under, and, as Freud himself found, they may even fall asleep.
Nye notes that Freud used a restricted sample while developing his theory so that it was not fully representative, and therefore his ideas only have limited applicability. (1975, p.146). Freud’s studies might also have been selectively chosen to represent his ideas – considering the complex nature of concepts such as the Oedipus complex it is unlikely that his findings were reliably consistent.
As Webster says in criticism of Freud:
(He) made no substantial intellectual discoveries. He was the creator of a complex pseudo-science which should be recognized as one of the great follies of Western civilization. In creating his particular pseudo-science, Freud developed an autocratic, anti-empirical intellectual style which has contributed immeasurably to the intellectual ills of our own era. (Webster: 1995, p.438)
A large amount of Freudian theory is indeed based around hypothetical concepts – such as the id and the ego, and is restricting in the sense that all behaviour can be traced back to some hidden primal source. Yet it is necessary to bear in mind that much of Freud’s theory has found its way into everyday language – such as the ‘unconscious’ and ‘conscious mind‘, the ‘ego‘, etc, and this in itself suggests that the theory makes adequate sense to the human mind.
Thus, we are left with a theory that is at the very least plausible but left very much open to interpretation: like many opposing theories evidence can be found for and against it, and it is left to the individual to determine whether or not the theory is acceptable to them.
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