Defining Psychoanalysis and the Psychodynamic Perspective

Compiled and elaborated from original threads (May 2023 & March 2024).

Theory and Practice

Psychoanalysis is a theory and a practice. As a theory it refers to a set of conceptually related constructs that, when taken together, can explain a wide variety of clinical phenomena, generate testable hypotheses, and undergo revision as needed when new data emerge. Psychodynamic perspectives are coherent theoretical frames; they are not merely a collection of techniques.

Many have taken swings and hit home-runs, doubles, or fouled out when defining psychoanalysis, psychoanalytic psychology, or the psychodynamic perspective. What we know for sure is that it is both a theory of mental life and a professional technical practice. As a theory, it consists of core principles, constructs, and models for the classification of mental functioning. As a practice, it is comprised of a dialectical continuum between affirmation and confrontation (or support and expression).

As a practice, psychoanalysis has been defined broadly—and consistent with current applications—in an excellent, clear, transtheoretical manner by Jonathan Shedler. Narrower definitions also exist. The essential point remains that it is not just a practice. The theoretical architecture is what gives the technical interventions their coherence and depth.

Key Psychoanalytic Theoretical Concepts

Psychoanalytic theory conceptualizes human psychology at multiple interlocking levels: motivation (instincts, drives), social relationships (object relations), personality (ego functioning), psychopathology (defense mechanisms, neurosis), development (separation-individuation), neuroscience (neuropsychoanalysis), and cognition (ego functioning). It can be subdivided into domains in essentially the same way as academic psychology. Many central constructs differ from their academic counterparts in name only or in relative emphasis.

Among the core theoretical concepts that organize the frame are the following:

• Aggression — Not merely hostility, but a fundamental motivational force that can be channeled, inhibited, or turned against the self. Its management is central to both symptom formation and character structure.
• Sublimation — The transformation of drive energy into socially valued or creative activity. It remains one of the few genuinely adaptive outcomes of conflict.
• Ambivalence — The simultaneous presence of opposing feelings toward the same object. The capacity to tolerate ambivalence without splitting is a developmental achievement.
• Self-preservation — The drive toward survival and the protection of psychic integrity; often in tension with object-related aims.
• Superego — The internalized moral agency that can function protectively or, when harsh and archaic, become a source of self-attack and inhibition.
• The capacity to love — More than attachment; the ability to invest in another while retaining a sense of self, and to sustain concern across frustration and disappointment.
• The capacity to be alone — Winnicott’s formulation of the developmental achievement of comfortable solitude in the presence of a reliable other; foundational for genuine autonomy and creativity.
• Attachment theory — Integrated into contemporary psychoanalytic thinking as a bridge between early relational experience and later patterns of relatedness and affect regulation. (See also the history of the ECR-SF attachment tradition.)
• Defense mechanisms — Unconscious operations that keep unacceptable contents and affects out of awareness. They differ from conscious coping skills in that they operate implicitly and often maintain the very adversity they were meant to manage. (see also self-regulation & defense)
• Unconscious processing — The foundational premise that significant mental activity occurs outside awareness and continues to influence thought, feeling, and behavior.

Psychopathology, Defense, and Technique

It is in connection to the psychoanalytic theory of psychopathology that the features of the technical practice of psychodynamic psychotherapy and psychoanalysis can be traced. The basic assumption is that we know information we don’t want to know and resources are devoted to the maintenance of blissful ignorance. However, in reality, there is no such thing as blissful ignorance. There is only a leaking dam best illustrated by “serenity now” in Seinfeld gradually leading to “insanity later” when someone ‘cracks’ or ‘blows.’ The different ways in which people keep what they don’t want to know, understand, or think about unknown, unprocessed, and ergo unproblematic are called defense mechanisms. They are similar to “coping skills” from academic psychology but differ in core respects.

Defense mechanisms operate unconsciously, without awareness, and implicitly. Coping skills are explicit, controlled, and conscious attempts at dealing with adversity. Defense mechanisms keep the existence of the adversity itself out of awareness.

Much has been made of transference patterns and for good reason. Maladaptive relational schemas from childhood based on early caregiver experiences get replayed, enacted, and relived throughout life with different significant others—from friends to lovers, bosses, family members, and spouses. The readiness to play out a maladaptive interpersonal conflictual pattern from childhood (or other extended period of relating with a central figure that was formative) on a relatively neutral target, or the degree of overlap between reality and relational schema, reflects severity of individual psychopathology. Someone going around forming transferences to anyone who crosses their path is living in a dreamlike self-fulfilling prophecy of interpersonal damnation. Someone who forms an extremely intense, rigid transference with a small number of significant others also has issues. Someone who does both is obviously worse off. (CCRT assessment)

Circling back to the basic assumption of defensive functioning, pathological transference patterns (problems of object relations and attachment) are understood as a defense mechanism against awareness of the content and affect associated with the maladaptive relational schema. As such, a pathological personality style itself can be conceptualized at the level of a defense mechanism. (personality disorder scales)

Ironically, interpersonal pathology then is enactment to avoid awareness of what is being enacted. It is with these two dimensions of pathology in mind—interpersonal and intrapersonal—that we can understand and discern a global, unitary applied psychoanalysis, i.e., its clinical practice.

Making the Unconscious Conscious

The core underlying shared feature of psychoanalysis and its talk-therapy derivatives is the universal goal—in the words of Sigmund Freud himself—of “to make the unconscious conscious” at the most general level. In the language of academic psychology, this entails making the implicit explicit, basically through the application of attentional resources. Once explicit, what was implicit can become a controlled process, subject to intentional modification. In psychodynamic lands this might be described as transference-focused therapy, defense-mechanism analysis, or merely the generic descriptor “insight-oriented therapy.”

In CBT, automatic negative thoughts are described as cognitive biases or distortions. Splitting is a good example of both a distortion and a defense mechanism. This observation opens the door to a broader conceptualization of cognitive distortions as defense mechanisms—but against unacceptable core beliefs as opposed to unacceptable core conflicts or wishes. The leap from “belief” to “wish” is a little muddy, though it works. Defense mechanisms are interpreted—i.e., identified and explained in functional terms—with the assumption (whether psychoanalysts are aware of it or not) that attention attenuates. Core beliefs are functionally unconscious in practice whether CBT therapists explicitly describe them as such or not.

The Therapeutic Relationship as Working Through

Verbal or worksheet-based working through (making the unconscious conscious) only works in the context of a good therapeutic relationship, which is built via supportive techniques such as mirroring, empathy, validation, and being amiable, together with the establishment of trust, intimacy, and mutual fondness. All therapy has this as a necessary but not sufficient condition for positive change to some extent.

Psychoanalysis offers us the insight that for some patients the establishment and maintenance of that positive therapeutic relationship is the “working through,” leading to awareness via explicit interpretation (or sometimes not even) and shared understanding of the reasons why that positive alliance was so challenging to build. This is the personality-disordered situation, also manifest with personality pathology to a lesser degree. (integrative psychodynamic assessment)

References

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Source threads (original phrasing retained wherever possible):
https://x.com/drwinarick/status/1661805465167167493
https://x.com/drwinarick/status/1769489927723454621

Author sites: PsychologistsNY.com · Implicitify.com · MotiveScoring.com