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Psychology

Notes

Psychology

Sections





Overview

  • Here, we will learn about psychology – through this tutorial, we will better understand how our patients and we, ourselves, deal with distress.

Overview

  • Start a table.

We'll focus on the following key concepts in psychology:

  • Ego defenses, which we divide into:
    • Mature (we'll use the acronym 'SASH' to remember these) versus
    • Immature. We'll focus on the socially stabilizing versus destabilizing nature of these defenses.
  • Conditioning, we'll address:
    • Classical (involuntary) versus
    • Operant (voluntary) forms of conditioning.
  • Transference/countertransference, which impacts how our patients relate to us and how we relate to them.
  • Freudian theory highlights

Ego Defenses

  • Let's begin with ego defenses, which we divide into: Mature (Stabilizing) & Immature (Destabilizing) ego defenses.
    • Mature ego defenses are personally and socially productive; whereas, immature ego defenses are destructive to our social networks and diminish our growth as individuals.
    • Note that intertextual variation exists in how the immature ego defenses are categorized.

Mature Ego Defenses

  • Let's start with mature ego defenses, which we can remember with the acronym: SASH (Sublimation, Altruism, Suppression, Humor).

Sublimation

  • Write: My true goal (eg, to overcome grief) isn't immediately achievable…. So I focus on something that I can succeed at.
  • Via sublimation, we channel our distress into attainable, positive end-outcomes when our desired end-outcome is not possible. The goal can be similar – a loved one dies of cancer and we fight for cancer awareness or less obvious – we go through a difficult break-up, so we channel our distress into self-improvement. In short, we make ourselves feel better through goals that can bring lasting satisfaction.

Altruism

  • Write: I don't feel good… It feels good to do something for someone else.
  • We feel good through giving (resources or time), which turns the volume down on our distress. This is an especially useful strategy when we are too depressed to focus on ourself.

Suppression

  • Write: The distress overwhelms me… I'm relieved that I can put it away for awhile.
  • In short, if we can forget it about, we show ourselves that the distress can't be too horrible.

Humor

  • Write: It can't be too bad, if I still can… Laugh it off.

Immature Ego Defenses

  • Now, let's run through the numerous immature (destabilizing) ego defenses in alphabetical order and compare similar defenses where possible to help chunk the material. These can be especially helpful in understanding why individuals make choices that seem inappropriate, illogical, or self-destructive.

Acting Out

  • Write: I feel constrained/repressed… I take back my power by being bad.
  • Whether the action is big (eg, stealing a car) or small (skipping an appointment), we derive power from allowing ourselves to do something bad/wrong. While empowering, this is inherently destructive.

Avoidance vs Denial

  • Write: It doesn't have to be real if… Through Avoidance – I don't see it. Through Denial – I don't believe it.

Displacement vs. Projection

  • Write: Use an object (an empathetic figure) to handle your distress.
    Displacement – Make them absorb it for you.
  • When we are abused, we often are unable to protect ourselves against our attacker. The distress of feeling powerless against the abuse becomes its own hurt and we abuse a less threatening figure in our life as a way to release that distress.
    Projection – Make them wear/own it for you. Via projection, we assign an internally distressing impulse to a neutral figure in our life, so we can attack that impulse through the neutral individual without having to attack ourself.
  • Both displacement and projection damages our perception of the less threatening/neutral figure and potentially their self-perception, as well.

Dissociation vs. Identification

  • Write: I can't escape the distress... So, through Dissociation – I disappear (imagine floating above the situation – in short, we lose ourself - we are separated from reality in some way, think: disconnected) or through Identification – I become someone else (imagine adopting traits and characteristics of an entirely different, seemingly powerful individual): it's easier to become someone else than fix what's broken within us. We become a false self, which is inherently fragile.
  • While both defenses may seem somewhat innocuous, they are both disempowering, we have to leave our own needs and interests behind to escape the distress.

Fixation vs. Regression

  • Write: Find comfort in an earlier developmental state. Through Fixation, we never grow up (think: Peter Pan). Through Regression, we revert to a less stressful time in our life (think: midlife crisis).

Idealization vs. Splitting

  • To avoid the distress of ambiguity…
  • We use the following:
    Idealization – I blindly believe in a protector (I delude myself to preserve their purity). Splitting – Think: black-and-white thinking (ie, all good or all bad).
  • Ambiguity, by nature, is distressing and so through splitting and idealization, we reduce that distress.
    • Through idealization, we generate a false hero. Eventually, the idealized individual fails to meet our needs and expectations and we can no longer delude ourself about their ability to care for us, so we cast them aside and find another. This is the idealization/devaluation/dismissal cycle that will perpetuate itself until we learn to handle the distress for ourself.
  • Splitting offers a similar means of distress management – it creates simple divisions between good and bad, helpful and hurtful, but, it is a reality distortion and, thus, when reality comes in conflict with our perceptions, our perspective is shattered and we are forced to shift our thinking.

Intellectualization vs Isolation of affect

  • Write: To reduce distress… We use the following:
  • Intellectualization – I distract myself with facts; we demonstrate an academic fixation on circumstantial details. This is different than a goal-oriented attempt to understand and better manage the source of the distress. We can be intelligent about understanding our distress without intellectualizing it.
  • Isolation (of affect) – I go numb (think: robotic, devoid of emotion).

Passive aggression

  • Write: If I am directly hostile, I am vulnerable to criticism… So I attack in non-confrontational ways.
  • We can be just as disruptive by not doing what we are supposed to do as we can through open hostility. Passive aggression offers the security of making us less vulnerable to criticism, but we end up compromising our standards (eg, we aren't a good team-player) and in this way it is ultimately destructive (as well as dishonest).

Rationalization

  • Write: The truth is too distressing… So I believe in a lie.
  • When reality comes in conflict with our needs, we may elect to believe in a lie to maintain our perceptual distortion. Of course, ultimately this false belief is simply a stopgap because we have not addressed the truth in our situation.

Reaction formation

  • Write: What I feel is bad (makes me feel guilty)… so I do the opposite to compensate.
  • When an internal impulse is so distressing that we can't even address it, we will sometimes go to the extreme opposite to avoid the distress. Reaction formation prevents us from understanding where the guilt originates from and managing it and leads us to enacting a false self.

Repression

  • Write: The distress of an event overwhelms me… So I bury it in my subconscious (note that suppression is a mature, conscious ego defense whereas repression is an unconscious, involuntary defense).

Conditioning

  • Next, let's turn our attention to conditioning.

Classical Conditioning

  • Begin with classical conditioning – a field pioneered by Ivan Pavlov.
  • We'll demonstrate his famous salivating dog experiment.
  • First, establish what is called the conditioned stimulus (CS), which in this case is a bell.
  • Show that the conditioned stimulus, alone, produces no response (NR).
  • Next, show that the unconditioned stimulus, in this case meat (or meat powder), causes the dog to salivate; the unconditioned stimulus is one that naturally produces an involuntary response in the subject.
  • Now, show that when the conditioned stimulus (the bell) and the unconditioned stimulus (the meat) are presented together, of course, the dog still salivates (there is a response).
  • But show that after the conditioned and unconditioned stimuli are presented simultaneously for a period of time, the conditioned stimulus is now able to produce a response on its own – when the dog hears a bell, it salivates.

Operant Conditioning

  • Next, let's use a grid to learn about operant conditioning – a field pioneered by BF Skinner.
  • First, along the side, indicate that we divide operant conditioning into measures to increase a certain behavior through reinforcement and measures to decrease a behavior through punishment.
  • Indicate that for we can give/add something wanted or unwanted or take away/remove something wanted or unwanted via both reinforcement or punishment.

For instance:

Reinforcement

  • Positive reinforcement: we can give a prize to reinforce good behavior.
  • Negative reinforcement: we remove a chore to reinforce good behavior.

Punishment

  • We give a verbal reprimand to punish bad behavior.
  • We take away a toy to punish bad behavior.

Comparison

  • Let's recap with a table to compare the two forms of conditioning.

Classical conditioning

  • For classical conditioning:
    • the nature of the response is involuntary;
    • the stimulus is presented prior to the response (the meat is the stimulus and it triggers salivation, the response);
    • and the learner's role (the dog's role) is passive.

Operant conditioning

  • In comparison, indicate that:
    • the nature of operant conditioning involves voluntary actions – non-automated;
    • the reinforcing or punishing stimulus is enacted after the participant's activity;
    • and the learner takes an active role in the process.
  • For instance, if operant conditioning is being used to promote good study habits, the learner will always have the choice whether or not to enact those habits (the behavior is volitional); the reinforcement or punishment comes after the learner done the behavior (after the learner has studied); and the learner must actively engage with the behavior, itself (the learner has to actually study – not just drool over a textbook!).

Extinction

  • As a final component of conditioning, let's address extinction.
  • Draw a graph and label the X-axis as Time and the Y-axis as Response (strong vs none).
  • Show that during the acquisition phase, Pavlov's dog went from not responding to the bell, over time, with the association of the meat powder (the unconditioned stimulus), salivating to the sound of the bell in the absence of the meat powder.
  • However, extinction to this conditioning was also observed. It was observed that if the bell was rung in the absence of the meat powder enough times, eventually, the salivation reflex to the conditioned stimulus went away.
  • Note that the extinction curve exists for operant conditioning, as well; we use classical conditioning only as an example. As we might imagine, tremendous work has gone into understanding the best methods for conditioning and ways to mitigate extinction.

Transference/Countertransference

Overview

  • Now, let's address transference/countertransference
  • Draw a patient and a doctor.

Transference

  • Show that via transference, the doctor evokes feelings about a significant person in the patient's life, and the patient then attaches those feelings onto the doctor, affecting the way the patient relates to the doctor.

Countertransference

  • On the contrary, show that via countertransference, the patient evokes feelings about a significant person in the doctor's life, and the doctor then attaches those feelings onto the patient, affecting the way the doctor relates to the patient.

Freudian Theory

  • Finally, let's address some highlights of Freudian theory:

psychosexual stages

First, indicate the following psychosexual stages:

  • Oral is the first 18 months of life: satisfaction from sucking/swallowing
  • Anal is 18 – 36 months: satisfaction from withholding/expelling feces (toilet training)
  • Phallic is 3 – 6 years: satisfaction from genitalia
  • Latency is 6 – 12 years (puberty): little sexual motivation (dormant libido)
  • Genital is 12 years and onward: adolescent sexual experimentation

We can use the mneomnic Old Age Pensioners Love Grapes to remember: Oral, Anal, Phallic, Latency, and Genital.

Personality

Lastly, indicate some basic Freudian personality terminology:

  • The Id refers to our instincts, for simplicity, draw a devil to illustrate the Id.
  • The superego refers to our morals, for simplicity, draw an angel to illustrate the superego.
  • The ego reconciles the Id, the Superego, and our external reality. Draw a human figure to represent the ego.